On June 22, the Senate Labor, Health and Human Services, Education and Related Agencies (LHHS) Appropriations Subcommittee held a hearing to discuss the fiscal year (FY) 2018 budget request for the National Institutes of Health (NIH). Appearing before the committee were NIH Director Francis Collins and six institute and center directors, including Douglas Lowy of the National Cancer Institute (NCI), Gary Gibbons of the National Heart, Lung, and Blood Institute (NHLBI), Anthony Fauci of the National Institute of Allergy and Infectious Diseases (NIAID), Richard Hodes of the National Institute of Aging (NIA), Nora Volkow of the National Institute on Drug Abuse (NIDA), and Joshua Gordon of the National Institute of Mental Health (NIMH).
As previously reported, the Trump Administration’s budget request for NIH seeks a cut of $7 billion or about 22 percent from current levels. The proposed reduction came at the same time Congress was putting the finishing touches on its $2 billion increase for the agency in FY 2017. NIH funding has long been one of the rare instances of unified, bipartisan support in Congress. In fact, at the outset of the hearing, LHHS Subcommittee Chairman Roy Blunt (R-MO) criticized the President’s request, stating that he “fundamentally disagree[s] with the proposed reduction.” While over the last two years Congress has worked to increase the NIH budget by more than 13 percent, the Administration offers a budget that would result in the loss of 90,000 jobs and $15.3 billion in economic activity, stated the chairman. Subcommittee Ranking Member Patty Murray (D-WA) added that the proposed cut would represent the lowest funding level for the agency since 2002. Other Subcommittee members expressed their objection to the request and pledged their support for increased NIH funding again in FY 2018.
In his prepared statement, Dr. Collins highlighted what he sees as areas of exceptional scientific opportunity, outlining exciting advances in areas like cystic fibrosis and Alzheimer’s disease. He stressed the importance of investing in the next generation of researchers in order to fully realize these and other gains in medical breakthroughs. Specifically, Dr. Collins mentioned the recently launched NIH Next Generation Researchers Initiative, which will attempt to bolster support for early career and mid-career investigators.
Chairman Blunt asked about the Trump Administration’s proposal to eliminate the Fogarty International Center. Dr. Fauci, NIAID Director, underscored the importance of Fogarty’s training efforts to combating outbreaks such as the recent Ebola and Zika crises, adding that almost all of the international scientists working in these areas have been trained by the Fogarty Center.
Sen. Blunt also asked about the proposed transfer of the Agency for Healthcare Research and Quality (AHRQ) to NIH as a new institute (called the National Institute for Research on Safety and Quality). Dr. Collins explained that AHRQ’s research is complementary and not duplicative of the NIH as it focuses on health safety and health quality. Should AHRQ be moved into NIH, the agency would “make the best of that circumstance.” As Dr. Collins explained, another model would be to distribute AHRQ’s research portfolio among the existing NIH institutes that do similar work, as opposed to standing up a separate institute. There did not appear to be strong endorsement of the Administration’s proposal by NIH or committee members.
Several Senators had questions about the Administration’s proposal to cap facilities and administration (F&A) costs for extramural researchers—sometimes referred to as “indirect costs”—at a 10 percent flat fee; F&A costs on average are about 28 percent in the extramural research community. Sen. Lamar Alexander (R-TN) in particular called into question the merits of the proposal, stating that in order to make up the difference in costs to the institutions, tuition (if it is a university) would need to increase or less research would need to be conducted, neither of which are palatable alternatives. He asked Dr. Collins to produce a report to the Secretary of Health and Human Services (HHS) and the Office of Management Budget (OMB) that explains the funding impacts of the proposal on universities, especially state universities, the extent to which universities are already contributing to F&A costs, and whether more or less research would be conducted as a result of such a change. Sen. Alexander added that he hopes Congress can “nip this idea in the bud,” calling it a “thoroughly awful idea and bad policy.”
Sen. James Lankford (R-OK) asked about the risk of duplication of funding for projects across the various agencies that support research, expressing concern about investigators who shop proposals around to multiple funding sources. The Senator asked how agency programs can best coordinate. While duplication is a concern, Dr. Collins explained that funding agencies do have ways of determining whether there is unintended duplication occurring. However, he added that sometimes duplication is a good thing, as is coordination on activities like the interagency BRAIN Initiative.
Sen. Richard Durbin (D-IL) spoke about the need for NIH to be better understood by the general public. While there are laws requiring that clothing or other products state where they were made, there is nothing stipulating that the NIH get credit for the 75 percent or so of pharmaceuticals and medical devices that can be traced back to NIH research. Sen. Durbin expressed interest in working with his colleagues on some sort of bipartisan efforts that would ensure NIH is cited for its contributions more regularly. Collins concurred about the lack of public understanding, citing that less than 20 percent of the public knows what “NIH” means or that the agency exists.
Other topics raised by the Subcommittee include the opioid epidemic, diabetes, Alzheimer’s disease, and a variety of other diseases and disorders of personal interest to the members.
No indication was given during the hearing about the timeline for possible release of an FY 2018 LHHS funding bill, although rumors suggest that details of the various appropriations bill may start to emerge following the July 4 recess and prior to the month-long August recess.
Dr. Collins’ written statement and an archive of the webcast are available on the committee website here.