More than a year into the second Trump administration, the National Institutes of Health looks, in some ways, better than expected.
Congress increased its budget for this fiscal year to over $47 billion, instead of cutting it 40 percent as the president had requested. The total amount of grant money it allocated last fiscal year also didn’t plunge, as many observers had expected.
But, as the agency that touts itself as the world’s largest public funder of biomedical research marches forward with full funding this year, it lacks permanent directors to lead it. Fifteen directors of the 27 institutes and centers that comprise the agency are in an acting capacity. Directors have departed for multiple reasons, including terminations by the Trump administration and resignations.
The vacancies raise questions about the agency’s future research funding strategy, both internally for its scientists and externally for university faculty who rely on NIH dollars. Now that the NIH has a budget, its leadership must shape how it uses it.
“The institute or center director is really responsible for setting the direction of that center, including implementing the funding priorities or the funding strategy,” said Heather Pierce, senior director of science policy for the Association of American Medical Colleges. While she said the acting directors are “highly competent,” it’s “important to have someone who is a permanent position in that role who can guide that forward.”
“After the highly disruptive year that was fiscal year 2025,” Pierce said, the community of federally funded researchers and institutions “is watching carefully to see” how grant dollars will be awarded.
Jeanne Marrazzo, the former director of the National Institute of Allergy and Infectious Diseases, filed a lawsuit in December against the NIH director and the secretary of the wider Health and Human Services Department alleging the department ousted her for blowing the whistle about “leadership’s anti-vax agenda” and politically biased grant and clinical trial cancellations. (HHS secretary Robert F. Kennedy Jr. ultimately appoints the directors, save for the National Cancer Institute director, whom the president appoints.) Marrazzo told Inside Higher Ed that “stable leadership with integrity and a commitment to doing great science is essential for the institutes.”
Marrazzo said almost all of the NIH’s budget is controlled at the level of the institutes, not within NIH director Jay Bhattacharya’s office, and her institute had a $6.6 billion budget alone.
“The institute directors do have extraordinary power because you could technically move large amounts of money,” she said. She said it’s possible the director positions remain unfilled because the Trump administration is looking for “puppets” to carry out its directives.
“The other possibility is that they are having trouble finding people who want to do the jobs,” Marrazzo said. “Even in the best of times, these are really hard jobs.”
A former NIH official who wished to remain anonymous said, “I think everybody is waiting to see: Is there going to be a political bent to who they pick?” But, they said, “the word is that good people did apply.”
The former official added that with able deputy directors stepping into the acting roles, “none of the institutes are in trouble; I think they have really good people at the top.” The bigger problem, they said, is the mass NIH layoffs last year left these acting leaders with “a real skeleton crew to work with.”
The lack of permanent leaders for the institutes and centers could be seen either as a problem for the NIH or as a saving grace, given that the Trump administration’s picks for permanent leaders could shift the agency more toward the administration’s way of thinking. The former NIH official said that an acting director’s job is generally to keep an institute or center operating as it was, rather than break new ground.
“The director leaves and the copilot drives the bus,” the former official said. “And they’re perfectly capable of doing that. But what they don’t do—and probably can’t do—is change direction of the bus.”
“NIH does need to fill all these spots very quickly,” they said.
Job Search Concerns
The NIH, for its part, says it’s working to fill the leadership roles, alongside the vacant spots on advisory panels that recommend which grants should receive funding.
“NIH is committed to filling all director positions and advisory panels with the most highly qualified and meritorious individuals, ensuring expert representation to address the chronic disease epidemic and uphold gold-standard science,” an NIH spokesperson said in an emailed statement.
How did the NIH get to this point? Four institute directors, including Marrazzo, were fired in the fall, long after the administration put them on leave in the spring, Science previously reported. Then, the administration didn’t reappoint Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke (NINDS), when his latest five-year term expired. He had been in the role for a decade.
The American Academy of Neurology issued a statement in December on Koroshetz’s ouster, calling him “a highly respected leader whose tenure has been marked by numerous advancements in the treatment of neurological conditions. Dr. Koroshetz’s departure will be deeply felt by neurologists, researchers, and the many patients whose lives have been positively impacted by his leadership.”
“This decision was made without consulting key neurology stakeholders, and there was no formal announcement nor a clear succession plan for NINDS leadership,” the academy said, adding that “it is essential that NINDS has strong leadership that will remain committed to evidence-based medicine.”
Gary H. Gibbons then retired from leading the National Heart, Lung and Blood Institute at the end of January. Add those six departures to others from before, and the following NIH national institutes and centers are now without permanent leadership: Allergy and Infectious Diseases; Child Health and Human Development; Clinical; Complementary and Integrative Health; Dental and Craniofacial Research; General Medical Sciences; Heart, Lung and Blood; Human Genome Research; John E. Fogarty International; Library of Medicine; Mental Health; Minority Health and Health Disparities; Neurological Disorders and Stroke; Nursing Research; and Scientific Review.
Some individuals in and outside of NIH have expressed concern about how the agency seeks to fill all these positions. Many were initially open for applications for just two weeks.
The anonymous former NIH official said it sometimes took years to name a new director in a process that included reviews from inside and outside the agency and a job posting that would often stay up for two months. But the agency, under pressure to fill the leadership roles, has made the decision “to short-circuit the process,” the former official said.
Marrazzo said the initial two-week posting “was a very brief window … for a very big job.”
“Previous processes to hire directors, to replace directors, were really rigorous,” Marrazzo said. “I went through a lot of interviews and was part of a large field of candidates who were considered. Now, I can’t imagine that they’re going to engage in a similar process.”
“We all worked all of our careers for this and we got these positions because people thought we were the best people for these jobs,” she added.
Pierce, of the Association of American Medical Colleges, said, “I do take the [NIH] director at his word that there’s an active process to fill those roles,” and “I think we will begin to see announcements in the near future.”
In addition to a National Cancer Institute director appointment in September, the Trump administration did appoint one director in recent months, but the choice was controversial. Kyle Walsh was director of Duke University’s Division of Neuro-epidemiology and an associate professor of neurosurgery, pathology, population health sciences and pediatrics before being appointed director of the National Institute of Environmental Health Sciences in October. The controversy, Science reported, came from his being appointed without a search—and because he has close ties to Vice President JD Vance, who officiated his wedding.
The former NIH official, though, is encouraging “spooked” people to still seek NIH positions. They said it’s important to keep politics out of science, and the agency does “breathtaking” work.
“There’s nothing like NIH to improve health across the country,” the former official said. As for the director role, “it’s usually there for 10 years, so it’s a chance-of-a-lifetime type of thing. If you miss out now, 10 years from now, you’re too old.”
