KFF Daily Global Health Policy Report

In The News

Trump Administration's FY18 Budget Proposal Seeks Cuts To Global Health & Food Assistance, Other Foreign Aid, Biomedical Research Programs

Devex: Trump budget thrusts U.S. foreign aid into a political fight
“…For more than a decade, U.S. engagement in global development efforts has stood as a rare exception to Washington’s constant partisan warfare, with both Democrats and Republicans tending to agree that relatively small investments in developing countries benefit U.S. national security and project American values. The Trump administration’s proposal to slash foreign aid spending by a third marks a distinct turn toward a more politically charged environment for these programs than has been seen in a long time, many in the development community agreed…” (Igoe et al., 5/24).

Devex: U.S. budget chief explains deep foreign aid cuts
“…[B]udget director Mick Mulvaney offered some insight into why the Trump administration sees fit to slash foreign aid spending. Speaking generally about programs slated for cutbacks, Mulvaney told reporters Monday that the White House is particularly skeptical of programs it feels haven’t sufficiently demonstrated a positive impact, as well as programs the U.S. Congress has not authorized with legislation…” (Igoe, 5/23).

Financial Times: State department funding to take a hit from Trump cuts
“The Trump administration plans to slash funding for the State Department, as it steers U.S. foreign policy from diplomacy towards military might and defeating Islamist terrorism. Rex Tillerson, secretary of state, said the 2018 budget, which plans spending cuts of 32 percent for diplomacy and overseas aid, ‘acknowledges that U.S. diplomacy engagement and aid programs must be more efficient and more effective’…” (Manson/Sevastopulo, 5/23).

The Hill: Trump budget makes heavy cuts to science research
“President Trump’s fiscal 2018 budget unveiled Tuesday proposes massive cuts for the National Science Foundation. … Mick Mulvaney, the director of the Office of Management and Budget, defended the proposal, accusing the foundation of wasteful spending…” (Breland, 5/23).

Nature: Trump budget would slash science programs across government
“U.S. President Donald Trump released a revised budget plan on 23 May that would cut science programs across the federal government in 2018. Biomedical, public health, and environmental research would all be pared back. Those cuts, along with deep reductions in programs for the poor, are balanced by a proposed 10 percent increase in military spending…” (Reardon et al., 5/23).

New York Times: Cuts to AIDS Treatment Programs Could Cost a Million Lives
“At least one million people will die in sub-Saharan Africa and elsewhere, researchers and advocates said on Tuesday, if funding cuts proposed by the Trump administration to global public health programs are enacted. The United States currently spends more than $6 billion annually on programs that buy antiretroviral drugs for about 11.5 million people worldwide who are infected with HIV, the virus that causes AIDS. The Trump administration has proposed slashing those programs by at least $1.1 billion — nearly a fifth of their current funding, said Jen Kates, a vice president at the Kaiser Family Foundation…” (Harris, 5/23).

NPR: Medical Research, Health Care Face Deep Cuts In Trump Budget
“…No one thinks the president’s budget will pass as proposed, since Congress has budget and spending authority. But it does provide a baseline from which negotiations may begin…” (Kodjak/Stein, 5/23).

Reuters: Trump budget proposal slashes global health, peacekeeping
“The Trump administration’s budget proposal would significantly cut U.S. funding for global health programs, food aid, international peacekeeping, educational and cultural exchanges, and climate change programs, according to budget documents released on Tuesday…” (Torbati, 5/23).

Reuters: Republicans push back against Trump plan to cut foreign aid
“U.S. President Donald Trump’s fellow Republicans in Congress on Tuesday assailed his proposed cuts in the diplomatic and foreign aid budget, making it unlikely the cutbacks in global health, peacekeeping, and other programs will take effect…” (Torbati et al., 5/23).

ScienceInsider: What’s in Trump’s 2018 budget request for science?
“…As in the ‘skinny’ budget released earlier, the full NIH budget proposal eliminates the Fogarty International Center, which has a $72 million budget this year. But $25 million would be set aside for other institutes to fund some of the center’s global health research and training…” (5/23).

STAT: HIV programs, mental health: 8 ways Trump’s new budget might affect public health
“…The budget outline released by the White House Tuesday contains sharp cuts to everything — from a … reduction in global health funding that includes HIV programming to grass-roots community health grants. And while it’s not clear what cuts will survive the congressional budget process, the proposal reveals a White House that, for the most part, wants a leaner public health system, and less American money used overseas…” (Facher, 5/24).

Washington Post: Trump budget seeks huge cuts to science and medical research, disease prevention
“President Trump’s 2018 budget request, delivered to Congress on Tuesday with the title ‘A New Foundation for American Greatness,’ has roiled the medical and science community with a call for massive cuts in spending on scientific research, medical research, disease prevention programs, and health insurance for children of the working poor…” (Achenbach/Sun, 5/23).

Washington Post: Foreign aid under the ax in State Department budget proposal
“The White House is proposing a State Department budget that would make deep cuts in long-term development aid, humanitarian food assistance, and peacekeeping missions around the world. … The Trump administration’s proposed reductions include health programs that fight HIV/AIDS, malaria, and polio. The plan would eliminate an emergency food aid program that purchases food from U.S. farmers. It would continue funding for NATO but cut contributions to U.N. peacekeeping by more than half … State Department officials said that despite the cuts, the United States would remain a leading donor to humanitarian and health needs…” (Morello, 5/23).

Washington Post: Lindsey Graham: Trump’s State Department budget could cause ‘a lot of Benghazis’
“The Trump administration’s fiscal 2018 State Department budget proposal irresponsibly cuts diplomacy and diplomatic security in a way that could cause ‘a lot of Benghazis,’ according to Sen. Lindsey Graham (R-S.C.), chairman of the Senate appropriations subcommittee on the State Department and foreign operations. He promised that Congress would reject the cuts…” (Rogin, 5/23).

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Ethiopia's Tedros Adhanom Ghebreyesus Elected As WHO Director General

Associated Press: Ethiopia’s Tedros to be next leader of U.N. health agency
“Africa, where viruses such as HIV, Ebola, and Zika emerged, has its first chief of the U.N. health agency. Tedros Adhanom Ghebreyesus, a former Ethiopian minister of health, was elected Tuesday as the next director general of the World Health Organization, becoming the first non-medical doctor and the first African tapped to lead an influential agency that helps set health priorities worldwide…” (Keaten/Cheng, 5/24).

Devex: The next WHO director general is Tedros Adhanom Ghebreyesus
“…The former minister of health of Ethiopia beat two other finalists in the race — the U.K.’s David Nabarro and Pakistan’s Sania Nishtar — with a final vote of 133 out of a possible 186, according to an unofficial tally leaked to the press. The WHO, as was the case during the elimination round in January, did not release the final breakdown of votes…” (Ravelo, 5/23).

Devex: A ‘new era’ for WHO as first African head elected — but challenges await
“…Tedros takes the helm of the United Nations health agency at a critical time, when its legitimacy is at stake. Despite winning by a wide margin, the former minister of health’s campaign for the leadership was also marked by concerns over human rights. There were many congratulations from organizations and individuals alike on the evening following the election…” (Ravelo/Saldinger, 5/24).

Financial Times: Ethiopia’s Tedros Adhanom to head World Health Organization
“…His appointment sends a strong signal of support for a leader from lower and middle-income countries and reflects an election race during which he emphasized his commitment to supporting ‘universal health coverage’ to expand free health care…” (Jack/Aglionby, 5/23).

Nature: World Health Organization gets first leader from Africa
“…Tedros, 52, is a public health expert who has formerly been both a health minister and a foreign minister in Ethiopia’s government, and will lead the WHO for a five-year term…” (Butler, 5/23).

New York Times: WHO Elects Ethiopia’s Tedros as First Director General From Africa
“…[Tedros] promised as the head of WHO to pursue health insurance in even the poorest nations, strengthen emergency responses, and make the agency more accountable and transparent. He backs greater access to birth control and preventive care for women and is committed to having more gender and ethnic diversity in the agency. He also has promised to fight the health effects of climate change…” (McNeil/Cumming-Bruce, 5/23).

NPR: World Health Organization Elects First Director General From Africa
“…During a campaign in which many people have been calling for more openness at WHO, Tedros was criticized for Ethiopia’s habit of downplaying domestic cholera outbreaks by labeling them ‘acute watery diarrhea.’ But Tedros promised that transparency will be at the heart of the WHO once he’s in charge…” (Beaubien, 5/23).

Quartz: WHO has elected a former Ethiopian health minister as its first African director general
“…Ghebreyesus will take over WHO amid even more controversy, over how its outgoing Director-General Margaret Chan and her team have handled budget spending…” (Adegoke, 5/23).

ScienceInsider: Former Ethiopian health minister becomes first African head of the World Health Organization
“…The organization was widely criticized for its late response to the West African Ebola outbreak and is in the midst of reforms, while many fear that the Trump administration will significantly cut funding for international health…” (Kupferschmidt, 5/23).

Thomson Reuters Foundation: Expert Views — Challenges and priorities for WHO’s new director general Tedros
“…The Thomson Reuters Foundation asked global health experts and charity leaders what the new director general should prioritize…” (5/23).

TIME: World Health Organization Elects a New Director General from Ethiopia
“…In a speech before the election — part of a weeklong meeting of health ministers from 194 nations in Geneva — Tedros talked about growing up in Ethiopia, saying he comes from a background of ‘knowing survival cannot be taken for granted, and refusing to accept that people should die because they are poor’…” (Sifferlin, 5/23).

U.N. News Centre: Ethiopia’s Tedros Adhanom elected to top U.N. health post
“…[Tedros] also served as chair of the Global Fund and of the Roll Back Malaria (RBM) Partnership Board (RBM), where he secured ‘record funding’ for the two organizations and created the Global Malaria Action Plan, which expanded RBM’s reach beyond Africa to Asia and Latin America, according to the [WHO]…” (5/23).

Washington Post: WHO chooses first African to head the global health agency
“…The United States, [the WHO’s] largest donor, was represented by Health and Human Services Secretary Tom Price. He congratulated Tedros and called on the WHO to reform and strengthen the organization and ‘enhance the ability of all nations to protect the health of their people.’ Even as he noted that ‘global health security begins at home,’ the Trump administration’s budget for 2018 calls for massive cuts in spending on U.S. scientific research, global health, disease prevention programs, and health insurance for children of the working poor…” (Sun, 5/23).

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New WHO DG Tedros To Work For Bipartisan Support Of U.S. Global Health Funding

Associated Press: New WHO chief: Planned U.S. funding cuts not a ‘closed issue’
“The new head of the World Health Organization doesn’t believe the Trump administration’s calls to slash funding for international aid and U.N. agencies like his is a ‘closed issue.’ Tedros Adhanom Ghebreyesus, an Ethiopian ex-health minister, said he was looking forward to further talks with the U.S., WHO’s biggest donor. ‘I wouldn’t take it as a final issue,’ he told reporters on Wednesday, the day after his election to a five-year term by WHO member countries. ‘I have worked with both Republicans and Democrats and if we can communicate with them the right way … I think we can also address that’…” (Keaten/Cheng, 5/24).

Reuters: New WHO head seeks U.S. bipartisan support for global health
“…Tedros said he preferred to see global agencies including WHO, the World Bank, GAVI, [the Vaccine Alliance], and [the] Global Fund as part of one ‘big envelope.’ ‘We need to expand the donor base … If we have as many countries as possible who can contribute, it could be any amount, I think that will help,’ he said. ‘By expanding the donor base, we help the health financing to have a kind of shock absorber’…” (Nebehay, 5/24).

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Expanded Mexico City Policy Will Negatively Impact Reproductive Health Services For Kenyan Women, NGO Workers Say

Reuters: Kenyan medics say U.S. health aid cuts will mean more abortions
“President Donald Trump’s dramatic expansion of a policy blocking U.S. aid to [foreign] organizations offering abortion services will have one sure result, say medical workers in this city: more abortions. … The extension requires all [foreign] health organizations receiving U.S. aid to guarantee they do not provide abortion services or discuss abortion policy, even if the abortion-related activities are funded by non-U.S. government sources. … The policy means cuts to programs like the one run by Kenyan nurse Monica Oguttu, who founded the Kisumu Medical and Education Trust to help poor women get health care and education in the country’s third largest-city. The trust had been scheduled to receive a total of $2 million from USAID from 2017 to 2021, around 56 percent of its budget. It now expects to lose all its U.S. funding…” (Wadekar, 5/23).

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International Community Must Better Utilize Resources, Forge New Partnerships To Address Growing Humanitarian Crises, U.N. Officials Say

U.N. News Centre: One year after humanitarian summit, U.N. stresses reforms to put people ‘at heart’ of decision-making
“The 2016 World Humanitarian Summit in Istanbul rallied global actors to save lives and protect the most vulnerable, but with the number of people in need growing, the international community must use resources better and galvanize new partnerships, top United Nations officials said [Tuesday]…” (5/23).

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Strong Political Actions Can End Obstetric Fistula, UNFPA Head Says On International Day

U.N. News Centre: On International Day, U.N. agency urges ‘hope, healing, dignity’ for fistula sufferers
“Obstetric fistula has largely been eliminated in developed countries, but more than two million women and girls still live with the condition, the head of the United Nations women’s health agency [Tuesday] said, calling for investment and support to eliminate the debilitating and stigmatizing condition. ‘With strong political leadership, investment, and action, we can end this scourge in our lifetime,’ the executive director of the U.N. Population Fund (UNFPA), Babatunde Osotimehin, said in his message for the day…” (5/23).

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U.N. SG Guterres Proposes Shifting Unspent $40.5M From Haiti Mission To Cholera Fund; Health Experts Warn Of Nation's Widespread Food Insecurity Following Hurricane

Agence France-Presse: U.N. wants to shift $40 mln to Haiti cholera fund
“The United Nations is proposing that $40.5 million from the unspent budget of the U.N. mission in Haiti be poured into a special fund to help its cholera victims, according to a report released Tuesday. U.N. Secretary-General António Guterres made the proposal to the U.N. General Assembly to address a major shortfall in the $400 million needed to help Haiti recover from the epidemic…” (5/23).

Humanosphere: ‘Ignored’ hunger crisis unfolds in post-hurricane Haiti
“Health experts say the international community has turned a blind eye to widespread food insecurity in Haiti, where communities across nearly every region of the island are approaching risk of famine…” (Nikolau, 5/23).

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Health Authorities To Test Experimental Ebola Vaccine In DRC Outbreak With 43 Suspected Cases

Financial Times: Congo to test experimental Ebola vaccine as disease re-emerges
“Health authorities in the Democratic Republic of Congo are preparing to use an experimental vaccine to help fight an outbreak of Ebola, in what could be an important step towards getting regulatory approval for the world’s first vaccine against the deadly virus. The World Health Organization said on Tuesday that there were 43 suspected cases of Ebola in the remote northern Bas Ulele province of Congo, with four deaths and two laboratory-confirmed cases. More confirmed cases were likely, it said…” (Pilling, 5/23).

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Number Of Suspected Cholera Cases In Yemen Jumps, Death Toll Increases To 361, WHO Reports

Reuters: Yemen cholera caseload leaps, death toll rises: WHO
“The number of cholera cases in Yemen has leapt, a World Health Organization document showed on Tuesday, with 35,217 suspected cases since April 27, when the outbreak began to spread rapidly. That represents a 50 percent increase in the reported incidence compared with figures given last Friday by the WHO representative in the country, Nevio Zagaria, who said at that point there had been 23,425 cases since April 27. A WHO epidemiology bulletin covering the period up to May 22 said 361 deaths had been reported, mainly in western governorates of Yemen. That is a rise of more than 100 since Friday, when Zagaria said 242 people had died…” (Miles, 5/23).

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Editorials and Opinions

5 Core Principles Should Guide U.S. Foreign Assistance

The Hill: Five key principles for U.S. foreign assistance success
Carolyn Miles, president and CEO of Save the Children, and David Beckmann, president of Bread for the World, both former co-chairs of the Modernizing Foreign Assistance Network (MFAN)

“…[T]he president’s budget will have an enormous impact on our nation’s standing in the global community and its ability to uphold American humanitarian values. … [W]e join our MFAN colleagues in urging Congress to use its leadership and budget authority to ensure that the following core principles are reflected in the national budget and any proposed reforms of U.S. foreign assistance: Foreign assistance structures must uphold diplomacy and development as distinct and equal disciplines. Foreign assistance must help create the conditions under which it is no longer necessary. Foreign assistance should focus on countries where the need is greatest or where it can have the most impact. Foreign assistance must be transparent and accountable to American taxpayers, as well as local citizens in developing countries. Foreign assistance must utilize broadly accepted best practices such as strengthening local institutions and identifying and working with local stakeholders to address development constraints. … In the coming weeks, MFAN will lay out a coherent and principled approach to effective foreign aid based on the principles above. … With our MFAN colleagues, we look forward [to] joining the vigorous debate and exchange of ideas on these issues in the weeks and months ahead” (5/22).

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Private Sector Has Ability To Maintain, Increase Progress Against Global Poverty

The Guardian: Foreign aid is being cut, but business will keep fighting poverty
William Warshauer, president and CEO of TechnoServe

“…The new U.S. administration has proposed cutting the foreign aid budget … and eliminating certain programs. … But it’s worth remembering that there is another force out there that I believe will maintain, and even increase, progress against poverty: business. … Increasingly, … the private sector is fighting poverty abroad simply as a regular part of doing business. … [F]or the majority of businesses, sustainability has moved from a buzzword to a watchword, a necessary means to succeed in competitive markets. … Many large companies have developed their own public sustainability pledges, committing them to specific targets of improving incomes for people in the developing countries where they operate. Consider that the combined annual procurement budgets of some of these companies is larger than the entire U.S. foreign aid budget, and you start to get a sense of the potential impact. … Yes, foreign assistance can do much to help these people and many will suffer if the U.S. reduces its aid budget. But business will keep reducing poverty regardless — driven not only by growing markets but also by the limitless determination of millions of entrepreneurs in the developing world” (5/24).

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New WHO Director-General Tedros Should Put Women, Girls At Center Of Agency's Agenda

Devex: Opinion: 4 priorities on women’s health for new WHO chief Dr. Tedros Ghebreyesus
Shannon Kowalski, director of advocacy and policy at the International Women’s Health Coalition

“…As next director general of the World Health Organization, Tedros [Adhanom Ghebreyesus] will take the helm as countries such as the United States are stepping up their efforts to roll back progress on women’s and girls’ sexual and reproductive health and rights. … Here are four priorities for women and girls that should be at the top of Tedros’ agenda. 1. Support countries to expand access to safe, legal abortion … 2. Recognize and respond to the Zika virus as the emergency for women that it still is … 3. Be a champion for adolescent girls’ sexual and reproductive health and rights … 4. Ensure that universal health coverage does not leave women and girls behind … For women and girls, a WHO director general who prioritizes their health and human rights, allocates the necessary resources to address them, and is a vocal champion on their behalf can make all the difference to their ability to survive and thrive. We call on the new director general to step up to the challenge and put women and girls at the center of the WHO’s agenda” (5/23).

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Global Community Must Address Child Marriage, FGM, Early Pregnancy To Prevent Obstetric Fistula

Thomson Reuters Foundation: Obstetric fistula; a silent death for millions of women and girls
Jenny Vaughan, senior campaigns and advocacy officer at FORWARD

“…Fistula affects mostly those left behind, often those whose lives are affected by multiple factors; social norms that promote child marriage, FGM, and the condoning of domestic violence result in a lack of choices and early and multiple pregnancies. If we are to address obstetric fistula we must continue to make these links and understand the factors that cause fistula. … We must, as a global community, do more. Fistula is treatable; we must enable girls and women who are living with fistula now to access the treatment they need and provide holistic support for them to re-integrate into their communities. But most importantly fistula is preventable. Ending harmful traditional practices like FGM and child marriage would significantly decrease the likelihood of girls becoming child mothers and developing fistula due to early and repeated pregnancy. FORWARD … will continue to push for the links between these issues to be recognized and understood, [and] we call on global leaders to join us” (5/23).

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From the Global Health Policy Community

CGD Blog Post Discusses President Trump's Budget Proposal, Approach To Foreign Assistance

Center for Global Development Blog: There is an Emerging Trump Philosophy for Foreign Assistance
Scott Morris, senior fellow and director of the U.S. Development Policy Initiative at CGD, discusses insights gleaned from President Trump’s FY 2018 budget request on foreign assistance priorities. Morris writes, “Emerging from the president’s budget proposal is an approach that sees foreign aid overwhelmingly as an instrument of geostrategic interests. Protecting military aid to Israel and Egypt amidst deep cuts elsewhere is one striking element of this approach. But it’s also reflected in the elimination of the USAID-based ‘development assistance’ account, which has had clearly defined development-related objectives, in favor of a more strategically-oriented ‘economic support and development fund’ based at the State Department. This is a troubling path to be starting down, both for the opportunities lost if we abandon the priorities that have guided foreign assistance in recent years and for the risks that arise as we expose more of our aid budget to the loose objectives of ‘geostrategic’ interests…” (5/23).

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Clinton, Sridhar Outline 5 Priorities For New WHO DG

BMJ Opinion: Chelsea Clinton and Devi Sridhar: Five tasks for the new WHO DG
Chelsea Clinton, vice chair of the Clinton Foundation and adjunct assistant professor at the Mailman School of Public Health at Columbia University, and Devi Sridhar, professor in global public health and director of the global health governance program at the University of Edinburgh’s Medical School, outline five priorities for newly elected WHO Director-General Tedros Adhanom Ghebreyesus (5/24).

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Lancet Comment Piece Discusses Gaps In Global Pandemic Response, Recommendations To Strengthen Preparedness

The Lancet Global Health: Financing of international collective action for epidemic and pandemic preparedness
Gavin Yamey, professor of the practice of global health at Duke University, and colleagues discuss the gaps in the global response to pandemics, “call for scaled-up financing of international collective action for epidemic and pandemic preparedness,” and propose “five key ways to help prevent mortality and economic shocks from disease outbreaks…” (5/18).

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New Issue Of Foreign Service Journal Focuses On Global Health Diplomacy

Foreign Service Journal: May 2017
The May issue of this journal focuses on global health diplomacy and includes articles on leveraging U.S. health investments globally as tools for diplomacy, PEPFAR’s accomplishments, the U.S. Department of Health and Human Services’ role in global health diplomacy, and the U.S. pandemic response (May 2017).

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From the U.S. Government

U.S. State Department Fact Sheet Outlines FY18 Budget Request, Agency's Priorities

U.S. Department of State: Department of State and U.S. Agency for International Development Fact Sheet: FY 2018 Budget Request
The fact sheet states, “The combined budget request of $37.6 billion for Fiscal Year 2018 reflects the President’s commitment to a leaner, more efficient government, and ensures that every tax dollar spent is aligned with the Administration’s foreign policy objectives. The budget request supports the President’s ‘America First’ vision…” (5/23).

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From KFF

Kaiser Family Foundation Budget Summary Analyzes Global Health Aspects Of President's FY18 Budget Request

Kaiser Family Foundation: White House Releases FY18 Budget Request
This budget summary highlights global health-related funding proposals contained in President Trump’s FY 2018 budget request released on Tuesday. The request includes significant cuts to global health including a decline in funding provided to the State Department and USAID, which represents the bulk of global health assistance. Funding provided to the State Department and USAID (through the Global Health Programs account) would decline by more than $2.2 billion (-26%), from $8,725 million in FY 2017 to $6,481 million, which would be the lowest level of funding since FY 2008 (5/24).

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