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FY22 OMB Letter February 11, 2020 Rob Fairweather Acting Director, Office of Management and Budget 1650 Pennsylvania Avenue NW Washington, D.C. 20503 Dear Acting Director Fairweather: Global Health Council is the leading alliance of nonprofits, businesses, and universities dedicated to saving lives and improving the health of people worldwide. We encourage continued support for global health; nutrition; and water, sanitation, and hygiene (WASH) programs within the International Affairs (150) and HHS (550)-related global health budgets as you consider Fiscal Year (FY) 2022. These programs are some of the most cost-effective, critical, and greatest successes of foreign assistance. For more than a decade, we have witnessed incredible success in combating the world’s most deadly diseases and other threats to public health. In fact, many diseases that once threatened millions continue to decline because of the substantial U.S. commitment over recent decades. Because of America’s leadership, we are in sight of reaching the first AIDS-free generation and ending preventable maternal and child deaths. Further, these investments help protect the health of Americans by strengthening our capacity to better prevent, detect, and respond to infectious disease outbreaks, like COVID-19, which know no borders. At a minimum, GHC recommends that you support Global Health Programs at the FY 2021 levels enacted by Congress. However, in order to achieve U.S. global health goals and commitments, we urge you to support a significantly greater investment for FY 2022. This includes at least $15 billion for global health programs at the Department of State and USAID; $540 million for water in all accounts; and $134 million for UNICEF. In addition we must recommend an investment of $6.356 billion for the National Institute of Allergy and Infectious Disease (NIAID), $3.845 billion for the Office of AIDS Research, and $91 million for the Fogarty International Center at the National Institutes of Health (NIH); and an investment of $735 million for the Center for Emerging Zoonotic and Infectious Diseases and no less than $898 million for the Center for Global Health at the Centers for Disease Control and Prevention (CDC). Global Health Council | 703-717-5200 (local) | 800-836-4620 | globalhealth.org twitter.com/globalhealthorg | facebook.com/globalhealthcouncil | globalhealth.org/linkedin Americans consistently support global health and development assistance funding and rightfully so -- these investments benefit the U.S. economy. There is no better example of this than the funding used for global health research and development. This funding creates jobs, builds U.S. research and technological capacity, and is an injection of investment into the U.S. economy - not to mention a health benefit to Americans. In fact, approximately 89 cents of every dollar spent by the U.S. government on global health research and development goes directly to U.S.- based researchers and product developers. While the appendix to accompany this letter outlines the specific programmatic requests contained within each account, strong overall funding helps meet health needs that cut across diseases. The United States has unparalleled technical expertise that can help developing countries’ improve and strengthen their health systems to help prevent and contain the spread of deadly diseases. The U.S. commitment also provides for continued investment in groundbreaking research and the development of new health technologies and more innovative and cost-effective approaches to tackling difficult challenges – allowing U.S. taxpayer dollars to be used more effectively and help more of those in need. Moreover, maintaining robust investments in global health, while also preserving funding for other critical humanitarian and development programs, will enable the U.S. to reach its goal of reducing poverty and supporting communities that are stable, resilient, and democratic. We are excited for the opportunity of continued partnership with the administration to ensure that the U.S. maintains its leadership and impressive record of success in addressing global health challenges. We look forward to working with you in the coming months to ensure the President’s FY 2022 budget request reflects this continued commitment. Please find an appendix with specific programmatic request levels and justifications for each request below. Sincerely, Loyce Pace, MPH President & Executive Director Appendix Account/Program Recommendations for Fiscal Year 2022 (in thousands) FY 2022 Minimum FY 2022 Funding Level Recommended Funding Level (Highest FY20 enacted or House or Senate proposed FY21) Global Health Programs (USAID & State) $9,761,500 $15,151,500 Maternal and Child Health $865,000 $984,000 of which GAVI $290,000 $290,000 Polio (all accounts including ESF) $65,000 $65,000 Malaria (PMI) $785,000 $902,500 Tuberculosis $325,000 $1,000,000 Family Planning (all accounts) $805,500 $1,740,000 of which UNFPA (IO&P) $55,000 $117,000 Nutrition $150,000 $300,000 Vulnerable Children $25,000 $30,000 Neglected Tropical Diseases $106,000 $125,000 HIV/AIDS (USAID) $330,000 $350,000 PEPFAR $4,370,000 $5,120,000 Global Fund to Fight AIDS, TB, and Malaria $1,560,000 $1,560,000 Global Pandemic Preparedness Fund $2,000,000 Global Health Security $275,000 $675,000 Of which CEPI $200,000 Of which GHS Grand Challenge $200,000 Emergency Reserve Fund $100,000 $300,000 Water (in all accounts) $450,000 $540,000 UNICEF (IO&P) $134,000 $134,000 NIH (HHS) Fogarty International Center $86,455 $91,000 NIAID $6,142,540 $6,356,000 Office of AIDS Research $3,200,000 $3,845,000 CDC (HHS) Center for Global Health $523,600 $898,000 of which Parasitic Diseases and $26,000 $30,000 Malaria of which Global Public Health $228,200 $456,400 Protection, Global Disease Detection and Global Health Security of which Global Tuberculosis $10,000 $21,000 of which Global Immunization $226,000 $226,000 Center for Emerging Zoonotic and Infectious $644,600 $735,000 Diseases Infectious Diseases Rapid Response Fund $300,000 Appendix: Account & Program Justifications for Fiscal Year 2022 Global Health Programs (USAID and State): FY22 Minimum Funding Level: $9.76 billion FY22 Recommended Funding Level: $15 billion U.S. global health funding through the Department of State and USAID helps to address diseases; undertake health emergencies and global health security threats; expand access to voluntary family planning and reproductive health information and services; prevent and treat malnutrition; develop new health technologies and vaccines; assist women with the timing and spacing of pregnancies and reduce maternal and child mortality; provide training to the frontline health workforce to create stronger health systems and enhance global health security; and support the President’s Malaria Initiative (PMI) and President’s Emergency Plan for AIDS Relief (PEPFAR). Investments in global health programs by the United States have saved lives, and improved the economic growth and stability of developing nations. As the COVID-19 pandemic continues to affect lives across the globe, these investments are more important than ever. Global health works, and the return on investment is particularly impressive. U.S. leadership in global health has contributed to a halving of preventable child deaths, a 60% decrease in deaths from malaria, and a 45% reduction in maternal mortality since 1990. Programs are providing antiretroviral treatment to 15.7 million people living with HIV1 and have prevented HIV transmission to millions more. Immunization programs save more than 3 million lives each year2 and since its inception, PMI has distributed more than 346 million long-lasting, insecticide- treated mosquito nets, supplied more than 27 million preventative treatments for pregnant 1 https://www.state.gov/wp-content/uploads/2020/09/PEPFAR2020ARC.pdf 2 https://www.usaid.gov/reports-and-data women in FY 2019,3 and sprayed more than 5.8 million houses with insecticides, providing protection for over 21 million people.4 Continued dedication to investments in global health will enable the U.S. to reach its goal of reducing poverty and supporting communities that are stable, resilient, and democratic. Maternal and Child Health (MCH) FY22 Request: No less than $984 million for Maternal and Child Health, including $290 million for Gavi, the Vaccine Alliance Investments in maternal and child health (MCH) build the foundation for the U.S.-spearheaded global goal of ending preventable child and maternal deaths by the year 2030. Despite the progress that has been made, reaching these goals will require the world to “bend the curve,” as experts at the 2012 Child Survival: Call to Action noted. Reaching the goal of ending preventable child and maternal deaths will require increased investment in critical maternal and child survival programs. The COVID-19 pandemic has severely disrupted essential services for maternal and child health, and additional investment to combat these impacts is desperately needed to protect progress made in the last 10 years. Investments are working but face severe setbacks due to COVID-19 Investments in the maternal and child health account have lifesaving effects. In 2019 alone, investment through the MCH account helped more than 84 million women and children gain access to essential— and often life-saving care.5 The global number of under-five deaths fell from 12.6 million in 1990 to 5.3 million in 2019, while during the same time period, maternal deaths decreased from 532,000 to 295,000
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