Global Health Funding in the FY 2020 Conference Agreement

The FY 2020 appropriations conference agreement, released by Congress on December 16, 2019 and passed by both the House (12/17) and the Senate (12/19), includes funding for U.S. global health programs at the State Department, the U.S. Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). The agreement still needs to be signed by the President. Key highlights are as follows (see table for additional detail):

State Department & USAID:

  • Funding for global health programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.1 billion, an increase of $255 million above the FY 2019 enacted level, and $2.7 billion above the President’s FY 2020 request.
  • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,700 million, flat compared to the FY19 enacted level, but $1,350 million above the FY20 Request ($3,350 million).
  • The bill includes $1,560 million as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), an increase of $210 million above the FY19 enacted level ($1,350 million) and $602 million above the FY20 Request ($958 million). The bill states that this amount is for the first installment of the sixth replenishment. In addition, the explanatory statement accompanying the bill reaffirms the U.S. share of 33% of contributions.
  • Funding for tuberculosis (TB) totals $310 million, $8 million above the FY19 enacted level, and $49 million above the FY20 Request ($261 million).
  • Funding for malaria totals $770 million, $15 million above the FY19 enacted level ($755 million), and $96 million above the FY20 Request ($674 million).
  • The bill includes $851 million for maternal and child health (MCH), an increase of $16 million above the FY19 enacted level ($835 million), and $231 million above the FY20 Request ($629 million). Specific areas under MCH include:
    • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY19 enacted level, and $40 million above the FY20 Request ($250 million).
    • Polio funding through all accounts totals $61 million, $2 million above the FY19 enacted level ($59 million), and $38 million above the President’s FY 2020 Request.
    • The bill includes $139.0 million for the U.S. contribution to the United Nations Children’s Fund (UNICEF) provided through the International Organizations and Programs (IO&P) account, $1.5 million above the FY19 enacted level ($137.5 million). While the FY20 Request did not specify a funding amount for UNICEF and proposed to eliminate the IO&P account, it is possible that organizations such as UNICEF could receive funding through other accounts.
  • Funding for nutrition totals $150 million, $5 million above the FY19 enacted level ($145 million), and $71 million above the FY20 Request ($79 million).
  • Bilateral family planning and reproductive health (FP/RH) funding totals $575 million ($524 million through the GHP account and $51 million through the ESF account), matching the FY19 enacted level, and $316 million above the FY20 Request ($259 million).
  • Funding for the United Nations Population Fund (UNFPA) totals $32.5 million, matching the FY19 enacted level; the FY20 Request proposed eliminating funding for UNFPA.
  • Funding for the vulnerable children program totals $25 million, $1 million above the FY19 enacted level ($24 million); the FY20 Request proposed eliminating funding for this program.
  • Funding for neglected tropical diseases (NTDs) totals $102.5 million, matching the FY19 enacted level, and $27.5 million above the FY20 Request ($75 million).
  • Funding for global health security (GHS) totals $100 million in the bill. While this is a decrease compared to the FY19 enacted level ($138 million), $38 million of the FY19 amount was provided through a one-time transfer of unspent emergency Ebola funding. The FY20 conference agreement amount is a $10 million increase compared to the FY20 Request ($90 million).

Centers for Disease Control and Prevention (CDC): Funding for global health provided to the CDC totals $571 million, an increase of $75 million compared to the FY19 enacted level ($496 million) and $114 million above the FY20 Request ($457 million). The entire increase in CDC funding is to support global health security activities.

Fogarty International Center (FIC): Funding for the Fogarty International Center (FIC) at the National Institutes of Health (NIH) totaled $81 million, $3 million above the FY 2019 enacted level ($78 million) and $14 million above the FY20 Request.

Additional Global Health Legislation: The appropriations bill also included the “End Neglected Tropical Diseases Act” as well as the “Preventing Child Marriage in Displaced Populations Act.” Learn more about these two bills on the KFF U.S. Global Health Legislation Tracker here.

Additional Resources:

The table below compares global health funding in the FY 2020 conference agreement to the FY 2019 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2019” (P.L. 116-6; KFF summary here), the President’s FY 2020 request (KFF summary here).

Table: KFF Analysis of Global Health Funding in the FY20 Conference Agreement
Department / Agency / Area FY19
Enactedi
(millions)
FY20
Requestii
(millions)
FY20
Conference Agreement
(millions)
Difference
(millions)
FY20
Conference
– FY19 Enacted
FY20
Conference
– FY20 Request
 State & Foreign Operations (SFOPS)
HIV/AIDS $4,700.0 $3,350.0 $4,700.0 $0
(0%)
$1350
(40.3%)
State Department $4,370.0 $3,350.0 $4,370.0 $0
(0%)
$1020
(30.4%)
USAID $330.0 $0.0 $330.0 $0
(0%)
$330.0
(NA)
of which Microbicides $45.0 $0.0 $45.0 $0
(0%)
$45.0
(NA)
Global Fund $1,350.0 $958.4 $1,560.0 $210
(15.6%)
$601.6
(62.8%)
Tuberculosisiii $262.0
Global Health Programs (GHP) account $302.0 $261.0 $310.0 $8
(2.6%)
$49
(18.8%)
Economic Support Fund (ESF) account Not specified $1.0 Not specified
Malaria $755.0 $674.0 $770.0 $15
(2%)
$96
(14.2%)
Maternal & Child Health (MCH)iv v
GHP accountvi $835.0 $619.6 $851.0 $16
(1.9%)
$231.4
(37.3%)
of which Gavi $290.0 $250.0 $290.0 $0
(0%)
$40
(16%)
of which Poliovi $51.5 $16.0 $61.0 $9.5
(18.4%)
$45
(282.2%)
UNICEFvii $137.5 Not specified $139.0 $1.5
(1.1%)
ESF account Not specified $75.5 Not specified
of which Poliovi $7.5 $7.0 vi
Nutritionviii $89.7
GHP account $145.0 $78.5 $150.0 $5
(3.4%)
$71.5
(91.1%)
ESF account Not specified $11.2 Not specified
Family Planning & Reproductive Health (FP/RH) $607.5 $259.0 $607.5 $0
(0%)
$348.5
(134.6%)
Bilateral FPRH $575.0 $259.0 $575.0 $0
(0%)
$316
(122%)
GHP account $524.0 $237.0 $524.0 $0
(0%)
$287
(121.1%)
ESF account $51.1 $22.0 $51.1 $0
(0%)
$29.1
(132%)
UNFPA $32.5 $0.0 $32.5 $0
(0%)
$32.5
(NA)
Vulnerable Children $24.0 $0.0 $25.0 $1
(4.2%)
$25.0
(NA)
Neglected Tropical Diseases (NTDs) $102.5 $75.0 $102.5 $0
(0%)
$27.5
(36.7%)
Global Health Security $138.0 $90.0 $100.0 $-38
(-27.5%)
$10
(11.1%)
GHP account $100.0 $90.0 $100.0 $0
(0%)
$10
(11.1%)
Ebola transfer $38.0 $0.0 $0.0 $-38
(-100%)
$0.0
(0%)
Emergency Reserve Fund $2.0 $0.0 ix
Ebola transfer $2.0 $0.0 $0.0 $-2
(-100%)
$0.0
(0%)
SFOPs Total (GHP account only) $8,837.5 $6,343.5 $9,092.5 $255
(2.9%)
$2748.9
(43.3%)
Health & Human Services (HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $495.8 $457.0 $570.8 $75
(15.1%)
$113.9
(24.9%)
Global HIV/AIDS $128.4 $69.5 $128.4 $0
(0%)
$58.9
(84.7%)
Global Tuberculosisx $7.2 $7.2 $7.2 $0
(0%)
$0
(0%)
Global Immunization $226.0 $206.0 $226.0 $0
(0%)
$20
(9.7%)
Polio $176.0 Not specified $176.0 $0
(0%)
Other Global Vaccines/Measles $50.0 Not specified $50.0 $0
(0%)
Parasitic Diseases $26.0 $24.5 $26.0 $0
(0%)
$1.5
(6.3%)
Global Public Health Protectionxi $108.2 $149.8 $183.2 $75
(69.3%)
$33.4
(22.3%)
Global Disease Detection and Emergency Response $98.4 Not specified $173.4 $75
(76.2%)
of which Global Health Security (GHS) $50.0 $99.8 $125.0 $25.2
(25.3%)
Global Public Health Capacity Development $9.8 Not specified $9.8 $0
(0%)
National Institutes of Health (NIH) – Total Global Health $880.2 $760.1 Not yet known
HIV/AIDS $590.1 $511.1 Not yet known
Malaria $212.0 $182.0 Not yet known
Fogarty International Center (FIC) $78.1 $67.0 $80.8 $2.7
(3.4%)
$13.8
(20.5%)
Notes:
i – The FY19 Enacted includes the transfer of $40.0 million in unspent Emergency Ebola funding including: $2.0 million for the Emergency Reserve Fund and $38.0 million for “programs to accelerate the capacities of targeted countries to prevent, detect, and respond to infectious disease outbreaks.”
ii – In the FY20 Request, the administration proposed to consolidate the Development Assistance (DA), Economic Support Fund (ESF), the Assistance for Europe, Eurasia, and Central Asia (AEECA), and the Democracy Fund (DF) accounts in to one new account — the Economic Support and Development Fund (ESDF). ESF funding for the FY20 Request reflects the amounts requested by the administration for ESDF.
iii – Some tuberculosis funding is provided under the ESF account, which is not earmarked by Congress in the annual appropriations bills and determined at the agency level (e.g. in FY17, TB funding under the ESF account totaled $2.64 million).
iv – Some MCH funding is provided under the ESF account, which is not earmarked by Congress in the annual appropriations bills and determined at the agency level (e.g. in FY17, MCH funding under the ESF account totaled $56.54 million).
v – It is not possible to calculate total MCH funding in the FY20 request because UNICEF, which has historically received funding through the International Organizations and Programs (IO&P) account, was not specified in the FY20 request.
vi – The minority summary of the FY20 conference agreement states that part of the increase in MCH funding is “due to a shift of $7.5 million for polio prevention programs from the Economic Support Fund account to the Global Health Programs account.”
vii – UNICEF funding in the FY19 bill and the FY20 Conference Agreement both include an earmark of $5 million for programs addressing female genital mutilation.
viii – Some nutrition funding is provided under the ESF account, which is not earmarked by Congress in the annual appropriations bills and determined at the agency level. (e.g. in FY17, nutrition funding under the ESF account totaled $21 million).
ix – The explanatory statement accompanying the FY20 Conference Agreement states that the “agreement includes authority to reprogram $10,000,000 of Global Health Program funds to the Emergency Reserve Fund if necessary to replenish amounts used during fiscal year 2020 to respond to emerging health threats.”
x – In FY20, the administration proposed to formally transfer $7.2 million from the “HIV/AIDS, Viral Hepatitis, STI and TB Prevention” account to “Global Tuberculosis” activities under “Global Health Programs” at CDC. The FY20 conference agreement formalizes this transfer. The FY19 total has been adjusted to reflect this administrative change.
xi – In the CDC FY20 congressional justification, this funding line is titled “Global Disease Detection and Other Programs”.
Updated: December 19, 2019

The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.