President-elect Donald Trump is tapping Dr. Jay Bhattacharya, a Stanford University health researcher, to be the next director of the National Institutes of Health.
"Together, Jay and RFK Jr. will restore the NIH to the Gold Standard of Medical Research as they examine the underlying causes of, and solutions to, America's biggest Health challenges, including our Crisis of Chronic Illness and Disease. Together, they will work hard to Make American Healthy Again!" Trump wrote in a statement making the announcement.
Bhattacharya, a physician and health economist whose nomination requires Senate confirmation, would take charge of an agency that employs more than 18,000 workers and funds nearly $48 billion in scientific research through nearly 50,000 grants to more than 300,000 researchers at more than 2,500 universities, medical schools and other institutions.
If confirmed, Bhattacharya could dramatically affect the future of medical science. The NIH is the world's largest public funder of biomedical research. But the NIH could be among the top targets for restructuring as the next administration tries to overhaul the federal government.
While the NIH has historically enjoyed bipartisan support, Trump proposed cutting the agency's budget during his first term. The NIH came under heavy criticism from some Republicans during the pandemic. That animosity has continued, especially towards some former long-serving NIH officials like Dr. Anthony Fauci, who led the National Institute of Allergy and Infectious Diseases for 38 years, and Dr. Francis Collins, NIH director from 2009 to 2021.
One factor was an open letter called "The Great Barrington Declaration," which was released in October 2020 and challenged policies such as lockdowns and mask mandates.
Bhattacharya was one of three authors of the document. The declaration called for speeding herd immunity by allowing people at low risk to get infected while protecting those most vulnerable, like the elderly.
It was denounced by many public health experts as unscientific and irresponsible. "This is a fringe component of epidemiology," Collins told The Washington Post shortly after the document was released. "This is not mainstream science. It's dangerous. It fits into the political views of certain parts of our confused political establishment."
"They were wrong," says Dr. Gregory Poland, president of the Atria Academy of Science & Medicine, a nonprofit group based in New York. "So it is concerning," Poland says of Bhattacharya's selection.
Others reacted even more strongly.
"I don't think that Jay Bhattacharya belongs anywhere near the NIH, much less in the director's office," says Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. "That would be absolutely disastrous for the health and well-being of the American public and actually the world."
Still, others are more measured.
"There were times during the pandemic where he took a set of views that were contrary to most people in the public health world, including my own views," says Dr. Ashish Jha, the dean of the Brown University School of Public Health who served as President Biden's COVID-19 Response Coordinator. "But he's fundamentally a very smart, well-qualified person."
"Are there views of his that I can look at and say, 'I think he was wrong' or 'They were problematic?' Yeah, absolutely. But when you look at his 20 years of work, I think it is hard to call him fringe," Jha says. "I think he's been very much in the mainstream."
Possible changes at NIH
Bhattacharya's allies argue the intense criticism the declaration triggered exemplifies how insular and misguided mainstream scientific institutions like the NIH have become.
"I think he's a visionary leader and I think he would bring fresh thinking about these issues," says Kevin Bardosh, who heads Collateral Global, a London-based think tank Bhattacharya helped start. "I think he would return the agency back to its mission and cut out the culture of groupthink that's infected it over the years."
Others agree major changes are needed.
"We have to restore the integrity of the NIH," says Martin Kulldorf, an epidemiologist and biostatistician who helped write the declaration with Bhattacharya. "I think Dr. Bhattacharya would be an excellent person to do that because he's very much an evidence-based scientist."
But other researchers expressed concern about Bhattacharya taking the reins of the NIH, given his views about the pandemic and at a time when Robert F. Kennedy Jr. is on track to lead the Department of Health and Human Services, which includes the NIH.
Kennedy, a vocal critic of mainstream medicine who questions the safety of vaccines and fluoridated water, has said he'd like to immediately replace 600 NIH employees.
"If Jay becomes the NIH director, the hardest part will be to insulate NIH against some very bad ideas that RFK Jr. has been espousing," Jha says. "He'll have to deal with a boss who holds deeply unscientific views. That will be a challenge for Jay Bhattacharya but I suspect that will be a challenge for anybody who becomes the head of NIH."
Republican members of Congress as well as conservative think tanks like the Heritage Foundation have been proposing changes that would radically restructure the NIH. One proposal would streamline the agency from 27 separate institutes and centers to 15.
Another re-thinking would impose term limits on NIH leaders to prevent the establishment of future figures like Collins and Fauci.
Fauci became a hero to many scientists, public health experts and members of the public. But he also became a lightning rod for Republican criticism because of changing advice about masks, support for the vaccines, and, most heatedly, about the origins of the virus.
"In the United States we abandoned evidence-based medicine during the pandemic. Therefore there's now enormous distrust, I think, both in medicine and in public health. NIH has an important role to restore the integrity in medical research and public health research," Kulldorff says.
One proposal causing concern among some NIH supporters would give at least some of the NIH budget directly to states through block grants, bypassing the agency's intensive peer-review system. States would then dispense the money.
Many proponents of biomedical research agree that some changes in grantmaking could be warranted and helpful. But some fear they could result in budget cuts to the NIH, which could undermine the scientific and economic benefits generated by agency-funded research.
"What I worry about is that if somebody like Jay Bhattacharya comes in to 'shake up' the NIH, they're going to dismantle the NIH and prevent it from actually doing its job rather than just carry out constructive reforms," the University of Saskatchewan's Rasmussen says.
Some kinds of research could face restrictions
The next Trump administration may also crack down on funding research that became especially politically charged during the pandemic – known as "gain-of-function" research. That field studies how pathogens become more dangerous. The NIH also funds other hot button experiments that involve studying human embryonic stem cells and fetal tissue.
Restricting certain types of research has some supporters.
"There are potential positives that a Trump administration might bring to NIH and its agenda," says Daniel Correa, chief executive officer at the Federation of American Scientists. "Tightening lab security and revisiting and strengthening oversight over risky research, like gain-of-function research, may be central to the next NIH agenda. And I think that would be welcome."
But Correa and others say that the new administration also appears likely to reimpose restrictions on other types of medical research as well, like fetal tissue experiments, that were lifted by the Biden administration.
"It would be a mistake to restore a ban on fetal tissue research since it was based on false and misleading claims of a lack of important progress and use of fetal tissue," says Dr. Lawrence Goldstein, who studies fetal tissue at the University of California, San Diego. "If Americans want to see rapid research on repairing organ damage and brain damage and all the other diseases we're trying to fight, fetal tissue is a really important part of that tool box."
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