White House Releases FY 2023 Budget Request
President Biden released the FY 2023 budget request to Congress on March 28, 2022. The request includes discretionary 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). In addition, the request includes newly proposed mandatory funding for pandemic preparedness activities. Key highlights for the known amounts are as follows (see tables 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 $10.6 billion, an increase of $746 million (8%) above the FY22 enacted level, almost all of which was for the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) and global health security. The FY23 request also included mandatory funding to support pandemic preparedness activities at the State Department and USAID (see below).
- The request includes $2.0 billion for the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), an increase of $440 million (28%) above the FY22 enacted level, and states this funding would be the first contribution towards a $6 billion pledge to the Global Fund’s 7th Replenishment (2024-2026).
- Funding for global health security totals $995 million, an increase of $295 million (42%) above the FY22 enacted level ($700 million).
- Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4.7 billion, a slight decrease of $20 million (-0.4%) compared to the FY22 enacted level ($4.72 billion).
- Funding for tuberculosis (TB) totals $350 million, a decline of $21 million (-6%) compared to the FY22 enacted level ($371 million).
- Funding for malaria totals $780 million, a slight increase of $5 million (0.6%) compared to the FY22 enacted level ($775 million).
- The request includes $880 million for maternal and child health (MCH), a slight decrease of $10.5 million (-1%) below the FY22 enacted level ($890 million). Other specific areas under MCH include multilateral contributions to:
- Gavi, the Vaccine Alliance which totals $290 million, matching the FY22 enacted.
- UNICEF which totals $135.5 million, a decline of $3.5 million (-3%) compared to the FY22 enacted level ($139 million).
- Funding for the nutrition program totals $150 million, a decline of $5 million (-3%) compared to the FY22 enacted level ($155 million).
- Bilateral family planning and reproductive health (FP/RH) funding totals $572 million through the GHP account (additional funding that may be provided through the ESF account is not yet known), an increase of $48 million (9%) above the FY22 enacted level ($524 million). Funding for multilateral contributions to the United Nations Population Fund (UNFPA) totals $56 million, $23.5 million (72%) above the FY22 enacted level ($32.5 million)
- Funding for the vulnerable children program totals $25 million, a decline of $2.5 million (-9%) compared to the FY22 enacted level ($27.5 million).
- Funding for neglected tropical diseases (NTDs) totals $114.5 million, an increase of $7 million (7%) compared to the FY22 enacted level ($107.5 million).
- The request also included $10 million for a newly established Health Resilience Fund to “support cross-cutting health systems strengthening in challenging environments or countries emerging from crisis.”
Centers for Disease Control and Prevention (CDC): Funding for global health provided to the CDC totals $748 million, an increase of $101 million (16%) above the FY22 enacted level ($647 million), almost all of which ($100 million) is to support global health security activities; all other areas declined slightly except for parasitic diseases funding. The FY23 request also included mandatory funding to support pandemic preparedness activities at the CDC (see below).
National Institutes of Health (NIH) [i]: Funding for the Fogarty International Center (FIC) at NIH totals $96 million, $9 million (10%) above the FY22 enacted level ($87 million).
Mandatory Funding for Pandemic Preparedness: The FY23 budget request proposes to establish mandatory funding to support both domestic and international pandemic preparedness efforts including $6.5 billion at USAID and the State Department as well as significant additional resources at CDC (it is not possible to determine a specific amount for global activities at the CDC as some funding is designated to support both global and domestic efforts; the table below highlights funding that was designated as either 1) specifically for global efforts, or 2) could potentially be used to support global activities).
- White House FY 2023 Budget Resources
- State/USAID FY 2023 Congressional Budget Justification
- CDC FY 2023 Congressional Budget Justification
- NIH FY 2023 Congressional Budget Justification
Table 1 below compares global health funding in the FY 2023 request to the FY 2022 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2022” (P.L. 117-103; KFF summary here). Note that total funding for global health is not currently available as some funding amounts provided through USAID, the Department of Health and Human Services (DHHS), and the Department of Defense (DoD) are not yet available. Table 2 below details mandatory funding for pandemic preparedness through the Department of State, USAID, and the Centers for Disease Control and Prevention in the FY 2023 request. The tables can be downloaded here.
See the KFF budget tracker for details on historical annual appropriations, including Senate and House amounts, for global health programs.
|Table 1: KFF Analysis of Global Health Funding in the FY23 Budget Request|
|Department / Agency / Area||FY22
FY23 Request –
|State, Foreign Operations, and Related Programs (SFOPs) – Global Health|
|of which Microbicides||$45.0||$45.0||$0
|Global Health Programs (GHP) account||$371.1||$350.0||$-21.1
|Economic Support Fund (ESF) account||Not specified||Not specified||–|
|Maternal & Child Health (MCH)ii||–||–||–|
|of which Gavi||$290.0||$290.0||$0
|of which Polio||$75.0||Not specified||–|
|ESF account||Not specified||Not specified||–|
|of which Polio||Not specified||Not specified||–|
|ESF account||Not specified||Not specified||–|
|Family Planning & Reproductive Health (FP/RH)iv||$607.5||–||–|
|ESF accountiv||$51.1||Not specified||–|
|Neglected Tropical Diseases (NTDs)||$107.5||$114.5||$7
|Global Health Security||$700.0||$995.0||$295
|USAID GHP accountvi||$700.0||$745.0||$45
|State GHP accountvii||–||$250.0||–|
|Emergency Reserve Fund||viii||ix||–|
|Health Resilience Fundx||–||$10.0||–|
|SFOPs Total (GHP account only)xi||$9,830.0||$10,576.0||$746
|Labor Health & Human Services (Labor HHS)|
|Centers for Disease Control & Prevention (CDC) – Total Global Health||$646.8||$747.8||$101
|Other Global Vaccines/Measles||$50.0||$50.0||$0
|Global Public Health Protection||$253.2||$353.2||$100
|Global Disease Detection and Emergency Response||Not specified||Not specified||–|
|of which Global Health Security (GHS)||Not specified||Not specified||–|
|Global Public Health Capacity Development||Not specified||Not specified||–|
|National Institutes of Health (NIH) – Total Global Health||–||–||–|
|Malaria||Not specified||Not specified||–|
|Fogarty International Center (FIC)||$86.9||$95.8||$8.9
|Labor HHS Total||Not yet known||Not yet known||–|
|i – The FY22 Omnibus 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 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 – UNICEF funding in the FY22 Omnibus includes an earmark of $5 million for programs addressing female genital mutilation.|
|iv – The FY22 Omnibus stated that “not less than $575,000,000 should be made available for family planning/reproductive health.”|
|v – The FY22 Omnibus states 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 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.”|
|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 Request states that the Health Resilience Fund (HRF) “will support cross-cutting health systems strengthening in challenging environments or countries emerging from crisis.”|
|xi – The FY22 Omnibus “includes $100,000,000 for a U.S. contribution to support a multilateral vaccine development partnership for epidemic preparedness innovations.”|
|KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, Congressional Appropriations Bills, U.S. Foreign Assistance Dashboard, and personal communication.|
|Table 2: Mandatory Funding for Pandemic Preparedness|
|Department / Agency / Activity||FY23 Request
|Department of State and USAID|
|Global Health Programs Mandatory Budget Authority for Pandemic Preparedness||$6,500|
|Global Health Security and Pandemic Preparedness Fund (GHP – State)||$4,500|
|Research, Development, and Delivery (GHP – USAID)||$500|
|Health Worker Initiative||$1,000|
|GHP – State||$250|
|GHP – USAID||$750|
|Emergency Reserve Fund (GHP – USAID)||$500|
|Centers for Disease Control and Prevention|
|Mandatory Funding for Pandemic Preparednessi||$13,100|
|Global MCM Capacity Development||$5,700|
|Global Health Security Capacity||$1,150|
|Global & Domestic||$6,350|
|Domestic and Global Threat Detection||$5,250|
|Antimicrobial Resistance (AMR)||$1,000|
|i – The FY23 CDC Congressional Justification includes a total of $28 billion in mandatory funding for pandemic preparedness. This table includes amounts that were designated as either 1) specifically for global efforts (e.g. “Global Health Security Capacity”), or 2) could potentially be used to support global activities (e.g. “Domestic and Global Threat Detection”).|
[i] Total funding for global research activities (e.g. HIV/AIDS and malaria programs) at NIH is not yet known.
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