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Lawmakers on Capitol Hill extended a lifeline to US global response efforts with the provision of supplemental funding. Early on, sums dedicated to the overseas fight were modest, but last year's end-of-year spending package included $4 billion for Gavi, the Vaccine Alliance—to support the multilateral vaccine procurement platform COVAX. And the spring 2021 reconciliation package, known as the American Rescue Plan, included close to $11 billion for international pandemic response.

Setbacks and stalled progress across US global health priorities will demand new investment.

The funding has helped enable the administration to procure more vaccine doses for donation than any other country, while making investments to bolster global vaccine manufacturing capacity and providing support for other critical tools in the fight—including therapeutics, diagnostics, and personal protective equipment. Yet much work remains. To control the spread of COVID-19 and prevent the emergence of new variants, vaccines must reach people. And supporting countries’ recovery from the pandemic will require still greater effort. Setbacks and stalled progress across US global health priorities will demand new investment and lost economic growth could limit the ability of low-income countries to co-finance global health action.   

This blog unpacks what we know about the status of emergency funding and examines what might be on the horizon for US global health spending in the months ahead.

What do we know about supplemental aid funding for the international COVID-19 response?

Getting a sense of how much international COVID-19 relief money remains and where those funds have been spent isn't nearly as straightforward as we'd like. Mercifully, USAID recently issued an updated factsheet highlighting topline figures and key investments, but details are limited. And though we appreciate the concept behind the US government's COVID-19 spending data hub, it’s impossible to make sense of the foreign assistance data, which—when compared to USAID’s own reporting—is seemingly incomplete and definitely outdated.

The interactive chart below depicts the share of supplemental appropriations of international COVID-19 aid that USAID has obligated, based on information from USAID's October update

*USAID-GHP account includes funding allocated for the agency's Emergency Response Fund. Source: USAID fact sheet

Supporting countries in the fight against COVID-19 will require shifting new attention to the logistical challenges associated with getting shots in arms.

During a House Appropriations Subcommittee hearing last week, Executive Director of USAID's COVID-19 Task Force (and former CGD fellow) Jeremy Konyndyk affirmed what the agency's latest updated indicates—much of the USAID-managed funding has been obligated. In fact, the resources available to USAID may be even more limited than this chart suggests. Konyndyk promised lawmakers forthcoming notifications and signaled most of the remaining funding is all but committed. He suggested USAID will be left with only around $250 million in the early part of 2022—which will coincide, he noted, with the agency entering its "most operationally intensive phase of the response." As vaccine supply constraints slowly ease, supporting countries in the fight against COVID-19 will require shifting new attention to the logistical challenges associated with getting shots in arms. The fact that USAID's funding designated expressly for this work is nearly tapped raises questions about the scope and scale of the agency's future engagement.

Our understanding of the status of State Department-managed funds is also a bit murky, though the Department boasts an impressive vaccine sharing dashboard—which provides a regularly updated tally of delivered vaccines and showcases the wide range of country recipients. The largest share of supplemental funding channeled through the State Department was a $3.5 billion contribution to The Global Fund to Fight AIDS, Tuberculosis and Malaria—more than half of which has reportedly been obligated. Deputy Assistant Secretary for Population, Refugees and Migration Lesley Ziman shared Wednesday that $447 million of the $500 million provided by the American Rescue Plan for Migration and Refugee Assistance is out the door; nearly $215 million of this total is supporting UNHCR’s emergency response appeal.

The interactive chart below depicts supplemental appropriations of international COVID-19 aid managed by the State Department. In the absence of clear data from the Department, we are unable to represent obligations.

*Economic Support Funds are jointly managed by the State Department and USAID. $250 million was appropriated to ESF under the Coronavirus Response and Preparedness Supplemental, $9.9 million of which is managed by the State Department. Of that amount, $9.2 million in spending has been notified, according to USAID’s October factsheet. USAID notes that a portion of the funding designated as ESF through American Rescue Plan is managed by the State Department but doesn’t provide any updates regarding this share.

**The American Rescue plan was passed via budget reconciliation and as such international affairs line items aren’t specified using the standard terminology. We assume proximate values for these accounts based on context and language in the bill.

State Department Coordinator for Global COVID-19 Response and Health Security Gayle Smith, who also testified Wednesday, described the administration's ongoing work to encourage other donor countries to step up their contributions and engage with private sector actors urging the same. But she acknowledged the Department will face a gap in funding “in the not too distant future.”

What's next for US global health spending?

The federal government is currently operating under a continuing resolution that runs through December 3, giving both chambers a few more weeks to agree to a full FY22 appropriations package. But while the spending bills drafted by House and Senate Appropriations Committees would provide slightly more global health funding than was included in the president's budget request—neither would deliver a major boost. And, as is typical, appropriators have specified precisely how global health funds should be allocated, directing resources to an array of diseases and longstanding US global health priorities. Amid ongoing concerns about pandemic-related health service disruptions, fully funding regular global health programming is important. But extensive spending directives leave limited flexibility to respond to urgent and evolving circumstances, and the scale of the job ahead.

Table 1. Global health programs FY22 funding proposals ($ in millions)

Account President’s Request House Senate
Global Health – USAID $3,870.95 $4,561.45 $4,423.95
Global Health – State $6,180.00 $6,080.00 $5,930.00

Critically, each bill provides $1 billion for global health security. Recent experience has left little question that we need to invest more in global preparedness to address future health threats.

But—on the whole—the limited scale-up of foreign aid spending, even as USAID and State have spent down previously appropriated response money and needs increase, threatens the United States' efforts to bring the pandemic under control.

What about other potential sources of financing?

During this unprecedented global crisis, international financial institutions continue to be a vital line of defense, with direct country relationships and financing at a scale that is simply unmatched. In the months ahead these institutions are going to be increasingly vital to expanding vaccine access around the world.

Replenishment cycles and capital increase contribution schedules typically drive US annual funding levels for the multilateral development banks. In recent years, Treasury's international programs budget request has utterly failed to address growing US arrears to some key institutions. The Biden administration's first budget broke that trend by seeking to clear unmet commitments to the World Bank associated with past International Development Association (IDA) pledges along with more modest contributions toward unmet commitments to the concessional windows of the African Development Bank and Asian Development Bank. As shown in the chart below (use the dropdown to select the institution), both House and Senate delivered on the smaller sums for the African Development Fund and Asian Development Fund. Neither included additional funding for IDA.

Many in the development community are expecting donor countries—including the US—to put the new issuance of IMF special drawing rights (SDRs) to use supporting global COVID-19 response and recovery. The president's budget request included language to authorize loans of SDRs to a designated IMF trust fund. The House passed spending bill includes the requested text; the bill from the Senate Appropriations Committee does not.

Emergency spending provided by Congress has enabled an increasingly robust US international response to the pandemic. But the prospect of sizable new funding looks uncertain at best, raising questions about how key US agencies can provide the support needed to help bring an end to the pandemic. Lawmakers on both sides of the aisle have acknowledged the critical role of US leadership when it comes to fighting COVID-19 around the world, urging the administration to do more and do it faster. But realizing that vision seems certain to require new resources. The question is whether the United States is prepared to demonstrate the political will to meet this moment of crisis.

Thanks to Amanda Glassman and Scott Morris for comments on an earlier draft.

Disclaimer

CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.

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