The Reality Of Clinical Research Federal Funding Cuts

By Pamela Garzone, Ph.D.

Last year, the U.S. government sought to reduce federal funding for basic science research and for programs designed to support early-career researchers. That did not happen as intended.

However, if the proposed cuts had been fully approved as intended, the National Science Foundation (NSF) said the number of early-career researchers it serves would have been reduced from approximately 95,000 to 21,400 — a 78% decrease.¹ That cut would’ve meant reduced exposure of undergraduate students to research, less support for science and engineering graduate programs, fewer students entering research careers, and a reduction in young investigator grants that are critical for preparing the next generation of scientists to lead their own laboratories and research programs. The cut would have shrunk the scientific workforce at the exact moment when investment is needed most.

In fact, NIH funding was associated either directly or indirectly with all drug approvals between 2010 and 2016, with >90% of funding representing basic research² — including  polymerase chain reaction (PCR) technology and GLP-1-based therapeutics.³ This underscores how today's workforce cuts could become tomorrow's gaps in the drug development pipeline.

Still, the delays in funding did cause harm, albeit on a much smaller scale than originally planned (and feared).

After The Initial Proposal, An Encouraging Legislative Response

Funding cuts can affect basic science research by delaying experimentation, stopping programs entirely, and reducing the scope of ongoing research. Because it often takes years to generate applied or commercial outcomes from basic science discoveries, the full negative impact of these cuts may not be visible for a decade or longer.

Prior to Congress’ final decision, the Congressional Budget Office (CBO) evaluated the effects of a permanent 10% reduction in NIH funding on the development of new drugs.³ CBO estimated that a 10% reduction, assuming this reduction was in external preclinical research, would reduce the number of drug candidates available for Phase 1 clinical trials by 4.5% and take 12 years to reach the full effect.⁴ This 10% reduction would have also decreased NIH support of Phase 2/3 clinical trials, reducing the number of drugs reaching the market, although the magnitude was not evaluated.

In the end — if you can call it that — Congress rejected the most significant proposed cuts in February 2026. Specifically, the House and Senate Appropriations Committees blocked and rejected the proposed 15% cap on indirect costs. They also rejected the proposed 40% cut to the NIH, and instead increased NIH funding by approximately 1% to $48.7 billion. All 27 NIH institutes and centers were retained. However, they did reduce funding to the NSF by only 3.4%, significantly less than the proposed 57% reduction.

Scientists and supporting groups reacted with widespread relief after the passage of the appropriations bill. Its passing was the culmination of tireless efforts to ensure funding continued — and we celebrated the outcome. Scientific organizations, notably the Federation of American Societies for Experimental Biology (FASEB), ASCO, and the American Association of Immunologist, among other large scientific organizations also applauded members of Congress and the Appropriations Committees. Unfortunately, the release of those funds and the approval of institutional budgets have been slowed, serving only to increase uncertainty within the scientific community. Delayed funding disbursements, even after legislative resolution, can disrupt ongoing studies, jeopardize trainee support, and erode institutional capacity.

The Damage Is Already Done To Clinical Translation

By the numbers, harm has already come to early-stage research. Patel and colleagues used NIH ExPORTER to identify all NIH-funded interventional clinical trials supported by active grants as of February 28, 2025, the date of the first reported grant termination, and found that terminated funding affected 383 clinical trials and a total of 74,311 individuals in those trials.⁵ Prevention trials were disproportionately affected, with 123 out of 1,460 (8.4%) impacted — the highest proportion of any category and the one that achieved statistical significance. Affected treatment trials numbered 140 out of 5,909 (2.4%), while health services research accounted for 43 out of 795 (5.4%). By intervention type, 60 drug trials out of 3,095 (1.9%) were disrupted, along with 15 device trials and six dietary supplement trials.

The abrupt trial terminations diminishes the scientific knowledge gained from clinical trials but also constitutes a profound ethical breach. The Belmont Report⁶ established the ethical framework for human research in the United and its three core principles of respect for persons, beneficence, and justice govern both the Department of Health and Human Services (HHS) and the NIH. When a terminated clinical trial is ethically justified, the reasons are clear: unexpected risks to participant safety, demonstrated efficacy of the intervention, or established futility. The 2025 terminations did not meet any of these criteria. The Bethesda Declaration of June 9, 2025,⁷ a document written by former and current NIH staff and members of the advocacy group 27 UNIHTED, stated that the 2025 grant terminations produced ethically unjustifiable disruptions. Specifically, the terminations conflicted with commitments made to participants during the informed consent process. All of this leads to distrust of the process and investigators, thereby resulting in reduced or no enrollment in trials.

Patients Are Caught In the Middle

A reduction in basic research funding also disrupts the translation of scientific findings into clinical trials, causing slower patient enrollment due to reductions in staff associated with identifying, enrolling, and consenting patients and reduced or delayed access to evidence-based information, an outcome that directly contradicts the administration's emphasis on evidence-based policy as promulgated in Evidence-Based Policymaking: Practices to Help Manage and Assess the Results of Federal Efforts.¹¹

Early-phase clinical trials represent some of the most meaningful hope available for patients. Dr. Elizabeth M. Jaffee, an oncologist and immunologist at Johns Hopkins recognized for her pioneering work in immuno-oncology, described the anguish of facing her patients without answers in an interview⁸: “If I can't launch or continue my clinical trials, what can I say to patients with pancreatic cancer who want to enroll in these studies to have access to these most promising experimental therapies?”

Early-Career Researchers Are Still Suffering

Early-stage researchers depend on a single primary grant to support their laboratories, their teams, and their own salaries. Historical data on physician-scientist training underscore the impact: Between February 2025 and April 2025, 694 NIH grants were terminated, of which approximately 20% were early-career grants.¹⁰ Further, the 2025 NIH grant terminations did not harm all researchers equally.¹⁰ Among those at the earliest stage of independent research careers, 59.8% of terminated projects were led by women. Of those whose training was disrupted, women represented 60.2% of doctoral candidates and 48.0% of postdoctoral fellows. Women also had more ongoing committed funds at the time of cancellation — 57.9% for women compared with 48.2% for men, suggesting women lost a proportionally greater share of unrealized scientific findings. These graduate and post-doctoral students and early researchers form the foundation of the next-generation scientific workforce.

The Path Forward: Strengthening The Research Ecosystem

New funding models and partnerships among state governments, academic institutions, and the private sector may help ensure that the U.S. remains at the forefront of research and innovation. Such partnerships could play an important role in workforce development, regional innovation hubs, and public-private technology platforms. Greater university endowment spending, family office investments, and philanthropy can also help to fill the gaps created by reduced federal funding, such as how. SPARC (Milken Institute Science Philanthropy Accelerator for Research and Collaboration) partnered with a family office to develop a strategy to invest in early-career researchers¹². Philanthropic support would have the greatest impact on post-doctoral fellowships and on early-career researchers pursuing innovative research in a competitive funding environment.

However, alternative funding models are not a replacement for federal research investment. Government funding supports high-risk, long-term, early-stage, and public interest science, unlike most research funded by the private sector. All these funding sources are necessary, but federal investment remains the backbone.

Clinicians, researchers, and policymakers have a shared stake in the outcome of these funding decisions. Advocating for sustained federal investment in basic science, supporting early-career researchers, and engaging with legislative processes are concrete steps that the scientific and medical communities can take to protect the research infrastructure upon which scientific progress and patient care depend.

References:

1. Azoulay P, Sadun R, Scur D; Before the Exodus? Young scientists and future of US Science, Working Paper 35330. http://www.nber.org/papers/w35330
2. Galkina Cleary E, Beierlein JM, Khanuja NS, McNamee LM and Ledley FD. Contribution of NIH funding to new drug approvals 2010-1016. PNAS 2018; 115:2329-2324.
3. Editorial. Why cuts to fundamental research are a mistake. Nature 2025; 646:1026.
4. Congressional Budget Office Report www.CBO.gov, July 18, 2025
5. Patel VR, Liu M, Jena AB. Clinical Trials Affected by Research Grant Terminations at the National Institutes of Health. JAMA Internal Medicine. 2026;186:126-128; doi:10.1001/jamainternmed.2025.6088.
6. Belmont Report https://www.hhs.gov/ohrp/sites/default/files/the-belmont-report-508c_FINAL.pdf
7. 27UNIHTED.The Bethesda Declaration: One Year Later. https://www.27unihted.org/bethesda-declaration-one-year-later
8. The ASCO Post September 10, 2025,
9. Garrison HH and Deschamps AM: NIH research funding and early career physician scientists: continuing challenges in the 21st century. FASEB J 2014; 28, 1049 –1058. doi: 10.1096/fj.13-241687
10. Lisa Lammore Ouellette; The Trump administration’s multi front assault on Federal research funding July 9, 2025; justsecurity.org.
11. GAO-23-105460 Published: Jul 12, 2023.
12. Robers B and Das I. How Philanthropy Can Fuel the Next Generation of Biomedical Researchers. https://milkeninstitute.org/content-hub/insights/how-philanthropy-can-fuel-next-generation-biomedical-researchers

About The Author:

Pamela D. Garzone, Ph.D., is a pharmaceutical executive with experience in drug development and leadership. She serves as an advisor to executives, venture capitalists, and nonprofit research foundations engaged in healthcare and is an independent board director for private and public life sciences companies. Pamela is a steering committee member of Women’s Health Advocates and a member of Milken Institute’s Women’s Health Network.