efforts rely on grants, especially individual investigator-initiated grants, as the mechanism of support, and on the peer-review system, in which research applications are rated for scientific merit by disciplinary study sections of experts. Through these processes NIH supports a high proportion of basic research initiated by individual investigators as well as more directed efforts to apply the results of basic research in clinical practice and public health prevention and control programs. Thus, in fiscal year 1990, more than 60 percent of NIH's non-AIDS budget supported basic research (Figure 4.3), and 59.5 percent of the non-AIDS budget supported investigator-initiated grants (research project grants) rather than research centers, contracts, intramural research, or other research mechanisms (Table 4.6). Some of the larger institutes with a more explicit disease focus, such as NCI and NHLBI, have substantial applied efforts (e.g., drug screening and development, clinical trials) and prevention and control programs (antismoking, cholesterol and blood pressure control), but they still devote half of their resources to basic research.

NIH's emphasis on basic research and its traditional posture of waiting for high-quality research proposals turned out to be too slow in the case of AIDS. As public and congressional pressure mounted in the mid-1980s to expand AIDS research, NIH pursued several routes: it quickly expanded its intramural efforts and, extramurally, expedited grant review, used RFAs and RFPs to stimulate research in specific areas, funded some applications with relatively lower peer-review scores, and used directive mechanisms (e.g., cooperative agreements, contracts) to support specific approaches. It is for these reasons that less of the NIH AIDS budget than the non-AIDS budget goes to research project grants. The share of AIDS research funds for basic research is also comparatively lower, although the exact figure is unknown. The large-scale programs initiated through RFAs and supported by cooperative agreements–AIDS clinical trials units, the national cooperative drug and vaccine development groups, and so forth–are classified as research project grants; on the other hand, some fundamental research in immunology and virology of relevance to AIDS research is funded through the non-AIDS budget. Although the share of the AIDS budget going to research and development contracts has been greatly reduced (down from 53 percent in 1986), it still accounts for more than 26 percent of the AIDS budget in 1990 (compared with 5.5 percent of the non-AIDS budget3). Reliance in the AIDS program on intramural research is also higher –16.5 percent of AIDS funding compared with 10.8 percent of non-AIDS funding–although this figure includes a substantial clinical treatment program mandated by Congress.

Categories of Research

NIH has used several sets of research categories for tracking AIDS funding over the course of the epidemic. Currently, NIH uses the so-called Mason categories, which are also used by the PHS to track AIDS activities in all its agencies (see Table 4.8 for a breakdown of NIH spending in fiscal years 1989–1991). Yet none of the sets of functional categories used to report the content of the PHS AIDS program have been especially suited to a scientific characterization of NIH's program. It is not possible to determine how much of the AIDS budget goes to such basic science areas as immunology, virology, molecular biology, and microbiology, or to categories of biomedical research, such as epidemiology and natural history, etiology, pathogenesis, therapeutics, and vaccine development. From 1984 to 1989, NIH used the Charlottesville functional categories, which came closest to those used by the PHS; the agency used projected rather than actual data for 1989 and 1990, however (Table 4.9). The committee was unable to obtain a parallel breakdown of non-AIDS categories for comparison.

3  

Looking just at the extramural part of the budget, 35 percent of the AIDS extramural budget went for contracts, compared with 7 percent of the non-AIDS extramural budget.



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