Dr. Francis Collins, the Director of the National Institutes of Health, has been one of the best advocates for the NIH I have ever seen. His ability to easily maneuver from one NIH research topic to another during budget hearings has been truly artful at times. While his guitar playing has driven me personally crazy (When was the last time secretaries John Kerry and Chuck Hagel used a banjo to sing about their budget woes?), it has been an effective way to communicate the NIH budget problems to a broader audience. I am concerned, however, that Dr. Collins went too far on Sunday.
In a Huffington Post article by Sam Stein (Ebola vaccine would likely have been found by now if not for budget cuts: NIH director, 10/12/14), Dr. Collins explicitly stated that we would have an Ebola vaccine if not for NIH funding cuts over the past few years.
“Frankly, if we had not gone through our 10 year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.” – Dr. Francis Collins
As an advocate, I know what Dr. Collins is doing here. Having spoken with dozens of members of Congress on the importance of NIH funding, I know how hard it is to get support for discovery research* funding. While we all know that discovery research is critical to the cures, vaccines and treatments of tomorrow, it is about as sexy as an L.L. Bean flannel nightgown. To gain support for discovery research, we have to sell it on its promise and the cures coming down the road. I get that, and I am guessing you get that too. However, when a disease captures the American public’s attention as Ebola has, you have to “never let a crisis go to waste” as Winston Churchill put it. Dr. Collins obviously understands this and is using the Ebola spotlight to direct some attention to the harmful NIH cuts.
While we recognize his argument for what it is, unfortunately, I am not so sure Congress will get it, which is why Dr. Collins’ statement is dangerous. There is decidedly little wiggle room in Dr. Collins’ assertion that budget cuts have prevented the development of an Ebola vaccine. Did budget cuts affect the pace of research for an Ebola vaccine? Almost certainly. Is it possible that a vaccine would have been in production if funding had remained steady? Possibly. But is it with the certainty Dr. Collins told the Huffington Post? Not a chance. Biomedical research does not work that way. The outcomes of research, including clinical trials, are unpredictable. I am reminded of U.S. Health and Human Services Secretary Mary Heckler who, in 1984, declared an HIV vaccine was two years away. 30 years later…
What happens when Congress listens to Dr. Collins’ argument and appropriates millions of dollars for Ebola research or an Ebola vaccine, and the magic bullet doesn’t come quickly? What happens when there are unintended and unforeseen side effects in clinical trials? What happens when the efficacy is far lower than anticipated? Does Congress understand the difficulties of predicting outcomes in the biological sciences? Will Congress have the patience to wait, or will Dr. Collins be brought to testify in front of a panel of angry members of Congress blasting the NIH and the biomedical research community for failing to live up to their end of the bargain? Will they be as likely to fund research in the future?
Dr. Collins has opened up the NIH budget process to politics in a way I truly wish he had not, and we are already seeing the effects. On Twitter, people are highlighting areas of research the NIH has funded instead of funding Ebola. (On paper, the grants sound frivolous. We know they aren’t, but our political enemies do not!) In a time when dozens of bills are introduced in Congress to fund the disease du jour of a member of Congress, and researchers at other agencies are forced to explain the broader impacts of their research, Dr. Collins is sending a dangerous message that more money equates to more cures.
In addition to the danger in his argument, we should remember that Ebola kills FAR fewer people each year than influenza or malaria. It frankly isn’t the existential threat to our health and well being as fear mongers want us to think. There is a reason why the NIH has not funded billions in research for Ebola, and it is because it does not pose the threat that many other infectious diseases do. Diseases like diabetes and Alzheimer’s. The diseases that are more likely to kill many more of us.
NIH funding has been decimated, and we are all feeling the pain of those cuts. In fact, ASBMB issued a report last year on how damaging budget cuts have been to the nation’s scientific enterprise. And earlier this year the Coalition for Health Funding (of which ASBMB is a proud and active member) issued another report on the affect of cuts on public health this summer. We are certainly losing potential life-saving cures and treatments as well as the economic benefits of being the global leader in biomedical research and development. But no one, not even the director of the NIH, can predict what those are. Frankly, we have a strong enough case for why Congress should increase research funding without needing to resort to Ebola fear mongering.
*BTW, polls indicate that “basic research” is a term we should never ever use. The average American thinks the U.S. should not be doing “basic research” because we are America dammit, and we are way more advanced than doing “basic research.” Therefore, “basic research” will hereafter be referred to in this space as “discovery research.”