The AIDS Research Program of the National Institutes of Health (1991) / Chapter Skim
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4 Supporting the NIH AIDS Research Program
4 Supporting the NIH AIDS Research Program
Pages 95-130
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From page 95... ...
Some observers point to this expansion as adequate and call for maintenance, if not actual reduction, of AIDS funding levels. Yet the epidemic is still growing and spreading, and it threatens to persist for years to come.
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From page 96... ...
The syndrome was first recognized and described by NIH grantees in mid-1981, and the first AIDS patient was admitted to the NIH clinical center in September 1981. Before the end of that year, NCI viral epidemiologists began studies; NCI held a national conference on Kaposi's sarcoma and AIDS-related opportunistic infections; general clinical research centers supported by the National Center for Research Resources became involved in AIDS studies; and NIAID supplemented grants to its extramural sexually transmitted disease centers and other researchers to study AIDS.
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From page 97... ...
In companson, intramural research accounted for only about 12 percent of NIH's non-AIDS budget during that time. The use of contracts was prominent in the early years, reaching 53 percent and 43 percent of the AIDS budget in the 1986-1987 fiscal years when the large extramural programs, such as the AIDS clinical trials units, were being launched.
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From page 98... ...
The share of AIDS research funds for basic research is also comparatively lower, although the exact figure is unknown. The large-scale programs initiated through RFAs and supported by cooperative agreements—AIDS clinical trials units, the national cooperative drug and vaccine development groups, and so forth~re classified as research project grants; on the other hand, some fundamental research in immunology and virology of relevance to AIDS research Is funded through the non-AIDS budget.
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From page 99... ...
lithe NIH AIDS program must respond in a balanced way to gaps in needed knowledge, emerging scientific opportunities, changes in the epidemic (for example, as the virus moves into new populations or responds to improved treatments) , and other, unforeseen contingencies.
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From page 100... ...
The committee believes that behavioral research, nursing research, development and testing of therapies for AIDS-related opportunistic infections and cancers, and research training are examples of fields that have received relatively little support and deserve a much greater investment by NIH as part of a long-range effort to reduce HIV infection and deal with its consequences. The committee has recommended that about 3 percent of the AIDS budget go to the support of research training, triple the current level.
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From page 101... ...
A definite benefit for the slower-growing non-AIDS programs is that AIDS funds have supported some immunology, molecular biology, and other basic research that might otherwise not have been possible, although, as already noted, the share of the AIDS budget going to basic research is relatively small. 6It would take $7835 million to sustain this level of expenditures in fiscal year 1991 after inflation (using the biomedical research and development price index)
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From page 102... ...
A perception at the appropriations committee level that AIDS and non-AIDS funding shares were out of balance and that AIDS research should compete with non-AIDS studies in priority setting at the institutes resulted in no formal AIDS earmark in fiscal year 1990 for the first time since 1984. Although the institutes are expected to maintain the detailed budgets submitted in the congressional justification, including those for AIDS, lack of an earmark means that "the precise amount expended is determined by the institutes based on the quality of applications submitted and competing research priorities," according to the House appropriations committee in its report (U.S.
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From page 103... ...
GRANTS POLICY AND ADMINISTRATION One of NIH's key resources is a large-scale process for identifying high-quality research ideas and productive investigators worthy of funding support. NIH's grant review system maintains a pipeline of research proposals deemed to have high scientific merit by other scientists.
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From page 104... ...
These concerns have not been mitigated by the fact that institute review groups of AIDS experts rather than disciplinary DRG study sections review many AIDS grant applications. Concerns remain because some of the studies are large, complicated projects, often solicited by the institute with an RFA, and funded through cooperative agreements, which involve institute staff in the direction of a project.
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From page 105... ...
As a result, the ratio of solicited to unsolicited grant awards dropped from more than 2 to 0.5, and most of the solicited awards were for the large NIAID AIDS programs—for example, the national cooperative drug discovery groups, the AIDS research centers, Programs of Excellence for Basic Research in AIDS, and AIDS clinical trial units. The priority scores of unsolicited grants improved, whereas the number of solicited grant awards with priority scores greater than 175 fell sharply (NIH, 1989a)
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From page 106... ...
The share of the AIDS budget allocated to research project grants has increased, from a low of 19 percent in 1986 to about 40 percent currently. This share is still smaller than in other NIH-supported research areas, however, where research project grants constitute nearly 60 percent of the budget.
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From page 107... ...
In 1988, the IOM committee to study the NIH intramural program criticized OMB-imposed ~ l h; ceilings for inhibiting effective management: "The overall effect of ~ lE; ceilings that grow more slowly than budgets is that managers who are best placed to make decisions about how to allocate money to fulfill congressional mandates are prevented from making the most productive decisions (IOMINAS, 1988:67~. The NIH AIDS effort has experienced two types of personnel problems that have hampered efforts to recruit and retain staff and thus hindered program managers from making the most effective use of public resources.
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From page 108... ...
These problems have been especially severe for the AIDS program because of its fast growth, long work hours, and intense pressures associated with implementing AIDS research programs with inadequate numbers of staff. For example, congressionally mandated plans to double the AIDS outpatient and inpatient capacity of the NIH clinical center were slowed by problems in recruiting nurses and other support staff.
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From page 109... ...
These personnel constraints have acted to redirect intramural staff from non-AIDS to AIDS research and to hold down the number of staff available to plan, implement, and monitor the extramural AIDS research programs. Initially, NIH institutes responded to the AIDS epidemic with their most flexible resource, the intramural program; t-lE; ceilings subsequently hampered needed adjustments to compensate for the shifts of intramural staff to AIDS wore This situation can be seen most clearly at NCI.
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From page 110... ...
The heavy workload took a heavy toll on staff members, however, at the same time causing delays and other implementation problems for the research projects. OMB and DHHS recently gave the NIH director increased authority to determine NIH staffing ceilings, which will allow the agency to bring its staffing levels into line with program requirements.
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From page 111... ...
The committee also supports broader efforts to maintain the excellence of the NIH staff by addressing personnel problems relating to compensation and to inflexible or cumbersome policies and procedures of government personnel systems. It endorses as well special efforts to resolve problems specific to the AIDS program, such as recruitment and retention of medical officers in the NIH AIDS treatment research (clinical trials)
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From page 112... ...
The agency's 1991 budget request includes $88.6 million for buildings and facilities, including $16.5 million for AIDS facilities.~° The need for Moreland more appropriate—facilities specifically for AIDS work was acutely apparent in early 1988 when NIH director James Wyngaarden and NIH AIDS coordinator Anthony Fauci testified before several congressional committees (U.S. Congress, 1988a:259, 1988c:331~.
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From page 113... ...
As a result of the major effort begun in 1988 to accommodate the space needs of the NIH AIDS research program, space occupied by NIH AIDS activities has doubled between July 1988 and March 1990, from 109,000 to 226,000 square feet, although it is still short of the 309,000 square feet planned. Additional funding will be needed, however, to complete planned renovations, expansions, and new construction of AIDS space at NIH (for example, an on-campus retrovirus lab and full renovation and expansion of one of the buildings at the Frederick facility)
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From page 114... ...
SOURCE: Institute of Medicine's National Institutes of Health AIDS program data base, which is based on published and unpublished data from NIH's Division of Financial Management and Division of Research Grants and from the National AIDS Program Office. Bunion of Dollars 10 9 8 7 6 4 3 1 o 1981 1982 1983 1984 1985 1966 1987 1988 1989 1990 1991 $3.4 321.7 344.1 363.7 SI34.7 S260.9 3473.3 3602.3 $740.5 3804.6 (Eat.)
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From page 115... ...
115 C: Cal U: O ~ CD A lo; ._ U]
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F] GURE 4.4a AIDS funding by functional category, fiscal years 1984-1990 SOURCE: Division of Financial Management, National Institutes of Health.
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117 in SO Cat o o A o .
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Source: Division of Research Grants, National Institutes of Health.
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From page 119... ...
aAppropnated. SOURCE: Institute of Medicine's NIH AIDS program data base, which is based on published and unpublished data from NIH's Divisions of Financial Management and Research Grants and from the National AIDS Program Office.
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From page 120... ...
TABLE 4.4 AIDS Funding as a Percentage of Total Funding by Institute, Center, and Division, Fiscal Yea m 1990-1991 Unit 1990 Percent 1991 Percenta National Cancer Institute 9.1 9.4 National Heart, Lung, and Blood Institute 3.9 3.9 National Institute of Dental Research 3.4 4.4 National Institute of Diabetes and Digestive and Kidney Diseases 0.9 1.0 National Institute of Neurological Disorders and Stroke 3.3 3.0 National Institute of Allergy and Infectious Diseases 47.3 47.7 National Institute of General Medical Sciences 2.1 2.1 National Institute of Child Health and Human Development 6.1 6.5 National Eye Institute 2.3 2.2 National Institute of Environmental Health Sciences 1.9 1.9 National Institute on Aging 0.4 03 National Institute of Arthritis and Musculoskeletal and Sl;in Diseases 0.7 0.8 National Institute on Deafness and Other Communication Disorders - 0.5 National Center for Research Resources 12.6 14.2 National Center for Numing Research 2.9 7.2 Fogarty International Center 31.6 30.5 National Library of Medicine 0.6 0.6 Office of the Director 11.0 13.4 Buildings and Facilities Program 19.2 5.6 Total 100.0 100.0 aEstimated. SOURCE: Division of Financial Management, National Institutes of Health.
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From page 121... ...
by Mechanism, Fiscal Yeam 1982-1991 Mechanism 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991a Research grants Projects 20.1 41.5 32.6 28.0 18 8 30.9 40.5 38.3 39.0 39.3 Centers 19.0 5.8 3.8 5.3 4.7 4.1 S.3 8.7 7.9 7.7 Other 0.2 0.1 0.4 1.4 1.3 0.9 2.8 2.5 1.8 1.7 Total 39.4 47.4 36.8 34.7 24.8 35.9 51.7 49.5 48.7 48.7 Research training _b _ <0.1 0.2 <0.1 0.1 0.7 1.1 1.0 1.2 Research and development contracts 13.4 21.5 34.9 39.1 53.4 42.9 29.4 27.7 26.7 26.5 Intramural research 47.2 31.1 27.2 25.1 20.1 16.9 14.0 15.5 16.5 16.9 Research management and support - - 1.0 0.9 1.5 2.4 2.8 3.6 3.5 3.8 All others ~ 0.1 1.8 1.4 1.8 3.5 2.9 Total NIH 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 AIDS funding (millions of dollam) $3.4 $21.7 $44.1 $63.7 $134.7 $260.9 $430.6 5602.3 $740.5 $804.6 aEstimated.
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From page 122... ...
SOURCE: Division of Research Grants, National Institutes of Health, TABLE 4.8 National Institutes of Health AIDS Funding (in thousands of dollars) by Mason Functional Categories Fiscal Year 1989 Fiscal Year 1990 Fiscal Year 1991 Categoty Budget Authority Appropriation President's Request Basic science researek Biomedical research HIV and HIV genome 62,120 66,320 71,887 Immunology 37,954 44,911 48,075 Blood/blood products 11,063 12,154 8,879 Diagnostic methods/reagents development 7,869 10,853 11,956 Animal models and related studies 29,683 36,308 39,264 Subtotal 148,689 170,546 180,061 Neuroscience and neuropsychiatric research 16,645 20,324 21,669 Behavioral research Mechanisms of behavior and behavior change 3,863 4,188 4,530 Prevention of high-nsk behaviors 1,315 611 642 Subtotal 5,178 4,799 5,172 Therapeutic agents Development 131,421 163,712 176,082 Clinical trials 103,840 139,966 150,306 Subtotal 235,261 303,678 326,388 Vaccines Development 49,238 64,301 70,499 Clinical teals 10,581 14,332 15,631 Subtotal 59,819 ' 78,633 86,130 Research enhancement Training 6,473 8,253 9,445 Construction (extramural)
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From page 123... ...
602,294 8,263 37,353 10,683 4,676 9,400 23,341 83 16,245 101,781 16,154 117,935 1,797 344 560 2,701 668 10,014 540 10,554 1,249 1,164 2,413 16,336 142,534 14,765 743,532 8,981 43,290 11,460 4,856 8,839 25,254 100 17,284 111,083 16,951 128,034 1,826 369 601 2,796 716 10,846 820 11,666 1,342 1,264 2,606 17,784 154,799 16,500 800,164 aNo funds allocated. SOURCE: National AIDS Program Office, Office of the Assistant Secretary for Health, U.S.
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From page 124... ...
124 of _.
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From page 125... ...
SOURCE: Division of Financial Management, National Institutes of Health, May 16, 1986. TABLE 4.11 Priority Scorea at 50th Percentile for Applications and Awards, AIDS and Non-AIDS R01s and All Research Project Grants, Fiscal Year 1989 AIDS Non-AII:)
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From page 126... ...
and All Research Project Grants (RPG) , Fiscal Year 1989 Recommendation Success Ratea Award Rateb Ratec Grant lope Reviewed Approved Awarded (percentage)
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127 _ ~4 Go or _.
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From page 128... ...
TABLE 4.15 Staffing Levels (in ~ll-time equivalents [FTh;~) for the National Institutes of Health AIDS and Non-AIDS Programs, 1981-1991 FTEs Flscal Year Total AIDS Non-AIDS 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990a l990b l99la aPresident's budget request.
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From page 129... ...
Cambridge, Mass.: Harvard University Press. Presidential Commission on the Human Immunodeficiency Virus Epidemic.
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From page 130... ...
1990c. Hearings on Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, Fiscal Year 1991.
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