Medical Research Funding

What do I need to know about how we fund medical research?

Medical research is the scientific effort dedicated to expanding our understanding of health and disease. It is different from the care doctors provide to individual patients, but it helps create the knowledge, tools, and medications that doctors use. The goal is to help more people live longer, healthier lives.

The total cost of medical research is much more than lab supplies: it represents decades of investment in the talent, training, teams, technology, and facilities that make life-saving breakthroughs not just possible, but routine. In the US, the federal government, private companies, universities, and philanthropic foundations collectively invest more than $245 billion (PDF) in medical research each year. Federal funding has normally happened through agencies like the Department of Defense (DoD), Department of Veterans Affairs (VA), the U.S. Agency for International Development (USAID), and most notably, the Department of Health and Human Services (HHS), which includes the National Institutes of Health (NIH).

For decades, the NIH has been the largest public funder of medical research in the world. Its budget is roughly eight times as much as the medical research budgets of the DoD, VA, and USAID combined.* In recent years, it has spent more than 25 times as much on research as the next largest funder, which is the Wellcome Trust in the UK. In 2024, the total budget of the NIH exceeded $47 billion, split across three major categories:

1. 84% went toward funding “extramural” research conducted at universities, medical schools, and other research institutions;
2. 11% went toward self-funded “intramural” research in what is the largest biomedical research institution on earth; and
3. The remaining 5% covered operating expenses of the agency itself.

Federal research grants are not gifts or donations, they’re binding legal instruments between the federal government and the recipient’s institution. These grants are extremely competitive, and their terms are carefully negotiated and routinely audited. It’s helpful to understand that the U.S. specifically invests in research as an ecosystem because a large network of interconnected collaborations generates vastly more innovation and discovery (PDF) than any single lab or discipline.

What is happening?

The Trump administration and Congress are eliminating billions of dollars of funding for medical research while also gutting the scientific workforce. Specifically, they are:

• Terminating more than $2.4 billion in active grants and obstructing new awards. More on this
• Radically altering budget structures and reducing future funding. More on this
• Eroding expertise and ending training programs. More on this

On this page, we’ll break down those lines of attack, along with the countermoves and resilience efforts we’re seeing across American society.

Attack: Grant terminations and obstructions

Last updated: May 30

Our best working estimates calculate that the NIH alone has cancelled more than 1,500 grants so far, representing a loss of more than $2.4 billion (PDF) in previously-committed medical research funding, with more expected. When delays (an additional $2.3 billion) are factored in, the total value of lost research funding approaches $5 billion.

The changes to grants management have been rapid, large-scale, and chaotic. In the past, grant terminations have typically been associated with misconduct and extraordinarily rare: from 2012 to 2024, there were fewer than five such terminations. Since February, however, hundreds of researchers across the country have received termination letters telling them that their work “no longer effectuates agency priorities.” This specific phrase references an obscure update to the Office of Management and Budget rules from the first Trump administration that allows them to unilaterally sever grants in service of the president’s political agenda. This executive branch maneuver is called “impoundment” and it functionally overrides Congressional authorization and appropriation.

Some of the terminations are blatantly ideological; a result of DOGE-directed screening and searches for flagged keywords like “women,” “trans,” “nonbinary,” “diversity,” or “COVID.” The attack on “woke DEI ideology” targets research focused on HIV/AIDS, LGBTQ+ health, reproductive health, addiction and mental health, health equity and systemic racial disparities, and more. Other terminations have nothing to do with the subject of the research, and instead must be understood as part of the administration’s attempt to strip universities of their independence.

In addition to terminating active funding, the administration is interfering with the process for reviewing new proposals and making new awards. Immediately after inauguration, NIH expert review panels were put on an abrupt and indefinite pause, as part of a freeze on communications across health agencies. Months later, those review panels started meeting again, albeit in unusually short sessions. Compared to the past ten years, the NIH has awarded $2.3 billion less than expected in new awards so far in 2025.

Where this stands

• The government is not providing an accurate, transparent accounting of grant terminations and delays. Instead, journalists are relying on a massive volunteer effort to aggregate data.
• The initial freeze on disbursements was halted by a temporary restraining order, but the administration exploited a loophole to maintain the freeze through March. Washington state has filed a lawsuit claiming that the NIH continued to cancel research grants in violation of a court order, and that government lawyers have refused to respond to discovery requests. (This lawsuit relates to gender identity and gender-affirming care. For more on the topic, see our Transgender Healthcare page.)
• Grant reviews have restarted. The advisory councils that prioritize funding for peer-reviewed grants met as scheduled in April and May, and study sections seem largely restored. However, a new analysis has raised the fear of “shadow terminations” for grants that should have had a routine annual renewal. More than 1,500 grants are now more than 30 days overdue. Experts are concerned that the funding backlog will be spun as a huge NIH “budget surplus” that justifies the steep budget cuts for the next fiscal year.
• The NIH has stopped all payment on grants and contracts to Brown, Columbia, Cornell, Harvard, and Northwestern. These schools have also been blocked from future funding. Although NIH staff are prohibited from explaining why, the administration is demanding unprecedented control over the autonomy and academic freedom of these schools.
• The latest interference with established research practices at the NIH include a ban on payments to international collaborators.
• DOGE-projected “savings” misrepresented the total value of unspent funds and do not reflect the wasted value of lost effort and incomplete data. Nor do they acknowledge negative impacts on research ecosystems or the communities they serve. Experts say it will take years to understand what has been lost so far, but we know some of the damage is likely to be irreversible.

Who will be affected?

In brief, nearly everyone. Federally-funded science is a global driver of life-saving care, treatments, and technologies in both obvious and surprising ways. For example, the government only funds about one quarter (PDF) of the total U.S. investment in medical R&D each year, but those dollars have an outsized impact because they flow into the basic research that catalyzes and enables everything else. 354 of the 356 new drugs approved between 2010 and 2019 were made possible by government funding. This system was able to transform basic research into safe and effective products at unimaginable speed: it cannot be quickly turned on again after it’s been turned off.

More specifically, upending federal funding for American medical research:

• Harms patients right now. When clinical trials abruptly end, some patients are stranded with experimental drugs in their systems or devices in their bodies. Others, including those with rare diseases, are suffering as treatment possibilities are delayed and precious time slips away. Overall, we expect to see a smaller number of clinical trials proceeding more slowly than before.
• Betrays active duty military members and veterans, whose service creates specific health risks and hazards related to training, combat, and exposure to hazardous materials. The National Association of Veterans’ Research and Education Foundations estimates that medical care for 10,000 veterans may be immediately affected by research funding cuts.
• Destroys scientific careers. While institutions may be able to pivot to alternative funding, like donations or contracts, it is very difficult for individual researchers to supplement or replace the funding they have lost. At last count, NIH grants directly support more than 300,000 researchers, at more than 2,500 institutions across all 50 states, Puerto Rico, and other territories. When communications specialists, facilities staff, and all the other people making the research possible are counted, NIH funding underpins more than 407,000 U.S. jobs.
• Affects everyone living outside the United States as well. This includes children in Pakistan with tuberculosis, pioneering South African virologists, and Europeans living with HIV. Trust in the US as a reliable research collaborator will be difficult to restore.

It’s important to note that all these affected groups overlap in important ways with BIPOC, LGBTQ+, disabled, and neurodivergent identities. The people who have been most neglected by science and medicine in the past are more likely to have worse health outcomes now, to be underrepresented within the ranks of the research community, and to focus their careers on studying these issues. They are at risk because of who they are and what they study.

Countermoves: legal and legislative actions

In early April, a lawsuit filed by 16 states challenged the NIH grant terminations and delays as unlawful violations of the Administrative Procedure Act (APA). More than 40 cities joined an amicus brief requesting a nationwide injunction to protect their local workforces and economies. The court has determined that it has jurisdiction in the matter, and the case is open. More recently, two groups of scientists and doctors working on LGBTQ+ health issues have sued the NIH and its leadership on the grounds that grant terminations are a violation of congressional mandates and the NIH’s strategic plan, as well as Fifth Amendment equal protection rights. Both cases are open.

Congressional representatives from both parties have also sought to bring attention to the issue. In February, every member of the Senate Democratic Caucus signed a letter (PDF) urging the HHS to allow the work of the NIH to continue uninterrupted. In May, representatives held contentious and wide-ranging public hearings on both the House and Senate sides to question HHS Secretary Robert F. Kennedy Jr. about his agency’s priorities, funding, and budget plans. In those sessions, Kennedy’s claims that they have “not fired any working scientists” and are “not withholding money for lifesaving research” were repeatedly and flatly debunked.

Countermoves: community campaigns & resilience efforts

• Volunteer data scientists have built Grant Watch to track the status and total number of delayed, terminated, and reinstated research grants. The database is constantly updated from crowd-sourced records and official reports.
• Professionals are digging into the procedural specifics of legal grant terminations in order to appeal unlawful terminations. As institutions have begun contesting terminations, there have been haphazard reinstatements of a small number of grants. Public outcry has possibly contributed to high profile reversals, like the flagship Women’s Health Initiative.
• Many universities are deploying internal “bridge” funding to support research labs that have suddenly lost their grants. In nearly all cases, these emergency funds are a short-term, stopgap measure: they do not replace the entirety of the funding that is lost.
• Faculty in the Big Ten conference are pushing their universities to pool legal and financial resources in mutual defense compacts.
• Researchers whose grants have been cancelled are sharing ideas for alternative strategies for continuing their scholarly work.
• Graduate students launched Stand Up For Science in February and immediately began drawing large crowds to dozens of local and national protests. This grassroots organization is coordinating large-scale partnerships and actions via the Summer Fight For Science. Among their key demands are an end to political interference and censorship of science, the full restoration of funding, and a 20% increase in federal funding for science over the next three years.
• Scientists are coordinating to publish op-eds in their hometown newspapers and share public letters describing the community impact of their research.

Attack: Budget cuts and cost controls

Last updated: May 30

In February, the NIH attempted to cap “indirect rates” at 15%. Indirect costs refer to all the overhead expenses, like facilities and administrative costs, that research institutions incur. Indirect rates reflect documented historical costs and cost analysis: they are routinely renegotiated by HHS to reflect the specific context of each institution. Some universities have indirect rates as high as 60%, but the average is 28%. This means that for every $100 a researcher receives to cover project staff and supplies, the institution needs $28 to cover the costs of personnel, buildings, libraries, and everything else needed to keep operating. The impact of a flat 15% rate has been estimated at $9 billion in economic losses and 40,000 jobs so far, and perhaps $16 billion in economic losses annually.

Separately, the executive branch put forth a budget proposal that would drastically shrink the NIH budget by 44% ($18 billion), If Congress moves forward at the new level of just $27 billion, the agency would be working with less funding than in the past twenty years—longer if we adjust for actual spending power.

Where this stands

• In some cases, entire lines of politically disfavored medical research—such as LGBTQ+ health or the health impacts of climate change—have been cut from future budgets.
• Since courts have blocked the administration’s attempt to impound research funding, the administration is now expected to request permission to rescind funding Congress already allocated. Such “rescission” would legalize the delays to grant review and disbursement. The White House was expected to send the rescission package to Congress in mid-May. There have been no recent updates.
• Full details on the White House’s proposed budget for fiscal year 2026 are expected soon. This expanded version is still only a blueprint that lays out priorities. It must go to Congress, where proposed cuts may face hurdles. A similar proposal in Trump’s first term was rejected on a bipartisan basis.
• When NIH released guidance capping indirect rates at 15% in February, the agency was immediately and successfully sued by 22 state attorneys generals and a coalition of associations representing hospitals and medical, pharmacy and public health schools. The government has appealed the permanent injunction handed down against a 15% indirect cost cap in April.
• Economists have calculated that over the next 25 years, the proposed NIH budget would reduce spending by $500 billion but cost $8.2 trillion in lost life expectancy.

Who will be affected?

The overall burden of cuts to research funding is suffered most acutely by patients, especially those from marginalized and oppressed groups. Focused cancellations eliminate funding for some of those people’s unique needs, while the combination of overall cuts and indirect cost limits will result in fewer, smaller grants that do not go as far. This means missed treatments, delayed clinical trials, and an overall loss of momentum in life-saving progress. The disruptions ripple out into the future. In the US, two million people will be diagnosed with cancer in 2025 alone. More than 900.000 will die from heart disease while more than 50 million cope with chronic pain. Every day that diagnostics, treatments, and cures are delayed has a human cost.

Scientists are experiencing not just direct financial harm, but the moral injury of being forced to abandon their work. Because of uncertainty around indirect rates and other federal funding, many university programs paused or cut biomedical graduate admissions this spring, impacting an entire cohort of future doctors and medical researchers. The low-cost labor of those PhD students plays a pivotal role in how universities conduct research and undergraduate instruction alike. The fallout will have catastrophic impacts on research departments, which will likely divert university funding away from arts and humanities departments. These cascading impacts will devastate universities that rely on public funding rather than private wealth, and radically change higher education in the long term.

The damage is hardly limited to academic institutions. New economic analysis suggests that just a 25% cut to federal research funding would damage local and state economies so severely that the overall Gross Domestic Product (GDP) would be reduced by an amount comparable to the 2008 Great Recession. At present, the proposed cuts exceed 40% for the NIH and 56% for the National Science Foundation.

Countermoves

• Researchers have built SCIMap, an interactive tool for people to explore the consequences of cuts to indirect funds in terms of job losses and economic impacts in their own state and county.
• National associations of universities, medical schools, and other research institutions have formed a task force to develop a more efficient and transparent model for federal funding that will address legitimate concerns about indirect costs without hindering research.
• A massive coalition of professors, patient advocates, and labor unions joined forces for a national day of action in April called Kill the Cuts. Such solidarity across difference is a key priority for building momentum.
• At the local levels, mutual aid and participatory action research are emerging as key solutions to psychosocial and other health challenges. Meanwhile, community science projects, such as those monitoring air quality linked to asthma, heart disease and other health issues, build local capacity to rigorously collect and analyze data.

Attack: Cutting staff and eliminating training programs

Last updated: May 30

In addition to stable funding, successful research depends on personnel, power, and a training pipeline. That is:

• the collective skills and capacities of current researchers;
• the integration of scientific expertise into decision-making; and
• the ability to train the next generation of researchers.

The administration is undermining all three.

Since the beginning of the year, repeated waves of deliberately cruel firings, layoffs, buy-outs, and reductions in force have removed tens of thousands of people from federal jobs. A lack of data, reversals and reinstatements, and ongoing legal challenges complicate any attempt to understand how many experts have been affected, much less which precise jobs are vacant or no longer exist. The best estimate is that the federal workforce has shed more than 260.000 employees since January, with more to come. There is no official tally.

The researchers who do remain are increasingly constrained and sidelined. Earlier this year, researchers were under gag orders, entirely forbidden from communicating externally, including with their peers at scientific conferences. Meanwhile, DOGE gained access to the central electronic business system called the “wallet” of the NIH. DOGE staffers are now screening research proposals and making funding decisions. The administration also seeks to eliminate, reorganize, and relocate the research units of the NIH in the coming fiscal year. This is a move that hundreds of biomedical research organizations oppose as dictating science “in violation of process and procedures.” There are twenty-seven institutes and centers now: the target is just eight. Taken together, these changes substantially diminish the decision-making power of medical researchers who remain in their federal roles.

An important aspect of scientific decision-making power has to do with how junior colleagues are educated and prepared for their careers. Medical research labs are powered by trainees—these are undergraduate and graduate students, as well as recently-minted PhDs whose postdoctoral research appointments are the final step toward becoming the head of their own lab. At each career stage, trainees build the skills and experience required to conduct increasingly sophisticated biomedical research. Investing in this pipeline is a critical priority. Yet this too is also being dismantled. Since March, numerous training programs have been cancelled, including the 2025 summer research internships at the NIH. Many of the terminated programs were specifically designed to support minoritized scientists.

Finally, the medical research workforce is vulnerable to anti-immigration policies. International researchers make up half of the biomedical workforce overall. They are vital contributors to the biomedical research enterprise, and have an outsized impact on innovation and patents. International researchers and trainees are being stripped of their visas, detained at the border, and threatened with deportation. The U.S. earned its biomedical dominance with a combination of intensive investments and immigration policies that brought in talent from around the world. Both are now being throttled.

Where this stands

• The government is not providing accurate, transparent reports of how many federal scientists—or the teams that directly make their work possible—have been removed from the government workforce. To the best of our knowledge, HHS has been reduced by roughly 20,000 employees, approximately 24% of the agency’s total staff, including leaders at the highest levels. An unknown number of researchers in other agencies are affected.
• In some cases, entire research labs have been fired. Amidst an active outbreak, all 27 members of the CDC’s hepatitis lab were fired in April. All but one member of the only team coordinating federal research on pain were fired at the same time. In some cases, layoffs were subsequently reversed, though in many cases, those reinstated workers were then placed on administrative leave.
• Universities have begun reducing PhD admissions or rescinding PhD program offers. Although applications have been re-opened for post-baccalaureate research internships at the NIH, program directors report that many training programs have been cancelled nationwide.

Who will be affected?

• Patients are already suffering. Staffing reductions have created months-long delays in NIH clinical trials for the hardest-to-treat diseases, including aggressive metastasized cancers where every day counts.
• Untold thousands of people who are currently healthy will not have access to the drugs, treatments, and therapies that would be discovered under research-as-usual conditions. When the ecosystem of scientific collaboration collapses, it cannot be rebuilt quickly or easily, even if funding is fully restored.
• The careers of scientists are directly affected. In addition to its role in funding extramural research, the NIH previously employed more than 5,000 scientists: the Intramural Research Program has long been the largest biomedical research institution in the world. The hyper-specific nature of research jobs makes it difficult for federal researchers to find work in the private sector, which is itself at risk in the U.S.. With 75% of scientists considering leaving the country, experts urgently warn of functionally irreversible “brain drain.” Early-career scientists are particularly vulnerable. Eligibility for funding, fellowships, and career advancement are all tightly time-limited. The chaos and disruption of this year threatens to derail all the cohorts currently in training, just as opportunities to enter the pipeline are dramatically reduced.

Countermoves:

• Labor unions have sued the administration on behalf of those federal employees whose dismissal letters inaccurately attributed their dismissal to poor performance. On May 3, the judge issued a preliminary injunction. The government has since appealed. Separately, some of those same unions plus scientific societies, nonprofit organizations, states, counties, and cities joined forces to sue the president and agency heads over the large-scale reduction in force. A temporary restraining order was issued on May 9 and extended on May 22. The defendants have appealed.
• City councils and counties are providing local information hubs for recently separated federal employees, while larger coalitions have assembled a state-by-state guide and legal defense network for those affected by layoffs.
• Mutual aid groups are gathering resources, connecting affected researchers to lawyers, and offering Know Your Rights training for academic communities.