NIH drops special 10% set-aside for AIDS research

In a major shakeup for the HIV/AIDS research community, the National Institutes of Health (NIH) today announced it will no longer support setting aside a fixed 10% of its budget—or $3 billion this year—to fund research on the disease. The agency also plans to reprogram $65 million of its AIDS research grant funding this year to focus more sharply on ending the epidemic.

The changes follow growing pressure in Congress and from some advocacy groups for NIH to reallocate its funding based on the public health burden a disease causes. In recent years, HIV/AIDS has been imposing a lower burden as death rates have dropped and treatments have improved.

The changes are drawing a mixed reaction from the AIDs community and scientists. Although some scientists’ grants are now at risk, “there is broad support for the idea of oversight and review and a rigorous focus on the highest priority science with our precious research dollars,” says Johns Hopkins University epidemiologist Chris Beyrer, president of the International AIDS Society. More worrisome to his group and others is uncertainty about future increases for AIDs research.

AIDS has received 10% of NIH’s overall budget since the early 1990s, when Congress and NIH informally agreed it should grow in step with NIH’s overall budget. But the need for each NIH institute to spend its annual AIDS allocation has led some institutes to stretch the definition of HIV research and others to relax quality standards. In addition, some patient groups and members of Congress have recently asked why AIDS receives disproportionately far more than diseases with higher death rates, such as heart disease and Alzheimer’s.

Last year, Congress omitted instructions asking NIH to maintain the 10% AIDS set aside. NIH Director Francis Collins agrees: At a meeting of his Advisory Committee to the Director (ACD) today, he noted that no other disease receives a set proportion of the NIH budget and the argument that AIDS still deserves such a set-aside is “not a defensible one.”

The end of the set-aside has “free[d] us up” to refocus NIH’s AIDs portfolio, Collins says. In August, the agency announced a new list of priorities that puts vaccines and therapies high on the list and research not directly related to HIV infection further down. NIH’s Office of AIDS Research (OAR) then reviewed AIDs grants coming up for renewal in fiscal year 2016 to see how they fit the new priorities.

That review, presented today to the ACD by OAR acting director Robert Eisinger, found that about 20%, or 242 of 832, extramural grants fell on the low priority list (they made up 16% of the funding, or $65 million). They include basic virology and immunology and studies involving pathogens that don’t appear in the context of HIV infection. Among intramural AIDS-funded programs, a larger proportion—47%, or 26 of 56 projects—were deemed low priority; they totaled $6.6 million. (A contract for $1.26 million was also low priority.)

OAR now plans to pass the low priority list on to institutes who will then notify investigators, who sometimes aren’t even aware that their grants are funded with AIDS dollars. If they do well in peer review, these studies may still receive funding from NIH, but it would have to come from non-AIDS dollars for which competition may be stiffer.

The freed up $65 million will go into a “common pool” for AIDS research that institutes can compete for based on the new priorities, Collins says. “It will result in shifting the dollars around,” he said. OAR will continue this process for the next few years as grants turn over; if the same proportion of grants is deemed low priority in future years, the total could come to more than $400 million.

ACD members were generally positive about the AIDS review. The reshuffling is “necessary” if “difficult” and “painful,” said virologist Ian Lipkin of Columbia University.

Beyrer points out that the impact for now may be slight since it only affects about 2% of the overall HIV/AIDS portfolio. “Nevertheless if it’s your funding, it’s going to be very challenging for people,” he says. Mark Harrington, executive director of the Treatment Action Group in New York City, says while his group is generally supportive of the change, he worries that studies on infections that co-occur with HIV —such as tuberculosis—may go by the wayside and that could be “a real loss.”

What worries AIDs groups more is what the end of the 10% set aside will mean for the AIDS budget. Collins says the numbers won’t shift in fiscal year 2016 because that budget is about to be approved by Congress. After that, even if AIDS no longer gets 10%, “HIV research should not be precluded from receiving any share of [an NIH] increase,” says Kimberly Miller of the HIV Medicine Association in Arlington, Virginia.

One peculiarity of AIDS research will not change—that NIH must treat AIDS dollars as a distinct pot of money within its overall budget. That is because a 1993 law carved out a separate HIV/AIDS budget, Collins says. And undoing that law would take action by Congress.