FY23 Budget Outcomes: National Institutes of Health

Congress increased the National Institutes of Health’s base budget by $2.5 billion to $47.5 billion for fiscal year 2023, with each of the agency’s 27 institutes and centers receiving a boost of at least 3.7%.

In addition, it provided $1.5 billion outside of NIH for the new Advanced Research Projects Agency for Health, a 50% increase over its first-year budget but significantly less than the $5 billion the Biden administration requested . To accommodate the amount requested for ARPA–H, the administration had proposed modest cuts across NIH’s institutes and centers.

The appropriation also incorporates an array of policy provisions related to public health and biopreparedness, including legislation formally authorizing ARPA–H that resolves open questions about its funding and leadership structure.

Further policy direction for NIH and ARPA–H is included in an explanatory statement accompanying the legislation and a report prepared by House appropriators. Summary figures are collected in FYI’s Federal Science Budget Tracker .

ARPA–H takes shape

Initially proposed by President Biden in his first budget request, ARPA–H will aim to drive forward high-risk, high-reward research using the Defense Advanced Research Project Agency as a model. Congress established the agency through its fiscal year 2022 appropriations legislation, providing initial funding of $1 billion to the Department of Health and Human Services, NIH’s parent agency, which HHS subsequently transferred to NIH.

Although some lawmakers pushed for ARPA–H to be completely independent of NIH to help it develop a distinct culture of innovation and avoid sapping resources from existing NIH programs, the new authorization establishes it within the larger agency. The Biden administration advocated for keeping the two agencies tied together, pointing particularly to NIH’s established administrative capacity as a resource ARPA–H can draw on as it finds its footing.

The authorization does exempt ARPA–H from various NIH policies and requires its budget request to be handled separately. It also requires ARPA–H to be headquartered away from the main NIH campus in Bethesda, Maryland, and to have offices in at least three geographic areas. Cities have begun lobbying to host the headquarters, but ARPA–H itself has downplayed the importance of its location, noting, “The vast majority of our funding will leave our agency as programs launch. ... We expect opportunities for a great many hubs of innovation to work on ARPA–H projects.”

The legislation specifies that the ARPA–H director be presidentially appointed for a four-year term, with the option of a reappointment for a consecutive term lasting another four years. It also restricts the agency from hiring personnel who have been employed by NIH within the past three years, with some exceptions allowed.

To serve as ARPA–H’s inaugural director, Biden selected biologist Renee Wegrzyn, who previously served as a program manager in DARPA’s Biological Technologies Office.

ARPA–H is now hiring its first cohort of program managers, who are permitted to serve up to two consecutive three-year terms and select what projects to fund without consulting peer review panels. In an interview with the journal Science, Wegrzyn said she expects to hire up to 20 program managers by the end of 2023, with a focus on diversity in subject-matter expertise, professional background, and demographics.

Other priorities

Biosecurity. The appropriation includes an array of policy provisions focused on biosecurity, including the PREVENT Pandemics Act . Among its provisions, the act requires the White House to establish an Office of Pandemic Preparedness and Response Policy. It also requires the White House Office of Science and Technology Policy to develop a strategy for managing and maintaining labs that conduct research on dangerous pathogens and to quadrennially review federal policies for funding research involving “enhanced pathogens of pandemic potential.”

Congress rejected the administration’s request for $82 billion in mandatory funding to launch an HHS-wide pandemic preparedness initiative, which would have channeled $12 billion to NIH to support vaccine R&D, disease surveillance, expanded clinical trial infrastructure, and upgrades to biosafety laboratories.

Foreign influence. As it did last year, Congress provided $2.5 million for NIH’s Office of Extramural Research to “expeditiously complete grant compliance reviews” related to investigations of undue “foreign influence” on NIH-funded research. It also directed NIH to transfer $5 million to the HHS inspector general in support of the investigations, which began in 2018 and have focused on uncovering instances of NIH-funded researchers maintaining undisclosed ties to foreign institutions. As of December 2022, the office had contacted institutions concerning 246 cases , of which 103 resulted in the scientist in question resigning or being fired.

The legislation also includes several statutory provisions dedicated to research security, including one that requires extramural researchers funded by NIH to disclose their participation in foreign talent recruitment programs, including by providing “copies of all grants, contracts, or other agreements related to such programs.” This provision goes beyond direction included in the CHIPS and Science Act, which grants all science agencies the authority to request such documentation but does not require it.

Workforce diversity. Congress met the administration’s request to boost funding for NIH’s scientific workforce diversity office from $16 million to $22 million, nearly quadruple the office’s 2021 budget. The office leads the UNITE initiative , which seeks to advance racial equity in the biomedical research workforce.

Infrastructure modernization. Congress increased funding for NIH’s core Buildings and Facilities account by $100 million to $350 million, exceeding the administration’s request by $50 million. However, Congress has rejected the administration’s repeated proposals to allow NIH to transfer up to 1% of the appropriations for its institutes and centers into the account to help address a maintenance backlog that exceeds $2 billion. Appropriators explained, “This is highly unusual authority for a federal agency and NIH has once again provided no explanation for why this mechanism would be appropriate for NIH, but not other federal agencies.”

Congress is providing an additional $80 million for grants to upgrade research facilities at public and nonprofit institutions, a $20 million increase over last year. The report encourages NIH to prioritize projects focused on specialized imaging capabilities and to fund “a significant number of newly constructed or renovated facilities.”

Radiopharmaceutical infrastructure. The appropriation directs NIH and the Department of Energy to include in their fiscal year 2024 budget request an update on how shortages of medical isotopes and radiopharmaceuticals have impacted the ability to conduct cancer research, as well as an analysis of the “infrastructure necessary” to produce them.

Elaborating on the issue, the House report states, “While clinical trials for radiopharmaceuticals are presently ongoing, domestic production of such drugs relies on a very small number of reactors, and the future loss of such reactors would not only deal a significant blow to domestic patients due to the short half-life of many of these drugs, but would also limit [the National Cancer Institute’s] ability to continue to support and conduct this important research. The [Appropriations Committee] is aware of alternative technologies to produce radionuclides by accelerators, such as the one located at Brookhaven National Laboratory; however, some radionuclides can be produced only in nuclear reactors.”

DOE collaboration. House appropriators also request an update on ways NIH collaborates with DOE and how to continue to expand their partnerships. They highlight opportunities identified in a report by the Secretary of Energy Advisory Board and encourage NIH to consider “additional pilots to address key computation and imaging bottlenecks in cancer research.” The appropriation also encourages NIH to launch a pilot project with DOE to “study the potential for quantum computing for biomedical sciences.”