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S. 3676 – Department of State, Foreign Operations, and Related Programs Appropriations Bill, 2011

The Senate Committee on Appropriations approved by a vote of 18-12 the FY 2011 State and Foreign Operations appropriations bill with the following recommendations:

Total Funding for State & Foreign Operations: $54.06 billion ($2.6 billion below the President’s FY11 request; $5.3 billion above the FY10 enacted level)

Global Health and Child Survival Account (GHCS): $8.239 billion ($274 million below the President’s request; $460 million above the FY10 enacted level) with funding for specific areas is as follows:
– HIV/AIDS activities and the Global Fund to Fight AIDS, Tuberculosis and Malaria: $5.85 billion
– HIV/AIDS: $5.05 billion

- Global Fund to Fight AIDS, Tuberculosis and Malaria contribution: $800 million
– Malaria: $635.5 million

- Tuberculosis: $230 million

- Neglected Tropical Diseases (NTDs): $100 million

- Child Survival and Maternal Health: $641 million

- Nutrition: $100 million

- Family Planning and Reproductive Health: $700 million which includes funding from multiple accounts and provides $55 million to the United Nations Population Fund (UNFPA)

Millennium Challenge Corporation: $1.105 billion ($174.7 million below the President’s FY11 request; equal to the FY10 enacted level)

Feed the Future: $1.3 billion ($344 million below the President’s FY11 request)

“Global Gag” Rule Amendment:The Committee approved by a vote of 19-11 an amendment to the appropriations bill introduced by Senator Frank Lautenberg (D-NJ) that would codify into law President Obama’s decision to rescind the “global gag” rule (otherwise known as the Mexico City Policy), which prevented the U.S. from providing foreign assistance for family planning purposes to any organization that performed or promoted legal abortion.

Ambassador Goosby provides an update on PEPFAR programs in Uganda

In a State Department blog post titled “PEPFAR Programs in Uganda: An Update,” U.S. Global AIDS Coordinator Ambassador Eric Goosby summarized recent challenges surrounding HIV treatment in Uganda and outlined some of the actions PEPFAR will take to address these challenges including:
– Strengthen PEPFAR’s linkages, through the Global Health Initiative (GHI), with other U.S.-supported health programs;

- Support treatment scale-up and expansion of access to HIV prevention and care services;

- Provide an immediate infusion of antiretroviral drugs;

- Provide increased short- and medium-term financial assistance;

- Promote best practices and innovations in service delivery;

- Conduct an analysis of treatment expenditures in order to develop a plan that expands access to treatment;

- Accelerate the full functioning of grants from the Global Fund to Fight AIDS, TB and Malaria; and

- “Pursue a new approach to purposeful engagement with the Government of Uganda and civil society” in order to coordination and collaboration.

President Obama announces new global HIV treatment and prevention goals; Administration statements and resources commemorating World AIDS Day

White House:

President Barack Obama provided remarks at a World AIDS Day event hosted by ONE and (RED) at the George Washington University and issued a presidential proclamation to commemorate World AIDS Day.   During his remarks, President Obama announced new treatment and prevention goals of “providing anti-retroviral drugs to more than 1.5 million HIV-positive pregnant women over the next two years . . . [and] helping 6 million people get treatment by the end of 2013” – an increase of 2 million over the prior target, and called on countries to fulfill their commitments to The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Additional Administration Statements and Resources Commemorating World AIDS Day:

State Department:

Health and Human Services (HHS):

  • Statement from HHS Secretary Kathleen Sebelius on World AIDS Day. Secretary Sebelius also announced the appointment of Nancy Mahon, Executive Director of the MAC AIDS Fund, as the Chair of the Presidential Advisory Council on HIV/AIDS (PACHA).
  • Statement by National Institutes of Health (NIH) Director Dr. Francis Collins, NIH Office of AIDS Research Dr. Jack Whitescarver, and NIAID Director Dr. Anthony Fauci.

U.S. Agency for International Development (USAID):

U.S. Mission to the United Nations:

  • Statement from U.S. Permanent Representative to the United Nations Ambassador Susan E. Rice.

Peace Corps:

  • Peace Corps statement commemorating World AIDS Day.

Department of Defense (DoD):

  • DoD statement titled “World AIDS Day Raises Awareness, Highlights Advances”.

Department of Labor (DoL):

  • DoL Secretary Hilda Solis’ statement titled “Forging Ahead on World AIDS Day”.
UPDATED: House-Senate Conference Committee releases FY 2012 Appropriations Agreement

UPDATE: The President signed the bill into law (Public Law #112-74) on December 23, 2011 after the Conference Agreement passed the House (296-121) on December 16, 2011 and the Senate (67-32) on December 17, 2011. Additionally, the Senate voted against (43-56) a resolution (H.Con.Res. 94) that would have applied a 1.83% across-the-board rescission to all FY 2012 appropriations except the Department of Defense (DoD), Military Construction, and Veterans Affairs.
————-

Representative Hal Rogers (R-KY, 5th; Chairman House Committee on Appropriations) released a statement announcing that a joint House-Senate Conference Committee had reached agreement on final FY 2012 Appropriations legislation (H.R. 2055), which includes funding for global health programs through the State Department, U.S. Agency for International Development (USAID), the Department of Health and Human Services (HHS), and the Department of Defense (DoD). While total funding for the Global Health Initiative (GHI) is not yet available, the appropriations detailed in this agreement totaled $8.3 billion.

According to the Conference Report and the Joint Statement of Managers, the legislation also:

  • Directs that no FY 2012 global health funds may be used for needle exchange programs;
  • Includes additional Congressional oversight before the Administration makes a multi-year funding pledge;
  • Requires the Administration to report back to Congress with an analysis of the potential costs/savings of transitioning the Office of the Global AIDS Coordinator (OGAC) into USAID; and
  • Requires the Administration to report back to Congress with an analysis of transitioning the leadership of the Global Health Initiative (GHI) to USAID as outlined in the Quadrennial Diplomacy and Development Review (QDDR).

Global health appropriations as provided in the Conference Report (House Report 112-331) and Joint Statement of Managers are summarized as follows:

Area

Part of the GHI*

FY11 Enacted (millions)

FY12 Request (millions)

FY12 Conference Agreement
(millions)**

Difference
(millions)

Conference – FY11

Conference – Request

State & Foreign Operations

Maternal & Child Health (MCH)

X

$548.9

$846.0

$605.6

$56.7
 (10.3%)

$-240.5
 (-28.4%)

        GAVI (non-add)

X

$90.0

$115.0

$100.0

$10
 (11.1%)

$-15
 (-13%)

Nutrition

X

$89.8

$150.0

$95.0

$5.2
 (5.8%)

$-55
 (-36.7%)

Vulnerable Children

X

$15.0

$15.0

$17.5

$2.5
 (16.9%)

$2.5
 (16.7%)

HIV/AIDS

X

$4,935.1

$4,991.9

$4,842.9

$-92.3
 (-1.9%)

$-149
 (-3%)

        USAID

X

$349.3

$350.0

$350.0

$0.7
 (0.2%)

$0
 (0%)

        State Department

X

$4,585.8

$4,641.9

$4,492.9

$-93
 (-2%)

$-149
 (-3.2%)

Global Fund

X

$748.5

$1,000.0

$1,050.0

$301.5
 (40.3%)

$50
 (5%)

Family Planning/Reproductive Health (FP/RH)***

 

$615.0

$769.1

$610.0

$-5
 (-0.8%)

$-159.1
 (-20.7%)

        GHCS Account

X

$524.0

$625.6

$524.0

$0
 (0%)

$-101.7
 (-16.2%)

        Other Bilateral Accounts

 

$51.1

$96.0

$51.1

$0
 (0%)

$-45
 (-46.8%)

        UNFPA

 

$40.0

$47.5

$35.0

$-5
 (-12.5%)

$-12.5
 (-26.3%)

Tuberculosis

X

$224.6

$236.0

$236.0

$11.5
 (5.1%)

$0
 (0%)

Malaria

X

$618.8

$691.0

$650.0

$31.2
 (5%)

$-41
 (-5.9%)

Neglected Tropical Diseases (NTDs)

X

$76.8

$100.0

$89.0

$12.2
 (15.8%)

$-11
 (-11%)

Pandemic Preparedness

X

$47.9

$60.0

$58.0

$10.1
 (21.1%)

$-2
 (-3.3%)

MCC

 

$898.2

$1,125.1

$898.2

$0
 (0%)

$-226.9
 (-20.2%)

Water

 

-

-

$315.0

-

-

Health and Human Services (HHS)

CDC Global Health

 

$340.3

$381.2

$348.9

$8.6
 (2.5%)

$-32.4
 (-8.5%)

        of which HIV

X

$118.7

$118.0

$117.8

$-0.9
 (-0.8%)

$-0.2
 (-0.2%)

NIH – Global Fund

X

$297.3

$300.0

$0.0

$-297.3
 (-100%)

$-300
 (-100%)

NIH – Fogarty International Center

 

$69.4

$71.3

$69.6

$0.2
 (0.3%)

$-1.7
 (-2.4%)

Department of Defense (DoD)

HIV

X

$10.0

$0.0

$8.0

$-2
 (-20%)

-

The Global Health Initiative

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  • FY2012 Consolidated Appropriations Act introduced in the House

    Representative Hal Rogers (R-KY, 5th; Chairman House Committee on Appropriations) introduced the “Consolidated Appropriations Act, 2012” (H.R. 3671), which includes funding for global health programs through the State Department, U.S. Agency for International Development (USAID), and the Department of Health and Human Services (HHS). Chairman Rogers also introduced a resolution (H.Con.Res. 94) that would apply a 1.83% across the board rescission to all FY 2012 appropriations except the Department of Defense (DoD), Military Construction, and Veterans Affairs.

    According to the bill and the Chair’s summary, the bill also:

    • “Directs that no HIV/AIDS funding be provided for needle exchange programs”;
    • “Requires additional congressional oversight before the Administration makes public announcements of multi-year funding pledges”;
    • Requires that the Administration report back to Congress with an analysis of the potential costs (including savings and increases) of transitioning the Office of the Global AIDS Coordinator (OGAC) into USAID; and
    • Requires that the Administration report back to Congress with an analysis of transitioning the leadership of the Global Health Initiative (GHI) to USAID as outlined in the Quadrennial Diplomacy and Development Review (QDDR).

    Global health appropriations included in the bill are as follows:

    Department / Agency

    Part of the GHI*

    FY11 Enacted (millions)

    FY12 Request (millions)

    FY12 House Bill (H.R. 3671) (millions)**

    Difference
    (millions)

    House – FY11

    House – Request

    State & Foreign Operations

    USAID-GHCS

    X

    $2,495.0

    $3,073.6

    $2,625.0

    $130
     (5.2%)

    $-448.6
     (-14.6%)

    State GHCS

    X

    $5,334.3

    $5,641.9

    $5,542.9

    $208.5
     (3.9%)

    $-99
     (-1.8%)

            of which GF

    X

    $748.5

    $1,000.0

    $1,050.0

    $301.5
     (40.3%)

    $50
     (5%)

    FP/RH***

     

    $615.0

    $769.1

    $610.0

    $-5
     (-0.8%)

    $-159.1
     (-20.7%)

            of which UNFPA

     

    $40.0

    $47.5

    $35.0

    $-5
     (-12.5%)

    $-12.5
     (-26.3%)

    MCC

     

    $898.2

    $1,125.1

    $898.2

    $0
     (0%)

    $-226.9
     (-20.2%)

    Water (all acounts)

     

    -

    -

    $315.0

    -

    -

    Health and Human Services (HHS)

    CDC Global Health

     

    $340.3

    $381.2

    $348.9

    $8.6
     (2.5%)

    $-32.4
     (-8.5%)

            of which HIV

    X

    $118.7

    $118.0

    $117.8

    $-0.9
     (-0.8%)

    $-0.2
     (-0.2%)

    NIH – Global Fund

    X

    $297.3

    $300.0

    $0.0

    $-297.3
     (-100%)

    $-300
     (-100%)

    NIH – Fogarty International Center

     

    $69.4

    $71.3

    $69.6

    $0.2
     (0.3%)

    $-1.7
     (-2.4%)

    Department of Defense (DoD)

    HIV

    X

    $10.0

    $0.0

    $8.0

    $-2
     (-20%)

    -

    The Global Health Initiative

    Total GHI (known amounts)****

     

    $8,255.4

    $9,133.5

    $8,293.7

    $38.3
     (0.5%)

    $-839.9
     (-9.2%)

    *GHI: U.S. Global Health Initiative.
    **The FY 2012 Consolidated Appropriations Act included an across-the-board 0.189% rescission to all funding provided through the Labor-HHS portion of the bill.
    ***The FY 2012 Consolidated Appropriations Act states that “not less than $575,000,000 should be made available for family planning/reproductive health” through all bilateral accounts, but does not delineate this amount by account. UNFPA funding is in addition to the bilateral funding and is provided through the International Organizations and Programs (IO&P) account.
    ****Total funding for the GHI is not currently available as some funding provided through SFOPS, HHS, and DoD were not delineated in the FY 2012 appropriations bills.

    Senate Appropriations Committee introduces Continuing Resolution for the remainder of FY 2011; includes overall increase in global health funding

    The Senate Committee on Appropriations introduced a Continuing Resolution (CR) that would authorize appropriations for the remaining seven months of FY 2011 (the first 5 months of FY 2011 were funded under FY 2010 levels). This legislation would replace the full-year appropriations bill (H.R. 1) that was recently passed by the House on February 19, 2011. Unlike H.R. 1, which proposes to cut global health funding, the Senate CR proposes an overall increase in global health funding (see table below). Additionally, the summary of the CR provided by the Senate Committee on Appropriations categorizes State and Foreign Operations funding as part of National Security.

    Senator Lugar releases report entitled “Fraud and Abuse of Global Fund Investments at Risk Without Greater Transparency”

    Senator Richard Lugar (R-IN), Ranking Member of the Senate Committee on Foreign Relations, released a minority staff report entitled, “Fraud and Abuse of Global Fund Investments at Risk Without Greater Transparency”. The report provides an historical overview of U.S. involvement with the Global Fund to Fight AIDS, Tuberculosis and Malaria though the President’s Emergency Plan for AIDS Relief (PEPFAR) and provides recommendations for improvement to both the U.S. government and the Global Fund.

    H.R. 755 – Investing in Our Future Act of 2011

    The proposed bill would impose a 0.005% tax on the value of the currency (if greater than $10,000 USD) acquired in a currency exchange transaction. The revenue generated by this tax would be directed to three new trust funds established at the Department of the Treasury: 10% would be directed to a “Child Care Assistance Trust Fund,” 25% to a “Multilateral Global Health Trust Fund,” and 25% to a “Global Climate Change Adaptation and Mitigation Trust Fund.” The remainder would be directed to federal budget deficit reduction or reduction of the federal debt.

    The Secretary of State would have authority to provide grants from the Multilateral Global Health Trust Fund to entities such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and other multilateral organizations that meet specific criteria outlined in the bill. The bill also states that funding for the multilateral organizations must be in addition to and not replacing existing funding and should be used for the purposes of “addressing HIV/AIDS, tuberculosis, malaria, maternal mortality, family planning, neglected diseases, and other health issues affecting developing countries.”

    White House releases FY 2012 Budget Request

    The White House released the FY 2012 budget request, which included the following funding totals for the U.S. Global Health Initiative (GHI) and other global health and related activities:

    b>Global Health Initiative (GHI) total: $9.8 billion, including

    - $8.7155 billion from State & Foreign Operations Global Health & Child Survival (GHCS) account, and

    - Over $1.0693 billion from HHS, DoD, and other State & Foreign Operations accounts.

    - PEPFAR: Included in the GHI total is $7.154 billion for PEPFAR of which $1.3 billion is for the Global Fund ($1.0 billion from the State Department and $300 million from HHS).

    Additional funding details on the GHI and other global health related accounts:

    State and Foreign Operations funding for the global health:

    - Global Health & Child Survival (GHCS): $8.7155 billion

    • USAID: $3.0736 billion
      • Maternal & Child Health: $846.0 million
      • Nutrition: $150.0
      • Vulnerable Children: $15.0 million
      • HIV/AIDS: $350.0 million
      • Family Planning/Reproductive Health: $625.6 million
      • Malaria: $691.0 million
      • Tuberculosis: $236.0 million
      • Neglected Tropical Diseases (NTDs): $100.0 million,
      • Pandemic Influenza and Other Emerging Threats: $60 million
    • Department of State: $5.6419 billion
      • HIV/AIDS: $5.6419 billion (includes $1.0 billion for the Global Fund)

    Millennium Challenge Corporation: $1.125 billion

    • Health and Human Services (HHS) funding for global health:
      • National Institutes of Health (NIH):
        • HIV/AIDS Research: $489.4 million
        • Malaria Research: $110.2 million
        • Global Fund: $300.0 million
      • Centers for Disease Control and Prevention (CDC) ($ total): $381.2 million
        • Global AIDS Program: $118.0 million
        • Global Immunization Program: $163.6 million
        • Global Disease Detection & Emergency Response: $44.2 million
        • Parasitic Diseases & Malaria: $19.6 million
          • Malaria: $9.2 million
        • Global Public Health Capacity Development: $35.8 million
    • Fogarty International: $71.3 million
    Congressional letter to Appropriations Committees calls for “robust” funding of FY 2012 global health programs

    Approximately 100 members of Congress signed a letter calling on the Chair and Ranking Member of the Subcommittee on State and Foreign Operations in both the House and Senate Appropriations Committees to support the Senate proposed funding level for FY 2012 global health programs.