By David Stephen
The sweeping and aggressive cuts to research funding at the National Institutes of Health [NIH] suggests that it may be likely that several of the Institutes and Centers [ICs] of the NIH could be merged, to cut costs as well as to reduce headcount.
According to the NIH, there are “27 Institutes and Centers, each with a specific research agenda, often focusing on particular diseases or body systems.” Preparing for these cuts could mean exploring how to categorize the ICs, with respect to outcomes. 27 ICs could be reduced to 7 ICs, at most, or say 5 ICs, hypothetically.
Most of the intramural research would proceed in the new structure with most labs intact as well as the introduction of new labs, but several administrative roles could be erased. There could also be new paths to funding and grants for extramural research to pursue the most possible paths towards health security across groups while dedicating a [small] fraction to long shot, long-term attempts.
There could be a brain category, general health category [I & II], AI category, new funding center, innovation center, information category, and health prospective category. These could be [a bit] expanded or reduced, but all 27 ICs may fit in these categories.
The brain category could consist of all institutes whose work are concerned with brain diseases or disorders. General health for all body systems. AI category for intense research in AI and its possibility for health care—including robotics. Innovation center for innovation in health, with medical technology, new drug delivery methods, new compounds and so forth. Information category will be for health information service to people, nationally—and if possible, globally, especially against epidemics and pandemics. Health prospective category would be prevention research, wherever possible, for diseases.
These generalizations and categorizations of important health research are deeply lamentable, but with sweeps across departments and agencies in recent weeks, it is better for some of those who may care about the NIH to start looking at what might happen, how to prepare for it, what to include and remove, so that the core of the mission is preserved—so to speak.
Brain Category = National Institute on Drug Abuse (NIDA); National Institute of Mental Health (NIMH); National Institute of Neurological Disorders and Stroke (NINDS); National Institute on Alcohol Abuse and Alcoholism (NIAAA).
General Health Category I = National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI); National Human Genome Research Institute (NHGRI), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) National Institute on Aging (NIA); National Center for Advancing Translational Sciences (NCATS); NIH Clinical Center (CC).
General Health Category II = National Eye Institute (NEI); National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute on Deafness and Other Communication Disorders (NIDCD); National Institute of Dental and Craniofacial Research (NIDCR), National Institute on Minority Health and Health Disparities (NIMHD).
AI Category = National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institute of General Medical Sciences (NIGMS).
New Funding Center = Center for Scientific Review (CSR).
Innovation Center = National Institute of Nursing Research (NINR), Fogarty International Center (FIC), National Center for Complementary and Integrative Health (NCCIH), National Institute of Environmental Health Sciences (NIEHS).
Information Category = Center for Information Technology (CIT), National Library of Medicine (NLM).
Health Prospective Category = National Institute of Allergy and Infectious Diseases (NIAID); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
While these are preliminary, it is possible to use them as a template of what to expect, as changes may come to many of these outstanding institutes that have been responsible for advances in global health for decades.
All of their work should continue, even if categories may be adjusted and work may become more interconnected than before. There could also be themes to the categories, which could run in fiscal years. These themes would allow some of the intramural and extramural researches to explore the near-term, not just the long-term, especially for results that would justify preventing steeper funding cuts.
Themes for the near term
Brain Category = How does the brain work to explain mental disorders, addictions and degenerative diseases, using the evidence of electrical and chemical signals for their presence in all functions that are ascribed to neurons?
General Health Category I = Expansive cellular research.
General Health Category II = Additional tissue and molecular research.
AI Category = Fundamental and applied AI research for health enhancement.
New Funding Center = Traditional funding and new grant categories.
Innovation Center = Intensifying science.
Information Category = Methodic evidence sharing.
Health Prospective Category = Minimal to maximum prevention solutions.
While these are step explorations, it is hoped that whatever the future holds for the NIH would remain beneficial to foremost health research—globally.
There is a recent [March 6, 2025] news release, NIH centralizes peer review to improve efficiency and strengthen integrity, stating that, “Today the National Institutes of Health is announcing plans to centralize peer review of all applications for grants, cooperative agreements and research and development contracts within the agency’s Center for Scientific Review (CSR). The proposed approach is expected to save more than $65 million annually by eliminating duplicative efforts across the agency, making the review process more efficient. Funding decisions are made through a rigorous dual-level review process. Scientific review groups or study sections, first evaluate and score research proposals for scientific and technical merit. Study sections are made up of volunteer scientists, mostly from academia, and overseen by NIH staff known as scientific review officers. Advisory councils for NIH ICs and the NIH Office of the Director then perform a second-level review for mission relevance. Ultimately, IC directors make final funding decisions, taking into consideration current research priorities and the existing funding portfolio. The new centralization effort will apply to the first stage of the review process. NIH’s CSR, which was established in 1946 to manage the scientific review of NIH grant applications and to ensure independent, expert review free from inappropriate influence, currently manages the peer review process for more than 78% of NIH grants. The remaining 22% are reviewed in study sections within 23 ICs, each operating separately with its own administrative and support overhead. The proposed consolidation would eliminate the IC-based study sections so that CSR conducts all first-level review.”
There is a recent report [11 MARCH 2025] in The Transmitter, U.S. BRAIN Initiative set to lose $81 million this year, stating that, “The National Institutes of Health (NIH) BRAIN Initiative program could sustain another major loss in funding this year, according to a government spending bill passed today by the U.S. House of Representatives. The bill would avert a federal government shutdown on 14 March and keep it funded for the rest of the current fiscal year, which concludes at the end of September. Funding for the BRAIN Initiative, on the other hand, would drop by 20 percent, according to the bill. It specifies $91 million for the program, which is allocated from the 21st Century Cures Act, and would hold base funding from NIH institutes and centers at 2024 levels. As a result, the program would lose $81 million compared with fiscal year 2024, when the program received $402 million—$172 million from the Cures Act and an additional $230 million in base funding.”
