Potential Trade-Offs of Proposed Cuts to the US National Institutes of Health.

Importance: Proposed US National Institutes of Health (NIH) funding cuts under the second Trump administration have raised concerns about their implications. As a key sponsor of foundational research and workforce training, the NIH plays a vital role in biomedical innovation. Understanding the potential impacts of these cuts is critical for policymakers. This study aimed to examine how NIH budget cuts interact with the broader economic and biomedical innovation systems, identifying trade-offs.

Observations: In this qualitative systems modeling analysis, a causal loop diagram was developed that centers on fiscal deficit management theories and incorporates evidence from innovation economics, organizational sciences, and science and technology policy through a structured literature synthesis. The causal loop diagram highlights 4 cycles that may amplify the effects of NIH budget cuts and potentially offset the intended fiscal savings. First, a reduction in fundamental research, which contributes to discoveries, could slow future innovations. Second, the erosion of human capital due to fewer NIH-funded training and career opportunities may shrink the future biomedical workforce. Third, health care expenditures could increase as greater reliance on private sector research and development increases the costs of medical innovations. Finally, decreased investment in public health and translational research may lead to missed opportunities for disease prevention, further increasing health care expenditures.

Conclusions and relevance: Results of this qualitative analysis using systems modeling suggest that NIH budget reductions may have far-reaching implications for scientific progress, the biomedical innovation environment, and health care costs. Beyond immediate budgetary impacts, systemic interactions shaping long-term biomedical research and public health must be considered in funding policies.