Historical Trends in U.S. Funding for Global Health

  • The U.S. is the largest donor to global health in the world, and funding for global health has grown over time. To provide context for the release of the first, full budget request from the Biden administration, this brief provides an overview of trends in U.S. global health funding. It examines both regular as well as supplemental, or emergency, appropriations over time, changes in funding for major program areas, and trends in the distribution between bilateral and multilateral support.
  • U.S. funding for global health, through regular appropriations, has grown significantly over the past two decades, rising from $1.7 billion in FY 2001 to $11.4 billion in FY 2021, with the steepest increase occurring in the earlier decade. Most of the increase ($8.3 billion or 85%) was provided between FY 2001–FY 2011, a decade which marked the creation of PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President’s Malaria Initiative.
  • Since FY 2011, funding increases have been more modest. Between FY 2011 and 2021, funding rose by $1.4 billion, most of which has come in recent years. There were also fluctuations over the period, including some declines.
  • Funding for most global health program areas has increased since FY 2011, particularly the Global Fund and global health security; funding was flat for PEPFAR and declined for family planning and reproductive health. All other program areas – tuberculosis, malaria, maternal and child health, nutrition, vulnerable children, and neglected tropical diseases – increased over the period.
  • Most global health funding has been provided bilaterally (ranging from 79-85% between FY 2011 and 2021), but the amount and share of funding for multilateral organizations has increased at a faster rate. Bilateral funding increased by 8% over the period while multilateral funding increased by 48%. Funding for multilateral organizations now makes up a fifth (20%) of the global health budget, up from 15% in FY 2011.
  • Emergency funding, provided to respond to specific disease threats, has become a more prominent part of the global health budget in recent years. Since FY 2011, the U.S. has provided $11.8 billion in emergency funding for global health (9% of overall global health funding over the period). Most of this funding (90%) has been provided for COVID-19. Emergency funding has also been provided to respond to Ebola and Zika outbreaks.
Issue Brief

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