Who Decides What Science Gets Done?

The History Behind the NIH Funding System the Trump Administration Is Dismantling

NIH Building 1, Bethesda, Maryland, 1951, Provided by U.S. National Library of Medicine: https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101394961-img

In 1945, two appointed staff members of the newly created NIH Division of Research Grants wrote a letter to the dean of every medical school in the United States to solicit the first grant applications under the new system authorized by the Public Health Service Act of 1944. Within a year, 264 grants totaling $3.9 million had been awarded to researchers at 77 universities across 26 states (Van Slyke, 1946). The first grant, for $92,000, supported a study of the inheritance of muscular dystrophy at the University of Utah (Tabor, 2022). Those two NIH staff members and their two secretaries had just built the administrative foundation for what would become the most productive publicly funded biomedical scientific enterprise in human history.

Eight decades later, the system that grew from those letters, including the two-tiered scientific peer review process, the independent Advisory Councils, the public announcement of funding priorities, and the principle that scientists decide what science gets funded, is being fundamentally restructured. To understand what is being lost and why it matters, it helps to understand how that system was built, why it was designed the way it was, and what it has produced.

I spent 22 years as a Program Officer at NIH, developing funding opportunities, shepherding them through scientific review, and building programs that trained the next generation of researchers. I watched the system evolve over two decades. I never imagined watching it be dismantled. This essay draws on both the historical record and my own direct experience to explain what that system actually was, and what we stand to lose.

Before the Government Got Involved

Before World War II, the United States government did not fund much medical research outside its own laboratories (Tabor, 2022). Most medical and public health research was supported by pharmaceutical companies and private foundations. By 1934, the Rockefeller Foundation alone provided two-thirds of medical research funding in the country (Tabor, 2022). NIH existed, having been established in 1930 by renaming the Hygienic Laboratory of the U.S. Public Health Service, but it was conceived as a government laboratory, not a national funder of outside science (Tabor, 2022).

This arrangement had a structural limitation that was rarely articulated clearly, because the alternative was not yet imaginable. As Dzau and Yamamoto (2025) observe in their National Academy of Medicine analysis, government support for biomedical research has been unique in its emphasis on basic knowledge discovery, its support for investigations that lack immediate promise of profitable product development, and its underwriting of large-scale, long-term research endeavors. Private foundations fund research that interests them. Pharmaceutical companies invest in research with commercial applications. Philanthropies gravitate toward causes with high public visibility. None of these mechanisms reliably fill the space that basic science requires: long-horizon studies with uncertain payoffs, research on diseases too rare or too unglamorous to attract industry investment, and fundamental investigations into how biology works that may not produce a clinical application for twenty years. That gap is the space that government funding was eventually built to fill.

War Builds the Machine

The catalyst for federal investment in science was World War II. As Tabor (2022) recounts, James Conant, president of Harvard University, brought the idea of a government scientific research committee to Vannevar Bush, head of the Carnegie Institution, who brought it to President Roosevelt. In 1940, Roosevelt created the National Defense Research Committee under Bush to channel government resources into war-related research at civilian universities. In 1941, a Committee on Medical Research was created under the same umbrella to address military medical needs. The returns were rapid: advances in penicillin production, blood banking, and infectious disease, among others (Dzau & Yamamoto, 2025).

Roosevelt wanted to sustain that investment after the war, so he commissioned Bush to evaluate the case for ongoing national support of science. The resulting 1945 report, Science, the Endless Frontier, concluded that sustained investment in basic research and scientific training would be essential to postwar prosperity and national security (Dzau & Yamamoto, 2025). It became the intellectual blueprint for the expansion of NIH. By 1962, the NIH budget was 1,000 times what it had been in 1938 (Dzau & Yamamoto, 2025).

The wartime Committee on Medical Research (CMR) funded science through contracts, not grants. Tabor (2022) draws an important distinction: contracts gave the government control over the direction and goals of the work, whereas grants trust scientists to identify the right problems and pursue them with rigor. The CMR used contracts because it needed specific military problems solved on a defined timeline, but even within that constrained model it employed outside scientific experts to evaluate proposed contracts, because the government recognized it was not qualified to judge scientific merit on its own (Tabor, 2022). That practice of outside reviewers became the template for what followed.

NIH converted the CMR contracts into grants at the end of 1945, and the Committee on Medical Research was disbanded on December 31, 1946 (Tabor, 2022). NIH created an Office of Research Grants in 1945 and appointed Dr. Cassius J. Van Slyke as its director on January 1, 1946 (Tabor, 2022). Working with a staff of four, Van Slyke created the administrative structure and grants procedures that would remain largely in use for the next three-quarters of a century (Tabor, 2022). He predicted the program “may have early and profound effects upon the course of medical history and the national health” (Van Slyke, 1946). It was a considerable understatement.

Building the Firewall: Peer Review and the Two-Tiered System

The decision to have all grant applications reviewed by scientists from outside the government was not accidental. According to Tabor (2022), there was a clear institutional philosophy that outside review was essential to prevent political interference in scientific decisions and to avoid conflicts of interest within an agency that was both funding and conducting its own research. The Public Health Service Act of 1944 specified that outside scientific experts should review NIH grants, and that Advisory Councils would make recommendations to the U.S. Public Health Service regarding the research investments (Van Slyke, 1946; Tabor, 2022).

To find reviewers for the first applications, Van Slyke and his colleague Ernest Allen used the directory American Men of Science to identify specialists in each subject area (Tabor, 2022). As Allen later recalled, “we would write to three or four of these people and get their opinions on the merit of the proposal. We then took [their assessments of] the proposals to the National Advisory Health Council” (as cited in Tabor, 2022). Later, the grants office began establishing Study Sections, composed of civilian scientists to review applications for grants in specialized fields (Swain, 1962).

A process formalized into a standard two-tiered peer review system was fully established by 1955 (Tabor, 2022). The first tier, study sections, brought together panels of external scientists to evaluate applications on scientific merit alone: the significance of the research question, the rigor of the proposed approach, and the qualifications of the investigators (Tabor, 2022). By 1950, study sections assigned numerical scores rather than simple approve-or-disapprove decisions, allowing funding to be prioritized in order of appraised merit (Tabor, 2022).

The second tier, Advisory Councils at each institute, evaluated whether meritorious science fit the institute’s mission and priorities. By 1955, each of the eight NIH institutes then in existence had its own Advisory Council of outside experts conducting this second-level review (Tabor, 2022). Institute directors made the final funding decisions, but within a system designed so that scientific merit was evaluated first by external scientists.

Van Slyke articulated the animating principle: the NIH grants program should be “a medical research program of scientists and by scientists” that maintains “the integrity and independence of the research worker and his freedom from control, direction, regimentation, and outside interference” (Van Slyke, 1946).

The extramural research program expanded rapidly as Congress established additional institutes: the National Mental Hygiene Institute (1946), the National Heart Institute (1948), and the National Dental Research Institute (1948), among others (Reynolds & Price, 1949). As specified in law, each new institute was required to have its own Advisory Council. By 1948, the growth of the program had led to the pluralized designation “National Institutes of Health.” Today there are 27 NIH Institutes, Centers, and Offices, all operating within that same statutory framework.

Over time, the system this principle produced supported 174 Nobel laureates among NIH-funded researchers, along with the sequencing of the human genome, antiretroviral therapy for HIV, vaccines for polio and hepatitis B and HPV and COVID-19, and treatments for cancers that were uniformly fatal within living memory (Dzau & Yamamoto, 2025). None of those advances were predicted at the time the underlying research was funded. That is not a coincidence. It is the point.

The Councils that provide that second tier of accountability are now themselves under threat. The majority of the 25 NIH Advisory Councils are now operating with less than half their full complement of members, according to STAT’s analysis of annual reports of council activity submitted at the end of December (Molteni, 2026). It is unknown why the Trump administration hasn’t moved to fill these vacancies. The upshot is that many of these Advisory Councils are in danger of running afoul of federal laws governing council makeup and operations, the same laws that have governed them since the Public Health Service Act of 1944 mandated their creation.

Going Public: The NIH Guide and the Promise of Transparency

For the first two decades of the NIH extramural grants program, funding opportunities were communicated informally: direct outreach to institutional contacts, institute-specific announcements, and word of mouth. A researcher not connected to the right people at the right institution might simply not learn about an opportunity directly relevant to their work.

On April 30, 1970, NIH launched the NIH Guide for Grants and Contracts. Early issues of the Guide (NIH, 1971) show a centralized weekly bulletin covering new funding opportunities, policy changes, and scientific priorities across all NIH institutes. For the first time, every researcher in the country had access to the same information, through the same channel, at the same time. A scientist at a small rural university could learn about a new funding opportunity at the same moment as a researcher at a well-connected major research institution. The Guide democratized access in a way that institutional networks and direct outreach could not.

The Guide also created accountability that had not previously existed in any systematic form. When NIH decided to make a particular area of research a priority, it had to say so publicly, in writing, in a permanent archived record that any researcher, institution, member of Congress, or member of the public could read. Funding priorities became matters of documented public record rather than internal decisions communicated through informal channels. I relied on the Guide throughout my 22-year career, as did every Program Officer and grant administrator in the country.

In August 2025, NIH announced it would stop posting funding opportunities in the NIH Guide beginning in fiscal year 2026, consolidating all postings exclusively in grants.gov (NIH, 2025). The stated rationale was to reduce duplication across federal systems. In practice, this change has contributed to a significant reduction in transparency, by adding a new forecast layer that, as I have documented in my prior analyses (Ginexi, 2025; 2026a; 2026b), buries the large majority of anticipated funding opportunities before they are ever published as real announcements.

How a Funding Opportunity Actually Gets Made

My earlier essays have described what is happening to NIH funding opportunities now. This section describes what happened before, drawing on my 22 years of direct experience in the process.

The process began with program staff and Institute, Center, and Office leadership. Program Officers spend their careers monitoring the scientific landscape in their assigned areas: reading literature, attending conferences, talking with investigators, and analyzing the institute’s existing grant portfolio to identify gaps. The driving questions were: What diseases were under-researched? What scientific problems went unaddressed because no investigator had proposed to tackle them through a standard unsolicited grant? What gaps in the scientific workforce needed targeted intervention? Ideas for new funding opportunities came from many directions, including portfolio gap analysis, requests for information from the scientific community, scientific workshops with external subject matter experts, strategic plan priorities, Advisory Council input, and recognition by program staff that a clinical population or a scientific problem was being systematically neglected.

Once an idea survived internal vetting, progressing through branches, divisions, and institute or center directors, it was developed into a formal Concept document. That Concept went before the Advisory Councils. With a mandate dating all the way back to the original 1944 Public Health Service Act, NIH Advisory Councils are federally chartered committees of external scientific experts and public representatives who advise on NIH research priorities and policies. They meet three times a year. A program officer presenting a Concept prepared a formal presentation, described the scientific rationale and proposed grant mechanism, and answered questions from council members in an open public meeting. Council members voted on whether the idea was sound and ready to proceed. A negative vote sent the program officer back to work. Sometimes an idea came before the council twice before being approved, and sometimes it did not survive the second presentation.

Writing the NOFO itself was a substantial undertaking. The document had to specify what NIH was looking for and why, what scientific approaches were appropriate, which grant mechanism was being used and why, what the budget parameters were, and what review criteria would be applied. The choice of mechanism was not administrative box-checking; it carried real scientific meaning. An R03 funds exploratory work. An R01 supports an individual investigator’s program. A P50 funds a multifaceted research program on a specific disease with multiple interconnected scientific components. A U01 is a cooperative agreement involving closer NIH participation in the conduct of the research. A T32 supports institutional training programs. A K01 supports scientists needing further training in a specific area.

When a targeted NOFO was published as a Request for Applications (RFA) with a monetary set-aside or as a Program announcement with special receipt, referral, and/or review (PAR), the applications generated could be reviewed by a specially convened expert panel, scored against each other rather than against the full universe of NIH applications. This meant that a proposal for rare disease research was evaluated by reviewers with relevant expertise, competing against other rare disease proposals, rather than being forced into a general study section alongside cancer immunotherapy and cardiovascular genomics proposals. The result was a realistic pathway to funding the best ideas within a specialized targeted area.

The requirement that all NOFOs receive Advisory Council concept clearance before publication became universal policy around 2014, following the NIH Reform Act of 2006 and subsequent internal policy updates. When I started as a Program Officer in 2003, not all NOFOs required that level of review. By the time I left, it was standard practice for all of them. The effect was that every targeted funding opportunity NIH published had been vetted by external scientific experts in a public meeting, with a recorded vote, before any researcher was invited to apply. That public accountability was not bureaucratic formality. It was the mechanism by which the scientific community, and the public it represents, had a documented role in setting research priorities.

What Changed in 2025-2026, and Why It Is Different in Kind

The changes the Trump administration has made to this system since 2025 are not a simplification or a streamlining and show no sign of stopping. They are a transfer of authority at every stage of the process, moving decision-making power away from scientists and toward political appointees.

The sequence of policy changes was rapid. In April 2025, NIH staff were informed that HHS was requiring a redesign of the NOFO format and that within one year all institutes would be expected to reduce the number of NOFOs by 50%. Staff were told that Advisory Council concept clearance would now require HHS pre-approval first. That HHS approval process, I have learned from colleagues still at NIH, can take six months or longer. The political approval gate now precedes the scientific review gate.

On August 14, 2025, when NIH announced the discontinuation of the NIH Guide for Grants and Contracts as a source for funding opportunities beginning in fiscal year 2026 (NIH, 2025), it also introduced the new forecasting requirement. Every institute, center, or office must now post a brief high-level forecast of an anticipated funding opportunity before being permitted to develop the actual NOFO. As of May 2025, each institute was limited to submitting just five targeted NOFOs for approval consideration, a cap with no scientific rationale.

By September 2025, an NIH NOFO Reform Group had been established to oversee compliance with the reduction mandate and to move the agency towards using mostly “Parent Announcements,” (or Parent NOFOs), which are broad Notice of Funding Opportunities that allow investigators to submit unsolicited, investigator-initiated research grant applications to the NIH. Unlike specific RFAs, they cover general, wide-ranging research areas, often for popular mechanisms like R01, R21, or R03, allowing researchers to submit applications for any project within an institute’s mission rather than a specific topic. NIH wants to expand the number mechanisms that use Parent Announcements, and significantly reduce the use of targeted NOFOs.

The written policy governing these changes is the Unified Funding Strategy, which requires that all awards align with administration priorities as determined by NIH/OD and HHS. Internally, NOFO reform efforts cite the Executive Order on Improving Oversight of Federal Grantmaking (The White House, 2025) as a rationale. Colleagues still at NIH have told me that OMB review is now required after HHS approval, adding a third political approval layer to a process that previously had none. A dizzying array of Updates to Finding NIH Funding Opportunities and Information are underway (NIH, 2026), with more likely coming. As of this writing, new implementation guidance continues to appear, each round further constraining what ICOs can propose and how, all purporting to “simplify the process” and consolidate 27 ICOs to conform to one NIH central authority.

The practical result is what I have documented in my prior analyses (Ginexi, 2025; 2026a; 2026b): 83% fewer posted NOFOs in 2025 compared to recent baselines, a forecast graveyard of 205 open forecasts already past their promised publication dates, with 28 forecasts permanently canceled, and a replacement “Highlighted Topics“ portal that lists general research areas without the scientific specificity, mechanism selection, set-aside funding, or dedicated peer review panels that targeted NOFOs previously provided. These figures reflect data through early 2026. The trajectory shows no indication of reversal.

The Highlighted Topics portal illustrates what the transfer of authority looks like in practice. Under the previous system, Advisory Councils of external scientists would have evaluated, in public meetings with recorded votes, whether these were the highest-priority areas for NIH investment and delineated specific grant mechanisms as the best match for the science at hand. Under the current system, the list is vetted and approved by political appointees.

The irony of instituting “Highlighted Topics” under the guise of a “Unified Funding Strategy” is rich. Applications submitted for these topics will be harder to track (compared to a targeted NOFO) as they may not be reviewed together in the same study sections; they may use wildly different grant mechanisms and budgets; they may target very different institute and center missions; and they may not even arrive in the same council rounds. This means that disparate program staff across the NIH will have a difficult time ranking the best “Highlighted Topics” applications for funding consideration to achieve a so-called “Unified Funding Strategy.” This new approach introduces more undue administrative complexity than existed before.

These changes are not complete. New guidance continues to arrive, existing forecasts continue to age past their promised dates, and the research community has no reliable way to know which anticipated funding opportunities will ever materialize. What began as a series of specific policy decisions has become the operating reality of NIH.

Why Expert Control Is Not Just Tradition

The case for peer review and expert-driven priority setting is sometimes presented as though it were primarily a matter of institutional habit. The historical record does not support that interpretation. Congress deliberately intended for the NIH to rely on scientists to vet its grants (Van Slyke, 1946; Tabor, 2022). If political priorities rather than scientific judgment determine what gets funded, NIH will lose the structural characteristic that makes it irreplaceable.

The catalogue of advances that Dzau and Yamamoto (2025) document, including a 56% decline in heart disease deaths between 1950 and 1996, a 54% reduction in the global AIDS death rate since 2010, vaccines for six major infectious diseases, and cancer therapies that have converted previously fatal diagnoses into manageable conditions, were not predicted at the time the underlying research was funded. That is the point of the system Van Slyke built: it trusted scientists to identify the right questions before the answers were visible. Political appointees cannot reliably do that, not because they lack intelligence, but because political utility is a different criterion than scientific promise, and optimizing for one reliably undermines the other.

From my own experience across 22 years at NIH, the structures built around funding opportunity development, Advisory Councils, concept clearance, two-tiered peer review, the NIH Guide, and the NOFO itself, were not bureaucratic excess or undue administrative complexity. Each structure was built through legislation and because experience showed it was necessary. The Guide was built because informal networks excluded researchers who were not well-connected. Advisory Councils were built because NIH was mandated by Congress to implement external scientific accountability that government staff alone could not provide. Targeted NOFOs were instituted because “we will fund good research in this general area” is not always a sufficient signal to the research community, while specific, publicly documented announcements of scope, mechanism, budget, and review criteria allow researchers to address particular gap areas.

Unlike what the current NIH leadership would have you believe, targeted calls for research have never been solicited at the expense of investigator-initiated research. There is no limit for investigators to propose novel or unexpected ideas. In fact, over 80% of NIH extramural funding each year goes to investigator-initiated science solicited by general funding announcements such as the Parent R01 (NIH, n.d.-a; NIH, n.d.-b). The system, while not perfect, was working.

Van Slyke stated the founding principle in 1945 and it has not become less true since: the NIH grants program should be “a medical research program of scientists and by scientists” that preserves “the integrity and independence of the research worker and his freedom from control, direction, regimentation, and outside interference” (Van Slyke, 1946).

The Future of Biomedical Research in the United States

In 1945, Van Slyke predicted that the NIH grant program “may have early and profound effects upon the course of medical history” (Van Slyke, 1946). In fiscal year 2024, NIH invested over $37 billion in extramural research, distributed across more than 2,500 universities, medical schools, and research institutions (NIH, 2024).

What made that growth possible was a principle embedded in the system from the very beginning: when scientists propose the science, other scientists evaluate the proposals, and the results of that evaluation are published for anyone to scrutinize, the country gets the science it could not have predicted it needed. That is what Van Slyke’s letter to the medical school deans was about. It was not about administrative efficiency or reducing fragmentation. It was about asking scientists what science is needed, trusting the answer, and building a transparent, accountable public system to fund the best ideas.

What is being built in its place is a system where research priorities are set by whoever holds political power in Washington. It is a system where the political approval gate precedes the scientific review gate, where funding opportunities are replaced by highlighted topic lists approved without public scientific input, and where the research community waits in a forecast graveyard for targeted announcements that may never come.

The question before us is whether we understand what we are trading away, and whether we think it is worth it.

The system Van Slyke built trusted scientists to ask the right questions. The system replacing it trusts politicians to know the answers. Eighty years of evidence tells us which of those bets paid off.

Sources

Dzau, V. J., & Yamamoto, K. R. (2025, August 18). Government-funded health and biomedical research is irreplaceable. National Academy of Medicine. https://nam.edu/perspectives/government-funded-health-and-biomedical-research-is-irreplaceable/

Ginexi, E. (2026, March 17). Why is the NIH abandoning science? This is not a temporary slowdown. The Chronicle of Higher Education. https://www.chronicle.com/article/why-is-the-nih-abandoning-science

Ginexi, E. (2025). I wrote research funding announcements for NIH for 22 years. This year they’ve published 14. Substack. https://substack.com/@elizabethginexi/p-191085985

Ginexi, E. (2026a). The NOFO graveyard. Substack. https://elizabethginexi.substack.com/p/the-nofo-graveyard

Ginexi, E. (2026b). Inside the NIH forecast graveyard: What NIH is canceling, what it is burying, and what it means. Substack. https://substack.com/@elizabethginexi/p-192737949

Molteni, M. (2026, January 22). Unfilled vacancies have depleted NIH advisory councils, key players in grant approvals: Panels are operating without full range of expertise needed to make informed decisions. STAT. https://www.statnews.com/2026/01/22/nih-advisory-council-vacancies-raise-questions-funding-politicization/

National Institutes of Health. (2026). Updates to finding NIH funding opportunities and information. Retrieved April 8, 2026, from https://grants.nih.gov/policy-and-compliance/implementation-of-new-initiatives-and-policies/updates-to-finding-nih-funding-opportunities-and-information

National Institutes of Health. (2025, August 14). NIH will stop posting notices of funding opportunities in the NIH guide for grants and contracts in FY2026 [Notice NOT-OD-25-143]. https://grants.nih.gov/grants/guide/notice-files/NOT-OD-25-143.html

National Institutes of Health. (2024). Total NIH Budget Authority: FY 2024 Final. U.S. Department of Health and Human Services. https://report.nih.gov/nihdatabook/report/4

National Institutes of Health. (n.d.-a). Research project grants (RPGs): Number of awards and total funding, by type [Report 34]. NIH Data Book. https://report.nih.gov/nihdatabook/report/34

National Institutes of Health. (n.d.-b). Research project grants (RPGs): Number of awards and total funding, by mechanism [Report 35]. NIH Data Book. https://report.nih.gov/nihdatabook/report/35

National Institutes of Health. (1971, July 29). NIH Guide for Grants and Contracts, 1(9). https://grants.nih.gov/grants/guide/historical/1971_07_29_Vol_01_No_09.pdf

Reynolds, F. W., & Price, D. E. (1949). Federal support of medical research through the Public Health Service. American Scientist, 37(4), 578–586. https://pubmed.ncbi.nlm.nih.gov/18148854/

Swain, D. C. (1962). The rise of a research empire: NIH, 1930 to 1950. Science, 138(3546), 1233–1237. https://www.science.org/doi/10.1126/science.138.3546.1233

Tabor, E. (2022). The origins of NIH medical research grants. Hektoen International: A Journal of Medical Humanities. https://hekint.org/2022/10/18/the-origins-of-nih-medical-research-grants/

The White House. (2025, August 7). Improving oversight of federal grantmaking [Executive Order]. https://www.whitehouse.gov/presidential-actions/2025/08/improving-oversight-of-federal-grantmaking/

Van Slyke, C. J. (1946). New horizons in medical research. Science, 104(2711), 559–567. https://www.science.org/doi/10.1126/science.104.2711.559

This essay is part of an ongoing series reflecting on what I learned over more than two decades working inside the U.S. biomedical research enterprise. Each piece stands alone, but together they examine how science is shaped not only by ideas and funding, but by the structures that support or con