HHS FY 2018 Budget in Brief - NIH

The National Institutes of Health is the largest public funder of biomedical research in the world.  NIH expands the biomedical knowledge base by funding cutting-edge research, improves health by seeking new treatment and prevention options, supports the training of the current and future biomedical workforce, and drives economic growth and productivity.

NIH builds its research portfolio by evaluating current scientific opportunities and public health needs while maintaining strong support for investigator-initiated research.  NIH strategic planning and priority setting processes provide an established framework within which priorities are identified, reviewed, and justified. 

The Fiscal Year (FY) 2018 Budget provides $26.9 billion for NIH, which is $5.7 billion below the FY 2017 Continuing Resolution level.  The FY 2018 Budget eliminates the Fogarty International Center while retaining a total of $25 million in mission-critical international research and research related activities within NIH Office of Director. 

The FY 2018 Budget also includes $272 million in budget authority within NIH to preserve key research activities previously carried out by the Agency for Healthcare Research and Quality (AHRQ), including critical survey activities, support for the U.S. Preventive Services Task Force, evidence-based practice centers, patient safety, investigator-initiated grants, and researcher training grants.  Remaining funds will be directed towards evidence-based practice centers, addressing the opioid epidemic, and the Healthcare Cost and Utilization Project.  This reorganization within NIH would structure AHRQ as an institute and preserve links between many of the closely-related continuing activities, simplify administrative responsibilities for consolidating and continuing the programs, and maintain an entity that can serve as a center of excellence for improving the quality and safety of health care services. 

More than 80 percent of NIH's budget supports the extramural research community through nearly 50,000 competitive grants. These grants support work by more than 300,000 researchers at more than 2,500 universities, medical schools, and other research institutions in every State and around the world.  About 10 percent of the NIH budget supports projects conducted by nearly 6,000 scientists in its own laboratories, most of which are on the NIH campus in Bethesda, Maryland.  Within the FY 2018 Budget, NIH will also support planning, policy-making, administration, management, and communication of NIH research.

Research Priorities in FY 2018

Fundamental Science Enhanced by Technological Advances
NIH invests in the essential building blocks of research, including basic science (knowledge of the mechanisms of biology and behavior), data science, and the development of new technologies.  This research can be applied across NIH’s disease portfolio and forms the foundation for translational and clinical studies.  For example, researchers are developing cryo-electron microscopy techniques to determine the atomic structures of proteins more rapidly than current methods allow.  These advances will identify more accurate protein structures and aid the development of more targeted and effective drugs.  Another example of potentially pivotal basic research is NIH’s investment in single cell analysis.  Though individual cells within a cluster may seem to be of the same type, such as a neuron or a nephron, in fact they can differ dramatically, with important consequences for the function of the entire organism.  By analyzing the dynamic states of single cells it may be possible to predict which cells in a group are more likely to become infected with a virus, or are more prone to cancer, or even to becoming drug resistant.  NIH-funded investigators have revealed a huge diversity of neuronal subtypes in the human brain.  Single cell analysis has the potential to uncover fundamental biological principles and ultimately improve the detection and treatment of diseases and conditions.  Basic research represents more than half of NIH’s research budget and will continue to be a very high priority.

Treatments and Cures
Designing effective treatments and cures depends upon innovative researchers translating fundamental knowledge about cells, systems, and organisms, into potential targets for therapeutic development.  Cell or tissue samples, animal models, and computer simulations often are used to design and test candidate approaches for diagnostics, devices, treatments, and cures.  The most promising are then moved into human clinical trials, where they are tested first for safety and then efficacy.  NIH supports research all along this pipeline to facilitate discovery of novel treatments for myriad diseases and conditions.  

One groundbreaking treatment supported by NIH resources is cancer immunotherapy.  This powerful technique harnesses a patient’s own immune system to attack cancer cells.  Patients with a variety of cancers have benefitted from immunotherapy, and ongoing and future NIH-supported research aims to understand what enables immunotherapy to work in some patients, but not in others, as well as to expand the use of immunotherapy to other types of cancer.  Studies also will test the efficacy of cancer immunotherapies earlier in disease progression as well as in combination with other standard cancer treatments such as chemotherapy and/or radiation.

Health Promotion and Disease Prevention
NIH supports research to promote health, prevent disease, and develop strategies to address the progression of disease before symptoms appear.  Advances in these research areas require a deep understanding of the many factors that affect health, and include identification and assessment of genetic and environmental risk factors, screening of at-risk individuals for diseases, development of risk-reduction strategies, as well as translation, dissemination, and implementation of strategies to prevent diseases and conditions.  One important preventive strategy is vaccination, which is the safest, most cost-effective, and efficient way to reduce the burden of infectious diseases.  NIH is engaged in research to develop vaccines for many diseases, including a universal influenza vaccine to protect against seasonal infection that can sometimes lead to very serious health complications.  Such a vaccine would induce a strong, long-lasting immune response to the part of the virus that does not change much from year to year, and several NIH-funded researchers have made progress towards this goal.

Enhancing Stewardship
As stewards of Federal investments in biomedical research, NIH strives to earn and maintain the public’s trust.  The role of the United States as a leader in biomedical research depends not only on innovation in the laboratory and the clinic, but also innovation in how science is funded, performed, and managed.  NIH is engaged in many efforts to encourage good stewardship practices across all levels of the biomedical research enterprise.  These include ways to streamline administrative processes for investigators, efforts to support new and early stage investigators, and a focus on cultivating a world-class biomedical research workforce.

A key way in which NIH is strengthening stewardship is through new policies designed to enhance reproducibility of scientific research through increased rigor and transparency in reporting.   NIH has released principles and guidelines for reporting preclinical research and created training materials for graduate students and fellows in best practices in experimental design.  Planned future activities include extending NIH’s previously established Rigor and Reproducibility Policy to additional types of grants, collaborating with scientific journal editors and other stakeholders to improve rigor and reproducibility in publications, and working to improve data sharing and accessibility.

21st Century Cures Act

In FY 2017, Congress enacted the 21st Century Cures Act, authorizing $4.8 billion over ten years in support of high priority NIH initiatives and research areas:  the Precision Medicine Initiative; the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative; the Beau Biden Cancer Moonshot; and Regenerative Medicine.  The NIH FY 2018 Budget includes $496 million authorized for these initiatives.

Precision Medicine Initiative:  This initiative was launched in 2015 to accelerate our understanding of individual variability and its effect on disease onset, progression, prevention, and treatment.  Toward this goal, NIH is establishing a group of one million or more volunteer participants that reflect the diversity of the United States to contribute health information over many years, known collectively as the All of Us Research Program.  This national resource of clinical, environmental, lifestyle and genetic data will help uncover new information that can be used to find new strategies for preventing and treating diseases that account for individual variability.

BRAIN:  Informed by a report (BRAIN 2025: A Scientific Vision) of a working group of the Advisory Committee to the NIH Director,  the BRAIN Initiative seeks to accelerate the development and application of innovative technologies to produce a new, dynamic picture of the brain that shows how individual cells and the neural circuits they form interact in time and space. This information will fill current knowledge gaps and provide opportunities to explore how the brain records, stores, processes, and uses information.  This understanding will provide important new insights on the connection between brain function and behavior and could transform our ability to diagnose and treat neurological and mental disorders.

Beau Biden Cancer Moonshot:  By capitalizing on emerging scientific discoveries, the Beau Biden Cancer Moonshot aims to accelerate progress in cancer research, improve prevention and early diagnosis, and ensure access to cancer treatment and clinical trials for all patients.  A Blue Ribbon Panel of experts established ten scientific priorities for the initiative, including enhanced data sharing, developing new cancer technologies, expanded use of prevention and early detection strategies, cancer immunotherapy, and pediatric cancer.  NIH released funding opportunity announcements related to these priorities in FY 2017, and more are planned for the future.

Regenerative Medicine:  Regenerative medicine seeks to develop functional tissues and organs to repair or replace biological function that has been lost due to congenital abnormalities, injury, disease, or aging.  The state-of-the-art in regenerative medicine integrates tissue engineering (based on advanced biomaterials development) and cell-based therapy, springing from advances in stem cell research   and developmental biology.  Funding from the 21st Century Cures Act will be awarded in coordination with the Food and Drug Administration to support clinical research using adult stem cells, which could open doors for possible new treatments.

Maximizing Efficiency and Effectiveness

The institutes, centers, and offices that make up NIH work together to coordinate and collaborate on research priorities, leveraging resources and expertise toward the common goal of improving health.  Through trans-NIH efforts at planning and assessment and in consultation with HHS leadership, NIH continually seeks innovative ways to streamline its processes and structure to ensure efficient and effective scientific management.

Restructuring Global Health Research at NIH
The Budget for NIH eliminates the Fogarty International Center. Approximately $25 million within the Office of the Director will be dedicated to coordinating global health research across the NIH, including issues regarding workforce development and engagement with NIH’s international biomedical research partners. 

Consolidation of Healthcare Research and Quality
To help focus resources on the highest priority research and reorganize federal activities in a more effective manner, the Budget consolidates the Agency for Healthcare Research and Quality (AHRQ) into NIH.  The Budget consolidates select research activities within a new National Institute for Research on Safety and Quality (NIRSQ) to improve efficiency, minimize potential overlap, and increase coordination of health services research.  The creation of NIRSQ will simplify administrative responsibilities for consolidating and continuing former AHRQ programs, and maintain an entity that can serve as a center of excellence for improving the quality and safety of health care services.

The Budget includes $272 million in budget authority for the NIRSQ.  As part of the consolidation, the institute will invest $5 million in a comprehensive review of health services and translational research across NIH to identify gaps and develop a strategy for investing in the highest priority research and ensuring that the research is adopted by other Federal agencies and stakeholders.  The Budget also preserves key activities that were previously funded in AHRQ to improve the quality and safety of American health care, while reducing or eliminating lower priority programs that may potentially overlap with activities administered by other components of HHS.

The Budget continues funding for select former AHRQ activities that have a demonstrated record of effectiveness and make unique contributions to quality improvement and patient safety through supporting the data generation, analysis, and evaluation necessary to improve quality of care and enhance patient safety.  The Budget includes support for research to enhance patient safety at AHRQ’s FY 2017 Continuing Resolution level to continue driving progress on reducing healthcare-associated infections, and developing and disseminating evidence on the frequency and prevention of safety incidents. 

Many public and private healthcare organizations across the country rely on this evidence base to provide the strategies and tools needed to minimize risks and harms to patients.  Funding for the Medical Expenditure Panel Survey will continue at $70 million—$4 million above the FY 2017 Continuing Resolution level—to maintain the integrity of the national and State sample sizes and the quality of the core data products. As the only national source for comprehensive annual data on the use of medical care in the U.S., the survey provides an important data source for research efforts aimed at improving health services. 

NIRSQ will continue to provide administrative support for the United States Preventive Services Task Force at $7 million, a reduction of $4 million below AHRQ’s FY 2017 Continuing Resolution level.  Within Health Services Research, Data, and Dissemination, the Budget includes funding of $46 million for investigator-initiated research grants and research training, $10 million for the Healthcare Cost and Utilization Project, $1 million for Evidence-Based Practice Centers, and $3 million for opioid treatment research grants. These investments will provide researchers the support needed to conduct studies that focus on quality, effectiveness, and efficiency of health care services, and provide a means for the dissemination of research results with the greatest potential to improve care.

The Budget reduces or eliminates potentially overlapping or lower priority programs.  For instance, no funding is included for the research and dissemination activities of the Health Information Technology portfolio, which could potentially be funded by other continuing programs.  Many contract-funded activities in Health Services Research, Data, and Dissemination, such as development of quality measures are discontinued due to potential overlap with other HHS programs.

In addition, NIRSQ is projected to receive $107 million in mandatory resources from the Patient-Centered Outcomes Research Trust Fund to continue translating and targeted dissemination of comparative clinical effectiveness research study results and workforce development efforts.  These funds will also support training researchers to conduct high quality studies in this area and research designed to help patients and providers make better informed health care decisions.

Indirect Costs

Increasing efficiencies within the NIH remains a priority of the Administration.  The FY 2018 Budget changes reimbursement of indirect costs for NIH grants, which will be capped as a percentage of total research, in order to better target available funding toward high priority research.  In addition, Federal research requirements for grantees will be streamlined to reduce grantee burden through targeted approaches as proposed by NIH.

Table Footnotes

1/  Subtotals and Totals may not add due to rounding.
2/  In addition, the FY 2016 Zika Response and Preparedness Act (P.L. 114-223) provided $152 million in supplemental resources to NIH for Zika response and preparedness activities.
3/  Reflects the annualized level of the Continuing Resolution that ended April 28, 2017, including the across the board reduction, the 21st Century Cures Act, and directed transfers.
4/  Number of grants and dollars for the Common Fund and ORIP components  of OD are distributed  by mechanism and are noted here as a non-add.
The Office of the Director - Appropriations also is noted as a non-add because the remaining funds are accounted for under OD - Other.
5/  Includes B&F appropriation and funds for facilities repairs and improvements  at the NCI Federally Funded Research and Development  Center in Frederick, Maryland.
6/  Number of grants and dollars for Program Evaluation  Financing are distributed  by mechanism above; therefore, the amount is deducted to provide subtotals only for the Labor/HHS  Budget Authority.
7/  Number of grants and dollars for mandatory Type I Diabetes are distributed by mechanism above; therefore, Type I Diabetes amount is deducted to provide subtotals  only for the Labor/ HHS Budget Authority.