Global Health Security: Background and Issues for Congress

Global Health Security: Background and Issues for Congress

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February 9, 2024
Global Health Security: Background and Issues for Congress
Background
c. To date, Congress has not enacted an FY2024 State, Foreign
Congressional interest in the capacity of health systems,
Operations appropriation. Congress enacted a continuing
especially in low- and middle-income countries (LMIC), to
resolution, which authorized federal agencies, including DOS
detect, control, and respond to infectious disease threats is
and USAID, to continue spending for most programs at FY2023
growing. Programs to build such capacity are integral to
rates through February 4, 2024.
U.S. “global health security” (GHS) policy. Key areas of
d. Includes $500.0 mil ion for a contribution to the World Bank
focus of such programs include strengthening national
Pandemic Fund and $10.3 mil ion from the Diplomatic Programs
laboratory and surveillance systems and improving risk
account for salaries and administrative expenses.
communication. GHS appropriations have been growing,
particularly since the emergence of COVID-19 in early
GHS Mandatory Funding Request
2020. Related issues for Congress include deliberation of
The increased frequency and severity of infectious disease
funding levels for GHS programs, oversight of
outbreaks has intensified debates about the effectiveness of
reorganization within the Department of State (DOS) to
appropriating funds annually for global health security. In
establish the new Bureau for Global Health Security and
March 2022, the Biden Administration released its FY2023
Diplomacy (GHSD), and consideration of how the
State, Foreign Operations (SFOPS) Congressional Budget
reorganization might affect the administration of global
Justification (CBJ), which included a $6.5 billion request
HIV/AIDS programs.
for mandatory multiyear funding authority for GHS
GHS Appropriations
programs (global health funding is typically discretionary).
The funds were requested in addition to the discretionary
Appropriations for GHS efforts administered by the U.S.
appropriations detailed in Table 1, and included
Agency for International Development (USAID)—the
primary funder of U.S. bilateral GHS programs—more than
• $4.5 billion “in seed funding” from DOS for the World
quadrupled between FY2021 and FY2023 (Table 1). Since
Bank Pandemic Fund;
FY2022, the Biden Administration has also requested
• $1.0 billion, including $250.0 million for DOS and
multilateral GHS funding in the DOS budget. These
$750.0 million for USAID bilateral GHS programs;
amounts are in addition to funds provided for COVID-19
control through emergency appropriations.
• $500.0 million to USAID for a contribution to the
Coalition for Epidemic Preparedness Innovations
Table 1. Global Health Security Funding by Agency:
(CEPI) to support vaccine research, development, and
FY2016-FY2024
delivery, and to develop and deploy innovative tools to
(Global Health Programs account, current U.S. $ mil ions)
build resilience for future pandemics; and
• $500.0 million to replenish the Emergency Reserve
Fiscal
USAID
USAID
DOS
DOS
Fund, which USAID uses to respond rapidly to
Year
Request
Enacted
Request
Enacted
infectious disease outbreaks.
FY2016
50.0
72.5
0.0
0.0
Congress did not enact the mandatory spending proposal,
FY2017
72.5
72.5
0.0
0.0
but it authorized $5.0 billion for GHS activities for the
FY2018
0.0a
72.6
0.0
0.0
same five-year period through the Global Health Security
FY2019
0.0
and International Pandemic Prevention, Preparedness and
a
100.0
0.0
0.0
Response Act of 2022 (“Global Health Security Act,” Title
FY2020
90.0
100.0
0.0
0.0
LV of P.L. 117-263, FY2023 National Defense
FY2021
115.0
190.0
0.0
0.0
Authorization Act), discussed below.
FY2022
745.0
700.0
250.0b
n/s
FY2023
745.0
908.0
250.0b
n/s
Global Health Security Act
FY2024
745.0
c
510.3d
c
Congress enacted the Global Health Security Act in
December 2022. Among other things, the act addressed
Source: Congressional budget justifications, appropriations, and
many of the items in the Biden Administration’s multiyear
explanatory notes.
budget request for global health security and included
Acronym: not specified (n/s), Department of State (DOS)
provisions to enable congressional oversight of authorized
Notes: Excludes emergency appropriations, mandatory funding
activities, such as the following:
requests, and recissions.
a. The Administration proposed reprogramming $72.5 mil ion of
Support for World Bank Pandemic Fund. Authorized
Ebola emergency supplemental funds for GHS programs.
U.S. contributions to (up to 33% of contributions from all
b. Requested for the World Bank Pandemic Fund.
sources) and participation in a Financial Intermediary Fund
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Global Health Security: Background and Issues for Congress
for Pandemic Prevention, Preparedness, and Response (later
In August 2023, Secretary of State Antony Blinken
referred to as the Pandemic Fund) at the World Bank.
announced the launch of GHSD, which houses several
operating units across DOS, including the Office of
Coordination of bilateral GHS activities. Required the
International Health and Biodefense, the Office of Global
President to identify the relevant departments and agencies
Health Diplomacy, and the Office of the Global AIDS
leading U.S. responses to global infectious disease
Coordinator (OGAC), along with the functions of the
outbreaks, and to notify the appropriate congressional
Coordinator for Global COVID-19 Response and Health
committees of the aforementioned roles and responsibilities
Security. In September 2023, President Biden formally
no later than 120 days after enactment of the act, and
nominated the current U.S. Global AIDS Coordinator,
regularly thereafter.
Ambassador Dr. John Nkengasong, to serve as
Ambassador-At-Large and Senior Bureau Official for
Allocate USAID staff for GHS activities. Authorized
Global Health Security and Diplomacy. The Biden
USAID to cover the cost of detailing its employees to
Administration intends for the Ambassador to concurrently
address global health emergencies and natural or human-
lead GHSD and OGAC. The Senate is considering the
induced disasters, and required the USAID Administrator to
nomination.
notify the appropriate congressional committees at least 15
days before making funds available for such purposes.
The DOS FY2024 CBJ included the first budgetary request
for the administration of GHSD ($10.3 million). According
Global Health Security Strategy. Required the President
to the CBJ, the funds are to be used to pay the salaries of 35
to develop and maintain a strategy for improving GHSD for
staff through the Diplomatic Programs account. An
pandemic prevention, preparedness, and response. The
additional 102 positions are to be funded through OGAC.
strategy was to be submitted to the appropriate committees
within 180 days of enactment, followed by annual progress
Issues for Congress
reports. As of February 8, 2024, the Administration has not
Funding. Congress has increased GHS appropriations,
published a GHS Strategy, per se, though it released a
while also raising questions about the capacity of programs
National Biodefense Strategy and Implementation Plan in
to expand. The House Appropriations Committee noted in
October 2022, which outlined goals for building “capacity
H.Rept. 118-146, “a substantial amount of unobligated
across at least five technical areas in at least 50 countries.”
balances despite critical needs.” Questions from some
Members about the pace of GHS spending through bilateral
U.S. Coordinator for Global Health Security. Instructed
programs reflect longstanding debates about the appropriate
the President to designate an appropriate senior official to
balance of funding for bilateral and multilateral programs.
be the U.S. Coordinator for Global Health Security, who
The bulk of the Administration’s FY2023 multiyear request
shall be responsible for the coordination of the Global
and FY2024 GHS request was for the multilateral Pandemic
Health Security Agenda Interagency Review Council. (See
Fund, not bilateral programs.
GHSD Bureau section for more information.)
Oversight. The Senate Appropriations Committee has
Ambassador-at-Large for Global Health Security and
questioned how bilateral GHS funds are being used, calling
Diplomacy. Established the position of Ambassador-At-
for greater oversight of the funds. In S.Rept. 118-71, for
Large for GHSD at DOS to ensure oversight, coordination,
example, the committee instructed the USAID
and management of GHS funds used by DOS; lead, in
Administrator to report to the Appropriations Committees
collaboration with the U.S. Department of Health and
on how it intended to use GHS funds per country and
Human Services (HHS) Secretary and USAID
project within 90 days of enactment and every 90 days until
Administrator, diplomatic GHS activities; and promote
such funds are expended. Other oversight interests might
investments for building GHS worldwide. (See GHSD
include the status of a GHSD strategy, as required by the
Bureau section for more information.)
Global Health Security Act, and clarification with regard to
which agency is to receive funds authorized by the Global
Coordinating global health and GHS. Directed the
Health Security Act and for which activities.
USAID Administrator to collaborate and coordinate with
the Global Malaria Coordinator, Global AIDS Coordinator,
Reorganization. Congress may also consider whether, and
the Ambassador-at-Large for GHSD, and the HHS
to what extent, it seeks to oversee ongoing reorganization at
Secretary, where possible, on U.S. global health programs.
DOS for the establishment of the GHSD Bureau. According
to the FY2024 CBJ, roughly 74% of GHSD positions are to
GHSD Bureau
be held by OGAC staff. In 2022, the Government
On December 13, 2022, DOS submitted a congressional
Accountability Office issued a report describing workload
notification (CN) to Congress describing its intent to create
and retention issues at OGAC. Congress may choose to ask
a new GHSD Bureau whose mission is to lead U.S.
the Administration how DOS will effectively administrate
diplomatic engagement and improve the efficiency of U.S.
additional GHSD duties while simultaneously addressing
GHS programs; leverage and help coordinate bilateral
staffing challenges at OGAC. Congress might also debate
foreign aid; promote international coordination for
whether one person can effectively oversee two major
improving GHS and convene global stakeholders to
global health programs (PEPFAR and GHSD).
establish norms and policies to mitigate global health
threats; and elevate and integrate global health security as a
Tiaji Salaam-Blyther, Specialist in Global Health
U.S. national security and foreign policy priority.
IF12590
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Global Health Security: Background and Issues for Congress

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