Disruption At NIH Likely, But Direction And Kinds Of Changes Unclear

Once dismissed as “fringe” by Francis Collins, former Director of the National Institutes of Health, Jay Bhattacharya is President-elect Trump’s pick to run the NIH, the world’s largest funder of biomedical research. Bhattacharya has a medical degree and is a health economist. He is a professor at Stanford University.

Trump announced the selection of Bhattacharya on Truth Social: “Together, Jay and RFK Jr. will restore the NIH to the Gold Standard of Medical Research as they examine the underlying causes of, and solutions to, America’s biggest Health challenges, including our Crisis of Chronic Illness and Disease. Together, they will work hard to Make American Healthy Again!”

While disruption at the NIH is likely should Bhattacharya be confirmed by the Senate, the specific direction the agency will take is far from clear.

Republicans in Congress want to reform the NIH and make changes to the ways in which its $47 billion research budget is allocated. The impetus for an overhaul of the agency comes in part from a desire to rebuild public trust following perceived failures in its handling of the COVID-19 pandemic.

Bhattacharya rose to prominence during the COVID pandemic when he became a critic of the public health response. As co-author of the Great Barrington Declaration in October 2020, prior to there being a vaccine, he advocated a “focused protection” of those most vulnerable to the coronavirus while letting it spread elsewhere in the population to arrive at herd immunity. Population immunity never happened and many in the science and public health community denounced the policy outlined in the GBD.

Like many other Republicans, Bhattacharya believes in the so-called lab leak theory, which suggests that the coronavirus originated in a laboratory in Wuhan, China. The NIH has denied funding gain-of-function studies in labs in China that would make a coronavirus more dangerous to humans. Moreover, former top-ranking NIH officials, such as Anthony Fauci, has pointed to “accumulating evidence” that the coronavirus was transmitted naturally at a wet market in Wuhan.

Nonetheless, harsh condemnation lingers, with Bhattacharya being one of the most vocal critics: “Fire all the people currently responsible for pandemic preparedness. They likely caused the pandemic, locked you down, kept your kids out of school, demolished economies, and want more power to do it again,” Bhattacharya posted on X in January of this year. And just last week, he added “it is not a virtue to exaggerate an infectious disease threat at the start of a pandemic to panic the population into compliance. It’s not a vice to ask for data to understand the true risk.” Further, in response to his nomination by Trump, he wrote “we will reform American scientific institutions so that they are worthy of trust again.”

Perhaps these statements provide clues as to what Bhattacharya may or may not do with respect to policies related to pandemic preparedness. This is certainly important in light of the potential threat that bird flu could pose. But the NIH is much more than an entity designing ways to plan for infectious disease outbreaks. It is a driving force behind research aimed at improving public health.

And, as for hints regarding which NIH reforms Bhattacharya would pursue, these are murky at best. Would he, for instance, go along with what his prospective boss, nominee for Secretary of Health and Human Services, Robert F. Kennedy Jr., has said and fire and replace 600 employees at the NIH? Or, as a corollary, would he seek to cut roughly in half the number of NIH institutes and centers from 27 down to 15, as Republican legislators have urged?

Republican lawmakers, such as Representative Cathy McMorris Rodgers, have embraced holism, with the goal of eliminating the demographic- or disease-specific siloed nature of the current NIH structure, hereby ensuring that each institute is considering the whole individual and all populations across the entire lifespan. One example of this is combining organs such as the heart, lungs and gastrointestinal tract into a National Institute of Body Systems Research.

Also, would Bhattacharya institute Kennedy’s suggested eight-year pause for infectious-diseases research at the NIH so that the agency can instead focus on chronic diseases such as diabetes and obesity?

If confirmed, Kennedy will be in charge of HHS, including all 13 operating divisions (ten agencies) that are housed within the department. As reported in the Washington Post, he sees it as his mandate to “clean up corruption and conflicts at the agencies and to end the chronic disease epidemic.”

Maybe chronic disease, and specifically obesity, would be one of Bhattacharya’s priorities, given that more than a decade ago he published several studies examining the high costs associated with obesity. He described the difficulties policymakers encounter when trying to reduce obesity. “Behavioral economists have pointed out that many people lack self control over their dietary and exercise habit. … optimal population weight and how to achieve it is a complicated and controversial topic, filled with tradeoffs, and an area where uninformed tinkering with public policy can have unexpected and in some cases undesirable results.”

Here, his nuanced perspective could collide with Kennedy’s view expressed on Fox News in October that “if we just gave good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight.”

And as evidenced by the long history of federal government initiatives on obesity prevention which have focused on altering dietary patterns, what’s conspicuous is that there isn’t a lot of novelty in Kennedy’s proposals other than the hyperbolic messaging. Similarly, the Department of HHS has been in the business of putting forth series of chronic conditions initiatives for many years under successive administrations. Likewise, the Centers for Disease Control and Prevention have provided numerous reports on chronic illness and associated expenditures.

With the exception of a deemphasis on pandemic preparedness, particularly around blunt applications of the precautionary principle (a conservative approach to managing risk in the face of uncertainty), the kind of disruption of the agency that the nominee for Director of the NIH, Bhattacharya, would preside over, is unclear.