Major Reforms at NIH: Significant Changes Under Trump 2.0 for Biomedical Research

Major Reforms at NIH: Significant Changes Under Trump 2.0 for Biomedical Research

The world's largest public funding body for biomedical research is set to undergo significant restructuring in the coming years.

Proposals from both chambers of the US Congress as well as statements from the future administration of US President Donald Trump show that there is a significant need for reform of the National Institutes of Health (NIH) and its $47 billion research budget. However, it remains unclear exactly how this transformation will take place; The proposals range from halving the number of institutes to replacing some of the agency's employees.

To address increased government scrutiny, the NIH launched a series of meetings on November 12 at which an advisory group of internal and external scientists will review various proposals and make their own recommendations for reform.

Jennifer Zeitzer, who directs the public affairs office of the Federation of American Societies for Experimental Biology in Rockville, Maryland, says: "There is definitely movement on Capitol Hill to discuss how to streamline and reform the NIH. Now the agency is joining that discussion, too."

Shrinking and shortening

The NIH advisory meeting comes after Republicans won the 2025 congressional elections. This year, two separate legislative proposals to reform the agency were introduced by Republican members of Congress — one by Rep. Cathy McMorris Rodgers of Washington and the other by Sen. Bill Cassidy of Louisiana. These proposals are prompted in part by dissatisfaction with the agency's response to the COVID-19 pandemic and the perception that oversight of research into potentially risky pathogens was lax, been initiated.

McMorris Rodgers' plan Provides for reducing the number of institutes and centers at the NIH from 27 to 15, allowing the parent agency to cancel any grant deemed a threat to national security, establishing a 5-year term for institute directors that can be renewed only once, and enforcing stricter oversight of research on risky pathogens. Cassidy, who is expected to chair the Senate Health Committee in 2025, announced more transparency to introduce the processes the agency uses to review research applications.

If these plans - outlined in a white paper - come to fruition, they would represent the first comprehensive reform of the NIH in nearly 20 years. In the last major overhaul in 2006, the U.S. Congress passed legislation with bipartisan support to create a review board and require the agency to send reports to lawmakers every two years. However, similar support from both sides of the political spectrum is unlikely for the proposals currently under consideration.

The NIH has been a frequent target of Trump and his Republican and other allies. Robert F. Kennedy Jr., whom Trump tapped to lead the U.S. Department of Health and Human Services (HHS) — the NIH's parent agency — said in 2023 that he was seeking an eight-year pause on infectious disease research at the NIH so that the biomedical funder could instead focus on chronic diseases such as diabetes and obesity. He also expressed on November 9 that he would like to replace 600 employees at the NIH. (Neither Trump nor his appointees can currently fire agency staff members whose positions are legally protected, but this could change change if Trump keeps his promise to reclassify federal employees.)

Harold Varmus, a cancer researcher at Weill Cornell Medicine in New York City and former head of the NIH, told Nature that Kennedy's comments "troubled" him. “We may need the support of congressional Republicans and even Democrats who traditionally support the NIH to advocate for the agency and its importance to public health.”

Final spurt

At the meeting of the NIH advisory body, the Scientific Management Review Board (SMRB), members discussed the agency's structure and research scope for the first time since 2015 and developed recommendations for the NIH director and HHS. Congress had asked the agency to initiate this process.

NIH officials hope the group can meet five more times in the coming calendar year to produce a report on its findings and recommendations by November 2025. This ambitious timeline suggests that "there is a recognition that the SMRB must act quickly to keep pace with Congress or risk Congress making decisions they don't like," Zeitzer says.

In fact, several committee members expressed concern during the Nov. 12 meeting that Congress might act before the group's reporting. Kate Klimczak, the head of the NIH's Office of Legislative Policy and Analysis, tried to reassure the panel: "The authors of the various [congressional] proposals obviously wanted this panel reestablished and to do its work," she said. “We have to believe them that they are looking forward to receiving [a report] from you.”

NIH Director Monica Bertagnolli, who is likely to resign before Trump takes office, expressed her opposition to proposals to downsize the institutes. She emphasized that the current system allows people with illnesses and patient groups to work with a specific institute for their concerns, such as the National Institute of Mental Health or the National Institute on Aging. “If we were to downsize, we would definitely lose something in terms of our engagement with the public,” she said.

It is unclear what direction the SMRB will take with its recommendations, but there were hints during the meeting. Several participants were surprised by the legislative proposals. For example, the McMorris Rodgers White Paper states that “decades of non-strategic and uncoordinated growth have created a system vulnerable to stagnant leadership, research duplication, gaps, misconduct and undue influence.” James Hildreth, president of Meharry Medical College in Nashville, Tennessee, called the language "almost offensive." He added: "I know we shouldn't allow politics to intrude into what we do, but how could that not be the case?"