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1 1 (February 9, 2024)

handle is hein.crs/goveohp0001 and id is 1 raw text is: Con gressionol Research Service nforming the IegisIative debate since 1914 February 9, 2024 Global Health Security: Background and Issues for Congress Background Congressional interest in the capacity of health systems, especially in low- and middle-income countries (LMIC), to detect, control, and respond to infectious disease threats is growing. Programs to build such capacity are integral to U.S. global health security (GHS) policy. Key areas of focus of such programs include strengthening national laboratory and surveillance systems and improving risk communication. GHS appropriations have been growing, particularly since the emergence of COVID-19 in early 2020. Related issues for Congress include deliberation of funding levels for GHS programs, oversight of reorganization within the Department of State (DOS) to establish the new Bureau for Global Health Security and Diplomacy (GHSD), and consideration of how the reorganization might affect the administration of global HIV/AIDS programs. OHS Appropriations Appropriations for GHS efforts administered by the U.S. Agency for International Development (USAID)-the primary funder of U.S. bilateral GHS programs-more than quadrupled between FY2021 and FY2023 (Table 1). Since FY2022, the Biden Administration has also requested multilateral GHS funding in the DOS budget. These amounts are in addition to funds provided for COVID-19 control through emergency appropriations. Table 1. Global Health Security Funding by Agency: FY20 16-FY2024 (Global Health Programs account, current U.S. $ millions) Fiscal USAID USAID DOS DOS Year Request Enacted Request Enacted FY20 16 50.0 72.5 0.0 0.0 FY2017 72.5 72.5 0.0 0.0 FY20 18 O.Oa 72.6 0.0 0.0 FY2019 O.Oa 100.0 0.0 0.0 FY2020 90.0 100.0 0.0 0.0 FY2021 115.0 190.0 0.0 0.0 FY2022 745.0 700.0 250.0b n/s FY2023 745.0 908.0 250.0b n/s FY2024 745.0 c 510.3d Sources: Congressional budget justifications, appropriations, and explanatory notes. Acronyms: not specified (n/s), Department of State (DOS) Notes: Excludes emergency appropriations, mandatory funding requests, and recissions. a. The Administration proposed reprogramming $72.5 million of Ebola emergency supplemental funds for GHS programs. b. Requested for the World Bank Pandemic Fund. c. To date, Congress has not enacted an FY2024 State, Foreign Operations appropriation. Congress enacted a continuing resolution, which authorized federal agencies, including DOS and USAID, to continue spending for most programs at FY2023 rates through February 4, 2024. d. Includes $500.0 million for a contribution to the World Bank Pandemic Fund and $10.3 million from the Diplomatic Programs account for salaries and administrative expenses. G HS Mandatory Funding Request The increased frequency and severity of infectious disease outbreaks has intensified debates about the effectiveness of appropriating funds annually for GHS. In March 2022, the Biden Administration released its FY2023 State, Foreign Operations (SFOPS) Congressional Budget Justification (CBJ), which included a $6.5 billion request for mandatory multiyear funding authority for GHS programs (global health funding is typically discretionary). The funds were requested in addition to the discretionary appropriations detailed in Table 1, and included * $4.5 billion in seed funding from DOS for the World Bank Pandemic Fund; * $1.0 billion, including $250.0 million for DOS and $750.0 million for USAID bilateral GHS programs; * $500.0 million to USAID for a contribution to the Coalition for Epidemic Preparedness Innovations (CEPI) to support vaccine research, development, and delivery, and to develop and deploy innovative tools to build resilience for future pandemics; and * $500.0 million to replenish the Emergency Reserve Fund, which USAID uses to respond rapidly to infectious disease outbreaks. Congress did not enact the mandatory spending proposal, but it authorized $5.0 billion for GHS activities for the same five-year period through the Global Health Security and International Pandemic Prevention, Preparedness and Response Act of 2022 (Global Health Security Act, Title LV of P.L. 117-263, FY2023 National Defense Authorization Act), discussed below. Global Health Security Act Congress enacted the Global Health Security Act in December 2022. Among other things, the act addressed many of the items in the Biden Administration's multiyear budget request for GHS and included provisions to enable congressional oversight of authorized activities, such as the following: Support for World Bank Pandemic Fund. Authorized U.S. contributions to (up to 33% of contributions from all sources) and participation in a Financial Intermediary Fund

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