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Updated June 10, 2021
U.S. Global Health Funding: FY2017-FY2022 Request
Background
State-Foreign Operations (SFOPS) Appropriations
Congress has prioritized global health, increasing related
include funds for PEPFAR, the Global Fund, and USAID
funding, particularly for the creation of the President’s
global health programs. The FY2022 budget request
Emergency Plan for AIDS Relief (PEPFAR) and the
included almost $1.0 billion for global health security, $825
President’s Malaria Initiative (PMI) during the George W.
million more than FY2021-enacted levels. The funds are for
Bush Administration (Figure 1). During the Obama
expanding the Global Health Security Agenda (GHSA),
Administration, appropriations continued to rise, though at
identifying and addressing zoonotic threats, and bolstering
a slower pace and with some funding dips. Global health
laboratory and surveillance capacity. The request also
appropriations also increased during the Trump
includes $300 million for a contribution to the multilateral
Administration, despite requests from that Administration
Access to COVID-19 Tools (ACT) Accelerator for global
to cut global health spending. Following the emergence of
COVID-19 response, $250 million to support a new health
the Coronavirus Disease 2019 (COVID-19) pandemic,
security financing mechanism, and $90 million to replenish
appropriations for global health security rose and several
the Emergency Reserve Fund for rapid response by USAID
bills for bolstering global health security were introduced.
to infectious disease outbreaks. The budget request also
Figure 1. U.S. Global Health Funding, by
includes increases for maternal and child health (MCH) and
Administration: FY2001 Enacted-FY2022 Request
family planning and reproductive health (FP/RH) programs.
(current U.S. $ billions)
Labor-HHS Appropriations include funds for CDC global
health programs, which remained primarily at FY2021
levels, except for an additional $100 million for global
public health protection and $5 million for malaria.
Figure 2. Global Health Funding:
FY2017 Enacted-FY2022 Request
(current U.S. $ millions)
Sources: Appropriations, congressional budget justifications, and
engagement with CDC and USAID congressional relations personnel.
Notes: Excludes emergency appropriations, rescissions, and other
funds that may be used to improve health worldwide, such as
international HIV/AIDS research conducted by the National Institutes
of Health (NIH).
Acronyms: Enacted (E) and Request (R.)
Global Health Appropriations
Most U.S. global health funding is provided to the
Department of State to coordinate PEPFAR activities, and
to the U.S. Centers for Disease Control and Prevention
(CDC) and the U.S. Agency for International Development
(USAID) for a range of global health activities (Figure 2).
Congress also makes funds available for other global health
Sources: Appropriations, congressional budget justifications, and
activities, such as the National Institutes of Health (NIH)
engagement with CDC and USAID congressional relations personnel.
Office of AIDS Research (OAR), which supports
international HIV/AIDS research. Congress does not
Note: Excludes emergency appropriations and rescissions. FY2022
earmark funds for these activities, however, and NIH has
USAID GHS funding includes $250 mil ion from GHP-State.
not reported related grant amounts since FY2017.
Acronyms: Enacted (E), Request (R), Maternal and Child Health
(MCH), Vulnerable Children (VC), Family Planning and Reproductive
Health (FP/RH), and Neglected Tropical Diseases (NTDs).
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U.S. Global Health Funding: FY2017-FY2022 Request
Key Global Health Policy Issues
host being the most likely and introduction to humans
The Biden Administration has executed major executive
through a laboratory incident the least likely. U.S. officials
actions on global health policy, including
have expressed skepticism about the findings. The Biden
Administration is reconsidering previously discounted
revoking the Mexico City Policy;
assertions by the Trump Administration that the pandemic
halting U.S. withdrawal from WHO;
may have originated from a laboratory accident in Wuhan,
China. Congressional interest in U.S. membership in WHO
establishing within the Office of the President a
remains strong, with some Members in the 117th Congress
COVID-19 Response Coordinator;
having introduced legislation making U.S. membership in
establishing a National Security Council Directorate on
WHO contingent upon China’s withdrawal from the
Global Health Security and Biodefense; and
organization and others praising the Biden Administration’s
move to remain in WHO. For more information on this
directing the Assistant to the President for National
issue, see CRS In Focus IF11822, Origins of the COVID-19
Security Affairs (APNSA) to complete a review of and
Pandemic, coordinated by Tiaji Salaam-Blyther.
recommend actions to the President on emerging
domestic and global biological risks and national
Pandemic Preparedness and Response. Global infectious
biopreparedness policies.
disease outbreaks are occurring at greater frequency and are
Mexico City Policy. In 1984, the Reagan Administration
expanding in their scale and impact. The cost of epidemics
established the Mexico City Policy, which restricts U.S.
and pandemics is also rising. The Global Preparedness
assistance to foreign NGOs engaged in voluntary abortion
Monitoring Board estimated that a pandemic akin to the
activities, even if such activities are conducted with non-
scale and virulence of the 1918 influenza pandemic could
U.S. funds. Whereas the policy applied only to family
cost the global economy $3 trillion in Gross Domestic
planning and reproductive health programs under the
Product (GDP) and cause 50 million to 80 million deaths.
George W. Bush Administration, the Trump Administration
During the Obama Administration, the United States played
reinstated the policy in 2017, following its reversal during
a key role in developing and implementing the Global
the Obama Administration, and applied it to all global
Health Security Agenda (GHSA), a multilateral effort to
health programs under a new policy called Protecting Life
improve global pandemic preparedness and response. The
in Global Health Assistance (PLGHA). On January 28,
Trump Administration made public s tatements in support of
2021, the Biden Administration issued a memorandum
the GHSA but did not make specific funding commitments
revoking PLGHA. The memorandum also directed the
for sustaining the initiative, and did not maintain the GHSA
Secretary of State to resume United Nations Population
coordinating mechanism. In January 2021, the Biden
Fund (UNFPA) funding and withdraw co-sponsorship and
Administration reestablished the coordinating mechanism
signature from the Geneva Consensus Declaration (which
and created a new senior-level position to coordinate
was signed by the Trump Administration in October 2020
domestic and international COVID-19 activities.
and declared that there is no international right to abortion).
In the 117th Congress, Members introduced a range of bills
The Mexico City Policy remains a contentious issue, with
aimed at improving global pandemic preparedness,
Members having introduced legislation to permanently
including those that called for reestablishing the GHSA
enact or repeal the policy in the 117th Congress.
coordinating mechanism. Others bills would broaden the
U.S. Membership in WHO. On January 20, 2021,
focus of the efforts to include the integration of
President Joe Biden sent a letter to United Nation (U.N.)
environmental preservation and anti-wildlife trafficking
Secretary-General Antόnio Guterres indicating that the
efforts into global pandemic preparedness and control.
United States would remain a member of WHO. The letter
Outlook
retracted a July 6, 2020, decision by the Trump
Global health has remained a strong congressional priority,
Administration to withdraw the United States from WHO,
with funding increases continuing across Administrations.
effective July 6, 2021. The withdrawal determination
The bulk of related funding is aimed at controlling the
followed assertions by the Trump Administration that
spread of infectious disease, especially HIV/AIDS, TB, and
WHO failed “to independently investigate” reports
malaria. Growing concerns about pandemic threats may be
conflicting with the Chinese government’s accounts of the
contributing to recent increases in appropriations for related
pandemic and repeated “grossly inaccurate” or
programs. Emergency appropriations for U.S. international
“misleading” claims made by Chinese authorities about
efforts to control global disease outbreaks, particularly
COVID-19. On January 21, 2021, U.S. officials announced
Ebola and COVID-19, have outweighed regular
a resumption of regular engagement with WHO and an end
appropriations for pandemic preparedness. Given ongoing
to the drawdown of U.S. staff seconded to WHO. The
challenges with controlling the COVID-19 pandemic,
White House also issued a directive that, among other
Congress may consider calls for bolstering capacity to avert
things, directed the APNSA to make recommendations for
or control disease outbreaks. Many global health experts
reforming and strengthening WHO.
assert that investments in health systems, in addition to
A WHO-convened team of experts from China (17
infectious disease response, could help prepare the world
members) and other countries and organizations (17
for the next infectious disease threat.
members) investigated the origin of the COVID-19
pandemic in January 2021 but found no definitive source of
Tiaji Salaam-Blyther, Specialist in Global Health
the virus. The team ranked the likelihood of four prevailing
IF11758
scenarios, with transmission from an intermediate animal
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U.S. Global Health Funding: FY2017-FY2022 Request
Disclaimer
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https://crsreports.congress.gov | IF11758 · VERSION 3 · UPDATED