How the NIH dominates the world’s health research — in charts

Abrupt cuts by the Trump administration to the US National Institutes of Health threaten progress in medical research globally

A biologist working on cancer therapies at the US National Institutes of Health.Credit: Saul Loeb/AFP via Getty

Bruising cuts by the administration of US President Donald Trump to the US National Institutes of Health (NIH) have sparked fears about the future of the agency — by far the world’s biggest funder of biomedical research and widely considered the gold standard for a research-funding agency.

To understand the probable impact of these actions on the progress of science and medical research, Nature examines the agency’s dominance globally — in terms of its funding, publications and impact on disease.

“This is a severe blow to science and the training of the next generation of scientists,” says Siyuan Wang, a geneticist and cell biologist at the Yale School of Medicine in New Haven, Connecticut. “With fewer scientists, there will be less science and innovation that drive societal progress and the improvement of public health.”

Disruptions to the agency prompted by the Trump administration include the terminating of grants, thousands of staff lay-offs and the pausing of day-to-day operations, such as panels that evaluate grant applications.

Biomedical-funding behemoth

With an annual budget of roughly US$47 billion, the NIH dwarfs the rest of the world’s funders of biomedical research. The World RePORT project, which tracks global health-research spending, showed that, in 2022, the NIH spent 25 times more on grants than the next biggest funder — the London-based charity Wellcome — that reported data to the initiative (see ‘World leader’).

US biomedical science dominates the world in terms of papers, discovery and drugs, says Miriam Merad, a cancer immunologist at the Icahn School of Medicine at Mount Sinai in New York City, who receives funding from the NIH and other sources (see ‘Publishing prowess’). Merad points to a study¹ that shows that NIH-funded research contributed to 354 of 356 drugs approved by the US Food and Drug Administration in 2010–19.

“Without NIH, there would be no cancer immunotherapy, no anti-overdose medication, no anti-heart attack or stroke medication, no cutting-edge treatments,” addiction researcher Olivier George at the University of California, San Diego, tweeted in February.

The cuts mean “drug discovery is going to slow down, for sure”, says Merad. She is working with colleagues on new drugs, the development of which they will have to pause if they don’t have certainty on funding soon. “This is the type of thing that’s happening across the country.”

The NIH’s approach to funding scientists is unique in the world, says Merad. NIH grants often allow researchers to focus on scientific problems for four or five years without the need to raise further funds, she says. That provides freedom and stability that is not typically available in other regions such as Europe, or in industry. “They trust the brain, the mind, the intellect of the people they fund. In industry, you don’t have the luxury to pivot, you are constantly constrained.”

The NIH’s “support to basic biomedical research enables fundamental breakthroughs, the path to which would be considered too risky for any venture capitals or biopharmaceutical companies”, says Wang.