Francis Collins, Director of the US National Institutes of Health, wears a lapel pin in the shape of a guitar pick, on which is written HOPE@NIH. Collins is a musician as well as a physician, scientist, and administrator. The pin not only conveys the conviction of many patients who have been involved in clinical trials but also reflects the driving force behind much US policy for NIH.

President Joe Biden shares that hope. In his first speech to Congress, he laid out an aspirational plan for government to make the lives of citizens better. This included the call for a new health agency under the auspices of the NIH similar to DARPA, the Defense Advanced Research Projects Agency, whose mission is “to develop breakthroughs that enhance our national security.” 

Biden argued that an “advanced research projects agency for health” should have the “singular purpose to develop breakthroughs to prevent, detect and treat diseases like Alzheimer’s, diabetes and cancer.” 

He then recalled the creation of the “Beau Biden Cancer Moonshot,” named after his son who died of glioblastoma, a particularly aggressive and deadly form of brain cancer. “I can think of no more worthy investment,” Biden said. “I know of nothing that is more bipartisan. So, let’s end cancer as we know it.”

Yet is the creation of a new agency the best approach? The 27 institutes and centers of the NIH are already focused on developing breakthroughs to prevent, detect, and treat diseases like Alzheimer’s, diabetes and cancer.

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Do we need more units?

A new administrative component under NIH auspices as the President proposed may entail moving personnel from existing institutes and creating an entirely new cadre of administrative staff to provide services for them, with added inefficiencies and red tape.

Creating breakthroughs starts from the bottom up, with basic research. Scientists can only start at the baseline of the state of the field in their area of research.

The mRNA vaccines against Covid-19, for example, were developed quickly because of research since 1990, when scientists at the University of Wisconsin supported by an NIH grant learned that they could inject mice with mRNA to make their cells produce a protein. Since then, scientists in academia and commercial firms raced to figure out how to create mRNA vaccines and therapies that would be stable enough for clinical use.

When the pandemic arrived with its urgency and extra funding from Operation Warp Speed, the final formulation of vaccines could be made at the same time as clinical trials were run. It took decades of basic scientific research to provide the baseline from which the mRNA vaccines seemed to appear so quickly. This couldn’t have been mandated, let alone predicted.

Funding is the key

A critical factor for research advances, therefore, is funding over time. Research costs money for personnel, both current and trainees; for lab space and instrumentation; and – especially expensive – for clinical trials.