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In late May, the Biden-Harris administration released its detailed fiscal year 2022 budget request. Here's our breakdown of the details of the proposal and initial takeaways of how, if enacted, it could impact global health research and development programming.

June 17, 2021 by Marissa Chmiola

In late May, the Biden-Harris administration released its detailed fiscal year 2022 (FY22) budget request. While the budget proposes significant, and welcome, boosts in funding to US health and research agencies—including the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and the Biomedical Advanced Research and Development Authority (BARDA)—and global health security programming at the State Department and US Agency for International Development (USAID), it falls short in its proposals to address long-standing global health challenges, where it largely proposes flat funding across key global health funding lines.

Below we break down the details of the proposal and initial takeaways of how, if enacted, it could impact global health research and development (R&D) programming.

State & USAID Global Health Programs

In its budget narrative, the Biden-Harris administration touts plans to build on the global health sector’s “demonstrated success” and ensure we are “better prepared to prevent, detect, and respond to future biological threats and pandemics.” It recommends $10 billion in funding for USAID and State Department Global Health Programs—an $855 million, or 9.3 percent, increase over FY21 enacted spending—which is welcome news. Yet as you dive deeper into the proposal, it is clear one issue has risen to the top of the administration’s priority list: global health security. Of the $855 million overall proposed increase, $805 of it, or roughly 97 percent, is directed to health security–related funding lines. This includes $250 million for a new Global Health Security line under the State Department’s Global Health Programs to support a “new health security financing mechanism, which would be developed alongside U.S. partners and allies” and $555 million for USAID’s Global Health Security line. These investments could be transformative and are vitally needed as partner nations work to shore up their health systems to respond to COVID-19 and prepare for future health threats, and the new financing mechanism could support countries in strengthening their R&D capacity.

Yet, it is discouraging to see the proposal largely overlook other pressing global health needs. Outside global health security, only two other Global Health Programs funding lines—USAID Maternal and Child Health and USAID Family Planning—receive any proposed increases, and they are modest at $24 million and $26 million, respectively. All other programs and lines are level funded compared to FY21 enacted funding. This was disappointing given most funding for global health R&D at USAID is from these disease/health-area lines, and implementers need additional resources as they face the compounding costs and challenges of maintaining existing research and service delivery programs, while simultaneously battling COVID-19.

For more USAID and State budget details, view the chart below.

FY21 Enacted

2022 WH Request

2022 WH Request v. 2021 Enacted (%)

2022 WH Request v. 2021 Enacted ($)

USAID Global Health Programs

$3265.95

$3870.95

+$18.52%

+$605

Tuberculosis

$319

$319

0%

$0

Malaria

$770

$770

0%

$0

HIV/AIDS

$330

$330

0%

$0

Maternal & Child Health

$855

$879

+2.81%

+$24

Nutrition

$150

$150

0%

$0

Neglected Tropical Diseases

$102.5

$102.5

0%

$0

Vulnerable Children

$25

$25

0%

$0

Global Health Security

$190

$745

292.11%

$555

Emergency Reserve Fund

-

$90

-

$90

Family Planning – all

$575 ($233.95 for USAID FP)

$483.7 ($550 for USAID FP)

1.1% (4.97% for USAID FP)

$8.7 overall ($26.05 for USAID FP)

State Global Health Programs

$5,930

$6180

4.22%

$250

PEPFAR

$4,370

$4,370

0%

$0

Global Health Security

-

$250

-

$250

Global Fund

$1,560

$1,60

0%

$0


Global health R&D at NIH, CDC, and BARDA

In response to the COVID-19 pandemic and both the scientific promise and public health perils it has exposed, the administration put forward a budget proposal for Department of Health and Human Services subagencies aimed at delivering “a new generation of medical breakthroughs” and “improving America’s public health infrastructure.”

Most notable in terms of sheer funding, the budget proposes a $9 billion increase to the NIH budget, of which $6.5 billion, or nearly two-thirds, would go to support the launch of a new Advanced Research Projects Agency for Health (ARPA-H) within NIH. Likely to follow a similar model as the Defense Advanced Research Projects Agency, or DARPA, this proposed program would focus on advancing riskier, transformative breakthrough health innovations that would be unlikely to advance through the private sector alone.

While ARPA-H was initially proposed by advocates as a potential mechanism to address market failures in R&D, implying it could touch on neglected global health areas, the president’s budget proposal specifically mentions a focus on cancer, diabetes, and Alzheimer’s, suggesting a narrower initial scope that would likely not encompass poverty-related and neglected diseases. Outside ARPA-H, the budget proposes more modest increases to NIH institutes and programs key to global health R&D, including a proposed 2.9 percent increase to the National Institute of Allergy and Infectious Diseases, where most emerging and neglected disease research takes place within NIH, and a .32 percent increase to the Office of HIV/AIDS. In very welcome news, the budget proposes a 14.6 percent increase to the Fogarty International Center, a center devoted to strengthening international research capacity, reflecting calls by GHTC and other advocates.

Beyond NIH, the administration proposes a 10.5 percent, or $825 million, increase to the CDC budget, seeking to reverse a decade-long stagnant budget for the agency. Within that, there is a proposed 17.7 percent, or $105 million, increase to the Center for Global Health (CGH). However, mirroring similar trends seen in USAID and State funding, $100 of that $105 million increase is for global health security–related programming via the Global Public Health Protection line. The remaining $5 is for the CGH Division of Parasitic Diseases and Malaria, which is a welcome addition given this division has been flat funded for years. All other CGH funding lines remain flat funded. The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), which has supported development of diagnostics and vaccines for infectious disease threats, also receives a proposed $30 million or 4.6 percent increase.

Finally, the budget proposes a $226 million, or 37 percent increase, for BARDA to support the development of drugs, vaccines, and other medical countermeasures against public health threats. BARDA, which has been at the center of the US government’s COVID-19 R&D response, faces a dual mandate covering both man-made and naturally occurring health threats, but the latter part of its portfolio has been historically underfunded and over reliant on emergency funding. While GHTC has advocated for a new funding line at BARDA specifically for emerging infectious diseases and other naturally occurring threats, we welcome this overall funding boost, which will allow the agency to pursue a more forward-looking, robust portfolio in this space.

For more NIH, CDC, and BARDA budget details, view the chart below.

FY21 Enacted

2022 WH Request

2022 WH Request v. 2021 Enacted (%)

2022 WH Request v. 2021 Enacted ($)

NIH

$42,934

$51,953

21.01%

$9,019

NIAD

$6,069.619

$6,245.926

2.9%

$176.31

Office of AIDS Research

$3,090

$3,100

.32%

$10

National Center for Advancing Translational Sciences

$855.421

$878.957

$2.75%

$23.54

National Institute of Child Health and Human Development

$1,590.337

$1942.117

22.12%

$351.78

ARPA-H

-

$6,500

-

$6,500

Fogarty International Center

$84.044

$96.322

14.61%

$12.28

CDC

$7,874.804

$8,700.00

10.48%

$825.20

CGH

$592.843

$697.843

17.71%

$105

Global Immunization Program

$226

$226

0%

$0

Global AIDS Program

$128.421

$128.421

0%

$0

Global Tuberculosis Program

$9.222

$9.22

0%

$0

Parasitic Diseases and Malaria

$26

$31

19.23%

$5

Global Public Health Protection

$203.2

$303.2

$49.21%

$100

CDC-wide Infectious Disease Rapid Response Reserve Fund

$10

$35

250%

$25

NCEZID

$648.272

$678.272

$4.63%

$30

BARDA

$596.7

$823

37.93%

$226.30


While the president’s budget request provides a mixed picture for global health research advocates, with bold transformative investments for global health security paired with primarily flat funding for other critical health areas, it is ultimately up to Congress to decide our nation’s spending. GHTC will continue to track the appropriations process and engage with Congress to push for funding bills that meet the full spectrum of global health research needs.

Categories: US budget

About the author

Marissa ChmiolaGHTC

Marissa manages the development and implementation of the coalition’s communications strategies and activities. She oversees GHTC’s digital presence, media outreach, events, and publications. Marissa has over a decade of experience working in communications and policy...read more about this author