Republicans Push NIH Reform

House Republicans are seeking major organizational change at the National Institutes of Health, citing a need to streamline its sprawling network of research units and to rebuild public trust in the agency following perceived failures in its handling of the COVID-19 pandemic.

The chair of the NIH oversight committee in the House, Rep. Cathy McMorris Rodgers (R-WA), published a blueprint for NIH reform this month that calls for reducing the number of NIH institutes and centers (ICs) from 27 down to 15 by merging some of them together.

Notably, this proposal is incorporated in the draft FY25 budget legislation for NIH published by the House Appropriations Committee this week. The top Republican appropriator for NIH in the House, Rep. Robert Aderholt (R-AL), indicated his interest in restructuring the agency in an op-ed with Rodgers earlier this month.

“We support the NIH and the critical role it plays in serving Americans, furthering scientific discovery, and ensuring the U.S. remains the world’s leading pioneer in basic science and biomedical research innovation,” they wrote. “But historical support for what an agency should or could be cannot prevent us from seeking to build upon past lessons or correct areas that have fallen short.”

Democrats have not yet weighed in on the details of the proposals but have argued Republicans are moving too fast. During a meeting held today to advance the NIH bill, House Appropriations Committee Chair Rosa DeLauro (D-CT) criticized their decision to include the restructuring in a bill that lacks bipartisan support.

“The House needs to hold public hearings, engage in a thoughtful process to incorporate the best ideas to advance NIH as the crown jewel of biomedical research,” DeLauro said. “Any discussion to reauthorize the NIH needs to be bipartisan and bicameral — unfortunately, the proposed reorganization in today’s partisan bill falls short.”

Among its proposed consolidations, the bill would combine the National Center for Advancing Translational Sciences, the National Institute of Biomedical Imaging and Bioengineering, ARPA-H, and the Common Fund into a “National Institute on Innovation and Advanced Research.” Other new research institutes formed through mergers would focus on body systems, neuroscience, disabilities, and substance abuse.

“By encouraging each IC to utilize a holistic life stage approach, our goal is to eliminate the demographic- or disease-specific siloed nature of the current structure and ensure each institute is considering the whole individual and all populations across the entire lifespan,” the blueprint states.

Other proposals in blueprint include introducing a five-year term limit for institute directors with a maximum duration of two terms, adding new oversight measures for grantees, and enabling NIH’s parent agency to suspend grants that present national security risks, among many other proposals.

Rodgers said some of these changes are necessary because public trust in the NIH “has been broken” due to “countless missteps throughout the COVID-19 pandemic.” She also said congressional investigations “have turned up everything from systemic sexual harassment to serious lapses in oversight related to risky research” and that the agency’s culture has proven “resistant to transparency and accountability to Congress.” Democrats have generally defended NIH’s actions during the pandemic while expressing openness to reforming oversight of risky biomedical research.

Republicans have invited the public to submit comments on the blueprint by Aug. 16. “Our message to scientists, researchers, patient advocates, colleagues, and the American people is simple: Our door is open. Work with us. Be a partner,” wrote Rodgers and Aderholt in their op-ed.

Meanwhile in the Senate, less drastic reform to NIH is being pursued by Sen. Bill Cassidy (R-LA), the top Republican on the NIH oversight committee in the chamber. Cassidy published a white paper in May with recommendations aimed at making NIH better oversee grantees, maintain a balanced research portfolio, streamline the peer review process, and expand support for the biomedical workforce.

The white paper was informed by a call for public feedback on policy changes Congress should consider to modernize the NIH. Cassidy said that respondents raised concerns about NIH funding being directed away from early-stage research in favor of late-stage research.

Respondents also called for the agency to reestablish a management review board that serves as a mechanism for public input on agency structure and operations. The board is already mandated by Congress but has not met since 2015, according to the white paper.