U.S. Government Funding

and Legislative Issues

Brian Massa, Senior Manager,

Global Health Advocacy

1

U.S. Government Funding for Global Health and Immunization Programs

Overview

• Recent history and trends in global health and immunization funding• Federal budget process• Authorizations and Appropriations• Key agencies and organizations and their roles• The Road Ahead: New Administration, new Congress, new rules

U.S. Global Health Funding as a Share of the Federal Budget, FY 2016

Source:KFF

Federal Budget

$4.1 trillion

Global Health $10.2 billion

<1%

Key Takeaways

• Federal funding for global health accounts for a tiny portion of the total federal budget

Mandatory vs. Discretionary Spending

f

• Mandatory spending is set by statute and not subject to annual appropriations acts

• Discretionary spending comes from annual appropriations under the control of House and Senate Appropriations Committees

Total Mandatory vs. Discretionary Spending, FY15 ($3.8 trillion)

f

U.S. Global Health Funding FY2006-FY2016

Source: Kaiser

Key Takeaways

• U.S. Funding for global health activities has roughly doubled since the mid 2000s

• Funding plateau in recent years is actually a success story

• Global health funding has actually increased as a share of the overall international aid budget

U.S. Global Health Programs by Program, FY16

HIV/AIDS, Malaria, TB,

FPRH, Maternal Health, etc

$9,706 95%

Global Immunization

Programs$513 5%Total: $10,200

Source: KFF, in millions US$

Key Takeaways

• Across all USG $10.2 billion in spending for global health programs, about $513 million is devoted to global immunization programs

U.S. Government Funding for Global Immunization Programs FY12 – FY17 (est)

$0.00

$100.00

$200.00

$300.00

$400.00

$500.00

$600.00

FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 (est)

CDC Imm USAID-Gavi USAID-Polio

Mill

ion

s U

S $

Source: Adapted from Kaiser Family Foundation

Key Takeaways

• Significant increases for global immunization programs between FY12-FY17 estimated levels

• Including estimated FY17 levels, U.S. funding for global immunization would have increased by $217 million since FY12

• Up to Shot@Life advocates to keep the pressure on Congress to approve high FY18 levels

When do we Advocate?

President’s Budget Request

Congressional Budget

Resolutions

Congress creates spending bills

Spending Agreement finalized

February April May-July September-OctoberAdvocate2Vaccinate

Meet with you Members to

support strong vaccine

funding numbers

Call your

member of

Congress to

defend vaccine

funding.

Meet with your member

of Congress to thank

them.

The U.S. Congress and Global Health Policy

• Authorizing Bills • PEPFAR, Water for the World Act, Global Health

Technologies Act, Girls Count

• Appropriations Bills• Funding for GAVI, UNICEF, polio eradication, measles

elimination

• Commemorative and celebratory resolutions• World Polio Day Resolution, GAVI resolution

Authorizing Vs. Appropriating

• The Water Bucket Analogy• Bucket = Program• Water = Money

• Authorizing Committees create the buckets• Appropriating Committees fill them with water

(or often they don’t!)

Important Committees

House of RepresentativesAuthorizing Committees Appropriations Committees

--Foreign Affairs --State/Foreign Ops

--Energy and Commerce --Labor, HHS

U.S. SenateAuthorizing Committees Appropriations Committees

--Foreign Relations --State/Foreign Ops

--HELP --Labor, HHS, Education

Tying it Together: From Appropriations to Health Activity

Source: KFF

The U.S. is directly

involved in on-the-

ground efforts via:

CDCU.S. Centers for

Disease Control

and Prevention

United Nations UNICEF + WHO

USAIDU.S. Agency for

International

Development

Gavi, the

Vaccine Alliance

The U.S. also

supports and

invests in:

Lead Bodies for Global Vaccines

Lead Bodies for Global Vaccines: USAID

• An Independent agency that is funded by Congress through the State and Foreign Operations spending bill

• Operates programs with MNCH components in 58 countries 21 Of these are designated as MNCH “priority countries,” which are primarily in Africa and receive the majority of funding

• Global immunization policy and programs focus on investment, innovation and improving delivery in the field through cold chain and delivery systems

Lead Bodies for Global Vaccines: CDC

• An operating division of the Department of Health and Human Services and is funded by Congress through the Labor, Health and Human Services appropriations bill

• Global health initiatives involve over 1,700 staff in 60 countries and focus on building country public health and technical capacity to better prevent and respond to public health emergencies

• Leading partner of the Global Polio Eradication Initiative

• Founding partner of the Measles & Rubella Initiative

Lead Bodies for Global Vaccines: Gavi

• Independent public-private partnership

• The U.S. is one of the largest donors and channels funding through USAID

• Focus on introducing new and underused vaccines in developing countries, improving equitable access (gender, income), cost containment, strengthening country accountability and transparency

Lead Bodies for Global Vaccines: The UN

• World Health Organization (WHO)• UN Agency with country members paying assessed dues • Policy focuses on safety, standardization, research and

development and global policy

• UNICEF• UN Agency with countries paying voluntary dues• Policy focuses on procurement, expanding immunization

coverage, cold chain, community engagement, and social mobilization

The Road Ahead: FY17, FY18 and Beyond

President’s

FY18

“Skinny”

Budget

Request

Budget Comm.

finalizing FY18

topline numbers

Congress works on FY18

spending bills FY17 ends; FY 18

begins

April May-July September-OctoberMarch

FY17 CR Expires;

Likely facing cuts

for remainder of

FY17

President Releases full

FY18 budget

Questions?