Issue Deep Dive
US / Global Health
Last updated: April 28, 2023
In 2021, the US was the largest donor to global health, providing US$14.6 billion in health ODA. The US spent 30% of its development assistance on global health, second only to Canada in terms of relative prioritization.
Biden’s FY2024 budget proposal requests a small 3% increase in overall global health spending from FY2023 to a total of US$10.9 billion. Overall, the US’ ODA for health has been relatively consistent in recent years, but spending has been reprioritized in the wake of the COVID-19 pandemic, with increased spending on COVID control and global health security. In FY2023, the budget for global health grew 8% over the enacted total of US$9.8 billion in FY2022. In addition, the Biden administration continues to prioritize global health security, with US$1.2 billion allocated in Biden’s FY2024 budget proposal .
As with its overall development budget, the US channeled the majority of its ODA bilaterally in 2021.
The US spent a total of US$8.2 billion on bilateral health ODA in 2021, including earmarked funding through multilaterals. This represented 56% of its ODA to health. The US’ bilateral health ODA in 2021 focused on STD control, including HIV/AIDS (56%, or US$4.6 billion), COVID-19 control (10%, or US$830 million), malaria control (9%, or US$696 million), and reproductive health care (6%, or US$493 million).
The other 43% of the US’ health ODA was channeled as core funding to multilaterals, a significant increase from the 25% channeled as core funding to multilaterals in 2020. The largest disbursement in 2021 went to Gavi (US$4 billion, or 27% of global health ODA) for emergency funding to distribute COVID-19 vaccines through COVAX. The US also pledged US$1.2 billion in direct contributions for 2020-2023, an increase of US$200 million over its 2015-2018 pledge. In 2022, the US pledged a total of US$6 billion to the Global Fund for 2023-2025. The Global Fund continues to have strong bipartisan support on Capitol Hill.
The US’ main global health priorities are controlling the HIV/AIDS epidemic, fighting infectious diseases, and preventing child and maternal deaths: US global health spending for FY2023 includes US$4.4 billion for PEPFAR, as well as funding for SRHR, HIV/AIDS, malaria, tuberculosis, MNCH, and nutrition. According to the Kaiser Family Foundation, funding from the US accounted for 73% of international assistance to HIV from donor governments in 2021. The PEPFAR, which covers bilateral funding for HIV/AIDS and TB programs, as well as US contributions to the Global Fund and UNAIDS, channels about two-thirds of all US funding for global health. The US is also the largest funder of global initiatives to combat malaria. The US’ efforts against malaria are achieved primarily through PMI, an interagency initiative led by USAID. In FY2023, US bilateral malaria funding amounted to US$795 million. The Biden administration’s FY2024 budget proposes to reduce this funding down to US$780 million. In October 2021, PMI released a five-year End Malaria Faster strategy for 14 African countries, following the WHO’s approval of a groundbreaking malaria vaccine.
COVID-19 emerged as a focus of the US’ ODA: In March 2021, Biden signed the American Rescue Plan into law, which included US$11 billion for the global COVID-19 response. US$3.5 billion was allocated to the Global Fund and US$5.2 billion to USAID. Biden also launched a National Security Council Directorate on Global Health Security and Biodefense. Under Biden, the US joined COVAX to provide vaccines globally with an initial pledge of US$2 billion in February 2021 and a promised pledge of an additional US$2 billion. In July 2021, the Biden Administration released a US COVID-19 Global Response and Recovery Framework, setting forth the following five objectives to end the pandemic, mitigate its negative impacts, and strengthen future pandemic preparedness:
- Accelerate the equitable distribution of COVID-19 vaccinations;
- Strengthen health systems in order to reduce the severe effects of COVID-19 and to better prepare for future threats;
- Address the acute needs that COVID-19 has caused, including reducing household economic shocks and building resilience;
- Provide economic and other support to critical systems that COVID-19 has put under stress; and
- Bolster international health security architecture for a better response to pandemic threats.
The focus on efforts to counter COVID-19 was reinforced by USAID Administrator Samantha Power in a global health policy speech in April 2023, in which she outlined her three-point strategy for turning the tide on global public health. The three focus areas include: managing COVID-19 as an endemic disease, building up global capacity to address potential future pandemics, and investing in primary healthcare workers across the globe.
In spite of ongoing efforts to combat COVID-19, additional funding towards global COVID-19 relief has faced resistance in congress. Further global funding to address the COVID-19 pandemic has not been approved.
A significant focus of US health ODA is support for MNCH: US$910 million went toward MNCH in the enacted FY2023 budget, much of which is allocated through USAID. Despite the US’ policy emphasis on MNCH, family planning is a contentious issue in the US, particularly under Republican administrations. Since assuming office, the Biden Administration repealed two policies reinstituted under the Trump Administration that restrict US funding for SRHR programming: the Kemp-Kasten Amendment and the Mexico City Policy. The Kemp-Kasten Amendment withholds all US funding to UNFPA. The Mexico City Policy, also known as the ‘global gag rule’, blocks US global health funding for both non- US NGOs directly involved in abortion services or abortion rights advocacy as well as for those who fund or support other groups that provide or discuss abortion. President Biden’s FY2023 family planning budget was US$608 million , staying steady from FY2022.
In March 2023, USAID released its MNCH strategy document, Preventing Child and Maternal Deaths: A Framework for Action in a Changing World, 2023-2030. The strategy advances plans to reduce preventable maternal and child mortality in 25 target countries to 12% or lower as compared to total deaths by 2030.
To meet these objectives, the USAID strategy outlined the following priorities:
- Primary health care among the most underserved populations;
- Fostering local partnerships and commitments;
- Increasing investment in the healthcare workforce;
- Tailoring solutions to local contexts and priorities; and
- Increasing and improving evidence-based results.
|Global health R&D is also important to addressing many of the global health challenges that disproportionately affect the world’s most disadvantaged people. For more information on how donor countries are supporting global health R&D across three main areas — 1) EIDs; 2) PRNDs; and 3) SRH — read the excellent G-Finder reports and explore the interactive data portal created by Policy Cures Research. Not all funding mentioned in these analyses qualifies as ODA.|
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