Congress let the NIH drop the HIV/AIDS set-aside: Implications for NIDA?

Jocelyn Kaiser reported in Science Insider:

the National Institutes of Health (NIH) today announced it will no longer support setting aside a fixed 10% of its budget—or $3 billion this year—to fund research on the disease. The agency also plans to reprogram $65 million of its AIDS research grant funding this year to focus more sharply on ending the epidemic.

Whoa. Big news. This is an old Congressional mandate so presumably it needs Congress to be on board. More from Kaiser:

The changes follow growing pressure in Congress and from some advocacy groups for NIH to reallocate its funding based on the public health burden a disease causes…. some patient groups and members of Congress have recently asked why AIDS receives disproportionately far more than diseases with higher death rates, such as heart disease and Alzheimer’s….Last year, Congress omitted instructions asking NIH to maintain the 10% AIDS set aside.

Emphasis added. An act by omission is good enough for gov’mint work, eh? Congress is on board.

@jocelynkaiser was kind enough to link to relevant NIH budgetary distributions:

@drugmonkeyblog see p. 3 here https://t.co/P6pK4DjKfH

— Jocelyn Kaiser (@jocelynkaiser) December 14, 2015

As you can see, NIDA devotes about $300M to HIV/AIDS research. The annual NIDA budget allocation is about $1B so you can see that something on the order of 30% of the NIDA budget is (and has been) devoted to this Congressional Mandate.

Wait, whut? What about that 10% mandate above? Yep, the HIV/AIDS money has not been evenly distributed across the ICs.

Now, I don’t know exactly when and how all of this shook down. It was FY 1987 when the NIAID budget went up by something like 47% when other similarly sized ICs didn’t see such a large percentile increase. Clearly 1986 was when Congress got serious about HIV/AIDS research. We can’t assess the meaning of

AIDS has received 10% of NIH’s overall budget since the early 1990s, when Congress and NIH informally agreed it should grow in step with NIH’s overall budget.
…
NIH must treat AIDS dollars as a distinct pot of money within its overall budget. That is because a 1993 law carved out a separate HIV/AIDS budget, Collins says. And undoing that law would take action by Congress.

from this article. It is a little frustrating, to be frank. But…on to the NIDA situation.

NIDA doesn’t appear in the NIH tables until FY1993 because it didn’t actually join the NIH until 1992. Nevertheless that history page on NIDA notes:

1986: The dual epidemics of drug abuse and HIV/AIDS are recognized by Congress and the Administration, resulting in a quadrupling of NIDA funding for research on both major diseases.

There are many ways of looking at this situation.

Some in the NIDA world who are not all that interested in HIV/AIDS matters complain bitterly about why “A third of our budget is reserved for HIV/AIDS“. Our.

Another way of looking at this would be “If Congress mandated NIH devote 10% of its budget to HIV/AIDS but NIH did this by incorporating NIDA with its existing HIV/AIDS funding then the entire rest of NIH is shirking its response to the mandate on the back of NIDA”.

And yet a final way of looking at this* would be “Dude, NIDA wouldn’t even have this money if not for Congress’ interest in funding HIV/AIDS research so it isn’t ‘our‘ funding being diverted to HIV/AIDS research.”

Is this important? Yes and no.

The news is potentially huge for those who seek to get the HIV/AIDS funding via NIDA grants and for those who seek non-HIV/AIDS funding. It makes matters slightly better for the latter and worse for the former. Right? If there is no special set-aside, the latter folks now have at least a shot at that $300M that had been out of reach for them. This consequently increases the competition for those who have HIV/AIDS relevant proposals. Who are presumably sad right now.

But it all depends on what Collins plans to do with his newly won freedom. Back to Kaiser:

Francis Collins agrees: At a meeting of his Advisory Committee to the Director (ACD) today, he noted that no other disease receives a set proportion of the NIH budget and the argument that AIDS still deserves such a set-aside is “not a defensible one.”

The end of the set-aside has “free[d] us up” to refocus NIH’s AIDs portfolio, Collins says.

However the article only then talks about $65M being reprioritized. What about the rest of the 10% of the ~$30B / yr NIH budget? No idea.

So I want to know a few things. Is the $300M in the NIDA budget that goes to HIV/AIDS part of this 10% overall NIH mandate? If so, will Collins try to claw that back for some other agenda?

If a miracle occurs and it stays within NIDA, will Nora Volkow use this new-found freedom to ease the pressure on the non-HIV/AIDS researchers by letting them (ok, “us”) get a shot at that previously-sequestered pool?

Or will Volkow use it to pay for the latest boondoggle initiatives of ABCD and BRAINI?

The way I hear it, this latter is likely to happen because up to this point all other NIDA initiatives are being squeezed** to make ABCD and BRAINI happen.

Obviously I would prefer to see Volkow choose to use this new freedom a little more democratically by spreading the love across all of the portfolio.

__
*this has been my view for some time now.

**this manifests, IME, as profound pessimism on the part of POs that anything in the grey zone (which is robust reality at no-public-payline-NIDA) will be picked up because all spare change is going to the two aforementioned boondoggles.