We declare our conflicts-of-interest upfront. Our lengthy research careers have been supported by the National Institutes of Health (NIH), and one of us (David Schwartz) was Director of the National Institute for Environmental Health Sciences.   

We believe in the system of grant-funded, peer-reviewed research that supports independent investigators and team science. As a result, we believe that the current federal actions and threats will undermine the national research programs that have led to transformational advancements in human health. We are not alone in these concerns.  

Medicine was not always rooted in science. But in the late 1800s, the grounding of medicine in science began when the Johns Hopkins School of Medicine introduced a science-based curriculum that would later become the model for reform of medical schools. In 1910, The Flexner Report (written by Abraham Flexner, an educator who was commissioned by the Carnegie Foundation to review the state of medical education) transformed medical education and clinical care in the U.S. by advocating the Johns Hopkins approach. It launched the model of the academic physician—educator and researcher. Now, for more than 100 years, the linking of science to medicine and public health has advanced health in the United States and globally, underlying the tremendous gains in life expectancy that have added decades to lifespans since the start of the 20th century.  As the principal funder of biomedical research in the United States, the NIH has been the mainstay for this model of research continually advancing health.  

The Birth of the NIH 

The NIH dates its origins to 1887 when a government bacteriology laboratory, “a laboratory of hygiene,” was established on Staten Island. Across the first decades of the 20th century, the resulting Hygienic Laboratory evolved as the government’s health research center, becoming the National Institute for Health with the Ransdell Act of 1930. The National Cancer Institute, later added to the NIH, was created through the National Cancer Institute Act of 1937 and the 1944 Public Health Service Act expanded the authority of the NIH to provide research grants and also to carry out clinical research, resulting in the construction of the NIH’s Clinical Center after World War II. 

The 1945 report to President Truman, Science. The Endless Frontier, by Vannevar Bush, head of the U.S. Office of Scientific Research and Development during World War II, was foundational in setting out the proposition that government would support research in academic institutions and research institutes and build investigational capacity: “One lesson is clear from the reports of the several committees attached as appendices. The Federal Government should accept new responsibilities for promoting the creation of new scientific knowledge and the development of scientific talent in our youth.”  

The report also called for the creation of a central science funding agency, leading to the founding of the National Science Foundation in 1950. However, the NIH has been the principal funder of biomedical research and supported the training and career development of the research workforce in the health sciences, following the model called for by Vannevar Bush.  

Research Funding and Support

Post World War II, the academic biomedical research enterprise has grown steadily. The NIH expanded to 27 centers and institutes by the end of the 20th century to cover more diseases and organ systems. The NIH budget reached $47 billion in Fiscal Year 2024, having exceeded a billion in the late 1960s and 10 billion in the early 1990s when the doubling of its budget was approved by Congress (Figure). These funds support intramural research—that done by investigators who are employees of the NIH—and extramural research—that done by investigators in a wide variety of non-governmental institutions. Broadly, the two major extramural funding buckets for the NIH are research, and research training and career development. All funding is awarded competitively through a process involving peer review, that is evaluation of funding applications by researchers and others with relevant expertise and no conflicts of interest. The review process has several tiers, assuring that all applications receive intense scrutiny for the quality and significance of proposed research, the competence of the researchers, and the career potential for proposed trainees. NIH funding is highly competitive, with a success rate of 17% in 2024 for independent research grants. 

Figure (National Institutes of Health Funding: FY1996-FY2025)

The research supported by the NIH has had a profound impact on human health, the advancement of science, and improvements in public health. Although we could choose many examples to illustrate this point, a recent one stands out. Almost all of us have lived through the COVID pandemic. While the development, testing, and application of an effective COVID vaccine one year after the pandemic began seemed remarkably and unexpectedly rapid, the development of this vaccine was made possible by fundamental NIH-supported discoveries by Drs. Katalin Kariko and Drew Weissman that occurred at least a decade before. Their research enabled the development of mRNA vaccines for SARS-CoV-2, the virus responsible for the COVID pandemic. While Drs. Kariko and Weissman were deservedly awarded the Nobel Prize in 2023, the COVID vaccine demonstrates how basic discoveries can be translated into improvements in public health and how NIH-supported discoveries can create opportunities for the pharmaceutical industry and our economy. Research supported by the NIH has also led to transformative advances in heart disease, childhood leukemias, HIV/AIDS, cystic fibrosis, and many other diseases. The outcome of this research is not only improving longevity and quality of years lived, but many of these discoveries also fuel the American economy. One of the more conservative estimates indicates that for every $1 invested by the NIH, the U.S. economy grows by $2.46. 

New Staffing and Budget Cuts  

Despite these substantial contributions to human health and the economy, the present administration has stated that the NIH is “too big and unfocused” and has taken action and developed plans to reduce its size and scope. In the past few months, the NIH has laid off thousands of intramural scientists and administrators, reduced the commitment to scientific trainees at the NIH, terminated biomedical research and clinical trials in the extramural community that did not align with policies and directions of the new administration, limited support for HIV/AIDS, COVID, and other infectious diseases research, reduced the commitments to public health and the environment, and has attempted to limit research infrastructure payments to biomedical institutions. In fact, as of this writing, the NIH has terminated or delayed funding for almost 2,500 research grants. The Administration’s proposed budget for 2026 attempts to further reduce the scope and impact of the NIH through an overall budgetary reduction of 40% and by establishing an indirect cost recovery rate of 15% for all research grants. There are also plans to eliminate or consolidate some centers and institutes of the NIH. If approved by Congress, these changes would cripple research programs across Colorado and the U.S. and stall scientific advances that ultimately improve human health, curtail the development of our next generation of scientists, and constrict the pipeline of research that fuels our biotech and pharmaceutical community. 

How grants are funded has also been in the news because of the proposal to lower the rate of the indirect costs that come with NIH grants and contracts to 15%. Grant funding to institutions includes the direct costs needed to carry out the proposed research, such as laboratory equipment and supplies, technician support, and often some proportion of salary support for the researchers. Additional funds are added—indirect costs—to cover physical and administrative infrastructure and operating costs, such as research and laboratory space, computer resources, heating, lighting, maintenance, and so on. The rate of indirect costs is negotiated with the federal government by each institution, and typical percentages are well above 15%. At our campus, the University of Colorado Anschutz Medical Campus, the indirect cost rate is at 56%, well above the proposed 15%. Most institutions, including the University of Colorado, would be unable to make up the funding gap between payment of indirect costs at 15% and actual costs of supporting a research enterprise. For now, there is a permanent injunction from a federal court against the reduction of indirect costs to 15%. But any substantial reduction in indirect costs would have widespread consequences for research universities and institutes, undoubtedly leading to less infrastructure to support research, lay-offs of researchers, and the closing of laboratories. 

The Future of NIH-Funded Research

So, where do we go from here? First, we need to figure out how to continue to support our trainees and conduct high-quality research. We have had many conversations with early-career researchers who are alarmed about their futures. In the short term, some institutions are able to sustain operations and bridge to the future. For example, at the University of Colorado School of Medicine, Dean John Sampson has established a program using institutional funds to support trainees and investigators who have been impeded by delayed grant support at this moment of high uncertainty. Such funding draws on reserves and cannot continue indefinitely. For the longer term, we should consider reorienting the research enterprise toward team-oriented science, building funding portfolios mixing federal and non-federal sources of support, and shifting from federated, individual-based funding to a more centralized financial model with shared responsibilities across divisions, departments, and schools. We are encouraging a move towards integrated research teams addressing critical problems, such as obesity and diabetes, that have a mixed funding base that includes more than NIH support. We also urge a shift from internal organizational models with researchers as strictly independent agents to approaches providing more institutional support and commitment. The long-standing model of academic researchers independently maintaining funding across their careers was already failing, and its decline will accelerate sharply with proposed changes at the NIH.   

Second, we need to communicate more effectively with the public about the consequences of research for everyone. The public is the ultimate source of support for research, and we need the public to value and advocate for a vigorous and comprehensive research program supported by the federal government. In an April 2025 article in the Atlantic, journalist and professor Danielle Allen calls for a renewed social contract between universities and the country that reflects the need for civic strength. For her, civic strength is “the opposite of polarization.” Extended to research and the NIH, civic strength implies a mutual commitment to solving problems, regardless of disagreements. She calls for a business model for university research that lessens reliance on federal funding, which has created vulnerability to political interference and dependence. Third, we need to continue to let our policymakers know the value of federally funded research to our communities and to recognize that draconian cuts will have consequences for human health in the long run.  

Having engaged with and paid attention to the NIH for more than four decades each, we knew that there were imperfections and opportunities for refinement. As with any large bureaucracy, there were opportunities for efficiency, and for some funded research grants, pathways to beneficial impact can be obscure. Researchers need to more actively disseminate their work and address societal implications of findings. However, these issues do not lead either of us to call for a massive overhaul, such as that proposed and apparently underway. ### 

Did you know: The NIH had been successful as the world’s largest funder of biomedical research, funding over 50,000 grants and 300,000 investigators at 2,500 institutions each year. Its funded investigators include 174 winners of Nobel Prizes. Its staff numbered 20,000, including administrative staff supporting grant and contract awards, along with intramural researchers.  

Table:  Major Changes at NIH since January 20, 2025 

This article is part of a monthly column, The Jon Samet Report, on the biggest issues facing us today in public health, written by the former dean of the Colorado School of Public Health, Jon Samet, a pulmonary physician and epidemiologist, and Professor of Epidemiology and Occupational and Environmental Health, and his colleagues. Dr. Samet is a global health leader, shaping the science and conversation on issues ranging from tobacco control to air pollution to chronic disease prevention and more. Each month he shares expert insights on public health issues from local to global.