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NIH budget shrinks despite Ebola emergency funds
World Report
NIH budget shrinks despite Ebola emergency funds Even with a boost in funding for Ebola research, the US National Institutes of Health’s fiscal year 2015 budget is the lowest in years. Susan Jaffe, The Lancet’s Washington correspondent, reports. During last year’s contentious congressional hearings investigating the US response to Ebola, the Obama Administration’s top health officials fended off criticism hurled by both Democrats and Republicans. But in another show of bipartisanship only a few weeks later, Congress granted nearly all of President Barack Obama’s request for emergency funding to combat the disease here and abroad. In his State of the Union address earlier this month, the President expressed his appreciation: “In west Africa, our troops, our scientists, our doctors, our nurses, and health-care workers are rolling back Ebola—saving countless lives, and stopping the spread of disease”, he said, drawing applause from both sides of the aisle. “I couldn’t be prouder of them, and I thank this Congress for your bipartisan support of their efforts.” Congress narrowly approved the US$5·4 billion emergency Ebola funding contained in the $1·1 trillion spending bill that kept the US Government running. But so far, it has done little to loosen the budget constraints on the National Institutes
Bloomberg/Contributor
For The Lancet News podcast see http://www.thelancet.com/ lancet-news-audio/
NIH director Francis Collins
404
of Health (NIH)—even as a global health crisis such as Ebola reminded many lawmakers of its value. “It became pretty clear that no other organisation would have spent the last 15 years working on the basic science of this virus without any support from industry, until we got to this point”, NIH director, Francis Collins, told The Lancet. “I think people got it—that if there were no NIH, we would be in really deep trouble here”, he said.
“...Congress provided the agency with a slim 0·5% increase, essentially the same funding as last year...12% below fiscal year 2009 levels, after adjusting for inflation...” Last month’s budget agreement provides $3·7 billion “to prevent, prepare for, and respond to the Ebola virus disease outbreak” outside the USA, including $1·2 billion for the Centers for Disease Control and Prevention. Another $1·7 billion will fund efforts within the USA, including $571 million for the CDC’s efforts to create regional treatment centres and train health-care providers. The NIH received $238 million specifically targeted to support phase 2 and 3 clinical trials to evaluate the safety and efficacy of investigational Ebola vaccines and therapies, an NIH budget official explained. Because the Ebola funding was designated for emergency purposes, it is excluded from federal spending limits, Adam Wexler, director of the Global Health Budget Project at the Kaiser Family Foundation, a health policy research organisation, told The Lancet. And because the agencies can use the money over several years, it is not subject to uncertain 1 year budget cycles, future spending
caps, and politics. “They don’t have to go back to Congress to request more funding to support ongoing programmes”, Wexler said. Yet for most other NIH activities, Congress provided the agency with a slim 0·5% increase, essentially the same funding as last year. That’s 12% below fiscal year 2009 levels, after adjusting for inflation, according to an NIH official. And in constant dollars, the fiscal year 2015 budget is the lowest in 15 years.
“Starving” the research effort And things are not likely to get better: in the coming months, the NIH will face a new threat as Congress begins work on next year’s budget, Jennifer Zeitzer told The Lancet. She is the legislative relations director at the Federation of American Societies for Experimental Biology, which represents 27 associations of professional scientists and their 120 000 members. Unless Congress changes course, the automatic across-the-board spending cuts known as sequestration return after a 2 year delay in fiscal year 2016, beginning Oct 1, 2015. The effect of sequestration will be to hold spending at 2015 levels, which are about the same as 2014 for the NIH. “The only way Congress can provide any significant increase for NIH in fiscal year 2016 while still living under the strict budget caps is to cut something else”, Zeitzer said. And there will be tough competition for funds among advocates for education, community health centres, transportation, and a host of other government programmes. A flat budget is really a shrinking budget, Zeitzer said, because it doesn’t keep pace with biomedical research inflation, expected to be 2·5% next year. “The public and Congress wondered why we weren’t ready www.thelancet.com Vol 385 January 31, 2015
immediately to combat and eradicate Ebola”, Mary Woolley, president of Research!America, told The Lancet. Her organisation includes 400 academic and independent research institutes. “Part of the answer is we’ve been starving research on a whole range of diseases and emerging conditions for decades.” “We are down now by about 25% in our purchasing power for research compared to where we were 12 years ago”, said Collins. “That has been a pretty painful experience for anyone who is depending on the NIH to support their research, including most academic researchers in the USA and a number who are outside our country.” Until 2003, only about one of three grants that were submitted to the NIH was ultimately funded after going through a rigorous peer review, he said. Now the success rate is down to about one out of six. “That means an awful lot of really important science is being left on the table”, he said.
long-term effects, said Florida Democrat Kathy Castor. “There are young researchers who have devoted their careers to finding cures and treatments and their grants are coming to an end”, Castor told The Lancet. “It’s costing jobs, causing a lot of uncertainty, and I think affecting America’s ability to be innovative and find the cures of the future.” Last May, Castor’s legislation to protect the NIH from further sequestration cuts was defeated by the Republican majority in the House of Representatives. Collins is also concerned about the threat to continued research. “We have visionary scientists—particularly those early in their careers—and yet they are encountering the most difficult time in history to get their labs going and to sustain them”, he said. “And many of those are becoming quite discouraged and some are actually leaving the field or leaving the country.”
A slow down
“‘We have visionary scientists— particularly those early in their careers—and yet they are encountering the most difficult time in history to get their labs going and to sustain them’...”
“If we had been able to maintain stable support for biomedical research and at least keep up with inflation, then all areas of research—whether it’s autism or Alzheimer’s disease or Ebola—would’ve had the chance to go a little bit more quickly”, Collins continued. That’s not the only reason why an Ebola vaccine was not ready for distribution last year, he said. It also needed the backing of a drug company. “Commercial partners generally aren’t very interested in a vaccine until it’s clear there is going to be wide use of it”, he said. “GlaxoSmithKline is that partner now for our vaccine and that’s going very rapidly forward.” But he cautioned that the effect of years of under-funded research on the Ebola vaccine development should not be oversimplified. “Certainly we could’ve gone faster with better support but that’s not the only factor.” A shrinking NIH budget eroded by inflation not only slows down research but can also have damaging www.thelancet.com Vol 385 January 31, 2015
But other members of Congress question whether an increase in NIH funding is necessary. “I want the NIH to have money and I want them to use the money wisely”, Texas Republican and physician Michael Burgess told The Lancet. “But if you scrub that budget, you will see places where money was spent that was perhaps less than wise as an investment.” With a stagnant budget, shifting funds from one project or another is not a solution, said Zeitzer. “That’s basically rearranging the deck chairs on the Titanic under a flat budget”, she said. But Congress might soon have an opportunity to boost the NIH research programmes as part of the bipartisan, wide-ranging “21st Century Cures” initiative, spearheaded by Republican Fred Upton, chairman of the House
Rafe Swan/CULTURA/SCIENCE PHOTO LIBRARY
World Report
of Representatives Energy and Commerce Committee and Democrat Diana DeGette. Their goal, they wrote recently, is “to update the process of discovering, developing, and delivering medical therapies to help people live longer and better lives”. As this article went to press, they were planning to release a “discussion draft” of proposed legislation based on the project’s year-long series of hearings, roundtable discussions, and white papers. Woolley is encouraged by the unprecedented initiative. “We have health challenges in this country that science will provide answers for if given the chance and we haven’t given science that opportunity”, she said. “Alzheimer’s disease alone could bankrupt the nation if we end up having to essentially house millions of and millions of Alzheimer’s patients.” But even President Obama acknowledged the challenges of sustaining medical research while managing a tight budget. “When it comes to issues like infrastructure and basic research, I know there’s bipartisan support in this chamber, members of both parties have told me so”, he reminded Congress in his State of the Union address. “Where we too often run onto the rocks is how to pay for these investments.”
Susan Jaffe 405
NIH budget shrinks despite Ebola emergency funds Even with a boost in funding for Ebola research, the US National Institutes of Health’s fiscal year 2015 budget is the lowest in years. Susan Jaffe, The Lancet’s Washington correspondent, reports. During last year’s contentious congressional hearings investigating the US response to Ebola, the Obama Administration’s top health officials fended off criticism hurled by both Democrats and Republicans. But in another show of bipartisanship only a few weeks later, Congress granted nearly all of President Barack Obama’s request for emergency funding to combat the disease here and abroad. In his State of the Union address earlier this month, the President expressed his appreciation: “In west Africa, our troops, our scientists, our doctors, our nurses, and health-care workers are rolling back Ebola—saving countless lives, and stopping the spread of disease”, he said, drawing applause from both sides of the aisle. “I couldn’t be prouder of them, and I thank this Congress for your bipartisan support of their efforts.” Congress narrowly approved the US$5·4 billion emergency Ebola funding contained in the $1·1 trillion spending bill that kept the US Government running. But so far, it has done little to loosen the budget constraints on the National Institutes
Bloomberg/Contributor
For The Lancet News podcast see http://www.thelancet.com/ lancet-news-audio/
NIH director Francis Collins
404
of Health (NIH)—even as a global health crisis such as Ebola reminded many lawmakers of its value. “It became pretty clear that no other organisation would have spent the last 15 years working on the basic science of this virus without any support from industry, until we got to this point”, NIH director, Francis Collins, told The Lancet. “I think people got it—that if there were no NIH, we would be in really deep trouble here”, he said.
“...Congress provided the agency with a slim 0·5% increase, essentially the same funding as last year...12% below fiscal year 2009 levels, after adjusting for inflation...” Last month’s budget agreement provides $3·7 billion “to prevent, prepare for, and respond to the Ebola virus disease outbreak” outside the USA, including $1·2 billion for the Centers for Disease Control and Prevention. Another $1·7 billion will fund efforts within the USA, including $571 million for the CDC’s efforts to create regional treatment centres and train health-care providers. The NIH received $238 million specifically targeted to support phase 2 and 3 clinical trials to evaluate the safety and efficacy of investigational Ebola vaccines and therapies, an NIH budget official explained. Because the Ebola funding was designated for emergency purposes, it is excluded from federal spending limits, Adam Wexler, director of the Global Health Budget Project at the Kaiser Family Foundation, a health policy research organisation, told The Lancet. And because the agencies can use the money over several years, it is not subject to uncertain 1 year budget cycles, future spending
caps, and politics. “They don’t have to go back to Congress to request more funding to support ongoing programmes”, Wexler said. Yet for most other NIH activities, Congress provided the agency with a slim 0·5% increase, essentially the same funding as last year. That’s 12% below fiscal year 2009 levels, after adjusting for inflation, according to an NIH official. And in constant dollars, the fiscal year 2015 budget is the lowest in 15 years.
“Starving” the research effort And things are not likely to get better: in the coming months, the NIH will face a new threat as Congress begins work on next year’s budget, Jennifer Zeitzer told The Lancet. She is the legislative relations director at the Federation of American Societies for Experimental Biology, which represents 27 associations of professional scientists and their 120 000 members. Unless Congress changes course, the automatic across-the-board spending cuts known as sequestration return after a 2 year delay in fiscal year 2016, beginning Oct 1, 2015. The effect of sequestration will be to hold spending at 2015 levels, which are about the same as 2014 for the NIH. “The only way Congress can provide any significant increase for NIH in fiscal year 2016 while still living under the strict budget caps is to cut something else”, Zeitzer said. And there will be tough competition for funds among advocates for education, community health centres, transportation, and a host of other government programmes. A flat budget is really a shrinking budget, Zeitzer said, because it doesn’t keep pace with biomedical research inflation, expected to be 2·5% next year. “The public and Congress wondered why we weren’t ready www.thelancet.com Vol 385 January 31, 2015
immediately to combat and eradicate Ebola”, Mary Woolley, president of Research!America, told The Lancet. Her organisation includes 400 academic and independent research institutes. “Part of the answer is we’ve been starving research on a whole range of diseases and emerging conditions for decades.” “We are down now by about 25% in our purchasing power for research compared to where we were 12 years ago”, said Collins. “That has been a pretty painful experience for anyone who is depending on the NIH to support their research, including most academic researchers in the USA and a number who are outside our country.” Until 2003, only about one of three grants that were submitted to the NIH was ultimately funded after going through a rigorous peer review, he said. Now the success rate is down to about one out of six. “That means an awful lot of really important science is being left on the table”, he said.
long-term effects, said Florida Democrat Kathy Castor. “There are young researchers who have devoted their careers to finding cures and treatments and their grants are coming to an end”, Castor told The Lancet. “It’s costing jobs, causing a lot of uncertainty, and I think affecting America’s ability to be innovative and find the cures of the future.” Last May, Castor’s legislation to protect the NIH from further sequestration cuts was defeated by the Republican majority in the House of Representatives. Collins is also concerned about the threat to continued research. “We have visionary scientists—particularly those early in their careers—and yet they are encountering the most difficult time in history to get their labs going and to sustain them”, he said. “And many of those are becoming quite discouraged and some are actually leaving the field or leaving the country.”
A slow down
“‘We have visionary scientists— particularly those early in their careers—and yet they are encountering the most difficult time in history to get their labs going and to sustain them’...”
“If we had been able to maintain stable support for biomedical research and at least keep up with inflation, then all areas of research—whether it’s autism or Alzheimer’s disease or Ebola—would’ve had the chance to go a little bit more quickly”, Collins continued. That’s not the only reason why an Ebola vaccine was not ready for distribution last year, he said. It also needed the backing of a drug company. “Commercial partners generally aren’t very interested in a vaccine until it’s clear there is going to be wide use of it”, he said. “GlaxoSmithKline is that partner now for our vaccine and that’s going very rapidly forward.” But he cautioned that the effect of years of under-funded research on the Ebola vaccine development should not be oversimplified. “Certainly we could’ve gone faster with better support but that’s not the only factor.” A shrinking NIH budget eroded by inflation not only slows down research but can also have damaging www.thelancet.com Vol 385 January 31, 2015
But other members of Congress question whether an increase in NIH funding is necessary. “I want the NIH to have money and I want them to use the money wisely”, Texas Republican and physician Michael Burgess told The Lancet. “But if you scrub that budget, you will see places where money was spent that was perhaps less than wise as an investment.” With a stagnant budget, shifting funds from one project or another is not a solution, said Zeitzer. “That’s basically rearranging the deck chairs on the Titanic under a flat budget”, she said. But Congress might soon have an opportunity to boost the NIH research programmes as part of the bipartisan, wide-ranging “21st Century Cures” initiative, spearheaded by Republican Fred Upton, chairman of the House
Rafe Swan/CULTURA/SCIENCE PHOTO LIBRARY
World Report
of Representatives Energy and Commerce Committee and Democrat Diana DeGette. Their goal, they wrote recently, is “to update the process of discovering, developing, and delivering medical therapies to help people live longer and better lives”. As this article went to press, they were planning to release a “discussion draft” of proposed legislation based on the project’s year-long series of hearings, roundtable discussions, and white papers. Woolley is encouraged by the unprecedented initiative. “We have health challenges in this country that science will provide answers for if given the chance and we haven’t given science that opportunity”, she said. “Alzheimer’s disease alone could bankrupt the nation if we end up having to essentially house millions of and millions of Alzheimer’s patients.” But even President Obama acknowledged the challenges of sustaining medical research while managing a tight budget. “When it comes to issues like infrastructure and basic research, I know there’s bipartisan support in this chamber, members of both parties have told me so”, he reminded Congress in his State of the Union address. “Where we too often run onto the rocks is how to pay for these investments.”
Susan Jaffe 405