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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus's Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: 10.17226/25483.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Prepublication Copy – Subject to Further Editorial Correction MANAGING THE NIH BETHESDA CAMPUS’S CAPITAL ASSETS FOR SUCCESS IN A HIGHLY COMPETITIVE GLOBAL BIOMEDICAL RESEARCH ENVIRONMENT Committee on Assessing the Capital Needs of the National Institutes of Health Board on Infrastructure and the Constructed Environment Division on Engineering and Physical Sciences A Consensus Report of PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by Contract No. HHSN292201700014C. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25483 Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Managing the NIH Bethesda Campus’s Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25483. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson, is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

COMMITTEE ON ASSESSING THE CAPITAL NEEDS OF THE NATIONAL INSTITUTES OF HEALTH KENNETH W. KIZER, NAM,1 University of California, Davis, School of Medicine, Chair EDWARD DENTON, University of California, Berkeley (retired) DON DETMER, NAM, University of Virginia School of Medicine LAURA FIDLER, AMC Strategies, LLC G. EDWARD (Edd) GIBSON, JR., Arizona State University SANJIV GOKHALE, Vanderbilt University MIKE HARBER, St. Jude Children’s Research Hospital KERSTIN HILDEBRANDT-ABDIKARIM, Children’s National Health System DOUG KINCAID, Applied Management Engineering, Inc. THOMAS MITCHELL, FM3IS Associates, LLC KIRK PAWLOWSKI, State of Washington Educational Service District 112 WILLIAM SEED, Jackson Health System SARAH SLAUGHTER, NAE,2 Built Environment Coalition PHIL TOBEY, SmithGroupJJR Staff GREG EYRING, Senior Program Officer MARTIN OFFUTT, Senior Program Officer CAMERON OSKVIG, Board Director JOSEPH PALMER, Senior Program Assistant 1 Member, National Academy of Medicine. 2 Member, National Academy of Engineering. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION v

BOARD ON INFRASTRUCTURE AND THE CONSTRUCTED ENVIRONMENT JAMES P. WHITTAKER, Facility Engineering Associates, Chair ADJO A. AMEKUDZI-KENNEDY,1 Georgia Institute of Technology WAYNE ARNY, Wayne Arny & Associates JAMES BAGIAN, NAE/NAM, University of Michigan2 ROSS COROTIS,1 NAE, University of Colorado MAJOR GENERAL ARNOLD FIELDS,2 U.S. Marine Corps (retired) PATRICIA D. GALLOWAY, Pegasus-Global Holdings, Inc. G. EDWARD GIBSON,2 Arizona State University SANJIV GOKHALE, Vanderbilt University CHRIS T. HENDRICKSON,2 NAE,3 Carnegie Mellon University CHRIS D. POLAND, NAE,3 Chris D Poland, Consulting Engineer JAMES RISPOLI,1 Project Time and Cost, Inc. JANICE L. TUCHMAN,1 Engineering News Record Staff CAMERON OSKVIG, Director JOSEPH PALMER, Senior Program Assistant MARTIN OFFUTT, Senior Program Officer 1 Through December 31, 2017. 2 Through December 31, 2018. 3 Member, National Academy of Engineering. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION vi

Preface For many decades, the National Institutes of Health (NIH) has produced a steady stream of cutting-edge advances in biomedical research and the health sciences. While these breakthrough discoveries garner news headlines, the laboratory facilities and other physical infrastructure that enable such scientific advances are rarely discussed. The evolving needs of biomedical research and clinical science place high demands on the buildings, laboratories, and utility and supporting services infrastructure. Without adequate infrastructure, neither NIH nor any scientific research entity would be able to accomplish its mission. Taking an interest in this tension between the science and physical plant, the U.S. Congress, per the Consolidated Appropriations Act of 2017, requested that the National Academies of Sciences, Engineering, and Medicine “[p]repare a report that assesses the capital needs of NIH’s main campus.” Legislators envisaged the study’s purpose as “to ensure the Committee is informed of NIH’s critical facility needs and inform future infrastructure budgets.” The request focused on the main NIH campus located in Bethesda, Maryland. The 310-acre Bethesda Campus houses the leadership of the 27 NIH institutes and centers, as well as a substantial portion of the Intramural Research Program (IRP). The latter is carried-out by some 1100 principal investigators (PIs) and several thousand additional scientists in government-owned facilities. The operating funds for the IRP comprise about one-tenth of the NIH budget. In addition to IRP funding, funds have been appropriated specifically for buildings and facilities, which are utilized mainly for the Bethesda Campus. The committee tasked with this study spent substantial amounts of time on the Bethesda Campus, looking first-hand at the biomedical and clinical research facilities and other infrastructure (e.g., the utilities that provide essential energy and sanitation services to the campus) providing research support. The committee augmented this with a detailed review of written records, attempting to understand not only planning and operations but also, to the extent it could be known, how appropriations related to the operating budgets of the Bethesda Campus and how scientific funds tallied against spending on specific buildings. The committee undertook its work with an eye toward how the capital assets on the Bethesda Campus were supporting the NIH mission today, as well as how they might do so into the future. The NIH Office of Research Facilities arranged multiple site visits that allowed the committee to see facilities that supported specialized laboratory spaces supporting newer avenues of scientific inquiry such as bioinformatics and high-speed computing—sciences that, generally speaking, are newer than the NIH buildings that house them. The committee also spent one full day in an interdisciplinary space, the Porter Neuroscience Research Center—a building delivered in two phases in 2004 and 2014—that represented a move away from the traditional approach to facilities on the Bethesda campus. Many individuals volunteered significant time and effort to address and educate the committee during its public information sessions. Dr. Francis Collins (NAS/NAM), director of NIH, held substantive discussions with the committee, as did Dr. Michael Gottesman MD (NAS/NAM) deputy director for intramural research, and Alfred C. Johnson, Ph.D., the Deputy Director for Management. The director of the National Eye Institute and chair of the NIH Facilities Working Group, Dr. Paul Sieving, MD (NAM), acted as the liaison to the committee from the institutes and centers. Dr James Gilman, MD, CEO of the Clinical Center, personally led the committee on tours of that center and provided informative briefings. Helping to pull it all together was Dan Wheeland, PE, the director of the Office of Research Facilities. Numerous other individuals, listed in Appendix B, provided valuable insights as well. To all these individuals and others not named here, the committee extends its heartfelt thanks and appreciation. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION vii

The committee considers NIH to be a critical national resource that is integral to the nation’s health, well-being and national security. We hope the Congress will embrace the committee’s findings, as detailed in this report, and provide NIH with the funding and support needed for it to fulfill its mission and continue its unparalleled legacy. Kenneth W. Kizer, MD, MPH, Chair Committee on Assessing the Capital Needs of the National Institutes of Health PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION viii

Acknowledgment of Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Norman Augustine, NAS1/NAE,2 Lockheed Martin Corporation (retired), Richard Berman, NAM,3 University of South Florida, Thomas Budinger, NAM/NAE, University of California, Berkeley, Steven Crane, Crane Strategies, Stephen Maiorisi, Harvard Medical School, Chris Poland, NAE, Chris Poland, Consulting Engineering, Gerald Rubin, NAS/NAM, Howard Hughes Medical Institute, and Elias Zerhouni, NAM/NAE, Sanofi, Paris, France. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Martin Philbert, NAM, University of Michigan. He was responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. 1 Member, National Academy of Sciences. 2 Member, National Academy of Engineering. 3 Member, National Academy of Medicine. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION ix

Contents SUMMARY S-1 1 INTRODUCTION 1-1  Origin of Study 1-1  Charge to the Committee 1-1  Committee’s Approach to the Statement of Task 1-2  Structure of the Report 1-2  2 GLOBAL AND NATIONAL BIOMEDICAL RESEARCH ENVIRONMENT 2-1  Biomedical Research Environment and Key Emergent Trends 2-1  The Research Built Environment and Key Emergent Trends 2-4  Summary 2-5  3 NIH BETHESDA CAMPUS: FACILITIES AND ACTIVITIES 3-1  Overview of mission (intramural, extramural) 3-1  Mission of NIH 3-1  History and Description of the NIH Bethesda Campus 3-1  How the Organization Addresses the Needs of the Facilities 3-3  Funding and Personnel 3-4  NIH, National Security, and the Bethesda Campus 3-8  NIH Contributions to the Nation’s Health Security 3-8  NIH Contributions to the Nation’s Economic Security 3-9  Security Considerations and Access to the NIH Bethesda Campus 3-9  Value and Accomplishments of NIH Intramural Program 3-11  NIH IRP Level of Investment in an International Context 3-11  Intramural Assets 3-12  Partnerships 3-18  Selected Extramural and Intramural Research Program Collaborations 3-18  4 CURRENT CONDITION 4-1  Infrastructure in Support of Scientific Activities at NIH-BC 4-1  Overview 4-1  Funding for Capital Projects 4-4  Space Utilization on NIH-BC 4-4  Current Conditions of IRP Facilities at NIH Bethesda 4-1  IRP Facilities Are a Mix of Recently Built and Past-Their-Prime Buildings 4-1  NIH BMAR and Facility Condition Index and the Degree to Which Maintenance Backlog Is/Is Not Part of the Decision Making Process 4-2  Risk to Research and Patient Care Created by Outages and Disruptions 4-4  Building Process and Monies Available or Used 4-5  Project Dashboard 4-7  Findings 4-9  Recommendations 4-9  5 CURRENT CAPITAL ASSET MANAGEMENT AT NIH 5-1  Determining the Value of Facilities on the Bethesda Campus 5-1  Value of Real Property Assets 5-1  Process by Which Projects Are Planned and Evaluated 5-3  PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xi

Description of Process 5-3  Condition Index Assessment 5-5  Planning Environment 5-6  Long-Range Planning Process 5-6  Constraints and Challenges 5-7  Assessing the Need for Renovation, Replacement, or Adaptive Re-Use 5-8  The Utility of the NIH Condition Assessment and B&F Prioritization Model 5-8  Committee’s Assessment 5-10  Using CI for Decision Making 5-12  Findings 5-13  Recommendations 5-14  Annex 5.A: Preventative Maintenance Measures and Life Cycle Cost Analysis 5-15  Preventative Maintenance Measures 5-15  Designing for Minimum Life Cycle Costs 5-16  6 NIH CURRENT APPROACH TO STRATEGIC PLANNING FOR THE BETHESDA CAMPUS BUILDINGS AND FACILITIES 6-1  Context 6-1  Investment and NIH-Wide Strategic Plan for Fiscal Years 2016-2020: Turning Discovery into Health 6-1  Long-Term NIH Intramural Research Program 6-4  Managing Investment 6-4  Comprehensive Master Plan—NIH Bethesda Campus 6-4  Areas of Further Attention for the Update to the NIH 2013 Comprehensive Master Plan— Bethesda Campus and Integration with the NIH-Wide Strategic Plan Fiscal Years 2016-2020 6-7  Capital Repair and Improvement—Current Reinvestment Approaches 6-10  Current Capital Cost Planning at NIH Bethesda 6-10  Findings 6-23  Recommendations 6-25  7 THE FUTURE OF CAPITAL PLANNING FOR THE NIH BETHESDA CAMPUS 7-1  Integrating Strategic Research Program and Strategic Capital Facilities Plans 7-1  Background 7-1  Existing Practices of Federal Agency Research Enterprises 7-1  Institute for Defense Analyses Benchmarking Analysis of Federal Security Laboratories 7-8  GAO Report on Best Practices for Federal Real Property Asset Management 7-11  Capital Asset Portfolio Performance-Based Capital Planning Decision Making 7-11  Findings and Recommendations 7-13  Findings 7-13  Recommended Strategies to Accommodate Short-, Mid-, and Long-Range Capital Planning Process Improvements at NIH 7-13  8 THE EVOLVING GLOBAL BIOMEDICAL RESEARCH ENVIRONMENT AND ITS IMPLICATIONS FOR NIH CAPITAL ASSETS 8-1  Background and Context 8-1  Organizational Structure and Funding 8-1  Multidisciplinary Team Science 8-3  Data Driven Science 8-5  Conclusion 8-6  9 RECOMMENDATIONS 9-1  PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xii

Necessary Short-Term Actions 9-1  Revise Expenditure Planning Processes and Practices 9-1  Improve Capital Planning Tools and Methods 9-1  Treat the Campus and its Activities as an Interrelated and Integrated System 9-2  Solicit Input from Experts External to NIH 9-2  Revise Governance 9-3  REFERENCES APPENDIXES A Committee Biographies B Committee Activities C Data on NIH Clinical Center D NIH Facilities: Cores E List of Facilities on Bethesda Campus F NIH Facilities: Space Utilization G Review of NIH Corporate Strategic Planning Process H Capital Asset Portfolio Performance-Based Capital Asset Decision Making I Glossary J Acronyms PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION xiii

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