HEALTH : AIDS Research Funding Changes Proposed in Bill

The federal AIDS research program, long criticized by AIDS activists, would undergo a major transformation under a bill pending in the new Congress.

The provision is part of the Senate version of the National Institutes of Health reauthorization bill. Until recently, the proposed change has been overshadowed by the bill’s major focus--safeguards for the use of fetal tissue in medical research.

But the measure also would dramatically reorganize the federal AIDS program by giving a single office powerful authority over how AIDS research dollars are spent.

The proposal has inspired a strong debate between its proponents--who believe that federal AIDS research efforts are now too piecemeal and decentralized--and its detractors, who argue that the change would create more red tape and ultimately delay the delivery of funds to researchers.

PROPOSAL: The bill would establish a new office of AIDS research whose director would report directly to the secretary of health and human services, rather than to the director of the NIH.

The new office would assume sole budgetary authority over the entire AIDS federal research program. The AIDS research budget would be submitted to Congress for its approval as one complete package, rather than as part of the NIH’s overall budget, which includes research funding for myriad diseases.

The NIH officials would continue to have input in deciding which research projects would be funded, but the process would be under the leadership of the new office and part of an overall plan, rather than the province of the individual institutes.

Moreover, budget authority for all AIDS research would rest in the new office, rather than within each institute, where it is now.

BACKGROUND: An office of AIDS research already exists as part of the NIH. But it serves as more of a coordinating body, in that it monitors overall research by the different institutes of the NIH and ensures that there is no duplication. It has no budgetary authority.

Its director is Dr. Anthony S. Fauci, a leading AIDS scientist who also directs the NIH’s National Institute of Allergy and Infectious Diseases. Although the office has no real power, Fauci wields considerable influence, often serving as the government’s spokesman for AIDS research.

Supporters of the change argue that his dual role poses a conflict of interest. He oversees the total AIDS research program and competes for research funding for his own programs.

DEBATE: Those concerned about the plan do not want to alienate AIDS activists, who are pushing hard for it. Those who favor the plan fear that their support will be seen as a criticism of Fauci, whom they do not want to offend. Few have been willing to express their opinions openly.

Fauci has refused to comment publicly about the legislation. But he did sign a recent letter from the NIH institute directors expressing their serious reservations about certain aspects of the idea.

Their biggest objection is that allowing all budgetary authority to rest within this single new office, instead of within individual institutes where research proposals initially are evaluated, will result in a slowdown in the execution of research projects.

Supporters of the plan, however, disagree, saying that the process will be enhanced. “Each institute will develop an internal budget request for AIDS, just the way it does now,” said Derek Hodel, of AIDS Action Council. “But they will be submitted to (this new office). And (the office) will ensure that new (research) programs are funded based on their incorporation into a larger strategic plan. The approach will be a collaborative one.”