The US Congress has repeatedly rejected Trump administration proposals to slash funding for foreign assistance, including global health. This year, the global health community is looking to Capitol Hill to again turn back deep funding cuts proposed for fiscal year 2020 and ensure these programs remain strong and effective for years to come.
House Appropriations subcommittees have begun work on their respective appropriations bills (the Labor, Health and Human Services bill – which funds NIH and CDC – was marked up last week, and the State and Foreign Operations bill – which funds USAID and the State Department – is expected to be marked up this week). Chair Nita Lowey (D-NY) wants to hold floor votes on all appropriations bills in June, and it is hoped that the Senate won’t be too far behind on its appropriations work. However, much remains to be seen in how the administration will respond to the spending package, and if it will continue to fight for its priorities, such as funding for a border wall.
Here are 5 things you need to know about U.S. global health funding this year:
Congress must take critical action on the Global Fund: At this fall’s 2019 replenishment meeting, donors to the Global Fund to Fight AIDS, Tuberculosis and Malaria will hopefully pledge $14 billion over 3 years to the fund. Currently, for every $2 other donors contribute, the US provides $1. This match is critical in encouraging other donors to contribute. Unfortunately, President Trump’s $958 million Global Fund request in his FY 2020 budget fell far short of the community’s recommendation of $1.56 billion. The president also proposed reducing the US match from 1:2 to 1:3.
Congress must respond with 2 critical actions. First, the House and Senate appropriations committees should increase funding for global health programs at the State Department, which includes support for the Global Fund as well as US-implemented HIV programs. This will create room for the full $1.56 billion Global Fund contribution, without jeopardizing other programs. Second, Congress must include strong legislative language reinforcing the $1 to $2 US match to ensure the full appropriated amount is delivered to the Global Fund in a timely manner.
Sustained investment in research and development is critical to global health progress: The administration has proposed extensive cuts to key federal agencies and initiatives that support research and development of drugs, vaccines and diagnostics. This included over $1 billion dollars in reductions to the CDC, NIH and USAID, which support critical research and tools like antiretrovirals for HIV/AIDS, vaccines for childhood diseases, and diagnostics for emerging infectious diseases.
Decades of bipartisan commitment to research has been the bedrock of global health progress. Cuts to R&D funding today will cost lives tomorrow.
Make investments today to fight the outbreaks of tomorrow: During the Ebola outbreak in West Africa in 2014, Congress passed an emergency $5.4 billion supplemental bill for response efforts including $1 billion for existing USAID and CDC programs that help build in-country capacity to prevent, detect, and respond to future outbreaks. This funding will expire at the end of FY 2019 (September 30, 2019). Without new funding in FY 2020, these programs that have upgraded labs, stockpiled drugs, and trained epidemiologists may be scaled back. Investing in pandemic preparedness now is a better (and cheaper) investment than spending billions of dollars during an outbreak. And preparing now can help stop the next outbreak, whether it’s Ebola, flu, or “disease X,” before it reaches the US.
Congress appropriates the money—what’s next?: Congress’ intent for global health funding is clear—these programs should continue to address the major causes of illness and death around the globe. However, some are concerned that the administration is slow walking this funding out the door, leading to the risk of the expiration of funding. Moreover last year, the administration twice proposed rescission packages that would have clawed back unobligated global health funding. Congress rejected both requests. Such funding uncertainty hinders long-term planning in countries, eroding the effectiveness of global health programming.
Given the president’s proposed cuts for FY 2020, the risk to funding reductions outside of the Congressional appropriations process remains. Congress and the global health community must stay vigilant to ensure every dollar appropriated is effectively used to improve health outcomes around the globe.
The future of global health: We are grateful that Congress has continuously rejected proposed cuts to global health programs and research efforts, but funding for far too many of these programs remain flat, stymying progress and our ability to take effective interventions to scale.
In order to finish the fight on AIDS, malaria, TB and address other global health threats, continued strong commitment from Congress is critical. Commitment is needed not just for increased funding but for sound policy and oversight of existing programs to ensure taxpayer dollars are spent smartly. Millions of people need help from the most effective health interventions possible.
Katie Coester is a policy advisor for the Elizabeth Glaser Pediatric AIDS Foundation; Emily Conron is the US policy and advocacy officer for the Global Health Technologies Coalition; and Danielle Heiberg is the senior manager for policy and advocacy for the Global Health Council.
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