Academic researchers and medical research advocates didn't expect Congress to go along with the Trump plan to slash 20% of the National of Institutes of Health budget.
But Sunday's news, that the agency would receive $2 billion in additional resources for the final five months of this fiscal year, was a delightful surprise.
"We didn't expect a funding boost," said Diana Zuckerman, an epidemiologist who's director of the National Center for Health Research, a Washington think tank.
Dr. Stephen Desiderio, director of the Institute for Basic Biomedical Sciences at the Johns Hopkins University School of Medicine, said he and his colleagues are so thankful to Congress for the appropriation. "This bodes well for fiscal year 2018," he said. "That's just fantastic."
More than 80% of the NIH's funding is awarded through almost 50,000 competitive grants to more than 300,000 researchers at more than 2,500 universities, medical schools, and other research institutions in every state and around the world.
Johns Hopkins is usually first or second in NIH awards, and has more than $430 million in research projects currently funded, including Desiderio's own lab, which studies the development of immune systems.
Of 2,300 faculty members at Johns Hopkins medical school, about 1,500 are active in medical research. And while Johns Hopkins has benefited from some major philanthropy, it's always NIH money that is by far the dominant source of salaries, supplies and equipment.
Overall, NIH's funding has been eroded by inflation over the last decade, and as a result, grants have been harder and harder to win. Less than 20% of applications succeed.
At the National Cancer Institute, which will get nearly $476 million in additional funding this year, success rates were down to 8%, Desiderio said.
All areas of the NIH will increase, but cancer, Alzheimer's, brain research and precision medicine were singled out for $100 million-plus earmarks.
He expects the agreement to have immediate effects, as NIH officials are currently making decisions on grant applications submitted in October. The February submissions will also be decided this fiscal year.
Zuckerman said it will be hard to push out $2 billion in five months, and if the NIH doesn't obligate the money, it will have to be sent back.
"If you really want to make the most of medical funding, for NIH or for anybody else, it needs to be a steady stream of funds," she said. "The problem is, what about next year? These are not one-year grants."
Although Desiderio is more optimistic, he also cautions that in order to support careers for researchers, funding has to be sustained. "These times are more unpredictable than any I've lived through," he said.
Dr. Arthur Levine, senior vice chancellor for the health sciences at the University of Pittsburgh and dean of its medical school, hailed the news. He emailed that the University of Pittsburgh School of Medicine is doing research in all four of the areas that got $100 million or more in increases, "including being one of the four institutions nationwide that were funded under the 'one million human genomes' Precision Medicine Initiative. The Institute for Precision Medicine, the Alzheimer's Disease Research Center, the University of Pittsburgh Cancer Institute and the Brain Institute are all recipients of NIH grants to conduct basic and clinical research, and we expect that the investigators will see more of their grant proposals awarded and renewed, allowing them to retain or recruit more researchers to aid their efforts. "
In addition to the NIH, the budget agreement, which will be voted on this week, sends an additional $650 million to prevent and treat opioid addiction. That money will mostly be distributed to community health centers and Comprehensive Addiction and Recovery Act-authorized treatment programs. It will also pay for research and clinician education through the National Institute on Drug Abuse, part of NIH.
The agreement increases rural health programs by $6.5 million, for rural outreach, rural hospital flexibility grants and telehealth.
Congress will increase medical residents' funding at free-standing children's hospitals by $5 million.
The agreement does not change funding for the Affordable Care Act, but does eliminate funding for the Independent Payment Advisory Board. "IPAB is a 15-member board of unelected bureaucrats created by the ACA to achieve a reduction in Medicare spending through the only means they have—rationing care," the budget summary said.
Providers disliked the IPAB. Major provider groups have lobbied for the elimination of IPAB since it came into existence six years ago. Advocates for specialists said that Medicare payment cuts that could come as a result of the board would discourage doctors from taking Medicare insurance.