Why the NIH Funding Freeze Matters

The attack on science from this administration has been multi-pronged, both in motivation and in result. Today we will look specifically at how this is playing out in the number one funder for biomedical research in America, the National Institutes of Health (NIH). 

Timeline and Motivations

Beginning January 21 with the (illegal) funding freeze on all grants and government contracts NIH stopped issuing awards and withheld funds of already issued awards, in a seeming attempt to avoid running afoul of the administration. Despite court orders to stay the Executive Order and return to issuing awards, the award notices did not resume immediately. Further, on February 7, NIH abruptly announced that the Indirect Cost (IDC) Rate would be capped at 15%, effective immediately, despite being a clear violation of existing appropriations laws that required any change in the IDC rate to go through Congress. While most Americans don't need to think very often about IDCs, they are a critical part of the research infrastructure, and thus this abrupt announcement was clearly a part of the sweeping agenda of the current administration’s “move fast and break things” strategy. 

Acting Director Matthew Memoli, who was appointed in January from his relatively low-level position as a flu researcher at the agency, but whose ideology aligns with the administration’s, finally allowed some few Notices of Award to start being issued on Feb. 7, but notably directed that none of the awarded grants should include traces of what the administration dismissively refers to as “DEI,” which in the context of NIH grants can be grants that look at social determinants of health; acknowledge that some diseases, such as Sickle Cell Disease, disproportionately affect certain populations; or encourage a broadened pathway for historically underrepresented populations of researchers in order to close a well-known gap in funding demographics. This gap hurts not only the individual researchers, but also the fields they study, and by extension health outcomes. None of these initiatives are at all discriminatory, which is the argument of the administration waging war on “DEI.” Instead, they aim to mitigate the effects of past and present discrimination, broadly conceived, particularly in the ways in which that discrimination has real, tangible, and indeed, deadly effects on Americans. 

But that is not all, of course. There is also the angle of science-denial and vaccine skepticism, made quite obvious by the appointment of RFK, Jr. as the head of the Department of Health and Human Services. Indeed, Acting Director Memoli notably decried Fauci’s leadership and supposedly refused the COVID vaccine himself. To recap, then, a previously low-level researcher with an outlier opinion on infectious disease interventions is now leading the entire NIH, including the robust institute devoted to Infectious Disease, NIAID , which comes in behind only the institute devoted to cancer, the NCI, in the number of projects among the 27 institutes in the NIH. Infectious disease research at the NIH is being held hostage by vaccine skeptics, even as diseases that vaccines have all but eradicated make a devastating comeback, like the measles outbreak, which just resulted in the first death from the measles in a decade. This fact, alone, is cause for alarm. Unfortunately, however, that just scratches the surface of the impacts of this administration’s stranglehold on the NIH.

Effects

Economic 

The economic impact of federal funding is huge, and states with robust research profiles see a large monetary ROI from those funds. Nationwide, every dollar invested in NIH results in $2.46 of economic activity.  A snapshot at the state level shows that in FY 2023, the state of Georgia had $780M in NIH funding, supporting 11,816 jobs and resulting in $2.18B of economic activity. Universities and hospitals in the Atlanta metro area dominate the list of top NIH recipients, with 7 of the 9 listed spots. By every metric, then, whether we look at it nationally, state-wide, or hyperlocally in Atlanta, NIH funding matters a great deal to our economic stability. It also undergirds much of the educational infrastructure to train the next generation of not just researchers, but also clinicians. In other words, federal biomedical research funding is so thoroughly intertwined with the budgets of Schools of Medicine that to disrupt that at the level currently underway catastrophically threatens the ability of America’s schools of medicine to continue training the medical practitioners of tomorrow. 

 Additionally, there is a profound impact on the biomedical innovation landscape, resulting in the US falling behind other countries, especially China, in a sector that had been, prior to this administration, a strategic area of focus. 

Healthcare/Public Health Outcomes

While the economic impacts are far-reaching and devastating, even worse are the impacts to the state of American healthcare and public health, the latter of which is also threatened massive cuts to the CDC. Healthcare improvements and innovations come directly from funded research, which is classified in one of three ways: basic science, translational research, and clinical research. Basic science lives at the bench; without it, the other two would not exist. This is where breakthroughs happen at the cell or molecular level, for example. Basic scientists look at biomedical research at the most detailed of levels. From there, breakthroughs are studied at the translational level—how do those discoveries in a petri dish or through the lens of a powerful microscope translate to medical interventions with the potential of saving or improving lives? After that is clinical research, which is where those interventions are tested, first for efficacy (how does it work in a controlled study?) and then effectiveness (how does it work in a real-world environment?). Without research funding those experiments from bench to bedside, innovative new treatments stop in their tracks, and money already spent to begin projects goes to waste. That is what is happening now. As of now, a small number of Award notices trickle out each day, but the agency has been prohibited to post notices to the Federal Register, meaning they cannot hold study sections, which is the way NIH peer reviews grant submissions. Through these methods, Memoli, acting on behalf of the guiding ideologies of the administration, is working around the court orders to resume funding.

Institutions and private citizens joined with the group, Research!America to register their dissent with these devastating cuts and make their voices heard in support of robust research funding. Many other organizations have issued statements as well, such as the  Association of American Medical Colleges, the American Society for Biochemistry and Molecular Biology, and many others.

In short, we are in the beginning of a national medical emergency.