Hearings to examine proposed budget estimates and justification for fiscal year 2027 for the National Institutes of Health.

Well, good morning, and I want to welcome everyone to our hearing. I'm going to give an abbreviated statement, and I will be adding more into the record. I want to thank Dr. Bachera and all of his colleagues for joining us this morning. This is really an important opportunity after— to look at the NIH budget from last year to see how we can understand priorities for 2027. I think all of us care a lot about biomedical research.

It's long been a bicameral and bipartisan priority, and I'm proud of the work that we did last year where we secured an additional $415 million for NIH funding. Areas of concern for me, and Those at the dais know this, are things— we're ground zero for the opioid epidemic in West Virginia communities. We still have some of the highest rates of overdose deaths, but we're making positive strides as we are across the country. Some of the CDC data shows a decrease, and I want to thank Dr. Volkow for coming to West Virginia and coming back, maybe, to West Virginia for visiting. We just had Dr. Hodes there as well.

And we're really pleased because of what's going on at the Rockefeller Neuroscience Institute. I think he was pretty wowed to see what WB is doing and the innovative and groundbreaking work that we're doing there. As a child of two parents who had Alzheimer's, I don't want to just find ways to keep people in a steady state. I want to find ways to cure, and I think that's what the NIH is all about. So one other area of interest for me is the Childhood Cancer Star Act.

I did that with Senator Reid. So Dr. Latai, thank you for coming to my office and looking forward to hearing about how you're going to grow our clinical trials in that area. So with that, I'm going to go ahead and turn to Senator Baldwin for her opening statement. Thank you, Chair Capito, and I want to welcome Dr. Bhattacharya and the Institute and Center directors here today. Um, I also want to note that the director of the National Institute of Allergy and Infectious Diseases was slated to testify, but, uh, stepped down from his position.

Other top officials at NIAID have also reportedly been reassigned and forced out of their positions. In the midst of an emerging Ebola outbreak, We have a leadership vacuum at the world's premier infectious disease institute and across our health agencies. Uh, this is of great concern. And that, of course, is in addition to the unprecedented termination and forcing out of thousands of career scientists across the NIH as part of this administration's anti-science and frankly anti-vaccine, uh, bent. Over the past 16 months, the Trump administration has waged war on science.

And I'm not talking about isolated policy disputes or partisan disagreements. I'm talking about systemic— systematic dismantling of longstanding research programs and the deliberate erosion of research institutions that make America the global leader in biomedical innovation. Across the country, researchers, universities, cancer centers, children's hospitals, and patients are experiencing disruptions because this administration has thrown NIH into chaos. They have terminated over 5,000 NIH grants, slashed nearly a quarter of NIH, uh, the NIH workforce, and cut the number of new research grants by more than $2,000 or 22%. That cut was largely due to a policy that OMB— the OMB director cooked up that requires NIH to expand multiyear funding, forcing the entire cost of a multiyear grant to be paid in advance.

This wasn't based on science or boosting the discovery of new treatments and cures. This was a political decision. And as a result, NIH spent $2.5 billion more on multi-year funded grants in fiscal year 2025 than it did the year before, an unprecedented amount. And what that means is that $2.5 billion was locked away in bank accounts for future years' expenditures that can't be spent on research now. Or today.

That's $2.5 billion that could have funded over 2,000 more research grants, each one a shot we didn't take at discovering the next medical breakthrough. There is simply no reason to do this. All it does is dramatically reduce the number of NIH, uh, grants funded. Take cancer research. Last year, the National Cancer Institute funded 334, or 21%, fewer new research grants.

That's 334 fewer opportunities to discover new cancer treatments and cures, an untold number of patients and families that won't benefit from this research, and this was the case across the NIH. The National Institutes On Aging, the primary funder of Alzheimer's disease research, funded 438 or 33% fewer grants last year. That's not creating stability for researchers. It's kicking the chair out from under them. I pushed hard to limit multiyear funding in our fiscal year 2026 bill, and although we included a provision that prevented the administration from doing even worse damage, I was disappointed that we weren't able to do more to stop it.

This chaos has ramifications across the country. Hiring freezes are hollowing out research labs and forcing institutions to rescind job offers to young scientists. Clinical trials are being canceled or postponed. For decades, NIH funding decisions were guided by scientific expertise and independent peer review. As they should be.

Now political appointees and ideological screening decide which grants get funded. Researchers are spending more time trying to decipher shifting political priorities than finding treatments and cures. Groundbreaking, groundbreaking research is being stifled. Notices of funding opportunities that NIH uses to solicit research on specific topics are down by 90%. These specialized funding calls are necessary for type 1 diabetes research, expanded access for ALS, um, and cancer and HIV research.

Even after this committee provided $415 million in increased funds for NIH in this fiscal year, the White House delayed getting that money out the door and left NIH unable to fund research for 40 days. I can't comprehend why this administration is so hell-bent on sabotaging the life-saving research NIH supports, but they are doing so at every turn. What concerns me most is that this damage will take years, if not decades, to undo because the cost is so much higher than lab closures, canceled clinical trials, or young investigators leaving science. The cost will be fewer treatments and cures, lost loved ones, and an entire generation of scientists gone. Congress should do more to stop this administration, uh, what they're doing to our biomedical research enterprise.

I've certainly been pushing to do that, but Congress also needs to get serious again about running a budget and appropriations process that truly, uh, allows us to prioritize biomedical research. From 2017 to 2023, we provided meaningful increases for NIH, and NIH awarded more grants each of those years. But that progress has stalled. Republicans' insistence on squeezing and cutting non-defense funding has meant NIH funding hasn't kept up with rising research costs. This, combined with misguided administration policies like multiyear funding will mean that NIH will award fewer research grants this year than any year since 2017.

Meanwhile, the president is asking for $1.5 trillion, an increase of $450 billion, or 42%, for defense spending. If we can find additional funding for bombs, we should be able to find additional funding for cancer research. We need meaningful increases in non-defense funding to be able to do that, and that's what I will be pushing for during the fiscal year 2027 appropriations process so that scientists can discover the next breakthrough and families can have hope for new treatments and cures.

Thank you. Uh, welcome, Dr. Bhattacharya. We will welcome you for your, uh, 5-minute opening statements before we go to questions. Thank you. Chair Caputo, Ranking Member Baldwin, and distinguished members of the subcommittee, it's an honor to appear before you again to discuss the work that's being done at the National Institutes of Health.

NIH's mission is to turn scientific discovery into better health outcomes and longer life for the American people. It's central to the Make America Healthy Again initiative. The NIH plays a leading role in confronting the chronic disease crisis, advancing rigorous nutrition science, prioritizing prevention, and so much more. Chronic disease remains the leading cause of death and disability in the United States, driving most healthcare costs and affecting millions of Americans. NIH is intensifying investment in research that identifies the root cause of these conditions, enables earlier, more effective interventions, including studies that, that integrate genetics, behavior, environment, and diet.

Diet is a major driver of chronic disease risk, yet critical gaps remain in understanding how specific foods affect health. Ultra-processed foods now account for about 60% of daily caloric intake, with growing links with obesity and metabolic conditions. To address this, the NIH is supporting multidisciplinary research advancing targeted interventions to address chronic disease at its source so we can make America healthy again. The NIH continues to deliver measurable progress by building on decades of foundational science. Our sustained investment in basic research is resulting in transformative clinical advances across multiple areas of medicine.

In 2019, President Trump announced the Ending the HIV Epidemic initiative, predicting that we could essentially eliminate HIV in the United States by 2030. Decades of NIH investments in basic science laid the groundwork for drugs like lenacapavir, a long-acting antiretroviral agent. A single injection lasting 6 to 12 months offers near total protection against HIV acquisition. Together with other antiretrovirals also supported by NIH research, this provides a credible pathway for ending the HIV transmission in the United States in coming years. Gene-based therapies have never shown more promise than they do now.

CRISPR-based gene editing has led to not just one but two treatments that can cure sickle cell anemia, a disease long thought untreatable. NIH-funded researchers built on this same platform to deliver personalized therapy to an infant with a rare and previously fatal condition, Baby KJ. Enabled by the NIH Common Fund, this treatment edited genes directly in the liver to correct a lethal mutation so that Baby KJ will live a long and healthy life. NIH is harnessing advances in artificial intelligence and data science. For example, NIH-supported researchers recently developed AI tools to match patients to clinical trials more efficiently, reducing the barriers to participation and accelerating access to potentially life-saving therapies.

NIH is advancing partnerships to expand the frontiers of biomedical science. We're proud to work with NASA on the Artemis II mission through the Avatar Project, which uses cells from astronauts to create organs-on-a-chip biosystems. I think my colleagues have brought an example, if you can show around, to show how— to model how deep space radiation and microgravity affect human biology. You may be asking how this helps the average American. Well, microgravity reveals aging-related changes in cardiovascular, immune, and muscular cell systems.

And this work informs treatment for chronic diseases here on Earth. While innovation is critical, affordability remains essential. Drug repurposing is a powerful lever to reduce the cost and accelerate access to this new technology. Testing FDA-approved drugs for new indications can happen faster and with less risk than for new drugs. NIH-supported studies suggest a shingles vaccine called Zostavax may reduce dementia risk, and my colleagues at the National Institute of Aging are organizing a roundtable on this.

Terezosin, long used for benign prostatic hyperplasia, shows potential on Parkinson's disease. While more research is needed, this approach allows us to deliver interventions more cost-effectively while maintaining scientific rigor. We're improving how science is conducted and funded. NIH is advancing a coordinated agency-wide effort to improve rigor, replication, and reproducibility, including the Common Fund Replication Initiative and new investments of approximately $100 million to validate key findings. I'm grateful to Congress for making that possible.

These efforts ensure the NIH-supported science is reliable, generalizable, and ready to inform clinical care. The NIH fosters innovation by supporting a balanced research portfolio. Through a unified funding strategy, the NIH is strengthening its ability to curate portfolios that span the full spectrum of scientific approaches and align with national priorities. We're working to broaden the geographic scope of funding, strengthening research capacity in institutions across the country while expanding the use of human-based research models to improve translatability, responsibly reducing animal use when appropriate. Let me just finish with the—.

Just a bit. The strength of American biomedical research lies in its rigor, transparency, and its early-stage investigators, its ability to deliver durable results. Our role as careful stewards of resources entrusted to us ensures that every taxpayer dollar produces reliable knowledge, produces measurable health gains, and has a lasting public benefit. We remain committed to scientific excellence and to improving the health of all Americans. Thank you, and I look forward to your questions.

Thank you very much, and I will now turn to the chair of the full committee, Senator Collins, for several minutes for a statement or questions or whatever she— whatever she can have, whatever she wants. I like that attitude. Just remember I'm the one who said it. Thank you so much, Madam Chair. First of all, let me welcome all of you this morning.

I have worked so closely with many of the members of this panel and admire your dedication to improving the health of the American people. There are, however, some budget issues that I find to be inexplicable in some ways. And I do want to discuss some of those with you today. In fiscal year 2025, the NIH awarded more than $120 million in grants and contracts to entities in my home state of Maine. This funding directly supported 1,378 jobs jobs and more than $280 million in economic activity.

I mentioned that because there is an economic impact to the research that we're doing, as well as an impact on the health and well-being of Americans. This funding has also led to very exciting developments such as a clinical trial for a new Lyme disease vaccine, and another clinical trial investigating how GLP-1 drugs could be used to treat Long COVID. Really exciting developments. Breakthroughs like these can only be sustained if research institutions are able to cover this cost. Yet the administration's budget request once again proposes a 15% arbitrary across-the-board cap for indirect research costs after Congress specifically blocked a similar proposal last year.

Such a cap would negatively affect cutting-edge research happening at universities, nonprofit laboratories, medical centers around the country, and undermine the foundation of our nation's global leadership in biomedical research and technological innovation. Dr. We discussed the FAIR model and other alternatives last year to have more accountability, increase transparency on indirect costs that are funded with taxpayer dollars. I would like to ask you whether you have a specific proposal for improving the current indirect cost system without adopting this one-size-fits-all arbitrary, very harmful cap across the board. Senator, we absolutely remain committed to making sure that the research institutions of this country receive the support that they need to have the success that you described. I'm really grateful that you started with the examples of a potential vaccine for Lyme disease, GLP-1s for so many different uses, and so much more.

I'm sure you could have gone on for a very long time. The key thing that I'd love to have happen, and I'm going to convene a committee of my advisory committee directors so that we can discuss this openly, and is a proposal to de-link the way to compete, to allow competition, free and open competition for these facilities money the NIH has for institutions. The key idea is that right now, in order for Maine and other places to win the facility support, you have to have excellent scientists that win the grants, and linked to that is the facilities money. But in order to have people win the grants in the first place, you have to have, you have to attract the great scientists to your facility. You have to have great facilities.

This catch-22 guarantees that our investments in institutions will be concentrated. 20 Institutions get about a third of our facility support. We need to fix that. And I'd love to work with you all, and I know we've had such great conversations about this, to de-link this connection and then allow there to be sort of more open competition for the facilities money by places like Maine, like Kansas, like— I've visited so many of these great institutions across the country where there's so many great scientists. We need to make it easier to build up facilities.

NIH is like seed money for these places. Once you invest, once we invest, you get other foundations investing as well. And I want to work with you to launch a launch essentially a renaissance in biomedical research across the country where we just have a couple of super biomedical hubs, but everywhere across the country where there are amazing scientific ideas, people should be able to get support for it. Thank you. Dr. Rogers, it's great to see you again, although I don't think this hearing will be quite as moving and inspiring.

As the Children's Congress hearing, at which you testified last summer. Seeing all those delegates with type 1 diabetes from across the country, including little 6-year-old Carolyn from the state of Maine, who traveled to share her story, was truly moving. Recent type 1 diabetes research funded by NIH has led to some exciting developments. And clinical trial data resulting from NIH funding, a clinical islet transplantation consortium, has contributed to FDA's approval of the first-ever stem cell treatment for type 1 diabetes. And I realize the clinical trials have been small so far, But it is so exciting that after receiving this treatment, 10 out of 12 patients in clinical trials no longer needed insulin.

That is extraordinary. Therefore, for the life of me, I cannot understand why the budget would propose a $167 million cut for your institute, the National Institute of diabetes and digestive and kidney diseases. By contrast, we have increased funding for the Special Diabetes Program. But this is the last point at which we should be cutting funding for biomedical research, period. But your institute, given that we're finally seeing real progress, could you please comment on this.

Sure, Senator Collins, first of all, thank you for your ongoing support for the Special Diabetes Program and yours and your colleagues. This has really led to some major breakthroughs in the way that people in this country with type 1 diabetes have enjoyed long and very— the quality of life has changed dramatically. You mentioned the first-ever FDA-approved stem cell treatment transplantation, but also the first drug under your watch, teplizumab, which can delay the onset of type 1 diabetes by at least 3 or more years. And also, it was that SDP support that's responsible for 5 of the 6 commercially available artificial pancreas technologies, and these are now being applied in many other areas. A reduction in funding will have consequences, of course.

We'd have to either delay or postpone many of our efforts, including our trial net effort, which was actually the vehicle which led to this approval ultimately of the first drug to delay the onset. And we're right on the cusp of understanding what the The environmental determinants of diabetes in youth, or the so-called TEDDY study, we're right at that point where we're in the intense data analysis phase. This could certainly delay that to some extent. Nonetheless, we're very help— we're very thankful for what we get and we'll make the appropriate adjustments as necessary to ensure that all of our funding goes out as required by the law. Thank you.

Thank you. Thank you, Madam Chair. I know I've gone over my time. I will submit for the record, uh, questions on Alzheimer's disease, which is also one of our top priorities, and women's healthcare grants. Great.

Thank you. Senator Baldwin. Thank you. Um, the, the current Ebola, uh, outbreak highlights the potential use of mRNA technology to respond rapidly to viral threats. Especially ones we don't have vaccines or treatments for, like the Ebola strain that is emerging in Central Africa.

But last year, Health and Human Services terminated $500 million in contracts for cutting-edge mRNA vaccine development and then redirected that funding to 80-year-old vaccine technology. Experts have expressed serious concerns that this technology is outdated and inferior, and that the way the funding was awarded circumvented the scientific review process. Dr. Bhattacharya, will you commit to providing this subcommittee with the contracts that awarded that funding? Senator, uh, so first I should say that the, um, the bunyaviridae virus that, uh, Ebola virus that's now in in the DRC. We don't have a vaccine for it, but we do have with NIH—.

So I'm raising an issue that there was $500 million in contracts for mRNA research vaccine development that was cut off and then redirected. And so I was wondering— what I asked was, will you commit to providing this committee with the contracts that awarded that funding? So first of all—. Is that an easy yes or no? Those are BARDA contracts, not NIH contracts.

So you can ask HHS specifically. As far as NIH contracts, absolutely, we're an open book for that. Okay. Was there an open, fair, transparent call for proposals for this funding? We used this for the funding for the universal flu vaccine, you mean?

For the funding that was taken from the mRNA contracts and redirected. So the universal flu vaccine that the NIH is investing in for research, research purposes, followed our normal processes for identifying intramural research opportunities. So the answer is yes. So was there peer review of that process? It's the same standard process that we use for all our intramural researchers.

This is a very promising vaccine platform, so the idea that we could get a single vaccine that can end—. So essentially bypass the standard peer review competitive process? No, that's not accurate, Senator. $100 Million internally to two NIH researchers, one of whom is your deputy director. Senator, that's just not accurate.

It followed the normal process for determining how intramural— you know, NIH has a tremendous number of amazing scientists, some of whom you see here at the table with me. There's a normal process for deciding which projects get funded. $500 Million in contracts were terminated $100 million redirected to 80-year-old technology without competition. And the researcher, one of them is best known for being a COVID vaccine skeptic, had his lab's annual operating budget increased by more than 50 times. Did Secretary Kennedy his special assistants direct NIH to award this funding to these two investigators?

Senator, the project you're talking about is a tremendously promising project that could end—. Did Secretary Kennedy's special assistant direct NIH to award this funding to these investigators? The NIH followed normal processes for deciding whether to invest in this universal flu platform. If the project works out and looks tremendously—. Early results look very promising, we could have a single injection so you don't have to get annual flu shots.

I'm very concerned about the process, um, the lack of competition, lack of peer review. This funding was appropriated in the American Rescue Plan. Congress agreed in our fiscal year 2026 Labor HHS Appropriations Bill to rescind that funding. That bill was made public on January 20th. NIH obligated this funding on January 31st.

Well after the bill was public, but 3 days before it was enacted into law and would have been rescinded. In late January, did anyone at NIH discuss needing to award this funding before Congress rescinded it? Senator, we followed the law on allocating the funding, and we've allocated it to a very promising project that promises to end the need for annual flu vaccines with a single injection that can protect people from the flu forever. My understanding is that those discussions did happen. And to be clear, the Trump administration rushed out American Rescue Plan funding before Congress could rescind it, as we tried to do in our bill.

Secretary Kennedy has his own narrative about the effectiveness or lack thereof of mRNA vaccine technology and hiding studies to show their effectiveness is something that I'm deeply disturbed about. And meanwhile, NIH is bypassing its actual gold standard scientific review process to unilaterally award more than $100 million to two NIH researchers, one of whom is best known for being a COVID vaccine skeptic, and the other, uh, who reportedly just stepped down as NIAID director without any public explanation. Forgive me, those, those researchers you're talking about are among the most important flu flu vaccine researchers in the world. They've had a tremendous track record of success in, uh, in, in flu, uh, infectious disease for flu, and particularly flu vaccination research. I mean, they're NIH-funded researchers, NIH researchers that have been here for decades.

They're among the world's leaders in flu vaccine research. We'll expect to see those contracts. Thank you.

Well, I was going to start my question with Dr. Latai, but I have to respond a little bit, and Senator Baldwin and I get along really well. But I'm— the insinuation from the markets, we're sitting in front of 6 incredible scientists for our country that are trying to solve some of the most deepest, devastating problems, that it's being done on the lam or done illegally or done suspiciously is very offensive to me. And so I just wanted to say that before I ask Dr. Which he probably knows— he knows what I'm going to ask him, I think. I am from a rural state, as we know, and I'm very interested in the NCI Cancer Center designations.

And I've seen several projects where it talks about the concentration of cancers in rural areas such as mine, such as many of our states here. And some of the states that bear the highest cancer incidence and mortality rates remain largely without access to NCI. Designated care where it's proven the care is better, more successful, and has better rates of cure. So, you know, we have the IDEA program which has great success, and to help get some of that biomedical research out to our rural areas, what I would like to see is this NCI cancer designation branch sort of an alternative designation pathways or or something so that the structural barriers that are preventing our eligible institutes and states such as mine from getting— and I know mine's working towards this, so— and I know you're working with them and I appreciate that. Will you continue to keep looking at this comprehensive review of cancer center support?

And maybe you could give us just a, like, 30-second how much more successful the rates are around cancer center designations for the patients that are being served in those immediate or regional areas?

So, uh, thank you, Senator. First, I'd, I'd like to say that, uh, I think an undercurrent of your question is that, uh, it's no good to have major advances in cancer research unless we can reach all Americans with them. Correct. I and the NCI wholeheartedly agree with you on that. With respect to West Virginia, we are working closely with Dr.

Hazard Jenkins to make sure that, uh, when an application is submitted, it will be a successful application. As you may know, NCI-designated cancer centers are specifically designated because of their devotion to research. Right. As well as clinical, as well as basic research if they are a comprehensive cancer center. And I think that's a very laudable goal.

And I agree with you that our cancer centers, not only providing clinical care, but also advancing the standard of care, our NCI-designated cancer centers have been essential to that function. And we look forward to cancer centers from rural states joining that group. I will, I also wanna make the point though that NCI-designated cancer centers aren't the only way that we bring top-quality care to the more rural areas of America. We also have NCORP sites as well as NCTN sites throughout the country where people can enroll in NCI-supported cancer clinical trials. And that's a way of getting cutting-edge clinical research to people whether they're in rural environments or urban environments.

We look forward to continuing that. Thank you. Thank you very much. Dr. Volkow, you know in your visit to West Virginia and your many years of working in the, in your area of expertise that we still got a big problem. We're having breakthroughs also in your area.

Some exciting opioid research results from NIDA intramural research team and I'm going to I'm not even going to try to say his last name, so I'm just going to say Dr. Mike, and his team identified a novel, highly potent opioid that shows potential therapy for pain and opioid use disorder. Could you describe that research, please? Yeah, thanks very much for the question. And it is actually quite important because the overdose crisis was born out of lack of treatments for people suffering from chronic pain that led to the use of opioids. So a priority for our institute in partnership with others is to develop safer treatments for people with severe pain.

And so the one that you are reporting by Dr. Michaelides actually works. It's an opioid itself. So you can either go to mechanisms that don't invoke the opioid system or those that do. And most of the most powerful drugs we have actually activate that opioid system. What he has been able to document in animals is that this molecule activates the opioid receptor in a different way such that the signaling inside the cell results in, does not result in the respiratory depression or the addictiveness of typical opioid drugs.

So in that respect, it's a breakthrough because you are manipulating chemistry to create a conformation that can lead you to the analgesia, but it's safer. So of course we need to bring this into humans. So basically what I'm saying is, or what you're saying is, an opioid that's non-addictive that can address the pain element of that. Opioids are really good at numbing the pain, but also have the side effects of the addictiveness. Exactly.

All right. But we need to test it in humans. Right. Okay. Senator Moran.

Chairman.

Are you sure I'm next? A Democrat, maybe. I am next on our—. Oh, you know what? You are right.

Excuse me. I hate saying that to you. In my opinion. Senator Durbin. Thank you, Senator Moran and Madam Chair.

I was a sophomore in high school, 14 years old. My father had lung cancer, and he died at age 53. And I stood by his hospital bed and felt absolutely helpless and destroyed as a kid. I never forgot that experience. I never will.

So when I came to Congress, I decided to take on big tobacco. 36 Years ago, I introduced a little amendment. It banned smoking on airplanes. That amendment triggered a reaction I didn't even anticipate. It was a tipping point.

At the time we passed that amendment to ban smoking on airplanes, 27% of high school students were smoking tobacco products. 27%. Today it's 2%. But our kids aren't safe from another product of Big Tobacco. It's called vaping.

Are you all familiar with vaping? Sure you are, as medical doctors. Dr. Volkow, is vaping dangerous to children? Uh, yes, vaping is, if, um, by itself, but even more so if it has nicotine, can produce addiction in, and particularly in children, this can actually escalate. So yes.

Do you, uh, hear any statistics about the percent of kids in high school and junior high who are vaping today? Yes, we monitor it very carefully. Unfortunately, we have seen significant reductions in vaping among teenagers in our country over the past 3 years, 4 years. So yes, fortunately, because the levels were very high. How high?

Went up to 23% of 12th graders, and now we are much lower than that. So Big Tobacco is no longer peddling tobacco to your kids and grandkids. They're peddling vaping. With the same addictive qualities of that nicotine and the same danger to these kids. So the question, Dr. Bacharia, is what is this administration doing about vaping?

Senator, you heard, you heard Dr. Volkow talk about our research programs in vaping. I agree it's dangerous for kids, but I think that for the NIH, our role is to document the ways that it, that, that vaping and other other things affect the health of children, um, as well as other, other, other people. So do you see any connection between fruit-flavored vaping and children being attracted to it? I mean, I would have to do research, but I absolutely— I think that that's probably inappropriate for children to be using fruit-flavored vapes. Do you realize that the announced policy of this administration within the last 2 weeks is going to make it easier for these companies to peddle Fruit Monster vaping, Candy King vaping, raspberry slushie vape, vaping to our children in junior high and high school now.

Senator, I think that vaping for kids is a dangerous thing. And I think that is the role of the NIH isn't to set policy. It's to do research, to document the, the ways to address these health problems. But you've conceded the obvious. They're peddling flavors that attract children.

Children who don't have the maturity to make the decision, and they become addicted to a product which is dangerous to them, according to Dr. Volkow, which I couldn't agree more. So how can we in good conscience say that this administration has the best interests of children at heart when they're exposing them to this deadly product? Senator, all I can say is about the NIH's commitment to make sure that we study this issue as fairly and evenly, objectively as possible, in a rigorous way. We don't need a study. We need action.

We need to stop this. And the previous administration wasn't much better, to be honest with you. And I was pretty critical of them as well. To think that these companies, many from China, are going to peddle some product to our kids, that they're going to vape in this steamy concoction of chemicals, chromium, and God only knows what else is in it. And we're going to look the other way as this administration says, let's have some more fruit flavors on hand for kids to dabble in and to try to make a decision.

Does this make sense to you? Senator, having kids have more access to vaping does not make sense to me. Is there anyone on the panel of you 6 doctors who think this is a sensible decision by the Trump administration to make it easier to peddle fruit-flavored vaping to kids? I'm asking the panel. Kids in high school and junior high school, is there anyone among you who thinks that's a good idea?

Thank goodness you're honest in your response. Well, I— there's a disclosure today, and I don't know the source of it here, about a $5 million donation from Big Tobacco that preceded the vaping decision. Reynolds sent along a check for $5 million, and the president switched his position on this. This is ghastly to think that we're allowing this to occur. And here I am, 36 years after passing banning on smoking on airplanes, seeing us introducing a new product and new variations on it to addict our children.

For God's sake, is there one person in the administration besides those who've already resigned who will stand up and say, enough, this violates my conscience? I yield. Thank you, Senator Durbin. Before I go to Senator Moran, and thank you for correcting me, by the way, I would like to recognize two of the ACS volunteers, youth volunteers from West Virginia that are in the audience, Nicole And Brendan, can you guys stand up real quick? Thank you all for what you're doing.

Okay. Senator Moran. Chairman Capito, thank you very much. Dr. Bhattacharya, I appreciated the opportunity to welcome you to Kansas last November. I appreciate your visit.

I have already invited Dr. Rutter to come home to Kansas. Dr. Hodes volunteered to come visit Kansas on his own volition this morning. Dr. Lietai, you are the only cancer director, and it's, it's the amount of time that you've been in office, not any other criticism, that hasn't been with me in Kansas to see what we're doing. And I would extend the opportunity and welcome the chance to showcase, but more importantly, those visits I hope affect how you look at research decisions that you make. But perhaps the most value is for us to figure out how we can do our jobs better to meet the needs of this country and this world in solving the problems related to diseases and afflictions.

And so I'm very appreciative of your presence here today, and I appreciate the relationship that we've developed with you all in the past and look forward to that continuing. Uh, I want to raise first a topic, uh, and I don't know that I've asked about Parkinson's disease in any one of these hearings before, but it's certainly— I'm becoming more aware of the challenges people face in regard to this disease. FY26, we were successful in adding a $5 million, uh, amount of money for implementation of the National Plan to End Alzheimer's. And Dr. Bhattacharya or Dr. Hodes, tell me what that means as a— what, what's going to happen as a result of that. I'm going to let my colleague Dr. Hodes say, because Dr.

Hodes So the National Plan for Parkinson's Disease, for which NINDS is the—. Will be taking a major lead, follows the pattern for Alzheimer's disease in which there's a National Advisory Council that's been established. This brings together scientific experts, advocates, members from private and public sector to work together in an unusual committee structure to survey and make recommendations for progress in research, in care, in long-term services, and I think the Parkinson's initiative is intended to model very much after this very effective and very all-encompassing approach to an important neurodegenerative disease. I was involved at least the funding and the initiation of efforts to, to do what you just described in the world of Alzheimer's, and I'm pleased to see it's seen as a role model for other things that we hope can we can address, as we are doing Alzheimer's now. I want to ask a question, uh, perhaps to all of you, because I think every institute may have something to do with this topic.

I'd like to discuss NIH research on CMV. Uh, it's not a thing that's well known, but it is a common, generally harmless virus that can be contracted at any age. CMV is the most common congenital viral infection affecting newborns. According to the CMV Foundation, 1 in 200 children born with congenital CMV each year. When transmitted to a child during pregnancy, the virus is, is often symptomless, but in some cases can lead to developmental disabilities and medical conditions in children.

I'm telling you something that you know, but I want my colleagues and I to understand what I'm talking about. There are treatments that are available for children who are born with congenital CMV and display symptoms like hearing loss if administered— that, that treatment is administered to that child shortly after birth. But there's a current patchwork of approach across our states for screening, testing, treatment. In Virginia, you have a hearing test on the birth of a child. In Kansas, you do not.

And my question is NIH has funded CMV research for decades, and in recent fiscal years there's been dozens of new grants awarded for the study. Would you speak to the developments in this issue that I've raised? So thank you, Senator, for bringing to the attention of the country this, this problem. Um, cytomegalovirus, the, the, uh, the virus you're talking about, can absolutely, when infecting children, cause, uh, the, some of the conditions you talked about, including hearing loss. We have a program to evaluate universal CMV screening policies to see how it can prevent exactly the outcomes you're talking about.

I think it's not as well known as people might hear about HIV or other viruses, but it is something where potentially early intervention can make a big difference in the life of a child. And we at the NIH are absolutely committed to studying it and figuring out ways to to better prevent it and so that children don't have to suffer for it. Are there any other directors that have comments on this topic?

Okay. My time has expired. Thank you, Chairman. Senator Shaheen. Thank you.

Thank you all for being here this morning. I'm going to ask a question. I understand that Senator Collins has already asked this question, but as the other co-chair of the Diabetes Caucus, I think it's worth following up, and I'm going to direct this to you, Dr. Rogers, and to Dr. Bhattacharya, because as we all know, the federally funded research through NIDDK through the Special Diabetes Program has really made a difference in advancing diabetes treatments, which is not only smart from a personal perspective to help those people who have type 1 and type 2 who require insulin, But it makes good policy sense because it saves money in the long run. And unfortunately, what we've seen in the President's budget is that it cuts both of those programs. So can both of you share why diabetes research funding is so critical and what's going to happen— what would happen if we were to cut all of that research funding?

Dr. Rogers.

Sure. Thank you for the question. And again, thanks for your long-term support on not only the special diabetes program but other forms of diabetes, which has been extremely important. On the type 1 diabetes front, the— we're really— while we've made a lot of major findings and accelerated the course so that really the care and the quality of life has really changed vastly over time, there are some discoveries that were right on the cusp of having a second level of impact. And I would say, you know, we know that people that have type 1 diabetes, for example, are potentially genetically prone, but it's something in the environment, a trigger, that turns on their immune system.

We have screened a large number of people, followed 8,000 kids from birth to the age of 2015, and we just concluded enrolling and completing the data collection on the last patient about a year ago. We're now in the phase in which we're analyzing these data using artificial intelligence and machine learning. And should there be a cut, this may be delayed in actually answering this question. If it turns out, of course, it's something in the diet, then dietary modifications would be in order, if it's a viral or some other etiology. I'm quite likely there are multiple causes of triggering, but those are the things that we're just on the cusp of learning.

We have, in terms of a cure of the disease, developed ways to expand stem cells derived from patients. We've got an FDA approval for that, but now we're trying to figure out how to get these stem cells You know, in large volumes in the patient to restore it. I'm very familiar with that, the islet cell therapy and Vertex, which has a new partnership with Lonza in New Hampshire, is working on that. And we've seen some really amazing results, I think, from that. I'm going to stop there because I'm about to run out of time, but I want to go to Dr. Volkov because you have been so helpful over the years from your research in addressing substance misuse and the opioid challenges we've had in New Hampshire, and we've appreciated that following up on Senator Capito's question about where are we.

So I would like you to give us an update on some of the new research, if you would, to address substance misuse, but I would also like to just register, Dr. Bhattacharya, my concern about merging NIDA with the National Institute on Alcohol Abuse and Alcoholism and cutting the funding at the same time by $165 million. I think at a time when the country is still recovering from this opioid epidemic, that is not the time to do that. But can you update us on some of your new research? No, and thanks very much for that question. And yes, we've done significant progress in actually, fortunately, in reduction in overdoses from opioids across the country.

But the numbers are still very, very high and we cannot forget about it. And the other issue that is very relevant is there are certain states where that is not happening. And particularly, for example, the reduction in overdose deaths is not as apparent in rural areas. So some of the states actually still are seeing increases in overdoses. Has become more complex because it's not just opioids, but it's also stimulants.

On the front of research, there's obviously some extremely exciting areas that are— look quite transformative. Particularly, I'm interested on a comment that Dr. Bhattacharya say related to repurposing. We're observing that the GLP drugs, which are the medications we use for obesity and diabetes, are actually leading patients to spontaneously stop taking them. And that's a very, very exciting area of research. In parallel as was being described also as we understand with the BRAIN Initiative how the brain works and tools to actually modulate that, we now have new ways of treating substance use disorder.

And two, we are getting into the space with drugs to be able to optimize the way that we can help the brain recover itself from harms through neuroplasticity. So the, this is a time of enormous amounts of discovery. And we're trying to translate them into products. Thank you. Thank you very much, Madam Chair.

Senator Hyde-Smith.

Thank you, Madam Chair. And I certainly appreciate the panel for being here today. You're all truly outstanding. And we have some Mississippians here. It takes a long time to get from Mississippi to here, but our folks that are interested in these health care issues traveled.

I'm thrilled to have Ashley Parker here that has survived cancer. And Ashley, will you stand up to She is just fiercely, fiercely helping other people going through this, and I certainly appreciate her. What we're dealing with in Mississippi is the University of Mississippi Medical Center. We are working toward the National Cancer Institution— Institute designation. Our local legislature in Mississippi has— they have given $100 million to start this.

We expect to break ground this fall in this. This is one of the most exciting things that we have going in Mississippi in healthcare. We've made a lot of progress in recruiting professionals, recruiting scientists, just the top there that are wanting to come help us, and we cannot be more excited about this for a cancer center and a research institute. But we know that attaining the NCI designation Although it's a top priority, priority for me and obviously the legislature in Mississippi, we know that that can be a tall hill to climb. And Dr. Lutay, I'm going to direct this to you and just ask about your commitment in maintaining open communication with UMMC, the University Medical Center there in Jackson, and my staff during this process, including meeting with UMMC leadership to identify ways that we can support this very important project in Mississippi.

Senator, that is an extremely easy commitment to make. Uh, we very much like to hear from centers, especially in states that don't already have an NCI-designated cancer center. We'd love to hear from centers who want to take that next step into designation. I love what I'm hearing about— there's really three 3 legs of this stool. There's institutional commitment, and there is infrastructure support, and I love what I'm hearing about what the state of Mississippi is doing towards that.

The third leg of that stool is research, and it's very important— very important part of the NCI designation is that there is a commitment to research. I actually am already familiar with some very high-quality research at University of Mississippi. I've worked for a couple years with Dr. Pierpaolo Claudio and his wife, who are doing excellent work in functional precision medicine there, and I look forward to continuing to help them. So I know that excellent research is taking place in Mississippi. It's very easy for me to say that with our Office of Cancer Centers, we very much look forward to working with the staff at University of Mississippi to make this a successful application.

Thank you very, very much for that encouraging Answer for sure. And Dr. Lute, I also appreciate knowing that we have your support and commitment. And I'd like to follow up on some things that Senator Capito made comments about addressing her questions about the challenges some states face toward NCI designation. We both represent very rural states. And we have so many areas that just don't have access to good healthcare.

And they're under-resourced states that, you know, they just don't have the same longstanding biomedical research infrastructure for various reasons, obviously, that, you know, we're small areas. But the funding of those pipelines and institutional capacity of heavily funded states, yet our need is immense. That's where we find some of our sickest patients in these rural areas. And I— Dr. Bachuchera, I would like for you to comment on this as well, about the commitment to supporting rural and historically under-resourced areas and academic medical centers pursuing the NCI designation and sustainable cancer research that we are certainly putting our best foot forward in Mississippi trying to address. Senator, we are absolutely committed to that.

Again, a very, very easy ask, as Dr. Latai said. There's the— at the NIH, we have many programs to make this happen. I'm looking for more. The program to make sure states like Mississippi and institutions in Mississippi have a chance to get NIH funding. The Care for Health program to make sure that patients in rural areas and other hard-to-reach places have access to the best clinical trials.

We want to make sure that Americans, no matter where they are, benefit from the fruits of biomedical research, and scientists, no matter where they are, if their ideas are good, have a chance to get NIH funding. Great. You all do an excellent job, and I'm so impressed with all of you and the things that are to come and your interest and your commitment and your dedication, your motivation to address these is very, very applauding. Thank you very much, Madam Chairman. Thank you.

Senator Schatz. Thank you, Chair, Vice Chair. Thank you to the panel and everybody who who does all this important work, who you represent. Dr. Padacharya, this subcommittee's investment in NIH has helped Hawaii to recruit top-tier talent and develop treatments and cures. Hawaii has a shot at $100 million grant to grow our workforce focused on AI in cancer research, but it's been sitting in administrative review at HHS for 6 months.

Do I have your commitment to unstick stick this decision as soon as possible? I'll absolutely look into it, Senator. I have a deep commitment to make sure that the, uh, Hawaii, uh, the native populations, tribal populations, and other places have the support, uh, from the NIH to do research that, uh, that can only be done in those places. Thank you. Um, and on the Native Hawaiian and Pacific Islander Health Research Office, Native Hawaiians and Pacific Islanders have less access to care compared to other Americans and suffer worse health outcomes, which is why 3 years ago, with the support of this subcommittee, we launched the NIH's first-ever Native Hawaiian Pacific Islander Health Research Office.

Last year it was funded at $5 million. Do you commit to staffing up this office? Absolutely, yes, Senator. Thank you. Um, last year, and again in my office last week, we talked about health disparities research.

You agree with me that there are fundamental biological differences that are worthy of scientific inquiry. Um, and that is not DEI. Um, some, some examples of biological differences in disease rates include Ashkenazi Jews and Tay-Sachs, African Americans and sickle cell disease, women and osteoporosis, Asian Americans and liver cancer. Do you still agree that we should keep studying these disparities? Uh, yes, absolutely, Senator.

We are absolutely committed to making sure that the NIH studies the health problems of anyone, everyone in the country. And we have to take into account the biological realities when we study them. Any research that we find has to be actionable. It has to be rigorous and has to be in scope. And that's not DEI research.

That's research that addresses fundamental health needs of people who are, no matter who they are. We are, we just saw a 73% drop in the awards for the National Institute on Minority Health and Health health disparities, and you just issued 7 competitive awards totaling $6 million. I just want to make the point that that is— every time I talk to you, I'm reassured, and every time I see the amount of money spent on health disparities research, I am not reassured. And so there seems to be a disagreement between the scientific community and appointees of President Donald Trump and someone else somewhere else in the administration. Who is alleging that this kind of scientific inquiry, that this kind of health disparity research somehow has a liberal bent.

Right. And I think it's preposterous. And I'd like you to, you know, look, I don't want to get you in trouble, okay? But this is ridiculous. And I think, you know, it's ridiculous.

And I think all of us on this committee should be able to wall off our disagreements about diversity, equity, and inclusion. And the extent to which the Biden administration or progressives over the last decade may have done things that Republicans or conservatives disagree with, and then letting it spill over into some basic biological questions that we really want to know the answer to. And I'd like you to respond to that. Well, Senator, the, the, uh, the NIMHD has, um, is, is absolutely committed to spending the allocation of funding that, that Congress has given this year, uh, as we did last year. And to spend it on excellent science.

The acting director, Dr. Monica Hooper, is an amazing scientist, and I have full confidence that they will be able to identify great research that improves the health and well-being of minority populations in this country. Finally, chronic pain exceeds hypertension and diabetes as the most prevalent, costly, and debilitating chronic disease in the United States. My STOP PAIN Act was enacted 9 years ago, and since then the NIH has funded hundreds of millions of dollars in pain research. We've seen good progress so far, but there's still more to do to ensure more people have access to safe, effective treatments. We need to recommit to funding studies, but instead you have limited pain research, and I'm wondering why.

I've not limited pain research. Dr. Volkow? No, I am not aware that there's any limitation on pain research. In fact, we're very, very grateful for the Congress for having given us for the first time allocation of $250 million. To study pain, and that has accelerated discovery.

So that's great to hear. I— what I have here is that there are staffing cuts at NIH's Office of Pain Policy and Planning. There's no proposed line for the HEAL Initiative for fiscal '27, and you terminated or paused millions of dollars in grants for cross-cutting HEAL initiatives. So if this is a misunderstanding, it's the best misunderstanding I've encountered in many, many months. And so let's plan that.

I love the initiative. I think it's such an important program for addressing addiction in this country. It's produced so much advance. And Dr. Volkow, who's the leader of NIDA, has been a champion of it. I fully support that.

I'm going to assume I'm wrong and be happy about it. And if I'm right, I'll be angry about it later. Thank you.

Senator Bozeman. Thank you. And thank all of you for being here. I've had the opportunity, I think, to have almost all of you in in my office on occasion, and I think those meetings have been as productive as any I've had, you know, since I've been here. I also understand that you all are very talented people and could do a lot better financially doing something else with your talents, so we appreciate your service to our country in the way that you're doing.

Dr. Bhattacharya, the program has played a critical role in expanding NIH-supported research in states like Arkansas that have historically received a smaller share of federal biomedical research funding. Many of these same states face some of the nation's highest rates of chronic disease and adverse health outcomes. Can you discuss the impact of the program? Program that it's had on strengthening research capacity, improving health outcomes in these states, and how NIH can continue to ensure that the benefits of scientific innovation and economic growth reach communities across the heartland. Senator, the program is such an important program for exactly the reason you said.

I think it's like 23 states that have difficulty, frankly, getting NIH funding. About a third of our portfolio goes to about 20 institutions. And that, that's a mistake because it means that we are underinvesting in the research capacities of the, of the whole rest of the country where there's so many great ideas and people who need access to the kind of research products that we have. So I'm absolutely committed not just for the Ideas Program, but also to other mechanisms to addressing that problem. Including reform of how we decide how we fund facilities in this country so that every facility in the country has a chance of getting NIH funding in a way that doesn't disadvantage you just because you're not in the top 20.

That's excellent. Dr. Ledy, one of the things that we're seeing is the trend of the rising incidence of cancer among younger adults who would otherwise be considered healthy and at low risk. Can you tell us a little bit— I know you all are working on this problem— can you tell us a little bit about what the Cancer Institute's doing to better understand the factors driving this and what research initiatives are underway to identify potential causes and prevention strategies, how we can help you with that? I think you have accurately identified what is a problem that many of us in the cancer community are aware of. I would say, uh, while there are several cancers that we are following with respect to increasing incidence in young people, the one that most captures my attention is colorectal cancer because that's a cancer where we've actually seen an increase in cancer mortality in young people, not just cancer diagnosis.

Uh, so we have several avenues. One is, uh, in our population science efforts, we are trying to identify are there any tags, are there any features of people getting this that are different from other people? I have to say, so far it's been a puzzling problem and it's difficult to assign a single cause. You might think, oh, it's obesity. Well, it's not so simple.

It's really probably not connected to obesity. We do know that colorectal cancer notoriously has environmental cues, so there may well be environmental cues, but we have not identified those yet. Among some of these cues is the microbiome. There's some very interesting research, some of it funded by the National Cancer Institute, indicating there might be particular microorganisms that contribute to this, particularly in young people. This is very early research.

We need to, I would say, solidify that. But an interesting thing about the microbiome is that if we do find that the bacteria in our own gut are contributing in some cases to this, we do have ways to manipulate the microbiome in our own guts. So that's another promising area of research. But I assure you, this has captured our attention, and we're very interested in figuring out the causes and then moving towards prevention of early colorectal cancer. Very good.

Thank you. Uh, Dr. Volkov, although we're making positive strides towards lowering the overall overdose which we've discussed, substance use disorder in places like Arkansas is still, still a critical issue. Recently, a powerful new synthetic opioid reported to be even stronger than fentanyl was linked to a death in our state. These synthetic drugs are being designed to look like legitimate prescription medications and make them incredibly difficult for experts to identify and track. Can you share how NIH Drug Abuse will ensure that federal research resources continue to adapt quickly enough to help our states tackle these things?

And then the other thing along, you know, very quickly, the—. Well, go ahead. Ya no, we have a multi-pronged approach to address it because the problem of synthetic drugs is per se not new, it's just getting worse and it's here to stay. So, and it is basically chemistry to try to maximize how addictive a drug can be and actually rapidly also gain competition with the others in the market. So we are, number one, assessing the emergence of what drugs are occurring across the country.

The second one is analyzing the characteristics of these drugs and then communicating and implementing interventions for people that are sort of overdosing with them, how to treat them, and trying to ourselves also develop the guidelines while working with other agencies so that we can have a concerted effort. Because this is not just us in isolation, is working with the CDC, is working with the DEA, and is working with the FDA so that we can come in, they can use then this knowledge to generate policies on what should be, um, be there or not. Thank you. Thank you, Madam Chair. Thank you.

We're joined by the co-chair of the full committee, Senator Murray. So thank you for coming. Thank you very much, Madam Chair, and welcome to all of you. Look, the NIH funding level is— isn't just a number on a page. It really determines how much we can fund opportunities to discover the next life-saving cures, whether it's for cancer, Alzheimer's, or diabetes, so much more.

And that's why so many of us have fought so hard to boost NIH funding. Between 2017 and 2023, we were able to increase NIH funding to support more than 6,000 additional grants for research on childhood cancer, on dementia, and on many other terrible diseases. And not that— now that that was only possible because our overall non-defense budget was growing. But now what we have in front of us is that congressional Republicans have for years now held that domestic budget flat, and that meant that NIH funding has been essentially flat for the last 3 years, resulting in fewer grants and fewer cures. And the budget that we have now been presented by you and the president are literally asking Congress to cut NIH's budget by $6 billion in order to provide room to give Trump his $1.5 trillion war budget.

So, Dr. Bhattacharya, how do you justify cutting NIH research by billions to send a half a trillion more to the Pentagon? Do you personally support that? Senator, the budget is obviously a major problem for this country. The NIH, What my job is to make sure that my colleagues have the resources they need to fund the best biomedical research in this country, and I'm really grateful to work with Congress and the administration to make sure that that's possible. Well, you didn't really answer the question, and I know why, but just for all of us to understand, we're being asked to cut NIH by $6 billion.

Why? In order to provide a huge increase on the defense side. And according to one estimate, it would not take not even 2% of Trump's war budget to prepare candidate vaccines against active viral diseases. So I hope this committee rejects that request and works to make sure that we provide opportunity for, for Americans when it comes to biomedical research. Um, Dr., we are now dealing with the hantavirus outbreak and a deeply concerning emerging Ebola outbreak.

I am very concerned because there is a void of public health leadership from this administration, especially as you now work to balance two roles, as we talked about yesterday, um, two full-time jobs. With less funding and fewer staff and stalled research, can you credibly tell us that we are better prepared for public health threats than we were a year ago? Senator, what I can tell you is that as the Acting Director of the CDC, uh, the last, uh, about 2.5 months, 3 months, what I've just encountered is absolute professionalism, a CDC public health staff who has devoted their lives to protecting this country and, frankly, the world from the kind of infectious disease threat you've seen. The hantavirus outbreak, for instance, which the CDC has played such an important role in addressing, is largely contained in part because of the professionalism of the CDC employees that that I've had the privilege to lead. Yeah, I don't doubt the professionalism, and I greatly admire everybody who's doing this hard work.

But the reality is we are behind. I just heard that at least 8 of the top 10 officials at NIAID are no longer in the roles, and that includes the institute's director, its top allergy and immunology scientist of nearly 30 years, and the microbiology and infectious disease director. We, we need to have those people on the job right now, and I— this is, I think, deeply concerning to all of us as we look at that. And, um, and this administration has also terminated over 1,000 infectious disease research grants, terminated $500 million in promising mRNA vaccine contracts, our best bet for a rapidly developing, uh, is for rapidly developing vaccine as we are looking at hantavirus and Ebola. So I'm just really concerned that you have even terminated NIAID funding for a group that was studying the exact type of hantavirus that caused the deadly outbreak that we're dealing with right now.

We've lost 4,000 expert staff. I know you're scrambling to rehire, but it just seems like we have dismantled our infectious disease research and development pipeline, and we will pay the price. So let me just address that. So the NIAID is such an important part of the NIH. And for many years it has had civilian biodefense as among one of its goals.

We've shifted the focus of NIAID to address diseases and conditions that people actually have, including the hantavirus, including Ebola, and so much else. And we also shifted the priorities to prioritize allergy and immunology. That shift means that we need some new leadership. The folks you're talking about are still at the NIH, but they've been assigned to places where they can help with the changed mission of the NIAID to focus on infectious diseases and on allergy immunology. The—.

Well, I would say we need both, and I'm very worried that these people—. Well, civilian biodefense, I don't think the NIAID should play a leading role. We are a civilian agency and we should be focused on the threats to health that Americans actually face. So for instance, like ending the HIV epidemic, we need implementation science. So I've asked the NIAID to bring scientists who are excellent at implementation science because we have the tools we need, the technological tools.

We just need to understand how to use them to end the HIV epidemic. That's going to mean a new set of scientists and expertise at the NIAID. We have had that, but I've just increased the emphasis on that. I want to use the NIAID for addressing the health needs of the country. Okay, so I'm not going to— I hate to interrupt you, but I just am telling you we are watching this.

It's deeply concerning. I know you're trying to justify it, but I think at a time when we are seeing these kinds of outbreaks, that it is disconcerting to all of us to see the public health side of CDC and NIH lose a lot of their experts. Let me ask you one other question, because I want to ask you about the Pediatric Trial Network, which funds studies into safe use of medication for children. Are you aware that last year's NIH Pediatric Trial Network received only part of its funding? I know there's some contracting issues with it.

I'm absolutely committed to making sure that we do have opportunities for children across the country to work on clinical—. Participate in clinical trials. Let me ask you specifically. Specifically because it received $11 million. That is $7 million less than in 2024.

And researchers were told by NIH that this year's funding is going to be even less. In fact, researchers at Seattle Children's Hospital are going to have to stop their work investigating how pain medications can be safely used to help some of our sickest children as they face surgery and hospitalization. And this funding was cut because of an arbitrary nonsense rule made by OMB Director Vought that caps spending on contracts. We have more than 4,000 children from 29 different states. They're currently enrolled in active trials, including in my home state of Washington.

Do you know what will happen to all that data and infrastructure that was built to conduct these pediatric trials? Senator, we want— we make sure that any, any trial that's ending, make sure that we have the data that from those trials as part of the contract. It is hundreds of Blood samples have been wasted. That is what I'm being told. Blood samples from more than 400 children and other tissue that was given selflessly.

So labs are closed and scientists across the country are really looking at what is being lost here. And the worst part is we have kids who are not able to receive evidence-based treatment. So I am watching this and I am deeply concerned, and so are many families in my state. Senator, we've invested in a new PICU, a pediatric intensive care unit at the clinical center. At the NIH campus so that we can expand our research on very, very sick kids.

I'm absolutely—. I appreciate what you're saying there, but I'm telling you, I'm seeing the reality on the ground at Seattle Children's that is deeply concerning. I'm happy to connect with you to make sure that we can address that. Thank you. Senator Britt.

Thank you, Madam Chairman. Dr. Bhattacharya, thank you so much for your commitment to ensuring that life-saving and life-changing research continues and is seen through to fruition. I know this entire group is responsible for that. You are giving people hope and giving people an opportunity to live another day. And I just want to tell you how grateful I am for that and what an honor it is to stand alongside you in that.

I want to pick up on something that we heard earlier from my colleague from Hawaii. Dr. Volkow, I appreciate your leadership at NIDA. When we're looking at addiction and we're looking at different, different abuses, your research has really been groundbreaking. One of your areas of study is actually gambling addiction, and we are seeing that run rampant. You could ask any 15 through 30-year-old about people gambling and the prevalence of that addiction amongst their peers, and you will be startled by what you hear.

Can you talk to me a little bit about what we know about gambling disorder and what characteristics make some groups uniquely vulnerable to this addiction?

Thanks very much for that question. And I think this is an important issue that deserves attention. To your very specific question in terms who are the highest risk, is teenagers. Yep. The transition from teenagers to young adults.

And that what we are do seeing is a significant rise in gambling, whether it is through sports or other means among young population as well as in adults. And so if you look at it from our understanding from the biology, we know that the circuits involved with addictive behaviors to drugs actually overlap with those that leads to compulsive use of behaviors like gambling. We are also very interested in determining if therapeutic interventions that we are using for addictive drugs can have beneficial effects for gambling addiction. So that's another area. But I do think it is crucial that we educate the public and that we mount prevention interventions that can protect children and adolescents from gambling disorders.

So I wanna talk about prevention. When you're looking though, real quick, so you're saying younger people, And I have found in, in research that I have seen that it seems to be younger men, it's even more prevalent in that space. But this addictive behavior can occur with any young person. They're susceptible to, to what is driven to them, and then they get into a pattern that they cannot get out. And we see if they start this earlier, am I right, that that will continue?

The prevalence of that continuing through their life is significant. You just mentioned prevention. Senator Blumenthal and I dropped the GAME Act this week where it bans digital marketing to teenagers, to underage individuals for gaming. Right now we're seeing that not be the case. We think that that could make a significant difference if they're not being driven that marketing.

Do you agree with that? I would agree from what we know, absolutely. And that could prevent them from getting exposed. Okay. And that's— we've got to do something.

You just mentioned it's the next generation. We continue to hear these stories. We continue to see the data. But yet Congress continues to be feckless when it comes to actually dealing with what's happening with our young people, with social media, with putting up proper guardrails and protecting them from these types of advertisements. I mean, the truth is, when you look at things like gaming or pornography, when we all grew up, if that's something that somebody engaged in, you, you had to actually go, go somewhere, go, go to a store, you had to call a bookie, you had to do all of these things to make this happen.

All of that is now in the palm of a child's hand. They are being delivered advertisements to, to gamble. They are being delivered pornography on the daily. And the fact that we are doing nothing about it is absurd. And so I hope that people will take a look at your research and that we will do our job and protect the most vulnerable, um, which is our children.

So thank you so much. Please continue to do that research, and I look forward to working with you. Um, Dr. Bhattacharya, um, you have been prioritizing early career researchers. Just real quick, I don't have much time, and I have one more question. I, I wanted to ask about just early stage investigators and how you're making sure they're able to compete compete with more well-established investigators to make sure that we have the best research and that we're creating a pipeline where America continues to dominate?

And then I also wanted to just have a quick question about rural healthcare. We talked about clinical trials. I heard some of my colleagues talk about that as well. It's important that those occur, and it's important that those are accessible to every single individual regardless of their zip code. So, I'd also like to know what NIH is doing to make that more obtainable.

In places that are sometimes unreached. Thank you, Senator Britt. So, on early career investigators, very quickly, we have a funding strategy called the Unified Funding Strategy that allows institute directors that you see here to identify projects that are at the cutting edge, which tend to be early career investigators that propose them, and prioritize them for funding. We're also going to continue the training grants and all of the— all of the sort of standard investments we make and double down on those because I completely agree with you. Our investment in early-career investigators is vital for the future in biomedical research in this country.

Dr. Rutter, would you mind talking about investments in rural health and—. Absolutely. Thank you so much, and thank you for your question. I would also just agree with the idea that we are at NCATS supporting in our Clinical and Translational Science Awards Program many more early training career development programs and early research programs. We're excited about that.

In terms of rural research, Senator, I'm also from a small western town in Garden City, Kansas, and so this is very personal to me. With a large clinical and translational science awards program, we work with the State programs, and we work with other hubs and spokes that the CTSA also award. And through that, we've developed a rural health network. Within that program called the CORES program. And what they're do is they're funding rural pilots, they're funding workforce models that they can share across their, what they're learning and doing, and they're solving common barriers that exist within the rural environments.

And this has been very critical to those activities. And so in a way, the CTSA program, even though it is not necessarily in and of itself in rural environments, it is partnering with those who are and helping to disseminate the research findings to get it out into those communities things like digital health and telemedicine to be able to disseminate those findings more broadly. I'd love to continue to work with you on that. Thank you. Thank you.

Thank you. Senator Reid. Thank you very much, Madam Chairman. Uh, Dr. Badachar Iya, uh, we're looking at an Ebola outbreak in the Democratic Republic of Congo and Uganda, which the WHO has declared a world emergency. And at the same time, you're proposing to eliminate the Fogarty Center at the NIH.

The, the Fogarty Center, by the way, is named after Congressman John Fogarty, who is iconic to me and all Rhode Islanders. And its mission is to train workers and researchers, particularly in, in developing countries. And that doesn't seem to make sense when we're seeing an Ebola outbreak and you're taking away one of the means that we try to deal with international problems that could come quickly to the United States. So it's more than ironic. I think it's a— I think we're failing on a major effort.

So, Senator, the Fogarty Center serves an important role that absolutely will continue at the NIH in making foreign collaborations easier and safer to conduct. Because those are important for research. As far as the Ebola response, I've been— just this morning I spoke with the Minister of Health at the Democratic Republic of Congo with my CDC hat on. And again, I've just emphasized the professionalism of the CDC staff that have been working on the Ebola outbreak. We've been collaborating closely with the Ministry of Health in the DRC.

We have a country office there that is we feel, 30 different professionals of epidemiologists, a whole host of expertise to address this outbreak. And I can assure you, Senator, that they are well equipped to help the DRC. The DRC has had 16 Ebola outbreaks in the last few years, and the CDC has led the way in helping address each and every one of those outbreaks.

Congolese or Ugandan officials, graduates or associates with the Fogarty Center over the years? Do you know where they are these days? I'd have to go talk to them. I would request you do that. I think you'd be surprised because I think you'd find at least one or two of them in key positions had some experience with the Fogarty Center.

One of my most memorable moments was co-sponsoring the Childhood STARR Act with the Chairwoman. We have funded it at $30 million every year. In fact, President Trump signed it in 2018. I would hope that you would not only continue the funding and get a commitment to do so at $30 million, but increase it to $50 million. We've been trying to do that over the last several years, both House and Senate.

Can you commit to the $30 million level of funding at least? I mean, Senator, we talked about the STARR Act before. You know my support for it, for the for the research that comes from it. I mean, as far as like particular funding levels, I'm really grateful to work with Congress and with the administration to make sure that those initiatives, which are really vital, and I share your commitment to that, continue and expand if we possibly can. Well, we are today talking about the budget, but we also have to think about the second and third order consequences of what you're opposing.

And I think was illustrated quite well recently by the president of MIT, who indicated that their research portfolio shrunk by 10% and that their graduate student enrollment shrunk by 20%, uh, with respect to the funding and also the reclaiming of funds by DOJ and other operatives and the immigration laws, which are frankly, uh, scaring people from coming here. Now, uh, we are surrendering our leadership in the world on research, and your budget will reinforce that. Do you think about these consequences? Well, Senator, we were grateful last year, uh, to receive the funding that we received from Congress. Uh, you know, the previous year there was a lot of, uh, sort of accusations that we weren't going to spend the money that Congress had allocated.

And we did. We spent—. And it's really the testament to the work of my colleagues here and the other institute directors to identify excellent science, to make sure that every single dollar that's been allocated— that you all allocate to us goes to improving the health and well-being of the American people. We'll continue to do that, Senator. Absolutely.

Well, how do you explain the fact that our premier research universities— and I think I see many people here who can verify that they're doctor— have you seen any effects up at the Harvard Medical School on research? So of course I'm no longer there. You can speak objectively. So with respect to cancer funding, I think it's important to recognize that in 2025, despite what was a turbulent year, the NCI paid out more in extramural grants in dollars than we ever have in the past. And I would— and in 2026, we will be exceeding the amount that we gave to the extramural community in 2025.

Are you noticing, though, a decrease in overall research at medical schools, universities, et cetera, and a lack of students? Again, some of my colleagues are talking about dominating the world healthcare research. We're not dominating, we're surrendering. That's what we're doing in this budget. I completely I'm aligned with the priority of the United States biomedical research community maintaining its dominant role, and there's several ways to do that.

I have not seen a decrease in cancer research over the last, uh, over the last year or so. That's what I see as an important part of my job, is that we maintain our leadership in cancer research. Well, I mean, there are indications, and I won't go on, that our leadership is slipping and the Chinese are moving up in funding aggressively, and, uh, we're— this budget is heading us in exactly the wrong direction. Thank you. Thank you, Madam Chair.

Thank you, Senator Reid. So that will end our hearing today. I'd like to thank my fellow committee members for a thoughtful conversation and particularly thank the director, uh, and your colleagues for joining us today. Appreciate it. For any senators who wish to ask additional questions, questions for the record will be due May 28th.

The hearing record will remain open until then for members who wish to submit additional materials for the record. I think some members have already said they are going to submit some questions. The subcommittee now will stand in recess, and thank you very much.