Deep Cuts for NIH, Other Life Sciences in FY 2018 Budget Plan

Under the Trump Administration budget, NIH would see an historically large funding reduction, while the VA, CDC, and FDA research programs would founder.

See also:
DOD, EPA, and USGS in the FY 2018 Budget
USDA, NIST, and NOAA in the FY 2018 Budget
DOE, NSF, and NASA in the FY 2018 Budget

National Institutes of Health
Funding Tables: Budget by Institute | Budget by Mechanism
See also: NIH in the AAAS Appropriations Dashboard

Following a $2 billion increase for NIH in the 2017 omnibus, the FY 2018 request would allocate only $26.9 billion for the agency, representing a 21.5 percent reduction below omnibus levels. As seen in the institute funding table linked above, most individual institutes would receive reductions on the order of 22-23 percent. The National Institute on Aging would receive a 36.4 percent reduction below 2017 levels, owing to a large 2017 increase for Alzheimer’s research in the omnibus. On the other end of the spectrum, the National Library of Medicine would receive an 8.3 percent reduction, with some databases, services, and outreach programs for access and training scaled back. In the aggregate, these reductions represent the toughest NIH budget proposed by any Administration in over 40 years, and would return the NIH budget nearly to its pre-doubling level in constant dollars (see budget graph above). As part of the effort to control costs, NIH is also proposing an agency-wide cap of 10 percent on indirect costs. The Administration believes this will lead to more efficient spending by ensuring a greater share of dollars go to research activities rather than overhead, while many outside government fear such a cap would make NIH-funded research unaffordable for some performers.

These spending changes would also come with some major structural changes. The Fogarty International Center, a hub for international research activities, would be eliminated, with certain activities amounting to $25 million of its $72 million budget folded into the NIH Director’s office going forward. According to the Fogarty budget justification, these would be limited to NIH visa and passport services, and certain foreign and intra-agency partnerships and collaborations. The elimination of Fogarty makes room for the consolidation of the Agency for Healthcare Research and Quality (AHRQ) within NIH. Renamed the National Institute for Research on Safety and Quality (NIRSQ), the new institute would receive a 12.5 percent reduction from its 2017 spending from all sources as a separate agency, with several programs eliminated. The new institute would reduce support for the U.S. Preventive Services Task Force and for investigator-initiated grants, while moderately increasing support for the Medical Expenditure Panel Survey and patient safety research above 2017 omnibus levels. It would zero out the AHRQ/NIRSQ health IT portfolio.

Naturally, the overall cuts for NIH would mean sizable reductions in funding awards, as seen in the mechanism funding table linked above. NIH-wide, competing research awards in 2018 would decline by over 1,600, or at least 18 percent. Most other funding mechanisms would also see double-digit reductions. Bear in mind, the official mechanism figures for 2017 don’t actually reflect the increase NIH received in the omnibus, as the May omnibus happened too late to be factored into the executive branch budget process. Instead, like other agencies, NIH assumed a full-year continuing resolution as its 2017 baseline. That means the number of awards to be issued in FY 2017 will be larger than predicted, and thus the actual reductions proposed in FY 2018 from FY 2017 levels is in reality larger than those shown in these initial figures.

Under the FY 2018 request, NIH also projects a success rate of 13.7 percent in FY 2018, the lowest funding rate since at least 1970 (see graph at right for recent years).

In most years, individual NIH institutes provide more detailed breakdowns of funding by mechanism and specify program spending changes. Such detail is not available in this year’s institute justifications, though narrative descriptions of institute priorities are provided.

The 2018 budget also includes the full $496 million authorized by the 21st Century Cures Act for major initiatives. This breaks down to $300 million for the Cancer Moonshot; $86 million for the BRAIN Initiative; $100 million for the Precision Medicine Initiative’s “All of Us” program; and $10 million for Regenerative Medicine. Beyond these Cures-authorized ventures, several other cross-agency initiatives would see at least some reduction in the request, including, for instance, the Big Data to Knowledge (BD2K) and Stimulating Peripheral Activity to Relieve Conditions (SPARC) programs.

One set of programs not apparently slated for large reductions are the High-Risk program pool, comprising a set of four programs: the Pioneer Award, New Innovator Award, Transformative Research Award, and Early Independence Award. These awards are generally geared to young investigators and/or unconventional research directions. A continuing focus on younger researchers was also evident in NIH’s controversial proposal to cap awards for individual awardees; that proposal was dropped barely a month after it was unveiled.

Department of Veterans Affairs (VA) (long funding table)
See also: 'Other Agencies' in the AAAS Appropriations Dashboard

Despite longstanding support for VA medical research, the President’s budget proposes a $33 million or 5.0 percent cut to VA’s Medical and Prosthetic Research account. With additional funds requested from the VA Medical Care Program in support of research, and estimated services and grants from other federal and private sources totaling $1.4 billion, the combined total estimated VA-performed research and development would exceed $1.9 billion (see funding table above).

The proposed FY 2018 budget would make reductions across VA’s four intramural research accounts: (1) Biomedical Laboratory Science; (2) Rehabilitation; (3) Health Services; and (4) Clinical Science. VA estimates that it will support 2,132 projects during 2018, a decrease from the current 2017 estimate of 2,156. This would impact a range of funding areas, including research on kidney and lung disorders, digestive diseases, central nervous system injuries, and sensory loss.

Amidst the proposed budget downsizing, the VA would prioritize research around pain management and opioid addiction, mental health and suicide, and Gulf War Veterans Illness.  Additionally, the agency would continue efforts to advance precision medicine and cancer genomics in support of the Million Veteran Program (MVP), which aims to collect blood samples and health information from one million veteran volunteers to study how genes affect health. As of mid-February 2017, more than 544,000 Veterans have provided DNA specimens, military exposure information, and access to health records to facilitate studies on topics ranging from the biological underpinnings of Gulf War illness and PTSD to schizophrenia and bipolar disorder.

Centers for Disease Control and Prevention (CDC)

CDC’s Chronic Disease Prevention and Health Promotion account would see a large decrease as part of a new administrative effort to focus more narrowly on leading causes of death and disability such as heart disease. As a result, the budget would eliminate funding for epilepsy research, lupus studies, and the Prevention Research Center (PRC) Program, which works with academic institutions to study how individuals and communities can prevent chronic illnesses. The FY 2018 request also terminates Education and Research Centers (ERCs) investments, including funding to academic programs focusing on industrial hygiene, occupational health nursing, occupational medicine, and occupational safety. The proposed budget provides no funding for the Academic Centers for Public Health Preparedness, established in 2000 to strengthen bioterrorism and emergency preparedness by linking academic expertise to state and local health agencies.

Within the Emerging and Zoonotic Infections account, the budget would eliminate funding for prion disease activities as well as chronic fatigue syndrome research. Funding to support the ongoing Antibiotic Resistance initiative would be reduced, including investments in research, according to agency budget documents. The FY 2018 budget would zero out funding for the Injury Control Research Centers (ICRCs) and research to address elderly falls. Within CDC’s Environmental Health Program, the Administration proposes to terminate both the Climate and Health Program and the Amyotrophic Lateral Sclerosis (ALS) research program. CDC’s Environmental Health Laboratory would essentially be flat-funded at last year’s enacted levels.

Food and Drug Administration (FDA)

The Trump Administration proposes significant funding reductions to field activities and research centers across FDA’s programs including: Foods; Human Drugs; Biologics; Animal Drugs and Feeds; and Devices and Radiological Health. The Center for Biological Evaluation and Research (CBER) would reduce its applied scientific research and cut back the number of research fellows hired to support the regulatory science program. FDA’s Center for Drug Evaluation and Research (CDER) would reduce contracts that promote drug safety and research studies. A large proposed cut to the Center for Veterinary Medicine (CVM) could impact applied research and the level of engagement in international activities, according to agency budget documents. The requested cut to the Center for Food Safety and Applied Nutrition (CFSAN) may include the elimination of support for the Centers of Excellence, which partner with several academic institutions to conduct research on protecting the food supply. FDA’s National Center for Toxicological Research (NCTR) would see a small $3.1 million decrease below last year’s level of $63.3 million. 

Biomedical Advanced Research and Development Authority (BARDA)
BARDA and its Project BioShield initiative would see essentially no change from FY 2017 omnibus funding levels, with each funded at or just above $510 million.

[Associated image: National Eye Institute, National Institutes of Health/Flickr (CC BY-NC 2.0)]