Covered in Politico last week, looks like NIH is finally getting the attention it deserves and hopefully a much-needed boost in funding as well.
In summary, the “21st Century Cures Act” just passed the vote in the house of representatives (yippee), and now goes on to the senate. A lot of the provisions on this bill are administrative stuff (think: how long the NIH director can serve, etc); HOWEVER a key provision creates a new NIH Innovation Fund and calls for $9.35 billion in funding. This will be particularly helpful for those of us early in our careers.
After a dozen years of flat funding, the National Institutes of Health has become a top target on Capitol Hill — not for less money but more, potentially billions more by 2020.
It’s a remarkable turnaround for the huge medical research agency, one triggered by a confluence of circumstances. Fears that the United States is losing ground to international competitors in science and technology synched with lawmakers’ need to show frustrated voters that they can work in a bipartisan manner, and NIH offered “an easy win” on both, advocates say
Add in the institutes’ director, Francis Collins, a scientific celebrity with guitar-playing, motorcycle-riding everyman charm, who has wooed over 300 lawmakers in recent years. Plus crowds of patients flooding the halls of the Capitol and headlines about the fantastic promise of new cancer immunotherapies.
All of this has made for a billion-dollar movement — or $2 billion, as Senate appropriators have proposed adding to NIH’s budget next year. Even lawmakers whose usual mantra is fiscal restraint and less government spending are now among the agency’s most vocal cheerleaders.
If anything, said Emily Holubowich, executive director of the nonprofit Coalition for Health Funding, there’s “competition among lawmakers of who is going to save NIH first.”
As the largest supporter of biomedical research in the world, NIH has long had an aura about its work that gave it almost sacred space amid partisan bickering. Although that didn’t protect it from sequestration in 2013, the fallout may have been a blessing in disguise, underscoring the urgency for funding and reinvigorating efforts by advocates and the research community to help the agency regain ground.
“The broader pressures of sequestration and austerity” have “really put a lot of pressure on lawmakers, and rightfully so, that this is not acceptable,” Holubowich said.
Yet those other factors played heavily into the recent moves for greater resources. The emergence of key research-driven efforts like the president’s Precision Medicine Initiative and the House’s 21st Century Cures Act only intensified the interest.
NIH funding “transcends where you sit on the political spectrum,” said Sen. Jerry Moran, a member of the newly formed Senate NIH Caucus. It’s why the Kansas Republican can simultaneously call himself a “fiscal hawk” and say that making the case for the institutes’ budget is “so easy.”
Republicans now talk about curing disease as a way of also curing government spending. “We can’t solve mandatory health spending problems without finding cures for Alzheimer’s, heart disease, cancer and diabetes,” said Maryland Rep. Andy Harris.
Key NIH allies like Sen. Dick Durbin have lobbied colleagues on both sides of the aisle to get to this point.
“In football terms, I flooded the zone,” Durbin said recently as he considered the changed atmosphere. The Illinois Democrat remembers advising a very conservative Republican senator who was up for reelection that moderates and Democratic voters could be won over through support of NIH.
“If you bring up the topic of medical research, you are going to be surprised,” Durbin told the lawmaker. “Everybody is for that.”
Collins himself sounds alternately pleased, confident and somewhat surprised by the reversal of fortune. An internationally known geneticist, he’s been an unflagging ambassador for the agency since he became director in 2009.
“I can’t remember a single one of those [Hill meetings] that went badly, just because the case is so strong,” he said. Not just in terms of the nation’s economic health but — he pounds his hand over his heart for emphasis — “it also gets you where you live.”
He notes high-profile support from “unpredictable voices” like former House Speaker Newt Gingrich as well as tea party-backed Rep. Matt Salmon of Arizona, who told a cancer advocacy meeting that balancing the federal budget on the back of NIH was a mistake. Salmon then proposed “to go well beyond anything anyone in his party had been talking about in terms of dollar figures,” Collins recalled.
“It has been a lot of effort on the part of many voices — advocates, scientists, our colleagues in the private sector — to make a case that whether you are interested in advancing human health or stimulating the economy or encouraging American competitiveness, every dollar you put into medical research is a really good investment,” Collins said during a break last month at the BIO International Convention in Philadelphia.
“To see this growing momentum this year, finally, is really gratifying. It even gives one hope that it might translate into actual votes and knowledge,” he added.
The major research work being done in other countries has also been a definite “wake-up call” for some people, Collins believes. China, for example, last year filed more patents in the life sciences than the United States.
“That ought to be a cause of considerable concern if you are thinking about our future economic health,” he said. “What we had considered to be a given, that is America’s dominance in biotech, in pharma, is now really being eroded.”
Of course, the real proof of support will come with the final appropriation for next year. The institutes’ flat-line funding since 2003 has effectively meant a 23 percent loss in purchasing power. And despite everyone’s enthusiasm, the proposed increases for fiscal 2016 are far from certain since they could come at the expense of other health programs.
The president’s budget requested an additional $1 billion for NIH, while both House and Senate appropriations subcommittees are pushing more, from $1.1 billion in the House to $2 billion in the Senate. The Senate’s effort would push the institutes’ funding to nearly $32.2 billion — though, in adjusted dollars, that would still be at least $3.6 billion below the level of a dozen years ago.
“In this era of deficit problems, it’s a huge increase,” Rep. Hal Rogers (R-Ky.) said after the House bill passed out of committee in late June. “It shows the respect and appreciation we have for that agency.”
Health advocates are already criticizing the funding bills for the cuts that would result. House appropriators are looking to eliminate all dollars for the Agency for Healthcare Research and Quality, for example. A teen pregnancy prevention program would be cut by more than 90 percent, and other programs also would lose resources.
In this regard, the NIH spending legislation “would do more harm than good,” the Coalition for Health Funding said.
The 21st Century Cures legislation, now targeted for a House floor vote in July, would give NIH a separate $8.75 billion over five years — though even that extra resource won’t solve all of the catch-up needs, according to Collins.
But NIH’s readiness to work closely with Republicans on exactly how its money is spent should bode well for additional funding increases in coming years.
“Dr. Collins has shown a willingness to take steps to increase the efficiency and effectiveness of money spent at NIH, and Congress is willing to provide more funds as a result,” Harris said. “Congress has made clear that if NIH is willing to make some internal reforms, Congress will be willing to provide more money for lifesaving research.”
NIH’s leader sees the work done there as a “noble enterprise.”
“This is a way we can try to eliminate suffering,” Collins said. “This is one of the greatest things the government does, and the track record over the decades is stunning.”