The future of the National Institutes of Health (NIH) is uncertain following proposed budget cuts and restructuring efforts by the Trump administration. Plans to reduce the NIH’s annual budget by approximately $18 billion have triggered widespread concern among researchers about the agency’s ability to continue supporting crucial biomedical research. The ongoing layoffs, terminated grants, and conflicts with major universities have led many to believe that the NIH, a key player in American scientific advancement, has been severely damaged.
Despite these disruptions, the long-term effects on scientific research remain unclear. There is a consensus that the core of publicly funded American biomedical science is not beyond repair. What is evident, however, is that we are at a critical juncture in the history of NIH and public scientific funding. Research indicates that both Americans and their elected officials largely favor a continued government role in health research initiatives. A recent poll revealed that 57% of Republicans and 75% of Democrats support maintaining federal funding for scientific and medical research.
The United States has been funding medical research since 1887, initially focusing on infectious diseases. This focus shifted during World War II to support wartime efforts, and since then, the NIH has expanded its scope significantly. The agency’s budget has grown from $400,000 in 1938 (equivalent to about $9 million today) to a projected $42 billion in 2024. The NIH’s mission is to seek fundamental knowledge about living systems and apply that knowledge to enhance health, prolong life, and reduce illness and disability.
Publicly funded research is critical for fostering basic biological discoveries and understanding health on a population level, particularly for studies that may not be profitable for the private sector. It is vital to ensure that the NIH’s budget is utilized in ways that serve the public interest. This raises questions about how to maximize the benefits of limited federal resources for medical research.
Determining the best use of these funds is complex and requires weighing various costs and benefits. Policymakers must rely on rigorously established scientific facts to guide funding decisions aligned with public interests. While political considerations will inevitably influence funding choices, the scientific community must communicate effectively about the potential impacts of various research initiatives.
It is essential to differentiate between established scientific facts—such as the prevalence of obesity and cancer—and the values that guide funding decisions. For example, mRNA vaccines and artificial intelligence represent significant technological advancements in health but also present challenges. The establishment of scientific facts remains nonpartisan, yet political priorities will shape which areas receive funding.
Taxpayer-funded research decisions are political choices that must reflect the electorate’s values. Elected officials require substantial input from the scientific community to make informed decisions regarding funding and resource allocation. Scientists must understand that their research goals may not always align with public sentiment and must engage in a transparent dialogue about the impacts and trade-offs of their work.
Measuring the impact of research is inherently challenging, particularly for basic science, whose contributions may not be immediately evident. For instance, the CRISPR gene-editing technology, which has recently been used to treat sickle cell disease, has its foundations in studies from the mid-1990s. Meanwhile, research that shows ineffectiveness can still hold significant value, though it often goes unrecognized.
Current metrics of research productivity, such as the number of published papers or patents, do not always correlate with tangible health outcomes. A comprehensive approach to measuring impact is necessary to evaluate the cost-effectiveness of research funding. In some cases, supporting multiple smaller projects may be more beneficial than funding one large study.
Investing in biomedical research has yielded substantial advancements in public health over the past century, and there is little appetite among stakeholders to abandon this progress. The challenge lies in ensuring that shifts in funding priorities do not undermine the scientific infrastructure or the careers of dedicated researchers.
As the NIH navigates these turbulent waters, it must remain committed to maximizing public benefit. The public deserves a careful, data-driven, and collaborative examination of any proposed changes to funding and research direction, as the outcomes could have far-reaching implications for health and well-being.
Christopher M. Worsham and Anupam B. Jena, both professors at Harvard Medical School and authors of “Random Acts of Medicine,” underscore the importance of a thoughtful approach to NIH funding and its role in advancing health initiatives.
