Trump’s budget plan puts squeeze on NIH, boosts FDA

Donald Trump
Critics say the proposed cuts to NIH would "devastate important research" (C-SPAN)

President Trump’s budget proposals for 2020 are in, seeking a cut for the National Institutes of Health (NIH) for the third year in a row but an increase in the FDA’s finances.

The plan is allocating $35.4 billion for the NIH—estimated to be somewhere between $4.5 and $6 billion less than in the current financial year—and is accompanied by other cuts including a $1 billion reduction for the National Science Foundation (NSF).

Among the biggest losers within the NIH are the National Cancer Institute, which would see $900 million carved off its budget to $5.2 billion, and the National Institute of Allergy and Infectious Diseases (NIAID), which would get $4.75 billion, a drop of $750 million, according to a Health and Human Services document (PDF).

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The move has been attacked by research bodies including the American Association of Immunologists, which says (PDF) that the proposed cut “would devastate important research intended to prevent, treat, and cure innumerable diseases, in part by funding 2,824 fewer research project grants and cutting short the work of many talented and dedicated scientists.”

Critics are incensed that the cuts to the NIH come alongside a 5% increase in defense spending plus an $8.6 billion request for funding of the Mexican border wall.

"Ultimately, the president’s proposed $2.7 trillion in spending cuts will leave the nation less healthy and less safe,” says Benjamin Corb, public affairs director for the American Society for Biochemistry and Molecular Biology (ASBMB).

“While it is important to tackle the federal deficit and balance budgets, the scientific community should not shoulder that burden.”

To be clear, the Administration’s budget proposals have no legal standing and are often torn up by Congress, with plenty of resistance expected this time around with Democrats in command of the House. In the last two years, similar NIH funding cut requests haven’t made it through thanks to bipartisan support for the agency, with Congress in fact agreeing to increase the funding made available.

Still, the FDA does rather better in Trump’s plan, with a total budget of $6.1 billion from October that according to the proposals is a $643 million increase on fiscal 2019. The allocation includes $55 million to support the agency’s efforts to curb the opioid epidemic and another $55 million to advance digital healthcare technologies.

Advocacy group the Alliance for a Stronger FDA says it is “quite pleased” with the proposed increase in appropriated funding for the regulator, although it puts the increase over the previous year at a smaller figure of $362 million, the net of existing and proposed user fees.

Nevertheless, that would help “hire needed scientific personnel to carry out the FDA’s far-ranging mission,” it adds.

The budget proposal also includes $291 million for an initiative to end HIV in the U.S. by 2030 and additional cash to combat the opioid epidemic, although one think tank—the Center on Budget and Policy Priorities—claims these initiatives would be undermined by sweeping changes to Medicare and Medicaid programs “that people with these conditions need to get care.”

Trump’s plan sees spending on Medicare and Medicaid trimmed by $818 billion and $1.5 trillion respectively over the next 10 years, and a range of measures that could impact the biopharma industry by putting pressure on drug prices.

That includes:

  • Removing the cap on Medicaid manufacturer drug rebates.
  • Allowing Medicaid programs to negotiate drug prices directly with manufacturers.
  • A series of initiatives to encourage generic drug use and prevent brand owners blocking approvals through citizen petitions.
  • Capping payment for Medicare Part B drugs to the consumer price index rather than the healthcare inflation rate.

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