U.S. Global Funding for COVID-19 by Country and Region: An Analysis of USAID Data
As Congress again considers increased assistance for the global response to COVID-19, we look at how current funding is being channeled, particularly to countries and regions. Congress has enacted six emergency supplemental funding bills to address the COVID-19 pandemic as of June 23, 2022, which collectively provide approximately $19.03 billion for the global response, including for health and humanitarian efforts. Of this amount, $10.54 billion (55%) was either directly appropriated to or is managed by the U.S. Agency for International Development (USAID).1 The remainder was appropriated to the State Department and the Centers for Disease Control and Prevention (CDC).2 To better understand how this funding has been used, we analyzed newly available data from USAID (current data disaggregated by country and region were not available for other agencies). This included overall USAID funding obligated3 as of March 31, 2022, as well as country and regional funding amounts obligated as of the same date. Data were aggregated from several documents to provide a more complete analysis of what is known.
- USAID reports that, as of March 31, 2022, of the $10.54 billion directly appropriated to or managed by the agency, it had obligated approximately $9.81 billion in COVID-19 emergency funding for programming and related efforts to respond to COVID-19 globally, with an additional $584 million approved or notified to Congress.4 Together, this represents all emergency funding directly appropriated to or managed by USAID to date.
- Included in the $9.81 billion in funding obligated by USAID for programming and related efforts are the following:
- $4.14 billion5 (42%) for country and regional COVID-19 programming (as of March 31, 2022) to support a range of activities, including: delivery and distribution of vaccines; strengthening health care systems by expanding surveillance, supporting health workers and facilities, and providing essential health supplies; providing emergency food assistance; and improvement of sanitation and hygiene services;
- $4.0 billion (41%) to support Gavi’s COVID-19 vaccine procurement and delivery activities through COVAX,6 and
- $1.5 billion (15%) for COVID-19 vaccine procurement for distribution through COVAX. See Figure 1.
- Funding was obligated to 124 countries (additional countries may be reached through regional programming) See Table 1.
- The top ten countries, by funding amount, each received at least $89 million and together accounted for nearly half of funding (47% or $1.9 billion) obligated by USAID. Four countries received more than $200 million each: Ethiopia, Yemen, Syria, and India. See Figure 2.
- By region, the largest share of country and regional funding was directed to sub-Saharan Africa (44%), followed by Asia (20%), the Middle East and North Africa (19%), Latin America and the Caribbean (13%), and Europe and Eurasia (4%). See Figure 3.
- By bureau, the largest share of country and regional funding was directed through the Bureau for Humanitarian Assistance (59%), followed by the Bureau for Global Health (23%), regional bureaus (18%), and the Bureau for Development, Democracy, and Innovation (<1%),7 though this distribution varied widely by region. For example:
- in sub-Saharan Africa, the Bureau for Humanitarian Assistance received most funding (68%), followed by the regional bureau (19%) and the Bureau for Global Health (13%);
- in Asia, the Bureau for Global Health received most funding (61%), followed by the regional bureau (20%) and the Bureau for Humanitarian Assistance (19%); and
- in Europe and Eurasia, the regional bureau received the largest share of funding (43%), followed by the Bureau for Global Health (39%). See Figure 4.
This includes certain funding provided through the ESF accounts, which are sometimes jointly managed by the State Department and USAID, and funding provided through the U.S. Department of Agriculture for the Title II program but managed by USAID.
CDC has posted broad information on how it plans to spend $1.55 billion of the emergency funding; see CDC, “CDC’s COVID-19 Resources for Global Results,” fact sheet, April 2022, https://www.cdc.gov/budget/documents/covid-19/COVID-19-Global-Response-fact-sheet.pdf. As of June 22, 2022, CDC reports it has obligated approximately $900 million from FY20-FY22 and plans to obligate about $456 million more in FY22. KFF personal communication with CDC, June 24, 2022.
An obligation is a legal commitment for payment, which may be dispersed immediately or sometime in the future. An agency incurs an obligation “when it places an order, signs a contract, awards a grant, purchases a service, or takes other actions that require the government to make payments to the public or from one government account to another.” See, GAO, A Glossary of Terms Used in the Federal Budget Process, 2005, https://www.gao.gov/assets/gao-05-734sp.pdf.
Agencies must, in most cases, notify Congress of their intent to obligate funds. Additionally, there is other funding ($250 million provided to State to address the impact of COVID-19 on HIV efforts, $40 million in existing funding, and $99 million of prior year USAID funding from the Emergency Reserve Fund for Contagious Infectious Disease Outbreaks/ERF), some of which is managed by USAID, that is not yet identifiable and therefore not included in the funding totals. The obligated and notified totals also do not include funding provided to USAID for operating expenses, which USAID does not include in COVID-19 programming totals, per KFF personal communication with USAID, April and June 2022. Of the $143 million managed by USAID for operating expenses, it has obligated $93 million and notified $50 million.
Some of this funding is Department of State and USDA COVID-19 emergency COVID-19 funding that has been provided to USAID for implementation, per USAID, COVID-19 Fact Sheets, March and April. 2022, https://www.usaid.gov/coronavirus/fact-sheets. Additionally, this funding includes $40 million in existing funding (reprogrammed Ebola funding) as well as $81.2 million of prior year funding through the Emergency Reserve Fund for Contagious Infectious Disease Outbreaks (ERF), per KFF personal communication with USAID, April and June 2022. In earlier fiscal years, Congress provided funding to the ERF at USAID to allow such funding to be made available to support future responses to any “emerging health threat that poses severe threats to human health.” See KFF, The U.S. Government and Global Health Security.
Total does not sum to 100% due to rounding.