Well, it’s mid-January and we didn’t fall off the fiscal cliff. But don’t breathe a sigh of relief quite yet –  for those of us in development, we are still peering over the edge. The fate of most federal programs, including those that fund global health, still hangs in the balance. The American Taxpayer Relief Act of 2012 only delayed budget sequestration by two months. The only good news in all of this, if I’ve understood it correctly, is that it also reduced the level of the total cuts that would occur from $109 billion to $85 billion.

What’s this mean for global health? To be honest, I’m not sure anyone knows yet.  Leading up to the original fiscal cliff deadline there were a number of briefs and campaigns looking at the human impact of sequestration, especially in terms of global health. Supposing all programs are equally cut by 5.9% (instead of the previous 8.2%) in FY2013, global health programming at USAID could face up to $482 million in cuts, and NIH’s budget could be cut by an estimated $1.8 billion.

With a new deadline at the end of March, Congress could continue to delay, or come up with a long-term budget plan which would eliminate the sequestration altogether. Based on Boehner’s recent interview with the WSJ, though, that seems unlikely.  To make things even more uncertain, the Obama Administration budget request for FY2014, which could provide some hints, will be delayed until sometime in March (instead of early February).

Any predictions I would make at this point would be purely speculation. I will admit that I worry about the implications of funding cuts on PEPFAR Blueprint: Creating an AIDS-free Generation, the Global Fund for AIDS, Tuberculosis, and Malaria, and what it might mean for the US Department of State’s new Office of Global Health Diplomacy.

It’s never easy to make cuts, and I’m glad I don’t have to make the tough decisions.  However, given the importance of global health, it seems to me that cuts to global health would have a negligible impact on the deficit reduction. but it would both have a devastating direct and indirect effects for hundreds of thousands, and possibly millions, of people around the world and damage US foreign policy goals, given that the Office of Global Health Diplomacy is tasked with guiding the “diplomatic efforts to advance the United States’ global health mission to improve and save lives and foster sustainability through a shared global responsibility.”

(Photo Credit: Lorea Russell – Pakistani children waiting at clinic near Abbottabad)