Senate Appropriations Committee Releases FY 2022 State and Foreign Operations (SFOPs) and Labor Health and Human Services (Labor HHS) Appropriations Bills

The Senate Appropriations Committee released its FY 2022 State, Foreign Operations, and Related Programs (SFOPs) (links to bill and report) and Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) (links to bill and report) appropriations bills and accompanying reports on October 18, 2021. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID), while the Labor HHS bill includes funding for global health programs at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).[i] Key highlights are as follows (see table for additional detail):

State, Foreign Operations, and Related Programs (SFOPs):

  • Funding provided to the State Department and USAID under the SFOPs bill and through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totals $10.4 billion in the bill, $1.2 billion above the FY21 enacted level, $303 million above the President’s FY22 request, but $288 million below the FY22 House level. Funding for all global health programs at State and USAID either increased or remained flat compared to the FY21 enacted level (the largest increase is for global health security). Several program areas in the Senate bill are below House levels, including bilateral HIV/AIDS, tuberculosis, malaria, and family planning and reproductive health. Details on specific programs are as follows (unless otherwise specified, totals represent funding through the Global Health Programs account):
    • Funding for global health security totals $1 billion in the bill, which is $810 million (426%) above the FY21 enacted level ($190 million), $87 million (10%) above the FY22 Request ($913 million[ii]), and matches the FY22 House level.
    • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4.7 billion in the Senate FY22 bill, matching the FY21 enacted and FY22 Request levels, but $150 million (3%) below the FY22 House bill ($4.85 billion).
    • The bill includes $1.56 billion as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), matching the FY21 enacted, FY22 Request, and FY22 House level.
    • Funding for tuberculosis (TB) totals $400 million, $81 million (25%) above the FY21 enacted and FY22 Request level ($319 million), and $69 million (15%) below the FY22 House ($469 million).
    • Funding for malaria through the President’s Malaria Initiative (PMI) totals $800 million, $30 million (4%) above the FY21 enacted and FY22 request level ($770 million), and $20 million (2%) below the FY22 House level ($820 million).
    • The bill includes $941 million for maternal and child health (MCH) programs, an increase of $85.5 million (10%) above the FY21 enacted level ($855.5 million), $61.5 million (7%) above the FY22 Request ($879.5 million), and $61 million (7%) above the FY22 House level ($880 million). Specific areas under MCH include:
      • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY21 enacted, FY22 Request, and FY22 House level.
      • Polio funding through the GHP account totals $101 million, $36 million (55%) above the FY21 enacted, FY22 Request, and FY22 House level ($65 million).
      • $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, FY22 Request, and FY22 House level.
    • Funding for nutrition totals $160 million, $10 million (7%) above the FY21 enacted and FY22 Request level ($150 million), and matching the FY22 House level.
    • Bilateral family planning and reproductive health (FP/RH) funding totals $650 million, $75 million (13%) above the FY21 enacted level ($575 million), $66 million (11%) above the FY22 Request ($584 million), but $110 million (15%) below the FY22 House level ($760 million).
    • Funding for the United Nations Population Fund (UNFPA) totals $55 million, $22.5 million (69%) above the FY21 enacted level ($32.5 million), $1 million (2%) below the FY22 Request ($56 million), and $15 million (21%) below the FY22 House level ($70 million).
    • Funding for the vulnerable children program totals $30.5 million, $5.5 million (22%) above the FY21 enacted and FY22 Request level ($25 million) and $0.5 million (2%) above the FY22 House level ($30 million).
    • Funding for neglected tropical diseases (NTDs) totals $112.5 million, $10 million (10%) above the FY21 enacted and FY22 Request level ($102.5 million), and matching the FY22 House level.
    • The SFOPs bill also includes the following policy provisions and transfer authorities:
      • A permanent repeal of the Mexico City Policy, representing the first time it has been included in the underlying bill in the Senate.
      • A provision directing USAID and the U.S. Global AIDS Coordinator that, for operating units implementing more than one global health program area, at least 10% of each GHP program line is spent on “cross-cutting health systems strengthening activities.”
      • 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.
      • States that up to $250 million of funding from the GHP account “may be made available for a contribution to an international financing mechanism for pandemic preparedness.”

Labor, Health and Human Services, Education, and Related Agencies (Labor HHS):

  • Total global health funding at CDC and NIH through the Labor HHS bill is not yet known, as funding for some programs at NIH is determined at the agency level rather than specified by Congress in annual appropriations bills. [iii] Of the known amounts[iv], the Senate bill totals $694 million, which is $17 million above the FY21 enacted level, but $100 million below the FY22 Request and $246 million below the FY22 House level. Funding for all global health programs at CDC and NIH in the Senate bill either increased or remained flat compared to the FY21 enacted level. Several program areas in the Senate bill are below House levels, including parasitic diseases and global public health protection at CDC. Details on specific programs are as follows:
    • Funding provided to CDC for global health through the Labor HHS bill totals $598 million, an increase of $5 million (1%) above the FY21 enacted level ($593 million), $250 million (42%) above the FY22 Request ($698 million), but $245 million (29%) below the House FY22 level ($843 million). All of the increase at CDC compared to FY21 is for polio. Global health funding at CDC includes:
      • $128.4 million for global HIV/AIDS, matching the FY21 enacted, FY22 Request, and FY22 House level.
      • $9.2 million for global tuberculosis (TB), matching the FY21 enacted, FY22 Request, and FY22 House level.
      • $231 million for global immunization, $5 million (2%) above the FY21 enacted, FY22 Request, and FY22 House level ($226 million). Within this total are the following:
        • Funding for polio totals $181 million, $5 million (3%) above the FY21 enacted, FY22 Request, and FY22 House level ($176 million).
        • Funding for CDC’s other global vaccines/measles program totals $50 million, matching the FY21 enacted, FY22 Request, and FY22 House level.
      • $26 million for parasitic diseases and malaria, matching the FY21 enacted level and $5 million (16%) below the FY22 Request and FY22 House level ($31 million).
      • $203 million for the global public health protection program, matching the FY21 enacted level, $100 million (33%) below the FY22 Request ($303 million), and $245 million (55%) below the FY22 House ($448 million).
    • Funding for the Fogarty International Center (FIC) at NIH totals $96.3 million, $12.2 million (15%) above the FY21 enacted level ($84 million) and essentially matching the FY22 Request and FY22 House level.

Resources:

  • FY2022 State, Foreign Operations, and Related Programs Appropriations Bill – Bill
  • FY2022 State, Foreign Operations, and Related Programs Appropriations Bill – Report
  • FY2022 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill – Bill
  • FY2022 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill – Report

The table (.xlsx) below compares global health funding in the FY 2022 Senate SFOPs and Labor HHS appropriations bills to the FY 2021 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2021” (P.L. 116-260; KFF summary here), the President’s FY 2022 request (KFF summary here), and the House FY 2022 SFOPs and LHHS bills (KFF summaries here and here).

See the KFF budget tracker for details on historical annual appropriations for global health programs.

Table: KFF Analysis of FY22 Senate Appropriations for Global Health
Department / Agency / Area FY21
Enactedi
(millions)
FY22
Request
(millions)
FY22
Houseii
(millions)
FY22
Senateii
(millions)
Difference
(millions)
FY22 Senate
– FY21 Enacted
FY22 Senate
– FY22 Request
FY22 Senate
– FY22 House
State, Foreign Operations, and Related Programs (SFOPs) – Global Health
HIV/AIDS $4,700.0 $4,700.0 $4,850.0 $4,700.0 $0
 (0%)
$0
 (0%)
$-150
 (-3.1%)
State Department $4,370.0 $4,370.0 $4,520.0 $4,370.0 $0
(0%)
$0
(0%)
$-150
(-3.3%)
USAID $330.0 $330.0 $330.0 $330.0 $0
(0%)
$0
(0%)
$0
(0%)
of which Microbicides $45.0 $45.0 $45.0 $45.0 $0
(0%)
$0
(0%)
$0
(0%)
Global Fund $1,560.0 $1,560.0 $1,560.0 $1,560.0 $0
 (0%)
$0
 (0%)
$0
 (0%)
Tuberculosisiii $321.0  –  –  –  –
Global Health Programs (GHP) account $319.0 $319.0 $469.0 $400.0 $81
(25.4%)
$81
(25.4%)
$-69
(-14.7%)
Economic Support Fund (ESF) account Not specified $2.0 Not specified Not specified  –  –  –
Malaria $770.0 $770.0 $820.0 $800.0 $30
 (3.9%)
$30
 (3.9%)
$-20
 (-2.4%)
Maternal & Child Health (MCH)iv $1,039.5  –  –  –  –
GHP account $855.5 $879.5 $880.0 $941.0 $85.5
(10%)
$61.5
(7%)
$61
(6.9%)
of which Gaviv $290.0 $290.0 $290.0 $290.0 $0
(0%)
$0
(0%)
$0
(0%)
of which Polio $65.0 $65.0 $65.0 $101.0 $36
(55.4%)
$36
(55.4%)
$36
(55.4%)
UNICEFvi $139.0 $139.0 $139.0 $139.0 $0
(0%)
$0
(0%)
$0
(0%)
ESF account Not specified $21.0 Not specified Not specified  –  –  –
of which Polio Not specified $0.0 Not specified Not specified  –  –  –
Nutritionvii $154.8  –  – $-154.8
 (-100%)
 –
GHP account $150.0 $150.0 $160.0 $160.0 $10
(6.7%)
$10
(6.7%)
$0
(0%)
ESF account Not specified $4.0 Not specified Not specified  –  –  –
AEECA account  – $0.8  –  –  –  –  –
Family Planning & Reproductive Health (FP/RH)viii $607.5 $639.7 $830.0 $705.0 $97.5
 (16%)
$65.3
 (10.2%)
$-125
 (-15.1%)
Bilateral FP/RHviii $575.0 $583.7 $760.0 $650.0 $75
(13%)
$66.3
(11.4%)
$-110
(-14.5%)
GHP accountviii $524.0 $550.0 $760.0 $650.0 $126
(24%)
$100
(18.2%)
$-110
(-14.5%)
ESF accountviii $51.1 $33.7 Not specified Not specified  –  –  –
UNFPAix $32.5 $56.0 $70.0 $55.0 $22.5
(69.2%)
$-1
(-1.8%)
$-15
(-21.4%)
Vulnerable Children $25.0 $25.0 $30.0 $30.5 $5.5
 (22%)
$5.5
 (22%)
$0.5
 (1.7%)
Neglected Tropical Diseases (NTDs) $102.5 $102.5 $112.5 $112.5 $10
 (9.8%)
$10
 (9.8%)
$0
 (0%)
Global Health Security  $190.0 $913.3 $1,000.0 $1,000.0  $810
(426%)
$86.7
 (9.5%)
$0
 (0%)
GHP account $190.0 $905.0 $1,000.0 $1,000.0 $810
(426.3%)
$95
(10.5%)
$0
(0%)
USAID GHP accountx $190.0 $655.0 $1,000.0 $1,000.0 $810
(426.3%)
$345
(52.7%)
$0
(0%)
State GHP accountxi  – $250.0  –  –  –  –
ESF account Not specified $8.3 Not specified Not specified  –  –  –
Emergency Reserve Fund xii $90.0 xii xii  – $-90
 (-100%)
 –
SFOPs Total (GHP account only) $9,196.0 $10,051.0 $10,641.5 $10,354.0 $1,158
 (13%)
$303
 (3%)
$-287.5
 (-2.7%)
Labor Health & Human Services (Labor HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $592.8 $697.8 $842.8 $597.8 $5
 (0.9%)
$250
 (42.2%)
$-245
 (-29.1%)
Global HIV/AIDS $128.4 $128.4 $128.4 $128.4 $0
(0%)
$0
(0%)
$0
(0%)
Global Tuberculosis $9.2 $9.2 $9.2 $9.2 $0
(0.2%)
$0
(0%)
$0
(0%)
Global Immunization $226.0 $226.0 $226.0 $231.0 $5
(2.2%)
$5
(2.2%)
$5
(2.2%)
Polio $176.0 $176.0 $176.0 $181.0 $5
(2.8%)
$5
(2.8%)
$5
(2.8%)
Other Global Vaccines/Measles $50.0 $50.0 $50.0 $50.0 $0
(0%)
$0
(0%)
$0
(0%)
Parasitic Diseases $26.0 $31.0 $31.0 $26.0 $0
(0%)
$-5
(-16.1%)
$-5
(-16.1%)
Global Public Health Protection $203.2 $303.2 $448.2 $203.2 $0
(0%)
$-100
(-33%)
$-245
(-54.7%)
Global Disease Detection and Emergency Response $193.4 $293.4 Not specified Not specified  –  –  –
of which Global Health Security (GHS) Not specified Not specified Not specified Not specified  –  –  –
Global Public Health Capacity Development $9.8 $9.8 Not specified Not specified  –  –  –
National Institutes of Health (NIH) – Total Global Health $918.8 Not specified Not specified Not specified  –  –  –
HIV/AIDS $616.7 $617.1 Not specified Not specified  –  –  –
Malaria $218.0 Not specified Not specified Not specified  –  –  –
Fogarty International Center (FIC) $84.0 $96.3 $96.8 $96.3 $12.2
(14.5%)
$-0.1
(-0.1%)
$-0.6
(-0.6%)
Labor HHS Total $1,511.6 Not yet known Not yet known Not yet known  –  –  –
Notes:
i – The FY21 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 – The FY22 House and Senate SFOPs bills provide 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. The FY22 House SFOPs bill states that an unspecified amount of funding from the GHP account “may be made available for a contribution to an international financing mechanism for pandemic preparedness.” The FY22 Senate SFOPs bill states that up to $250 million of funding from the GHP account “may be made available for a contribution to an international financing mechanism for pandemic preparedness.”
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 FY19, TB funding under the ESF account totaled $3.6 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 FY19, MCH funding under the ESF account totaled $14.42 million).
v – 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.”
vi – UNICEF funding in the FY21final, FY22 House, and FY22 Senate bills include an earmark of $5 million for programs addressing female genital mutilation.
vii – 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).
viii – The FY21 final bill states 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. The FY22 House SFOPs bill text states that “not less than $760,000,000 shall be made available for family planning/reproductive health.” According to the FY22 House SFOPs bill report, $760 million is provided through the GHP account; however, it is possible that the administration could provide additional funding for FPRH activities through the ESF account. The FY22 Senate SFOPs bill text states that “not less than $650,000,000 shall be made available for family planning/reproductive health.” According to the bill report, $650 million is provided through the GHP account; however, it is possible that the administration could provide additional funding for FPRH activities through the ESF account.
ix – The FY21 final bill and FY22 House and Senate SFOPs bill texts 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.”
x – 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.”
xi – 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.”
xii – 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.” The FY22 House SFOPs bill text 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.” The FY22 Senate SFOPs bill text 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.”

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

[ii] The FY22 Request provided $913 million for global health security, of which $905 million was through the GHP account and $8.3 million through the ESF account.

[iii] Funding for global HIV/AIDS and malaria research programs provided through the NIH is not yet known.

[iv] Known amounts include total global health funding at CDC and funding for the Fogarty International Center at NIH.

The KFF Daily Global Health Policy Report summarized news and information on global health policy from hundreds of sources, from May 2009 through December 2020. All summaries are archived and available via search.

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