A second Trump White House could radically change infectious disease research

Life-saving HIV treatment. Drugs for hepatitis C. New tuberculosis treatment regimens and RSV vaccine.

These and other critical medical breakthroughs have come about in gigantic part thanks to a major division of the National Institutes of Health, the largest funder of biomedical research in the world.

For decades, scientists funded by the NIH’s National Institute of Allergy and Infectious Diseases have been working quietly in red and blue states across the country, conducting experiments, developing treatments and conducting clinical trials. With a $6.5 billion budget, NIAID played a key role in discoveries that kept the nation at the forefront of infectious disease research and saved the lives of millions of people.

Then came the Covid-19 pandemic.

NIAID helped lead the federal response, and its director, Dr. Anthony Fauci, has drawn fire over nationwide school closures and face mask mandates. Lawmakers were outraged when they learned the agency had funded an institute in China that focused on controversial research on bioengineered viruses, and expressed doubts about whether there was enough oversight. Republicans in Congress have held numerous hearings and investigations into NIAID’s work, flattened the NIH budget, and proposed a complete overhaul of the agency.

Recently, Robert F. Kennedy Jr., Trump’s nominee to director of the Department of Health and Human Services that oversees the NIH, said he wanted to fire and replace 600 of the agency’s 20,000 employees and move research away from the infectious diseases and vaccines that underlie it. NIAID’s mission to understand, treat, and prevent infectious, immunological, and allergic diseases. He said it half of the NIH budget should focus on “preventive, alternative and holistic approaches to health.” He is particularly interested in improving diets.

Even NIH’s staunchest defenders agree that the agency could benefit from reforms. Some would like to see fewer institutes, while others believe that directors should have a narrow term of office. Important debates are ongoing whether to fund and how to supervise controversial research methodsand concerns about the way the agency he managedtransparency. Scientists inside and outside the institute agree that work must be done to restore public trust in the agency.

But experts and patient advocates fear that renovating or eliminating NIAID without a clear understanding of the critical work done there could jeopardize not only the development of future life-saving therapies but also the nation’s position at the helm of biomedical innovation.

“The importance of NIAID cannot be overstated,” said Greg Millett, vice president and director of public policy at amfAR, a nonprofit organization dedicated to AIDS research and advocacy. “The amount of expertise, research and breakthroughs that have come from NIAID — it’s just amazing.”

To understand how NIAID works and what the up-to-date administration’s challenges are, ProPublica spoke with people who have worked for NIAID, received funding from it or served on boards or panels advising the institute.

Decisions, decisions

The director of NIAID is appointed by the head of NIH, who must be confirmed by the Senate. Directors have wide discretion in deciding what research to fund and where to award grants, although traditionally these decisions are based on recommendations from panels of external experts.

Fauci led NIAID for nearly 40 years. It has been controversial in the past, especially in the early years of the HIV epidemic, when community activists criticized it for initially excluding them from the testing program. But overall, until the pandemic, he enjoyed relatively solid bipartisan support for his work, which included a robust focus on vaccine research and development. Upon his retirement in 2022, he was replaced by Dr. Jeanne Marrazzo, an HIV researcher who previously served as director of the division of infectious diseases at the University of Alabama at Birmingham. She spent much of her time in the halls of Congress, working to restore bipartisan support for the institution.

NIH directors typically cover presidential administrations. However, Donald Trump has nominated Dr. Jay Bhattacharya to be director of the NIH, and current director Dr. Monica Bertagnolli told staff this week that she will resign on January 17. Bhattacharya, a professor at Stanford University, has devoted his career to studying health policy issues such as the implementation of the Affordable Care Act and the effectiveness of U.S. funding for HIV treatment internationally. He also conducted research at the NIH and concluded that while the agency funds much pioneering and cutting-edge research, it should do even more.

In March 2020, Bhattacharya co-authored an opinion in Wall Street Journal arguing that the pandemic’s death toll is likely to be much lower than expected and calling for a re-evaluation of lockdown policies. In October of the same year he helped write declaration which recommended lifting Covid-19 restrictions for people “at minimal risk of death” until herd immunity is achieved. In an interview for a libertarian magazine Reason in Junestated that in his opinion the Covid-19 epidemic most likely has its origins in a laboratory accident in China and that he does not see Trump’s Operation Warp Speed, which led to the development and distribution of Covid-19 vaccines at an unprecedented speed, as a total success, because it was part of the same research program.

Bhattacharya declined ProPublica’s request to talk about his priorities for the agency. Recent Article in the Wall Street Journal. said he is considering how to tie “academic freedom” on college campuses to NIH grants, although it is unclear how he would measure it or how he would make such a change. He also raised the idea of ​​limiting the terms of office of directors and said that the pandemic “was simply a disaster for American science and public health policy” which is now in desperate need of reform.

Where does the money go?

NIAID grants reach nearly every state and more than half of the nation’s congressional districts, creating thousands of jobs across the country. Last year, nearly $5 billion of NIAID’s $6.5 billion budget went to U.S. organizations outside the institute, according to a ProPublica analysis. NIH reportan online database of his expenses.

In 2024, NIAID’s largest recipients were Duke University in North Carolina and the University of Washington in Missouri, which received more than $190 million and $173 million, respectively, for research on HIV, West Nile vaccines, and biodefense, among others.

Over the past five years, $10.6 billion, or about 40% of NIAID’s budget for outside U.S. institutions, went to states that voted for Trump in the 2024 presidential election, the analysis shows. Research suggests that every dollar spent by the NIH generates: $2.50 Down $8 in business activities.

This money is the key to the development of medicine and a scientific career. Most students and postdoctoral researchers rely on the funding and prestige of NIH grants to launch their careers.

New drugs and global impact

The NIH pays for most basic research around the world on up-to-date drugs. The private sector relies on public financing; Bentley University researchers found that the NIH was delayed with its money every up-to-date drug approved between 2010 and 2019.

This includes RSV therapies for children, a Covid-19 vaccine and Ebola treatments, all of which hold key patents based on NIAID-funded research.

NIAID research has also improved the management of chronic diseases. New understanding of inflammation from NIAID-funded research has led to novel drug research for Crohn’s disease and ulcerative colitis, and growing evidence shows that viruses can have long-term effects, from multiple sclerosis to long-term Covid-19. 19. When private companies turn this research into blockbuster drugs, society benefits from up-to-date treatments, as well as jobs and economic growth.

Several people said that the importance of NIAID’s funding also allows it to play a quieter role that is imperative to advancing science and the United States’ role in biomedicine.

The Institute brings together scientists who normally compete with each other to share discoveries and tackle critical research questions. Having this neutral space is imperative to pushing knowledge forward and ultimately spurring breakthroughs, said Matthew Rose of the Human Rights Campaign, who has served on numerous NIH advisory boards. “Academic bodies are very competitive. It is helpful for NIH to bring grantees together to talk to each other and share research.”

NIAID also funds researchers internationally, ensuring the United States continues to be an influential voice in global discussions on biosecurity.

NIH is also working to improve representation in clinical trials. Straight white men are still around is overrepresented in clinical trials, which has led to misdiagnoses for women and all people of color, as well as members of the LGBTQ+ community. As an example, Rose cited women’s long history of missing heart disease symptoms. “These are things that commercial companies don’t care about,” he said, noting that NIH helps set the agenda on these issues.

Nancy Sullivan, former senior researcher at NIAID, stated that NIAID’s strength is its ability to invest in a broad understanding of human health. “This is basic research that allows us to develop treatments,” she said. “You never know which part of basic research will be the basis for curing a disease or defining a disease to know how to treat it,” she said.

Sullivan should know: It was her work at NIAID that led to the development of the first approved Ebola drug four years ago.