The US House of Representatives passed a more than $1 trillion spending package, bringing an end to a five-day partial government shutdown over the Department of Homeland Security funding.

Among the allocations is a $9.42 billion package for global health programs – signaling strong bipartisan support and maintaining significant global health aid. 

The Fiscal Year 2026 (FY26) National Security-State Department Appropriations Bill maintains funding for global health at a substantially higher level than envisaged by the Trump adninistration, in an apparent bipartisan rejection of the administration’s proposed cuts. 

The $9.42 billion package agreed to by the US House and Senate, and signed into law by the President, is substantially lower than the $12.4 billion allocation in 2024 and 2025 – but it is still $5.7 billion more than requested last September by US President Donald Trump in his America First Global Health Strategy.

Although the administration requested major cuts to foreign aid, Congress’s version of the bill preserves flagship global health programs like President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight TB, AIDS and Malaria, and HIV/AIDS programs previously administered through USAID – and reasserts Congress’s role in government spending. 

The global health allocations are part of a larger $51.4 billion foreign aid spending package for the 2026 fiscal year. That foreign aid bill, while a 16% cut from 2024, is nearly $20 billion more than what the Trump Administration initially requested.

The broader bill also includes $5.4 billion in funding for humanitarian assistance and comes as the Trump administration moves forward on a $11 billion plan for direct bilateral assistance to developing country governments – some of which would also be dedicated to health. 

Funding for HIV/AIDS, malaria, TB, family planning

Of the $9.42 billion earmarked in the bill specifically for global health programs, some $5.9 billion would be allocated to HIV/AIDS – with $1.25 billion channeled through the Global Fund, $45 million for UN AIDS, and $4.6 billion through PEPFAR, the flagship US program founded in 2003. This represents $200 million more for PEPFAR, and a $400 million decrease (24%) for the Global Fund from FY25 levels. 

And while less than the $7.1 billion level of support to these organizations under the Biden administration in FY24, it’s a major increase from the $2.9 billion for HIV/AIDS requested by Trump. At the same time, the Bill also calls for PEPFAR, founded by former US President George Bush, to transition to a largely self-reliant program of national governments over the coming years. 

Other global health priorities still see strong funding: $795 million is dedicated to malaria, and $379 million for tuberculosis; $85 million is earmarked for polio.

Some $575 million for family planning and reproductive health services are also included in the funding package – despite the historic reticence of some conservatives to fund such programs, and the fact that the Administration requested no funds for these programs.  

And although the administration has ordered a US withdrawal from the UN Population Fund (UNFPA), Congress allocated $32.5 million for the organization, as part of the family planning funds. The bill does stipulate that the agency cannot spend these funds on China – and that if the Trump administration makes good on its plan to withdraw from UNFPA, the money should then be transferred to other global health programs. 

Allocations earmarked for “Global Health Security,” are $615.6 million for organizations like Pandemic Fund and the Coalition for Epidemic Preparedness Innovations (CEPI). While global health security overall was cut by about 12% from FY25, these funds could also be used in the event of a public health emergency.

Funds will also go to neglected tropical diseases (NTDs; $109 million) and nutrition ($165 million).

US to continue funding Gavi despite federal anti-vaccine rhetoric

In late January the US froze all funds to Gavi, the Vaccine Alliance, over concerns that the organization, which procures and delivers life-saving vaccines, provides vaccines with the preservative thimerosal. 

And while the US FDA has stated that the preservative “has a long record of safe and effective use preventing bacterial and fungal contamination of vaccines,” the US plans to withhold the $300 million already allocated by the Biden administration but not yet paid, as well as any new funds. 

Despite this, the newly passed FY26 bill does include another $300 million for a US contribution to Gavi. The Administration had requested Gavi funds be eliminated. 

New ‘National Security Fund’ also includes health components

In another twist, support for family planning, reproductive health and countering child marriage is also supported through a new National Security Fund of $6.77 billion that Congress aims to create – to “combat China’s influence” among other things. 

The fund, which also includes monies for clean cook stoves, a Young African Leaders Initiative, peace process monitoring, trade capacity building, and assorted other priorities, specifies that at least 15% of the fund should go to the African continent. 

This story is a follow up to a 15 January piece, which can be found here:

US Congressional Leaders Agree to $9.4 Billion for Global Health – Countering Trump Proposal for Deeper Cuts

Image Credits: UNICEF, Senate Appropriations.