Wondering what NIH leadership really thinks about the future of federal funding for biomedical research? Interested in learning about the impact NIH-funded research is having and the progress that’s been made on large NIH initiatives? Deputy Director for Extramural Research, Sally Rockey, addressed these topics and more in a recent opening plenary presentation at the NIH Regional Seminar on Program Funding and Grants Administration in Baltimore. The full 55 minute presentation, View of NIH from 10,000 feet, is available for viewing here, but following are some highlights:
- 10 percent of NIH’s budget goes toward HIV/AIDS research, an investment that has had a significant impact on the quality and length of patients’ lives. In the mid-1980s, a young person presenting with AIDS had a prognosis of 3 to 6 months to live. HIV research and resulting therapies have given patients diagnosed this year a life expectancy of 70+ years .
- Cancer rates are declining at the rate of 1 percent per year due to early detection and better treatments.
- Cardiovascular disease deaths are down over 60 percent in the last half century.
- Human Genome Sequencing is close to being performed at a cost of $1,000. This compared to the $2 billion spent on the Human Genome Project in the early 1990s.
NIH’s budget has been essentially flat since 2003, and yet inflation demands larger awards be made to cover research costs. As a result, fewer awards can be made, and success rates have dropped from over 30 percent prior to 2003 to about 18 percent in 2014 .
“Too much good science is being left on the table,” asserts Rockey, so the Office of Extramural Research is advocating for a slow yet predictable trajectory for budget growth rather than continued cycles of rapid expansion and drastic cuts. The funding practices of the past 11 years are “no way to sustain an enterprise,” said Rockey. But she’s optimistic given what she’s hearing from Congress about growing bi-partisan support for more stable and consistent growth.
Rockey also presented data on international research investment compared to that of the U.S./NIH. The percentage of other countries’ budgets spent on biomedical research is growing significantly, while the U.S.’s is declining. China in particular is making large investments in both infrastructure and workforce: between 2007 and 2012, China’s compound annual growth rate of biomedical R&D expenditures was over 32 percent, while the U.S. showed a negative 1.9 percent growth rate.
Programming and initiatives
With investment on the decline, the U.S. is facing an innovation deficit, which is why, according to Rockey, it is imperative that NIH move forward with new initiatives despite the current funding challenges. She provided updates on several initiatives:
Precision Medicine: Though the term is now bandied about in the media after President Obama’s call to action, Rockey believes most people don’t fully understand NIH’s objectives around Precision Medicine. She elaborated on NIH’s vision for this Initiative:
- Near term: Cancer as a model of precision medicine
- Longer term: Expanding the model to other diseases
- Policy changes: Remove barriers to clinical implementation
Though still in the initial phase, NIH is putting together a diverse, million-person cohort to serve as a knowledge base for Precision Medicine. NIH will employ new health monitoring technologies, genomics, and electronic patient record system improvements to study and treat this cohort over the coming years.
Ebola Virus: Vaccine development is under way. A Phase I trial was conducted, and two Ebola test vaccines appear safe. Phase II clinical trials are under way in West Africa, but since the outbreak has died down, progress is slow. Treatment protocols are also being developed, the most promising of which has been coined “Z-Mapp” (antibody disruption of the virus).
Antimicrobial Resistance Activities: This Initiative has three components, including:
- Early detection: NIH is working on being able to identify a resistant microbe in three hours (vs. the ~72 hours it takes now).
- Surveillance: Early detection will allow for monitoring the behavior of these microbes with sufficient time to treat with other antibiotics.
- Network: NIH will link hospitals to facilitate rapid response and to set up clinical trials in hospitals that have resistant microbes present.
BRAIN Initiative: Among the 58 projects under way, many are focused on developing technologies to advance basic neuroscience, map circuitry, and create non-invasive tools for brain imaging.
Of particular note:
With the most recent guidelines (NOT-OD-14-074) allowing for multiple “re-submissions” in the same research area, NIH submissions are up 25 percent, which Rockey believes will result in a very low success rate for 2015. She admits, “With any new policy we promulgate, there are always unintended consequences.”
Though Rockey’s talk addressed a number of challenges in implementing NIH plans, the tone was not always serious. Watch the video of Rockey’s talk, and you’ll see NIH Director Francis Collins, sing and play the guitar, and hear a few chuckles about the new biosketch format requirements. Rockey ended her presentation by speaking about her blog, Rock Talk, and thanking the research community for their reader comments, both positive and negative, as they often spark new ideas on how to address the complex demands of overseeing extramural funding.