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U.S. House appropriators rehearse National Institutes of Health budget balancing act

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By Mari Serebrov
Washington Editor

Balancing the realities of budget constraints with the tantalizing promise of biomedical research, a House appropriations subcommittee Wednesday looked for ways to deliver on the promise at the National Institutes of Health (NIH) while living within the means of fiscal 2015 spending caps.

Some members of the Labor, Health and Human Services, Education Subcommittee pushed for an increase in NIH funding for fiscal 2015, while Chairman Jack Kingston (R-Ga.) urged ending a budget cap that would allow the Department of Health and Human Services (HHS) to use up to $800 million in NIH funding for other purposes.

Rep. Rosa DeLauro (D-Conn.), a cancer survivor, spoke passionately about the need for more funding. “I am here by the grace of God and because of biomedical research,” she said, noting that NIH-supported research has allowed millions of Americans to live productive lives while pumping money into the economy. Every dollar awarded in an NIH grant generates $2.21 for the economy, she said.

Despite its role as an economic driver and its successful track record, the agency has lost more than 19 percent of its purchasing power since 2005, DeLauro said. Much of the loss occurred in 2013 due to sequestration. Congress restored some of the loss in the fiscal 2014 budget, which reflected a 3 percent increase in NIH funding over the previous year. But the $29.9 billion appropriated for 2014 still falls below the agency’s funding for fiscal 2012. (See BioWorld Today, Jan. 16, 2014.)

The president’s proposed budget for fiscal 2015, which includes about a $200 million increase for NIH, or 1 percent, would do little to help the agency regain its lost footing. Adhering to the discretionary spending caps agreed to by Congress, the 2015 budget President Barack Obama unveiled earlier this month requests $30.2 billion for NIH. That’s still more than $700 million short of what the agency lost to sequestration, Rep. Nita Lowey (D-N.Y.) said. (See BioWorld Today, March 6, 2014.)

Ending the budget cap would fully restore that funding, Kingston noted. Congress has allowed the budget mechanism for several years, initially letting HHS tap up to 1 percent of NIH’s funds for specified purposes. The cap now stands at nearly 2.5 percent, and the president has proposed increasing it to 3 percent in fiscal 2015, which could effectively erase any budget gains for the agency.

COMMITMENT TO RESEARCH

Both DeLauro and Lowey pointed out how the reduced budget is impacting the country’s role as a global leader in biomedical R&D. “If we are to be at the cutting edge, we must invest” in the NIH and strengthen its R&D capability, DeLauro said.

While the U.S. is decreasing its public research commitment relative to GDP, other countries are increasing theirs.

From 2007-2012, China increased its research commitment by 33 percent and Korea increased its commitment by 12 percent. Meanwhile, the U.S. commitment decreased by 2 percent, DeLauro pointed out.

Kingston put some context to those numbers, pointing out that even with the increase, China is only spending $2 billion on biomedical research.

He also questioned some of the details of the president’s proposed NIH budget. For instance, the 2015 proposal would cut $1 billion from efforts to advance scientific knowledge and innovation, while giving $600 million of that savings to an “emphasis on primary and preventive care linked to community” and the rest to efforts to ensure program integrity and stewardship.

NIH Director Francis Collins responded that he wasn’t sure what the emphasis on primary and preventive care linked to community means. However, the agency has a very clear idea internally of how to make the most of its proposed budget, he added.

SETTING PRIORITIES

That raised the issue of how the agency sets its priorities. In particular, Rep. Andy Harris (R-Md.) questioned the $3 billion proposed for HIV research, which comes down to $200,000 per HIV-related death in the U.S., when NIH spending is much less for diseases that claim more lives. For example, the proposed spending for research on stroke and heart disease comes down to $2,000 per death in the U.S., he said.

“I can understand the rationale for that question,” answered Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, especially given the advances that have been made in HIV. But dealing with an ongoing global pandemic like HIV is different from dealing with a stable disease, he explained.

Recognizing the many research needs in the U.S., Collins said he would be uneasy with a top-down effort that identifies one area as more important than others or with relying on philanthropic efforts to fund most biomedical research.

Committee comments throughout the hearing showed just how difficult it would be to leave the decision-making up to Congress or foundations focusing on particular diseases. The lawmakers each had their own disease priorities, ranging from Alzheimer’s to sickle cell anemia and from minority health disparities to increased inclusion of women in clinical development.

To make those decisions at the NIH, each institute looks at its disease landscape and identifies the knowledge and treatment gaps. Grants are then awarded accordingly, Collins said, adding that NIH is working on a report that explains the process in detail. The report is due out later this year.

Rep. Mike Honda (D-Calif.) urged his colleagues on the committee to look at the NIH budget in a holistic way, recognizing that the more they invest in the agency, the more they will get. It’s all a matter of “you get what you pay for vs. you make do with what you get,” he said.