Issue Deep Dive: US/Global Health

Last updated: January 10, 2023

ODA Spending

ODA in Context

2020, the US was the world’s largest donor to global health, representing 41% of all health ODA provided by OECD DAC donor countries. Compared to the size of its overall ODA budget, the US was fourth among DAC donors in terms of its prioritization of global health.

In 2020, the US spent 29% of its development assistance on global health, more than any other donor.

The USODA for health has been consistent in recent years but spending on infectious disease control — the second-highest funded health sub-sector in 2017 — plummeted by 83% over the course of three years to US$114 million in 2020. This steep decline represents the period of relative calm between three major health events, namely the Ebola (2015), Zika (2016), and COVID-19 epi/pandemics (2020).

As with its overall development budget, the US channeled a majority of its ODA bilaterally in 2020.

ODA Breakdown

Bilateral Spending

The US spent a total of US$7.8 billion on bilateral health ODA in 2020 (including earmarked contributions to multilateral organizations). This represented 75% of its ODA to health. The US’ bilateral health ODA in 2020 focused on STD control, including HIV/AIDS (63%, or US$4.9 billion, a 26% increase from 2019), malaria control (9%, or US$708 million; a 24% decrease), reproductive health care (6%, or US$494 million; a 15% decrease), and COVID-19 control (6%, or US$436 million; emerging for the first time in 2020 due to the COVID-19 pandemic).

Multilateral Spending and Commitments

The other 25% of the US’ health ODA was channeled as core funding to multilaterals. The largest disbursement in 2020 went to the Global Fund (US$2.1 billion, or 20% of global health ODA). The US pledged US$4.7 billion to the Global Fund for 2020-2022. In 2020, the US also disbursed US$272 million (3%) to Gavi. The US pledged US$1.2 billion in direct contributions for 2020-2023, an increase of US$200 million over its 2015-2018 pledge.

Funding and Policy Outlook

The US’ main global health priorities are controlling the HIV/AIDS epidemic, fighting infectious diseases, and preventing child and maternal deaths: According to the Kaiser Family Foundation, funding from the US accounted for 76% of international assistance to HIV from donor governments in 2020. 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. In FY2022, PEPFAR disbursed US$7 billion (including US$5.4 billion for bilateral HIV programming and US$1.6 billion for multilateral efforts, including the Global Fund and UNAIDS). 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 FY2022, US bilateral malaria funding amounted to US$775 million. The Biden administration’s FY2023 budget proposes to up this funding 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 has emerged as a focus of the USODA: 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$2.0 billion in February 2021 and a promised pledge of an additional US$2.0 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
  • Bolster international health security architecture for a better response to pandemic threats.

A significant focus of US health ODA is support for MNCH: The FY2023 budget request puts US$880 million toward MNCH, 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 and for those who fund or support other groups which provide or discuss abortion. Biden's State Department provided US$31 million in core funding to UNFPA in FY2021, with US$33 million appropriated in the budget for FY2022. President Biden’s FY2023 budget provides a 8% increase in the overall family planning budget to US$653 million.

Key Bodies

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.

Adam Jennison

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