Major biomedical funder NIH ready for large-scale reforms under Trump 2.0

The world’s largest public funder of biomedical research appears ready for a major reorganization in the coming years.

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Proposals from both houses of the United States Congress, as well as comments from the incoming administration of newly-elected US President Donald Trump show that there is a strong appetite to reform the National Institutes of Health (NIH) and its $47 billion research portfolio. What is less clear is how this transformation will unfold; The proposals include everything from halving the number of institutes to replacing some of the agency’s staff.

Reflecting this increased government scrutiny, the NIH launched a series of meetings on November 12 at which an advisory group of insiders and outside scientists will consider the various proposals and make its own recommendations for reform.

It will be a mad dash to the finish line for these parties in terms of whose vision will win out, says Jennifer Zeitzer, head of the public affairs office of the Federation of American Societies for Experimental Biology in Rockville, Maryland. “There is definitely movement on Capitol Hill to discuss how to optimize and reform the NIH,” she says. “We now also have the agency participating in that conversation.”

Crimping and cutting

The NIH advisory meeting comes in the wake of Republicans gaining control of both chambers of Congress and the White House for 2025. This year, two separate bills to reform the agency were advanced by Republican members of Congress — one led by Rep. Cathy McMorris Rodgers. from Washington State and one from Senator Bill Cassidy of Louisiana. These proposals are motivated in part by dissatisfaction with the agency’s response to the COVID-19 pandemic the perception that oversight of research into potentially high-risk pathogens has been lax.

McMorris Rodgers’ plan would collapse the number of institutes and centers at the NIH from 27 to 15, allow the parent agency to revoke any grant determined to pose a threat to national security, impose a five-year term on institute directors who can only be extended once, and introduce stricter supervision of research involving high-risk pathogens. For his part, Cassidy, who will become chairman of the US Senate committee in charge of overseeing health issues in 2025, says said he would introduce more transparency in processes the agency uses to review research grant proposals.

If these plans – laid out in white papers – come to fruition, they would represent the first major reform of the NIH in nearly two decades. The last time there was a review, in 2006, Congress passed the legislation with bipartisan support, creating a review board and requiring the agency to send updates to lawmakers every two years. However, the same support from both sides of the political aisle is unlikely to occur with the proposals currently under consideration.

The NIH has been a frequent target of Trump and his Republican and other allies. Robert F. Kennedy Jr., whom Trump picked to lead the U.S. Department of Health and Human Services (HHS) — the parent agency of the NIH — said in 2023 that he would seek an eight-year break from research into infectious diseases at the NIH so that the biomedical funder can instead focus on chronic diseases such as diabetes and obesity. He also said on November 9 that he would seek to replace 600 employees at the NIH. (Neither Trump nor his appointees can currently fire career staffers at the agency, whose jobs are protected by law, but that could change if Trump makes good on his promise to reclassify the federal workforce.)

Harold Varmus, a cancer researcher at Weill Cornell Medicine in New York City and former head of the NIH, says Nature that he is “alarmed” by Kennedy’s comments. “We may need Republicans in Congress and even Democrats who are traditional supporters of the NIH to stand up for the agency and its importance to public health.”

Run to the finish line

At this week’s meeting of the NIH advisory committee, called the Scientific Management Review Board (SMRB), panelists met for the first time since 2015 to review the agency’s structure and research portfolio and make recommendations to the director from the NIH and the HHS. Congress requested that the agency initiate this process.

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NIH officials hope the group will meet five more times over the next calendar year so they can produce a report with their findings and recommendations by November 2025. This ambitious timeline suggests that “there is a recognition that the SMRB will have to take steps to catch up with Congress quickly or risk Congress making decisions they don’t like,” Zeitzer says.

Several committee members even noted at the Nov. 12 meeting their fear that Congress would act before the group issued its report. Kate Klimczak, director of the NIH Office of Legislative Policy and Analysis, tried to reassure the committee: “the authors of the various (congressional) proposals clearly wanted this board to be re-established and wanted this board to do their job .” she said. “We have to take them at their word that they are looking forward to getting (a report) from you.”

NIH Director Monica Bertagnolliwho is likely to resign before Trump takes office, expressed her disapproval of the proposals to reduce the number of institutions. She said the current system allows people with diseases and patient advocacy groups to coordinate with a special institute for their cause, for example the National Institute of Mental Health or the National Institute on Aging. “If we were to collapse, we would certainly lose something in terms of our engagement with the public,” she said.

It is unclear what direction the SMRB will take with its recommendations, but there were hints during the meeting. Several panelists were surprised by the legislative proposals. For example, McMorris Rodgers’ white paper says that “decades of unstrategic and uncoordinated growth have created a system ripe for stagnant leadership, duplication, gaps, misconduct, and undue influence” at the NIH. James Hildreth, president of Meharry Medical College in Nashville, Tennessee, called this language “almost offensive.” He added: “I know we don’t want politics to creep into what we do, but how could it not?”