The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and behavioral research. Its mission is to seek fundamental knowledge about the nature and behavior of living systems and 3 the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.
The NIH funds a wide range of research projects, from basic science to clinical trials, conducted by scientists at universities, medical schools, and other research institutions around the country.It funds more biomedical research than any other public institution in the world, dedicating 91 percent of its $49 billion budget to research both inside and outside the agency. However, Congress has not thoroughly reviewed NIH operations and practices since the 21st Century Cures Act passed in 2016, nearly a decade ago.
An now after the presidential election, there is an abundance of media speculation that the NIH is under the cross hairs of the upcoming Donald Trump presidency. The agency has historically enjoyed bipartisan support, Trump proposed cutting its budget during his first term.
“I do think you probably will see changes in NIH, as well as other public health agencies like CDC and maybe even FDA,” says Dr. Joel Zinberg, a senior fellow at the Competitive Enterprise Institute and director of the Public Health and American Wellbeing Initiative at the Paragon Health Institute, both conservative think tanks. “And that’s primarily I think because there was a real erosion in trust in those agencies during the pandemic,” he says.
And shaking up the NIH has fans. Robert F. Kennedy Jr., a vocal critic of mainstream medicine, has President-elect Donald Trump’s ear. According to a report by NPR, over the weekend, Kennedy said he’d like to immediately replace 600 NIH employees. “We need to act fast, and we want to have those people in place on Jan. 20 so that on Jan. 21, 600 people are going to walk into offices at NIH, and 600 people are going to leave,” Kennedy said while speaking at the Genius Network Annual Event in Scottsdale, Ariz.” As of September 30, 2021, the NIH had 18,718 employees, according to its website.
Kennedy previously proposed in a Wall Street Journal op-ed that half of NIH’s research budget should be spent on “preventative, alternative and holistic” medicines. He has also said he will clear out “entire departments” of the U.S. Food and Drug Administration (FDA) if given a place in Trump’s administration, as the former president has repeatedly promised.
Earlier this year, U.S. Senator Bill Cassidy, M.D. (R-LA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a white paper detailing proposals to improve the National Institutes of Health (NIH). Last year, Cassidy requested feedback from stakeholders on policies Congress could consider to modernize NIH.
The report also examined how the United States can sustain its advantage in biomedical research to ensure Americans receive the most innovative treatments as quickly as possible. Cassidy laid out several proposals to address this, including streamlining peer review of research, and addressing challenges in recruiting and maintaining our biomedical workforce. He also highlighted the importance of robust collaboration between NIH, public health and health care institutions, and the private sector in identifying how NIH policies can be adapted to most effectively support potentially transformative research.
Additionally, many stakeholders noted that NIH has failed to convene the Scientific Management Review Board (SMRB), an advisory board required by Congress to provide feedback on agency structure and operations. This lack of transparency combined with declining public trust in the agency during the COVID-19 pandemic underscores the need for greater accountability. In the report, Cassidy emphasized the need for NIH to enhance transparency, including reestablishing SMRB and creating an apparatus allowing public input on agency practices.
Nonpartisan watchdogs, such as the Department of Health and Human Services Office of the Inspector General (HHS OIG), have also found deficiencies in NIH oversight of its extramural grants. Cassidy recommends holding NIH accountable to carry out its grants management responsibilities while balancing more effective oversight with reducing unnecessary burden on researchers.
And conservative think tanks like the Heritage Foundation have been floating long to-do lists for changing the NIH.