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Appropriators warn of NIH funding challenges ahead

May 23, 2024
NIH Director Monica Bertagnolli

NIH director Monica Bertagnolli. Photo: Tom Williams/CQ-Roll Call via Getty Images

NIH faces tough odds of getting meaningful spending increases in the current budget environment, which would mark a break from the recent past, Senate appropriators warned Thursday.

Why it matters: Discretionary spending caps in the Fiscal Responsibility Act are weighing on both the defense and nonmilitary side of the ledger and threatening to put a drag on biomedical research, Democrats warned.

What they're saying: "The tough caps that are squeezing DOD are squeezing NIH," Senate Appropriations Chair Patty Murray said at a hearing Thursday on NIH's FY25 budget request. "They are threatening to slow or derail breakthroughs patients and families are desperately counting on."

  • While defense hawks tend to discuss raising the caps for the military, Murray stressed the need for parity in also increasing spending on domestic priorities like medical research.
  • Sen. Tammy Baldwin, chair of the Appropriations subcommittee overseeing HHS, said House Republicans are proposing "draconian cuts" that "would be devastating for biomedical research."

By the numbers: NIH's funding levels this year fell slightly from $47.5 billion in FY23 to $47.1 billion.

  • Mandatory funding from 21st Century Cures decreased and is projected to drop to around $125 million in FY25, per Raymond James analyst Chris Meekins.
  • House Republicans' proposed NIH funding, expected next month, is likely to cut the agency's spending levels, Meekins notes.

The other side: Senate Republicans touted the need for NIH funding but largely steered clear of the larger top-line spending debate highlighted by Murray and Baldwin.

  • "This will be a challenging funding year," acknowledged Sen. Shelley Moore Capito, the ranking Republican on the subcommittee. "But for me biomedical research at NIH is a priority."

Between the lines: Baldwin also used the hearing to press the new NIH director, Monica Bertagnolli, appearing at her first budget hearing before the panel, about the agency's "slow" work on long COVID research.

  • "NIH has moved slowly to enroll patients in clinical trials, and there [are] still zero FDA-approved treatments for long COVID," Baldwin said.
  • Long COVID patient advocates arranged for patients to attend the hearing, and senators mentioning the need for long COVID research were repeatedly met with applause.
  • "We fully admit we are not where we want to be in terms of a rapid, nimble clinical trials enterprise that's testing promising treatments very quickly," Bertagnolli responded. "That is our focus right now, moving forward to do that."

A trio of Democratic senators is pushing for more long COVID research funding in next year's appropriations bills, but the fate of that effort could hinge on the broader top-line funding discussions.

The bottom line: Because Congress is likely to punt on big funding questions and pass a CR to get past the elections, it will likely be a while before the outlook for NIH becomes clear.

  • The agency is also facing scrutiny, particularly from Republicans, over its funding of coronavirus research in Wuhan, China.
  • Capito noted that the agency has now disbarred the Wuhan Institute of Virology and EcoHealth Alliance but said those moves "should have probably been done much sooner."
  • "The NIH has a credibility problem here when it comes to gain of function research," she said.
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