The White House released its FY 2021 budget request to Congress on February 10, 2020, which includes significant cuts to global health programs compared to the FY 2020 enacted levels. In addition, in some cases, these cuts are steeper than those proposed by the Administration in last year’s request. The FY 2021 budget request 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). Key highlights 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, totaled $5,998 million, a decrease of $3,095 million (34%) from the FY 2020 enacted level, and $346 million below the President’s FY 2020 request. Almost all program areas in the FY21 request declined compared to FY20 enacted levels.
• Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $3,180 million, $1,520 million below the FY20 enacted level, and $170 million below the FY20 Request ($3,350 million).
• The request includes $658 million for the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), a decrease of $902 million below the FY20 enacted level ($1,560 million) and $301 million below the FY20 Request ($958 million). The administration states that the U.S. will match $1 for every $3 contributed by other donors and that, when combined with already appropriated funding, this will keep the U.S. on track to meet its $3.3 billion pledge for the Global Fund’s sixth replenishment.
• Funding for tuberculosis (TB) totals $275 million, $35 million below the FY20 enacted level ($310 million), and $14 million below the FY20 Request ($261 million).
• Funding for malaria totals $709 million, $62 million below the FY20 enacted level ($770 million), and $35 million below the FY20 Request ($674 million).
• The request includes $660 million for maternal and child health (MCH), a decrease of $191 million below the FY20 enacted level ($851 million), and $40 million below the FY20 Request ($620 million). This decrease is to bilateral MCH funding. Gavi, the Vaccine Alliance, which is included under MCH funding, is the only program area that did not decline compared to the FY20 enacted level; funding totals $290 million, matching the FY20 enacted level, and $40 million above the FY20 Request ($250 million).
• Funding for nutrition totals $90 million, $60 million below the FY20 enacted level ($150 million), and $12 million below the FY20 Request ($79 million).
• Bilateral family planning and reproductive health (FP/RH) funding totals $237 million, $287 million below the FY20 enacted level ($524 million), and the same level as requested in FY20 ($237 million). The FY21 Request proposed eliminating funding for the United Nations Population Fund (UNFPA). In FY20, Congress provided $32.5 million for the U.S. contribution to UNFPA. However, it is anticipated that the Trump Administration will invoke the Kemp-Kasten amendment to withhold this funding again (learn more about the Kemp Kasten amendment here).
• The FY21 Request proposed eliminating funding for the vulnerable children program, which was funded at $25 million in FY20.
• Funding for neglected tropical diseases (NTDs) totals $75 million, $28 million below the FY20 enacted level ($103 million), and matching the FY20 Request ($75 million).
• Funding for global health security totals $90 million, a decrease of $10 million below the FY20 enacted level ($100 million) and matching the FY20 Request.
• Funding to replenish the Emergency Reserve Fund, which is used to “quickly and effectively respond to emerging disease outbreaks,” totals $25 million; in FY20, Congress provided the authority to transfer $10 million in funding from other areas to the Emergency Reserve Fund if needed.
• Funding for the World Health Organization (WHO) totaled $58 million, a $65 million decrease compared to the FY20 enacted level ($123 million) and flat compared to the FY20 Request.
• Funding for the Pan American Health Organization (PAHO) totaled $16 million, a $50 million decrease compared to the FY20 enacted level ($66 million) and a $17 million decrease compared to the FY20 Request ($33 million).

Centers for Disease Control and Prevention (CDC): Funding for global health provided to the CDC totals $532 million, a decrease of $39 million compared to the FY20 enacted level ($571 million) and $75 million above the FY20 Request ($457 million). The entire increase in CDC funding is to support global health security activities; all other areas declined except global tuberculosis funding which remained flat. For example, funding for global HIV activities in the request declined by $59 million and funding for global immunization activities declined by $20 million.

Fogarty International Center (FIC): Funding for the Fogarty International Center (FIC) at the National Institutes of Health (NIH) totaled $74 million, $7 million below the FY 2020 enacted level ($81 million) and $7 million above the FY20 Request ($67 million).

• White House FY 2021 Budget Resources (.pdf)
• State/USAID FY 2021 Congressional Budget Justification
• CDC FY 2021 Congressional Budget Justification
• NIH FY 2021 Congressional Budget Justification