[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> i now call to order the hearing on fiscal year 2023 president's budget for the national institutes of health. this is a hybrid hearing so we need to address a few housekeeping matters. welcome my colleagues who are with us the screen. for the members enjoying virtually, once you start speaking there is a slight delay before you are displayed on the main screen. speaking into the microphonemaee activates the camera, displaying the speaker on the main screen so do not stop your remarks if you do not immediately see the screen switch. if the screen does not change after several seconds please make sure you are not muted. to minimize background noise and insure the correct speakers being displayed we ask you remain on mute unless you sought recognition. the chairir or an individual designated by the chair may get participants microphones when they are not under recognition to eliminate an important background noise. members or virtual are responsible for muting and unmuting themselves. finally, house rules require me to remind you with set up an e-mail address to which members can send anything they wish to submit in writing at any of our hearings. beene-mail address has provided in advance to your staff. with that what i'd like to do is acknowledge and thank ranking member tom cole and all of the members of the subcommittee joining today's hearing both virtually and in person. and i thank you to our witnesses testifying before us today, dr. tabak, welcome to the subcommittee. you started in this role just a few short months ago. you have proven in your over 12 years as principal deputy director of national institutes of health and ten years as a director of the national institutes of dental and craniofacial research to be a thoughtful, efficient leader. thank you for your commitment to making america i hope your place and our healthcare research more equitable. our deepest thanks. let me also welcome institute directors joining dr. tabak today, and are subcommittee this morning. dr. diana bianchi, director of the eunice kennedy shriver national suit of child health and human felt with her dr. anthony fauci director of national institute of allergy and infectious diseases. dr. gary gibbons,r director of the national heart, lung, and blood institute. dr. doug lowy, director of the national cancer institute and doctor nora volkow, director of the national institute on drug abuse. i also want to note and i think i've said this before, we were able to get once before, i do intend to invite an additional panel of institute and center directors to testify before this committee later this year. we have not been able to hold a second panel in the past two years that i value the research of every institute, every center, and want to make sure the subcommittee has thesu opportunity to hear from others directly. i'm also going too be reviewing the funding across all the institutes and centers for looking for a pattern over time, and to hear more about how the institute and the centers set priorities. and i just say this with all sincerity, i mean, i always think this is one of the most exciting and exhilarating and meaningful hearings that we have before the appropriations committee. the work thate. you do, all of e staff, the grantees that the nah supports g and what you're doneo continue prioritizing covid-19 research over the past two years, we would be nowhere close to where we are in defeating this virus. through the research of the nihs own science, and everyone talks about, you know, how quickly we moved and how successful we were in terms of a vaccine. it just didn't happen overnight. it was the years of research of investment in research that allowed us to move as quickly as we were able to. so through the research of ourch scientists, research grant institutions a partnership with the private sector, our knowledge of buyers has dramatically improved, reliable protection diagnostic technologies have been developed, treatment options have been committed and vaccines and other prevention methods were accelerated and distributed all in record time. nih's response to desperate what i've known for for a long tt are significant a long-standing support for biomedical research is absolutely critical to ensuring we are prepared to prevent and address healthcare crises whenever that may arise. the work you do save lives and protect family centered families were over. with the proper resources and leadership at nah are biomedical research can move very quickly, refocused ways to achieve high priority goals and continue to save lives. none of these transformational advances would have been possible without the annual sustained investment in basices biomedical research made by this committee in a bipartisan way in recent years which is why i am so proud that over the past seven years congressve has increased nih funding by nearly $15 billion, or 49%. and i i repeat, this has been de in a bipartisan effort. and in the 2022 on the bus recently passed, congress provided congress provided a 2.25 billion increase over 2021 -- omnibus. this includes an increase of $353 million to fund a greater number of research proposals at the national cancer institute and support for the canister moonshot initiative that will save lives by speaking cancer research progress and improvinge prevention, detection and treatment effort. we also provide an increase of $289 million for the alzheimer' alzheimer's, for alzheimer's disease and related dementia research to help you understand the cause of alzheimer's and advanced research and diagnosis, care, treatment and prevention for those with and at risk of developing these. i am especially proud of the $30 million increase for the improve maternal health research initiative and maternal mortality rate in this nation is far too high, high, the hy developed nation.f and more must be done to address this crisis that killed hundreds of mothers every year. these increased funds to support research on maternal more improve the health of pregnant people, especially those mothers, the victims of our nation's health disparities will have been historically underserved. and health disparity impacting underrepresented communities are an unacceptable issue in nearly every corner of our physical and mental health care system. which is why we delivered an increase of $50 million for research to identify and reduce health disparities across our country. i'm also proud of the $8 million increase congress provided for the office of women's health, research on women's health, to further promote the interest and involvement of women in nih supported research. and i am personally grateful to the $159.4 million in fiscal year fiscal year '22, the nih grant that has been delivered, many have been delivered to my own district, connecticut's third, following 572.8 million in fiscal year 2021. that's nih funding for the district. this funny has already advanced reticle research efforts, strengthen the future economy and growing opportunitiessunitst request for 2023 proposes an increase of nearly a $4.3 billin for nih. i'm pleased the proposed increase research to address health disparities and thehe opioid crisis. to make major issues impacting the health far too many across the nation.he particularly glad to see the proposed $50 million increase for universal flu vaccine research and development an issue i have been fighting to address for years. and the request would double funding for gun violence prevention research nih building off investment the subcommittee has made over the past few years. despite all the great investment in the bill, however, i am concerned about the lack of balance between the budget request for arpa-h and the request for other more quote traditional nih activities. i know the the president fir 123 budget request for nih was developed before the 2022 omnibus was enacted and might've been different had it been an acted sooner. however, the proposed increase, $274 million, core nih activity, is insufficient and threatens the progress this committee has made in the past several years. a significant, sustained investment in biomedical research. i have said before and i will repeat it, i am proud of the work we've done together to establish our age. it is clear the $1 billion investment in 2022 funding this committee made to establish arpa-h has incredible potential to develop transformative technology that saves lives to the stored funding and it will be used to research the causes and address debilitating impact of major diseases like alzheimer's, diabetes, cancer, als, and others that impact allies of millions of americans, and exacerbate already existing health disparities. however, it is critical we strike a balance between investments that we make in our age and those in basic research and discovery at the nih. dr. tabak, i know this was not true decision but while i strongly support nih and recognize its long record of success, in supporting our medical research i believe that placing arpa-h within nih is mistake and will have the agencies ability to achieve the breakthroughs i just outlined. i strongly believe our h would be moreon successful in its unie mission if it were established as an independent agency within health and human services. with that, let me just say i thank you all for joining us today. your work again is invaluable to the health infrastructure of our nation. to really improving our medical discoveries from making his medical discoveries and ultimately saving lives. i look forward toward discussions morning and her work together in the months to come, and by the recognize congressman lieu goal for his opening remarks. >> thank you very much. before you begin my prepared remarksuc i draw one great lessn as brodeur graduate, it's a great thing to represent yale. what a great magnet for research and good things. well, good morning. i am please we can come together in person this morning for the first time in two years to tr directly from the institutes of health about the administration's budget proposal for fiscal a year 2023. this is our first hearing in many years without our friend francis collins, and we all wish him well in his new endeavors. as i say every year, a sustained commitment to increasing funding for the nih is a vital step to preserving our status as a world leader in biomedicals research and to finding cures for many diseases burdening our healthcare system. and we know the funding also goes, does far more. several studies have shown funding ator the nih has a multiplier effect contributing to overall u.s. economic growth. like the chairman, the chair, i am proud what this committee has done year after year on a bipartisan basis since 2015. then nih budget has increased every year beyond inflation during that period, regardless of who was president, regardless of which party was in control of the congress. and it shows there are certainly some important things we can work togetherth on and and k will have positive results for the country. and i particularly want to praise my good friend, i make this point a lot, the chairwoman, when i was privileged to be the chair of this subcommittee for four years she was kind enough to back my budget not the first one but the last one, the one that passed, every single time. i have been very proud to vote for her budget for three terms since then. we may start in different places but we have a way of ending up at the same place, and this agency, the nih, is a big reason why quite frankly, so you can shave it to bipartisan comity and cooperation. given all that i had to kick off a hearing on a sour note, but i probably, where the chairwoman is, i am perplexed as to why the administration has chosen to pour billions of dollars of funding into the new arpa-h program at the expense of ongoing basic research at the nih. arthur h was funded for the first time in march, and i might add with my support, like the chairwoman i see much potential goodti here, but as you pointed out in her remarks there are still great deal of controversy around it and different if pain is for both republicans and democrats and, quite frankly, within their ranks over how it should be organized, where it should be placed. in the end, almost every decision was simply left to the secretary of health and human services, someone i hold in high regard but he is an executive official and a think it's unprecedented for the creation of a new agency to be, lie largely in the hands of one individual. we still don't know the structure of thisan new agency will ultimately take. we don't have a director. any possible of a director or any idea when this individual will be named. we don't have a a physical location for the new agency. we don't know how grants will be made and who will be responsible for deciding how billionsl of tx dollars are dispersed or . we don't know how arpa-h will interface with existing nih institutes and research or how weh can ensure that it will be value added rather than an agency that competes with an siphons off talent. we don't know the rules for hiring staff or how they would be compensated. so i think it makes no sense to propose an enormous increase off $4 billion for this new agency while proposing what is essentially flat funding and for some important agencies even a modest cut for the rest of nih. i will have some tough questions about that today but sounds to me like we probably have some of the same concerns, madam chair. next, i think everyone in this room needs to address the difficult topic of the loss of public confidence and credibility across our public health agencies including the nih during the covert pandemic. i fear that mistrust in our government public health system has eroded to a dangerous level. from our own leaders placing too much trust in the chinese government in the beginning of the pandemic to locking down our society, economy and schools, mixed messages unmasking and vaccine mandates through what many believe is a cover-up and the role if any at the wuhan lap played in the origins of the covid virus. public health agencies have made mistakes may need to be acknowledged and corrected. this has weakened confidence in oured public health and governmt system for many of our constituents at a time when we desperately need to comee together as a people and heal. i pledge to work with my friends across the aisle to rebuild a bipartisan coalition of support for basic science and research, and talk honestly about ways we can translate that information into evidence-based practices using data, not just talking points. most of our constituents want to do the right thing to stop the spread of covid. many just don't believe what they're being told by government officials anymore. i suspect will hear some difficult questions about that this morning. much attention in the past year has gone to covid, and rightly so. but i hope we can also continue our conversations and scientific advancements in such areas as cancer treatment and dealing with alzheimer's, diabetes, other diseases and chronic illnesses. these diseases are responsible for the loss of hundreds of thousands of american lives every year. h again i fear this work may be shortchanged by the hyperfocus on the newd arpa-h, and i sincerely hope that will not come to pass. we have an excellent team representing some of the largest institutes and most promising frontiers of new discoveries before us today. as we know, nih is composed of 27 institutes and centers, most of whose leaders are not able to be with us today. but even though we are not able to each director, before us, our office is continually learn about the groundbreaking work and collaborative partnerships that all of the nih component and were all very proud of that work and know our role in making sure it goes forward. we know the work done at nih in each institute or center is a contributor. in closing i wantr to stress eah dollar invested in the nih is in my view a down payment on our future. this work has in the past and in the course, and will change in the course of disease detection, jurors in the years and generations to come. i know congress commitment to advancing these shared objectives is unwavering and bipartisan. i want to thank you, madam chair for holding the hearing and thank our witnesses for being here. i yield back. >> thank you, ranking member. dr. tabak, your full written testimony will be entered into the record. and now you're recognized for five minutes of for your opening statement. thank you. >> thank you chair, ranking member and distinguished subcommittee members. i am honored to be your two of my colleagues represent the national institutes of health. this is a time for nih and the entire biomedical research community to re-examine all of our efforts to rake the covid pandemic we are driven by the urgency of the moment. nih must learn from this experience and seize the opportunity to define a new normal exacting director and committed to new strategies, new voices and a renewed focus on the future. now is the time to reflect on what worked and did not work to address covid and shape new strategies. sustained investment nih research set the stage for the mrna technology design key to development of safe and vaccines unprecedented timeline. since these vaccines have become available to estimated more than 2 million lives were saved and more than 17 million hospitalizations were averted. now we need continued support for a wide range of biomedical fields including behavioral and social sciences, to identify successfully implement better ways of responding to the short and long-term health effects of covid-19 to prepare for future pandemics and to ensure equitable protection of our diverse population. it is not just about vaccines. rapid acceleration of diagnostics covid-19 testing to help ensure his benefits showed those disproportionately red x underserved populations and nih community engagement alliance. these experiences along with other nih led efforts focused on covid treatment development, demonstrate the extraordinary value of public-private partnerships. the nih could build upon momentum of the covid response and apply it to other challenges for the advanced research project agency for help. thanks your inclusion of key authorities and funding nih is beating to frame the basic administrative infrastructure. this is a first key step in creating permanent home with the strategic partnership there so urgently needed to address cancer, diabetes, alzheimer's and many other diseases. but we cannot stop there. in addition to new strategies biomedical research needs new voices. growing body of demonstrates inclusion have better outcomes clinical setting, diverse medical teams provide more accurate diagnoses and improved health for patients while building trust. we do better science we have a diversity of scientists of different backgrounds and communities, scientific fields and various career stages. nih continues to prioritize fund and empower early-stage investigators so that they can succeed as independent researchers in 2021 reach an all-time high of early-stage investigators funded 1513. voices of people living with the lot wide range of diseases and conditions conversations with patients and their advocates are sometimes difficult. those are often the discussions that teach us the most. from the aids advocacy group of the 1980s to today's groups for autism dcfs on covid and many others these voices have refused to be ignored and ultimately all of us benefit assist for renewed focus on the future spent a lot of time encouraging early-stage scientists i also think about the importance of engaging elementary school age children like those my wife has taug