The NIH supports research programs essential to public health and to stimulating valuable economic sectors in health care and biomedical sciences, and creating our future scientific workforce. The current fiscal impasse is alarming to the biomedical research community. NIH appropriations already had fallen short in recent years, with the Agency losing one-fifth of its purchasing power over the past decade. The budget sequestration now in effect would further cut NIH funding by over 5 percent in the current fiscal year, which actually would equal nearly 9 percent over the remaining FY 2013 period.
The ASM is very concerned by the probable fallout from this additional approximately $1.6 billion decrease in NIH’s FY 2013 funding, particularly when biomedical research should receive more, not less, federal support. NIH recently informed the scientific community that all grant awards currently being funded likely would receive less than their full FY 2013 commitment levels. Under sequestration, the Agency also will distribute fewer new awards. The most recent success rate of grant applications was already at a low 18 percent compared with 30 percent in 2003. In February, analysis by United for Medical Research (UMR) projected that sequestration of NIH funding could force the loss of 20,500 US jobs and $3 billion in economic output. Sequestration decreases foreshadow the already grim scenario of an estimated $900 billion in NIH spending cuts over the next ten years mandated under the Budget Control Act.
NIH funding jeopardizes the Nation’s competitive edge in biomedicine and thus our economic success in the innovation dependent global marketplace. Budget cuts also will have a chilling effect on whether young Americans choose research careers, if those careers appear to lack professional and financial stability. It is generally agreed that the United States must attract and inspire, not discourage, the next generation of scientists. We urge Congress to also recognize that inadequate NIH funding would fail a national public health system faced with rising healthcare costs, as well as an aging and increasingly diverse population. In 2011, national health spending reached an estimated $2.7 trillion (17.9 percent of the GDP), a startling argument for those effective disease treatment and prevention approaches discovered through NIH funding.
The ASM strongly urges Congress to add additional funding for the NIH in FY 2013 and FY 2014 and fund the NIH at the highest possible level of funding.
NIH Funding of Biomedical Research is Essential to the Fight against Infectious Diseases
Biomedical advances extend life expectancy and steadily improve our quality of life. Examples include HIV/AIDS studies transforming a fatal disease into a chronic condition through treatment, and the vaccine development responsible for dramatic global declines in diphtheria, polio, yellow fever, tetanus, and smallpox. Each year, three NIAID supported vaccines are now saving numerous children worldwide: pneumococcal vaccine, 826,000; Haemophilus influenzae type b vaccine, 386,000; and rotavirus vaccine, 435,000.
Despite lower mortality from communicable causes, infectious diseases persist as significant threats to public health. Detecting, preventing, and treating infectious diseases is a critical part of NIH’s portfolio. In allocating resources, it is important to remember that NIH is the nation’s primary federal supporter of basic, clinical, and translational research in medicine, generating diagnostics, therapeutics, prevention strategies, and surveillance tools that help lift the burden of infectious disease.
Health agencies in the United States periodically confront infectious diseases variously classified as newly emerging, reemerging/resurging, or deliberately emerging (bioterrorism), as well as pathogens increasingly resistant to drug therapy. In recent years, these so called emerging infectious diseases (EID) have included those caused by hantavirus, HIV, and highly virulent strains of E. coli and influenza viruses; rising numbers of dengue, listeriosis, and West Nile; and drug resistant forms of Staphylococcus aureus. In 2012 alone, emerging examples included a novel disease causing coronavirus initially reported in the Middle East and a variant influenza virus (H3N2v) that spread from swine to people in US farm communities. The media report this month (March) of a man infected with a deadly form of the tuberculosis pathogen, one considered to be “extensively drug-resistant” (XDR TB), is just the most recent reminder that we cannot afford to fall behind in our understanding of, and science based responses to, microbial pathogens and their host interactions. US health officials found his TB strain to be resistant to at least eight of the available standard drugs. Before being stopped at the US-Mexico border and placed in medical isolation, he had traveled through 13 countries over three months. XDR poses a major threat due to its frightening drug resistance.
Scientists funded by the NIAID consistently achieve advances against HIV/AIDS, malaria, tuberculosis, influenza, and other diseases significant to our health and economy. To illustrate their importance, NIAID supported these examples from the past year:
- Genetic changes in the salivary glands of mosquitoes infected with dengue virus might increase virus transmission, elucidating viral biology that must be understood to develop countermeasures. There currently is no vaccine or drug treatment for dengue, which globally infects about 50 million to 100 million each year and has been reported in parts of the United States.
- Discovery of a toxin transport system in S. aureus suggests a new approach to drugs against a pathogen notorious for its ability to resist traditional antibiotics. Methicillin resistant staph (MRSA) is a leading cause of US hospital acquired infections, causing an estimated 18,000 deaths in 2005. In other research, genome sequencing of multiple strains of vancomycin resistant S. aureus gives scientific insight into pathogens resistant to an antibiotic of last resort.
- Universal flu vaccines against a wide range of virus strains are moving closer to reality with results from studies like those of human immune cells producing broadly neutralizing antibodies against flu viruses and those showing that a prime boost vaccine regimen can elicit “universal” antibody production. Several clinical trials of first generation universal vaccines are either under way or planned at NIAID’s Vaccine Research Center.
- Clinical trials demonstrated the most effective antiretroviral drug regimens to prevent HIV infection (pre-exposure prophylaxis, or PrEP); other research helped shape antiretroviral treatment for HIV infected individuals. Last August, NIAID awarded $7.8 million in first year funding to universities and medical centers for basic research to identify new approaches in HIV vaccine design, part of a much larger HIV vaccine discovery effort.
The NIGMS has funded basic research on the structure and function of HIV, in search of new treatments, for more than 25 years. It is a partner with the National Science Foundation, the US Department of Agriculture and others in the Ecology and Evolution of Infectious Diseases (EEID) program, contributing expertise in basic research. Last year, NIGMS supported scientists developed a new improved CH-activation technique to add molecules to existing compounds, making it easier to tailor make new drugs; others reported on how iron uptake plays a role in bacterial invasion of host tissues.
We invest in NIH each year to expand our vital scientific knowledge, but also to create real world products that protect our communities. In February, for example, researchers launched early-stage clinical trials of two candidate vaccines against Shigella infection, which each year causes about 90 million cases of severe diarrheal illness and 108,000 deaths worldwide. Others are working toward broad spectrum antivirals effective against groups of pathogens, like that being developed against all enveloped viruses, including the Nipah, Ebola, HIV, influenza, and Rift Valley fever viruses. NIH also is supporting development of new technologies like nanoscience techniques to detect pathogens hidden deep in human tissue and genome sequencing to better track infectious disease outbreaks.
NIH Funding Stimulates Economic Sector, Workforce Expansion
Biomedicine is big business―the US medical innovation sector employs 1 million US citizens, generates $84 billion in wages and salaries, and exports $90 billion in goods and services. Yet US industry performs only 17 percent of basic research, leaving most of the biomedical “foundation building” to federal responsibility. NIH is the largest funder of biomedical research in the world, including the research of 138 Nobel Prize winners. It contributes more than 80 percent of federal biomedical research funding in the United States. The NIH extramural program supports about 50,000 competitive research grants and 300,000 scientists and research personnel at more than 2,500 medical schools, universities, and other institutions throughout the country. Annual appropriations also support nearly 6,000 scientists working at the 27 NIH institutes and centers. The UMR analysis released in February reinforced the agency’s importance as an economic motive force. In 2012 alone, the NIH financed more than 402,000 jobs and $57.8 billion in economic output nationwide.
Investment in NIH clearly reaps rewards well beyond improved public health. Since 2000, for example, NIGMS supported research has received 18 Nobel Prizes either in Chemistry or in Physiology or Medicine. In December, NIH proposed multiple initiatives to help strengthen both the US biomedical research enterprise and the Nation’s global competitiveness, designed ”to support a research ecosystem that leverages the flood of biomedical data, strengthens the research workforce through diversity, and attracts the next generation of researchers.” To be successful, initiative strategies like enhanced training of graduate students and better management of “big data” through high performance computing will require sufficient funding increases.
NIH support for university research has long been a major factor in scientific and technological innovation in medicine. Unfortunately, the current fiscal scenario will force reductions in existing grants and likely fewer new awards going forward. Scientists at US universities are already reporting sequestration related setbacks to their planned research, casting doubt on both potential breakthroughs and student training programs. Stakeholders in biomedical research are concerned that among the research jobs at risk, younger scientists will be particularly affected. Undermining a future workforce generation is shortsighted, and the ASM fears subsequent negative impacts on new R&D discoveries, public health, and US global competitiveness.
The ASM urgently requests the Congress increase funding for the NIH and biomedical research.