Global Health Funding in the FY 2023 Omnibus

Updated on January 3, 2023

The FY 2023 Omnibus appropriations bill and accompanying reports, released by Congress on December 20, 2022, and signed by the President on December 29, 2022, includes funding for U.S. global health programs at the State Department, U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH).[i] Funding provided to the State Department and USAID through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totals $10.6 billion, an increase of $731 million above the FY 2022 enacted level and $15 million below the FY 2023 request. The bill provides higher levels of funding for almost all program areas compared to the FY 2022 enacted level, with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and global health security receiving the largest increases; funding for bilateral HIV and family planning and reproductive health (FPRH) remained flat. Funding for global health provided to the CDC totals $693 million, an increase of $46 million compared to the FY22 enacted level, but $55 million below the FY23 request. Funding for the Fogarty International Center (FIC) at the NIH totaled $95 million, $8 million above the FY22 enacted level and essentially flat compared to the FY23 request. See the table below for additional detail on global health funding in the FY 2023 omnibus (downloadable table 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 FY23 Omnibus
Department / Agency / Area FY22
Finali

(millions)
FY23 Request (millions) FY23 Omnibusi
(millions)
Difference:
FY23 Omnibus – FY22 Final
Difference:
FY23 Omnibus – FY23 Request
State, Foreign Operations, and Related Programs (SFOPs) – Global Health
HIV/AIDSii  – $4,700.0  –  –  –
State Department $4,390.0 $4,370.0 $4,395.0 $5
(0.1%)
$25
(0.6%)
USAID $330.0 $330.0 $330.0 $0
(0%)
$0
(0%)
of which Microbicides $45.0 $45.0 $45.0 $0
(0%)
$0
(0%)
ESF Account Not specified $0.5 Not specified  –  –
Global Fund $1,560.0 $2,000.0 $2,000.0 $440
(28.2%)
$0
(0%)
Tuberculosisii $352.0  –  –  –
Global Health Programs (GHP) account $371.1 $350.0 $394.5 $23.5
(6.3%)
$44.5
(12.7%)
Economic Support Fund (ESF) account Not specified $2.0 Not specified  –  –
Malaria $775.0 $780.0 $795.0 $20
(2.6%)
$15
(1.9%)
Maternal & Child Health (MCH)ii $1,044.0  –  –  –
GHP account $890.0 $879.5 $910.0 $20
(2.2%)
$30.5
(3.5%)
of which Gavi $290.0 $290.0 $290.0 $0
(0%)
$0
(0%)
of which Polio $75.0 Not specified $85.0 $10
(13.3%)
 –
UNICEFiii $139.0 $135.5 $142.0 $3
(2.2%)
$6.5
(4.8%)
ESF account Not specified $29.0 Not specified  –  –
of which Polio Not specified $0.0 Not specified  –  –
Nutritionii $161.0  –  –  –
GHP account $155.0 $150.0 $160.0 $5
(3.2%)
$10
(6.7%)
ESF account Not specified $10.3 Not specified  –  –
AEECA account Not specified $0.8 Not specified  –  –
Family Planning & Reproductive Health (FP/RH)iv $607.5 $653.0 $607.5 $0
(0%)
$-45.5
(-7%)
Bilateral FP/RHiv $575.0 $597.0 $575.0 $0
(0%)
$-22
(-3.7%)
GHP accountiv $524.0 $572.0 $524.0 $0
(0%)
$-48.1
(-8.4%)
ESF accountiv $51.1 $25.0 $51.1 $0
(0%)
$26.1
(104.2%)
UNFPAv $32.5 $56.0 $32.5 $0
(0%)
$-23.5
(-42%)
Vulnerable Children $27.5 $25.0 $30.0 $2.5
(9.1%)
$5
(20%)
Neglected Tropical Diseases (NTDs) $107.5 $114.5 $114.5 $7
(6.5%)
$0
(0%)
Global Health Securityii  – $1,003.8  –  –  –
USAID GHP accountvi $700.0 $745.0 $900.0 $200
(28.6%)
$155
(20.8%)
of which for the Coalition for Epidemic Preparedness Innovations (CEPI) $100.0
State GHP accountvii Not specified $250.0 Not specified  –  –
ESF account Not specified $6.0 Not specified  –  –
AEECA account Not specified $2.8 Not specified  –  –
Emergency Reserve Fund viii ix x  –  –
Health Resilience Fundxi  – $10.0  –  –  –
Health Reserve Fundxii  –  – $8.0  –  –
SFOPs Total (GHP account only)xiii $9,830.0 $10,576.0 $10,561.0 $731
(7.4%)
$-15
(-0.1%)
Labor Health & Human Services (Labor HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $646.8 $747.8 $692.8 $46
(7.1%)
$-55
(-7.4%)
Global HIV/AIDS $128.9 $128.4 $128.9 $0
(0%)
$0.5
(0.4%)
Global Tuberculosis $9.7 $9.2 $11.7 $2
(20.6%)
$2.5
(27.1%)
Global Immunization $228.0 $226.0 $230.0 $2
(0.9%)
$4
(1.8%)
Polio $178.0 $176.0 $180.0 $2
(1.1%)
$4
(2.3%)
Other Global Vaccines/Measles $50.0 $50.0 $50.0 $0
(0%)
$0
(0%)
Parasitic Diseases $27.0 $31.0 $29.0 $2
(7.4%)
$-2
(-6.5%)
Global Public Health Protection $253.2 $353.2 $293.2 $40
(15.8%)
$-60
(-17%)
Global Disease Detection and Emergency Response Not specified Not specified Not specified  –  –
of which Global Health Security (GHS) Not specified Not specified Not specified  –  –
Global Public Health Capacity Development Not specified Not specified Not specified  –  –
National Institutes of Health (NIH) – Total Global Health $954.0  –  –  –
HIV/AIDS $628.1 $614.8 Not specified  –  –
Malaria $239.0 Not specified Not specified  –  –
Fogarty International Center (FIC) $86.9 $95.8 $95.2 $8.3
(9.5%)
$-0.6
(-0.7%)
Labor HHS Total $1,600.8 Not yet known Not yet known  –  –
Notes:
i – The FY22 Final bill includes 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 HIV, tuberculosis, MCH, nutrition funding, and global health security funding is provided under the ESF and AEECA accounts, which is not earmarked by Congress in the annual appropriations bills and is determined at the agency level.
iii – UNICEF funding in the FY22 Final bill includes an earmark of $5 million for programs addressing female genital mutilation.
iv – The FY22 Final and FY23 Omnibus bills state that “not less than $575,000,000 should be made available for family planning/reproductive health.”
v – The FY22 Final and FY23 Omnibus bills 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.”
vi – According to the Department of State, Foreign Operations, and Related Programs FY23 Congressional Budget Justification, $250 million of this funding is “for contributions to support multilateral initiatives leading the global COVID response through the Act-Accelerator platform.”
vii – According to the Department of State, Foreign Operations, and Related Programs FY23 Congressional Budget Justification, this funding is “to support a new health security financing mechanism, being developed alongside U.S. partners and allies, to ensure global readiness to respond to the next outbreak.”
viii – The FY22 Final bill 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.”
ix – The FY23 Request states that “this request includes $90.0 million in non-expiring funds to replenish the Emergency Reserve Fund to ensure that USAID can quickly and effectively respond to emerging infectious disease outbreaks posing severe threats to human health.”
x – The FY23 Omnibus states that “up to $90,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.”
xi – The FY23 Request states that the Health Resilience Fund (HRF) “will support cross-cutting health systems strengthening in challenging environments or countries emerging from crisis.”
xii – The explanatory statement accompanying the FY23 Omnibus states that these funds are “to support cross-cutting health activities, including health service delivery, the health workforce, health information systems, access to essential medicines, health systems financing, and governance, in challenging environments and countries in crisis.”
xiii – The FY22 Final bill “includes $100,000,000 for a U.S. contribution to support a multilateral vaccine development partnership for epidemic preparedness innovations.”

Resources:

  • “Consolidated Appropriations Act, 2023” – Bill Text
  • FY2023 Department of State, Foreign Operations, and Related Programs (SFOPs) Appropriations – Explanatory Statement
  • FY2023 Department of Labor, Health and Human Services, and Education, and Related Agencies (Labor HHS) Appropriations – Explanatory Statement

[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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