New Director May Bring Positive Changes to the NIH

By Colin Burdette and Sarthak Tiwari

In 2023, the Tri-I received 1,056 grants—nearly $600 million in total—from the U.S. National Institutes of Health (NIH).  While many members of the Tri-I community rely on such NIH funding, we represent just 1.5% of NIH-funded research. The NIH had a total budget of almost $48 billion last year, of which $40 billion was allocated for extramural research, while the rest was used internally. While there are certainly other sources of funding opportunities, common programs such as the NSF partition funding from a significantly lower total ($10 billion in 2023). These funds are critical for most biologically or medically oriented labs, but can we continue to rely on the NIH? How has the NIH changed over the last few decades, and what sorts of changes can we expect going forward?

The first thing expected to change is next year’s funding. The NIH has requested $48.6 billion, an increase of about $1 billion from last year. However, the House and Senate have not agreed on any numbers so far, and the House voted on a resolution that only allocates $45 billion (a decrease of over 1%). The NIH also requested an additional $2.5 billion for a separate institution within the NIH, for different types of research funding. Concessions will likely be made, as lawmakers need to reach a budget agreement soon to avoid a government shutdown. Both houses of Congress have continually made short-term budget extensions to continue funding these agencies, but no clear guidelines have been established on NIH funding. As of January 2024, the Senate approved a 2% increase to the NIH budget, but it is unlikely that the House will agree to this. In the instance of a government shutdown, NIH funding for 2024 is at least guaranteed through March 7. Despite this lifeline, many government agencies along with the NIH will struggle to properly allocate funding, since it’s unclear what the total budget will be.

The NIH comprises twenty-seven specialized institutes and centers, each focusing on different areas of health research. Once overall NIH funding is allocated to each of the twenty-seven institutes, each institute reviews and awards proposals related to its core research focus.

Dr. Monica Bertagnolli, M.D., was nominated by President Biden last May and approved by the Senate in October to lead the NIH. Dr. Bertagnolli grew up on a cattle ranch in Wyoming, and during her time as a researcher, she advocated for including rural populations and communities in clinical trials. These areas are often under-serviced and offer unique environmental and cultural conditions that are not well studied or accounted for. Bertagnolli started as an attending surgeon near the Tri-I at the NewYork-Presbyterian Hospital in 19942. She later became a professor of surgery at Harvard Medical School and faculty at the Dana-Farber Cancer Institute. She previously studied how inflammation drives colon cancer in mice. This research led her to work on a large clinical trial for a Cox-2 inhibitor, a drug to reduce inflammation and potentially prevent polyps that could develop into colon cancer. In 2022, she was appointed as the head of the National Cancer Institute (a subsection of the NIH). She revealed that she was a cancer patient herself when she was diagnosed with breast cancer just two months after assuming her position. Before heading the NCI, she had worked with the organization to facilitate the merging of several groups running cancer trials within the NCI. As NCI director, she unveiled new plans to cut cancer rates in half by 2047 and established a unit of the NCI to work on innovative approaches for clinical trials.

As NIH director, she aims to make the organization’s research more equitable and accessible and make AI a bigger focus of future biological research. In particular, she wants to build a learning health system that uses AI to find important patterns in Electronic Health Record (EHR) data. Currently, many labs conduct research using EHR data but often struggle with inaccessible or poorly formatted data1.

Due to Bertagnolli’s strong background in basic and translational science, as well as her previous work with the NCI, many people think she is a great choice for director. She was initially hesitant but decided to accept the role1. There are many internal problems at the NIH that Bertagnolli may address as she inherits this leadership role. Next year’s funding is one of the organization’s main priorities. Congress is unlikely to grant the NIH’s request for a budget increase; in fact, its budget may decrease over the next two years. Another major challenge the NIH faces is postdoctoral research salary. In recent years, postdoc applications have slowed to a crawl6. While there are many factors, a major one is the massive pay disparity between postdoc positions and industry roles. Many labs want to pay more but are restricted by NIH policies. The NIH scale starts at $56,484 for the first year and increases by less than a percent each year. This doesn’t match inflation, and many industry positions can often pay two to three times as much. As more and more postdocs leave, valuable research goes unfinished. An internal report from the NIH recommends that the minimum salary be increased to $70,000; however, no action has been taken, and a 25% increase in the postdoc salary is unlikely given current budgetary constraints.

Another major issue that needs to be addressed is the award value of R01 grants. R01 grants are one of the oldest forms of grants used in the United States and fund everything from researcher salaries to lab supplies. While these are usually competitive, the grant amount has effectively not changed in over twenty years. An R01 grant equivalent in 1998 was worth $246,522. In 2020, the average size was $559,680. Adjusted for inflation, this award size comes out to $295,014, an increase of effectively $50,000 over twenty years. Low award sizes may limit how many researchers can work on a project, ultimately lowering its scope. In the Tri-I, this award amount is slightly offset due to the abundance of cores and facilities that assist researchers without individual labs having to buy certain instruments. Nevertheless, increasing actual grant amounts should be a top priority of the NIH to promote larger-scope projects that reasonably prepare labs for the high costs of science.

Another challenge the NIH currently faces is the allocation of funding regarding AI technology. AI is becoming increasingly important for biology research, and large databases are needed for training. On top of the data required, the model training process can also be prohibitively expensive without proper hardware. The NIH needs to decide how to allocate funds for these databases. There are many exciting prospects for future biomedical research, and the NIH will play a key role in helping to fund AI technology in a biological context.

While much is still uncertain about the NIH, a few things are clear. It will continue to be one of the largest sources of public funding in the U.S., especially in biomedical research. Because NIH policies and funding dictate the pace of research, understanding its position is crucial for understanding the research landscape. Current political tensions are particularly important for the NIH, and it is difficult to tell how this will affect future research projects and stipends. Bertagnolli has many difficult challenges to navigate, but her experience with science, clinical studies, and leading government agencies makes her a uniquely qualified leader who will play a major role in the direction of research in the U.S.

Under Bertagnolli’s leadership, perhaps the NIH will undergo multiple positive changes that will enhance the capacity for groundbreaking fundamental and translational biomedical research. As for the near future, we can hope that researchers continue to seek and gain financial support from the NIH to conduct science for the benefit of humanity.

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