Deal leaves risks for global health to fall or be pushed off the cliff

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The deadline-driven deal with which lawmakers rang in the New Year reflected an agreement not to jump off a fiscal cliff — at least until March — but leaves suspended in mid-air the fates of programs essential to meeting the goals of continued global health responses — including the implementation of PEPFAR’s Blueprint for an AIDS-free generation, and whatever promise the new Office of Global Health Diplomacy will offer.

The deal averted the immediate imposition of sequestration — across-the-board 8-percent cuts to current levels of government spending on most programs — which would have led to drastic and uncompromising drops in global health and research funding. But  as it only postpones, but does not eliminate the threat of sequestration, it leaves open the possibility that those cuts could still come just as the Continuing Resolution reached last September expires. Some of the most immediate and likely impacts of those cuts — in lives and progress — have been discussed, here and elsewhere. They would, for example, devastate efforts to provide life-saving and preventive HIV treatment, making it impossible to reach the goal of a tipping point, at which the numbers of people on treatment would surpass the numbers of people getting infected with virus that leads to AIDS. They would all but eliminate the current level of funding by the National Institutes of Health to external researchers developing new treatments for drug-resistant strains of illness.

But even if another deal is reached to prevent indiscriminate cuts, what values that deal will put on global health and medical research remains a question. The New Years Eve deal already will have an impact on available funding, as, in it, Congress has lowered the cap on discretionary spending by $4 billion. So far, nothing indicates what priorities might trump science. The Senate’s overwhelming bipartisan rejection of an amendment from Sen. Rand Paul (R- KY)  to take $9 billion from the International Affairs Budget, gives some hint that foreign aid is considered a worthwhile investment, but little more.

Adding to the unknowns — the President’s budget, normally released in the first week of February, is expected to be delayed this year. Stayed tuned, as we continue to follow.

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