Investing In Our Future: A Stronger NIH for a Healthier America
Federation of American Societies for Experimental Biology (FASEB)
“To have first-rate health care for Americans, you must have first-rate research programs.” - Senator Tom Harkin, May 11, 2009 “The quality of health care delivered to the American people rests fundamentally on the level of knowledge we have about diseases.” - Congressman David Obey, June 19, 2008
“We must make key investments in the National Institutes of Health… We must also allow scientists to pursue research they believe has the highest likelihood to heal.” - House Speaker Nancy Pelosi, Sept. 5, 2008
“The United States is a world leader in conducting cutting-edge research into diseases and disorders. The quest to learn more, discover more, and save more lives continues to drive medical breakthroughs, and one of the greatest responsibilities of Congress is authorizing and funding research at the federal level.” -Rep. Joe Barton, Oct. 6, 2006
“This is yet another example of how our investment in this important agency today saves billions of dollars in future health care spending and prevents untold human suffering… underscoring the value of our investment in biomedical research at the National Institutes of Health, and I trust that, like me, my colleagues will recognize the positive impact these advancements will have on the health of our Nation.” – Rep Michael Simpson, May 22, 2008
“While some might argue that at a time when our economy is struggling we cannot afford to invest more in medical research. The fact is that research offers the only hope of saving lives, allowing our citizens to lead longer, more productive lives and saving billions of dollars in health care cost. To those critics I would say we cannot afford NOT to invest in medical research. This is not simply good social policy; it is good economic policy as well.” -Senator Arlen Specter, April 25, 2009
Throughout its history, the National Institutes of Health (NIH) has had a profound impact on the health and well-being of people in the United States and around the world. Thanks to the work of NIHfunded scientists working at universities and research institutions across the nation, many deadly diseases and seriously debilitating illnesses have been cured or turned into manageable conditions. A new study by Manton et al. reports that funding from NIH helped avert up to 1.35 million deaths annually. This year, Congress provided a generous and much needed investment when it included $10.4 billion for NIH in the American Recovery and Reinvestment Act (ARRA). This economic stimulus legislation is enabling NIH to start innovative new research projects, upgrade facilities and equipment at research institutions around the country, and expand the scope of ongoing work. These projects are providing jobs and generating commercial activity throughout the broader economy. And this is only the beginning. The bounty of new research findings will have lasting benefits for the public in the form of new therapies, better prevention, and improved quality of life. Timely, valuable, and in great demand, ARRA funds are available for only a limited duration. Unless preparations are made, newly funded research projects will be halted, jobs will be terminated, and productive scientific careers cut short. In addition to delaying relief to those suffering from the burdens of disease, other more subtle effects will play out over the course of several years, with potentially damaging results for the U.S. research enterprise. “Boom and bust” cycles are not the best way to maximize investment in biomedical research. Predictable, long-term plans for federal investments in science would facilitate coordination and planning, encourage investments by other sectors, attract new talent, reduce the startup costs of projects, and eliminate the waste inherent in abrupt termination of valuable scientific investigations.
Despite outstanding progress, all of the battles have not been won. For these patients and their families, research provides their only hope for a brighter future. And they are not the only ones depending on biomedical science. We are all increasingly vulnerable to new and emerging threats to our health. Investment in NIH allows scientists to rapidly respond to new threats like SARS and pandemic influenza. As we look to the future, the aging population in the U.S. and many other industrialized nations will dramatically increase our need for better health care and more effective treatments.
DID YOU KNOW?? Thanks to NIH funded research, more than one million lives per year are saved due to therapies to prevent heat attack and stroke, resulting in a four year gain in American life expectancy. Since 2002, deaths from cancer have been steadily reduced and in the past 30 years, survival rates for childhood cancers have been increased from less than 50 percent to over 80 percent.
NIH Budget in Current and Constant Dollars
40000 35000 Dollars (Millions) 30000 25000 20000 15000 10000 5000 0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 * Pres * FY2010 President’s budget Budget
With ARRA Current ($ Millions) Constant 2009 ($ Millions)
Learning from the Past
NIH funding has been characterized by “boom and bust” cycles which are at odds with optimal management of the biomedical research enterprise. Even before actual experiments begin, it takes years to build new facilities, train more scientists, assemble research teams and design new research protocols. In response to growth in the NIH budget from 1998-2003, universities and medical schools made substantial investments to increase their research capacity , and more young people embarked on research careers. The precipitous end of growth in funding was costly . NIH funding for new research projects actually declined following the 1998-2003 expansion. The number of “new and competing” R01 grants, the major driver of research progress, fell from 7,255 in FY2003 to 5,878 in FY2006, a decline of 19 percent. Awards rebounded in FY2007 with NIH budget increases provided by the Joint Funding Resolution, but dropped again by 6.3 percent in FY2008 when the funding for NIH failed to keep up with rising costs.
With fewer grants being funded, research progress slowed and talented individuals reconsidered their options as career plans were disrupted. Not only had survival as a scientists become more difficult as four out of five grants went unfunded, but large annual fluctuations in the numbers of annual grant awards made the funding process unpredictable and capricious. This roller coaster pattern complicates planning for long-term goals, limits the scope of work that can be undertaken when funding does increase, and diminishes the likelihood that necessary resources in terms of equipment and personnel will be available when opportunities emerge.
“History teaches us the greatest advances in medicine have come from scientific breakthroughs…”
President Barack Obama April 27, 2009
Looking to the future...
President Barack Obama recently pledged “the largest commitment to scientific research and innovation in American history.” He has also called for “doubling the budgets of research agencies in ten years” and “sustained and predictable increases in research funding.” This is a philosophy embraced by other nations as they expand their capacity for research. In June, Germany announced plans to increase funding for research over the next decade, and Chancellor Angela Merkel noted that the agreement will send a “signal of predictability to researchers, facilitating long-term plans for the use of
What is sustained predictable growth for biomedical research? When NIH program managers are asked for their view of the minimum budget increase necessary to keep up with scientific opportunity, a common response is three percent above inflation. This figure is not far from the historical rate of growth for NIH’s budget.: for 30 years proceeding the 1998-2003 “doubling,” the rate of growth has been three percent in constant dollars. The extraordinary progress made by NIH funded researchers during this period is evidence of the efficacy of this average growth rate. Had this rate of growth been steady and predictable, instead of the result of independent annual decisions made over three decades, the return on investment would no doubt have been even greater.
Number of NIH Research Project Grants: Before, During and After ARRA
50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011* 2012* 2013* Pres Budget Projected
Awards
*
Additional tables on NIH funding trends available at: http://NIHresearchfunding.faseb.org
The Looming Cliff...
An extended discussion on the optimal level of investment is certainly needed. In the near term, however, we face a potential crisis as we reach the end of ARRA funding. The ARRA funds came at a very opportune moment, as funding for NIH had not increased since 2004, and the agency lost over 11 percent of its purchasing power by FY2009. Response from the research community was immediate and overwhelming. After five lean years, the pent up demand for new research resources was enormous, and by the end of May, NIH had received applications for over 23,000 Challenge Grants, 2,700 Grand Opportunity Grants, 2,900 competitive revisions to existing grants, and 2,000 instrumentation proposals. NIH staff and reviewers are making heroic efforts to evaluate thousands of new proposals as the volume of applications has more than doubled. Progress in science and medicine arises through steady, persistent work over many years. ARRA funding, however, was designed to be a short-term stimulus bill and is currently serving that function. A reversion back to pre-ARRA funding levels will result in lost jobs, terminated projects, and delays in life-saving research. Recognition of this challenge has been growing and has been acknowledged in recent congressional hearings by Presidential Science Advisor John Holdren, HHS Secretary Kathleen Sebelius, and Senator Tom Harkin.
The overwhelming response of the scientific community to ARRA opportunities is just the beginning. The legislation designed to stimulate the economy inspired the creative energies of scientists across the nation, and NIH expects the flood of ideas to continue.
What happens if NIH funding returns to previous levels after ARRA funding expires?
•
The NIH program budget, combining the annual appropriations plus the ARRA funds, is $35.9 billion in FY2009 and FY2010. If the FY2011 budget for NIH reverted to the level in the President’s FY2010 budget ($31 billion), the NIH capacity to support biomedical research would decrease by $4.9 billion (13.6 percent) in current dollars and $5.9 billion (16.4 percent) in constant dollars. Using ARRA funds and its annual appropriation, NIH plans to award 16, 564 research grants in FY2009, bringing the total number of research project grants to 44,652. Returning to FY2009 levels of 9,850 awards would represent a loss of 6,714 awards (40.1 percent) in FY2011. The total number of projects, new and continuing, could drop from 44,562 to 38,033. Since each project represents a promising scientific idea with the potential to be the next medical breakthrough, this represents a tremendous loss in our capacity to develop new therapies.
•
•
Modeling a Post-ARRA Era
What We Need: A More Rational Approach to Research Appropriations To truly maximize planning and preparation, expand the scope of work that can be undertaken, and increase the likelihood that we will have an appropriate labor force and infrastructure in alignment with scientific opportunities, we need to consider a long-term approach to research funding. An Outline of a Possible Solution Knowing that ARRA funds will be provided only for the next two years makes it imperative that we think strategically about how to avoid the cliff scenario. Any loss of capacity to perform research will delay cures, terminate projects, and eliminate jobs. We believe that sustaining this level of support is critical to the continued success of our biomedical research enterprise and that now is the time to consider models of sustainability. For example, a10 percent increase in fiscal year 2011, followed by two years of increases equal to three percent above the biomedical research inflation index (or BRDPI) is one possible pathway to mitigate this loss of capacity. By our calculations, this could bring us back to ARRA funding levels by fiscal year 2012.1 From that point forward, we recommend a commitment to predictable, sustainable growth in NIH-funded research: a three percent increase in constant, inflation-adjusted dollars.
1
Avoiding the Cliff: Two Approaches to a Post-ARRA Strategy
Extend the Ledge: Allow grantees to
spend the grant money over a longer period of time.
Raise the Floor: Increase the NIH base
appropriations in the years after ARRA (FY2011 and beyond) Used singly or in combination, these strategies can alleviate the most harmful consequences of “the cliff.”
Disruption could also be minimized if investigators expended their ARRA funds over an extended period of time, making liberal use of “no cost” extensions.
NIH and the Nation’s Well Being
A half-century of public investment in NIH has dramatically advanced medicine and improved the lives of Americans and of people around the world. These investments give patients, their families, and researchers renewed hope for the future, and help ensure the leadership of our nation’s medical research enterprise. ARRA is providing an immediate infusion of funds to highly-competitive research labs across the country. This is allowing our scientists to sustain the pursuit of improved diagnostics, better prevention strategies, and new treatments for many devastating and costly diseases. NIH funding available through ARRA is supporting innovative research ideas, state-of-theart scientific facilities and instrumentation, and the scientists, technicians, laboratory personnel, and administrators necessary to maintain rapid progress in science and health. To truly fulfill the promise of biomedical research, we must avoid another abrupt plunge into a disruptive funding cycle. Instead, we must seize this opportunity to take the first step in renewing a national commitment to longterm, predictable growth in NIH funding. This is an essential element in restoring and preserving both national and local economic growth and vitality, as well as sustaining the hope of those waiting for the next generation of treatments and cures.
Additional information:
For additional data tables and information about NIH research funding, please visit: http://NIHresearchfunding.faseb.org
References:
•
National Institutes of Health: Research Results for the Public: http://www.nih.gov/ about/researchresultsforthepublic/index.htm Kenneth Manton, et al, “NIH funding trajectories and their correlations with U.S. health dynamics from 1950 to 2004.” PNAS, early print edition, 2009. Meredith Wadman, “Grant applications swamp agency.” Nature, 459, 763. 2009. Science Insider, “From the science policy blog.” Science, June 12, 2009
•
• •
Figure sources:
•
National Institutes of Health and National Institute of General Medical Sciences Photo Galleries: http://images.nigms.nih.gov/ iStockphoto
•
Acknowledgments:
Mark O. Lively, Ph.D. Wake Forest University FASEB President Guy Fogleman, Ph.D. Executive Director Howard H. Garrison, Ph.D. Deputy Executive Director for Policy Director, Office of Public Affairs Carrie D. Wolinetz, Ph.D. Director, Scientific Affairs and Public Relations
Federation of American Societies for Experimental Biology (FASEB) 9650 Rockville Pike Bethesda, MD 20814 (301) 634-7650 http://opa.faseb.org