peer-review system for ranking research applications, is discussed in a later section of this chapter. If not a sufficient condition for high-quality research results, however, adequate funding surely is a necessary one, especially in a completely new area of research that lacks an existing body of researchers, ongoing studies, appropriate facilities and equipment, and training programs. This section reviews the history of AIDS research funding at NIH, in total and by institute, mechanism, and category of research; it also assesses its adequacy, its impact on non-AIDS research funding and progress, and the appropriateness of its allocation among categories of research, types of research support, and research mechanisms.

History of AIDS Funding
NIH and Its Institutes

The AIDS epidemic was first recognized in early 1981, a time of severe fiscal stringency in the federal budget that constrained the initial federal response (Office of Technology Assessment, 1985; Lee and Arno, 1986; Panem, 1988) and continues to affect federal action. The NIH budget for fiscal year 1981 was $3.57 billion, just 4.2 percent higher than the previous year's, and it increased only 2 percent–to $3.64 billion–in fiscal year 1982. After inflation, NIH's research purchasing power, using the biomedical research and development price index, actually declined by 5.6 percent in 1981 and by 6.1 percent in 1982, regaining its 1980 level only in 1984 (NIH, 1989a:Table 7). Yet despite the constraints on funding, some researchers in NIH's intramural programs and extramural projects and centers found AIDS to be an urgent medical problem, as well as an interesting scientific puzzle, and they began to study it.

The syndrome was first recognized and described by NIH grantees in mid-1981, and the first AIDS patient was admitted to the NIH clinical center in September 1981. Before the end of that year, NCI viral epidemiologists began studies; NCI held a national conference on Kaposi's sarcoma and AIDS-related opportunistic infections; general clinical research centers supported by the National Center for Research Resources became involved in AIDS studies; and NIAID supplemented grants to its extramural sexually transmitted disease centers and other researchers to study AIDS. In the first several years, support for AIDS research had to be reprogrammed from other areas of research. Congress first appropriated additional funding for AIDS research at NIH in a supplemental appropriations bill in July 1983, which provided about $9 million of the $21.7 million that NIH spent on AIDS in fiscal year 1983. The recent substantial growth in AIDS funding started in 1986 when Congress began “earmarking” AIDS funding in the regular appropriations to the institutes (Figure 4.1). As a result, AIDS funding began to increase more quickly than funding for non-AIDS activities (Table 4.1)–between 81 and 111 percent per year in fiscal years 1986 through 1988, and about 25 percent per year in fiscal years 1989 and 1990. In part because of the AIDS funding, NIH's budget went from $3.6 billion in 1981 to $7.6 billion in 1990, an increase of 112 percent. After inflation, the increase was 51 percent (using the gross national product deflator), or 28.8 percent (using the biomedical research and development price index). AIDS funding accounted for 18.5 percent of the overall NIH increase ($741 million of the $4 billion).

AIDS activities have grown steadily as a proportion of NIH spending, from less than 0.1 percent in fiscal year 1982 to 9.8 percent in fiscal year 1990 (Figure 4.2 and Table 4.2).1 Most of

1  

Although the fiscal year 1991 appropriation for AIDS represented an increase of 8.7 percent, the appropriation for non-AIDS research was also larger. Consequently, the AIDS share of the NIH budget dropped slightly, to 9.7 percent.



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