The First Cut is the Deepest

Last week, President Trump publicly unveiled his 2018 budget proposal. If left unchanged, that financial blueprint would increase US federal defense spending by more than $50 billion, while also appropriating billions more to bolster immigration enforcement and build a 2,000 mile-long wall along the US border with Mexico. A self-proclaimed deficit hawk, the President would offset those increased expenditures will sharp cuts to the US Departments of State, Energy, Health and Human Services, and the US Environmental Protection Agency.

In sharp contrast to campaign trail promises to boost the economy, create jobs, and protect Americans at home and abroad, however, Trump’s 2018 budget is likely to do the exact opposite. Consider, for example, the proposal to cut nearly $6 billion from the US National Institutes of Health (NIH).

Made up of 27 different institutions and centers, the NIH is the largest supporter of biomedical research in the world. Through the NIH or other funding agencies, the federal government supports almost half of all the biomedical research in the US. Private businesses support another quarter, and the remainder of biomedical research support comes from state governments and nonprofit organizations.

With an annual operating budget of $30 billion, the NIH provides training and support to thousands of scientists at its main campus in Bethesda, Maryland. Moreover, through a system of extramural grants and cooperative agreements, the NIH provides financial support for research-related programs to over 2,600 institutions around the country, creating more than 300,000 full- and part-time jobs.

Given this, the cuts proposed in the 2018 budget are devastating. Coupled with inflation and the costs of supporting current activities and the activities of the Agency for Healthcare Research and Quality – a $350 million agency whose activities the NIH is expected to absorb this year – a $6 billion reduction would essentially eliminate all new extramural funding programs for 2018. The impact on American science and research, not to mention the US economy, is catastrophic.

The money that the NIH provides to academic institutions through extramural funding and collaborative partnerships does more than pay the salaries of the nation’s top scientists. In order to support studies designed to develop new treatments for diseases like cancer, Alzheimer’s, Parkinson’s, and HIV/AIDS, these researchers also spend billions of dollars to purchase equipment, services, and supplies for local companies. In one analysis that looked at nine Midwestern institutions that receive about $7 billion annually from the NIH, the National Science Foundation, and other funding agencies, economists found that those universities, in turn, spent over $1 billion yearly buying goods and services from various US vendors and subcontractors.

Finally, the NIH is a net generator of jobs and income for the US. The basic research that the NIH and similar federal funding agencies support through extramural grants is used by private biotechnology, chemical, computer, electronic, nanotechnology, pharmaceutical companies, among others, to develop the new technologies and create the new products that have made the US a global leader in science and engineering. In fact, one economic study found that for every $1 spent on NIH-supported projects, there is an estimated return of nearly $2.20 to the US economy.

Admittedly, as a public health researcher, I am a little biased in this regard. For much of my career, my research has been supported in part or in full by federal grants. I also currently direct two federally funded research ethics training programs that face an uncertain future. Those projects are supported by multi-million dollar grants from the Fogarty International Center, the smallest of the NIH’s 27 component parts.

Operating with a minuscule $70 million annual budget, less than half of what the US taxpayer will spend this year on travel and security for Trump’s weekend golf outings at Mar Largo, Fogarty supports a number of collaborative training programs and research partnerships between US and international institutions. Trump plans to eliminate the Fogarty International Center entirely, most likely because the international focus of the Center’s projects – and the fact that US tax dollars are being spent overseas – has drawn the ire of nationalists in his administration.

But this ire is misplaced. Fogarty’s programs and research partnerships are designed to combat global health threats like Ebola, HIV/AIDS, malaria, and Zika virus, the very diseases that increasingly threaten American shores. Ending five decades of US leadership in the area of global health at a time when our nation faces an increasing number of new and remerging disease threats is thus horribly shortsighted. The border wall might prevent undocumented workers from slipping into Texas, but it won’t prevent a Zika-infected mosquito from crossing the Rio Grande.

Hopefully, our leaders in Congress are not so myopic as those in the Trump Administration. Even though our leaders in Washington have often seemed to ignore science when it suited them – denying the existence of anthropogenic climate change or funding abstinence-only sex education – the NIH has often had bipartisan support. Slashing the budget of that organization will not only result in a net loss of jobs, it will set back scientific research for decades, threaten the nation’s status as the world leader in science and technology, and put us all at risk should there be an outbreak of infectious disease somewhere in the world. It is hard to see how that meets anyone’s definition of “making America great again”!

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on March 23, 2017, and is available on the WAMC website.]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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