Global Health Funding in the FY 2022 Omnibus

The FY 2022 omnibus appropriations bill (and accompanying reports), released by Congress on March 9, 2022 and yet to be finalized, 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).[i] Key highlights from the FY22 omnibus appropriations bill 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, totals $9.8 billion, an increase of $634 million above the FY21 enacted level, but $221 million below the President’s FY22 request. Most areas increased with the exception of funding for family planning & reproductive health (FP/RH) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), which remained flat compared to the FY21 enacted levels. The majority of the increase was for global health security activities.
  • Funding for global health security totals $700 million in the bill, accounting for the largest increase in funding for all program areas compared to the FY21 enacted level. Funding in the FY22 omnibus bill is $510 million (268%) above the FY21 enacted level ($190 million), but $205 million (-23%) below the FY22 request ($905 million).
  • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,720 million, $20 million (0.5%) above the FY21 enacted and FY22 request level ($4,700 million).
  • The bill includes $1,560 million as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), matching the FY21 enacted and FY22 request level.
  • Funding for tuberculosis (TB) totals $371 million, $52 million (16%) above the FY21 enacted and FY22 request level ($319 million).
  • Funding for malaria totals $775 million, $5 million (0.6%) above the FY21 enacted and FY22 request level ($770 million).
  • The bill includes $890 million for maternal and child health (MCH), an increase of $34.5 million (4%) above the FY21 enacted level ($855.5 million), and $10.5 million (1%) above the FY22 request ($879.5 million). Specific areas under MCH include:
    • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY21 enacted and FY22 request level.
    • Polio funding totals $75 million, $10 million (15%) above the FY21 enacted and FY22 request level ($65 million).
    • The bill includes $139 million for the U.S. contribution to the United Nations Children’s Fund (UNICEF) provided through the International Organizations and Programs (IO&P) account, matching the FY21 enacted level and FY22 request level.
  • Funding for nutrition totals $155 million, $5 million (3%) above the FY21 enacted and FY22 request level ($150 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 FY21 enacted level, but $8.7 million (-2%) below the FY22 request level ($583.7 million).
  • Funding for the United Nations Population Fund (UNFPA) totals $32.5 million, matching the FY21 enacted level, but $23.5 million (-42%) below the FY22 request ($56 million).
  • Funding for the vulnerable children program totals $27.5 million, $2.5 million (10%) above the FY21 enacted and FY22 request level ($25 million).
  • Funding for neglected tropical diseases (NTDs) totals $107.5 million, $5 million (5%) above the FY21 enacted and FY22 request level ($102.5 million).
  • The bill also includes the following provisions:
    • States that up to $100 million be made available under the GHP account for the Emergency Reserve Fund, which is a mechanism that is used to quickly respond to emerging infectious disease outbreaks.
    • Provides the authority to transfer an amount “not to exceed an aggregate total of $200,000,000 of the funds appropriated by this Act” for international infectious disease outbreaks.
    • Includes $100 million from the GHP account “for a U.S. contribution to support a multilateral vaccine development partnership for epidemic preparedness innovations.”

Centers for Disease Control and Prevention (CDC): Funding for global health provided to the CDC totals $647 million, an increase of $54 million (9%) compared to the FY21 enacted level ($593 million), but $51 million (-7%) below the FY22 request ($698 million). Almost all areas increased in FY22 compared to the prior year level, with global health security accounting for most of this increase.

Fogarty International Center (FIC): Funding for the Fogarty International Center (FIC) at the National Institutes of Health (NIH) totaled $87 million, $3 million (3%) above the FY21 enacted level ($84 million), but $9 million (-10%) below the FY22 request ($96 million).

Resources:

  • “Consolidated Appropriations Act, 2022” – Bill Text
  • FY2022 Department of State, Foreign Operations, and Related Programs (SFOPs) Appropriations – Explanatory Statement
  • FY2022 Department of Labor, Health and Human Services, and Education, and Related Agencies (Labor HHS) Appropriations – Explanatory Statement

The table (.xlsx) below compares global health funding in the FY 2022 omnibus bill compared to the FY 2021 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2021” (KFF summary here) and the President’s FY 2022 request (KFF summary here).

See the KFF budget tracker for details on historical annual appropriations, including Senate and House amounts, for global health programs.

Table: KFF Analysis of Global Health Funding in the FY22 Omnibus
Department / Agency / Area FY21
Enactedi
(millions)
FY22
Request
(millions)
FY22
Omnibus
(millions)
Difference
(millions)
FY22 Omnibus
– FY21 Enacted
FY22 Omnibus
– FY22 Request
State, Foreign Operations, and Related Programs (SFOPs) – Global Health
HIV/AIDS $4,700.0 $4,700.0 $4,720.0 $20
 (0.4%)
$20
 (0.4%)
State Department $4,370.0 $4,370.0 $4,390.0 $20
(0.5%)
$20
(0.5%)
USAID $330.0 $330.0 $330.0 $0
(0%)
$0
(0%)
of which Microbicides $45.0 $45.0 $45.0 $0
(0%)
$0
(0%)
Global Fund $1,560.0 $1,560.0 $1,560.0 $0
 (0%)
$0
 (0%)
Tuberculosisii $321.0
Global Health Programs (GHP) account $319.0 $319.0 $371.1 $52.1
(16.3%)
$52.1
(16.3%)
Economic Support Fund (ESF) account Not specified $2.0 Not specified
Malaria $770.0 $770.0 $775.0 $5
 (0.6%)
$5
 (0.6%)
Maternal & Child Health (MCH)ii $1,039.5
GHP account $855.5 $879.5 $890.0 $34.5
(4%)
$10.5
(1.2%)
of which Gaviiii $290.0 $290.0 $290.0 $0
(0%)
$0
(0%)
of which Polio $65.0 $65.0 $75.0 $10
(15.4%)
$10
(15.4%)
UNICEFiv $139.0 $139.0 $139.0 $0
(0%)
$0
(0%)
ESF account Not specified $21.0 Not specified
of which Polio Not specified $0.0 Not specified
Nutritionii $154.8
GHP account $150.0 $150.0 $155.0 $5
(3.3%)
$5
(3.3%)
ESF account Not specified $4.0 Not specified
AEECA account  – $0.8
Family Planning & Reproductive Health (FP/RH)v $607.5 $639.7 $607.5 $0
 (0%)
$-32.2
 (-5%)
Bilateral FP/RHv $575.0 $583.7 $575.0 $0
(0%)
$-8.7
(-1.5%)
GHP accountv $524.0 $550.0 $524.0 $0
(0%)
$-26.1
(-4.7%)
ESF accountv $51.1 $33.7 $51.1 $0
(0%)
$17.4
(51.5%)
UNFPAvi $32.5 $56.0 $32.5 $0
(0%)
$-23.5
(-42%)
Vulnerable Children $25.0 $25.0 $27.5 $2.5
 (10%)
$2.5
 (10%)
Neglected Tropical Diseases (NTDs) $102.5 $102.5 $107.5 $5
 (4.9%)
$5
 (4.9%)
Global Health Security $190.0 $913.3 $700.0 $510
 (268.4%)
$-213.3
 (-23.4%)
GHP account $190.0 $905.0 $700.0 $510
(268.4%)
$-205
(-22.7%)
USAID GHP accountvii $190.0 $655.0 $700.0 $510
(268.4%)
$45
(6.9%)
State GHP accountviii  – $250.0
ESF account $8.3
Emergency Reserve Fund ix $90.0 x
SFOPs Total (GHP account only)xi $9,196.0 $10,051.0 $9,830.0 $634
 (6.9%)
$-221
 (-2.2%)
Labor Health & Human Services (Labor HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $592.8 $697.8 $646.8 $54
 (9.1%)
$-51
 (-7.3%)
Global HIV/AIDS $128.4 $128.4 $128.9 $0.5
(0.4%)
$0.5
(0.4%)
Global Tuberculosis $9.2 $9.2 $9.7 $0.5
(5.4%)
$0.5
(5.4%)
Global Immunization $226.0 $226.0 $228.0 $2
(0.9%)
$2
(0.9%)
Polio $176.0 $176.0 $178.0 $2
(1.1%)
$2
(1.1%)
Other Global Vaccines/Measles $50.0 $50.0 $50.0 $0
(0%)
$0
(0%)
Parasitic Diseases $26.0 $31.0 $27.0 $1
(3.8%)
$-4
(-12.9%)
Global Public Health Protection $203.2 $303.2 $253.2 $50
(24.6%)
$-50
(-16.5%)
Global Disease Detection and Emergency Response $193.4 $293.4 Not specified
of which Global Health Security (GHS) Not specified Not specified Not specified
Global Public Health Capacity Development $9.8 $9.8 Not specified
National Institutes of Health (NIH) – Total Global Health $918.8
HIV/AIDS $616.7 $617.1 Not specified
Malaria $218.0 Not specified Not specified
Fogarty International Center (FIC) $84.0 $96.3 $86.9 $2.8
(3.4%)
$-9.4
(-9.8%)
Labor HHS Total $1,511.6 Not yet known Not yet known
Notes:
i – The FY21 final bill and FY22 Omnibus both include a provision giving the Secretary of State the ability to transfer up to $200,000,000 from the ‘Global Health Programs’, ‘Development Assistance’, ‘International Disaster Assistance’, ‘Complex Crises Fund’, ‘Economic Support Fund’, ‘Democracy Fund’, ‘Assistance for Europe, Eurasia and Central Asia’, ‘Migration and Refugee Assistance’, and ‘Millennium Challenge Corporation’ accounts “to respond to a Public Health Emergency of International Concern.”
ii – Some tuberculosis, MCH, and nutrition funding is provided under the ESF account, which is not earmarked by Congress in the annual appropriations bills and is determined at the agency level.
iii – The FY21 final bill text provides additional funding to Gavi to support coronavirus response efforts, stating, “For an additional amount for ‘Global Health Programs’, $4,000,000,000, to remain available until September 30, 2022, to prevent, prepare for, and respond to coronavirus, including for vaccine procurement and delivery: Provided, That such funds shall be administered by the Administrator of the United States Agency for International Development and shall be made available as a contribution to the GAVI, Alliance.”
iv – UNICEF funding in the FY21final bill and the FY22 Omnibus both include an earmark of $5 million for programs addressing female genital mutilation.
v – The FY21 final bill and FY22 Omnibus both state that “not less than $575,000,000 should be made available for family planning/reproductive health.” The FY22 request funding amounts are based on a bilateral total of $583.7 million as specified in the FY22 OMB Budget Appendices for the Department of State and Other International Programs.
vi – The FY21 final bill and FY22 Omnibus both state that if this funding is not provided to UNFPA it “shall be transferred to the ‘Global Health Programs’ account and shall be made available for family planning, maternal, and reproductive health activities.”
vii – According to the Department of State, Foreign Operations, and Related Programs FY22 Congressional Budget Justification, $300 million of this funding is “for contributions to support multilateral initiatives leading the global COVID response through the Act-Accelerator platform.”
viii – According to the Department of State, Foreign Operations, and Related Programs FY22 Congressional Budget Justification, this funding is “to support a new health security financing mechanism, which would be developed alongside U.S. partners and allies, to ensure global readiness to respond to the next outbreak.”
ix – The FY21 final bill states that “up to $50,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.”
x – The FY22 Omnibus states that “up to $100,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.”
xi – The FY22 Omnibus “includes $100,000,000 for a U.S. contribution to support a multilateral vaccine development partnership for epidemic preparedness innovations.”

[i] Total funding for global health is not currently available as some funding provided through USAID, NIH, and DoD is not yet available.

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