On behalf of the National Institutes of Health (NIH), I am ...

On behalf of the National Institutes of Health (NIH), I am transmitting the Congressional Justification of the NIH request for the fiscal year (FY) 2022 budget. This request for a $52.0 billion total program level is critical to supporting NIH's mission to seek fundamental knowledge about the nature and behavior of living systems and to apply that knowledge to enhance health, lengthen life, and reduce illness and disability. Importantly, this budget request enables the NIH to support critical biomedical discoveries that lead to life-saving medical interventions and enables the biomedical research workforce from across the full inclusive richness of the Nation to transform inspiration into innovation.

It is hard to put into words just how remarkable the biomedical research accomplishments in response to the COVID-19 pandemic are in the history of science. A vaccine development process that used to take many years, often decades, has been condensed to about 11 months. In our efforts to combat COVID-19, we have come a long way in a short period. But there is still plenty of work to do to get this pandemic and other public health crises facing our Nation under control. The NIH FY 2022 budget ensures that NIH can prioritize innovation to develop transformational tools and technologies, discover new clinical breakthroughs, and advance the next frontier of biomedical research.

It is important to recognize that the advances made in the past year could not have happened without the efforts of many scientists working tirelessly for many years to understand fundamental aspects of life and human health prior to the pandemic. The FY 2022 budget continues to advance NIH's long-standing commitment to investing in basic research and the arc of translation into clinical practice. Fundamental research is the key to unlocking the secrets of how living systems function and remains the foundation for developing novel treatments and cures. Just as investment in basic science led to the rapid development of COVID-19 vaccines, diagnostics, and therapeutics, basic research also serves as the foundation for the NIH Helping to End Addiction Long-term (HEAL) Initiative, which aims to curb the opioid epidemic and provide non-addictive alternatives for individuals who suffer from chronic pain. As the NIH builds upon its investments in basic research to develop innovative medical treatments, we look forward to being the home to the new Advanced Research Projects Agency for Health (ARPAH) and its exciting new capabilities to speed the application and implementation of health breakthroughs.

The FY 2022 budget allows NIH to secure the Nation's investment in this current biomedical workforce and the next generation of biomedical research scientists. As a science agency, the NIH understands that bringing diverse perspectives, backgrounds, and skillsets to address complex scientific problems enhances scientific innovation, and we are committed to ending structural racism in biomedical research. We will be instituting new ways to support diversity, equity, and inclusion which will help identify and dismantle any policies and practices that may

harm our workforce and our science. A new NIH initiative called UNITE will provide the framework for this important effort. UNITE goals are centered on ending structural racism and racial inequities across the biomedical research enterprise through short-term and long-term actions.

In conclusion, the FY 2022 budget provides resources for NIH, and the hundreds of thousands of researchers it supports, to accelerate discoveries that will enhance our ability to prevent and cure disease. I look forward to discussing the FY 2022 budget request.

Francis S. Collins, M.D., Ph.D.

TABLE OF CONTENTS

Organization Chart .................................................................................................................. 1

EXECUTIVE SUMMARY

Introduction and Mission ......................................................................................................... 3 Overview of Budget Request ................................................................................................... 4 Overview of Performance...................................................................................................... 19 All-Purpose Table.................................................................................................................. 22 Impact of Budget Level on Performance................................................................................. 23

OVERALL APPROPRIATIONS

Appropriations Language....................................................................................................... 25 Language Analysis ................................................................................................................ 35 Budget Mechanism Table ...................................................................................................... 37 Authorizing Legislation......................................................................................................... 38 Appropriations History .......................................................................................................... 39 Appropriations Not Authorized by Law.................................................................................. 40 Narrative By Activity Table/Header Table.............................................................................. 41 Program Descriptions and Accomplishments.......................................................................... 42 Funding History (Five-Year Funding Table)........................................................................... 58 Summary of Request Narrative .............................................................................................. 59 Outputs and Outcomes........................................................................................................... 62 Grant Awards Table............................................................................................................... 84 NEF Narrative....................................................................................................................... 85

SUPPLEMENTARY TABLES

Budget Request by IC (Summary Table) ................................................................................ 89 Appropriations Adjustment Table for FY 2020 ....................................................................... 90 Appropriations Adjustment Table for FY 2021 ....................................................................... 91 Budget Mechanism Table ...................................................................................................... 92 Budget Authority by Object Class Including Type 1 Diabetes ................................................. 93 Budget Authority by Object Class Including SSF and MF....................................................... 94 Salaries and Expenses............................................................................................................ 95 Detail of Full-Time Equivalent Employment (FTE) ................................................................ 96

Programs Proposed for Elimination........................................................................................ 97 Physician's Comparability Allowance Worksheet................................................................... 98 History of Obligations by IC.................................................................................................. 99 History of Obligations by Total Mechanism ......................................................................... 100 Statistical Data: Direct and Indirect Costs Awarded.............................................................. 101 RPGs ? Total Number of Awards and Funding..................................................................... 102 RPGs ? Success Rates ......................................................................................................... 103 Total R01 Equivalent Data for First Time and Established Investigators................................ 104 Competing RPGs by Length of Award ................................................................................. 105 Non-Competing Commitments............................................................................................. 106 MF General Statement......................................................................................................... 107 MF Budget Authority by Activity ........................................................................................ 107 MF Budget Authority by Object Class.................................................................................. 108 MF Detail of Positions......................................................................................................... 109 SSF General Statement........................................................................................................ 110 SSF Budget Authority by Object.......................................................................................... 111 SSF Detail of Positions........................................................................................................ 112 Digital Modernization.......................................................................................................... 113

TRANS-NIH INITIATIVES

Trans-NIH Initiatives........................................................................................................... 115

COMMON FUND

Common Fund..................................................................................................................... 165 Major Changes in the President's Budget Request ................................................................ 177 Budget Mechanism.............................................................................................................. 178 Budget by Program.............................................................................................................. 179 Justification of Budget Request............................................................................................ 180 Program Descriptions .......................................................................................................... 180

OFFICE OF AIDS RESEARCH

Office of AIDS Research..................................................................................................... 191 Organization Chart .............................................................................................................. 204 Justification of Budget Request............................................................................................ 206 Program Descriptions, Accomplishments, and Future Directions........................................... 206

DRUG CONTROL PROGRAMS

Resource Summary.............................................................................................................. 213 Program Summary............................................................................................................... 213 Budget Summary................................................................................................................. 216 Performance........................................................................................................................ 226

ORGANIZATION CHART

National Institutes of Health

Office of the Director Director: Francis S. Collins, M.D., Ph.D. Principal Deputy Director: Lawrence Tabak, D.D.S., Ph.D.

National Cancer Institute Ned Sharpless, M.D.

National Eye Institute Michael F. Chiang, M.D.

National Heart, Lung, and Blood Institute Gary H. Gibbons, M.D.

National Human Genome Research Institute Eric D. Green, M.D., Ph.D.

National Institute on Aging Richard J. Hodes, M.D.

National Institute on Alcohol Abuse and Alcoholism George F. Koob, Ph.D.

National Institute of Allergy and Infectious Diseases Anthony S. Fauci, M.D.

National Institute of Arthritis and Musculoskeletal and Skin Diseases Lindsey A. Criswell, M.D., M.P.H., D.Sc.

National Institute of Biomedical Imaging and Bioengineering Bruce J. Tromberg, Ph.D.

National Institute of Child Health and Human Development Diana W. Bianchi, M.D.

National Institute on Deafness and Other Communication Disorders Debara L. Tucci, M.D., M.S., M.B.A.

National Institute of Dental and Craniofacial Research Rena N. D'Souza, D.D.S., M.S., Ph.D.

National Institute of Diabetes and Digestive and Kidney Diseases Griffin P. Rodgers, M.D., M.A.C.P.

National Institute on Drug Abuse Nora D. Volkow, M.D.

National Institute of Environmental Health Sciences Richard P. Woychik, Ph.D.

National Institute of General Medical Sciences Jon R. Lorsch, Ph.D.

National Institute of Mental Health Joshua A. Gordon, M.D., Ph.D.

National Institute on Minority Health and Health Disparities Eliseo J. Perez-Stable, M.D.

National Institute of Neurological Disorders and Stroke Walter J. Koroshetz, M.D.

National Institute of Nursing Research Shannon N. Zenk, Ph.D., M.P.H., R.N., F.A.A.N.

National Library of Medicine Patricia F. Brennan, R.N., Ph.D.

John E. Fogarty International Center for Advanced Study in the Health Sciences Roger I. Glass M.D., Ph.D.

National Center for Advancing Translational Sciences Joni L. Rutter, Ph.D. (Acting)

National Center for Complementary and Integrative Health Helene M. Langevin, M.D., C.M.

Center for Scientific Review Noni Byrnes, Ph.D.

Clinical Center James K. Gilman, M.D.

Center for Information Technology Andrea T. Norris

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EXECUTIVE SUMMARY

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