the NIH AIDS funding (53.1 percent in fiscal year 1990) goes to NIAID; much of the rest goes to four other institutes: NCI (20.3 percent), National Center for Research Resources (NCRR; 6 percent), NHLBI (5.7 percent), and NICHD (3.6 percent). The remaining 11.3 percent is spread among the remaining NIH units (Table 4.3).
Because it receives more than half the AIDS funding at NIH, nearly half (47.3 percent in fiscal year 1990) of NIAID's overall budget is devoted to AIDS. AIDS funding amounts to 9.1 percent of NCI's budget, 6.1 percent of NICHD's, and less than 4 percent of most other units. It is a larger set of activities for the Fogarty International Center and the units providing intramural and extramural research support (NCRR, Buildings and Facilities, and the OD; Table 4.4). Because of AIDS funding, NIAID went from being the sixth largest institute in 1981 (23 percent the size of NCI, the largest institute at that time) to the third largest institute in 1990 (51 percent the size of NCI, still the largest NIH component).
Early in the NIH response to the AIDS epidemic, intramural research accounted for a large proportion of the agency's AIDS effort (47 percent in 1982, 31 percent in 1983, 27 percent in 1984, and 25 percent in 1985; Table 4.5). In comparison, intramural research accounted for only about 12 percent of NIH's non-AIDS budget during that time. The use of contracts was prominent in the early years, reaching 53 percent and 43 percent of the AIDS budget in the 1986–1987 fiscal years when the large extramural programs, such as the AIDS clinical trials units, were being launched. In those years contracts accounted for about 6 percent of the non-AIDS budget (Table 4.6).
The AIDS effort has relied less on grants, especially on research project grants, than has non-AIDS research. The proportion of AIDS funding going to research project grants (RPG) reached a low of 19 percent in 1986, during a time when the proportion of non-AIDS funding for such grants was increasing steadily (from 50 percent in 1982 to 56 percent in 1986). This trend in AIDS funding was reversed in 1987 when the large contracts for ACTUs were converted to cooperative agreements, which are classified as RPGs. In 1990 RPGs account for only 39 percent of the AIDS budget (compared with 59.5 percent of the non-AIDS budget; Table 4.5 and Table 4.62). In addition, compared with non-AIDS programs, relatively more of the AIDS RPG dollars go to RFA-initiated cooperative agreements with ACTUs, national cooperative groups for drug and vaccine development, and other large programs in which NIH staff play a role in decision making. About 60 percent of RPGs have been individual investigator-initiated R01s (Table 4.7), but the bulk of RPG funding goes to cooperative agreements (U01s) and research project grants (P01s), most of which are solicited by NIH through RFAs. This is because most of the non-R01 grants are very large. U01s for AIDS clinical trials units and national cooperative drug and vaccine discovery groups, for example, are in the range of $0.5 to $1 million. As Table 4.7 shows, however, the proportion of research grants solicited by RFAs has decreased.
NIH's standard planning mode has been, first, to let the public, through Congress, indicate broad priorities among health problems by appropriating a certain amount for each categorical entity of NIH (institutes, centers, and divisions), and, second, to allow NIH and the scientific community to identify the research efforts that are needed to address priority problems. These
These figures refer to overall AIDS expenditures, including extramural research, intramural research, and program support activities. In 1990 RPGs accounted for 51 percent of the AIDS budget for extramural grants and contracts, compared with 71 percent of the non-AIDS extramural budget.