AIDS Research at the NIH: A Critical Review

more or less by default.

At the NIH level, de facto AIDS policy decisions are made by Associate NIH Director for AIDS Research
Anthony S. Fauci, who is Director of the Office of AIDS Research (OAR), Director of the National
Institute of Allergy + Infectious Diseases (NIAID), and Chief of the Laboratory of Immunoregulation.
Extraordinary responsibilities rest by default on a man who tumrned down the chance to become NIH
Director in order to stay more in contact with AIDS research, yet who wears so many hats which
demand very different skills and decisions.
In addition, there is a dizzying array of advisory committees which advise every level of NIH, from the
overall AIDS effort to specific Institute and Division councils. Every major new program initiative must
be approved by an external advisory council, yet these decisions are often simply an elaborately
choreographed rubber stamp.
The NIH is actually a collection of fiercely autonomous fiefdoms (designated Institutes, Centers, or
Divisions, known as ICDs) loosely administered under an NIH Director. Each ICD Director develops
and administers his or her own budget, and there is little the NIH Director can do to allocate resources
across institutes (although she now has her own $20M "emergency fund"). Some ICDs, such as the
National Cancer Institute (NCI), have worked out special privileges within the Executive Branch - the
NCI "Bypass Budget" skips the desks of Assistant Secretary for Health Mason, Health and Human
Services Secretary Sullivan, and Office of Management and Budget Director Darman, and goes straight
to the President's desk. (This didn't stop the President from slashing the 1993 NCI request just as
much as he slashed those of of every other ICD.) OAR Director Fauci, who is supposed to coordinate
AIDS research across ICDs, has little real say in the half he does not directly control as NIAID Director.
Thus, there is no truly centralized planning and execution of AIDS research, and no adequate oversight
from either Congress or the Administration. Neither is there enough systematic, comprehensive
information about existing NIH AIDS programs. Since 1990, activists, the Congress, and the Institute of
Medicine (IOM) have all encouraged the NIH to develop a comprehensive plan for its AIDS efforts, and
NIH has been working for the last year on a "Strategic Plan for HIV-Related Research."
MATERIALS + METHODS
This report is based on the following sources:
* NIH budget information from 1982-1993;
* "The NIH Strategic Plan for HIV-Related Research," DRAFT of 11.8.91;
* "The NIH Five-Year Plan for HIV-Related Research," a similar DRAFT of 4.29.92;
* "The AIDS Research Program of the NIH" by the Institute of Medicine, NAS, 1991;
* The NIH's "Annual Report to Congress" for 1991;
* The Office of AIDS Research's "Institute AIDS Science Reports", which periodically
chronicle AIDS work done by the various ICDs every three (now 6) months;
* Abstracts of 2,625 extramural NIH AIDS awards in Fiscal Year (FY) 1991 obtained from
the OAR AIDS Research Information System (ARIS) database, which obtained them
from the DRG (Division of Research Grants) CRISP database;
* Abstracts of the intramural Z01 projects from CRISP;
* A list by institute of all 2,624 extramural AIDS awards in FY 1991 obtained from ARIS
[this list was not identical to the abstracts from CRISP];
* Letters, budget information and plans from staff at each Institute, Center or Division;
* A list of the original AIDS budget requests for FY 1993 from each ICD Director, and the
subsequent budget history