Breaking Down the U.S. Global Health Budget by Program Area

U.S. Global Health Budget: Overview

The U.S. Government is the largest donor to global health in the world and includes support for both disease (HIV, tuberculosis, malaria, and neglected tropical diseases) and population (maternal and child health, nutrition, and family planning and reproductive health) specific activities as well as global health security. Most U.S. funding for global health is provided bilaterally (approximately 80%). Of the multilateral share, the majority is provided to The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The U.S. investment in global health grew significantly in the early 2000s, largely due to the creation of new initiatives including the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). However, over the last decade, U.S. funding for global health has remained relatively flat, with spikes in some years due to emergency supplemental funding for Ebola in FY 2015, Zika in FY 2016, and COVID-19 in FY 2020 and FY 2021. In FY 2024, funding for global health totaled $12.4 billion.

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U.S. Global Health Budget: Global HIV Funding, Including PEPFAR

The U.S. first provided funding to address the global HIV epidemic in 1986. U.S. efforts and funding increased slowly over time until the launch of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, which initiated a period of significant increases and is the largest effort devoted to a single disease in the world. The majority of U.S. global HIV funding is for PEPFAR bilateral efforts (89%) with additional funding for UNAIDS and international HIV research activities. As part of its global HIV response, the U.S. also provides funding to the Global Fund (see below for details). PEPFAR funding is specified by Congress in annual appropriations bills and is largely provided to the Department of State, which is responsible, through the Bureau for Global Health Security and Diplomacy (GHSD), for coordinating all U.S. programs, activities, and funding for global HIV efforts. Other agencies that receive HIV funding under PEPFAR include the U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and Department of Defense (DoD). In addition, the National Institutes of Health (NIH) supports international HIV research activities, (funding which is not counted as part of PEPFAR). Global HIV funding through regular appropriations¹ has historically accounted for the largest share of the U.S. global health budget (ranging from 42% to 50% between FY 2015 and FY 2024). In FY 2024, global HIV funding totaled $5.4 billion, of which $4.9 billion is for PEPFAR² ($4.8 billion for bilateral HIV and $50 million for UNAIDS), and approximately $575 million is for international HIV research activities at NIH.

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U.S. Global Health Budget: Tuberculosis (TB)

Since 1998, when the U.S. Agency for International Development (USAID) began a global tuberculosis (TB) control program, U.S. involvement in global TB efforts has grown and it is now one of the largest donors to global TB control in the world. U.S. bilateral TB funding is provided through USAID and includes U.S. contributions to the TB Drug Facility (additional U.S. support for TB activities is provided through its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria). U.S. funding for TB has grown over the past decade, with much of the increase occurring in more recent years. U.S. funding for TB rose from $242 million in FY 2015 to $406 million in FY 2024, and currently accounts for approximately 3% of the U.S. global health budget.

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U.S. Global Health Budget: Malaria/PMI

The U.S. government has been involved in global malaria activities since the 1950s and, today, is the second largest donor to global malaria efforts in the world (the largest is the Global Fund to Fight AIDS, Tuberculosis and Malaria). The U.S. response to malaria is driven by the President’s Malaria Initiative (PMI), an interagency initiative to address global malaria that is led by the U.S. Agency for International Development (USAID), and co-implemented together with the Centers for Disease Control and Prevention (CDC), with additional activities provided by the National Institutes of Health (NIH) and Department of Defense (DoD). In addition to its bilateral programs, the U.S. also supports malaria programs through its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. U.S. bilateral funding for malaria increased over the past decade from $854 million in FY 2015 to approximately $1 billion in FY 2024; while funding increased over the period, it has been relatively flat in recent years. In FY 2024, malaria accounted for 9% of the U.S. global health budget.

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U.S. Global Health Budget: The Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is an independent, public-private, multilateral institution which finances HIV, TB, and malaria programs in low- and middle-income countries. The Global Fund receives contributions from public and private donors and in turn provides funding to countries based on country-defined proposals. The U.S. provided the Global Fund with its founding contribution in 2001 and has since been its largest single donor (U.S. contributions to the Global Fund are counted as part of PEPFAR). However, Congress places a number of restrictions on U.S. contributions, including a funding match requirement that limits the amount the U.S. can contribute. The U.S. contribution to the Global Fund through regular appropriations has fluctuated over the past decade but reached its highest level to date ($2.0 billion) in FY 2023. In FY 2024, funding for the Global Fund was $1.7 billion, $375 million less than the FY 2023 level, though Congress stated the decline was due to the funding match requirement that limits the amount the U.S. can contribute. In addition to regular appropriations, Congress provided $3.5 billion in emergency supplemental funding to the Global Fund to address the impacts of COVID-19 on HIV programs in FY 2021.

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U.S. Global Health Budget: Maternal & Child Health (MCH)

The U.S. has been involved in Maternal & Child Health (MCH) efforts since the 1960s (and is the largest donor government to MCH activities in the world). MCH funding, which includes funding for polio and U.S. contributions to Gavi, the Vaccine Alliance (GAVI) and the United Nations Children’s Fund (UNICEF), is provided through the U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and the State Department. U.S. funding for MCH increased slightly from $1.18 billion in FY 2015 to $1.31 billion in FY 2024. This was primarily driven by increased funding to GAVI and polio during the period. In fact, when these are removed, bilateral MCH funding has remained relatively level for several years over the period. In FY 2024, MCH accounted for the third largest share of U.S. funding for global health (11%).

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U.S. Global Health Budget: Nutrition

The U.S. has a long history of supporting global efforts to improve nutrition and is the largest donor to nutrition efforts in the world. Historically, support for U.S. global nutrition activities was included as part of broader maternal and child health (MCH) funding; starting in 2010, Congress began to designate funding for nutrition activities, all of which is provided through the U.S. Agency for International Development (USAID).³ U.S. funding for nutrition increased from $139 million in FY 2015 to $168 million in FY 2024 and has accounted for approximately 1% of the total U.S. global health budget over the period.

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U.S. Global Health Budget: Family Planning & Reproductive Health (FP/RH)

The U.S. has been involved in Family Planning & Reproductive Health (FP/RH) efforts since the 1960s and is currently the largest donor to global FP/RH in the world. The majority of U.S. FP/RH funding is provided through the U.S. Agency for International Development (USAID) for bilateral activities, with additional funding provided through the State Department for the U.S. contribution to the United Nations Population Fund (UNFPA).⁴ U.S. funding for FP/RH rose steadily in its first two decades⁵ and more recently, has remained relatively flat at just about $600 million, accounting for approximately 5-6% of the U.S. global health budget each year from FY 2015-FY 2024.

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U.S. Global Health Budget: Global Health Security

Since the 1990s, there has been growing concern about new infectious diseases that threaten human health including, in more recent years, the emergence and spread of threats such as Ebola, Zika, H1N1 influenza, COVID-19, and antibiotic resistance. U.S. global health security efforts aim to reduce the threat of emerging infectious diseases by supporting preparedness, detection, and response capabilities worldwide. Funding designated by Congress for global health security through both emergency and regular appropriations has fluctuated over time, rising largely in response to outbreaks, including Ebola in FY 2015, Zika in FY 2016, and COVID-19 in FY 2020 and FY 2021.⁶ The share of global health funding that global health security represents has increased over time, rising from 4% in FY 2015 to 10% in FY 2024. In FY 2024, funding for global health security was $1.3 billion.

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U.S. Global Health Budget: Neglected Tropical Diseases (NTDs)

NTDs are a group of parasitic, bacterial, and viral infectious diseases that primarily affect the most impoverished and vulnerable populations in the world. The U.S. Congress first designated funding to address NTDs in 2006, through the U.S. Agency for International Development (USAID).⁷ Funding was flat at around $100 million for several years before rising to a peak of $115 million in FY 2023 and remained flat in FY 2024. Funding for NTDs accounts for a relatively small share of the U.S. global health budget (1% in FY 2024).