The U.S. Government and Global Health Security
Definition drawn from WHO’s World Health Report 2007 - A Safer Future: Global Public Health Security in the 21st Century, 2007 (http://www.who.int/whr/2007/overview/en/); WHO’s Global Health Security web page (https://www.who.int/health-topics/health-security/#tab=tab_1), The terms “global health security” and “health security” do not have a universally agreed-upon definitions, and opinions can differ as to what is and is not included within each. See: C. McInnes, ‘The many meanings of health security’, in S. Rushton and J. Youde (eds), Routledge Handbook of Global Health Security, 2014, pp. 7-17; and W. Aldis, “Health security as a public health concept: a critical analysis,” Health Policy & Planning, 2008, 23(6):369–375.
Research and development activities for countermeasures to emerging diseases (such as diagnostics, treatments and vaccines), while recognized as being important for global health security, are not included within the scope of this analysis.
KFF personal communication with CDC, March 2020.
White House, “Letter to His Excellency António Guterres,” correspondence from President Biden, Jan. 20, 2021, https://www.whitehouse.gov/briefing-room/statements-releases/2021/01/20/letter-his-excellency-antonio-guterres/; White House, “Readout of Vice President Harris’s Call with World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus,” Jan. 21, 2021, https://www.whitehouse.gov/briefing-room/statements-releases/2021/01/21/readout-of-vice-president-harriss-call-with-world-health-organization-director-general-dr-tedros-adhanom-ghebreyesus/; White House, National Security Memorandum on United States Global Leadership to Strengthen the International COVID-19 Response and to Advance Global Health Security and Biological Preparedness, NSD-1, Jan. 21, 2021, https://www.whitehouse.gov/briefing-room/statements-releases/2021/01/21/national-security-directive-united-states-global-leadership-to-strengthen-the-international-covid-19-response-and-to-advance-global-health-security-and-biological-preparedness/; HHS, “Dr. Anthony S. Fauci Remarks at the World Health Organization Executive Board Meeting,” Jan. 21, 2021, https://www.hhs.gov/about/news/2021/01/21/dr-anthony-s-fauci-remarks-world-health-organization-executive-board-meeting.html; White House, National Strategy for the COVID-19 Response and Pandemic Preparedness, 2021, https://www.whitehouse.gov/wp-content/uploads/2021/01/National-Strategy-for-the-COVID-19-Response-and-Pandemic-Preparedness.pdf.
Department of State, “Secretary Antony J. Blinken Remarks to the Press on the COVID Response,” April 5, 2021, https://www.state.gov/secretary-antony-j-blinken-remarks-to-the-press-on-the-covid-response/.
KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, Congressional Appropriations Bills, U.S. Foreign Assistance Dashboard [website], available at: www.foreignassistance.gov, personal communication with DoD. See also KFF, Global Funding Across U.S. COVID-19 Supplemental Funding Bills.
KFF analysis of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123), the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136), CDC, “CDC COVID-19 Global Response,” fact sheet, Sept. 10, 2020, https://www.cdc.gov/budget/documents/covid-19/COVID-19-Global-Response-fact-sheet.pdf, and personal communication with appropriations and CDC staff, March 2021. See also KFF, Global Funding Across U.S. COVID-19 Supplemental Funding Bills.
KFF, Global Funding Across U.S. COVID-19 Supplemental Funding Bills; KFF personal communication with Hill and CDC staff, March 2021. Additionally, though not counted as part of global health security, note that Congress also provided $4 billion via USAID for a U.S. contribution to Gavi, the Vaccine Alliance, for vaccine procurement and delivery as part of emergency funding in the FY 2021 appropriations.
The $385 million provided to USAID by Congress in FY 2015 included $312 million in emergency Ebola funding made available with no end date, and the $218 million provided in FY 2016 included $145.5 million in emergency Zika funding to be expended in that fiscal year. $100 million in reprogrammed FY 2015 emergency Ebola funding in FY 2018 and $38 million in reprogrammed FY 2015 emergency Ebola funding in FY 2019 was directed to USAID global health security activities. See Table 1.
The U.S. has also shifted to having some standing funds for emergency response to outbreaks rather than relying only on emergency supplemental appropriations, which can lead to delays in response. Although this funding is not counted as part of global health security efforts, this is a form of preparedness for response, though the funds themselves count toward emergency response when used. Specifically, Congress provided $70 million for an “emergency reserve fund” in FY 2017, to be made available to support future responses to any “emerging health threat that poses severe threats to human health;” it also reprogrammed some unspent FY 2015 emergency Ebola response funding to provide an additional $35 million in FY 2018 and $2 million in FY 2019 and provided up to $10 million in FY 2020 through regular appropriations, $200 million under the first COVID-19 emergency supplemental appropriations bill in March 2020 in FY 2020, and up to $50 million in FY 2021. KFF analysis of congressional appropriations bills.
KFF analysis of American Rescue Plan Act of 2021, P.L. 117-2, and personal communication with CDC, March 2021.
The U.S. has also shifted to having some standing funds for emergency response to outbreaks rather than relying only on emergency supplemental appropriations, which can lead to delays in response. Although this funding is not counted as part of global health security efforts, this is a form of preparedness for response, though the funds themselves count toward emergency response when used. Specifically, Congress established an Infectious Diseases Rapid Response Reserve Fund with $50 million in FY 2019, which allows use of the funds by CDC and certain parts of HHS to prevent, prepare for, or respond to “an infectious disease emergency” in the U.S. or abroad; Congress also provided an additional $85 million in FY 2020, a total of $600 million under the first and third COVID-19 emergency supplemental appropriations bills in March 2020 in FY 2020, and $10 million in FY 2021. KFF analysis of congressional appropriations bills.