The Budget Landscape with Dr. Douglas R. Lowy

Dr. Douglas R. Lowy

By Erik MacLaren, PhD

The National Cancer Institute (NCI) and researchers who rely on the funding it provides have spent much of the past year under the shadow of expected cuts in federal funding. President Trump’s budget request last year proposed cutting the National Institutes of Health (NIH) budget overall by $7.7 billion to $26.9 billion, a reduction of 22%. After a 6-month delay, Congress passed a spending bill for 2018 that unexpectedly increased overall NIH spending by $3 billion, or 8.3%, to $37 billion, exceeding the initial funding proposals of both the U.S. House of Representatives and the Senate.

Although unexpected, the budget increase from Congress continues a trend of bipartisan support and 4 consecutive years of increasing appropriations for the NCI and NIH as a whole. Douglas R. Lowy, MD, the deputy director and former acting director of the NCI, explained the yearly funding process to the IASLC Lung Cancer News. “First, Congress decides how much to appropriate to the NIH via the regular appropriation,” he said, including two main components: individual funding for special projects given to specific institutes and centers, and general funds, which are distributed based on the prior year’s appropriation.

The 2018 spending bill will deliver an increase of $275 million for the NCI’s “regular appropriation,” bringing the total budget to $5.665 billion. In addition, the 21st Century Cures Act, passed in 2016, authorized $1.8 billion over 7 years to fund the Cancer Moonshot including $300 million to fully fund the Cancer Moonshot for 2018.1 (See the sidebar for more about the Cancer Moonshot.) In terms of allocating funding for specific diseases or research areas, such as lung cancer or immunotherapy, Dr. Lowy explained that the NCI does not predetermine spending, but instead relies primarily on the process of peer review to determine which specific proposals are funded based on factors such as scientific merit. “Advances in one cancer type often benefit other cancer types,” he said. He also noted that “the NCI rapidly developed an extensive process for funding new awards related to the Cancer Moonshot, in line with the recommendations of the Blue Ribbon Panel,” and these are posted to the NCI website.2

At the American Society of Clinical Oncology’s annual meeting this past June, NCI Director Norman E. Sharpless, MD, discussed some of the ways the institute will use the budget increase.3 Nearly half of the funding increase, $127 million, will go to the Research Project Grants (RPG) funding pool, which is the source of most investigator grants from individual R01s to program project grants like P01s. This is the biggest increase in the RPG pool since 2003, and Director Sharpless described the decision as the most direct way for the institute to support investigator-driven research. He also emphasized the importance of investigator-initiated discovery as opposed to a top-down approach. Additionally, the budget increase has allowed the NCI to set aside funding dedicated to early-career investigators and increase the number of R01s awarded to these investigators by at least 25%.

Other areas benefitting from extra funding include big data and the NCI’s clinical trial networks. In order to create better tools to leverage large, complex datasets while protecting data privacy and security, the NCI is developing the Cancer Research Data Ecosystem, a project that received significant new targeted funding from the Cancer Moonshot. An additional $10 million will go to the National Clinical Trials Network and the National Community Oncology Research Program to increase perpatient reimbursements, off-setting higher costs to participating institutions.

This year, the White House’s budget request for overall NIH funding is flat. Asked what researchers should expect in 2019, Deputy Director Lowy noted that the budget request is only the first step in a lengthy process. Congress recommended increases to NIH funding in 2018 above the President’s budget, and this year, subcommittees in the House and Senate have once again proposed an increase to the NCI’s appropriation. However, any optimism should be tempered by the uncertainties involved. “Of course, it remains to be seen what the actual appropriation will be,” Dr. Lowy said. ✦

Resources:

1. National Cancer Institute. NCI Budget and Appropriations. https://www.cancer.gov/about-nci/budget. Accessed July 9, 2018.
2. National Cancer Institute. Cancer Moonshot. https://www.cancer.gov/research/key-initiatives/moonshot-cancer-initiative. Accessed July 9, 2018.
3. National Cancer Institute. Selected Presentations by the NCI Director. https://www.cancer.gov/about-nci/leadership/director/presentations/. Accessed July 9, 2018.