The National Institutes of Health (NIH) is currently embroiled in a complex situation following instructions from the Department of Health and Human Services (HHS) to maintain a pause on funding. This directive, with a few exceptions for pre-approved award subtypes, follows an initial freeze implemented by the Trump administration on January 21. The NIH's efforts to realign its strategies with the president's executive orders are pending formal approval from HHS, further complicating the agency's operations.
A significant development in this unfolding narrative is a federal judge's declaration that Trump's executive order targeting Diversity, Equity, and Inclusion (DEI) programming potentially violates the First Amendment. This ruling adds another layer of complexity to an already intricate situation. Despite legal advice, the administration continues to block NIH grants, creating challenges for the agency, which traditionally funds more than 60,000 proposals annually, supporting over 300,000 scientists at more than 2,500 institutions nationwide.
The NIH has issued only a fraction of its usual awards since late January. Many grants have been expedited through limited windows, reflecting the pressures faced by the agency. Taison Bell, a critical-care specialist at UVA Health, emphasizes the NIH's crucial role, stating that it has contributed to "nearly all of our major medical breakthroughs over the past several decades."
"a brave man who stood up when it was hard" – Jay Bhattacharya
Despite these challenges, some Republicans have advocated for years to reduce the number of institutes and centers within the NIH or redistribute its funding to states as block grants. The current pause on funding, however, poses logistical barriers to awarding grants even if allowed.
Matthew Memoli, the acting director of the NIH, finds himself in a challenging position. Despite lacking experience in overseeing external grants or managing a large agency, Memoli must navigate these turbulent waters. He acknowledges the shifting landscape, stating:
"we are going to have to accept priorities are changing" – Matthew Memoli
The administration's broad definition of DEI includes studies acknowledging that many diseases disproportionately affect Americans from underrepresented backgrounds. Ignoring these trends could lead to significant cuts in funding and overlook critical health disparities.
HHS lawyers have interpreted court instructions clearly, asserting that all stop work orders or pauses should be lifted to allow contract or grant work to continue. Sean R. Keveney from HHS emphatically stated:
"All payments that are due under existing grants and contracts should be un-paused immediately" – Sean R. Keveney
NIH's top lawyer, David Lankford, concurs with this perspective, indicating that the general counsel's office aligns with court positions that grants should be awarded as intended.
"All payments that are due under existing grants and contracts should be un-paused immediately" – Sean R. Keveney
Some NIH officials express concern about potential repercussions for violating presidential directives, despite Memoli's assurances of compliance with legal requirements. These worries persist as officials navigate the complexities of adhering to both legal and administrative expectations.
