In the past year, more than half of the leaders of the Institutes and Centers (IC) at the National Institutes of Health (NIH), as well as many other career government scientists across the agency, have left as part of President Trump’s agenda to reform and reduce the size of the federal government. While fresh perspectives and new vision can be positive, as a former NIH leader and biomedical research advocate, I worry that this rapid and substantial loss of institutional knowledge will be bad for those who NIH ultimately serves: patients and the American people.
Change Is Good, Loss of Expertise Is Not
No one who ever worked with me during my tenure in the federal government—which included serving as NIH associate director for science policy and chief of staff to the NIH director—would likely describe me as an institutionalist or a defender of the status quo. Much like the current leadership at the NIH, I sunsetted advisory committees, supported limits on the number of awards to individual investigators, argued for greater transparency around the review of dangerous pathogen research, and raised questions about the quality of animal research supported by NIH. Some of these efforts were in response to concerns raised by Congress or members of the public, some represented the priorities of changing administrations, and some were in response to evidence that new policies were needed to continually improve the way NIH was funding science.
Often, I found the biggest obstacles to change were long-term leaders or experts within the agency, who saw new priorities or ideas as distractions from a singular mission to support science. While I would argue that good policy and good science go hand-in-hand, policy changes might be perceived as burdensome new requirements or might require changes in the way ICs operated from day to day. I frequently left meetings with NIH IC Directors feeling like I’d been through a murder board.
But I am not applauding the recent exodus of IC directors and other career scientists through a year of terminations or departures under duress. This loss of institutional knowledge and leadership at NIH is flat out bad for the agency’s ability to invest in the best science to provide hope to millions of Americans desperate for treatments and cures.
In the near decade I spent at NIH, I observed or aided in the transition of 10 IC directors and many other career civil servants. In these capacities, I saw that being the scientific leader of a large government research institute is truly a unique role. These individuals oversee a large and diverse disease portfolio—across research, training, and policy activities. They set priorities and make decisions based not just on scientific interest or the development of marketable technologies, but also on public interest or national health needs. This is very different from practicing medicine in a particular field or focusing on a specific scientific question or discipline in an academic or private sector environment. It requires a deep understanding of the statutory authority that guides government decision making; trusted relationships with the stakeholder community, including scientists at all levels, patients, and public interest advocates; and established partnerships with other leaders across the agency and the federal government. Anyone who has served in a scientific leadership role in government, whether in a civil or political appointment, will tell you that such expertise is not acquired overnight; it can take years to learn and develop.
Being able to look across an entire landscape of scientific opportunity to identify and cultivate emerging areas of research or identify cross-cutting opportunities is founded on that experience. Some of the landmark accomplishments we point to in NIH funding—the Human Genome Project, the development of CAR T cell therapy, cutting-edge gene therapies—were only possible because of years of partnership across public and private sectors driven by experienced government career scientists.
For all that I might grumble about the pushback I received from IC directors or career scientists across the agency, the truth is that dynamic made for better decisions and better policies. Their institutional knowledge prevented me from reinventing the wheel on what I thought were ‘new’ ideas or to incorporate lessons learned from missteps of the past. The relationships career scientists built with their communities of researchers, patients, and practitioners helped me to get a sense of how the community would react to the details of any given change and assisted in socializing proposals to help set them up for successful implementation. Their deep knowledge of what had been funded in the past, what was being funded now, and why decisions were made facilitated oversight and responsiveness of the agency to inquiries from policymakers or the public.
Expertise, Experience, and Empathy Should Lead Institutes
Of course, NIH leaders can’t hold those positions forever, and public agencies have a responsibility to continuously evaluate whether their leaders are doing the job that taxpayers have funded them to do. Long-term tenure in any organization can lead to complacency, and priorities can benefit from a continuous stream of fresh perspectives. In many ways, this is the brilliance between the periodic political leadership and traditional long-term civil scientific leadership of federal research agencies—the perfect blend of experience and new vision. Plus, public servants (and all human beings) deserve the chance to retire from professional life and hand over the reins to the next generation of leadership. I would never suggest IC directors or any other position at NIH be a lifetime appointment or that any given individual is ultimately irreplaceable.
But what we are seeing at NIH—and across other government science agencies—is not representative of normal or strategic organizational change. The abruptness of departures leaves no time for transition planning and forces staff who are placed in acting positions (who deserve praise for their continued service) to assume multiple responsibilities without a commensurate increase in resources or bandwidth. Set against the backdrop of massive reductions in force, it means incoming leaders will be met with an emptier bench of institutional knowledge and few peers to help guide them into this unique role.
This will make it harder to get things done, particularly in collaboration with the external community who are the performers, participants, and thought partners for NIH research. Building trust and relationships between new leadership and the communities they serve will take time. New IC directors and their new senior leadership teams will need to learn how they can translate their ideas and priorities into research programs and policies. And pragmatically speaking, trying to maintain the same level of operations with fewer people, who have been through a year of significant and difficult transitions, will be challenging. While the remaining staff at NIH and the NIH director Jay Bhattacharya, deserve praise for successfully distributing the remaining 2025 funding despite freezes, delays, rapid-fire policy change, and personnel departures, the enterprise continues to experience delays in reviews and funding, less transparency around spending decisions, and less communication across the agency. It is hard to imagine that these will improve quickly in the face of dramatic leadership change.
Moreover, the unspoken issue that underlies these departures—and continues to send ripples of anxiety across an ecosystem that wonders what happens next—is the perception of a deep mistrust of exactly the sort of experience that is necessary for these roles: experience developed through years of service. There is also a conflation of expertise with conflict of interest, as if the very knowledge and relationships that allow one to be an effective government leader is somehow disqualifying or suspect. This attitude is a grave disservice to the scientists who dedicated their lives and expertise to serving the American people. Patients who look to NIH for hope, often at the worst moment of their lives, deserve to be met with an agency led with expertise, experience, and empathy. In my pursuit of reform and change, NIH IC leaders never let me lose sight of who NIH ultimately served, and I sincerely hope that guiding philosophy persists as new leaders emerge.
