Health research could face significant cuts and changes under Trump administration

Health research could face significant cuts and changes under Trump administration

Max Kozlov & Nature Magazine

The world’s largest public funder of biomedical research appears poised for a major overhaul in the coming years.

Proposals from both houses of Congress and comments by the administration of President-elect Donald Trump indicate a significant appetite to reform the National Institutes of Health (NIH) and its US$47 billion research portfolio. What is less clear is how this transformation will unfold. Proposals include everything from cutting the number of laboratories in half to replacing some of the agency’s staff.

Reflecting this increased government oversight, the NIH launched a series of meetings on November 12 in which an advisory group of agency insiders and outside scientists will consider various proposals and come up with their own reform plans. was decided to be presented.

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Jennifer Zeitzer, director of communications for the American Federation of Societies for Experimental Biology in Rockville, Maryland, said it will be a mad dash to the finish line between these parties in terms of whose vision will prevail. Talk about deaf. “There is definitely a movement on Capitol Hill to discuss how to optimize and reform the NIH,” she says. “Agents are now participating in those discussions.”

Shrinking and cutting

The NIH advisory meeting comes as Republicans gain control of both chambers of Congress heading into 2025. This year, two separate legislative proposals to reform the NIH were introduced by Republican lawmakers, one led by Representative Cathy McMorris Rodgers. One by a Congressman from Washington state and one by Sen. Bill Cassidy of Louisiana. These proposals are fueled in part by dissatisfaction with the agency’s response to the coronavirus pandemic and perceptions of lax oversight of research into potentially dangerous pathogens.

McMorris Rogers’ plan would reduce the number of NIH institutes and centers from 27 to 15, allow their parent institutions to revoke grants determined to be a threat to national security, and increase the number of institute directors. It would impose renewable five-year term limits. It only takes one time to enact stricter oversight of research involving dangerous pathogens. Meanwhile, Cassidy, who is set to become chairman of the U.S. Senate committee that oversees health issues in 2025, said the agency will introduce more transparency into the process by which research grant proposals are reviewed.

If the plans outlined in the white paper come to fruition, it would be the first major overhaul of the NIH in nearly 20 years. The last time it was reviewed was in 2006, when Congress passed a bill with bipartisan support that created a review committee and required agencies to send updates to lawmakers every two years. Obliged. But the proposals currently under consideration are unlikely to garner similar support from both sides of the political spectrum.

The NIH has been a frequent target of President Trump, Republicans and other allies. Robert F. Kennedy Jr., President Trump’s pick to head the U.S. Department of Health and Human Services (HHS), the NIH’s parent agency, said he would seek an eight-year moratorium on infectious disease research at the agency in 2023. So biomedical funders can instead focus on chronic diseases like diabetes and obesity. On November 9, he said he aims to fill 600 NIH staff positions. (Currently, neither President Trump nor his appointees can fire career employees at the agency, and their jobs are protected by law, but if President Trump makes good on his promise to reclassify federal employees) may change.)

Harold Varmus, a cancer researcher at Weill Cornell Medicine in New York City and former director of the NIH. nature He said he was “alarmed” by Kennedy’s comments. “Even traditional NIH supporters, Republicans and Democrats in Congress, may need to speak up on behalf of NIH and its importance to public health.”

dash to the finish line

At this week’s meeting of the NIH’s advisory committee, known as the Scientific Management Review Board (SMRB), committee members met for the first time since 2015 to review the agency’s structure and research portfolio and make recommendations to the NIH director and HHS. . Parliament called on the authorities to begin this process.

NIH officials hope the group will meet five more times over the next calendar year and produce a report of its findings and recommendations by November 2025. This ambitious schedule suggests that “there is a recognition that the SMRB must move.” “You have to rush to catch up with Congress or risk making decisions that Congress doesn’t like,” Zeitzer said.

Indeed, several commissioners indicated at the Nov. 12 meeting that they feared Congress would take action before the group submitted its report. Kate Klimczak, director of the NIH’s Office of Legislative Policy and Analysis, sought to reassure the committee. “The authors of the various (Congressional) proposals clearly wanted to reestablish this commission and wanted this commission to do its job,” she said. “You have to take them at their word that they’re looking forward to getting (the report) from you.”

NIH Director Monica Bertagnoli, who will likely resign before Trump takes office, said she does not support proposals to reduce the number of research institutions. She said the current system provides people with the disease and patient advocacy groups the ability to work with specialized organizations for that purpose, such as the National Institute of Mental Health and the National Institute on Aging. . “If we were to collapse, we would definitely lose something in terms of engagement with the public,” she says.

It is unclear what direction the SMRB will take with its recommendations, but there were hints at the meeting. Some panelists were surprised by the legislative proposals. For example, the McMorris Rogers white paper stated that at the NIH, “decades of nonstrategic and disorganized growth have created a system of stagnant leadership, duplication of research, gaps, fraud, and undue influence.” are. James Hildreth, president of Meharry Medical College in Nashville, Tennessee, called the language “almost offensive.” He added: “We know we shouldn’t allow politics to infiltrate our activities, but why shouldn’t we?”

This article is reprinted with permission. first published November 15, 2024.