During the hearing nih director and other leaders from the agency field questions on Psychedelic Drug research and maternal care among other topics. This is just over one hour 45 minutes. The Senate Appropriations subcommittee on labor, health, and human services, education and related agencies will please come to order. Good morning. Today is our fourth hearing on the biden administrations fiscal year 2025 budget request, and im happy to welcome dr. Bertinoli to testify for the first time in this committee as the director for the National Institutes for health. As the granddaughter of a n. I. H. Funded doctor myself, i understand the Important RoleBiomedical Research plays in treating and curing disease and bolstering our Economic Growth and ensuring america is a Global Leader in innovation. I know my colleagues here today agree. Im looking forward to working in a bipartisan manner again this year to develop a labor h. H. S. Bill that can pass the senate, pass the house, and be signed into law by the president. That should be a bill that invests in n. I. H. And the promise of finding lifesaving cures and treatments for deadly diseases. But i want to be clear, our ability to do that depends upon agreeing to adequate top line discretionary funding levels, because of House Republicans insistence on cutting funding for domestic programs, last years labor h. H. S. Allocation was more than 2 billion less than in fiscal year 2023. The first such decrease in more than a decade. With those cuts we found an increase in fiscal 2024. But we should do better. Like last year, more than a decade ago, republicans insisted on cutting discretionary funding as the price of raising the debt limit. As a result, back in fiscal year 2011 through h. H. S. Bill actually decreased in nominal terms. And as a result, n. I. H. Funding also decreased over that same period. Starting in fiscal year 2016, Congress Finally decided overly restricted discretionary caps were stifling critical investments, including n. I. H. Congress began modestly increasing domestic spending as a result. From 2016 to fiscal year 2023, funding for labor h. H. S. Increased on average by 7. 7 billion annually, a modest 3. 3 per year. But that allowed this subcommittee to increase funding for n. I. H. On average by 2. 3 billion annually over the same period of time. Unfortunately, republicans are now again insisting on cutting funding for domestic programs, including in labor h. H. S. And thats putting consistent meaningful increases for n. I. H. In peril. Im deeply concerned that that will put us on a path of stagnating funding for n. I. H. Just like what happened last time as i describeed. Almost every senator here today will say they strongly support n. I. H. Funding. Thats easy. But if thats the case, as we have seen over the last decade, we need a workable top line that allows for a workable labor h. H. S. Allocation. And i hope we can return to the bipartisan consensus of just a few years ago and agree to Adequate Funding for labor h. H. S. That allows meaningful, consistent increases for n. I. H. Alternatively agreeing to the draconian cuts proposed by our House Republican colleagues on the other side of the capitol, it would be devastating for Biomedical Research. It would set back years of progress made towards curing disease and weaken americas competitiveness, particularly against china. And we just cant let that happen. So today, i am happy to welcome director bertagnoli and others to discuss the budget. This budget highlights the need for tipped investments along a wide range of republican priorities and speaks to the breadth of research you all research as director of the n. I. H. Im pleased to see the report for Biomedical Research and innovation to develop better diagnostics, improve treatment and precision care for patients, including targeted investments for research on Womens Health and in support of the going to cut the cancer death rate by at least 50 over the next 25 years. And at a time when we are seeing the spread of h5n1 bird flu and the case of another human infection yesterday, it highlights the i am interested to hear from dr. Marrazzo about the important work that nyack is funding to detect and monitor this virus so that we can limit its spread. The fiscal year 2025 budget request includes 49. 8 billion in total resources for nih including mandatory cures act funding. An increase of 1. 25 billion over fiscal year 2024. I want to point out, however, that most of this increase is to backfill decreased cures act funding that falls under this jurisdiction of the health committee. Declining cares act funding combined with difficult Discretionary Spending caps created a uniquely challenging situation for fiscal year 2024 and will again in fiscal year 2025. Outside of those increases in Discretionary Spending for cares act programs, which im happy to see maintained, i am pleased to see increases for Cancer Research, Mental Health research, and neuroscience research. And during a time when Womens Health and reproductive rights are under attack in this country, i was pleased to see the budget proposes a 76 million increase for the office of research on Womens Health. But i was surprised to see that the budget does not call for any new resources for Alzheimers Disease Research. I want to hear more about that and what impact that will have on the progress weve made in Alzheimers Disease Research from dr. Hodes. And i want to hear about how nih is working to address our nations Mental Health and Substance Abuse disorder crises. Tragically, Overdose Deaths remain stubbornly high. In 2022, nearly 108,000 people died of an overdone. In my state, there were 1828 drug Overdose Deaths in 2022, surpassing the record set in 2021. Of those deaths, 1464 involved opioids. I would like to hear from dr. Volkow about how they are working together to bring an end to this crisis. I also want to hear about how nih is investing in the next generation of researchers, particularly in light of new data that reveal a decline in the number of u. S. Postdoctoral scholars at nih over the last two years. I want to know how you are supporting early stage investigators, particularly women and those from diverse backgrounds. And finally, i want to hear about nihs Ongoing Research on long covid. It has been more than three years since congress appropriated [applause] it has been more than three years since congress appropriated 1. 2 billion for Long Covid Research and nih has moved slowly to enroll patients and has yet to deliver treatments for this debilitating disease. Dr. Gibbons, i want to know how you plan to leverage the recover initiative to be more efficient and effective to finally move the needle for millions of americans who continue to suffer. I look forward to your testimony and appreciate all of you being here today. And in a moment, i will turn it over to Ranking Member capito for her opening remarks. Following senator capitos Opening Statement, we will hear from director bertagnolli, and then senators will have five minutes for a round of questions. Sen. Capito thank you for being here. Dr. Bertagnolli, it is good to see you. Thank you for being here but also congratulations on your fairly nearly new role as nih director. I also want to thank you for coming to West Virginia in march to see firsthand the Amazing Things that we are doing at West Virginia university, including seeing the work that the team is doing to combat alzheimers disease and addiction. As you witnessed, my home state of West Virginia is a rural state, with some of the highest rates of Health Challenges in the country. A partnership with nih is critical for us to make improvements. Dr. Volkow, who has also visited West Virginia, dr. Hodes who says he is coming, we just have to get the date, dr. Rathmell and dr. Marrazzo, and dr. Gibbons, thank you for being here to discuss the many Important Health issues facing our nation. And i said, many of you have visited or will visit, and im very grateful for that. This will be a challenging funding year, as chair baldwin lined that out. For me, Biomedical Research at nih is a priority for me and has been for this long bicameral bipartisan priorities as well. The budget proposes 49. 8 billion in funding for nih including 21st century cures and arpa h. The budget also proposes an additional 1. 5 billion in mandatory funding for the cancer moonshot. Last year, i was proud that we were at least able to get an increase of 300 million in very tough headwinds in Discretionary Spending for nih. Nih isnt just a Great Research and Biomedical Research institution, its also a driver of Economic Growth. Funding more than 92. 89 billion in National Economic activity across the nation in 2023. In my small state of West Virginia, nih supports 759 jobs and 140. 8 million Economic Impact in 2023 alone. This is in a state we really dont see too many dont see us as one of the areas for medical innovation, but we are proving the nation wrong every day. The nih impacts every american in some way, and i hope again to work in a bipartisan way to fund our joint priorities such as finding cures and treatments for cancer, parkinsons, als, alzheimers disease, and other conditions that plague americans. As i mentioned, dr. Bertagnolli i will get it someday, joins me with a name like capito that gets mispronounced have to time, you would think i would be better at this. Im trying. Im trying. She joined me and witnessed the talented Research Advancements we are doing in West Virginia. Much of this has been made possible by the partnerships fostered by nih over the years. Researchers throughout our state are making significant contributions to Biomedical Research in areas ranging from cancer to alzheimers disease, to Substance Use disorders. Unfortunately, West Virginia continues to rank above the average in new cancer diagnoses and deaths. So i am pleased that the budget devotes increases to finding cures and treatments for cancer. As a lead sponsor of the Childhood Cancer star act, i look forward to hearing about your priorities and advancements to combat cancer and grow our Clinical Trial networks, especially among our children. I will continue to prioritize fostering nih collaboration with smaller more rural states. Last year we were able to provide a modest increase for the nih idea program. This Program Provides funding for 23 states, including mine, that historically received very little federal Research Funding. And im proud of the friendship and partnership with nih for his leadership. The idea program and the other nih program has been instrumental for Marshall University and other institutions in the state developing worldclass research in neuroscience, cancer, stroke, vision, and addiction science. Dr. Bertagnolli was able to hear about West Virginia clinical and translation science institutes new mobile unit, named maverick, purchased thanks to an nih grant. Dr. Sally and her team will use this mobile unit to give individuals all over the state we know access is the issue in rural states the ability to participate in Clinical Trials for new treatments and is a prime issue of how nih investments can directly affect people. I do want to take a moment, and the chair and i are likeminded, to express my disappointment that the proposed nih budget doesnt devote new resources specifically for Alzheimers Disease Research at nih. I have seen through closed hands through both of my parents the devastating effects that alzheimers can have on the family, the patient, and the caregivers. Nearly seven million americans are currently living with alzheimers in our country. And the National Cost of caring for those with alzheimers and other dementias is estimated to reach 360 billion this year. That is staggering. Alzheimers and dementiarelated research must remain a national priority. I would also like to see more attention devoted to Substance Abuse. The National Institute on drug abuse receives only a nominal increase in this budget. Dr. Volkow has visited my state and has seen firsthand how West Virginia is in the crosshairs, and every state is in the crosshairs of opioid and addiction crisis. I would like to add my voice in agreement with the chair on the Recovery Program for those with long covid. And i know we have many in the audience today. [applause] i know we are dealing with a tough funding situation this year but investments in Biomedical Research are so important for the future of our country. Before i close, i would like to address dr. Bertagnolli on something we learned last week. I want to comment on something that is concerning. For years, the nihs leadership has taken the stance that nih gain of function research wasnt happening with the Echo Health Alliance or the Wuhan Institute of virology in china. This appears to be false based on the doctors response to a House Committee last week. When asked if nih grant funded gain of function research at wuhan. He answered, quote, if you are speaking about the generic term, yes, we did. last year hhs debarred the Wuhan Institute from receiving federal grants for 10 years and just last week suspended all funding for Echo Health Alliance and plans to debar them too. I think both of those should have probably been done much sooner. Nih has a credibility problem here when it comes to gain of function research, and i strongly encourage you and dr. Marrazzo in your new roles to restore strength and Research Integrity and trust to the nih in this area. Thank you very much. I look forward to your testimony. Chair baldwin thank you, senator capito. I will now introduce our witnesses. We have dr. Monica bertagnolli, she is the director of the National Institutes of health. We have dr. Gary gibbons, he is the director of the national heart, lung, and blood institute. Dr. Richard hodes is the director of the National Institute on aging. Dr. Jeanne marrazzo is the director of the National Institute of allergy and infectious diseases. Dr. W. Kimryn rathmell is the director of the National Cancer institute. And dr. Nora volkow is the director of the National Institute on drug abuse. Thank you all for joining us today, and i look forward to hearing from all of you. We will start with director bertagnolli. You may deliver your opening remarks. Dr. Bertagnolli chair baldwin, it is an honor to testify before you today concerning our fiscal year 2025 budget request. Let me start by sincerely thanking you for the funding you provided to nih in fiscal year 24. Every state received a share of nih investment. Each year, nih awards over 60,000 grants, supporting more than 300,000 researchers at more than 2500 institutions. We are proud to contribute to nationwide innovation in Biomedical Research and to support the next generation of researchers who will meet the challenges of the future. Nih is guided by the principle that our work is not finished when we deliver scientific discoveries. Our work is finished when all people are living long and healthy lives. Decades of sustained investment in fundamental science are producing exciting results. How can the brain be reprogrammed to relieve anxiety or depression or craving for harmful substances . How can we replace a defective gene, thereby achieving durable remission of a debilitating dise