Neighbor Tuesday: Additional NIH cuts, NIH subaward changes, impact to global health, and unconscionable actions

The changes to NIH, foreign aid, USAID, and funding freezes and the impact of all of that is beyond devastating. And, it keeps getting worse. Let’s do a quick recap of what’s happened so far. (Bonus: You can click on the links titled ‘From this post’ to read more about the topic.)

1. From this post: To date, billions of dollars in NIH grants have been canceled. But, as with all things right now, the impact is not equal.

In the past month, 600 grants have been canceled- all of which deal with diversity, equity, inclusion, LGBTQ+ research, COVID/pandemic response, women’s health, minority health, and (one of the hardest one to type) early-career scientists. If you look at the 48+ pages of cancelled grants (so far - 48 pages!), pages and pages of them are for early-career scientists like myself (in the link, look for the grants starting with a ‘K’ in column 2) or for students (look for the F31 grants). Ok, I’m getting teary even looking at it, especially for the F31 grants for students. These are specifically for PhD students just getting started, and the grants provide SCHOLARSHIPS. It’s just devastating. Many of these students cannot afford their program without scholarships. Look also at the P01 grants - these are large center grants that fund LOTS and lots of people and are given to highly innovative projects that take large teams doing big dream-type-research. One at Duke was looking at the development of a Pan-betacoronavirus vaccine that would work better than our current vaccines against new strains of COVID - cancelled. Below are screenshots of some of those 42 pages. They are not meant to be read - but, I wanted you all to focus in on the immensity of cancelling even one of those grants means cancelling a student working with community health centers for migrant children, a young investigator researching women’s health, a seasoned scientist working on life-saving cancer treatments, and all of their teams. I don’t really know how to put this into words, but I hope you’re feeling the emotion of it. It’s devastating. For those of us in limbo, it’s also scary.

2. From this post: With a budget of $48 billion, the NIH is the largest funder of biomedical research in the world. To put this into context, $48 billion is less than 1% of the overall federal budget.

So, gutting it with cuts to grants is not cost-saving. Neither was cutting USAID or foreign aid. Cuts to NIH COMBINED with cuts to USAID and foreign aid will only save about 2% in federal spending. It’s not saving money to cut. It’s a smokescreen.

In 2024, a study found that every $1 invested in NIH programs/research produces $2.56 in economic activity, resulting in $94.5 BILLION to the economy. Investing in NIH (and all the staff, scientists, students, etc) is good for our personal health - and also good for the economy’s health too.

3. From this post: The gutting of NIH indirect rates to universities means that hundreds of people are losing their jobs.

Think of your job and who helps you do it well. If you’re a teacher, that’s the principal, the always-awesome administrative staff, the janitorial staff, etc. Now imagine losing all of that and now you were doing the work of 5, 6, 7 people. That would be like losing indirect funding to scientists. So, indirect funds allow for universities to hire the support needed to do good science. And employs lots of great people along the way.

4. This week, everything got a lot worse for global health.

In a recent announcement, NIH announced that subawards for global work would be prohibited because of the “lack of transparency” and the “need to maintain national security”. Here’s a screenshot:

For my work, most of you know that I do global health work for children with cancer in some of the countries in the world that need it the most. Most of the children in these countries come in too late because the parents can’t afford the transportation costs to get to the hospital. The families have to make a decision between chemo for one child and food for the rest of the family. So, that means that 80-90% of children die from cancer in low-income countries, compared with that same percentage surviving in high-income countries (like the US). This is one of the starkest disparities in global health. I was awarded an NIH 5-year grant in Tanzania to figure out how to help families get the child with cancer to treatment earlier and make sure that decision doesn’t bankrupt the family. The grant was awarded to Duke, and then we (Duke) contract out to our Tanzania partners. Here’s the gorgeous Kilimanjaro Christian Medical Center, where our partners are. See Mt. Kili saying ‘hi’ in the background? It’s 1000x more incredible in person than this picture.

That ‘contract’ is called a ‘subaward’ in the grant world. My subaward ensures that I can hire an incredible team of in-country data collectors, data analysts, physicians, nurses, etc to do the work. Subawards also include any coverage of treatments for patients, food for outreach activities to rural villages, bednets to protect children against malaria…you get the picture.

Subawards are our main way of neighboring with our global health partners.

This way of doing grants has been a long-standing partnership between NIH and our foreign partners. At the same time of doing the work for the grant, the MAJORITY of us working in these countries are also building research capacity at the same time. For example, in my grant, we’ve matched’ the Tanzania data collector and analysts with a US-based data collector/analyst - often that is a Duke student getting his/her Masters degree in global health. This ‘matching’ helps train the next generation of epidemiologists, public health professionals, physicians, etc that are in Tanzania. The goal of this training is to one day work myself out a job there and hand over the research project (including the administrative and logistical parts of it) entirely to the Tanzania team. That’s always been the goal for myself and for ALL of my colleagues that I know doing similar work.

Subawards are our main way of doing that with our global health partners.

In other words, there’s no corruption. Subawards are how we build partnership with the long-term goal of bolstering their own research infrastucture. If you look back at the screenshot above of the Updated NIH Policy, it reads like there’s been a lack of transparency, corruption, misuse of funds, reporting corruption, etc. It reads like those of us working in global health through NIH-funded projects are misusing our funds, lacking transparency with how we have spent our money, etc. I can tell you exactly what I’ve spent the money on. I can tell you the accounting systems that are in place. I can also tell you that it’s not a lot of money to begin with. There’s no corruption or fiscal irresponsibility.

So, this new ‘policy’ feels like another smokescreen of blaming our international partners and NIH researchers for something that’s not going on. Now, do I think it’s a perfect system? No, but nothing is. And, if you want to look at corruption with funds, this is not the place to do it.

I guess what I’m trying to say is that the new policy is a smokescreen and an excuse to compound the already devastating effects of the changes in international partnerships. First it was the foreign freezes, then the USAID destruction, then canceling of hundreds of equity-based grants, and now the subawards. The compounding effects feel, well, cruel. And, unjust, irresponsible, untrue, and un-neighborly.

If you look at the new policy statement, the end result is basically ending all international grants with a subaward going to anyone outside the US. And, making the international partners be the prime designate of the grant and the US is now a sub. In theory, I love that idea! In fact, that’s the goal of us building research capacity in the first place. The goal is that our Tanzanian colleagues would be prime on a grant and we (in the US) would be the subaward. But, that takes an immense amount of infrastructure to build - and, that takes a lot of time and partnering. We are currently doing that - but, it will take more time. And this abrupt stopping halts that in destructive and cruel ways. It doesn’t make sense, is fiscally irresponsible, and humanly cruel. It is not as easy as ‘switching’ the prime on a grant to Tanzania.

A last word - Most of us got into this global-health-work to be the ‘helpers’ (like Mr. Rogers talked about) in the world - to be neighbors in collective solidarity. More often than not, that means we go to where the need is the highest - and, 99% of the time, those are regions with incredibly high rates of poverty, lack of infrastructure, healthcare access, availability of medicines or doctors, etc. So, expecting those regions to also have the capacity to manage grants like a large US-based institution that’s been doing it for decades is unrealistic. To me, this feels like modern-day colonialism of a country with ‘power’ telling other countries what to do. (I wrote several chapters on that in my book if you are interested in the intersection of colonalism, poverty, and global health.) We (my team and I) are trying to make sure we have enough chemo available for these children. Now, having to make sure these regions can also be considered ‘prime’ for an NIH grant is a big lift and will take time. It will also distract our ability to get chemo available in time (or HIV care or maternal/child care or…). And, will take money which continues to being cut - daily. See why I keep calling it ‘cruel’?

We, in global health, are reeling from these new policies. They keep coming and keep getting worse. Yes, we are resilient, and you bet I’m moving forward still. I’m pivoting and trying to be innovative and pivoting again. We all are. But, we shouldn’t have to move forward like this.

What can you do?

• Call your Congress person. Send them an email. Forward this post to them. And, then do it again the next day. I know I’ve said it before, but I’ve been told from people on the Hill that our advocacy is working!!! And continues to work.

• If you need help figuring out who to contact in Congress and what to say, our science-gal-pal-Dr.-Liz (and new Chief Science Officer at the Nerdy Girls - one of my fav groups!) wrote a great post helping us do that. You can read it here.

• You can also donate to those of us now in need. I wrote about my grant being affected here, and the response from this FNE community here. I continue to be gobsmacked at the response - and, I know that I’m one of hundreds in need because of these unnecessary global health cuts. Thank you for considering my team! If you want to still donate (including through check or QCD), you can here! We set up a fund through Duke so all donations are tax-deductible.

• Many of you know that I sometimes write from a Christian faith perspective since my husband’s a pastor. If you’re a person of Christian faith and in the US, please push back on the Christian Nationalism that is pervasive in this space of foreign aid. I keep hearing religious lingo justifying these foreign aid or NIH cuts. But, I can’t think of anything more unlike Jesus than taking money away from the poor, not feeding the hungry, refusing to clothe and house, not welcoming our neighbors. What would Jesus do? Not what’s happening today. If you hear that verbiage from friends or your church, please push back. (You might also consider finding another church like we did. You can read about how we came to that decision here.)

These days are hard, neighbors. But, also beautiful as I wrote about in Friday’s post when neighbors come together. Onward we go - pushing forward and against at times - but, also walking hand-in-hand with others that make it easier. Thanks for doing that with me.

In solidarity,

Emily