Biden Administration's Commitment to Global Health in FY 2023 President's Budget

The United States Government is proud to be the largest donor for global health and supporter of research and cooperation worldwide. As we work to end the COVID-19 pandemic, we remain committed to investing in global public health, science partnerships and collaboration, strengthening health systems and institutions, advancing global health security, and accelerating efforts towards achieving universal health coverage and the objectives of the Sustainable Development Agenda. The President's Budget for Fiscal Year (FY) 2023 requests mandatory and discretionary funding totaling over $17 billion for the Department of State (State) and the U.S. Agency for International Development (USAID) and over $11 billion for the Department of Health and Human Services to advance U.S. leadership in global health, including health system strengthening; HIV/AIDS, malaria, and tuberculosis; maternal and child health; family planning and reproductive health; nutrition; global health security, and pandemic and other biological threat preparedness, and neglected tropical diseases.

We continue to lead the global community toward a safer, more equitable future. Investments in global health advance U.S. foreign policy interests by protecting Americans at home and abroad, promoting economic progress and recovery, and supporting the rise of capable partners to better solve regional and global problems.

Over the last year, the Biden-Harris Administration has renewed U.S. leadership in global health, and the FY 2023 Budget will continue to advance global health priorities on the following:

• Strengthening health systems, including the global health workforce. The FY 2023 Budget prioritizes sustained investment across health programs to support health system resilience and strengthening. The Budget provides $1 billion in mandatory funding for State and USAID to support and protect the global health workforce as part of the Administration's increased prioritization and investments in human resources for health. These resources are intended to support the Administration's launch of a new Global Health Worker Initiative, which complements the Domestic Health Worker Initiative launched by the Administration last year. In addition, the FY 2023 Request includes $10 million for USAID to establish a Health Resilience Fund (HRF) to support cross-cutting health systems strengthening in countries emerging from crisis. The HRF will provide flexible, no-year funding to ensure basic health services are accessible to those most in need and to build more resilient health services and systems in order to prevent worse outcomes from ongoing health crises. The FY 2023 Request also includes over $265 million in discretionary funding for the Centers for Disease Control and Prevention (CDC) for partnerships that build critical health system capacity for global immunizations and the fight against parasitic diseases and malaria.
• Supporting enhanced global leadership on addressing HIV/AIDS, malaria, and tuberculosis. The Budget includes $4.37 billion for State to support U.S. President's Emergency Plan for AIDS Relief (PEPFAR) bilateral programs and the global AIDS response. Funds will continue to save lives, prevent millions of HIV infections, and help countries build a strong foundation to prevent, detect, and respond to other health threats, including COVID-19. Across 55 countries, PEPFAR invests in strengthening local health systems' ability to respond to HIV. The FY 2023 Budget also includes $2 billion to support the Global Fund's seventh replenishment for an intended pledge of $6 billion over three years, to save lives and continue the fight against HIV/AIDS, tuberculosis, and malaria, as well as $780 million for the U.S. President's Malaria Initiative to continue the fight against malaria. Finally, the FY 2023 Budget requests $350 million for USAID to support programs combatting tuberculosis around the world.
• Strengthening multilateral global health institutions: Funding requested in FY 2023 will support efforts to strengthen our partnerships with multilateral global health institutions, including the World Health Organization and the United Nations Children's Fund.
• Building global health security and pandemic preparedness capacities. The FY 2023 President's Budget includes nearly $750 million for USAID, and over $1.5 billion in mandatory and discretionary funding for CDC, to expand global health security capacity building to additional partner countries, strengthen global disease detection, bolster our commitment to the multilateral Global Health Security Agenda, and accelerate progress toward improved prevention, detection, and response to infectious disease threats. Funding through USAID would support $250 million for Access to COVID-19 Tools (ACT) Accelerator multilateral organizations, and $590 million in discretionary and mandatory funding to replenish USAID's Emergency Reserve Fund for Contagious Infectious Diseases (ERF).
• Financing for global health security and pandemic preparedness. The Budget includes $4.75 billion in mandatory and discretionary funding for State to establish a new financial intermediary fund (FIF) at the World Bank focused on global health security and pandemic preparedness. This catalytic, fit-for-purpose financing mechanism is critical to filling major gaps in the world's ability to prevent, detect, and respond to infectious disease threats and future pandemics at the national, regional and global levels. The Budget also provides $500 million over five years for the Coalition for Epidemic Preparedness Innovations (CEPI) to support innovations in science and technological capabilities to shorten the cycle for development of safe, effective, and globally accessible vaccines for pathogens with pandemic potential.
• Building global medical countermeasure readiness, research and development, and advancing capacity to conduct variant and strain surveillance through support for global innovations in vaccine and therapeutics policy development, program design, and effective monitoring of the viral strains that are circulating globally to detect the emergence of significant variants. The Budget includes $5.9 billion in mandatory funding for CDC for this effort which would expand and strengthen multi-pathogen and molecular laboratory capabilities, bioinformatics systems, and data modernization to detect and monitor respiratory and other high-consequence pathogens.
• Advancing biosafety and biosecurity in the United States and globally to prevent biological incidents. The Budget supports applied research and innovation in biosafety and biosecurity, which will expand capabilities to identify and minimize safety and security risks in the design and development of biotechnology. It also enables CDC and USAID to expand efforts to strengthen biosafety and biosecurity practices and globally.
• Leading global threat detection innovations through a globally connected network of public health surveillance systems that optimizes disease prevention and health promotion as we strengthen surveillance initiatives to provide necessary actionable data before, during, and after a pandemic. The Budget includes $2.47 billion in mandatory funding for CDC to will include enhancements to domestic sentinel surveillance programs, expansion of domestic and global wastewater surveillance, and investments in global genomic surveillance approaches as well as global respiratory disease surveillance platforms. CDC will transition and sustain genomic surveillance capacities initially developed for COVID-19 to support additional priority pathogens.
• Sustaining commitments in global maternal and child health. As the largest donor to both maternal health and voluntary family planning programs, including the provision of life-saving health care services in crisis settings, the United States will continue its efforts to make pregnancy and childbirth safer by strengthening health systems to provide women with integral health services, including increased access to maternal health care and voluntary family planning. The FY 2023 Budget includes $879.5 million for USAID to continue the United States' sustained commitment to ensure that critical health services continue to prevent child and maternal deaths globally. This includes $290 million for a contribution to Gavi, the Vaccine Alliance, to reach children with cost-effective vaccines to accelerate progress towards preventing child deaths. In addition, $25 million is requested for USAID to support the implementation of the U.S. Government's Strategy Advancing Protection and Care for Children in Adversity and USAID's Child Blindness Program to reduce childhood blindness and improve eye health.
• Advancing sexual and reproductive health and rights. In the last year, the Administration has taken several legislative and policy steps to advance sexual and reproductive rights around the world, starting with President Biden's issuance of a Presidential Memorandum on Protecting Women's Health at Home and Abroad in his first days in office, which revoked the expanded Mexico City Policy and directed agencies to resume funding to the United Nations Population Fund (UNFPA) in support of its essential work to prevent maternal deaths, expand access to voluntary family planning, and prevent and respond to gender-based violence around the world. Under the leadership of Secretary Blinken, the Department of State has returned to reporting on sexual and reproductive health issues in its Annual Country Reports on Human Rights. The Administration continues to advance sexual and reproductive health and rights (SRHR) for all, in support of accelerating progress toward universal health coverage and gender equality. The FY 2023 Budget provides $597 million to continue support for critical SRHR programs globally, as well as a $56 million contribution to the United Nations Population Fund. As the largest bilateral donor to family planning, the United States will continue to lead globally by advancing SRHR in multilateral fora and with bilateral partners. Funds will support increased access to SRHR services.
• Continuing to demonstrate strong global leadership on nutrition. Given increased rates of global malnutrition, and expected further impacts on global food security from Russia's unprovoked further invasion of Ukraine, the United States will accelerate efforts to support global nutrition, particularly for vulnerable populations. The FY 2023 Budget includes $150 million for USAID for global health nutrition programs, in addition to over $1 billion in State and USAID economic and development assistance, $1.7 billion in emergency food aid via Food for Peace Title II, and humanitarian assistance to support food security and nutrition globally.
• Supporting efforts to address neglected tropical diseases. The FY 2023 Budget includes $114.5 million to continue USAID's long-standing and effective public-private partnerships with pharmaceutical companies to focus on ending the most prevalent neglected tropical diseases (NTD). Over the past 15 years, USAID has leveraged $27.6 billion in donated medicines, resulting in the delivery of more than 2.8 billion treatments to approximately 1.4 billion people. This funding will also support USAID in achieving its goal to eliminate at least one NTD as a public health problem within 5 years in 15 countries, and to expand private sector partnerships.
• Leading the global COVID-19 response. The Biden Administration has submitted an urgent request to Congress for $5 billion to accelerate near-term COVID-19 global response. Without additional funding to support getting shots into arms, U.S. agencies will have to cut short efforts to turn vaccines into vaccinations across the globe. Leaving large unvaccinated populations worldwide will increase the risk of new, emerging deadly variants that could evade our current vaccines and treatments. Without additional funds, the Administration would be unable to extend Global VAX surge support to 20+ additional under-vaccinated countries that will need intensive support this year to get shots in arms. This will devastate our ability to ensure those countries can effectively deploy safe and effective vaccines. U.S. agencies will also be unable to provide life-saving supplies, tests, therapeutics, oxygen, and humanitarian aid to countries still struggling to manage a continuing COVID-19 disease burden.