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$6·5 billion proposed for new US health research agency

During his first address to a joint session of Congress last month, US President Joe Biden drew little applause from Republicans in the physically distanced, masked audience. A rare exception to their steadfast silence came when he unveiled an ambitious plan to eradicate cancer.

To help reach this goal, Biden would establish a new biomedical research agency within the National Institutes of Health (NIH) called the Advanced Research Projects Agency for Health (ARPA-H). The agency would provide a fast track for transforming basic science into real-world applications. But it would also consume nearly all of the NIH funding increase Biden has proposed for the fiscal year starting Oct 1, 2021.

The prospect of funding opportunities from a new NIH agency has raised hopes as well as concern in the biomedical research community. Like other sectors in the USA, biomedical research has not yet fully recovered from the economic and health effects of the COVID-19 pandemic shutdown. Diverting funds to ARPA-H would be short-sighted, critics say, and possibly delay resumption of the full range of basic, clinical, and translational studies that the NIH supports. Biden sees the issue differently.

“We are going to have a singular purpose—to develop breakthroughs, to prevent, detect, and treat diseases like Alzheimer’s, diabetes, and cancer”, he told Congress. “I’ll still never forget when we passed the cancer proposal in the last year I was vice president—almost $9 million going to NIH”. That proposal was the 21st Century Cures Act of 2016, which included a provision named for Biden’s son, Beau, who died from brain cancer in 2015. Then Biden departed from his prepared remarks to thank his most formidable adversary, the Senate’s minority leader Republican Mitch McConnell.

“And, excuse the point of personal privilege, I’ll never forget you standing, Mitch, and saying name it after my deceased son. It meant a lot. But so many of us have deceased sons, daughters, relatives who died of cancer. I could think of no more worthy investment, I know of nothing that is more bipartisan. So, let’s end cancer as we know it. It is within our power to do it.” Members of both political parties responded with an enthusiastic standing ovation. According to an overview of Biden’s first budget proposal, the NIH would receive $51 billion, or $8·1 billion more than last year, and $6·5 billion of that increase would be directed to ARPA-H.

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