A Lookback at the Biden Administration’s Development Agenda, Part II: Health, Food, and Human Capital

As I wrote in the first installment, my colleagues and I are preparing a series of blogs on the Biden administration’s global development agenda over the past 3 ½ years, with analysis on how the next Trump administration could affect its legacy. The blogs are based on the administration’s own account of its accomplishments as laid out in the U.S. Strategy on Global Development released by the White House in September 2024, which centers around five key objectives:

1. Reduce Poverty through Inclusive and Sustainable Economic Growth and Quality Infrastructure Development
2. Invest in Health, Food Security, and Human Capital
3. Decarbonize the Economy and Increase Climate Resilience
4. Promote Democracy, Human Rights, and Governance and Address Fragility and Conflict
5. Respond to Humanitarian Needs

For the second piece in this series, we look at the outgoing administration’s record on health, food security and human capital. Because President Biden came into office during the global pandemic, health policy was an urgent priority. An initial focus on vaccine production and distribution evolved into an agenda around pandemic preparedness in addition to the more traditional areas of reproductive health and HIV/AIDS prevention.

Of all the issues we consider, the administration’s legacy around health, especially reproductive health, is likely among those at highest risk under the Trump Presidency, along with support for decarbonization, democracy and human rights. The nomination of Robert F. Kennedy Jr., a prominent vaccine skeptic, as the Director of Health and Human Services, is also an ominous sign for global health cooperation.

U.S. Strategy on Global Development Pillar 2: Invest in Health, Food Security, and Human Capital

Health

The administration touts its role in leading an effort to vaccinate the world against COVID-19 as among its key accomplishments. Reversing a decision by the first Trump administration, the Biden administration joined the vaccine sharing initiative, COVAX, but the record here is mixed. While the US ultimately donated the largest number of vaccines, the initiative exposed tensions around vaccine equity and fairness that persist today. Notably, COVAX fell far short of key targets (e.g., providing less than half of the planned 2 billion vaccines by the end of 2021), due in no small part to vaccine hoarding by wealthy countries, including the US. More recently, President Biden announced that the US would provide $500 million and one million mpox vaccine doses to help African countries prevent and respond to the outbreak. 

In addition to the vaccine campaigns, the administration adopted capacity building to “prevent, detect, and respond to COVID-19 and future global health threats” as a priority. The administration launched a Global Health Security Strategy with the goal of advancing health security capacities through bilateral partnerships with more than fifty countries, and it was key to the launch of a new Pandemic Fund at the World Bank. Since concluding negotiations in 2022, the Fund has raised nearly $2 billion, including $700 million from the United States.

Unfortunately, the other major multilateral effort—a pandemic treaty at the World Health Organization—stalled because of disputes related to vaccine manufacturing and delivery, with intellectual property issues a major stumbling block. The administration was also hampered by Senate Republicans who have repeatedly voiced skepticism about international health agreements and called on the Biden administration to withdraw support.

On reproductive health, the Biden administration quickly reversed the Mexico City policy which blocks funding to foreign nongovernmental organizations that provide advice, information, referrals, services, and/or advocate for abortions, and has been in force under all Republican administrations since Reagan. In June 2024, the administration a set of robust measures to protect access to family planning and reproductive health on top of $600 million in funding through bilateral and multilateral programs. 

Finally, the administration supported major bilateral and multilateral efforts to curb HIV/AIDS and other communicable diseases, which have historically garnered support from both sides of the aisle. This included:

• Maintaining funding over $4.7 billion every year for the bilateral activities of PEPFAR, the HIV/AIDS program first authorized by Congress in 2004;
• Initially pledging $6 billion to the Global Fund over three years during its seventh replenishment in 2022 (contributions have since been reduced due to a statutory provision capping prohibition capping US contributions at $1 for every $2 from other donors); and
• Pledging at least $1.58 billion in 2024 to support GAVI over five years.  

Food Security

Food security has figured prominently in the Biden administration in response to rising food prices and shortages due to disruptions from Russia’s war on Ukraine and the growing frequency and intensity of climate events.

The US co-chaired the Global Food Security Summit in 2022 on the margins of the UN General Assembly, with President Biden announcing plans to spend $2.9 billion: $2 billion for humanitarian aid and the rest for development-related food security initiatives like Feed the Future, which invests in food-related technology to support climate-smart agriculture, soil health, and fertilizer efficiency. This program targets the most at-risk countries, chiefly in Africa, and in 2022 was expanded from 12 to 20 countries. The administration also targeted three countries—Malawi, Tanzania, and Zambia —for especially intensive efforts under a new Accelerator program.

The US Treasury drove the International Financial Institution (IFI) Action Plan to address food insecurity. It is hard to gauge if the plan actually improved conditions on the ground, as it was largely a compilation of the various commitments being pursued by signatory multilateral development banks (MDBs) and the International Monetary Fund. In her remarks in September 2023, Treasury Secretary Janet Yellen claimed success, noting that IFI funding for food security related projects and programs reached almost $15 billion in 2022, 60 percent higher than before the war in Ukraine began.

The US also made modest commitments to two multilateral facilities: $175 million to the Global Agriculture and Food Security Program (GAFSP) administered by the World Bank and $162 million to the 13^th replenishment of the International Fund for Agricultural Development (IFAD). Finally, the administration signed on to the Global Alliance Against Hunger and Poverty Brazil’s signature G20 initiative, a collaborative platform which commits members to scale and align efforts to combat hunger through innovation and knowledge sharing.

Human Capital

The administration doesn’t make much of a case for its accomplishments in human capital, possibly because health (a major form of human capital) is handled separately. The strategy document focuses chiefly on education, with commitments summarized as: “addressing barriers to quality education from pre-primary to tertiary education, helping young people to remain in school, and expanding access to vocational training, job markets, and other economic activities.” While the document does not offer any specifics, we found that the administration pledged $305 million to the Global Partnership for Education in 2021. But it may have decided against highlighting this commitment because it fell well short of the $1 billion that civil society and several Democratic senators had pressed for.

Legacy Assessment: Pillar 2

Major global health challenges are becoming increasingly common and depend on strong global cooperation to be effectively managed. President Biden committed to global engagement around health, and took significant action around pandemic preparedness and response, including an outsized role in standing up the World Bank’s new Pandemic Fund.

During the G7 Leaders’ Summit earlier this year, Biden called for another $2 billion to support the Pandemic Fund and pledged up to $667 million (a third of the total). Fulfilling that pledge will be up to Congress, and it is unclear what a final FY25 spending deal (if there is one) may net for the Pandemic Fund. The Senate appropriations bill includes $250 million while the House version lacks any spending directive. Notwithstanding this budget outcome, the Pandemic Fund will remain in force. Less clear is whether the incoming administration will see value in sustaining the bilateral partnerships designed to strengthen health systems in countries with limited capacity to manage and contain outbreaks of contagious diseases like COVID.

While the Biden administration also pledged to support several major health programs, it has yet to deliver on many of its funding commitment. An open question is whether Congress will approve Biden-era pledges to multilateral efforts like the Global Fund and GAVI and to bilateral programs like PEPFAR. PEPFAR has historically received strong bipartisan support but struggled to secure long-term reauthorization in 2023 due to unsubstantiated claims that funding could be used to support abortions.

The legacy around reproductive health will be limited because the Trump administration is expected to reinstate the Mexico City Policy immediately. In President Trump’s first term, his administration expanded its scope from covering international family planning assistance to all bilateral global health assistance, which had documented effects on service delivery across many US-supported global health programs. There is pressure from some quarters to expand the Mexico City Policy to apply to all US foreign assistance, which would add significant bureaucratic obstacles to the disbursement of aid.

Finally, the second Trump administration could follow through on earlier plans to withdraw from the WHO, which would deal a significant blow to global cooperation and efficacy around major health risks.

It is too soon to assess the legacy of the Biden administration’s impact on food security, as investments in agricultural productivity take time to manifest. But the US did play a key role in galvanizing global action around the food security crisis. At issue is whether Feed the Future will continue to receive the resources and attention needed to fulfill its goals. There is basis for some optimism here—the initiative was established in 2010 and in 2018, the Food Security Reauthorization Act, which reauthorized Feed the Future, was signed by then-President Trump with strong bipartisan support.