Advocacy Update

Advocacy Update ~ August 20, 2018

This post was written by Danielle Heiberg, Senior Manager, Policy & Advocacy, and Victoria Rodriguez, Advocacy Associate.

President’s Emergency Plan for AIDS Relief (PEPFAR) Reauthorization Bill

On August 3, Representatives Chris Smith (R-NJ) and Barbara Lee (D-CA), with Ed Royce (R-CA), Eliot Engel (D-NY), Ileana Ros-Lehtinen (R-FL), and Karen Bass (D-CA) as additional cosponsors, introduced the PEPFAR Extension Act of 2018 (H.R. 6651). The bill reauthorizes the President’s Emergency Plan for AIDS Relief (PEPFAR) through 2023 and upholds the United States’ commitment to address the HIV/AIDS epidemic.

In a press release, Representative Lee stated, “For the last 15 years, PEPFAR has been a testament to the bipartisan cooperation on U.S. leadership in global public health. Thanks to PEPFAR, millions of lives have been saved through HIV/AIDS treatment, care, and education. But our work is far from over – we are at a tipping point and Congress must recommit to this fight…I am so proud of our work across the aisle, ensuring that PEPFAR can continue to save lives for decades to come.”

GHC Executive Director Loyce Pace welcomed the legislation, stating, “Over the past 15 years, PEPFAR has had an impact on the lives of those living with HIV/AIDS, as well as building health systems to address malaria, TB, and maternal and child health. By renewing our commitment to this groundbreaking initiative, we emphasize its value and pave the way for even more global health progress worldwide.”

Read GHC’s full statement here.


OMB Expected to Send Rescissions Package to Capitol Hill

It is expected that the Office of Management and Budget (OMB) will send a new rescissions proposal to Capitol Hill sometime between now and the end of the fiscal year (FY), on September 30. The rescissions package is expected to target unobligated funds from FY 2017 and FY 2018, and which expire at the end of FY 2018, and could disproportionately impact the International Affairs Budget.

The timing of a new rescissions package is a bit of political maneuver on the part of the administration. The Congressional Budget and Impoundment Control Act states that Congress has 45 legislative days to act on a rescissions proposal, and during this time funding targeted for rescission is impounded, meaning it cannot be spent. If Congress fails to act within the 45 days, impounded funds are released. By timing a rescissions package with fewer than 45 days remaining in the fiscal year and by targeting expiring funds, the administration is essentially forcing Congress to take action to prevent the funds from expiring and returning them to the U.S. Treasury. It is unclear if Congress will take up the rescissions package with a busy schedule planned for September, including the FY 2019 appropriation bills in both chambers and the Supreme Court nomination in the Senate.

GHC will continue to monitor any proposed rescissions and will provide updates as needed.

For more information on the rescission process, please refer to our Rescission FAQ.


Appropriations Update

Both House and Senate State and Foreign Operations (SFOPS) and Labor, Health and Human Services (LHHS) Appropriations subcommittees have marked up their bills for FY 2019.

The Senate returned from a short recess on August 15 to resume work on the appropriation bills. The Senate is debating a “minibus”–several appropriation bills packaged together–which could contain the LHHS bill. Senate leadership believes a majority of the appropriation bills will be passed by the end of August, but could still leave other bills, like SFOPS, on the table. The House returns from August recess on September 4 and will have a little under two weeks to come to a decision on the bills prior to the end of FY 2018. If Congress has not enacted the bills in time, a continuing resolution will be needed to keep the government open.

As FY 2019 appropriations are being decided, GHC is also working with the greater global health community to complete funding recommendations for FY 2020 which will be delivered to OMB in the next few weeks.

Please refer to our previous Advocacy Update for highlights on each appropriations bill.


Global Health Security Simulation on Capitol Hill

In July, GHC in collaboration with the Johns Hopkins Center for Health Security, NTI | bio, and PATH hosted Clade X: A Global Health Security Simulation for Congressional staff to demonstrate the need for continued support to prevent serious infectious disease threats. The simulation—an abridged, modified version of the original day-long Clade X pandemic exercise designed and hosted by the Center for Health Security—was conducted to highlight the necessity for effective preventive interventions and the importance of accountability of government agencies during global health crises. The exercise gave Congressional staff a window into the choices government leaders must make during a pandemic and highlighted the need for the U.S. to play a leadership role in the global health security community. Read more.

Advocacy Update ~ July 16, 2018

This post was written by the GHC Advocacy Team.

Senate and House Appropriations Committees Release LHHS Bills
Both the Senate and House Appropriations committees marked up their respective Labor, Health and Human Services and Education bills (LHHS) for Fiscal Year (FY) 2019, which includes funding for global health programs at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). It is possible that the LHHS bill will be rolled into a minibus, several appropriations bills bundled into one bill, although the timing of this is unknown.

Download the funding chart.

Highlights of the House LHHS bill
The House provided $178.9 billion overall for the bill. The CDC’s Center for Global Health received flat funding at $488.6 million, with Global Health Protection receiving $108.2 million. The National Center for Emerging Zoonotic and Infectious Disease (NCEZID), also within CDC, received a $52 million decrease ($562.6 million in comparison to $614.6 million in FY 2018). The Fogarty International Center at NIH received a slight increase of $634,000 ($76.6 million in comparison to $75.7 million in FY 2018). The National Institute of Allergy and Infectious Diseases (NIAID) also received a slight increase ($5.4 billion in comparison to $5.3 billion in FY 2018).

Highlights of the Senate LHHS bill
The Senate provided $1.1 trillion overall for the bill. In the Senate bill, CDC’s Center for Global Health is flat funded at $488.6 million, of which $108.2 million is for the Global Public Health Protection. NCEZID received a $3 million increase ($617.5 million in comparison to $614.5 million in FY 2018). The Fogarty International Center received a little over $2 million increase ($78.2 million in comparison to $75.7 million in FY 2018). NIAID received an increase of about $200 million ($5.5 billion in comparison to $5.3 billion in FY 2018).

House Foreign Affairs Committee Holds Hearing on TB
Last week, the Centers for Disease Control and Prevention (CDC), U.S. Agency for International Development (USAID), and the State Department testified in front of the House Foreign Affairs Committee on Tuberculosis (TB) in Southern Africa. Agency representatives provided updates on current TB programs and progress on interagency collaboration on the U.S. Global TB Strategy. Witnesses included: Ambassador Deborah L. Birx, U.S. Global AIDS Coordinator at the Department of State; Irene Koek, Senior Deputy Assistant Administrator of the Global Health Bureau at USAID; and Dr. Rebecca Martin, Director of the Center for Global Health at CDC.

The hearing focused on the importance of collaboration among the three agencies and across other global health sectors, specifically in regards to TB/HIV coinfection. Dr. Martin discussed how CDC collaborates with the State Department through the President’s Emergency Plan for AIDS Relief (PEPFAR) to test TB patients for HIV, and provide treatment for people living with HIV/TB coinfections. Ambassador Birx emphasized the need to improve the scale of TB preventive therapy to help lower TB prevalence and reduce HIV coinfection. Both Dr. Martin and Ms. Koek stated that having U.S. government leadership present at the upcoming UN High-Level Meeting on TB provides opportunities for new political commitments to end TB and accelerate progress where it is needed the most.

Congressmen Tom Garrett (R-VA) and Joaquin Castro (D-TX) spoke about their families’ experiences with TB and the importance of this work both in the U.S. and abroad. Chairman Christopher Smith (R-NJ) expressed interest in TB funding and the return on investment (ROI) TB-related programs yield. Congressman Garrett pushed further on the issue of funding, asking what he should tell his constituents regarding the ROI of TB-related programs. Dr. Martin responded, “Investments in TB are smart, as every U.S. dollar invested in TB yields $43 in return.”

Advocacy Update ~ June 25, 2018

This post was written by Danielle Heiberg, Senior Manager, Policy and Advocacy and Melissa Chacko, Policy Associate.

FY 2019 Bills Marked Up, Senate Rejects Rescissions, Green Testifies, and Reorganization 
It was busy on Capitol Hill last week with the release of the State and Foreign Operations bills in both the House and the Senate, a vote on the rescission package, and testimony from Administrator Green. On the other side of Pennsylvania Avenue, the White House released its reorganization plan for federal agencies.

Senate and House Committees Release SFOPs Bills
Both the Senate and House State and Foreign Operations (SFOPs) Appropriations subcommittees marked up and approved their respective bills for Fiscal Year (FY) 2019. With committee action completed, the bills can be brought to the floor for a vote. The House could do this in the coming weeks, packaging the SFOPs bill as part of a “minibus” – several appropriations bills packaged together. The Senate is unlikely to bring the bill to a vote. Download the Funding chart.

Markup of the Labor and Health and Human Services appropriations bills is expected this week in both the House and Senate.

Highlights of the House SFOPs bill

The House provided flat funding for global health at $8.8 billion, and $54 billion for the entire bill. Of note were increased for Maternal and Child Health ($845 million compared to $829.5 million in FY 2018); nutrition ($145 million compared to $125 million in FY 2018); and tuberculosis ($302 million compared to $261 million in FY 2018). These increases appear to have come at the expense of the family planning account, which was decreased from $607.5 million in FY 2018 to $461 million.

During the full committee mark up several members offered amendments related to family planning, including an amendment offered by Congressman Tim Ryan (D-OH) to remove the cap on bilateral funding for family planning; an amendment by Congresswoman Nita Lowey (D-NY) to repeal the Mexico City Policy; and one offered by Congresswoman Barbara Lee (D-CA) to restore funding for the UN Population Fund (UNFPA).

Highlights of the Senate SFOPs bill

The Senate provided approximately about a $100 million increase to global health ($8.8 billion compared to $8.69 billion in FY 2018) and $54.4 billion (an increase of $400 million from FY 2018 levels) for the entire bill. Increases to global health accounts include: family planning ($632.6 million compared to $607.5 million); nutrition (up $10 million to $135 million); vulnerable children (up $2 million to $25 million); tuberculosis (up $14 million to $275 million); neglected tropical diseases (up $6 million to $106 million); and PEPFAR (up $50 million to $4.37 billion). In addition, Water account was increased to $435 million compared to $400 million in FY 2018.

The increase to family planning was part of an amendment by Senator Jeanne Sheheen (D-NH) to provide no less than $632 million for this account, including $37.5 million for the UNFPA. The amendment also strips the legislative language on the Mexico City Policy and replaces it with provisions of the Global HER Act (S.210)

Senate Rejects Rescissions Package
The Senate failed to discharge from committee and bring to the floor H.R. 3, a $15 billion rescission package based on recommendations the White House had sent to Congress in May. The 48-50 vote was along party lines, but Senators Richard Burr (R-NC) and Susan Collins (R-MN) joined the Democrats in voting no.

If you are a constituent of Senators Burr or Collins, we encourage you to call their offices to express appreciation for their no votes on this rescission package.

USAID Administrator Testifies on USAID Resources and Redesign
USAID Administrator Mark Green testified in front of the Senate Foreign Relations Committee on USAID Resources and Redesign. The hearing focused on a range of policy issues from the crises in Venezuela and Yemen, to initiatives such as Power Africa and the Better Utilization of Investments Leading to Development (BUILD) Act. Relevant to global health, Administrator Green touched upon global health supply chains in his opening statement and stated that USAID continues to monitor the performance of supply chain contracts to ensure that implementers are meeting the requirements.

Members of the committee continue to speak out against the President’s FY 2019 budget, which includes an almost 30% cut to foreign assistance. Chairman Bob Corker (R-TN) stated in his opening remarks that, “Congress decides funding levels despite this request, so the request is not relevant to what we [Congress] are doing.”

White House Releases Reorganization Plan
The day after Administrator Green testified on Capitol Hill, the White House released its long-awaited reorganization plan in which it aims to improve the “efficiency, effectiveness, and accountability” of every federal agency. Many of the proposals that would affect the State Department and USAID were rolled out earlier and are being pursued under USAID’s Transformation Initiative. The Global Health Bureau remains intact, but creates new bureaus for Resilience and Food Security; Development, Democracy, and Innovation; and Conflict Prevention and Stabilization. A new Bureau for Humanitarian Assistance would include the Office of Foreign Disaster Assistance and Food for Peace.

The proposal also establishes a new development finance institution by strengthening OPIC and consolidating it with USAID’s Development Credit Authority. A similar proposal is included in the Better Utilization of Investments Leading to Development (BUILD) Act, which was introduced by Senators Bob Corker (R-TN) and Chris Coons (D-DE) and Congressmen Ted Yoho (R-FL) and Adam Smith (D-WA).

Read more on USAID’s Transformation Plan.

Advocacy Update ~ June 11, 2018

This post was written by Danielle Heiberg, Senior Policy and Advocacy Manager, and Melissa Chacko, Policy Associate.

White House Withdraws Ebola Rescission

Early last week, the White House made a number of modifications to its proposed rescission package, including a removal of the rescission of $252 million in remaining unobligated Ebola response funding. The modifications to the package were expected after pushback from a number of Congressional Republicans on several of the proposed rescissions, including the Ebola response funding.  Late last week, the House voted on it modified bill, H.R. 3. The Senate has until June 22 to act on the rescission package, but it remains unclear if it will act on it. (Read more about the rescission process.)

The timing of the withdrawal also comes shortly after the administration committed an additional $7 million to respond to the current Ebola outbreak in the Democratic Republic of Congo. Health and Human Services Secretary Alex Azar announced the additional funding during the World Health Assembly in Geneva in late May. Read the Global Health Security Roundtable’s statement on the funding commitment.

The White House is reportedly working on another rescission package targeting unobligated funding from Fiscal Year (FY) 2018. The International Development Budget is expected to be a target and proposed rescissions will reflect the administration’s budget requests for FY2018 and FY2019.

FY19 Appropriations: Update on Bills and Pompeo Testifies on State Department Budget

Congress remains committed to completing the FY2019 appropriations process by the end of the fiscal year on September 30, with markups of the individual bills expected to begin this month. Last week, Senate Majority Leader Mitch McConnell (R-KY) canceled three weeks of the Senate August recess, in order to work on nominations and appropriations. The House is still expected to take all of August off. Despite all of this, many Beltway-insiders still expect that a Continuing Resolution (CR) will be needed to keep the government open after September.

In late May, Secretary of State Mike Pompeo testified in front of the House Foreign Affairs Committee and the Senate Foreign Relations Committee on the Fiscal Year (FY) 2019 State Department budget. Both hearings focused on a range of foreign policy issues including North Korea, Iran, and South Sudan, and on diplomatic security. There was little emphasis on global health issues. However, Representative Ami Bera (D-CA) and Representative Eliot Engel (D-NY) were concerned by the President’s rescission package which includes a $252 million cut to remaining unobligated Ebola response funding from the International Disaster Assistance (IDA) account at USAID (the White House has since withdrawn this rescission; see item above). In the Senate, Senator Jeff Merkley (D-OR) pushed on the administration invoking the Kemp-Kasten amendment and the withholding of funds from UNFPA without any evidence, to which Secretary Pompeo responded that he would follow up on the question.

Advocacy Update ~ May 21, 2018

This post was written by Danielle Heiberg, Senior Policy and Advocacy Manager, and Melissa Chacko, Policy Associate.

The following advocacy update was written May 21. A few additional highlights:

1.) The rescission package has stalled in the House. There do not seem to be enough votes to pass the legislation in its current form. The administration reportedly is considering changes to the proposal, including changing or removing the proposed rescission of Ebola funding. A vote is not expected in the House until sometime in June.

2.) This week the House and the Senate released 302(b) allocations, or topline spending levels for the FY2019 appropriations bills. For the State-Foreign Operation bills, the House provided $54 billion ($46 billion in base funding and $8 billion for Overseas Contingency Operations (OCO)) and the Senate provided $54.4 billion ($46.4 billion in base and $8 billion in OCO). Compared to the FY2018 enacted level, the Senate provides an additional $400 million in funding, while the House provides level funding. For Labor-Health, Human Services, the House provided $177.1 billion, which is level funding compared to FY2018 enacted, and the Senate provided $179.288 billion.

3.) Due to the World Health Assembly, we are unable to provide a summary of Secretary of State Mike Pompeo’s hearings. A summary will be included in the next advocacy update.


On May 8, President Trump sent a “special message” to Capitol Hill with his recommendations for rescissions, or cuts to already appropriated funding. Included in the rescission package is a $252 million cut to remaining unobligated Ebola response funding from the International Disaster Assistance (IDA) account at USAID. The announcement of the rescissions came a day after the WHO declared a new outbreak of Ebola in the Democratic Republic of the Congo, although it is not expected to have an effect on any U.S. response.

House leadership is bypassing the Appropriations Committee and will bring the bill, H.R. 3, directly to the floor for a vote. However, it’s not clear if they have the 218 votes needed for passage. It’s also unclear when it would come up for a vote; it was expected to be on the floor this week, but the failure to pass the farm bill on Friday might have thrown the House schedule into turmoil. Congress is in recess next week for the Memorial Day holiday, so it might not be until early June. While this process plays out, the proposed funds for rescission are impounded, meaning agencies are unable to spend the funds. The Senate is not expected to act on rescissions until the House passes its bill (if the House does not pass the bill, it’s unlikely the Senate will do anything).

Many members of Congress have stated that they are opposed to rescissions, but there could be a little more support for rescissions targeting appropriated funding prior to FY2018. The White House is expected to send another special message to Congress with proposed rescissions for FY2018 accounts at later date.

GHC’s Global Health Security Roundtable and the Global Health Security Agenda Consortium sent a letter to Congressional leaders opposing the proposed Ebola rescissions. Read the letter to Senate Leadership (and the identical letter sent to House Leadership).

Rescission FAQ

Fiscal Year 2019 Updates

Congress is in full swing with the Fiscal Year (FY) 2019 appropriation process. Since USAID Administrator Mark Green testified in April, Congress has held a hearing with Secretary of Health and Human Services (HHS), Alex Azar, who testified on the FY2019 budget for HHS. This week, Congress will hold hearings with Secretary of State Mike Pompeo who will testify on the FY2019 State Department budget. Congress is preparing for markups for appropriation bills which are expected to begin in June.

Appropriations Mark Ups

The Appropriations committees are determined to get the budget process back on track. Senate Chair, Richard Shelby (R-AL), and House Chair, Hal Rogers (R-KY), would like the appropriations process to return to normal, with the 12 appropriations bills brought to the floor and voted on, and there are rumors that the Senate may cancel or shorten their August recess to finish up. The Senate Appropriations Committee announced that the committee will mark up the State and Foreign Operations (SFOPs) bill the week of June 18 and the Labor, Health and Human Services (LHHS) bill the week of June 25. Despite the motivation to stay on track, there are some who believe that Congress will still need to pass a Continuing Resolution for FY2018 through the midterm elections. Since President Trump has signaled his unwillingness to sign another omnibus during his term, the bills may need to pass as standalone legislation, or as several “minibuses” (several appropriations bills grouped together).

HHS Secretary Azar Testifies on FY 2019 Budget Request

In early May, Alex Azar, Secretary of Health and Human Services (HHS), testified in front of the Senate Labor, Health and Human Services, and Education Appropriations subcommittee on the Fiscal Year (FY) 2019 Budget Request for HHS. The two-hour hearing mainly focused on U.S. domestic health priorities. In Secretary Azar’s opening statement, he highlighted global health security and stated that “one of the most effective ways to protect Americans from the threat of infectious diseases is to enable other countries to follow through on their own commitments to contain and respond to disease threats.” During the hearing, Senator Jerry Moran (R-KS) advocated for continued funding for the CDC’s Center for Global Health, stating that, “the funding is necessary, as seen with the Ebola outbreak, which had huge consequences on Americans.”

Secretary of State, Mike Pompeo, to Testify on Fiscal Year 2019 State Department Budget

Secretary of State Mike Pompeo will testify in front of the House Foreign Affairs Committee on Wednesday, May 23, at 9:00 am and before the Senate Foreign Relations Committee on Thursday, May 24, at 10:00 am. This is Secretary Pompeo’s first appearance in front of the committees since he was sworn in.

Senate Webcast link:

House Webcast link:

Ziemer Departs National Security Council

Also in early May, Rear Admiral Tim Ziemer was let go from his position as the head of global health security on the White House’s National Security Council (NSC). His departure came a day after the WHO declared an outbreak of Ebola in the Democratic Republic of the Congo. In addition to Ziemer’s departure, the global health office in the NSC was folded and staff shuffled into other offices. Although U.S. officials have stated that the United States remains committed to the Global Health Security Agenda, the timing of Ziemer’s departure, along with the proposed rescissions to Ebola funding and the new outbreak, has many worried. In a Huffington Post article, GHC Executive Director Loyce Pace stated, “We really need a strong leader in place from the U.S. who will help coordinate an interagency response and can really provide that kind of assurance and contribute to the progress made in global health security.”

In addition, Congressmen Gerry Connolly (D-VA) and Ami Bera (D-CA) sent a letter to the White House expressing concern that the administration is retreating from is commitment to global health security. Read the letter.