U.S. Global Health Funding: FY2020-FY2023 Appropriations

U.S. Global Health Funding: FY2020-FY2023 Appropriations

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Updated January 4, 2023
U.S. Global Health Funding: FY2020-FY2023 Appropriations
Background
Global Health Appropriations
Congress has appropriated significant increases in global
Congress provides most U.S. global health funding in two
health funding in recent decades, particularly to establish
annual appropriations measures: the Department of State,
and maintain the President’s Emergency Plan for AIDS
Relief (PEPFAR) and the President’s Malaria Initiative
Foreign Operations, and Related Programs (SFOPS), which

funds State Department and USAID programs, and Labor,
(PMI) initiated during the Bush Administration (Figure 1).
Health and Human Services, Education and Related
During the Obama Administration, appropriations remained
Agencies (Labor-HHS), which funds CDC global health
high for those programs and continued to rise for other
programs. Congress may make funds available for other
health programs, though at a slower pace and with some
global health activities as well, such as international
funding dips. Congress mostly maintained global health
HIV/AIDS research conducted by the National Institutes of
funding levels during the Trump Administration, despite
Health (NIH), but these amounts are not included in this
requests from that Administration for large cuts. The Biden
report as Congress does specify a funding level.
Administration requested almost $1 billion for global health
security (GHS) programs in FY2023 (Figure 2). In
Figure 2. Global Health Funding: FY2020-FY2023
December 2022, Congress appropriated $11.25 billion for
(current U.S. $ millions)
FY2023 global health activities, including funding to meet
FY2020
FY2021
FY2022
FY2023
FY2023
the Administration’s request for GHS.
Enacted
Enacted
Enacted
Request
Enacted
Successive global infectious disease outbreaks have
Global Health Total
9,663.3 9,787.0 10,422.8 11,323.8 11,253.8
prompted Congress to provide additional funds through
CDC Total
5
70.8 5
91.0 5
92.8 7
47.8 6
92.8
HIV/AIDS
128.4 128.0 128.4 128.4 128.9
emergency appropriations for outbreak control—including
TB
7
.2 9
.2 9
.2 9
.2 11.7
nearly $3 billion for U.S. Centers for Disease Control and
Immunizations
226.0 225.3 226.0 226.0 230.0
Prevention (CDC) and U.S. Agency for International
Parasitic Diseases/
Development (USAID) activities to control the 2015-2018
Malaria
26.0 25.9 26.0 31.0 29.0
Ebola outbreak and over $2 billion for international control
Global Public Health
of the COVID-19 pandemic. This product does not provide
Protection (GHS)
183.2 202.6 203.2 353.2 293.2
information on emergency appropriations.
State Total
5
,930.0 5
,930.0 5
,950.0 6
,620.0 6
,395.0
HIV/AIDS
4,370.0 4,370.0 4,390.0 4,575.0 4,395.0
Figure 1. U.S. Global Health Funding, by
Global Fund
1,560.0 1,560.0 1,560.0 2,045.0 2,000.0
Administration: FY2001-FY2023
USAID Total
3
,162.5 3
,266.0 3
,880.0 3
,956.0 4
,166.0
(constant 2023 U.S. $ bil ions)
HIV/AIDS
330.0 330.0 330.0 330.0 330.0
FP/RH
524.0 524.0 524.0 572.0 524.0
MCH
851.0 855.5 890.0 879.5 910.0
Nutrition
150.0 150.0 155.0 150.0 160.0
VC
25.0 25.0 27.5 25.0 30.0
TB
310.0 319.0 371.1 350.0 394.5
Malaria
770.0 770.0 775.0 780.0 795.0
NTDs
102.5 102.5 107.5 114.5 114.5
Other/Pandemics/GHS 100.0 190.0 700.0 755.0 908.0
Sources: Congressional budget justifications and appropriations.
Note: Excludes emergency appropriations, rescissions, non-GHP USAID
accounts, and other funds that may be used to improve health worldwide,
such as international HIV/AIDS research conducted by NIH. Global Public
Health Protection for CDC and Other/Pandemics for USAID is counted
as GHS funding. Enacted FY2022 and FY2023 USAID GHS include $250
mil ion from GHP-State.
Acronyms: Family Planning and Reproductive Health (FP/RH), Maternal
and Child Health (MCH), Neglected Tropical Diseases (NTDs),
Sources: Congressional budget justifications and appropriations.
Tuberculosis (TB), and Vulnerable Children (VC).
Notes: Excludes emergency appropriations, rescissions, non-GHP
USAID accounts, and other funds that may be used to improve health
SFOPS Appropriations. For FY2023, the Biden
worldwide, such as international HIV/AIDS research conducted by
Administration requested nearly $10.58 billion for global
the National Institutes of Health (NIH). FY2001-FY2019 actual;
health funding in SFOPS, almost 8% higher than FY2022-
FY2020-FY2023 enacted.
enacted levels. The request included almost $1 billion for
GHS, a $305 million increase from FY2022-enacted levels.
The GHS proposal included a $250 million contribution to
the multilateral ACT-Accelerator for COVID-19 control,
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U.S. Global Health Funding: FY2020-FY2023 Appropriations
$250 million for a new health security financing mechanism
 required the Global AIDS Coordinator to publish annual
jointly managed by the World Bank and World Health
reports on spending for HIV/AIDS programs by the
Organization (WHO), and $90 million to replenish
Global Fund, the U.S. government, and partner countries
USAID’s Emergency Fund for emergency response to
through 2024;
infectious disease outbreaks. The Administration’s SFOPS
 limited U.S. Global Fund contributions to 33% of all
request for global health also included $290 million for the
contributions and permitted partial withholding of those
last installment of a $1.6 billion multiyear pledge for the
amounts through 2023;
multilateral Gavi, the Vaccine Alliance 2020-2023 budget
cycle, and $2 billion for the first tranche of a $6 billion
 required that more than half of global HIV/AIDS
pledge for the 2024-2026 Global Fund budget cycle.
appropriations through 2023 be used to treat HIV/AIDS
and associated infections, and for nutritional support and
For FY2023, Congress appropriated $15.0 million less than
medical care for people living with HIV/AIDS; and
the Administration sought for SFOPS global health
programs and $731 million more than FY2022-enacted
 required that at least 10% of funds be used on care and
levels. FY2023 appropriations matched or exceeded
support for orphans and vulnerable children until 2023.
FY2023 appropriations for all global health subsectors, with
notable increases for the Global Fund (+28%) and GHS
The 118th Congress may consider whether to extend these
(+30%). In the joint explanatory statement, conferees
requirements. For more information on the aforementioned
indicated several areas of congressional oversight interest
laws, see CRS In Focus IF10797, PEPFAR Stewardship
by directing agencies to report on services provided to HIV-
and Oversight Act: Expiring Authorities.
positive women during pregnancy, labor and delivery, as
The 118th Congress may also deliberate proposals by the
well as the 12 months following delivery, including
Biden Administration to leverage and build upon
diagnosis and treatment services; the approximate number
PEPFAR’s assets to help strengthen country public health
of treatments provided for HIV/AIDS, tuberculosis, and
systems beyond the HIV/AIDS focus. The Administration
malaria, as well as the amounts expended to achieve such
maintains it will help countries respond to health security
outcomes; and information on programs related to maternal
threats. PEPFAR-supported health infrastructure has been
and child health, research and development of antibiotics,
used to support responses to a number of pandemics,
vulnerable children, and integration of mental health and
including COVID-19. Congress may consider whether to
psychosocial support.
authorize such actions on a permanent or temporary basis.
Labor-HHS Appropriations. For FY2023, the
Pandemic Funding and Authorities. In December 2022,
Administration requested $747.8 million for the CDC
the State Department notified Congress of its intent to
Global Health account, a $155.0 million boost from
create a Bureau of Global Health Security and Diplomacy
FY2022 levels. The bulk ($150.0 million) of the increase
“to strengthen global health security and to address growing
was proposed for GHS activities aimed at expanding
national security challenges presented by global health
disease detection training and enhancing emergency
crises.” The U.S. Global AIDS Coordinator would lead the
response in partner countries; providing technical assistance
new bureau, which would combine the Office of
for reducing cholera and other water-borne illnesses, as
International Health and Biodefense and the functions of
well as port-of entry surveillance; and accelerating the
the Coordinator for Global COVID-19 Response and
development of national and regional public health
Health Security with the Office of the U.S. Global AIDS
institutes, among other priorities. For FY2023, Congress
Coordinator. At the same time, Section 5562 of the FY2023
appropriated $692.8 million for CDC global health
National Defense Authorization Act authorized the
programs, $55.0 million less than the Administration
President to designate a senior official to be the U.S.
request but $100.0 million more than FY2022-enacted
Coordinator for Global Health Security and the
levels.
establishment of an Ambassador-At-Large for Global
Issues for Congress
Health Security and Diplomacy at the State Department.
The act instructs the USAID Administrator and other senior
PEPFAR Reauthorization. Congress has prioritized
officials to ensure that ongoing global health programs
fighting HIV/AIDS globally, having apportioned roughly
“contribute to the strengthening of health systems for global
65% of annual global health funding to bilateral HIVAIDS
health security and pandemic prevention and preparedness.”
programs and the Global Fund. Congress has also enacted
The act does not expressly authorize the Bureau of Global
legislation to authorize appropriations and set congressional
Health Security and Diplomacy.
priorities for PEPFAR and related programs, including the
“Leadership Act” of 2003 (P.L. 108-25), the “Lantos-Hyde
Congress may consider the extent to which the new bureau
Act” of 2008 (P.L. 110-293), the “Stewardship Act” of
and leadership positions might facilitate or complicate
2013 (P.L. 113-56), and the PEPFAR Extension Act of
efforts to coordinate U.S. global health security efforts
2018 (P.L. 115-305).The most recent authorizing law, the
across the U.S. government, and may wish to shape the
PEPFAR Extension Act,
priorities of the new bureau through legislation or oversight
activities.
 required the Inspectors General of the Department of
State, U.S. Agency for Global Media, HHS, and USAID
Tiaji Salaam-Blyther, Specialist in Global Health
to coordinate oversight activities through 2023;
Catherine L. Able-Thomas, Acting Research Assistant
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U.S. Global Health Funding: FY2020-FY2023 Appropriations

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