The $9.4 billion package agreed to by the US Senate and House Appropriations Committees, is more than double the $3.7 billion requested by the Trump Administration, and signals bipartisan support for maintaining significant global health aid – although the package still must be approved by both Senate and House, and could also be vetoed by president following passage. 

The $9.4 billion package agreed to by Congressional leaders in the US House and Senate is less than the $12.4 billion allocation in 2024 and 2025. But it’s still $5.7 billion more than called for last September by US President Donald Trump in his America First Global Health Strategy. 

The House and Senate have yet to vote on the spending bill, and face a 30 January deadline to pass the federal funding. The legislation would then have to clear the President’s desk before becoming law.

The global health allocations are part of a larger $50 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. Some of the funds from that pot will also be dedicated to health – in areas such as food security and nutrition, shelter protection, and  water, sanitation and hygiene (WASH). And it also includes a nod to the Trump administration’s plan to offer low- and middle-income countries some $11 billion in direct bilateral assistance  – some of which will also be channeled into health. The bilateral deals replace some of the assistance provided previously under USAID, which boasted a budget of around $44 billion in 2023, shortly before Trump abruptly dismantled it last year, making the US the world’s largest overseas donor. 

Funding for HIV/AIDS, malaria, family planning

Of the $9.4 billion earmarked in the bill specifically for global health programs, some $5.9 billion would be allocated to HIV/AIDS – with $1.25 billion channelled through the Global Fund to Fight TB, AIDS and Malaria, $45 million to UNAIDS, and $4.5 billion through the President’s Emergency Plan for AIDS Relief (PEPFAR), the flagship US program founded in 2003: 

While that is still less than the $7.1 billion level of support to the three agencies under the 2024 Biden administration, 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. 

In terms of other global health priorities: $795 million is dedicated to malaria, and $379 million for tuberculosis; $85 million is earmarked for polio.

Strikingly, some $524 million for family planning and reproductive health services are also included in the funding package – despite the historic reticence of conservatives to fund such 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.

Other, allocations are earmarked for “Global Health Security,” neglected tropical diseases (NTDs), and nutrition.

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. 

Bipartisan support, but with different takes 

Remarkably, both sides of the aisle – and congressional chambers – came together for the bill in a show of bipartisanship, and an exertion of Congress’s power of the purse. 

House and Senate Republicans are positioning the agreement as a win for reducing overall foreign aid spending – in this case by about 16% – while also countering growing Chinese influence and advancing President Trump’s foreign policy vision .

The bill is an “unprecedented reduction of spending” while still aligning with the “America First agenda,” said House Appropriations Chair, Representative Tom Cole (R-OK). 

Cole lauded the foreign aid bills larger design, saying it “eliminates wasteful spending on DEI or woke programming, climate change mandates, and divisive gender ideologies at the State Department,” and “holds the United Nations accountable.” The Republican Chair also noted that the bill “confronts human trafficking; provides support, funds, or assistance for Israel, Egypt, Jordan, and Taiwan; and denies China access to U.S.-backed resources.”

But for those across the aisle, the very act of funding global health programs resists the Trump administration’s fiery aid trajectory. 

The “[b]ill rejects Trump’s decimation of the U.S. foreign assistance enterprise— renewing bipartisan investments in American leadership and reasserting congressional control Supports key global health, humanitarian, and development investments and rejects extreme House Republican riders,” reads a summary  by Senator Patty Murray (D-WA), Vice-Chair of the Senate Appropriation Committee.

“While including some programmatic funding cuts, the bill rejects the Trump administration’s evisceration of U.S. foreign assistance programs and reaffirms bipartisan support for the full range of international initiatives long promoted by Congress to advance U.S. interests.”

WHO is not funded at all

Notably absent in the bill is any mention of funding for the World Health Organization, from which the Trump administration is in the process of withdrawing. Nor, is there provision in the bill for paying hundreds of millions in unpaid dues to the organization – for which it is in arrears, before the pullout date later this month.

See related story here. 

Member States to Discuss US Withdrawal from WHO as Failure to Pay Fees Violates Agreement

Image Credits: WHO, Senate Appropriations.