U.S. Global Health Assistance: FY2017-FY2021 Funding

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February 5, 2021
U.S. Global Health Assistance: FY2017-FY2021 Funding
international HIV/AIDS research. Congress does not
Congress has prioritized global health with foreign aid
earmark funds for these activities, however, and NIH has
funding rising over the past 20 years. The steepest increase
not reported related grant amounts since FY2017.
occurred during the George W. Bush Administration
State-Foreign Operations (SFOPS) Appropriations
(Figure 1), following the establishment of the President’s
include funds for the coordination of PEPFAR by the State
Emergency Plan for AIDS Relief (PEPFAR) and the
President’s Malaria Initiative. During the Obama
Department and USAID global health programs. From
FY2020 to FY2021, appropriations remained mostly level,
Administration, appropriations continued to rise, though at
except for a near doubling of funds for global public health
a slower pace and with some funding dips. Global health
protection, which includes support for the collection and
appropriations resumed a steady increase during the Trump
analysis of data on unknown viruses and pathogens. In
Administration, despite requests from that administration to
FY2021, Congress also increased funding for tuberculosis
reduce global health spending. The emergence of the novel
(TB) and maternal and child health programs.
SARS-CoV-2, which causes Coronavirus Disease 2019
(COVID-19), likely prompted funding increases for global
Labor-HHS Appropriations include funds for CDC global
health security efforts in FY2021. Several bills in the 116th
health programs, which remained at FY2020 levels in
Congress were aimed at bolstering global health security.
FY2021, except for new funding for TB programs and a
The 117th Congress may continue to focus on pandemic
near doubling for global health protection. Sufficient
control, as the COVID-19 pandemic continues and SARS-
resources are also available through the appropriations for
CoV-2 variants emerge.
international HIV/AIDS research conducted by NIH.
Figure 1.U.S. Global Health Appropriations, by
Figure 2. Global Health Appropriations:
Administration: FY2001-FY2021
(current 2020 U.S. $ bil ions)
(current U.S. $ millions)

Source: Appropriations legislation 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).
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
activities, such as the National Institutes of Health (NIH)

Sources: Appropriations legislation and engagement with CDC and
Office of AIDS Research (OAR), which supports
USAID congressional relations personnel.

U.S. Global Health Assistance: FY2017-FY2021 Funding
Note: Excludes emergency appropriations and rescissions.
attempt to withdraw the United States from WHO raised
Acronyms: Maternal and Child Health (MCH), Vulnerable Children
questions about congressional authority to inform the
(VC), Family Planning and Reproductive Health (FP/RH), and
withdrawal process. Some Members in the 116th Congress
Neglected Tropical Diseases (NTDs).
introduced legislation in support of or opposition to the
withdrawal decision.
Key Global Health Policy Issues
The Biden Administration has already executed major
Pandemic Preparedness and Response. Global disease
executive actions on global health policy, including
outbreaks are occurring at greater frequency and are
expanding in their scale and impact. The cost of epidemics
 revoking the Mexico City Policy;
and pandemics is also rising. The Global Preparedness
 halting U.S. withdrawal from WHO;
Monitoring Board estimated that a pandemic akin to the
scale and virulence of the 1918 influenza pandemic could
 establishing within the Office of the President a
cost the global economy $3 trillion in Gross Domestic
COVID-19 Response Coordinator;
Product (GDP) and cause 50-80 million deaths. During the

Obama Administration, the United States played a leading
establishing a National Security Council (NSC)
role in the development and implementation of the Global
Directorate on Global Health Security and Biodefense;
Health Security Agenda (GHSA), a multilateral effort to
improve global pandemic preparedness and response. The
 directing the Assistant to the President for National
Obama Administration hosted a summit on the GHSA;
Security Affairs (APNSA) to complete a review of and
committed to spend more than $1 billion in 30 countries on
recommend actions to the President on emerging
related efforts in FY2015-FY2019; issued an executive
domestic and global biological risks and national
order that outlined the role each agency and department
biopreparedness policies.
would play in implementing GHSA; and directed the NSC
to coordinate related work. The Trump Administration
Mexico City Policy. In 1984, the Reagan Administration
made public statements in support of the GHSA but did not
established the Mexico City Policy, which restricts U.S.
make specific commitments toward sustaining support for
assistance to foreign NGOs engaged in voluntary abortion
the initiative, and did not maintain the GHSA coordinating
activities, even if such activities are conducted with non-
mechanism. In January 2021, the Biden Administration
U.S. funds. Whereas the policy applied only to family
reestablished the coordinating mechanism and created a
planning and reproductive health programs under the
new senior-level position to coordinate domestic and
George W. Bush Administration, the Trump Administration
international COVID-19 activities.
reinstated the policy in 2017, following its reversal during
the Obama Administration, and applied it to all global
In the 116th Congress, Members introduced a range of bills
health programs under a new policy called Protecting Life
aimed at improving global pandemic preparedness,
in Global Health Assistance (PLGHA). On January 28,
including those that called for reestablishing the GHSA
2021, the Biden Administration issued a memorandum
coordinating mechanism. Others broadened the focus of the
revoking PLGHA. The memo also directed the Secretary of
efforts to include the integration of environmental
State to resume funding to the United Nations Population
preservation and anti-wildlife trafficking efforts into global
Fund (UNFPA) and to withdraw co-sponsorship and
pandemic preparedness and control. Given the near
signature from the Geneva Consensus Declaration (which
doubling of funding for pandemic preparedness and global
was signed by the Trump Administration in October 2020
health security efforts through both CDC and USAID, these
and declared that there is no international right to abortion).
issues may remain of interest to the 117th Congress.
The Mexico City Policy remains a contentious issue, with
Members having introduced legislation to permanently
Global health has remained a strong congressional priority,
enact or repeal the policy.
with funding increases continuing across administrations.
U.S. Membership in WHO. On January 20, 2021,
The bulk of related funding is aimed at controlling the
President Joe Biden sent a letter to United Nation (U.N.)
spread of infectious disease, especially HIV/AIDS, TB, and
Secretary-General Antόnio Guterres indicating that the
malaria. Growing concerns about pandemic threats may be
United States would remain a member of WHO. The letter
contributing to recent increases in appropriations for related
retracted a July 6, 2020, decision by the Trump
programs. Emergency appropriations for U.S. international
Administration to withdraw the United States from WHO,
efforts to control global disease outbreaks, particularly
effective July 6, 2021. The withdrawal determination
Ebola and COVID-19, have outweighed regular
followed assertions by the Trump Administration that
appropriations for pandemic preparedness. Given ongoing
WHO failed “to independently investigate” reports
challenges with controlling the COVID-19 pandemic,
conflicting with the Chinese government’s accounts of the
Congress may consider calls for bolstering capacity to avert
pandemic and repeated “grossly inaccurate” or
or control disease outbreaks. Many global health experts
“misleading” claims made by Chinese authorities about
assert that investments in health systems, in addition to
COVID-19. On January 21, 2021, U.S. officials announced
infectious disease response, could help prepare the world
a resumption of regular engagement with WHO and an end
for the next infectious disease threat.
to the drawdown of U.S. staff seconded to WHO. The
White House also issued a directive that, among other
Tiaji Salaam-Blyther, Specialist in Global Health
things, directed the APNSA to make recommendations for
reforming and strengthening WHO. The unprecedented

U.S. Global Health Assistance: FY2017-FY2021 Funding

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