Trump won. Is NIH in for a major shake-up? | Science | AAAS

 Thanks to Carolyn Elliott-Farino for this contribution!

Trump won. Is NIH in for a major shake-up?

Congress might serve as a bulwark, but some changes may be coming

by Joeclyn Kaiser

Former President Donald Trump’s win in yesterday’s U.S. presidential election—along with major changes in the makeup of Congress—will mean sweeping policy actions on everything from immigration to trade. For many U.S. scientists, one big question is whether the new administration will dramatically retool the world’s largest biomedical research agency, the $47 billion National Institutes of Health (NIH), which is responsible for roughly half of all federal spending on basic science.

Republicans had NIH in their sights even before the election, with proposals to restructure it and restrict some areas of research. Trump’s embrace of Robert F. Kennedy Jr., a vaccine skeptic, has also unsettled researchers. Trump has said he will let Kennedy “go wild on” health, medicines, and food policy.

“We’re definitely worried,” said one biomedical research advocate who spoke with Science. And former NIH Director Harold Varmus sees “enormous risks—especially if [Trump] placed someone as unhinged as [Kennedy] into a position of responsibility.”

Kennedy, who ran for president before dropping out and endorsing Trump under a “make America healthy again” platform, has said he wants an 8-year “break” in NIH funding for infectious diseases and would instead move money to chronic diseases. Although it’s unclear whether he would win a high-level post himself—Trump staffers have said no such decisions have been made—Kennedy has said his team is already helping identify candidates to lead health agencies such as NIH. The U.S. Food and Drug Administration and vaccine policies could also see major shake-ups spearheaded by Kennedy.

Then there’s Project 2025, the conservative Heritage Foundation’s agenda for a Trump administration. Although Trump has distanced himself from the effort, some Project 2025 ideas could still make their way into the new administration’s policies, research lobbyists say. It calls, for example, for clamping down on fetal tissue research, as the last Trump administration did, and shifting NIH’s extramural grants funding to “block” grants to states—which could mean scrapping the agency’s venerated peer-review process.

How many of those proposals will become reality is unclear. “I think there’s going to be a lot of talk and rhetoric, but whether that gets translated into action is a completely different story,” says Jennifer Zeitzer, public affairs director for the Federation of American Societies for Experimental Biology. That’s because much of what happens to NIH, particularly to its budget and structure, is determined by Congress.

The agency’s relationship with Congress has frayed in the past few years, in part because of clashes over the COVID-19 pandemic and potentially risky research involving viruses. That area drew scrutiny from Republicans during the pandemic because of NIH funding for bat coronavirus research at a laboratory in Wuhan, China, that some believe was the source of the pandemic virus. Some scientists and lawmakers have called for greater oversight—and even a moratorium or outright ban on studies that could create dangerous pathogens. One current proposal, the Risky Research Act backed by Senator Rand Paul (R–KY), would create a presidentially appointed board to approve these studies.

Onlookers do expect a change in NIH leadership. Current Director Monica Bertagnolli, a cancer researcher, will be expected, like many other presidential appointees, to submit a resignation letter to the president in late January when Trump takes office. (Her long-serving predecessor, geneticist Francis Collins, was retained by Trump, but there is no reason to expect that for Bertagnolli, who has been in the position for just a year.)

The Senate’s flip to a Republican majority could boost the chances that an unconventional candidate for NIH director could win Senate confirmation. Still, Zeitzer says, NIH has long had bipartisan support, and “I’d like to believe that will be on the minds of Senators: Can this person lead such a huge agency with such a critical mission?”

As for NIH’s structure, the House of Representatives Committee on Energy and Commerce, currently led by Representative Cathy McMorris Rodgers (R–WA), has proposed shrinking NIH’s 27 institutes and centers to just 15, along with a long list of other policy changes such as limiting number of grants an investigator can hold and tightening oversight for infectious disease research.

The restructuring plan made it into the House’s 2025 draft spending bill for NIH, but the current chair of the House appropriations committee, Representative Tom Cole (R–OK), has said spending bills are not the right vehicle for such major changes. Whether the legislation would be resurrected in the next Congress, which begins in January 2025, is unclear. McMorris Rodgers is retiring and even if the Republican Party retains control of the House—which likely won’t be known until later this week—no other Republican on the committee has shown interest in picking up the plan. “I don’t know that anyone has emerged,” says Carrie Wolinetz, a former NIH top official now with Lewis-Burke Associates, a lobbying firm that specializes in research issues.

More modest proposals could, however, come from Representative Diana DeGette (D–CO), who has expressed interested in crafting legislation that would build on the 21st Century Cures Act, a 2016 law aimed at speeding treatments to patients that she cosponsored.

In the Senate, Senator Bill Cassidy (LA), the senior Republican on the Committee on Health, Education, Labor and Pensions (HELP), released his own white paper on NIH reform earlier this year. It includes ideas such as tweaking the peer-review process and bolstering support for basic research. With the Senate shifting to Republican control next year as a result of the elections, Cassidy could become HELP’s chair, and he has said NIH reform will be a priority for him.

But again, any movement will depend in part on the priorities of other HELP members. “He’s really the only senator we’ve seen with that intense NIH interest,” Wolinetz says.

Few who spoke with Science think NIH will undergo a major consolidation. Varmus, who 25 years ago proposed collapsing NIH into just six institutes, says he’s still convinced that “would be more effective.” But, “I’ve learned how difficult it is to make the required changes,” he says, given “existing loyalties to the existing arrangements”—a reference to the powerful influence of disease advocacy groups who prefer the current setup. And "there are more important issues to worry about," he adds. 

One policy proposal that seems to have widespread support is limiting NIH institute directors to a 5-year term that can be renewed just once. Varmus says a “good case can made” for such limits as long as they allow for longer terms in “exceptional circumstances.”

Despite all this uncertainty, “We do think we will see action on NIH reform next year or in 2026,” Zeitzer says. “The momentum on that is so strong.”

More modest changes could happen sooner. Next week, at the request of lawmakers, NIH will reconvene a defunct advisory board created by Congress in 2006 to review the agency’s structure. The Scientific Management Review Board might start, for example, with looking at ways to share infrastructure for clinical trials across institutes, Wolinetz suggests. “It might be an opportunity to increase the efficiency without actually reorganizing the whole organizational chart.”