Up-is-down falsehoods are a hallmark of the second Trump administration. One vivid example: how they claim to advance science while taking actions that undermine it. So, when the White House Office of Science and Technology Policy (OSTP) published a request for information on “Accelerating the American Scientific Enterprise,” the Jacobs Institute of Women’s Health and Union of Concerned Scientists used the opportunity to recommend reversing some of the administration’s actions that are particularly destructive to biomedical science.
The National Institutes of Health (NIH) is the world’s largest public funder of biomedical and behavioral research. It has funded research that has led to innovations in genomics research, cancer treatment, and many other areas. Drawing on expertise inside and outside government, NIH supports the development of young scientists, enabling research careers that advance science and support the economy. The Trump administration has imperiled future such innovations by canceling millions of dollars in NIH grants, slashing staffing in offices that handle grant applications and management, and overturning the processes by which the agency uses expert input to award funding.
OSTP’s request for information seems to assume that scientific innovation should take place primarily in the private sector, but NIH funds the basic research that few private companies are willing to take on. In the case of drug development, NIH-funded research generates biological and chemical insights that allow investigators at universities and drug companies to synthesize new drugs and test the most promising candidates in clinical trials. Researchers at Bentley University found that NIH funding contributed to every one of the 210 new drugs approved by the FDA in 2010-2016. These authors reported that more than 90% of the $100 billion in relevant NIH funding was basic research related to the biological targets for drug actions—in other words, it provided the broad foundation for industry’s narrower research and development efforts.
In our comment to OSTP, we used the example of hepatitis C drugs to demonstrate the crucial role NIH plays in funding both basic research and research to help innovations reach the people who need them—and how the Trump administration’s attacks on science threaten such work in the future.
NIH’s role in a game-changing cure
The hepatitis C virus (HCV) spreads through exposure to an infected person’s blood. Sexual contact, sharing drug use equipment, needlestick injuries to healthcare workers, and maternal-infant transmission at birth are all potential routes of infection. People can also catch the virus from sharing grooming supplies like razors, toothbrushes, or nail clippers. Some people who get infected clear the virus, but many people develop chronic infections that can lead to liver damage, liver cancer, and even death. Most infected people don’t have symptoms and need to get tested to know they’re infected.
Prior to the approval of game-changing new drugs in 2013-2016, people who learned they were HCV-infected were offered a lengthy course of treatment that came with severe side effects and high treatment failure rates. But for the past decade, we’ve had access to direct-acting antivirals (DAAs) that can cure HCV far more reliably and with a much lighter burden of side effects than earlier treatments. Although in the US high rates of injection drug use contribute to continued spread of HCV and high prices for DAAs limit the number cured, HCV-related deaths have dropped substantially in this country — and countries like Egypt (which obtained a 99% discount on a DAA treatment) and Norway (which provides DAA treatment free of charge) are on track to eliminate HCV.
NIH funding played a key role in the development of this class of drugs, but the agency didn’t stop there. Realizing the potential of a new drug requires ensuring that the people who can benefit from it both know they need it and are able to get it. The US Department of Veterans Affairs (VA) is the nation’s largest care provider for HCV-infected patients. Between January 2014 and June 2017, VA started 92,000 veterans on DAA treatment thanks to a redesigned process for HCV testing, treatment, and management. As is often the case, though, people with the most challenging circumstances—low incomes, unstable housing, substance use disorders, multiple challenging medical conditions—were less likely to go through the process and get cured. This is where the social science arm of NIH-funded research becomes important. NIH institutes funded studies into HCV-positive populations who weren’t getting cured—including Spanish-speaking community health center patients, Veterans Health Administration patients with alcohol use disorder, and patients facing socioeconomic adversity—as a first step to designing systems that will do a better job reaching them. These investments go beyond the individuals who need them most: the ability to treat a wider range of people means all of us are safer from HCV.
Innovation under threat
Drugs and other interventions to cure a severe and potentially deadly disease are the kind of thing government research funding should support. This vital innovation is under direct attack by the Trump administration. The 383 NIH-funded clinical trials whose funding was terminated between February and August of 2025 disproportionately studied infectious diseases, prevention, and behavioral interventions. A Congressional Budget Office analysis found that a 10% reduction in federal funding for NIH would decrease the number of new drugs coming to market by about two drugs per year. Over a decade, with 20 fewer drugs than we would see under 2024 funding levels and procedures, there is a greater likelihood that one of those drugs would be something like a DAA for HCV—a transformative advance that can save lives and increase years of healthy life for a large portion of the population.
Another threat to disease cures is the deceptively named “Gold Standard Science” (GSS) executive order and the accompanying guidance. As others have noted, the GSS approach makes no mention of the importance of conducting independent science free of political interference, and it opens the door to political interference by putting political appointees in charge of evaluating alleged violations of scientific standards. It’s a political restriction on science dressed up, unconvincingly, as scientific principle.
Failing to support independent agency science imperils the uptake of innovative drugs. FDA scientists are responsible for examining the research that manufacturers submit as part of their applications for new drug approvals. Their work, along with the input of advisory committees, informs FDA Commissioners’ drug approval decisions. A rigorous process for evaluating new drug applications—and, importantly, for monitoring and responding appropriately to data collected once drugs are on the market—helps make sure that the drugs available to US consumers are safe and effective. If the public loses trust in FDA’s process because they fear an appointee is pressuring career staff to distort their findings about a drug’s safety or efficacy, or because an appointee is stacking an advisory committee with ideologues rather than independent experts, clinicians will hesitate to prescribe new drugs and consumers will be less willing to take them.
Our recommendations
Whether we know it or not, most of us have benefited from a drug or other intervention that NIH supported. To keep the innovation engine running, our comment to OSTP recommended that the administration restore NIH funding and grantmaking procedures to what they were at the end of 2024, and rescind the GSS order and guidance.
We should also support responses like the Scientific Integrity Act, which would require agencies to adopt scientific integrity policies that prohibit political interference in scientific research and designate career staff (not political appointees), to implement them. Such safeguards can help ensure that future investments in biomedical and social science research actually improve public health and wellbeing.
For decades, government investments in basic biomedical research have been the foundation for innovation across the private sector and academia. By firing scientists, canceling grants, restricting what experts can study, and putting every part of the process at the whim of politicians, the Trump administration is hammering away at that foundation—and without it, the house won’t stand.