Inside (the Beltway) Scoop

By: Ellen Kuo
Wednesday, June 12, 2024
NIH Director Appears for the First Time Before Senate Appropriations Subcommittee

On May 23, NIH Director Monica Bertagnolli, MD, was welcomed before the Senate Labor, Health and Humans Services, Education and Related Agencies (LHHS) Subcommittee to discuss the fiscal year (FY) 2025 NIH budget request. Chair Tammy Baldwin noted her connection to NIH as the granddaughter of a NIH funded scientist. Additionally, she said she understood the important role biomedical research plays in treating and curing disease, bolstering economic growth, and ensuring America is a global leader in innovation. She called out Republican insistence on cutting funding for domestic programs, which resulted in the FY 24 allocation for LHHS being $2 billion less than FY 23. Through negotiations, however, Baldwin was able to secure a $300 million increase for NIH in FY 2024.

Baldwin also gave a history lesson to her fellow senators about the cuts to NIH from FY 2011 to FY 2015 where NIH funding decreased to nominal terms. Only in FY 2016 did Congress decide to remove overly restrictive discretionary caps that freed NIH for growth. From FY 2016 to FY 2023, funding for the LHHS increased on average by $7.7 billion annually, which is a 3.3 percent increase per year. As a result, LHHS could increase funding for NIH on average by $2.3 billion over the same period. Continued insistence on cutting funding for domestic programs will put NIH and biomedical research in peril setting back years of progress. The decline in 21st Century CURES Act funding that is to take place in FY 2025 will again create a challenging fiscal situation for NIH where the Precision Medicine and BRAIN initiatives will see significant loss of funds under the law of $199 million and $81 million respectively from FY 2024. 

As the senators had questions addressed on issues such as women’s health, investing in the next generation of researchers, overdose deaths, Alzheimer’s research, mental health, and long COVID, there was substantial applause from the audience when it came to what NIH was doing in these areas. With $1.2 billion appropriated for long COVID research, NIH was criticized for moving slowly to enroll patients in clinical trials and has yet to deliver treatments for this disease under the Recover Initiative.

Ranking member Shelley Moore Capito of West Virginia in her opening statement said her state has some of the highest rates of health challenges and partnering with NIH is critical to make improvements. Capito stated that, “The budget proposes $49.8 billion in funding for NIH, including 21st Century Cures and ARPA-H. The budget also proposes an additional $1.5 billion in mandatory funding for the Cancer Moonshot.” She added that biomedical research was a priority for her. NIH’s work is an economic driver of growth of more than $92.89 billion across the nation in 2023 and her state alone had 759 jobs generating $148 billion in economic impact in 2023.

Bertagnolli testified that the request of $50.1 billion for NIH includes both discretionary and mandatory funding. She also said that every state in the U.S. receives a share of NIH investments and the agency awards 60,000 grants supporting over 300,000 researchers and more than 2,500 institutions annually. Congress’ decades of funding in fundamental science has produced results such as the idea of reprogramming the brain to relieve anxiety, depression, and cravings.  She said that NIH’s track record has shown it can deliver progress.

Bertagnolli also acknowledged two major concerns. First was the need to improve the underrepresentation of people in medical research, especially those who are older, the uninsured, in minority groups or live in rural areas. To do this, NIH plans to enlist primary care clinicians to find ways to overcome health challenges and bring in care providers in underserved communities to contribute to the knowledge generation.

The second concern was to have comprehensive diverse data from clinical care environments to power AI approaches to improve health. Bertagnolli said there needs to be investment in secure and sustainable data sharing infrastructure to harness AI and machine learning to revolutionize clinical care and biomedical research. Health innovation on a national scale will require government, industry, and academic partners.

Bertagnolli also said that the president wants to reignite the Cancer Moonshot initiative in FY 2025 to cut cancer deaths by 50 percent by 2047. He is requesting $716 million in discretionary funding and seeks to reauthorize the 21st Century Cures Act Cancer Moonshot through FY 2026 by providing $1.448 billion in FY 2025 and FY 2026 or $2.9 billion in total mandatory funding in FY 2025 and FY 2026. In total, the budget proposes $2.164 billion in combined discretionary and mandatory funding for FY 2025.