An Important Message from NCI
We are entering one of the most difficult times in the history of the National Institutes of Health (NIH). This was the sentiment of NCI's Board of Scientific Advisors (BSA) at their meeting on June 28. Federal deficits resulting from the events following 9/11 have contributed to unanticipated fiscal pressures that have placed a significant stress on resources assigned to support the country's biomedical research enterprise. The single biggest challenge - and the foremost driver of uncertainty for the biomedical research community - is the annual discretionary budget appropriation supporting NIH and, specifically, NCI. It is a topic of discussion at scientific meetings, in the editorial pages of peer-reviewed journals, and among researchers and administrators at academic centers across the country.
To better inform these ongoing discussions, the entire research community must clearly understand the process NCI uses to make strategic decisions regarding optimal investments in science with a goal of maintaining the momentum brought about by the doubling of the NIH budget. It is important to describe some of the basic factors that influence the budget, as well as the processes and procedures we have instituted to manage our resources.
What Happens to NCI's Appropriation once Congress Passes the Budget?
It has been unusual in recent years for Congress to reach a vote on the discretionary budget before the September 30 fiscal year (FY) deadline. As a result, NCI often begins the year spending at a rate based on the prior year's budget during a "continuing resolution." This has an impact on grantees, as resources are held back and only a percentage of the grant is paid until more clear information is obtained about the actual appropriation. Our grants management and budget staff work diligently during this period to serve both NCI and the institute's grantees.
Let's look at the FY 2006 appropriation as an example of the process that must take place. Sometimes you need to read the fine print because, while an appropriation dollar figure is published, in FY 2006 there was an across-the-board 1 percent decrease in the discretionary budget. NCI experienced further decreases that included, among other mandatory commitments, a tap for the NIH Roadmap, rising utility costs, and also unforeseen expenses from the Department of Health and Human Services (HHS), such as Katrina relief and additional support to the Centers for Medicare and Medicaid Services call center as a result of strong beneficiary interest in the new prescription benefit program.
Added to this are the large NCI programs, such as the 61 NCI-designated Cancer Centers, the Specialized Programs of Research Excellence (SPOREs), and congressionally mandated programs like the Small Business Innovation Research grants. Given the very large proportion of the budget already committed, with a flat budget, the institute's flexibility becomes severely limited.
NCI's Leadership Is Working to Meet the Challenge
During the past 2 years, the leadership of NCI - that is, the Executive Committee (EC) - had to redeploy resources in order to maintain momentum toward the institute's strategic goals. The EC has engaged in a rigorous review of division programs and made tough decisions about what projects should be maintained, downsized, or even eliminated in order to find funds to redeploy.
The EC began work on the FY 2007 budget by holding a 2-day retreat this spring, during which each of the divisions and centers presented their programs tied to a priority ranking. Each EC member voted to maintain, reduce, phase out, or expand each of the programs and major initiatives. Their scores will be reviewed and discussed at future EC meetings over the summer. During these meetings, the division and center directors are working as a cohesive leadership group. I've been thoroughly impressed by their ability to work together to make tough, and often emotional, decisions.
This process provided the entire NCI leadership with an understanding of what could be done across divisions to maximize resources and gave us an opportunity to explore scientific opportunities that spanned divisions. The scientific retreat will be followed by a similar in-depth review of NCI's infrastructure support with the goal of making NCI leaner and more cost efficient in those offices providing support to the institute.
Involving the Extramural Community Is Critically Important
These decisions of resource allocations and priorities are not made in a vacuum. NCI leaders rely on guidance from our key advisory boards, which provide scientific review of research proposals and guidance on establishing priorities. This feedback - during regularly scheduled meetings, such as subcommittee deliberations and the annual advisory board retreat - figures prominently in the EC's budget deliberations.
There are also opportunities for scientific input during meetings of the Cancer Center directors and SPORE principal investigators, as well as during the AACR and ASCO annual meetings. During the year, many groups visit NCI to offer advice; in addition, there are numerous informal discussions between NCI leadership and the scientific leaders in the extramural community.
Looking Ahead - Some Personal Thoughts
There is broad agreement among NCI leaders about our path forward. First, we must continue to address NCI's strategic priorities by funding new initiatives. Second, we are committed to maintaining the number of competing awards and to funding new investigators. As a nation, we need to continue to make biomedical research an attractive career choice. It would be devastating if the best minds are kept away from a field so vital to our nation's health.
Since 1971, NCI has experienced budgets that have cycled with peaks and valleys - some periods included substantial growth, while other years were characterized by deep budget reductions. For the last 2 years, NCI's budget has essentially been flat, coming on the heels of a nearly 80 percent increase in its budget from 1998 to 2003. This trend has required NCI leadership to engage in tough budget planning sessions where priorities and strategic direction depend on limited available dollars.
Discussing priority setting and budget planning in this and other venues ensures greater transparency and openness. Hopefully, it will have another outcome: to unify the voice of advocacy for cancer research and care. Often fragmented, cancer advocacy is frequently tied to individual cancer types or specific scientific programs. To make the kind of impact that is needed today, we must speak with a unified voice to ensure adequate support of the entire cancer research agenda in the United States. We cannot afford to divide ourselves into factions that advocate only for support of liver cancer or prostate cancer or SPOREs. We must propose solutions as a community if we are to be effectively heard.
In my own research career, I have experienced similar swings in biomedical research funding. Such swings can take their toll on scientific momentum and discourage new investigators from committing to a career in research. I am urging us, as a cancer research community, to speak with one voice for a national plan that supports the biomedical research enterprise. I believe that such a plan is needed to maintain the United States' position as a worldwide scientific leader. The future of science will depend on investment in the life sciences, genetics, and biotechnology. We also need to recognize the importance of health care as a driver of the country's economic welfare.
So, yes, we face significant challenges. But I continue to be optimistic because I have seen what the cancer research community is capable of accomplishing, regardless of the obstacles presented to us. Our responsibility is to continue conducting quality research, offering solutions to our challenges, and speaking with a more unified voice to usher others to action on behalf of cancer research and, ultimately, cancer patients.
Dr. John E. Niederhuber