Deadline Nears for Comment on Republican Revamp Proposal for NIH

Republican legislators in the U.S. House of Representatives, arguing that “the American people’s trust in the National Institute of Health has been broken,” have released a blueprint for reforming the agency. Congresswoman Cathy McMorris Rodgers, a Republican from Washington state and chair of the House Energy and Commerce Committee, is listed as the author of the 22-page “Framework for Discussion.” The document was released in June and the comment period for those offering feedback on the proposal closes on August 18.

NIH is largest non-Depart of Defense science agency in the U.S. government, with a current budget of $46.8 billion. (The National Science Foundation, in contrast, has a budget of $9.1 billion this year.)

A precis of the larger NIH framework document acknowledges that while the NIH “is critical to life-saving medical research and innovation,” it argues the agency is wracked with structural faults:

Among the more salient structural changes the proposal calls for is reducing the NIH’s 27 existing institutes and centers into 15. “[O]ur goal is to better align the missions of each institute and center and establish more coordinated overarching research goals, agendas, and constituencies. By encouraging each IC to utilize a holistic life stage approach, our goal is to eliminate the demographic- or disease-specific siloed nature of the current structure and ensure each IC is considering the whole individual and all populations across the entire lifespan.”

Some of the concentrations are straightforward, such as melding the National Heart, Lung, and Blood Institute, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the National Institute of Diabetes and Digestive and Kidney Diseases into a new National Institute on Body Systems Research (saving an estimated $73 million annually, the authors estimate).

But others are less so (Science magazine termed them “head scratchers”), such as combining the National Institute of Environmental Health Sciences, the National Institute on Minority Health and Health Disparities, the National Center for Complementary and Integrative Health, the National Institute of Nursing Research, and the John E. Fogarty International Center (which facilitates health research between U.S. and international investigators) into a National Institute on Health Sciences Research. This would save $20 million according to estimates, but also lump in lots of apples with oranges.

The biomedical community has been keeping its eyes wide open on the proposal, acknowledging that some improvements would be welcome but not automatically embracing the framework unalloyed.

Juliane Baron, the executive director of the Federation of Associations in Behavioral & Brain Sciences, summed up that approach. “Chairwoman Cathy McMorris Rodgers raises some important questions about the National Institutes of Health and compelling reasons for a transparent and deliberative process to reauthorize NIH. FABBS is giving careful thought to the key elements of a reauthorization process, soliciting input from our members to draft a response. FABBS will encourage Members of Congress to focus on the mission of NIH and ask big picture questions about what we have learned about the contributors to health and the evolution of science since the last major NIH reauthorization in 2007.”

A letter from the American Society for Microbiology to McMorris Rogers also stresses that NIH had always received bipartisan support. “Recognizing the importance of biomedical research and the role of Congress in funding the federal agencies, both the Senate and House have worked in a bipartisan manner over the past several years to place the NIH budget back on the path of meaningful growth above inflation. Allocations of funding should follow scientific needs and opportunities identified by the scientific community and there are mechanisms at the agency to fund cross-cutting research and innovative ideas.”

A number of the proposed reforms clearly have roots in the recent pandemic and concerns (and even ill will) that many Republicans had with the medical establishment. The framework, for example, calls for reducing the tenure, and thus institutional clout, of leaders within the NIH. “There is also a growing need to address the stagnant nature of leadership at the NIH,” the framework reads. This likely would have meant that Dr. Anthony Fauci would not have had the soft power he wielded during the pandemic as the head of the NIH’s National Institute of Allergy and Infectious Diseases for almost four decades (an example the document notes explicitly).

In that vein, that institute would be into a National Institute on Infectious Diseases and that institute would specifically be subject to an independent review entity.

While COVID casts the largest shadow, McMorris Rogers and the Republicans cite their committee’s investigation into a proposed MPXV project (the former “monkeypox”) at NIH, a probe that “uncovered a lack of oversight and transparency from the Department of Health and Human Services, the NIH, and the National Institute of Allergy and Infectious Diseases.”

The framework also focuses on increasing the ability of Congress to make more granular funding decisions within the agency, including language on who grants are going to (more early-stage investigators, primary investigators with fewer than three concurrent NIH projects, and ideally only grantees who are American). This heavier hand is listed as supporting greater national security and offering greater transparency.

One ongoing focus of the committee has been allegations of sexual harassment at NIH and institutions receiving NIH funding, a subject that the committee has been lasering on since 2021. The NIH, which as a federal agency will not comment on proposals like the framework, has argued that it has made progress in addressing harassment in the biomedical sphere, especially after receiving additional weapons from Congress in 2022. This has not satisfied the committee, and the framework aims to “ensure the NIH is issuing and implementing comprehensive policies and procedures that enable full and robust oversight of investigations into allegations of misconduct, including sexual harassment, in both intramural and extramural research programs, as well as ensuring NIH whistleblower protections, trainings, and processes are sound.”