Health Research Could Face Severe Cuts and Changes under Trump

Health research could face drastic cuts and changes under Trump

Who Max Kozlov & Nature magazine

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

The proposals of both chambers of the US Congress, as well as the comments made The incoming administration of US President-elect Donald Trump Show that there is a strong desire to reform the National Institutes of Health (NIH) and its $47 billion research portfolio. What is less clear is how this transformation will unfold; proposals have ranged from cutting the number of institutes in half to replacing a subset of the agency’s staff.

Reflecting this increased government scrutiny, on November 12, the NIH launched a series of meetings in which an advisory group of scientists from inside and outside the agency will examine different proposals and offer their own recommendations for reforms.

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It will come down to the finish line between these parties whose perspective will win out, says Jennifer Zeitzer, who directs the public affairs office of the American Society for Experimental Biology in Rockville, Maryland. “There is absolutely movement on Capitol Hill to discuss how to optimize and reform the NIH,” he says. “Now we also have the agency involved in that conversation.”

Shrinking and cutting

The NIH advisory meeting comes as Republicans won control of both houses of Congress and the White House through 2025. This year, two separate bills to reform the agency were introduced by Republican members of Congress — one led by Rep. Cathy McMorris Rodgers. Washington State and Louisiana Senator Bill Cassidy. These proposals have been fueled in part by disagreements over the agency’s response to the COVID-19 pandemic the perception that oversight of research into potentially dangerous pathogens has been lax.

McMorris Rodgers’ plan It would drop the number of NIH institutes and centers from 27 to 15, allow its parent agency to cancel any funding deemed a threat to national security, impose a 5-year limit on institute directors that can be renewed only once, and impose stricter oversight of research involving dangerous pathogens. For his part, Cassidy, who in 2025 will become chairman of the US Senate committee responsible for overseeing health issues, he said he would introduce more transparency in the processes used by the agency to review research grant proposals.

If those plans—contained in white papers—are implemented, they would represent the first major reform of the NIH in nearly 20 years. The last time a review occurred, in 2006, the US Congress passed legislation with bipartisan support, establishing a review committee and requiring the agency to send updates to lawmakers every two years. The same support from both sides of the political aisle is unlikely to happen with the proposals currently under consideration, however.

The NIH has been a frequent target of Trump and his Republicans and other allies. Robert F. Kennedy Jr., Trump’s pick to lead the US Department of Health and Human Services (HHS) – NIH’s parent agency – said in 2023 that he would seek an eight-year hiatus for infectious disease research at NIH. so that biomedical funders can focus on chronic diseases such as diabetes and obesity. He also said on November 9 that he would replace 600 NIH employees. (Neither Trump nor his appointees can currently fire the agency’s career employees, whose jobs are protected by law, but that could change. If Trump keeps a promise to reclassify the federal workforce.)

Harold Varmus, a cancer researcher at Weill Cornell Medicine in New York and former head of the NIH, told nature That he is “alarmed” by Kennedy’s comments. “We need Republicans in Congress as well as Democrats who are traditional supporters of the NIH to speak up for the agency and its importance to public health.”

Shake it to the finish line

At this week’s meeting of NIH’s advisory board, called the Scientific Management Review Board (SMRB), panel 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. Congress asked the agency to initiate this process.

NIH officials expect the group to meet five more times over the next year to report their findings and recommendations by November 2025. The risk of catching up with Congress quickly, or making decisions that Congress doesn’t like,” says Zeitzer.

In fact, several members of the committee expressed their fear at the November 12 meeting that Congress would act before the group’s report. Kate Klimczak, director of the NIH’s office of legislative policy and analysis, tried to reassure the committee: “The authors of the various proposals ((in Congress) clearly wanted to reinstate this committee and wanted this board to do their job.” he said “We have to take your word for it that they expect to receive (a report) from you.”

NIH Director Monica BertagnolliTrump, who is likely to resign before taking office, expressed disapproval of proposals to collapse the number of high schools. He said the current system gives people with illnesses and patient advocacy groups the ability to coordinate with an institute dedicated to their cause, such as the National Institute of Mental Health or the National Institute on Aging. “If we did, we would definitely lose something in terms of our engagement with the public,” he said.

It is not clear what direction the SMRB will take with its recommendations, but there were hints at the meeting. Several panelists were surprised by the legislative proposals. For example, McMorris Rodgers’ white paper says that decades of “lack of strategic growth and coordination created a system ripe for stagnant leadership, research duplication, gaps, misconduct, and undue influence” at NIH. James Hildreth, president of Meharry Medical College in Nashville, Tennessee, called the language “almost offensive.” He added: “I know we shouldn’t allow politics to get into what we do, but how can we not?”

This article is and was reproduced with permission first published November 15, 2024.