Congress Approved $9.4B for Global Health. Will It Actually Get Spent?

When Congress passes a law and the president signs it, you'd expect the money to actually get spent. In America today, that's no longer a safe assumption.

Earlier this month, Congress passed a $9.4 billion global health funding bill — money for HIV treatment, childhood vaccines, and malaria programs across more than 50 countries. Given that the Trump administration had proposed slashing global health funding by more than 60 percent, this was genuinely surprising.

Even more striking were the specifics. Republicans who co-wrote the bill allocated $524 million for family planning programs that the administration wanted to eliminate entirely. Gavi, the international alliance that vaccinates more than half the world's children, received $300 million despite vocal opposition from Health Secretary Robert F. Kennedy Jr.

But here's the problem: having the law doesn't guarantee the money will flow.

Last Year's Cautionary Tale

Congress also appropriated billions for global health work last year. The administration simply chose not to spend more than a third of it. According to the Center for Global Development, US global health spending fell by more than a third, with devastating consequences.

Consider the Global Fund, which finances HIV, tuberculosis, and malaria programs in more than 100 countries. The US had pledged $6 billion to the fund for 2023-2025, and Congress approved the money. But less than one-third of that $6 billion actually reached the Global Fund by mid-2025.

Facing this US-driven shortfall, the Global Fund had to slash $1.4 billion from grants to lifesaving programs already in progress. In Lesotho, where TB rates are among the world's highest, clinics simply shut down. One patient visited nine HIV/TB clinics before finding one still open, according to an aid worker with direct knowledge of operations.

Some money meant for global health programs was diverted to pay for the White House budget director's security detail. The rest just sat there, unspent.

Congressional Pushback: Will It Work?

Under the Constitution, when Congress appropriates money, the executive branch is required by law to spend it as directed. Last year, the administration largely ignored this requirement — and got away with it.

This time, Congress is trying to force the issue. The new law sets specific funding floors for malaria, maternal health, tuberculosis, and nutrition programs. It uses unusually forceful language requiring the State Department to report spending plans to Congress and make quarterly payments to the Global Fund.

"These oversight requirements didn't exist at this level of scrutiny before," said Julianne Weis, co-founder of Aid on the Hill, which tracks foreign aid legislation.

But laws didn't stop the administration last year. AVAC, an HIV advocacy organization, sued the government over unspent funds — that case is still active. The real test is whether Congress will enforce its own law this time.

"Congress abdicated their responsibility last year for ensuring that the president spent what they had appropriated," said Mitchell Warren, head of AVAC. "Whether this Congress will act differently is an open question."

The Capacity Crisis

Beyond political will lies a more fundamental problem: operational capacity. Before USAID was gutted, its TB program alone had nearly 200 dedicated staff — 40 in DC and 150 worldwide — managing about $406 million annually across 24 countries.

Today, according to someone with direct knowledge of the program, two people at the State Department oversee that same portfolio. The President's Malaria Initiative, managing $795 million in funding, went from 66 staffers to five.

The administration's "America First Global Health Strategy" makes this worse. Instead of working through established aid organizations, the US is now striking deals directly with foreign governments — an approach experts say requires more specialized staff, not less.

The administration has signed 16 such deals so far, but they don't cover key areas Congress just funded. Family planning, which received roughly $524 million despite active administration opposition, remains uncovered by these new arrangements.

Compare: Two Approaches to Global Health Aid

The September Test

Despite these challenges, the new law signals that Republicans and Democrats in Congress want to reassert America's role in lifesaving global health work. "What this law mostly says is that Congress is back," Warren told me. For decades, foreign aid has had strong bipartisan support on Capitol Hill, even when presidents tried to reshape it.

But Warren isn't celebrating yet. "I'll declare victory when every dollar Congress appropriated is spent by the administration."

The fiscal year ends in September. Millions of patients worldwide — from HIV clinics in Uganda to malaria programs in Nigeria — are waiting to see if American promises translate into actual help.