The U.S. Government and Multilateral Global Health Engagement: 5 Key Facts

Issue Brief
  1. For development assistance more broadly, this is discussed in Ikenberry, “Is American Multilateralism in Decline?,” APSA, 2003; Biscaye, et al, “Relative Effectiveness of Bilateral and Multilateral Aid on Development Outcomes,” Review of Development Economics, 2016; ODI, “Bilateral versus multilateral aid channels Strategic choices for donors,” 2016; CGD, Realizing the Power of Multilateralism in US Development Policy, 2016.

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  2. DfID, Raising the standard: the Multilateral Development Review 2016, 2016, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/573884/Multilateral-Development-Review-Dec2016.pdf; Gavi, “Cost-effective,” webpage, https://www.gavi.org/about/value/cost-effective/; Global Fund, “Results & Impact,” webpage, https://www.theglobalfund.org/en/impact/; Katie Ryan, “The results are in: The Global Fund has saved 27 million lives!,” ONE Blog, Sept. 17, 2018, https://www.one.org/us/blog/global-fund-saved-27-million-lives/; Bill Gates, “Bill Gates: The Best Investment I’ve Ever Made,” Jan. 16, 2019, Wall Street Journal, https://www.wsj.com/articles/bill-gates-the-best-investment-ive-ever-made-11547683309.

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  3. See: KFF, A Check Up on U.S. Global Health Policy, After One Year of the Trump Administration; Scott Morris, “The Incredible Shrinking US Multilateralism,” CGD, Feb. 13, 2018, https://www.cgdev.org/blog/incredible-shrinking-us-multilateralism; Zachary Wolf and Joella Carman, “Here are all the treaties and agreements Trump has abandoned,” CNN, Feb. 1, 2019, https://www.cnn.com/2019/02/01/politics/nuclear-treaty-trump/index.html; Julie Pace, “Trump signals shift from Obama’s focus on multilateralism,” Associated Press, Dec. 29, 2016, https://www.apnews.com/8d8bf6847db8415b83ebd7ec704f065a.

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  4. Represents organizations receiving funding (base and supplemental) provided through the State Department, USAID, CDC, NIH, and DoD as specified in appropriations or sometimes determined at the agency level, including for U.S. contributions that are considered "regular," "core," or "assessed" contributions, which are usually identified in congressional budget justifications and/or appropriations legislation and related material and specifically directed by Congress.

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  5. Organizations included in the analysis include Gavi, the Vaccine Alliance; the Global Fund; PAHO; the TB Global Drug Facility; UNAIDS; UNFPA; UNICEF; and WHO.

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  6. U.S. contributions that are considered "regular," "core," or "assessed" contributions are usually identified in congressional budget justifications and/or appropriations legislation and related material and specifically directed by Congress.

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  7. OMB, Budget of the U.S. Government FY 2019, p.83, https://www.whitehouse.gov/wp-content/uploads/2018/02/budget-fy2019.pdf.

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  8. When calculating the proposed cut for FY 2018, the FY 2017 level did not include UNFPA funding; Congress provided $32.5 million for a U.S. contribution to UNFPA, which was withheld due to a presidential determination under the Kemp-Kasten amendment. See KFF, UNFPA Funding & Kemp Kasten: An Explainer.

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  9. When calculating the proposed cut for FY 2019, the FY 2018 level did not include UNFPA funding; Congress provided $32.5 million for a U.S. contribution to UNFPA, which was withheld due to a presidential determination under the Kemp-Kasten amendment. See KFF, UNFPA Funding & Kemp Kasten: An Explainer.

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  10. KFF analysis of documents from Gavi, Global Fund, PAHO, TB Global Drug Facility, UNFPA, UNICEF, UNAIDS, and WHO.

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  11. UNFPA, “Statement on the United States Decision to Again Withhold Funding from UNFPA,” press release, March 12, 2018, https://www.unfpa.org/press/statement-united-states-decision-again-withhold-funding-unfpa; UNFPA, “Statement by UNFPA on U.S. Decision to Withhold Funding,” press release, April 4, 2017, https://www.unfpa.org/press/statement-unfpa-us-decision-withhold-funding; UNFPA, “Donor Contributions: United States of America,” webpage, https://www.unfpa.org/data/donor-contributions/united-states-america; UNFPA data on donor contributions, 2016-2017, https://www.unfpa.org/data/donor-contributions; UNFPA, UNFPA Annual Report 2017, 2018, https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_PUB_2018_EN_AnnualReport.pdf; UNFPA, UNFPA Annual Report 2016, 2017, https://www.unfpa.org/sites/default/files/pub-pdf/Annual-Report-2016.pdf.

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  12. KFF, PEPFAR Reauthorization, brief.

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  13. Also see, UNICEF, “Immunization,” webpage, https://www.unicef.org/immunization.

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  14. Gavi, “Gavi, the Vaccine Alliance Board,” webpage, https://www.gavi.org/about/governance/gavi-board/.

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  15. Gavi, “Board members,” webpage, https://www.gavi.org/about/governance/gavi-board/members/.

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  16. Gavi, “Board Committees and Advisory Committees,” webpage, https://www.gavi.org/about/governance/gavi-board/committees/.

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  17. Global Fund, “Board – Members,” webpage, https://www.theglobalfund.org/en/board/members/.

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  18. Global Fund, “Board – Committees,” webpage, https://www.theglobalfund.org/en/board/committees/.

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  19. PAHO, “Dates of Governing Bodies Meetings and Committee Members in 2019,” https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=gb-governing-bodies-1&alias=42567-ags-2019-e&Itemid=270&lang=en.

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  20. UNAIDS, “2019 Composition of the Programme Coordinating Board (PCB),” http://www.unaids.org/en/resources/documents/2018/PCB_composition.

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  21. UNICEF, “Composition of the UNICEF Executive Board 1948-2018,” https://www.unicef.org/about/execboard/files/Executive_Board-Composition-2018-EN-11Oct17.pdf.

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  22. UNFPA, “Members of the Executive Board,” https://www.unfpa.org/executive-board/board-members.

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  23. WHO, “Executive Board Members,” http://apps.who.int/gb/gov/executive-board-members.html.

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  24. Centers for Disease Control and Prevention, “CDC Global Health Partnerships,” https://www.cdc.gov/globalhealth/partnerships.htm; FDA, “International Activities,” webpage, https://www.fda.gov/biologicsbloodvaccines/internationalactivities/default.htm.

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  25. WHO Collaborating Centres Global Database – search results for USA, http://apps.who.int/whocc/List.aspx?cc_code=USA&.

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