Global Health Funding in the FY 2021 Omnibus
The FY 2021 omnibus appropriations bill (and accompanying reports), released by Congress on December 21, 2020, includes 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).[i] The bill also includes funding for Coronavirus relief efforts, including $4 billion for Gavi, the Vaccine Alliance (see the KFF analysis of global funding included in the five COVID-19 supplemental funding bills here). Key highlights from the FY21 appropriations bill are as follows (see table 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, totals $9.2 billion, an increase of $104 million above the FY20 enacted level and $3.2 billion above the President’s FY21 request. Funding for tuberculosis, maternal and child health (including funding for polio), and global health security were the only areas that increased in FY21 compared to the prior year level; global health security accounted for most of this increase.
- Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,700 million, matching the FY20 enacted level, but $1,520 million (48%) above the FY21 request ($3,180 million).
- The bill includes $1,560 million as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), matching the FY20 enacted level, and $902 million (137%) above the FY21 request ($658 million). The bill states that this amount is for the second installment of the sixth replenishment.
- Funding for tuberculosis (TB) totals $319 million, $9 million (3%) above the FY20 enacted level ($310 million), and $44 million (16%) above the FY21 request ($319 million).
- Funding for malaria totals $770 million, matching the FY20 enacted level, and $61.5 million (8%) above the FY21 request ($708.5 million).
- The bill includes $855.5 million for maternal and child health (MCH), an increase of $4.5 million (<1%) above the FY20 enacted level ($851 million), and $196 million (30%) above the FY21 request ($660 million). Specific areas under MCH include:
- Gavi, the Vaccine Alliance funding totals $290 million, matching the FY20 enacted and FY21 request level.
- Polio funding through all accounts totals $65 million, $4 million (7%) above the FY20 enacted level ($61 million). The President’s FY21 request did specify a funding amount for polio.
- The bill includes $139.0 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 FY20 enacted level. The President’s FY21 request did not specify a funding amount for UNICEF.
- Funding for nutrition totals $150 million, matching the FY20 enacted level, and $60 million (67%) above the FY21 request ($90 million).
- Bilateral family planning and reproductive health (FP/RH) funding totals $575 million ($524 million through the GHP account and $51 million through the ESF account), matching the FY20 enacted level, and $287 million (121%) above the FY21 request ($237 million).
- Funding for the United Nations Population Fund (UNFPA) totals $32.5 million, matching the FY20 enacted level; the FY21 request proposed eliminating funding for UNFPA.
- Funding for the vulnerable children program totals $25 million, matching the FY20 enacted level; the FY21 request proposed eliminating funding for this program.
- Funding for neglected tropical diseases (NTDs) totals $102.5 million, matching the FY20 enacted level, and $27.5 million (37%) above the FY21 request ($75 million).
- Funding for global health security totals $190 million in the bill, accounting for the largest increase in funding for all program areas compared to FY20 enacted levels. Funding in the FY21 omnibus bill is $90 million (90%) above the FY20 enacted level ($100 million), and $100 million (111%) above the FY21 request ($90 million).
Centers for Disease Control and Prevention (CDC): Funding for global health provided to the CDC totals $593 million, an increase of $22 million (4%) compared to the FY20 enacted level ($571 million) and $61 million (11%) above the FY21 request ($532 million). Funding for tuberculosis and global health security were the only areas that increased in FY21 compared to the prior year level, with global health security accounting for most of this increase.
Fogarty International Center (FIC): Funding for the Fogarty International Center (FIC) at the National Institutes of Health (NIH) totaled $84 million, $3 million (4%) above the FY20 enacted level ($81 million) and $10.5 million (14%) above the FY21 request ($73.5 million).
Resources:
- “Consolidated Appropriations Act, 2021” – Bill Text
- FY2021 Department of State, Foreign Operations, and Related Programs (SFOPs) Appropriations – Explanatory Statement
- FY2021 Department of Labor, Health and Human Services, and Education, and Related Agencies (Labor HHS) Appropriations – Explanatory Statement
The table (.xls) below compares global health funding in the FY 2021 omnibus bill compared to the FY 2020 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2020” (P.L. 116-44; KFF summary here) and the President’s FY 2021 request (KFF summary 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 FY21 Omnibus Appropriations for Global Health | |||||
| Department / Agency / Area | FY20 Enacted (millions) |
FY21 Requesti (millions) |
FY21 Omnibus (millions) |
Difference (millions) |
|
| FY21 Omnibus – FY20 Enacted |
FY21 Omnibus – FY21 Request |
||||
| State, Foreign Operations, and Related Programs (SFOPs) – Global Health | |||||
| HIV/AIDS | $4,700.0 | $3,180.3 | $4,700.0 | $0 (0%) |
$1519.7 (47.8%) |
| State Department | $4,370.0 | $3,180.3 | $4,370.0 | $0 (0%) |
$1189.7 (37.4%) |
| USAID | $330.0 | $0.0 | $330.0 | $0 (0%) |
$330.0 (NA) |
| of which Microbicides | $45.0 | $0.0 | $45.0 | $0 (0%) |
$45.0 (NA) |
| Global Fund | $1,560.0 | $657.6 | $1,560.0 | $0 (0%) |
$902.4 (137.2%) |
| Tuberculosisii | – | – | – | – | – |
| Global Health Programs (GHP) account | $310.0 | $275.0 | $319.0 | $9 (2.9%) |
$44 (16%) |
| Economic Support Fund (ESF) account | Not specified | Not specified | Not specified | – | – |
| Malaria | $770.0 | $708.5 | $770.0 | $0 (0%) |
$61.5 (8.7%) |
| Maternal & Child Health (MCH)iii | – | iv | – | – | – |
| GHP accountv | $851.0 | $659.6 | $855.5 | $4.5 (0.5%) |
$195.9 (29.7%) |
| of which Gavi | $290.0 | $290.0 | $290.0 | $0 (0%) |
$0 (0%) |
| of which Poliov | $61.0 | Not specified | $65.0 | $4 (6.6%) |
– |
| UNICEFvi | $139.0 | Not specified | $139.0 | $0 (0%) |
– |
| ESF account | Not specified | Not specified | Not specified | – | – |
| of which Poliov | v | Not specified | Not specified | – | – |
| Nutritionvii | – | – | – | – | – |
| GHP account | $150.0 | $90.0 | $150.0 | $0 (0%) |
$60 (66.7%) |
| ESF account | Not specified | Not specified | Not specified | – | – |
| Family Planning & Reproductive Health (FP/RH)viii | $607.5 | – | $607.5 | $0 (0%) |
– |
| Bilateral FPRHviii | $575.0 | – | $575.0 | $0 (0%) |
– |
| GHP accountviii | $524.0 | $237.0 | $524.0 | $0 (0%) |
$287 (121.1%) |
| ESF accountviii | $51.1 | Not specified | $51.1 | $0 (0%) |
– |
| UNFPAix | $32.5 | $0.0 | $32.5 | $0 (0%) |
$32.5 (NA) |
| Vulnerable Children | $25.0 | $0.0 | $25.0 | $0 (0%) |
$25.0 (NA) |
| Neglected Tropical Diseases (NTDs) | $102.5 | $75.0 | $102.5 | $0 (0%) |
$27.5 (36.7%) |
| Global Health Security | $100.0 | $90.0 | $190.0 | $90 (90%) |
$100 (111.1%) |
| GHP account | $100.0 | $90.0 | $190.0 | $90 (90%) |
$100 (111.1%) |
| Emergency Reserve Fund | x | $25.0 | x | – | – |
| SFOPs Total (GHP account only) | $9,092.5 | $5,998.0 | $9,196.0 | $103.5 (1.1%) |
$3198 (53.3%) |
| Labor Health & Human Services (Labor HHS) | |||||
| Centers for Disease Control & Prevention (CDC) – Total Global Health | $570.8 | $532.2 | $592.8 | $22 (3.8%) |
$60.6 (11.4%) |
| Global HIV/AIDS | $128.4 | $69.5 | $128.4 | $0 (0%) |
$58.9 (84.6%) |
| Global Tuberculosisxi | $7.2 | $7.2 | $9.2 | $2 (27.4%) |
$2 (27.4%) |
| Global Immunization | $226.0 | $206.0 | $226.0 | $0 (0%) |
$20 (9.7%) |
| Polio | $176.0 | $165.0 | $176.0 | $0 (0%) |
$11 (6.7%) |
| Other Global Vaccines/Measles | $50.0 | $41.0 | $50.0 | $0 (0%) |
$9 (22%) |
| Parasitic Diseases | $26.0 | $24.5 | $26.0 | $0 (0%) |
$1.5 (6.3%) |
| Global Public Health Protection | $183.2 | $225.0 | $203.2 | $20 (10.9%) |
$-21.8 (-9.7%) |
| Global Disease Detection and Emergency Response | $173.4 | Not specified | $193.4 | $20 (11.5%) |
– |
| of which Global Health Security (GHS) | $125.0 | $175.0 | Not specified | – | – |
| Global Public Health Capacity Development | $9.8 | Not specified | $9.8 | $0 (0%) |
– |
| National Institutes of Health (NIH) – Total Global Health | Not specified | Not specified | Not specified | – | – |
| HIV/AIDS | Not specified | Not specified | Not specified | – | – |
| Malaria | $208.0 | Not specified | Not specified | – | – |
| Fogarty International Center (FIC) | $80.8 | $73.5 | $84.0 | $3.3 (4.1%) |
$10.5 (14.3%) |
| Notes: | |||||
| i – In the FY21 Request, the administration proposed to consolidate the Development Assistance (DA), Economic Support Fund (ESF), the Assistance for Europe, Eurasia, and Central Asia (AEECA), and the Democracy Fund (DF) accounts in to one new account — the Economic Support and Development Fund (ESDF). ESF funding for the FY21 Request reflects the amounts requested by the administration for ESDF. | |||||
| ii – 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 FY18, TB funding under the ESF account totaled $4 million). | |||||
| iii – 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. n FY18, MCH funding under the ESF account totaled $15.5 million). | |||||
| iv – It is not possible to calculate total MCH funding in the FY21 request because UNICEF, which has historically received funding through the International Organizations and Programs (IO&P) account, was not specified in the FY21 request. | |||||
| v – The minority summary of the FY20 conference agreement states that part of the increase in MCH funding is “due to a shift of $7.5 million for polio prevention programs from the Economic Support Fund account to the Global Health Programs account.” | |||||
| vi – UNICEF funding in the FY20 Conference Agreement both 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.” | |||||
| ix – The FY20 and FY21 final 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 – The explanatory statement accompanying the FY20 Conference Agreement states that the “agreement includes authority to reprogram $10,000,000 of Global Health Program funds to the Emergency Reserve Fund if necessary to replenish amounts used during fiscal year 2020 to respond to emerging health threats.” 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.” | |||||
| xi – In FY20, the administration proposed to formally transfer $7.2 million from the “HIV/AIDS, Viral Hepatitis, STI and TB Prevention” account to “Global Tuberculosis” activities under “Global Health Programs” at CDC. The FY20 conference agreement formalizes this transfer. | |||||
[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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