    [Senate Hearing 119-26]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 119-26

                      NOMINATION OF JAYANTA BHATTACHARYA
                          TO SERVE AS DIRECTOR OF THE
                         NATIONAL INSTITUTES OF HEALTH
    =======================================================================

                                    HEARING

                                     OF THE

                        COMMITTEE ON HEALTH, EDUCATION,
                              LABOR, AND PENSIONS

                              UNITED STATES SENATE

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                       ON

           EXAMINING THE NOMINATION OF JAYANTA BHATTACHARYA, OF CALI-
               FORNIA, TO BE DIRECTOR OF THE NATIONAL INSTITUTES OF
               HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES
                                   __________

                                 MARCH 5, 2025
                                   __________

     Printed for the use of the Committee on Health, Education, Labor, and
                                    Pensions

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                   __________

                           U.S. GOVERNMENT PUBLISHING OFFICE
    59-494 PDF                     WASHINGTON : 2026
    =======================================================================

              COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

                    BILL CASSIDY, M.D., Louisiana, Chairman
    RAND PAUL, M.D., Kentucky            BERNIE SANDERS (I), Vermont,
    SUSAN M. COLLINS, Maine                  Ranking Member
    LISA MURKOWSKI, Alaska               PATTY MURRAY, Washington
    MARKWAYNE MULLIN, Oklahoma           TAMMY BALDWIN, Wisconsin
    ROGER MARSHALL, M.D., Kansas         CHRISTOPHER MURPHY, Connecticut
    TIM SCOTT, South Carolina            TIM KAINE, Virginia
    JOSH HAWLEY, Missouri                MAGGIE HASSAN, New Hampshire
    TOMMY TUBERVILLE, Alabama            JOHN HICKENLOOPER, Colorado
    JIM BANKS, Indiana                   ED MARKEY, Massachusetts
    JON HUSTED, Ohio                     ANDY KIM, New Jersey
    ASHLEY MOODY, Florida                LISA BLUNT ROCHESTER, Delaware
                                         ANGELA ALSOBROOKS, Maryland

                    Amanda Lincoln, Majority Staff Director
               Danielle Janowski, Majority Deputy Staff Director
                    Warren Gunnels, Minority Staff Director
                   Zain Rizvi, Minority Deputy Staff Director

                                C O N T E N T S

                                  ----------

                                   STATEMENTS

                            WEDNESDAY, MARCH 5, 2025

                                                                       Page

                               Committee Members

    Cassidy, Hon. Bill, Chairman, Committee on Health, Education,
      Labor, and Pensions, Opening statement.........................     1
    Sanders, Hon. Bernie, Ranking Member, U.S. Senator from the State
      of Vermont, Opening statement..................................     2

                                   Witnesses

    Bhattacharya, Dr. Jayanta, Los Altos, CA.........................     6
        Prepared statement...........................................     7

                              ADDITIONAL MATERIAL

    Statements, articles, publications, letters, etc.
    Markey, Hon. Ed:
        Three Letters Terminating Funding............................    45

                            QUESTIONS FOR THE RECORD

    Response by Dr. Jayanta Bhattacharya to questions of:
        Sen. Sanders.................................................    51
        Sen. Murray..................................................    58
        Sen. Baldwin.................................................    61
        Sen. Kaine...................................................    61
        Sen. Hickenlooper............................................    62
        Sen. Markey..................................................    63
        Sen. Alsobrooks..............................................    71
        Sen. Collins.................................................    76
        Sen. Murkowski...............................................    77
        Sen. Marshall................................................    79
        Sen. Scott...................................................    80
        Sen. Banks...................................................    81

                       NOMINATION OF JAYANTA BHATTACHARYA
                          TO SERVE AS DIRECTOR OF THE
                         NATIONAL INSTITUTES OF HEALTH

                                  ----------

                            Wednesday, March 5, 2025

                                           U.S. Senate,
           Committee on Health, Education, Labor, and Pensions,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 10:02 a.m., in
    room 562, Dirksen Senate Office Building, Hon. Bill Cassidy,
    Chairman of the Committee, presiding.

        Present: Senators Cassidy, Paul, Collins, Marshall, Scott,
    Hawley, Tuberville, Banks, Husted, Moody, Ricketts, Sanders,
    Murray, Baldwin, Hassan, Hickenlooper, Markey, Kim, Blunt
    Rochester, and Alsobrooks.

                      OPENING STATEMENT OF SENATOR CASSIDY

        The Chairman. I don't have my gavel, but Senator Murray
    said that is a DOGE cut. So anyway----

        [Laughter.]

        The Chairman. The Senate Committee on Health, Education,
    Labor, and Pensions will please come to order. Thank you, Dr.
    Bhattacharya, for appearing before the Committee. The National
    Institutes of Health funds more biomedical research than any
    other public institution in the world.

        NIH's decades long investments have helped the United
    States lead the world in addressing critical health challenges,
    helping us better understand heart disease, preventing and
    curing certain cancers, just as examples. It has also led to
    significant accomplishments like mapping the human genome,
    which is the foundation of many medical breakthroughs.

        As a medical researcher who has engaged in NIH sponsored
    research for decades, Dr. Bhattacharya understands the power of
    these investments; and sir, if your name comes up just a little
    bit different every time I say it, I apologize in advance.
    Importantly, NIH grants have increased biomedical research
    capacities in states that otherwise would not have had
    sufficient resources to invest.

        My State, Louisiana, has received roughly $500 million
    through NIH's Institutional Development Award Program, or the
    IDeA Program, allowing institutions to bring lifesaving cures
    and treatments to people in my state and around the world.
    However, NIH, at times it appears, has prioritized funding for
    risk averse, incremental science.

        There is concern the current system incentivizes
    established scientists who study already proven concepts,
    rather than younger scientists who have unproven ideas with
    potential as major medical breakthroughs. While this practice
    may ensure the short-term success of Federal grants, it limits
    groundbreaking discoveries.

        I have discussed this with you, sir, previously and look
    forward to hearing more today. NIH is facing other serious
    challenges. During the COVID pandemic, there was a general loss
    of trust in public health and scientific institutions. To
    restore that trust, officials need to be more transparent and
    provide reassurance that they are publishing health guidance
    that is best for Americans health and not biased in any way.

        You have indicated you would like to promote a free and
    open debate at NIH, including among scientists who disagree,
    and this is encouraging. The NIH is at an inflection point. If
    confirmed as NIH Director, you will be tasked with leading an
    agency that desperately needs a reform.

        Last year, I released several proposals outlining ways to
    modernize the NIH, improving operations to better serve the
    American taxpayer. I look forward to hearing your vision today
    and working with you on these proposals, if you are confirmed.
    With that, I recognize Senator Sanders for his opening
    statement.

                      OPENING STATEMENT OF SENATOR SANDERS

        Senator Sanders. Thank you, Mr. Chairman. Thank you, Mr.
    Bhattacharya for being with us. Today, we will be considering
    the nomination of President Trump's nominee to be the Director
    of the NIH, Dr. Bhattacharya. The NIH, with a budget of $48
    billion, is the largest funder of medical research in the
    world.

        This research has led to new treatments and prescription
    drugs that have significantly improved the lives of Americans
    and people throughout the world. And I think all of us should
    be very proud of those accomplishments. But having said that,
    let me say a few words about my concerns. I don't have to tell
    any American that the health care system in our Country is
    broken, and it is failing.

        We spend almost twice as much per capita on health care as
    any other industrialized nation, yet we have 85 million people
    who are uninsured or underinsured. We don't have enough
    doctors, nurses, dentists, mental health specialists. Not only
    is our life expectancy 4 years lower than other wealthy
    countries, the bottom 50 percent in this country live on
    average 7 years shorter lives than the top 1 percent.

        In other words, being working class or low income in
    America is in many ways a death sentence. You are rich, you
    live long. Working class, 7 years shorter. And very relevant to
    the hearing that we are conducting right now, we pay, as I
    think every American knows, the highest prices in the world for
    prescription drugs.

        No great secret there. In some cases we pay more than ten
    times of what our friends in Canada or Europe pay. In my view,
    not only has the Federal Government not effectively regulated
    the price of prescription drugs, but the taxpayers of our
    Country have, over the years, provided hundreds of billions of
    dollars in research and development into new prescription drugs
    that have provided enormous benefits, financial benefits, to
    some of the most profitable pharmaceutical companies in the
    world.

        In 2023, when I had the privilege of chairing the
    Committee, this Committee released a report that found that the
    average price of new treatments that NIH scientists helped
    invent, NIH research over the past 20 years, is $111,000. In
    virtually all cases, American taxpayers are paying far more
    than people in other countries for the exact same medicine that
    the NIH and taxpayers helped develop.

        We have developed the drug, and then we end up paying 10
    times more than other countries for the drug that our taxpayer
    dollars helped develop. For example, Astellas and Pfizer
    charged Americans with prostate cancer over $179,000 for
    XTANDI, while the exact same drug can be purchased in Japan for
    just $18,000. We do the research, we pay for it as taxpayers,
    and then we get ripped off by the companies.

        In my view, we need an NIH Director who is prepared to take
    on the greed of the pharmaceutical industry and use every tool
    at his or her disposal to substantially lower the cost of
    prescription drugs. Not a new issue. An issue the people on
    this Committee have been talking about for decades. But with
    all due respect Dr. Bhattacharya, President Trump will not be
    giving you that authority.

        I don't know what your views are on the subject. You are
    not going to have that authority. That authority will rest with
    Mr. Elon Musk. Over the past several weeks, it has become
    abundantly clear that it really does not matter who the
    President nominates to be Director of the NIH or the--and I
    don't mean to be disrespectful in saying that.

        But it doesn't matter who he nominates to be Director of
    the NIH, or the Secretary of Labor, or the Secretary of
    Education, or the Commissioner of Food and Drug Administration,
    the real person in charge of all these Federal agencies is Mr.
    Elon Musk, and that will continue to be the case no matter who
    the Senate confirms to these positions.

        It is my understanding that Mr. Musk and his minions at
    DOGE have moved to terminate some 1,200 employees at the NIH
    already--6 percent of its staff. Further, I have been told that
    Mr. Musk and DOGE played a major role in freezing nearly all
    grant money at NIH, including grants that could lead to a
    potential cure for cancer, Alzheimer's, and many other life
    threatening diseases.

        Bottom line is that in my view, the real gentleman we
    should be having up there--and again, no disrespect to you,
    sir--is Mr. Musk. And Mr. Chairman, I would hope very much, and
    I think the American people would be really very grateful, if
    we could bring the real leader of the NIH, Department of
    Education, many other agencies of Government before us, and
    that is Mr. Musk. I will be looking forward to working with you
    to see if we can schedule a hearing with Mr. Musk. Thank you.

        The Chairman. Before we turn to the nominee for his own
    opening statement, Dr. Bhattacharya will be introduced by
    Senator Pete Ricketts, who will make clear the connection
    between you and Nebraska, which I am not quite sure what it is.

        Senator Ricketts.

        Senator Ricketts. Well, thank you, Chairman Cassidy and
    Ranking Member for holding this hearing. And to all his team
    Members, the Committee. It is an honor, a privilege to be able
    to introduce and recommend to you Dr. Jay Bhattacharya to be
    President Trump's nominee for the Director of the National
    Institute of Health.

        I had the opportunity to meet Dr. Bhattacharya during the
    COVID pandemic. A little bit about myself. I was Governor of
    Nebraska at the time, but in a prior life, I actually was a
    biology major undergrad and worked in a protein biochemistry
    lab. I am actually published. You can go find it out there.

        For a brief moment in time, I was actually involved in the
    research world that the NIH gives out grants to help support.
    And during the COVID pandemic, obviously we didn't know a lot.
    There was no playbook. And so, I was getting great advice from
    our folks at the University Nebraska Medical Center, but I also
    reached out to talk to other folks, like Dr. Bhattacharya,
    about how we should handle this pandemic.

        One of the things about Dr. Bhattacharya is he showed great
    intellectual honesty and courage because he offered alternative
    suggestions about how to handle the pandemic. Now, we know now
    that young people are not really impacted by the COVID virus as
    much as older people are.

        Typically in the past what we had done is--we had a policy
    of let's protect the vulnerable people and let other people go
    about their life. And we really kind of turned that on its head
    for the COVID pandemic, because we really didn't know what was
    going on. Dr. Bhattacharya helped give me a perspective, and it
    certainly demonstrated that he was thinking not just about how
    does the virus impact people, but if we do lockdowns and so
    forth, how will that impact people's health? And there were
    other impacts from doing those shutdowns.

        For example, we saw many school districts across the
    country shut down, and certainly in Nebraska as well. In March
    and April, we made those recommendations as well. However in
    July, I stood with my Director of Education--he said, we expect
    kids to be in classrooms in August, and that was important
    because kids need to be in classrooms.

        We found out during the pandemic, one of the downsides of
    the pandemic, is that kids learn better in the classrooms,
    generally with other kids. And so, one of the results of that,
    according to the 2022 Nation's Report Card, Nebraska scored
    highest in fourth grade math in test scores, and eighth grade
    math was second overall.

        We did very well in reading as well because our kids were
    back in the classroom. And I saw States like California where
    they weren't in the classroom, and I just worry about the
    damage that did to those kids' education by not being in the
    classroom. Dr. Bhattacharya helped us think about broadly how
    are we going to look at everybody's health. Not just about the
    virus, but mental health, education.

        In fact, Politico; I know you all are familiar with
    Politico. They ranked all 50 states on things like health
    outcomes, education, economy, and social well-being, and
    Nebraska ranked No. 1 overall. We were the--Politico ranked as
    the No. 1 best pandemic response state because----

        The Chairman. Who was--who was Governor?

        Senator Ricketts. This is while I was Governor, yes.

        [Laughter.]

        Senator Ricketts. This is while I was--well, right, if
    there had been another guy Governor, I probably would brag
    about him too. But this is about when I was Governor.

        [Laughter.]

        Senator Ricketts. But the point is, doctor--it was going to
    people like Dr. Bhattacharya who--he has been published in 135
    different peer reviewed publications on a variety of topics
    from law, medicine, economy.

        But having a broader perspective really helped us frame a
    pandemic response in Nebraska that helped us be very, very
    successful. And again, outside sources like Politico recognize
    that.

        I think what you are going to get from Dr. Bhattacharya is
    somebody who understands the scientific method. That is not all
    about, hey, we all agree on this. It is about, we published a
    research paper. It is out there for it to be replicated. Other
    people are supposed to replicate that and see if they get the
    same results.

        If they don't, and then their papers disagree. That is
    Okay. I read a lot of research papers during the pandemic.
    Guess what? A lot of them didn't agree. That is what science is
    about. It is not supposed to be about we all have group think
    that this is the established way it is. It is about challenging
    ideas, and about thinking, well, you have got this idea. Prove
    it. And then, Okay, you have done this experiment.

        I am going to replicate it. See if it actually comes out
    the way you said it did. That is the way research is supposed
    to work. This is what Dr. Bhattacharya in the real world
    demonstrated during the pandemic, that he had the courage to
    stand up and say, wait a second, I know this is what the
    established way of thinking is, but I think there is an
    alternative way to look at it.

        Because he did that, because he had that courage, I can
    tell you specifically in Nebraska, we benefited, and our school
    kids benefited by being in classrooms. Our state benefited on a
    number of different areas that I just mentioned whether it is
    health, social well-being, economy, education--we benefited.

        I highly recommend to you, Dr. Bhattacharya. I think he is
    great. He has used NIH grants in the past, so he gets how that
    program works. He will be a great person to be able to make
    sure that we have got the right way. That we are distributing
    those grants with transparency, accountability, and
    accomplishing what we want to accomplish, which is that basic
    research, which is why we have the health system we do in this
    country today.

        With that, Mr. Chairman, thank you.

        The Chairman. Thank you, Senator Ricketts. Dr.
    Bhattacharya, you are--you would like to give an opening
    statement, please?

     STATEMENT OF JAYANTA BHATTACHARYA TO SERVE AS DIRECTOR OF THE
              NATIONAL INSTITUTES OF HEALTH, LOS ALTOS, CA

        Dr. Bhattacharya. Sure. Thank you, Senator. Chairman
    Cassidy, Ranking Member Sanders, Members of the Senate HELP
    Committee, I am honored to speak with you today and deeply
    humbled by President Trump's nomination.

        I am delighted to have with me my wife Kathy, my son,
    Matthew, and my brother, [inaudible]. My two other adult
    children, Jody and Benjamin, unfortunately could not attend
    today but are here with me in spirit. The NIH has played a
    pivotal role in my career. I served for a decade as a standing
    member of NIH grant committees.

        I helped train many trainees prepare for scientific careers
    with NIH support. And I won NIH funding to study population
    aging, chronic disease, and obesity. I have made the study of
    scientific institutions, including the NIH itself, a focus of
    my own scientific work.

        The NIH is the crown jewel of American biomedical sciences,
    with a long and illustrious history of supporting breakthroughs
    in biology and medicine. I have the utmost respect for the NIH
    scientists and staff over the decades who have contributed to
    this success. The NIH's mission to support scientific
    discovery, enhance health, and lengthen life is vital to our
    Country's future and indeed the world.

        I love the NIH, but post pandemic, American biomedical
    sciences are at a crossroads. A November 2024 Pew study
    reported that only 26 percent of the American public had a
    great deal of confidence in scientists to act in the public's
    best interest. 23 percent have not much or no confidence at
    all.

        How can I help the NIH better achieve its mission? I have
    five concrete goals if confirmed as director of the NIH. First,
    NIH research should focus on research that solves the American
    chronic disease crisis. American health is going backward. Life
    expectancy flatlined between 2012 and 2019, plummeted during
    the pandemic, and still has not bounced back to pre-pandemic
    levels.

        The chronic disease crisis is severe, with hundreds of
    millions of Americans, children and adults, suffering from
    obesity, heart disease, cancer, and more. If confirmed, I will
    carry out President Trump and Secretary Kennedy's agenda of
    committing the NIH to address the dire chronic health needs of
    the country with gold standard science and innovation.

        Second, NIH supported science should be replicable,
    reproducible, and generalizable. Unfortunately, much modern
    biomedical science fails this basic test. The NIH itself, just
    last year faced a research integrity scandal involving research
    on Alzheimer's disease that throws into question hundreds of
    research papers.

        If the data generated by scientists is not reliable, the
    products of such science cannot help anyone. It is no stretch
    to think that the slow progress on Alzheimer's disease is
    linked to this problem. The NIH can and must solve the crisis
    of scientific data reliability, and under my leadership, if
    confirmed, it will do so. Third, if confirmed, I will establish
    a culture of respect for free speech in science and scientific
    dissent at the NIH.

        Over the last few years, top NIH officials oversaw a
    culture of coverup, obfuscation, and a lack of tolerance for
    ideas that differed from theirs. Dissent is the very essence of
    science. I will foster a culture where NIH leadership will
    actively encourage different perspectives and create an
    environment where scientists, including early career scientists
    and scientists that disagree with me, can express disagreement
    respectfully.

        Fourth, the NIH must recommit to its mission to fund the
    most innovative biomedical research agenda possible to improve
    American health. My plan is to ensure that the NIH invests in
    cutting edge research in every field to make big advances
    rather than just small, incremental progress over years. Fifth,
    the NIH must embrace and vigorously regulate risky research
    that has the possibility of causing a pandemic--must regulate
    risky research that has the possibility of causing a pandemic.
    It should embrace transparency in all its operations.

        While the vast majority of biomedical research poses no
    risk of harm to research subjects or the public, the NIH must
    ensure that it never supports work that might cause harm. If
    confirmed, I will work with Congress and the Administration to
    guarantee that happens.

        While I believe there are real problems to be addressed, I
    want to finish by reiterating my great respect for the work and
    mission of the NIH. If confirmed, I will carry out President
    Trump's agenda of making the public science institutions of
    this country worthy of trust and serve to make America healthy
    again. Thank you.

        [The prepared statement of Dr. Bhattacharya follows.]
                   prepared statement of jayanta bhattacharya
        Chairman Cassidy, Ranking Member Sanders, and Members of the Senate
    HELP Committee, I am honored to speak with you today and deeply humbled
    by President Trump's nomination. I am delighted to have my wife Cathy,
    my son Matthew, and my brother Deep with me today. My other two adult
    children, Jodie and Benjamin, unfortunately could not attend today but
    are here in spirit.

        The NIH has played a pivotal role in my career. I served as a
    standing member of NIH grant review committees. I helped many trainees
    prepare for scientific careers with NIH support. And I won NIH funding
    to study population aging, chronic disease, and obesity. I have made
    the study of scientific institutions--including the NIH itself--a focus
    of my own scientific work.

        The NIH is the crown jewel of American biomedical science, with a
    long and illustrious history supporting breakthroughs in biology and
    medicine. I have the utmost respect for NIH scientists and staff over
    the decades who have contributed to this success. The NIH's mission--to
    support scientific discovery to enhance health and lengthen life--is
    vital to our Country's future and, indeed, the world's.

        I love the NIH, but post-pandemic, American biomedical sciences are
    at a crossroads. A November 2024 Pew study reported that only 26
    percent of the American public had ``a great deal of confidence'' in
    scientists to act in the public's best interest; 23 percent have not
    too much or no confidence at all.

        How can I help NIH better achieve its mission? I have five concrete
    goals if confirmed as director of the NIH.
                             Chronic Disease Crisis
        First, NIH research should focus on research to solve the American
    chronic disease crisis. American health is going backward. Life
    expectancy flat lined between 2012 and 2019, plummeted during the
    pandemic, and has still not bounced back to pre-pandemic levels. The
    chronic disease crisis is severe, with hundreds of millions of American
    adults and children suffering from obesity, heart disease, diabetes,
    and cancer.

        If confirmed, I will carry out President Trump and Secretary
    Kennedy's agenda of Making America Health Again and committing the NIH
    to address the dire chronic health needs of the country with gold-
    standard science and innovation.
                               Reliability Crisis
        Second, NIH-supported science should be replicable, reproducible,
    and generalizable. Unfortunately, much modern biomedical science fails
    this basic test.

        The NIH itself just last year faced a research integrity scandal
    involving research on Alzheimer's disease that throws into question
    hundreds of research papers.

        If the data generated by scientists is not reliable, the products
    of such science cannot help anyone. It is no stretch to think that the
    slow progress on Alzheimer's disease is linked to this problem.

        The NIH can and must solve the current crisis of scientific data
    reliability, and under my leadership, if confirmed, it will do so.
                          Crisis of Scientific Dissent
        Third, if confirmed, I will establish a culture of respect for free
    speech in science and scientific dissent at the NIH. Over the last few
    years, top NIH officials oversaw a culture of cover-up, obfuscation,
    and a lack of tolerance for ideas that differed from theirs.

        Dissent is the very essence of science. I will foster a culture
    where NIH leadership will actively encourage different perspectives and
    create an environment where scientists--including early career
    scientists--can express disagreement respectfully.
                              Crisis of Innovation
        Fourth, the NIH must recommit to its mission to fund the most
    innovative biomedical research agenda possible to improve American
    health. My plan is to ensure that the NIH invests in cutting-edge
    research in every field to make big advances rather than just small,
    incremental progress over years and sometimes decades.
                      Crisis of Gain of Function Research
        Fifth, the NIH must vigorously regulate risky research that has the
    possibility of causing a pandemic. It should embrace transparency in
    all its operations. While the vast majority of biomedical research
    poses no risk of harm to research subjects or the public, the NIH must
    ensure that it never supports work that causes harm.

        If confirmed, I will work with Congress and the Administration to
    guarantee that happens.
                                   Conclusion
        While I believe there are real problems that need to be addressed,
    I want to finish by reiterating my great respect for the work and
    mission of the NIH.

        If confirmed, I will carry out President Trump's agenda of making
    the public science institutions of the country worthy of trust and Make
    America Healthy Again.
                                     ______

        The Chairman. Thank you, sir. I will start with questions.
    One thing that has been a real topic has been the issue of
    measles vaccines and autism. And we can see that the false
    article in Lancet decades ago has led to a lot of people not
    getting their child vaccinated.

        There is now a child who died from a vaccine preventable
    disease in Texas. Let me repeat that, a child who died from a
    vaccine preventable disease in Texas. The Secretary has put out
    an editorial, which is if you just read it, the kind of
    understanding of it is that you should get vaccinated.

        Now, I have been told that you have said that we need to
    invest NIH resources at looking at the link, a possible link
    between measles vaccine and autism. I have not heard that
    directly. It is hearsay. Any comment on that?

        Dr. Bhattacharya. Senator, it is a tragedy that a child
    would die from a vaccine preventable disease. I fully support
    children being vaccinated for diseases like measles that can be
    prevented with the vaccination efforts.

        As far as research on autism and vaccines, I don't
    generally believe that there is a link and based on my reading
    of the literature. But what I have seen is that there is
    tremendous distrust in the--in medicine and science coming out
    of the pandemic.

        We do have, as you know, Senator, a sharp rise in autism
    rates in this country. And I don't know, and I don't think any
    scientist really knows, the cause of it. So I would support an
    agenda of--a broad agenda, a broad scientific agenda based on
    data to get an answer to that.

        The Chairman. But this has been fairly well--in fact, it
    has been exhaustively studied. And there are limited resources.
    And if we keep plowing over ground that has been plowed over,
    knowing you can never prove a negative--and since we don't know
    the cause, we will still have a problem.

        We have got a responsibility with limited resources. How do
    we address those things that we don't know the cause for, or
    that can ameliorate those things that are related to this
    crisis of chronic disease?

        My state, by the way, is terribly affected by chronic
    disease, so I am totally with you on that. But what I want to
    make sure is there is an appropriate use. So again, just going
    back to--did you have an idea or an agenda that would once
    more, by golly once more, prove that measles vaccine is not
    associated with autism?

        Either the schedule, the vaccine, or anything else
    associated with it, because my concern is the more we pretend
    like this is an issue, the more we will have children dying
    from vaccine preventable diseases.

        Dr. Bhattacharya. I guess I will turn it around and say, I
    want to--I don't want to disprove a negative. That is almost--
    that is impossible really. But I want to address the rise in
    autism that----

        The Chairman. I accept that. I think is laudable. We need
    to do that.

        Dr. Bhattacharya. Yes, that is a positive----

        The Chairman. But I am asking the specific question, will
    we once more have to go back over this particular issue?
    Because that has been exhaustively studied.

        Dr. Bhattacharya. Yes, I mean, I think as I said, Senator,
    I don't think that there is a link between that--between the
    MMR vaccine and autism. I am convinced based on that
    literature. The only reason I am not wholeheartedly saying yes
    to the to your question, which I--every instinct of mine is to
    do that, is that there are people who might disagree with me. I
    want to make----

        The Chairman. But that is life.

        Dr. Bhattacharya. Yes.

        The Chairman. I mean, there are people who disagree the
    world is round. And I say that not to minimize these concerns,
    but people--people still think Elvis is alive. And so, if you
    just say someone disagrees with me, so therefore I am going to
    put precious limited taxpayer dollars to this and not to
    address the issues of obesity, heart disease, cancer, we have
    lost.

        There is an opportunity cost here. You are the economist.
    What am I doing talking about opportunity cost. So I am
    pressing you on this because I think that kind of is a
    framework. If just because somebody is upset about something,
    do we have the opportunity cost of devoting resources in
    something which has already been pretty well examined?

        Dr. Bhattacharya. I guess--yes, you are absolutely right,
    Senator. We don't need to address every idea that--or concern.
    But if those concerns result in parents not wanting to
    vaccinate their children for a vaccine that is well tested--my
    sense is that--my inclination is to give people good data. That
    is how you address those concerns. I don't know what else would
    do it.

        The Chairman. But I am not quite sure what--at what
    endpoint we say we have got good data. Because----

        Dr. Bhattacharya. I mean, I am convinced that we have good
    data on MMR and autism. But if other people don't agree with me
    and then they don't vaccinate their children, I think I don't--
    if I am confirmed as NIH Director, the one lever I will have is
    to give them good data. That is really the lever I have.

        The Chairman. But that good data already exists. You are a
    scientist, and you accept that.

        Dr. Bhattacharya. Yes.

        The Chairman. It seems more an endorsement with an
    appropriate allocation of current dollars would be a better way
    to spend precious limited Federal dollars.

        Dr. Bhattacharya. I mean, I think the most important
    childhood health problems have to do with childhood diabetes,
    childhood obesity. I think that is what----

        The Chairman. I accept that we should be studying that.

        Dr. Bhattacharya. That is what most--that is where the vast
    majority of the effort should go. Prevention of childhood
    infectious diseases also I think is important. I mean all of
    those are--and I think you and I agree--would be the main
    priorities. That is the priorities I will have if I am NIH
    Director.

        The Chairman. Thank you.

        Senator Sanders.

        Senator Sanders. Thank you, Mr. Chairman. Dr. Bhattacharya,
    as I mentioned a moment ago, in some cases we pay 10 times more
    for prescription drugs, the same drug, that people in other
    countries pay.

        Something like one out of four Americans can't afford the
    prescriptions that the doctors write when they get sick. Why do
    we pay the highest prices in the world by far for prescription
    drugs? And what would you do if you were confirmed as NIH
    Director?

        Dr. Bhattacharya. I don't have a full answer to that
    question, but I agree with your concern and the fact that we do
    pay the highest prices in the world for prescription drugs. If
    I am NIH Director--if I am confirmed as NIH Director, I think
    there is a very specific thing that we haven't done but we
    should do.

        The NIH should fund research on off patent--off label use
    of off patent drugs, inexpensive drugs. I will give you an
    example from the pandemic, Senator. There was a tremendous--
    tremendous achievement, I think. There was a study done in the
    United Kingdom of a cheap steroid called Dexamethasone. Very
    early in the pandemic, if used during--in----

        Senator Sanders. I don't mean to--I apologize, but I don't
    have a lot of time. And I hear what you are saying, and I am
    not in disagreement with that. Question is, historically the
    NIH has, as we all know, spent billions of dollars in
    developing important drugs.

        Yet, despite that taxpayer expenditure, we end up paying
    back more than other countries. Should a company that benefits
    from the taxpayer dollars research, basic research at the NIH
    be able to charge any price that they want?

        Or should we attach to those contracts a reasonable pricing
    clause that says, hey, if we help develop this drug and it is
    effective, you are going to have to charge a reasonable price
    for it?

        Dr. Bhattacharya. Senator, that is an issue where I think
    previous NIH Directors have said it is very difficult for--for
    a NIH Director alone to take action. I think that is something
    that Congress and the Administration would have to work
    together.

        Senator Sanders. I am not quite sure. Actually I think what
    we are learning from the President is a lot can be done through
    Executive Orders. And I would disagree with you. I think that
    is something that the NIH can do. Would you be open to that
    idea?

        Dr. Bhattacharya. I mean, Senator, I guess I would focus on
    the future. Imagine the NIH focuses on support for relatively
    inexpensive----

        Senator Sanders. I am hearing a no. Okay. Let me ask you
    this question. We talked about life expectancy. A very
    important issue. Why is it the working class people in America
    live 7 years shorter lives than the rich?

        Dr. Bhattacharya. Senator, it is the chronic disease crisis
    in large part----

        Senator Sanders. But why does somebody who is working class
    end up with more chronic diseases than somebody who is wealthy?

        Dr. Bhattacharya. I mean, I think, Senator, that is
    something I have devoted my career to trying to understand. I
    think that it is a tragedy that there is such a dispersion in
    life expectancy based on income.

        I think the solution that an NIH Director, if I am
    confirmed and I would fully commit to this, is to address the
    health problems that lead to that outcome, the rise in obesity,
    the rise in diabetes, the----

        Senator Sanders. Again, I apologize for interrupting. But
    what role does--the food industry out there sells a lot of crap
    to our children, right. And they spend zillions of dollars on
    advertising products that are really not healthy. What will you
    do about that?

        Dr. Bhattacharya. Senator, I think excellent research to
    try to find alternatives to make clear the link between the
    junk food that kids eat, and subsequent health outcomes can
    convince parents I hope to make better choices for their kids--
    to help them make better choices for their kids. I think the
    role of research is to elucidate those connections and give
    people tools.

        Senator Sanders. But you are going to have, if you are
    confirmed, a bully pulpit, so to speak. Would you support what
    a number of countries around the world are doing and saying to
    the food industry they cannot do TV advertising for unhealthy
    foods?

        Dr. Bhattacharya. I mean, if I am confirmed, I would
    absolutely advocate for--to give parents the tools they need so
    that their kids will eat healthy.

        Senator Sanders. I am answering the question. Sounds like a
    good politician here. There are TV ads as we speak right now
    telling kids to tell their mothers that they desperately need
    some food, which is really unhealthy. There are countries who
    say that those ads should not be allowed on television targeted
    to kids. Would you support those unless--would agree with that?

        Dr. Bhattacharya. I mean, if there is a movement to
    encourage advertisers to not push unhealthy foods, I certainly
    would be willing as Director----

        Senator Sanders. But you could lead that movement. Not be--
    will help lead that movement?

        Dr. Bhattacharya. I mean, absolutely. We want to make
    America healthy again. I don't know specifically how one would
    lead such a movement, but I would be willing to work with you,
    Senator, to do that.

        Senator Sanders. Thank you very much.

        The Chairman. Senator Paul.

        Senator Paul. Senator Sanders, I am glad to see that you
    are interested in junk food. In fact, I have a great offer for
    you. Probably you could transform health more in our Country by
    one policy change, and that would be removing junk food, sugar
    drinks, chips, Twinkies, Ding Dongs from food stamps.

        We have an epidemic of obesity, particularly among our
    poor, particularly among those on food stamps. Why not just
    take the food formulary and make it healthy food? We do this
    for WIC. We decided for pregnant women that we do. But I have
    had a bill out there for quite some time. I have no one from
    the other side of the aisle.

        I am glad to hear of your concern for junk food and hope I
    can get you to consider that. We talked about precious
    resources, and we say, well, gosh, we can't study autism or
    any--we are done with vaccines. The problem with that is there
    is a great deal of vaccine hesitancy. And there does need to
    be--it doesn't mean we need 99 percent of the NIH budget on
    autism and vaccines, but certainly I think we have room to have
    another study to try to convince those who are hesitant.

        We ought to look at populations of people who take no
    vaccines, the Amish and others, and try to compare them in a
    scientific way to those who do and see if we can learn
    something from that. But one way to have more precious
    resources directed toward good science is to get rid of the
    frivolous studies.

        William Proxmire sort of talking about this in the 70's. I
    have been talking about this for a dozen years. This is from
    the NIH, 2.1 million studying whether or not when you are at
    the Luby's cafeteria, and somebody in front of you sneezes on
    the food, are you more or less likely to take the food? I mean,
    that kind of stuff is ridiculous. You could have real science
    if you weren't doing that.

        But that has been going on for decades. One of the first
    things that Proxmire mentioned was a study on what makes people
    happy. That would be great for Cosmopolitan Magazine. I really
    highly suggest it. But it is a stupid idea for taxpayer money
    for a study. But that was 30 years ago.

        One of the ones he hated the worst was, what makes people
    more aggressive, gin or tequila? So they fed half the codfish
    gin and the other half the codfish tequila, and we all know
    it's got to be tequila, right? I mean, jeez, come on, we don't
    need to study that. But the thing is, there is lots of
    frivolous stuff out there that gives good science a bad name.

        I vote for almost no spending up here because it is almost
    all inflated, but I have voted for money for the NIH, but they
    have got to do a better job. And one of the things I hope is,
    is that you are directed toward diabetes, heart disease,
    cancer, Alzheimer's, these big diseases. But I don't think it
    is just good people.

        We have got to change the way the grants are so that
    somebody on the grant committee maybe should be one of the from
    the major five diseases should be on every behavioral study to
    make sure we are not wasting it on whether rats use--lonely
    rats use more cocaine than, well liked rats used. I mean, that
    was from last year.

        What do you think about trying to look at the way we do
    grants to try to, I don't know, populate the people on the
    grants. You said you were on a grant committee. To try to
    populate the grant committees where there is attention being
    paid maybe to the big five diseases and we don't get lost on
    a--down a rat hole, so to speak. Would you have any thoughts on
    that?

        Dr. Bhattacharya. Senator, I think that the resources at
    the NIH--the taxpayers gives the NIH are precious. And if
    confirmed, I absolutely commit to changing the grant committee
    make up so that they focus on the most important questions that
    address--that impact American health.

        I mean, there needs to be a mix of basic science work. And,
    I am not a basic scientist myself, but I can understand how
    some somewhat abstract basic science work can have fun
    advances. But at the same time, the research should really be
    focused on making America healthy. That is the mission of the
    NIH.

        Senator Paul. You mentioned, and you got cutoff a little
    bit, on steroids. But this was a pretty amazing thing during
    COVID. So steroids are virtually pennies. They have been around
    forever. They found a 36 percent reduction in COVID deaths from
    people entering the ICU. They are either going on the
    ventilator or almost on the ventilator.

        There was like a huge death rate among these people. And
    they found something for pennies that was a cure. And yet, when
    Dr. Fauci came to this Committee in March 2020, I asked him
    about using high dose steroids the way they do for necrotizing
    fasciitis and other infections.

        He said, oh, they don't work. We have tried it. And he was
    adamant that the steroids didn't work. And it turned out to be
    the best cure and the cheapest, and yet the knowledge didn't
    get out there because there was a bias. Do you think that we
    can change that kind of bias and hear open debate, and that
    will make a difference with disease?

        Dr. Bhattacharya. Absolutely, Senator Paul. That was a such
    a signal success of the pandemic--the study. But the shame is
    that it was a group in the UK that ran that study, not a group
    in the NIH. That is something the NIH ought to have run with
    billions of dollars for infectious disease.

        It is something that is changeable just with prioritization
    alone. I think we can align the incentives of the NIH so that
    it looks for those kinds of opportunities, because there are
    many of them out there.

        The Chairman. Senator Murray.

        Senator Murray. Thank you. Thank you, Dr. Bhattacharya, for
    being here. Really appreciate it. I don't think it is an
    exaggeration to say that right now President Trump and Elon
    Musk are really putting a lot of lifesaving research at risk.

        We have had grant freezes, pauses on advisory meetings,
    pauses on clinical trials, mass firings being carried out by
    the so-called DOGE. It is really threatening our ability to
    treat childhood cancer, to mitigate the effects of Alzheimer's
    disease and other forms of dementia, and to better understand
    and treat women's health issues.

        Do you support the recent researcher firings and grant
    freezes that have been implemented by Trump and DOGE?

        Dr. Bhattacharya. Senator, I was not involved in those
    decisions. If confirmed as NIH Director, I fully commit to
    making sure that all the scientists at the NIH and the
    scientists that the NIH supports have the resources they need
    to meet the mission of the NIH, which is to make America--do
    research to make America healthy.

        Senator Murray. Do you support further cuts at NIH funding
    or staff?

        Dr. Bhattacharya. Senator, I don't support--I don't have
    any intention to cut anyone at the NIH. If I am confirmed as
    Director----

        Senator Murray. What about all the grant freezes and the
    pauses and all the advisory committee meetings, all the pauses
    that are now in effect on clinical trials--trials that are
    happening there right now?

        Dr. Bhattacharya. Senator, I have read the press accounts
    of it. It is hard to know outside. I have not interacted with
    people in the agency.

        Senator Murray. If you are confirmed, day one, what will
    you do about that?

        Dr. Bhattacharya. Senator, I am going to assess it, day
    one. I am going to understand what the--what resources the
    whole NIH needs and make sure that the scientists that are
    working at the NIH have the resources to do the lifesaving work
    that they do, and that the scientists that are supported by the
    NIH also have that. The personnel decisions are hard to talk
    about unless I am actually confirmed, and I have more data.

        Senator Murray. I will just tell you right now that I am
    deeply concerned about the funding there, the research that has
    been stopped, and all that is going on. And I want a very
    strong assurance that you will get that moving again, day one.

        Dr. Bhattacharya. Senator, absolutely. I am going to be
    looking very carefully at the personnel decisions. I want the
    NIH to be staffed absolutely appropriately to meet the mission
    of the NIH. I am happy to work with you and other Members of
    Congress to make sure that happens.

        Senator Murray. Okay. Well, just a few weeks ago, the Trump
    administration announced an illegal plan to cap indirect cost
    rates at 15 percent.

        That amounts to a massive funding cut for research
    institutions, large and small, red and blue states, everyone,
    and brings a lot of lifesaving research to a screeching halt.
    Sick kids wouldn't get the treatment. Clinical trials shut
    down.

        I want to ask you, do you know what the indirect cost rate
    was for Stanford, your own institution, last year?

        Dr. Bhattacharya. I think it is on the order of 55 percent.

        Senator Murray. That is correct. So if the 15 percent cap
    was implemented, Stanford would lose approximately $160 million
    per year. So what do you say today to your colleagues at
    Stanford--researchers in my home State of Washington.
    Scientists across the country. But what do you say to the folks
    at Stanford about this?

        Dr. Bhattacharya. Senator, I have been a researcher at
    Stanford. I have earned NIH grants from--the NIH while I have
    been a professor at Stanford. The money that comes to me, the
    direct cost, as researchers, I understand exactly where that
    money goes. The indirect costs are kind of a tip, a 55 percent
    tip on top of that goes to the Administration----

        Senator Murray. You would tell the Stanford researchers
    they don't need that? Or are you just saying Stanford is
    different than everybody else?

        Dr. Bhattacharya. No, Senator--please let me finish. What I
    mean is that I don't know where that goes. I think that a lot
    of it likely goes to the things that are worthwhile. And I have
    heard lots of folks, including from Stanford, who say that, and
    I agree with them.

        Support for buildings, light bulbs to make sure that we can
    see in the lab and a whole host of other important things. But
    there is a lot of distrust about where the money goes because
    the trust in the public health establishments collapsed in the
    pandemic.

        I think transparency regarding indirect costs is absolutely
    worthwhile, and it is something that universities can fix by
    working together to make sure that where that money goes is
    made clear.

        I want to make sure that the money goes to the research. I
    want the money to specifically--if it goes to things that are
    not research and are labeled indirect costs, it is better to
    have that.

        Senator Murray. I just have a few minutes left and I wanted
    to ask you if you would--get the research committees going
    again, the advisory councils immediately upon day one?

        Dr. Bhattacharya. Yes, as soon as--if I am confirmed, I
    want those advisory councils. I want the--all that to go.

        Senator Murray. Well, I think we should all recognize that
    NIH is the largest research--medical researcher in the world.
    They are a global leader. We should be extremely proud of what
    they do.

        Nearly a third of all the Nobel Prizes to date have been
    awarded to scientists at NIH and supported by NIH funds. So, we
    have to be very careful moving forward. I am extremely
    concerned by the dramatic cuts, and firings, and stopping of
    the research that is going on at NIH right now.

        The Chairman. Senator Collins.

        Senator Collins. Thank you, Mr. Chairman. Doctor, welcome.
    I very much enjoyed our wide ranging discussion in my office. I
    am going to follow-up on Senator Murray's question about
    indirect costs.

        As I indicated to you, I am strongly opposed to the
    Administration's ill-conceived and completely arbitrary
    proposal to impose a 15 percent cap on indirect costs for NIH
    grants. Research labs and universities across the State of
    Maine have contacted me to describe the devastating impact that
    these--this cap would have on lifesaving and life enhancing
    biomedical research, on ongoing clinical trials, and on Maine's
    research related jobs.

        In 2023, NIH supported 1,470 jobs in this field, in the
    State of Maine alone. I think it is important that we all
    acknowledge that a one size fits all approach makes absolutely
    no sense, and that is why NIH negotiates with the individual
    grant recipient what the indirect costs cap should be. And it
    is legitimate to say that we should take another look at that.

        Are we doing the right amount for Stanford versus Jackson
    Laboratories or the University of Maine? Those are legitimate
    questions. But to impose this arbitrary cap makes no sense at
    all. Furthermore, and I really want to stress that this, this
    is against the law.

        Since 2017, we have had language in the Labor, HHS
    Appropriations Bill that specifically prohibits the indirect
    cost formula from being changed. And yet, that is what has been
    done without congressional intent, or agreement, or consent.
    And the language has been carried every single year, including
    in the Continuing Resolution that we are now operating under.

        I am not surprised that a judge has stayed the order. So if
    confirmed, will you work immediately to rectify and reverse
    course on having a one size fits all, 15 percent cap on
    indirect costs?

        Dr. Bhattacharya. Senator, if confirmed, I absolutely
    commit to the following the law--to addressing this issue very
    directly. I think that this is one of these issues--to me, it
    is an indicator of distrust that some have of universities and
    of the scientific process. And so, I want to make sure that we
    address those concerns as well.

        But I absolutely commit to follow the law, and I will
    consult with agency counsel immediately and work with you,
    Senator, as we spoke of in our meeting to make sure that your
    concerns are addressed as well.

        Senator Collins. Thank you. You testified that the NIH
    should focus on research involving chronic diseases, and I
    agree that we should do a lot more in this area. Half of all
    American families report having Alzheimer's disease in their
    family. And their suffering from this progressive and
    ultimately fatal disease is tragic.

        But the impact is not just humanitarian. It also has a huge
    financial impact on our Nation. And that cost burden is
    expected to reach $1 trillion by 2050. For more than 12 years,
    Congress has supported a national strategic plan to look at
    ways for research to come up with the means of prevention,
    effective treatments, and ultimately a cure.

        I co-authored the original NAPA Act, as we call it, in
    2011. And last year with my colleague, Senator Warner, led the
    reauthorization of the national plan through 2035. If you are
    confirmed, will you continue to support the national strategic
    plan targeting Alzheimer's?

        Dr. Bhattacharya. Absolutely, Senator. For me, it is not
    just a theoretical issue, although I have studied it in a--in
    my research work. I believe very fundamentally that there are
    very promising potential ways to prevent Alzheimer's that have
    not received support, including from some colleagues of mine at
    Stanford University, because they haven't aligned with a single
    dominant narrative about what causes Alzheimer's.

        I want to expand the set of things that we look at as a
    possible cause for Alzheimer's so that we can make advances. We
    should have had, I think, much more advances for the
    investments we have made to date.

        I want to make sure that all the hypotheses that are out
    there get addressed, because that is a vitally important
    problem, as you say, not just humanitarian, not just for
    health, but also for the fiscal health of our Country.

        Senator Collins. Thank you. I will submit the rest of my
    records--questions for the record.

        The Chairman. Senator Baldwin.

        Senator Baldwin. Thank you. So I want to begin by
    discussing the Trump administration's actions to halt thousands
    of NIH grants and billions of dollars in NIH research funding.

        Canceled study sections and importantly advisory council
    meetings mean that NIH cannot award grants to fund critical
    medical research. Additionally, the Administration attempted to
    illegally cap indirect costs.

        You have already gotten several questions about that. The
    indirect cost rates--and this is in blatant defiance of
    Appropriations law, which prohibits NIH from capping these
    costs. I am the Ranking Member of the Labor, HHS Appropriations
    Subcommittee, and I have been raising the alarm about this for
    weeks now.

        On Monday, I revealed that the Trump administration has
    halted $65 million in funding for Alzheimer's disease, stopping
    14 Alzheimer's disease research centers from finding ways to
    treat and prevent this devastating disease.

        If NIH does not reverse course on these really disastrous
    decisions, the centers will run out of funding at the end of
    April. So, Dr. Bhattacharya, do you agree with President Trump
    that NIH should stop funding for research on cancer and
    Alzheimer's disease?

        Dr. Bhattacharya. Senator, I don't believe President Trump
    has that as his priority. And I--of course I wasn't not in----

        Senator Baldwin. His actions are accomplishing that right
    now.

        Dr. Bhattacharya. Senator, if confirmed, I will follow the
    law, as I said to Senator Collins, on the indirect cost
    recovery. And my commitment is to make sure that every single
    researcher at the NIH, every single researcher supported by NIH
    money has the resources they need to do their lifesaving
    research.

        Senator Baldwin. I am going to talk more about those
    researchers who have been fired, but right now we have--this
    Administration has halted funding for 14 Alzheimer's disease
    research centers. Do you agree with that decision?

        Dr. Bhattacharya. Senator, I don't have access to that
    information from outside. If confirmed, I absolutely will look
    into it to make sure that if----

        Senator Baldwin. I mean, I know that you are not consulting
    with people at NIH pending your confirmation proceedings here,
    but you are not unaware that this is happening, and you should
    have a position on this.

        I mean, you have accepted President Trump's nomination, and
    you are watching these actions taking place in an organization
    that you may someday lead. Do you agree with the stripping away
    of funding this--for cancer and Alzheimer's disease?

        Dr. Bhattacharya. Senator, if I am confirmed, I will make
    sure that the NIH researchers and the NIH researchers that are
    funded by the NIH, outside the NIH, have the resources they
    need to make sure that they do their research. That is the
    mission of the NIH. If I am confirmed, my job will be to make
    sure that mission is met.

        Senator Baldwin. Moving on, I am concerned about how the
    Administration's recent actions are putting especially early
    stage researchers at risk. We talked about that when you
    visited with me in my office. In the year 2016, I worked with
    Senator Collins to enact the Next Generation Researchers Act.

        Since then, NIH has increased funding for early stage
    investigators. But now these researchers are precisely the ones
    being targeted by the Trump administration, and Elon Musk in
    his unelected, unaccountable capacity.

        Due to the NIH funding freeze, university admissions for
    graduate students have slowed or even stopped. Postdoctoral
    fellows can't find jobs to launch their research careers.
    President Trump and Elon Musk have fired nearly 1,200 NIH
    employees so far, including hundreds of scientists conducting
    lifesaving research.

        They put the rest of them on notice that more reductions in
    force are coming, and new restrictions from Trump and Musk
    could push out about 3,000 of the most promising early career
    researchers by refusing to renew their positions. This is the
    institute that you may be running. These actions threaten an
    entire generation of scientists. They threaten our future as a
    global leader in biomedical research.

        They threaten our future health and our ability to fight
    diseases. And frankly, they threaten our national security. So,
    Dr. Bhattacharya, you have said that as NIH Director, you want
    to increase support for the next generation of scientists. How
    will you repair the damage and support early career
    researchers?

        The Chairman. Could you please answer quickly because we
    are----

        Dr. Bhattacharya. Sure. Just very briefly, I am very
    committed to making sure early career researchers have
    resources. I think that it is not just for their own sake, but
    also because they have ideas that are at the cutting edge.

        Senator Baldwin. You will hire them back?

        Dr. Bhattacharya. It is--Senator, I wasn't involved in any
    of the personnel decisions to date. I will look very carefully
    at the personnel decisions, if I am--[technical problems].

        The Chairman. Thank you. And for the record, funding has
    not been canceled. They are meeting to allocate it. The funding
    has been delayed. But just for the record.

        Senator Marshall.

        Senator Marshall. Well, thank you, Mr. Chairman. As I
    listen to the conversation today, I am reminded that we all
    should doubt our own infallibility, and we should doubt the
    infallibility of the NIH as well. I am flabbergasted as I
    listen to this conversation of people that really have never
    been involved in the scientific process and that they don't
    understand indeed the infallibility.

        When I think of the NIH, the waste that has occurred. And I
    think of Alzheimer's, the waste is the path we went down the
    last--since 2005, 2006. Dr. Bhattacharya, you recall, I am
    trying to remember, an amyloid study that really--so all the
    NIH funds went that direction for 20 years, and then we find
    out, oh my gosh, it was NIH funded research. You remember that
    project?

        Dr. Bhattacharya. Yes, I mean, there is a whole set of
    projects, Senator, that have focused by the NIH on a particular
    hypothesis, the amyloid hypothesis, at the expense of other
    hypotheses. I agree with you about humility.

        That is the key to scientific progress. We have to as
    scientists say we might be wrong, because when we meet data
    that disagrees with us, or we have ideas that we disagree with,
    maybe that other ideas right and we are the one that is wrong.
    It is only by--if I am confirmed as NIH Director, I want to
    make sure that all the range of hypotheses are supported.

        That is how you make progress. One of the reasons I think
    that we have not made progress in Alzheimer's as much as we
    ought to have is because we have gotten--the NIH has not
    supported a sufficiently wide range of hypotheses.

        Senator Marshall. We also have, what, eight different
    supporting institutes studying it. They don't communicate with
    each other as well.

        I mean, my guess is when you make a 5-year grant, 20
    percent of those should be stopped after a year because they
    went down a road. It is a dead end. It is time just to start
    over.

        I am glad they are pausing these. I think that there is a
    significant amount of waste, fraud, abuse, and incompetence in
    the studies funded by the NIH. Let's talk about chronic disease
    just for a second.

        The NIH has spent a disproportionate amount of money on
    research on diseases that impact a very small, minuscule amount
    of Americans. Meanwhile, 60 percent of Americans have a chronic
    disease. Speak a little bit about your vision of researching
    for figuring out the causes and treatments of chronic disease.
    Specifically, how food as medicine might be intertwined in your
    vision.

        Dr. Bhattacharya. Senator, I think the chronic disease
    problem is something that the NIH ought to have done a better
    job at the last several decades. The mission of the NIH is to
    address the health needs the American people have and to expand
    life expectancy of the American people.

        We have not achieved that. It has been--it has flatlined.
    And you say food as medicine. That is the kind of research idea
    that would be very difficult, I think, to get research support
    from the NIH because it is not within the scope of the people
    who decide what NIH ought to support. I think we should expand
    the set of ideas to address a problem that we don't know how to
    address.

        The chronic disease problems of the United States are so
    broad that we need to have a lot more tolerance that the top
    scientists who controlled the ideas in their fields may be
    wrong. We need to allow other scientists who have other ideas,
    and food as medicine might be one of them, to have support. I
    don't know what is going to be the answer, but I do know that
    if we don't----

        Senator Marshall. Are you committed to helping us figure
    out the causes of these chronic diseases?

        Dr. Bhattacharya. I absolutely am, Senator. I mean, I think
    that is the heart and soul of the Make America Healthy Again
    movement, and millions and millions of Americans have been
    looking to us to do that. If I am confirmed, I absolutely
    commit to doing that.

        Senator Marshall. Yes. And a big part of that is the trust.
    That thanks to Dr. Fauci, no one trust the NIH, the CDC
    anymore. And we need a referee to come in and try to say, well,
    what is the latest science? Science is never settled. It is
    always changing.

        But, what is it in ultra processed food that is causing
    this uptick in chronic diseases? Speak a little bit about the
    indirect costs of these situation. Look, I think most of us
    understand that is just another grift for universities, and we
    are paying their very unfair share of overhead going forward.

        But what I am concerned about is two-thirds of research
    dollars are funneled to four or five states it looks like to
    me. Just would like your commitment for us flyover states to
    spread the love a little bit. It will prevent inbreeding. And
    hope that when you do, realize that not every good scientific
    idea comes from the coast.

        Dr. Bhattacharya. Senator, I have scientists colleagues
    from across the country and I hear your concern, that the NIH
    ought to be more committed than it has been to making sure that
    every scientist no matter where they are--they don't have to be
    in California or the Northeast Corridor to get support. I
    absolutely commit to supporting the IDeA Program that the NIH
    uses to identify scientists in----

        Senator Marshall. Just to make an explanation point, the
    indirect cost in Kansas University or Kansas State is going to
    be less than the coast. I don't know why--it is their own
    problem. If their indirect costs are that high, it is their own
    problem. It is not my fault. If we can do the research more
    efficiently, less expensive at Kansas State University or KU,
    then let's move it there.

        The Chairman. Thank you, Dr. Marshall.

        Senator Hassan.

        Senator Hassan. Thank you, Senator Cassidy. And good
    morning still. We are in the morning, so. And welcome.
    Congratulations on your nomination, doctor. I am going to start
    out with a question I start all these hearings now with, which
    is, if directed by the President to take action that would
    break the law, would you follow the law or would you follow the
    President's directive?

        Dr. Bhattacharya. Senator, I don't believe the President
    will ever ask me to break the law.

        Senator Hassan. Well, that strains credulity, given
    especially the last few weeks. And it is a disappointing
    answer. I will expect you to follow the law regardless of
    whether the President directs you to break it. Now, let me go
    to the second question. President Trump has effectively frozen
    NIH funding for existing grants, including grants that directly
    treat people with rare diseases.

        My office has heard from Christine in Brentwood, New
    Hampshire who was receiving treatment for colon cancer through
    an NIH funded clinical trial but now no longer knows the fate
    of her care because these freezes have delayed doctors who
    might be needing to hire new research assistants in the trial.
    This colon cancer trial may not have the research staff that
    they need to continue treating patients. If confirmed, will you
    commit to reversing the across the board funding freezes at NIH
    that have delayed lifesaving clinical trials?

        Dr. Bhattacharya. Senator, first, I absolutely commit to
    following the law, just in response to the previous question.
    But I will also say on this question now, absolutely. I think
    that--if I am confirmed as Director, I want to make sure that
    every single study that is advancing America--the health--our
    knowledge about health, including colon cancer--goes forward.
    Absolutely.

        Senator Hassan. Well, the freeze is really delaying things,
    and it can have an impact, on treatment, and especially
    treatments for something like cancer which can be very time
    sensitive. That is the harm that these illegal freezes by this
    Administration have really put into play here.

        I hope you will speak up loudly, and clearly, and push back
    at the President and Mr. Musk on these freezes. These were
    appropriated funds. Article I of the Constitution and the law
    says that the Administration is supposed to be spending those
    funds in accordance with the grants and the clinical trial
    plans.

        President Trump has not only effectively frozen NIH funding
    for existing clinical trials, has also stopped review of new
    grant applications to help develop new cures for diseases such
    as pediatric cancer.

        Your written testimony focuses heavily on questioning past
    NIH research, but you don't lay out a plan for supporting
    research by our talented scientists across the country to help
    treat devastating diseases. You have talked about this with
    some of my colleagues, but if confirmed, will you immediately
    restart all NIH academic review committees and get all
    appropriated money out the door?

        Dr. Bhattacharya. If confirmed, absolutely, Senator. My job
    would be to make sure that those fundamental scientific
    meetings and other activities happen. The purpose of the NIH
    Director is to support the mission of the NIH.

        Senator Hassan. Okay. Thank you. I am going to forego the
    other questions I was going to ask and just say this. For
    people watching this hearing, for parents who are worried about
    autism in particular, let me just say a couple of things.

        We see more cases of autism in this country than we used to
    for a number of reasons, part of which is we are much better at
    diagnosing it earlier and understanding what the spectrum of it
    is.

        We have ongoing science that is beginning to point at the
    NIH, among other places, to genetic issues that may play a part
    in the development of autism and environmental issues. The now
    retracted study that suggested, wrongly and fraudulently, that
    autism might have a relationship to the MMR vaccine has been
    refuted by seven studies, every continent that involved
    hundreds of thousands of children.

        For parents out there who may think that vaccines have
    something to do with autism, there is no scientific evidence
    that it does. And it disappoints me greatly that neither you
    nor the Secretary now of Health and Human Services are willing
    to say that declaratively and strongly, because what you do
    when you hesitate, what the Secretary does quite cynically in
    my view when he hesitates about this, is you turn and sow doubt
    and worry at a time when we should be focused on actually
    finding the cure--the cause and the cure of autism.

        Similarly, when we talk about the causes of chronic disease
    in our kids, there is plenty of evidence, you have talked about
    it--working class folks in America have worse health than
    richer people. And yet you are about to join an Administration
    that is dedicated to giving more tax cuts to billionaires and
    taking away things from families, money and services from
    families that could help them live healthier, better lives and
    have children less subjected to things like hunger and housing
    insecurity, which contribute to chronic illness. So I hope you
    will think about that. I am over my time, and I think Senator
    Tuberville is next.

        Senator Tuberville. Thank you. Thank you, doctor, for being
    here. It is always good to run into somebody whose name is
    harder to say than mine and mispronounced more.

        You got a hard job in front of you, but I share the ideas
    and desire that the President has to root out waste and the
    fraud that we have in this country. Because if we don't, we are
    not going to have a country left. It is going to be gone. And
    he is doing the right thing. You are going to have a tough job.

        You are going to have to put your team together and do the
    same thing. We have got to make sure we use American taxpayers'
    money the right way. So, kind of give me your plan of how you
    are going to do this to when you come into office and are
    confirmed, how are you going to put your team together?

        Dr. Bhattacharya. Senator, I should say, I have a
    background as an economist--[technical problems]. Senator, I
    should say is I have a background as an economist, as well as
    being a doctor. And to me, that background, what it leads me to
    do is understand that every dollar wasted on a frivolous study
    is a dollar not spent--every dollar waste on administrative
    costs that are not needed is a dollar not spent on research.

        The team I am going to put together is going to be hyper
    focused to make sure that the portfolio of grants that the NIH
    funds is devoted to the chronic disease problems of this
    country. It is going to be devoted to making sure we have not
    just incremental progress, but research projects that have the
    capacity to make huge advances in treatment for cancer, for
    diabetes, for obesity.

        That is how I am going to decide what the team is. And the
    NIH--actually, I am blessed in some ways because it already has
    so many excellent scientists there to advise me on the areas I
    don't know about. And I want to tap that resource. I want to
    make sure I talk to every single person who is already a leader
    at the NIH to understand where those opportunities are.

        Senator Tuberville. Yes. Well, thank you. For the past 4
    years, I have been on this Committee, and we have obviously
    gone through COVID. Devastating to not just our Country but the
    world.

        Transparency and trust is going to have to be earned again
    from a lot of people. Most people across this country don't
    know what the NIH stands for, Okay. But now they do because of
    COVID. You said that science has to be reliable. Exactly.

        But people also have to trust. We are finding out now we
    have biolabs in Ukraine where a war is going on and we are
    finding them. I mean, and so you have got to be on top of that
    and you have got to--the American people have to trust you that
    you will say, listen, we are going to keep our eye on, the
    biolabs in North Carolina or wherever we have them, because it
    scares me to death of what is going on. What is your plan
    there, of getting trust back in this country?

        Dr. Bhattacharya. Senator, first of all, I want to make
    sure that, and I want to work with the Congress to make sure
    that there is appropriate regulation of any risky research. The
    NIH should have--I don't think it should be doing any risky
    research that has the potential to cause a pandemic, and I want
    to work with Congress to make sure that happens.

        As far as trust, I think the key thing is we have to be
    utterly open as--if I am confirmed, I will be the head of an
    organization that is a scientific organization. As a citizen, I
    would often look for FOIA responses from the NIH, Freedom
    Information Act requests, and they would be fully redacted
    during the pandemic.

        You can't have trust unless you are transparent. And as--if
    I am confirmed as NIH Director, I fully commit to making sure
    that the American people can see all of the activities of the
    NIH openly, with limited sort of obfuscation, which has
    characterized I think, unfortunately, the NIH's way that they
    interacted with the American people.

        Senator Tuberville. I think that starts with being very
    visual on television. Telling people the truth. Don't hide
    anything because we have been hiding things for years and that
    doesn't work. We found that out.

        Chairman Cassidy and I led a letter to the NIH under the
    last Administration asking questions about a grant that the NIH
    funded focused on children transitioning genders. The study
    followed all these children. Two of them committed suicide.
    Devastating. So, how can we ensure the NIH doesn't grant funds
    to things like this?

        Dr. Bhattacharya. Well, first of all, I think if you have a
    negative result and you--and it is politically inconvenient to
    you, you have an obligation as a scientist to report it, right.
    So the NIH funds a study that shows that gender transition
    doesn't reduce suicide rate among adolescents.

        That researcher has an obligation report it even though she
    may think it is politically inconvenient. So I want to make
    sure that NIH researchers are required to report even negative
    results. And there is ways to do that we can talk about it. But
    I think as far as like the prioritization of studies, as I was
    telling Senator Paul, I think we want to make sure that the
    studies are focused on the diseases that really are hurting
    Americans--obesity.

        A lot of the research that it is so easy to come up with,
    examples of--there is one of a shrimp on a treadmill, for
    instance, that was once funded. I don't--it is not that I am
    necessarily against research like that, but the American
    taxpayer should be focused on the needs of American taxpayers.

        The research should be focused on those needs, the health
    needs of Americans. And I want to make sure that the NIH, if
    confirmed, focuses on exactly that.

        Senator Tuberville. Thank you. Good luck.

        Dr. Bhattacharya. Thank you so much.

        Senator Tuberville. Senator Hickenlooper.

        Senator Hickenlooper. Yes. I hit it and it turned itself
    off. Thank you for being here, and for all your service. As we
    have already heard today, and you are already well aware of,
    this cap on the indirect fees for all NIH grants has been
    traumatic.

        The system is now on a pause. Clearly, the solution is some
    sort of more transparent, well thought out, fair system by
    which research in the center of the country, the South, the
    Northeast, the West, is all a level playing field. How long--
    let's assume that we get the legal stuff sorted out, the chaos
    comes down a little bit. How long would it take to create a new
    system like that?

        Dr. Bhattacharya. Senator, I don't know that it would take
    a new system necessarily. I think the key thing is, as you
    said, Senator, the transparency, right. So audits of university
    spending of indirect costs would help--I think, help inform
    decisions. It is a complicated question.

        Of course, I wasn't involved in the decision about the cap.
    But if I am confirmed as NIH Director, that is something I will
    look very carefully at. The broader problem is we have deep
    distrust by the American people of the universities and the
    scientific establishment earned during the pandemic.

        To address that, transparency is the key way, just as I was
    telling Senator Tuberville. That transparency is what we will
    solve this problem.

        Senator Hickenlooper. We agree on that. We have been
    working on a project called the DeOndra Dixon INCLUDE Project
    Act. I think you know a little bit about it, but the idea is
    that we codify research activities at the NIH on co-occurring
    disorders of Down Syndrome across multiple institutes of the
    NIH.

        I am not asking your endorsement, but I am asking if you
    would be willing to work with us on this? We are very serious
    about it. And also look at more broadly on cross-institute work
    at the NIH to try and unlock new discoveries.

        Dr. Bhattacharya. Senator, I am absolutely committed to
    that. And I would be delighted to work with you on the project
    that you just mentioned, as well as other projects. I think
    there is tremendous opportunities for cross-disciplinary work
    across the NIH.

        I think it is at the back of the minds of so many reform
    proposals at the NIH I have seen over the years to try to make
    sure that the NIH research doesn't stay siloed within one
    institute, but that it is useful for researchers all across the
    NIH.

        Senator Hickenlooper. Right. I want to spend a little bit
    of time--just thank you for that. I appreciate that. A moment
    just looking at--we have heard a lot of people suggest that
    somehow the NIH is allowing the United States to be taken
    advantage of in some ways.

        One fact that is striking to me that in a 10 year period,
    99 percent of the drugs approved by the FDA were developed with
    research, to a larger or lesser extent, from NIH.

        Are you worried about the U.S. ability to maintain that
    leadership? Do you think we are being ripped off in some way?
    The fact that we do--we are affluent enough and care about
    science enough that we are leading the world in this research
    is--in some way that is unfair.

        Dr. Bhattacharya. Senator, I think that the United States
    is the greatest country on earth. And one of the reasons it is,
    is that it has a sincere commitment to doing fundamental
    research that benefits all of humanity.

        I think much of the NIH research does exactly that. I don't
    view it as ripping off when a scientist comes up with an
    amazing idea that solves--that treats diabetes better. Everyone
    on earth benefits from that.

        Senator Hickenlooper. Right.

        Dr. Bhattacharya. I--no, I think NIH as a fundamentally an
    institution aimed at the public good.

        Senator Hickenlooper. Here is a more difficult question,
    which I have caused just to be suggestive. Do you think we are
    spending enough on research? In terms of where you are coming
    in, part of your seat is going to say--I mean, are we running
    out of good ideas? Is there a shortage of things that really
    demand our attention?

        Dr. Bhattacharya. I think as I outlined in my opening
    statement, I think there is some real problems in how the
    scientific establishment is operating. The replicability
    crisis. A lack of desire to focus on the diseases and the
    conditions that really are inflicting Americans.

        Also, a sort of tentativeness to focus on the big ideas. No
    matter what the budget is, I want to reform it in that
    direction. I am happy to work with Congress. I mean, it is
    Congress that decides the budgets of the NIH, not----

        Senator Hickenlooper. No, no. We decide based on a lot of
    your advice. So be thinking of that. Well, obviously, increased
    vaccine skepticism. We are seeing a--just in the past school
    year, the number of kindergarten kids that are exempted for one
    or more routine vaccinations has continued to rise. Highest
    levels recorded.

        Is this rising skepticism around vaccines, is that going to
    make vaccine related research at NIH any less of a priority? If
    confirmed, how you balance the need to focus on research into
    chronic diseases with that need to invest in research on
    viruses and things that a vaccine can address?

        Dr. Bhattacharya. Senator, I think the increasing
    skepticism, which I view as a hangover from the COVID pandemic,
    sort of overstatement about how the COVID vaccine worked, makes
    it more important to do vaccine research. Senator, Secretary
    Kennedy has already said he favors the MMR vaccine. I agree
    with that.

        I think that research--maybe I am naive, Senator, but I
    believe very fundamentally that research, if it is done right,
    it is replicable, is so persuasive that it will move people to
    take actions. And that is the philosophy I operated under my
    entire career, and I intend to keep doing that, if I am
    confirmed.

        Senator Hickenlooper. From your lips to God's ear. Thank
    you.

        The Chairman. Senator Moody.

        Senator Moody. Thank you, Mr. Chairman. Good to see you. I
    am the most junior member on this Committee. And recently
    transitioned from my role as AG in the State of Florida, the
    great free State of Florida, to U.S. Senator.

        One of the things I have enjoyed the most is these
    confirmation hearings because so much of what I worked on in my
    prior roles, whether that was a judge, or a Federal prosecutor,
    or the Attorney General, have translated in my ability to be
    able to truly, in a meaningful way, talk to the nominees about
    their vision for these agencies or roles that they are taking
    over, and how they might bring a different perspective, or
    leadership, or ideas to bear. And I particularly enjoyed that
    in our discussion.

        I am honored that I was the last meeting you had before
    your confirmation hearing today. In Florida, during--as we were
    experiencing COVID here in the United States, Florida took a
    very deliberate, scientific, very thorough approach to making
    decisions. And we tried to bring to bear many varying opinions
    as to not only what we were experiencing as to the virus, but
    how--what were the best ways to go about making decisions, and
    providing leadership, and protecting the health, safety, and
    welfare of our citizens.

        To some extent, many of those decisions were challenged or
    even the first of their kind in the Nation because we were
    truly examining all aspects of information coming in, not just
    what was being pushed through certain narratives. And in many
    respects, many ideas and thought--and scientific approaches
    were suppressed.

        I want to talk to you a little bit about that, because I
    know you have been such an advocate of how we led in Florida,
    the things we did. As you remember, when I was AG, we opened
    our schools right back up, right away. We were sued by a
    teachers union. And everything from how we dealt with masks, to
    social distancing, to the vaccines, there were
    misrepresentations abound during this time.

        I want to talk to you about how--your opinion on how
    Florida handled that and how you think that might translate
    into your new role. Do you feel like your views and scientific
    opinions might have been disregarded or set aside in pursuit of
    some Government narrative that may not have been based--
    especially, I know even as to the six foot rule, for example.

        My office led a grand jury investigation on all kinds of
    misrepresentations, from the six foot rule to the vaccines. And
    I just wanted to get your thoughts on that and how that might
    affect your role moving forward, if in fact you are confirmed.

        Dr. Bhattacharya. Senator, thank you for that question. I
    am tremendously proud to have been involved in advising the
    Florida response to the pandemic. One of the things, I was
    actually involved in the case that resulted in the Florida kids
    being able to go back to school.

        Even as my kids were left out of school, basically out of
    the--not allowed to go back into the school buildings for a
    year and a half, the kids of Florida were allowed. And as a
    result, the results are so much better. The--Florida has a
    lower all cause excess death rate during the pandemic than
    California did.

        I think Florida's response to the pandemic was a tremendous
    success. But I am really glad you highlighted the role of
    censorship and restriction of scientific discussion. It was so
    refreshing to me to be allowed to speak my scientific views in
    Florida during the pandemic. I think the root problem--because
    a pandemic is a very difficult thing and so many people can
    have different ideas in an environment of uncertainty.

        The root problem was that people who had alternative ideas
    were suppressed. I was personally subjected to censorship by
    the actions of the Biden administration during the pandemic.
    Science, to succeed, needs free speech. It needs an environment
    where there is tolerance for dissent.

        The reason, I think, why Florida did so well was that it
    provided an outlet for that dissent, so that the Government of
    Florida, the State of Florida could adopt the best ideas for
    its, it is not that no mistakes were ever made. That is--you
    can't say that of any state in a pandemic. But in order to do
    well, you have to allow people to speak with each other openly,
    even when their ideas are controversial.

        Senator Moody. Much that we discussed, and what you want to
    bring to bear, I believe is taking publications or studies and
    having those replicated. And making replication of studies be a
    priority for NIH, because so often you have people publishing
    and there is not that. Can you elaborate?

        Dr. Bhattacharya. Sure. Senator, there is a crisis of
    replication. So many studies are not replicable. You do a study
    and then someone else tries to do the study, and people won't
    cooperate and give the data to you, so you try to do the
    replicate. And then other teams try to do it, and they can't
    replicate it.

        Many, many studies are published and there is no--it is not
    subject to replication at all. But replication is the heart and
    soul of what truth is in science. If I write a study and you
    find the same answers, then I am more likely to be right. I
    want to make the NIH committed to that kind of notion of truth
    rather than authority as the way that truth is determined.

        Senator Moody. Thank you. I set you up to go over time. I
    apologize.

        Dr. Bhattacharya. Sorry, Senator--yes.

        Senator Moody. Sorry, Mr. Chairman.

        The Chairman. Senator Kim.

        Senator Kim. Thank you, Chairman. Doctor, thanks for coming
    on out. You had said before that you were in favor of
    decentralizing the decision-making at NIH. I think a--
    ``restructure'' the NIH to allow there to be many more centers
    of power. Concerned about individuals or a small number of
    individuals dominating decision-making. Do you still stand by
    that? And if so, what is the importance of decentralization
    from your--[technical problems]?

        Dr. Bhattacharya. Senator, I think--I do stand by that,
    Senator. The key thing to me about decentralization is a
    diversity of ideas to address uncertainties.

        When we have problems that we don't have the answer to, we
    have to allow there to be many people with different ideas to
    test them. Having a diversity of ideas. We talked already with
    some of the other Senators about making sure smaller--the
    state, scientists from smaller states get access to NIH
    support. That is one way to do it. Having younger scientists or
    early career scientists with----

        Senator Kim. But you are also saying decentralization in
    terms of who is making the actual decision, not where the
    resources are going. Is that correct?

        Dr. Bhattacharya. Well, I mean if I am confirmed as NIH
    Director, the job will be to decide where--how to set processes
    to making those allocations. I want to make sure that those
    processes allow early career investigators to have support.

        I want to make sure that it allows scientists from
    nontraditional universities not just the Stanfords and
    Harvards, to have support. I want to make sure that the people
    with different points of view about scientific hypotheses, not
    just the--not just amyloid hypothesis, but other hypotheses,
    have some capacity for support.

        Senator Kim. In terms of the decision-making process that
    will try to diversify that--I guess my question to you, if you
    are pushing for a decentralized decision-making process for the
    grants, does that mean that you would oppose the HHS Secretary
    or the Trump White House from telling you to make decisions
    about where to spend money or funding grant decisions?

        Dr. Bhattacharya. Senator, I agree with the goal to make
    America healthy, meaning address the chronic disease crisis.
    That is a decision about allocation to different disease areas.
    The scientific ideas inside those disease areas----

        Senator Kim. What if the HHS Secretary said, I want you to
    fund this specific grant at this university.

        Dr. Bhattacharya. There is a process, Senator, for deciding
    who gets grants--the specific grants, right. There is a
    scientific----

        Senator Kim. But is that one of the processes? Is that
    something that you feel like is a valid way in which decisions
    can be made at the NIH?

        Dr. Bhattacharya. Senator, I don't believe that either the
    Secretary or the President would ever ask me to do that.

        Senator Kim. Well, I guess the reason why I ask this is you
    talk a lot about chronic diseases. I think all of us can agree
    we need to make--[technical problems]--chronic diseases. My
    question to you is, do you think that our work on researching
    chronic disease needs to come at the expense of research for
    infectious disease?

        Dr. Bhattacharya. Senator, I think that the allocation of
    funds to the different disease areas--first, Congress has a
    tremendously important role in deciding that, and I will work
    with Congress for sure to make that happen. But also----

        Senator Kim. But you think that we could probably do both,
    right? Both, chronic disease research and infectious disease
    research?

        Dr. Bhattacharya. Yes.

        Senator Kim. Okay. Well, the reason I mentioned this, and I
    ask these questions about the Secretary's ability to direct
    NIH--he had a quote that has just really stuck with me and
    alarmed me. He said, ``I am going to say to NIH scientists, God
    bless you all. Thank you for public service. We are going to
    give infectious disease a break for about 8 years.'' Now, does
    that sound like a good idea?

        Dr. Bhattacharya. Senator, I have had many conversations
    with Secretary Kennedy, and he is supportive of excellent
    infectious disease research. The idea that----

        Senator Kim. You believe he no longer stands by that quote?

        Dr. Bhattacharya. Senator, I don't know where that--maybe
    it is on Twitter or something, but people say things on
    Twitter. But as far as----

        Senator Kim. But he said it at a conference.

        Dr. Bhattacharya. Yes, I don't--again, I don't know about
    it. But my interactions with Secretary Kennedy, he is sincerely
    committed to making sure that every health need of this country
    is met, including infectious diseases.

        Senator Kim. In terms of a few other things, are there any
    vaccines out there that you are concerned about in terms of
    safety?

        Dr. Bhattacharya. Well, Senator, I was concerned about the
    COVID vaccines for young men with the causing myocarditis in
    2021.

        Senator Kim. Do you have a view on long COVID?

        Dr. Bhattacharya. Senator, I think it is a problem that
    affects millions of Americans that need answers.

        Senator Kim. Is this something worth NIH funding?

        Dr. Bhattacharya. Yes.

        Senator Kim. You had a quote before that I was concerned
    about. You said, ``there are more pressing health needs for the
    $1.1 billion that the NIH will spend on long COVID.'' Is that
    something--you still stand by that quote?

        Dr. Bhattacharya. Senator, I think that the funds that have
    been spent to date on long COVID have not provided answers to
    the millions of patients. I think that they deserve answers. We
    need to do a better job with the funds we spend at the NIH so
    that it actually produces better diagnostics, better cures,
    better prevention.

        Senator Kim. On transparency, just real quick. You talked
    about the importance of transparency. Are you familiar with
    something called the Richardson waiver?

        Dr. Bhattacharya. No, Senator.

        Senator Kim. Okay. Well, I ask you if you are confirmed
    that you look into this. The Secretary just reversed this, and
    it is something that closes some transparency and public
    comment periods. Thank you.

        The Chairman. Thank you, Senator Kim.

        Senator Banks.

        Senator Banks. Thank you, Mr. Chairman. Doctor,
    congratulations again on your nomination. As I have said
    before, your nomination is one of the most exciting picks of
    the entire Trump administration.

        You showed incredible courage in speaking the truth about
    COVID-19 when much of the rest of the world stayed silent about
    it. And freethinking people everywhere have not forgotten
    that--what you stood for then.

        It is remarkable to see that you are nominated to the--to
    be the head of the very institution whose leaders persecuted
    you because of what you believed during that period. I want to
    start by asking you about COVID.

        Lockdowns caused irreparable harm to our Nation, and they
    are still harming us 5 years later. What is NIH's proper role
    in the pandemic, and how did Director Francis Collins overstep
    that role during his time?

        Dr. Bhattacharya. Senator, the proper role of scientists in
    a pandemic is to answer basic questions that policymakers have
    about what the right policy should be. They are not--our role
    isn't to make decisions that say you shouldn't be saying
    goodbye to your grandfather as he is dying in a hospital.

        It shouldn't be to say you can't have a funeral because it
    is too dangerous. You should--the scientists say, here is what
    the risks are, and then you decide what the risk is--whether
    you take it. The role of the scientist shouldn't be to say you
    can't send your kids to school for 2 years. That you can't--you
    should close hospitals so that they can't treat heart attack
    patients.

        That you should not--the role of scientists should be to
    address those problems by giving good data and then let people
    make--science should be an engine for freedom, knowledge and
    freedom. Not something where it stands on top of society and
    says, you must do this, this, and this, or else.

        It shouldn't be pushing mandates for vaccines that have
    been--like the COVID vaccines that were tested for a relatively
    short period time. I took the COVID vaccine myself, but I think
    that the mandates that many scientists push have led to the
    lack of confidence that so many of the public has in science.

        If science is a force for freedom and for knowledge, it
    will have universal support. That is what the role of science
    is.

        Senator Banks. Very well put. You were demonized for
    coauthoring the Great Barrington Declaration in October 2020.
    Dr. Fauci called it total nonsense. Rochelle Walensky called it
    wrong and unsafe. Your opponents, who wrote the John Snow
    Memorandum, said it could harm a half a million people.

        Reading what you wrote in the declaration, you were
    undeniably right about all of it. You wrote, ``current lockdown
    policies are producing devastating effects on short and long
    term public health.'' Doctor, what does the public health data
    tell us today in the aftermath of COVID-19, in 2023 and 2024?
    What does that data tell us today?

        Dr. Bhattacharya. Well, Senator, first, millions of
    children were out of school for years. The rates of suicidality
    and depression are through the roof. Learning loss will have
    consequences throughout their entire life.

        The--there were people who skipped their cancer screening
    who have late stage cancer now that should have been picked up
    earlier. There is--the trillions of dollars we spent that
    actually caused the inflation that we still suffer from. The
    U.N. early in the pandemic estimated almost 100 million people
    would face starvation as a consequence of the economic
    dislocation caused by the lockdowns. This is devastating--this
    is a devastating policy that didn't need to happen.

        The Swedish example, for instance, where there is lower
    death rates, all cause excess death rates in Sweden relative to
    their neighbors, including Norway, including Germany which
    locked down more, is an example that we didn't need to do the
    lockdowns.

        Florida having lower all cause excess death rates than
    California, again, is an example where the lockdowns did not
    save lives but had tremendous consequences on the well-being of
    the poor, the working class, on children and the vulnerable.

        Senator Banks. Yes. I want to read a little bit more. You
    said in the declaration that ``keeping students out of school
    is a grave injustice.'' Now, today, we see student achievement
    and grades well below the pre-pandemic levels.

        You also wrote that, ``young, low risk adults should work
    normally rather than from home. Restaurants and other
    businesses should be open. Arts, music, sports, and other
    cultural activities should resume.''

        Now we see many communities and cities are unsafe today and
    have been dramatically changed because of the lockdowns during
    COVID. In a nutshell, doctor, what would you have done--what
    would you do differently now than what these obviously ill-
    advised leaders at NIH and otherwise in other places do--how
    would you have done it differently, in a nutshell?

        Dr. Bhattacharya. Well, I still would have opposed the
    lockdowns. But if I am confirmed as NIH Director, the kind of
    thing I would have done is I would have allowed there to be
    scientific debate and discussion. There is tremendous
    uncertainty on what to do during a pandemic.

        Senator Banks. Thank you, I yield back. We need debate.

        The Chairman. Thank you.

        Doctor--Senator Blunt Rochester.

        Senator Blunt Rochester. I am promoted.

        [Laughter.]

        Senator Blunt Rochester. Thank you, Chairman Cassidy. And
    thank you, Dr. Bhattacharya, for meeting with me ahead of time,
    as well as your testimony today. I want to echo some of the
    concerns that my colleagues shared about the risk to the entire
    NIH research enterprise.

        One, the concern about the reported 1,200 individuals who
    were fired, including scientists, hundreds of scientists. We
    talked about the concern for being able to recruit even and
    retain this kind of talent. Two, the blanket and illegal 15
    percent cap on indirect costs on our research institutions.

        Even in a bipartisan way, there was concern about that in
    this hearing. The funding and communication freezes. Cuts in
    programs for training for future generations of scientists. And
    the fear that supporting diverse clinical trials will no longer
    be a priority, cause serious concern and alarm.

        To understand that I think you can look no further than the
    issue of Alzheimer's disease and dementia. As we all know,
    Alzheimer's is a debilitating and costly disease afflicting
    nearly 7 million Americans and costing $360 billion in 2024.
    But this doesn't even include the cost of care that is provided
    by 11 million individuals, and it really doesn't even touch the
    toll that it takes on the individual and their families.

        I don't think there is anybody who hasn't been impacted by
    it, whether it is even my mother and my grandmother. Some of
    the most important work that NIH has been doing is on the
    disparities in cognitive aging. Do you think the
    Administration's Executive Orders and terminations of aging
    research projects is harmful or helpful to improving our
    understanding of Alzheimer's?

        Dr. Bhattacharya. Well, Senator, at first I should say I am
    fully committed, and as is this Administration, I believe, to
    making sure that all the health needs of every American are
    addressed, no matter what their race, color, sex, the--if the
    chronic--the goal of the NIH, the mission of the NIH is to meet
    those.

        For instance, the representation of minorities in trials,
    as you mentioned, is something that I am fully committed to.
    And there is--I have seen nothing in the President's Executive
    Orders to contradict that. In fact, quite the opposite.

        Senator Blunt Rochester. I think the challenge is they are
    vague, and people are questioning, what do they mean? What are
    the impacts? Even the fact that these programs that have been
    canceled or delayed include the Maximizing Access to Research
    Careers Program, training grants to support pre and
    postdoctoral scholars, the NIH Intramural Mural Program, the
    2025 NIH Summer Internship Program, the Advancing Diversity in
    Aging Research Program, and then the firing of 10 percent of
    the staff at the Centers for Alzheimer's and Related Dementias.

        That is what causes the concern, because we are thinking
    about the pipeline of those individuals that are going to work
    in this area. So do you--can you help me to just understand how
    getting rid of these programs is going to improve our
    understanding of Alzheimer's prevention and treatment? And what
    safeguards would you put in place to ensure that these changes
    don't lead to poorer health outcomes by any gender, race,
    disability, ethnic group, or other vulnerable communities?

        Dr. Bhattacharya. Well, Senator, first, I wasn't involved
    in any decision-making at the NIH during the--up to this point.
    If I am confirmed, I will look at those. Look to make sure that
    those programs and other programs, if they are appropriate,
    will continue.

        I want to make sure that every single scientist at the NIH
    that is doing this kind of lifesaving work, including on
    Alzheimer's disease, especially maybe on Alzheimer's disease,
    and also scientists supported by NIH funded research, have the
    resources they need. I am committed to making sure that the NIH
    funds are spent to address America's chronic health needs.

        Senator Blunt Rochester. The reality is that we know that
    individuals with Down Syndrome have a staggering 90 percent
    chance of acquiring Alzheimer's in their lifetime. Black and
    Hispanic individuals are more likely to develop Alzheimer's in
    a lifetime. Women are twice as likely as men. And so, I have
    some questions that I will potentially have to submit for the
    record. But will you commit to ensuring that researchers,
    specifically studying health disparities and working to
    increase clinical trial diversity, will not be targeted or
    penalized based on their work?

        Dr. Bhattacharya. Senator, I commit to making sure that
    researchers that are addressing the health needs of minority
    populations, and basically every American, will have the
    support they need.

        Senator Blunt Rochester. A lot of folks are using code
    words and selecting out, whether it is in a grant, they are
    doing targeting sweeps, word searches. Will you also commit
    that you will not do that as well?

        Dr. Bhattacharya. Senator, I guess I am not sure what you
    mean by targeting code words, but I will say that I believe
    very strongly--I have committed my life to addressing the
    health needs of vulnerable people, including minority
    populations. I am absolutely committed to that--the NIH
    continues to do research to address those health needs.

        Senator Blunt Rochester. My time is expired, Mr. Chairman.
    Thank you. And we want to make sure we work with you.

        Dr. Bhattacharya. I would look forward to that, Senator.

        Senator Blunt Rochester. That these Executive Orders don't
    have the adverse impact that we are already seeing. Thank you.
    I yield back.

        The Chairman. Thank you, Senator Blunt Rochester.

        Senator Hawley.

        Senator Hawley. Thank you, Mr. Chairman. Dr. Bhattacharya,
    congratulations on your nomination, and thank you for being
    here. I enjoyed getting to visit with you today. Let me just
    start with the subjects that you and I visited about and that I
    also asked your soon to be boss, Robert Kennedy Jr., about when
    he was sitting right where you are, and that is the use of
    abortive fetal tissue in NIH funded research.

        I asked now Secretary Kennedy directly if he would
    reinstate President Trump's policy that prohibits abortive
    fetal tissue research in NIH funded grants. He said that he
    would. Let me just ask you the same to make sure we are all on
    the same page here. Do you support that policy? Will you
    prohibit the use of aborted fetal tissue in NIH research--NIH
    funded research?

        Dr. Bhattacharya. Senator, I will absolutely follow the
    lead of Secretary Kennedy and President Trump on this. Just
    very quickly may I say why it is so important that we have
    alternatives.

        Because during the pandemic, I would often beyond Catholic
    radio and people would ask me whether the mRNA vaccines were
    made or developed with aborted--with fetal stem cell lines. I
    had to say, yes. And they had--a lot of folks were calling in
    had ethical objections. In public health, we need to make sure
    the products of the science are ethically acceptable to
    everybody.

        Having alternatives that are not ethically conflicted to a
    fetal stem cell lines is not just an ethical issue, but it is a
    public health issue. We need to make sure that everyone is
    willing to take the kinds of progress that we make in that. And
    so, I am absolutely committed to that.

        Senator Hawley. Very good. Thank you very much. And I think
    it is a tremendous point that it is not only an issue of moral
    principle. Although it is an extremely important issue of moral
    principle in the first instance.

        But it is also a public health issue when we think about
    millions and millions of Americans who are understandably very
    concerned about the components, if you will, of many of these
    palliatives and vaccines. And we want them to be able to access
    this on the same basis as others.

        Thank you for making that point. Let me ask you about
    something else that your soon to be boss, Secretary Kennedy,
    has said recently that he has talked about his concerns that
    NIH is working to advance in some instances big pharma's bottom
    line rather than the health needs and health interests of the
    American people.

        He recently wrote in the Wall Street Journal that he wants
    to propose stopping NIH funding going for researchers who have
    conflicts of interest, who have a financial benefit with a big
    pharma company.

        Can you comment on that? Do you support that effort? And
    can you comment on the importance of making sure that what we
    are doing with NIH funding is prioritizing the health of
    Americans, not the profit of any particular corporation.

        Dr. Bhattacharya. Senator, I think the transparency in
    conflicts of interest is fundamental to trust in science.

        I am absolutely committed to making sure that transparency
    is at the center of the work supported by the NIH. I also
    commit Senator to, and I mentioned this to Senator--too earlier
    to supporting research on products that are already off patent.

        That don't necessarily have a drug company behind it, but
    that could have potentially enormous benefit for treating
    chronic diseases or preventing chronic diseases. I think the
    NIH ought to be doing research in support of the public good,
    not just parochial research in support of a few companies.

        Senator Hawley. Fantastic. I think that is so important to
    restoring the sense of credibility and trust that the American
    people frankly have lost in the NIH and much of our public
    scientific apparatus.

        Because of the financial conflicts of interest, because of
    the prevalence of big pharma, but also because, and you and I
    discussed this as well, what happened during COVID-19. And I
    just want to ask you about that in my remaining moments here. I
    had the opportunity to question the author or one of the
    coauthors of the now infamous proximal origin paper.

        Dr. Robert Garry is the individual who I had the
    opportunity to question. He wrote that paper on March 17th,
    2020. You probably remember, doctor, this is the paper that
    infamously stated, and I am going to quote it now, that the
    SARS-CoV-2 ``is not a laboratory construct or a manipulated
    virus.''

        Under questioning by me, Dr. Garry admitted he actually had
    no knowledge of that at the time. He wrote that in March 2020.
    He had no evidence to suggest that was the case. This was, in
    fact, a piece of purist propaganda. He has since had many of
    his research products withdrawn from peer reviewed journals
    because he hasn't followed appropriate peer reviewed standards.

        This effort, this propaganda effort, and that paper, as you
    remember, was used as the basis of Government directed
    censorship to those in the scientific community, like yourself.
    To millions of ordinary Americans.

        The net effect of this was a tremendous loss in confidence
    by the American people in the NIH and in our public health
    officials. You and I discussed the vital importance of
    restoring some of that credibility. Talk to us about how you
    see going about doing that.

        Dr. Bhattacharya. Senator, that episode is a low point in
    the history of science. The top officials of the NIH abused
    their position to hide support for research that may have
    caused the pandemic.

        I commit to making sure that all of the activity at the
    NIH, not just backward but going forward, are transparent and
    open to the American people, and to Congress. That is vitally
    important for the future of the NIH and for future of science
    itself.

        The Chairman. Thank you, Senator Hawley.

        And now, Senator Alsobrooks.

        Senator Alsobrooks. Thank you so much, Mr. Chairman. Good
    morning, Dr. Bhattacharya. I know you have had great experience
    at NIH. And so, it goes without saying that NIH is a crown
    jewel, not only in the State of Maryland, which happens to be
    my state, but it is the crown jewel for our Country where we
    have many, many talented scientists and researchers who are
    there.

        That brings me to a quick line of questioning I have. I
    want to sound the alarm. That some very dangerous things are
    happening to scientists and researchers at NIH right now. And I
    want to ask you whether you believe that it is appropriate--and
    you mentioned a moment ago about a concept around knowledge and
    freedom for scientists.

        Whether you believe it is appropriate under any
    circumstance to retaliate against scientists or medical
    researchers based on the research they have done. Do you
    believe that?

        Dr. Bhattacharya. No, Senator. I have been subject to that
    myself. I know what it is like to be subject of devastating
    takedowns by top officials at the NIH specifically, and I will
    never do that. My--I absolutely commit to making sure that
    scientists are treated respectfully, especially those that
    disagree with me.

        Senator Alsobrooks. Now, you have even said that you
    believe--and you have spoken out against a culture of
    conformity in science and have criticized institutions that you
    allege destroy the reputations of scientists who do not conform
    with their viewpoint.

        I believe that is what is happening right now at NIH. In
    fact, your soon to be boss, Mr. Kennedy, when I questioned him
    about whether or not he would supplement his judgment for that
    of scientists, he said he intended to replace bad scientists
    with good scientists. Is this your viewpoint as well?

        Dr. Bhattacharya. Well, Senator, I think that science is--I
    don't know--what exactly--the nature of that conversation. But
    I think that the way that you decide what is good in bad
    science is by conversation, by data, by replication. I am
    absolutely committed to making sure that those processes are in
    place at the NIH.

        Senator Alsobrooks. Okay. And that we--and you agree that
    we should never retaliate or even fire a peer scientist because
    of his or her peer reviewed work that they published?

        Dr. Bhattacharya. Senator, I think retaliation and conflict
    that characterize the kind of discussions that we had among
    scientists, that comes from the top of the scientific
    institutions. And I commit to making sure to making sure, in
    fact, is one of the five points I emphasize in my opening
    statement, that we have--allow a culture of dissent and
    respectful conversation about scientific matters rooted in data
    at the NIH.

        Senator Alsobrooks. Okay. I just want to ask you about one
    other area of concern. It is no secret that this Administration
    feels absolutely triggered by any mention of equality, any
    mention of inclusion, and the President himself in his own
    words last night essentially said America intends to erase any
    reference whatsoever to race or gender.

        Having said that, I would like to refer to a study that you
    co-authored called, Persistent Racial Disparities in Survival
    Following Heart Transplantation, and to ask you whether or
    not--because I understand there are some watch lists that have
    been created. Whether you believe that on the basis of this
    study, should that work be placed on a DEI watch list because
    it references racial disparities?

        Dr. Bhattacharya. Senator, I am not aware of any watch
    lists. I don't intend to implement any watch list. I will say
    this that the health needs of the minority populations in this
    country are a vital priority for me. In fact, the health needs
    of every single American are a vital priority for me.

        I want to make sure that the research at the NIH does
    addresses those health needs. And I don't see anything in the
    President's orders that contradict that. In fact, quite the
    contrary. What I have heard from the Secretary and from the
    President is let's make America healthy, meaning all Americans.

        Senator Alsobrooks. I don't want to be naive, though. He
    did mention that he is absolutely triggered by anything that
    mentions equality, or inclusion, or any reference to race or
    gender.

        You are--the center that you co-direct, the Center for
    Advancing Sociodemographic and Economic Study of Alzheimer's
    Disease and Related Dementias, mentions that your mission is to
    diversify the set of researchers who are working in the field.

        I want to know whether or not based on that--and that it
    also mentions mentoring diverse scholars, which I think is a
    reference to race and to gender, and to people with different
    backgrounds. And so, whether you believe that this project,
    which received by the way--$872 million in taxpayer dollars--
    $800 million in taxpayer.

        Dr. Bhattacharya. No, no. Not that a much, but----

        Senator Alsobrooks. I am sorry, yes----

        Dr. Bhattacharya. It was less than that, but yes.

        Senator Alsobrooks. Well, was this a radical and wasteful
    use of Government spending on the basis of it doing--DEI work?

        Dr. Bhattacharya. Senator, I am proud of that project.
    Senator, I first I am proud of the project. It does. It is
    addressing Alzheimer's disease. And I would say further that
    the idea that diverse scientists--I think what that--to me what
    that means is a scientist with diverse ideas about scientific
    topics.

        I don't--I think fundamentally what matters is, does a
    scientist have an idea that advances the scientific field they
    are in? Do they have an idea that ends up addressing the health
    needs of Americans? That is the key thing.

        To me, that diverse set of ideas, allowing there to be a
    diverse set of ideas, people that disagree with each other, is
    fundamental to advancing science. I think free speech and----

        Senator Alsobrooks. That includes racial disparities. That
    is the work you have done, right?

        Dr. Bhattacharya. Well, racial disparities are important to
    identify, but more important is to address the health needs of
    every American, no matter whether it's minorities or not.

        Senator Alsobrooks. Thank you so much. I yield.

        The Chairman. Thank you, Dr. Alsobrooks. Very good sneaking
    that last comment in. You know what I am saying, after the
    buzzer.

        Senator Husted.

        Senator Husted. Thank you, Chairman Cassidy. Dr.
    Bhattacharya, thank for being here. Although, as someone who
    grew up watching professional basketball in the 70's and 80's,
    calling you Dr. J is a fun thing.

        [Laughter.]

        Dr. Bhattacharya. That is a--it is a real thrill for me
    whenever I hear that.

        [Laughter.]

        Senator Husted. Thanks for--this--your nomination, frankly,
    at this time in America is a victory for the scientific method.
    I know that you have been courageous in offering divergent
    views and backing them up and encouraging people to think
    differently about how we solve complex problems.

        That is what science is supposed to be about. So, thank you
    for being a champion in that during difficult circumstances. I
    want to just talk briefly about something we talked about is
    that in--we hear a lot of talk about inflation in America, but
    in this century, the No. 1 inflationary cost that affects
    Americans, American business, the quality of life, has been
    health care inflation.

        The idea that we can think differently about how we address
    healthy living, our diets, how we improve the quality of life,
    drive down costs and improve outcomes is something I think is
    sorely missing today.

        The conversation about health care and thinking differently
    about it is critical to doing that. So just give some thoughts
    about how you think your role as a Director could help advance
    that conversation.

        Dr. Bhattacharya. Senator, I really enjoyed our
    conversation that we had in your office about exactly this. The
    chronic disease problem--let's just take obesity. It seems
    almost intractable. For decades we have had body weight go up,
    diabetes rates, chronic disease. And in a way, that is an
    indictment on how the NIH has functioned. The goal of the NIH
    is to make Americans healthy.

        That is--to have the research that makes Americans healthy.
    I think, I want to make sure that we allow a broader set of
    ideas as possible to address this problem, because the set of
    ideas we have had so far have not actually addressed the
    problem. It has continued to get worse. Fundamentally to me--
    and this is an element of faith, I guess. I believe that if we
    allow science to have lots and lots of different ideas, that we
    will be able to meet the health needs of the American people.

        But if we say, Okay, only a few scientists with their ideas
    are allowed to have support with a narrow like one school of
    thought, we are not going to make any progress. I don't have
    the answer to how to solve the obesity crisis. If I did, I
    would have already--I would have published it. But I want to
    make sure that the scientist that does, that is out there, has
    support from the NIH, even if their ideas contradict what the
    top scientists at the NIH currently think.

        Senator Husted. Well, I spoke about this with Secretary
    Kennedy, and I know that this goes across agencies, from
    Department of Agriculture to Health and Human Services, but it
    is a tremendous cost to the American taxpayer, to the quality
    of life, to American competitiveness. All of those issues.
    Sustainability of our Federal budget. I just encourage creative
    thinking and collaboration on that issue.

        I want to mention--lots of conversation these days on NIH
    grants and talking about containing costs of how we do
    scientific research, but make sure whether we are putting more
    lead on the target of that research rather than administrative
    costs. I know that in Ohio, we have a number of entities, our
    universities, Cleveland Clinic, our hospitals so forth that are
    involved in this.

        I really believe that there are many institutions who are
    willing to work with you in sharpening their pencils, getting
    better, forcing change in how these grants are used,
    distributed, and focused on real--the research that needs to be
    done. And just give some thoughts, if you would, about how we
    can advance those conversations on this topic.

        Dr. Bhattacharya. Senator, I think the universities are
    partners of the NIH, not opponents. I do think that there is a
    lot of distrust now, coming out of the pandemic, of the
    scientific enterprise and of universities also. The way to
    address it is trust and transparency.

        I am absolutely committed to working with you and with
    others to make sure that--we can restore that trust by
    establishing transparency. Where did the administrative costs
    go? That is something that is a question that could be answered
    with audits, for instance. And establishing the right rates.

        That is going to--if I am confirmed, that is something I
    will look very carefully into. I think I want to make sure that
    every single dollar the American taxpayer entrusts the NIH goes
    to addressing the needs--the research that will address the
    health needs of the American people.

        Senator Husted. Great. Thank you. Thank you, Mr. Chairman.

        The Chairman. Thank you, Senator Husted.

        Now, Senator Markey.

        Senator Markey. Thank you, Mr. Chairman. Doctor, I have
    been hearing from researchers in Massachusetts and across the
    country about actions taken by Trump and Musk that are slowing
    down research into Alzheimer's, stroke, cancer, and our mental
    health crisis.

        One Ph.D. researcher who is working on finding better
    treatments for depression to prevent suicide, said hiring and
    funding freezes have, ``stalled their research and will stall
    the development of safer therapies for depression by years.''

        A Massachusetts doctor and mentor for biomedical
    researchers says that Trump's Executive Orders and Musk DOGE
    minions are leading us to face, ``an enormous brain drain'' as
    there is little confidence that these institutions will be able
    to function normally.

        This doctor is thinking about leaving the country, which
    would mean the United States cedes ground in the fight to lead
    the world in biomedical innovation. A cancer researcher at the
    University of Massachusetts said the Trump administration's
    cuts to NIH will ``send progress in curing human disease down
    the drain.''

        A professor of medicine and science working on improving
    care for Americans with dementia had their grant review meeting
    with NIH abruptly canceled without any plans to reschedule
    because of this Administration's funding freezes. This will
    delay research by several months at least, and inconsistent
    funding will mean layoffs and disruption to services that
    improve care at nursing homes.

        Just this week, I received copies of letters sent to
    researchers who received funding from the NIH to study
    Alzheimer's disease and improving support for caregivers, and
    to study how to improve mental health care in primary care
    settings.

        The letters terminated funding for these studies, stating,
    ``the premise of the grant is incompatible with NIH priorities
    because the study explicitly included LGBTQ people.'' And
    without this funding, grant recipients will now be forced to
    stop research to address the mental health crisis and
    Alzheimer's disease.

        People who have committed their lives, doctor, to these
    efforts will lose their jobs. By unanimous consent, I submit
    these letters for the record, Mr. Chairman.

        The Chairman. Without objection.

        [The following information can be found on page XX in
    Additional Material:]

        Senator Markey. Doctor, in your testimony, you stated that
    you want to encourage free speech and dissent among scientists.
    In the spirit of free speech and dissent, will you commit here
    today to object to any decision made by Donald Trump, Elon
    Musk, or Robert F. Kennedy that would slow or stop lifesaving
    research?

        Dr. Bhattacharya. Senator, I am not involved in the
    decisions of the NIH up to now. If I am confirmed, my
    commitment is to make sure that all the scientists at the NIH
    and all the scientists that receive funding from the NIH have
    the resources they need to do their lifesaving research.

        Senator Markey. Will you object if it slows or stops
    lifesaving research?

        Dr. Bhattacharya. Senator, my interactions with Secretary
    Kennedy and President Trump today suggest that they don't want
    to slow research. They want to speed it up.

        Senator Markey. Will you object if that becomes evident
    that they are slowing the research?

        Dr. Bhattacharya. Senator, I have to say, I don't believe
    that they are ever going to ask me to do that. I think they are
    committed to----

        Senator Markey. Will you commit here today to reinstating
    funding for scientists whose funding has been terminated
    because their research does not align with MAGA ideology?

        Dr. Bhattacharya. Senator, I don't believe that ideology
    ought to determine whether one gets research or not. I believe
    very fundamentally in----

        Senator Markey. Funding research on the mental health
    conditions of the LGBTQ community, that should not be a basis
    for canceling funding for research. Is that what you are
    saying?

        Dr. Bhattacharya. Senator, I would have to look--if I am
    confirmed, I will absolutely go look at the--the letter you
    submitted for the record, so I can go look. But if confirmed, I
    will go look carefully into that. I want to make sure that the
    processes that the NIH has----

        Senator Markey. On its face, of course, that is absurd,
    because they have mental health issues as well. So will you
    commit here today to do everything in your power to stand up
    for the American people and lifesaving biomedical research in
    the face of the Trump attacks on scientific freedom?

        Dr. Bhattacharya. Senator, I think--I absolutely commit to
    focusing and supporting the research that advances the health
    of the American people. I don't agree with you, Senator, that
    President Trump is opposed to that. In fact, quite the
    opposite. He is in favor--is quite in favor of making America
    healthy. And fundamentally, the research that we do at the NIH
    will----

        Senator Markey. I am told by the researchers in Boston that
    they can't even hire their new trainees because the trainees
    who are brilliant are uncertain there is going to be a career
    because there won't be funding. So it is just the opposite.
    Trump is actually freezing, scaring, frightening the whole next
    generation of scientists who believe the funding won't be there
    for them. That is the problem that we are going to be
    confronting. Thank you, Mr. Chairman.

        The Chairman. Thank you. Just a follow-up and then a
    closing statement. Again, thank you for being here. You said
    something I am trying to square. First, in context, we know
    that only about one-fifth of NIH applications are funded. And
    you have spoken about improving that, particularly for younger
    investigators. Which, by the way, I think your plan, just on
    the face of it, looks fantastic.

        Thank you for thinking creatively about that. And you have
    also I think correctly said we need to be putting more money
    into cutting edge research, which may fail. It is cutting edge,
    right, but what is the alternative? But what I don't--so what I
    am trying to square with that is the extra dollars for
    validation.

        With all the kind of caveats you put, you would have to
    have the full cooperation of the person who studies being
    validated, and you would have to have the same circumstances
    and the same genetic makeup, and the same this and that and
    this.

        It seems like the validation push would put more pressure
    on both the cutting edge research priority and the young
    investigators finding it easier to get money. So knowing that
    you have thought about that, how do you think of that?

        Dr. Bhattacharya. Senator, I think that validation work as
    central to doing good science. Like any portfolio that doesn't
    have that kind of validation built into it, is not going to be
    reliable. So even if you do cutting-edge research and it is not
    validated, you are not going to have--you are not going to get
    any chances.

        The Chairman. What is the difference between doing the
    validation research and kind of what you have criticized that
    we sometimes do the same thing over and over again?

        Dr. Bhattacharya. Well, so the difference is that
    validation research is focused on the particular results that a
    scientist may have. I publish a study, and you check my
    results. You get the same result as me. Incremental science is
    you propose a study that is like epsilon away from what already
    is known, and you do that.

        The Chairman. Now, inherently, if epsilon away fails, it
    calls into question the original premise, correct?

        Dr. Bhattacharya. Right. But it is much easier to be
    certain that--about research that is epsilon away from the
    frontier to be--to work versus like big ideas in different
    directions that might make big advances. Any research portfolio
    has to have lots of different approaches to this.

        I think the key to me is making sure that if early career
    researchers, researchers with nontraditional ideas about
    hypotheses, for instance, like with the example of Alzheimer's
    I have already talked about, those get support that are in the
    portfolios. Some of those won't fail and some of those will
    succeed.

        The ones that succeed can make big advances. I don't think
    that the validation research--validation is just a check. Is
    the research that I did--do you find the same thing? That tends
    not to get support in the scientific community, and I think
    that is a mistake. The scientific community ought to support
    that.

        The NIH ought to support that. That way, the entire
    research portfolio as a whole, it becomes more reliable because
    we know that it has been validated by independent teams.

        The Chairman. I don't object to the validation research. It
    does seem it is going to be a tension, so I look forward to you
    resolving that.

        Dr. Bhattacharya. Senator, I look forward to working with
    you on this.

        The Chairman. That would be great. Let me just then
    conclude. The issue of autism just is one of those things that
    we all think about. I want to note that last year, Congress
    reauthorized the Autism CARES Act.

        Senator Collins and the HELP Committee were those that did
    that, and the law coordinates the Federal autism research and
    is implemented by NIH. And so I look forward to working with
    you on that.

        But one thing that continues to concern me as I have
    listened to this conversation, there is an opportunity cost. If
    we continue to plow the barren ground of something which has
    already been validated multiple times, that there is not a
    connection--that there is not a connection between vaccination
    and autism, we don't have the money to go after the real thing.

        You said something which just--I mean, just, bing, bing,
    bing, bing, bing. I just thought was so good, that you have
    faith that a well done research that provides answers will be
    convincing to people.

        Well, we have already had that for the vaccination. What we
    need is the well done research finding the true reason for
    autism. And that is what the hope is for the people with
    autism. And if we are just pissing away money over here, that
    is that less money that we have to actually go after the true
    reason. You are an economist as well as an MD. You know this.

        I look forward to--I mean, the opportunity cost of wasting
    money on one more thing that has been proven exhaustively--
    denying the opportunity to find the real reason would be a
    tragedy for everyone who has to deal with autism, which is all
    of us.

        Dr. Bhattacharya. Senator, I share that passion that you
    have for finding the real--the cause of the increase. That is
    where the most--that is where the vast majority of effort ought
    to go. We want answers. Parents want answers. Kids are
    suffering. And the NIH ought to be doing the research to
    provide those answers. That is the most important thing.

        The Chairman. Yes. Well, thank you again for being here. I
    admire your sons for behaving--being so well behaved. I am sure
    the presence of their mother right next to them had some
    influence over that. This concludes our hearing. For any
    Senators who wish to ask additional questions, questions for
    the record will be due tomorrow at 5.00 p.m. We are through.

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                            QUESTIONS FOR THE RECORD

      Responses by Dr. Jay Bhattacharya to Questions of Senator Sanders,
     Senator Murray, Senator Baldwin, Senator Kaine, Senator Hickenlooper,
                    Senator Markey, and, Senator Alsobrooks.
                                senator sanders
        Question 1. Since January, the Trump administration has proposed
    billions of dollars in cuts from research institutions that are
    actively working on treatments for pediatric cancer, Alzheimer's, and
    various chronic diseases, and have also effectively stopped any new
    research grants from being funded. If confirmed, will you commit to
    reversing these policies on Day 1? Or do you plan to allow President
    Trump and Elon Musk to dismantle the NIH?

        Answer 1. NIH will not be dismantled and will continue to provide
    research grants.

        Question 2. Secretary Kennedy had previously said he wanted to fire
    600 NIH employees--but so far, nearly twice that number have been
    terminated. You claim to support the next generation of researchers.

            (a). Yes or no: Do you support the Administration's decision to
            fire NIH fellows, postdocs, and early career scientists?

            (b). Yes or no: If President Trump and Elon Musk demand more
            layoffs, will you stand up to them?

        Answer 2(a). I support the Administration's efforts to improve
    efficiency across the government.

        Answer 2(b). I will continue to support the Administration's
    efforts to improve efficiency across the government.

        Question 3. The American people are sick and tired of paying, by
    far, the highest prescription drug prices in the world. In January, the
    prior NIH director introduced a requirement that, whenever drug
    companies benefit from NIH patents, they have to come up with a plan
    describing how they will make drugs these available to the American
    people. Will you commit to keeping this policy? Further, will you
    commit to expanding this requirement so that if drug companies benefit
    from any taxpayer dollars, they cannot charge Americans the highest
    prescription drug prices in the world?

        Answer 3. The President has committed to lowering the price of
    drugs for all Americans. If confirmed, I look forward to working with
    Congress to ensure that all the dollars in the American healthcare
    system are devoted to working for the patient--including lowering the
    price of drugs by ensuring transparency in costs, providing
    accountability to middlemen, looking for innovative ways to provide
    high-cost drugs at low prices, and making sure other countries pay
    their fair share for prescription drugs.

        Question 4. You co-authored the Great Barrington Declaration, which
    called for letting COVID spread freely among ``low-risk'' individuals.
    You cited Sweden in the publication, but at the time, Sweden had
    already tried this approach--and it was a disaster. Their COVID death
    rate was 4 to 10 times higher than neighboring countries, and their own
    scientists called it a failure. Why should anyone trust your judgment
    as NIH director when you ignored history and real-time data to push a
    reckless, unscientific strategy?

        Answer 4. I was a fully tenured Professor at Stanford Medical
    School for 24 years and a research associate at the National Bureau of
    Economics Research, among other positions. I have published 180
    articles in top peer-reviewed journals in medicine, economics, health
    policy, law, statistics, epidemiology, infectious disease epidemiology,
    pediatrics, demography, and other fields. My research on the pandemic
    was joined by a Nobel laureate from Stanford as well as scientists from
    Oxford, Harvard, and other top institutions.

        Question 5. You also said that children were at ``low risk'' of
    complications from COVID, when scientists have known for decades that
    viral infections cause long-term illnesses, like Long COVID--which
    affects at least 17 million Americans, including children. Do you
    understand how your politicization of scientific research has real
    consequences for millions of Americans?

        Answer 5. As I stated in my hearing, I am against the
    politicization of science and if confirmed I look forward to restoring
    a culture of tolerance for differing opinions to the NIH.

        Question 6. After President Trump's disastrous order to freeze
    grants, a court directed NIH to unfreeze funding. But NIH did not
    comply with that court order for almost 2 weeks. In fact, NIH is still
    defying that court order by preventing meetings that are required to
    make payments.

            (a). Do you commit to complying with all Federal court orders?

            (b). Will you restart submissions to the Federal Register for
            scheduling all study sessions and advisory council meetings?

        Answer (a). I commit to complying with Federal law.

        Answer (b). I will review the various study sessions and advisory
    council meetings and restart submissions to the Federal Register if
    necessary.

        Question 7. Former and current NIH officials have said that HHS
    pressed staff to ignore court orders, even when it defied advice from
    NIH lawyers. And when NIH officials refused, they were told to get in
    line--or were pushed out altogether.

            (a). How would you respond if instructed to defy a court order?

            (b). Would you ever pressure your staff to defy a court order?

        Answer 7(a)--(b). If confirmed I will follow the law.

        Question 8. Who will have the final say at NIH: you, or DOGE?

            (a). Who will decide which staff to cut, you or DOGE?

            (b). Who will decide what offices at NIH or critical, you or
            DOGE?

            (c). Who will decide what research to fund, you or DOGE?

            (d). Don't the American people to deserve to know who is making
            these decisions?

            (e). You are here to be confirmed by the Senate. No one at DOGE
            has been nominated by the President or come before this
            Committee. How is it appropriate that DOGE would have final say
            over you?

        Answer 8(a)--(e). As has been widely reported, President Trump has
    asked that agency leadership oversee organizational and staffing
    matters.

        Question 9. There have been reports that the Trump administration
    would significantly decrease infectious disease research at NIH to
    focus on chronic disease. In a time when the U.S. just recently saw the
    first death from bird flu, do you believe that NIH should reduce
    funding for infectious disease research? If so, why?

        Answer 9. NIH will continue important research on infectious
    diseases.

        Question 10. You have been quoted as saying you support the
    reduction in the NIH workforce as you shift the focus of the agency.

            (a). Can you give the Committee a better and clearer sense of
            your vision for how you aim to reduce the workforce at NIH, and
            why you think that is critical to achieving your goals?

            (b). Are you concerned that staff reductions will slow the
            grant process and release of funds for new projects?

            (c). Can you envision potential unintended consequences from a
            reduced HHS workforce that would stymie research breakthroughs
            or slow innovation?

            (d). With the volume of researchers already at critical lows,
            do you think Federal workforce reductions, coupled with reduced
            grant access will cause fewer students from entering the
            medical research field?

        Answer 10(a)--(d). I support the Administration's efforts to find
    efficiencies and be fiscally responsible. If confirmed, I will work
    with agencies to uphold the gold standard of scientific and evidence-
    based research. My goal is for the U.S. to be the global leader in
    breakthrough, transparent health research accountable to the American
    people.

        Question 11. The across-the-board cuts to the Facilities and
    Administrative costs will curtail medical research, threatening the
    viability of U.S. based scientific research. What steps will you take
    to ensure that these cuts, if implemented, do not undermine the
    country's biomedical research enterprise?

        Answer 11. I support the Administration's efforts to find
    efficiencies and be fiscally responsible. If confirmed, I will assess
    NIH funding levels and work with relevant parties to make any necessary
    adjustments.

        Question 12. Recent directives, such as the sudden implementation
    of the indirect cost cap, have been issued without prior consultation
    with NIH officials or the scientific community, leading to legal
    challenges and concerns about the agency's autonomy. How will you
    safeguard the NIH's decision-making processes from external political
    pressures to preserve scientific integrity?

        Answer 12. Without speaking to any matters presently the subject of
    any legal challenge, I will remain committed to safeguard NIH's
    scientific decision-making process from external pressures to instill
    scientific integrity.

        Question 13.been the backbone of global innovation. In 2023, I
    issued a report that showed how the median price of a new treatment
    that NIH scientists helped invent over the past 20 years is $111,000.
    This includes treatments for cancer, chronic diseases, and the NIH-
    invented COVID vaccine. How should the government ensure that Americans
    are getting a fair deal for the innovations coming out of NIH?

        Answer 13. This is a very important issue, and if confirmed, I look
    forward to working with Congress to develop strategies to addressing
    the cost of new treatments.

        Question 14. You claim to want to use NIH to answer the questions
    the American people have. The American people want to know why, despite
    their tax dollars contributing to every single new approved drug from
    2010 to 2016, why they pay the highest drug prices in the world. Why
    despite an investment worth hundreds of billions of dollars can most
    Americans not afford the innovation that comes out of the NIH? Will you
    commit today to reinstating the NIH's reasonable pricing clause on
    taxpayer-funded drug discoveries?

        Answer 14. The President has committed to lowering the price of
    drugs for all Americans. If confirmed, I look forward to working with
    you to ensure that all dollars in the American healthcare system are
    devoted to working for patients.

        Question 15. Let's talk about march-in rights, which allows the
    government to step in and license patents funded by taxpayer dollars to
    competitors if the American people aren't getting a fair deal.

        The Biden administration issued guidance that said unaffordable
    drug prices are grounds for using march-in rights. Do you agree with
    their interpretation? Do you believe that the government should step in
    when taxpayers are being price-gouged?

        Answer 15. No with respect to march-in rights, which even the Biden
    administration never utilized in that way. With respect to laws
    protecting consumers from price-gouging, I will defer to and support
    enforcement of those laws by the appropriate Federal and state
    authorities.

        Question 16. Are you in any way willing to take on the
    pharmaceutical industry to help Americans better access and afford the
    innovation that comes out of the NIH?

        Answer 16. The President has committed to lowering the price of
    drugs for all Americans. If confirmed, I look forward to working with
    you to ensure that all dollars in the American healthcare system are
    devoted to working for patients.

        Question 17. During the COVID-19 pandemic, you were a strong critic
    of lockdowns and other measures designed to protect vulnerable
    individuals, and you estimated that the pandemic would only kill around
    40,000 people in the United States. Today, the pandemic's death toll is
    over 1 million individuals in the United States. Recently, control of
    the bird flu outbreak has led to massive culling of infected flocks to
    contain the virus, driving up egg prices and creating fears of another
    pandemic. If another deadly pandemic were to occur today and the weight
    of the scientific evidence clearly supported public health measures
    that may be politically unpopular, would you support such rules?

        Answer 17. I commit to working with the Administration, and
    particularly Secretary Kennedy and all HHS subagencies, to ensure a
    robust and effective response to any future pandemic.

        Question 18. One of the studies you conducted claimed that COVID-
    19's fatality rate was much lower than reported and was immediately
    seized upon as justification to oppose public health measures like
    downs. But here is what you didn't disclose. That study was secretly
    funded by billionaires who had a financial interest in reopening the
    economy--like JetBlue's founder and other corporate executives. For
    someone who wants to restore public trust in an agency and produce
    independent and objective science, you yourself did not do enough to
    root out conflicts of interest.

            (a). Do you believe it is acceptable for NIH-funded research to
            be manipulated by wealthy donors with a financial stake in the
            outcome?

            (b). Is this how you define ``gold standard'' science--secret
            corporate funding and conclusions that align with the interests
            of the people paying for the research?

            (c). Will you allow private money and political ideology to
            dictate scientific findings?

        Answer 18(a)--(c). I personally received $0 from Jet Blue for any
    study. If confirmed I commit to abiding by all ethics laws as well as
    guidance from agency counsel.

        Question 19. You've expressed support for linking NIH grants to
    ``academic freedom'' on college campuses, according to reporting by the
    Wall Street Journal.

            (a). How would you enforce such policies, and how would you
            define academic freedom in a way that ensures it is not used as
            a proxy for penalizing campuses that uplift certain viewpoints
            that are not popular with the Administration?

            (b). For example, would teaching about structural inequities
            associated with the healthcare system be protected under your
            theory of academic freedom?

        Answer 19(a)--(b). As I stated in my hearing, I am against the
    politicization of science and if confirmed I look forward to restoring
    a culture of tolerance for differing opinions to the NIH.

        Question 20. You've previously expressed support for decentralizing
    NIH and giving more funding control to state governments.

            (a). Do you continue to stand by this proposal, and can you
            explain what your role as NIH Director would be if you were to
            give more power to non-Federal officials?

            (b). Many of your colleagues have suggested that such a
            proposal would disrupt the NIH's work and set back American
            scientific research, how would you respond to such critiques?

        Answer 20(a)--(b). If confirmed I look forward to working with
    Congress on this and other issues.

        Question 21. Since the start of President Trump's second term,
    there have been significant changes at the National Institutes of
    Health (NIH), including a reduction of force with further reductions
    expected and the imposition of a 15 percent cap on facilities and
    administrative costs for new and existing grants. The policy on
    facilities and administrative costs are currently being challenged in
    court.

            (a). Do you understand the implications of this policy on
            future advances in medical care? Increases in tuition at public
            and private colleges and universities?

            (b). Local economies and unemployment?

            (c). As NIH Director how will you address these and other
            consequences on the future of biomedical research in this
            country?

        Answer 21(a)--(c). I support the Administration's effort to find
    efficiencies, be fiscally responsible, and reduce bloat in government.
    I am not aware of any negative impact to critical missions as a result
    of recent workforce reductions but will inquire further if confirmed.

        Question 22. The research both conducted and funded by NIH is vital
    to our understanding of public health and medicine. In the current
    reproductive health landscape, it is more critical than ever that there
    is sound, rigorous research regarding health access and outcomes for
    people who can become pregnant.

            (a). If confirmed, how will you ensure that NIH scientists
            studying reproductive health topics can conduct their work
            according to their fields' accepted practices and ethical
            guidelines?

            (b). Do you commit to ensuring that findings related to sexual
            and reproductive health are able to be communicated accurately,
            free from political pressures?

            (c). How will you ensure that decisions regarding research
            funding, including those related to sexual and reproductive
            health, are based on the merits of proposed research rather
            than political motivations?

        Answer 22(a)--(c). NIH will continue to conduct evidence-based
    research and publish relevant findings.

        Question 23. I have seen grant applications and materials across
    agencies reviewed for terms related to gender and race, in addition to
    key information on these topics scrubbed from government Web sites. A
    central goal of public health and biomedical research is to evaluate
    the experiences and health outcomes of different communities. This is
    particularly true in sexual and reproductive health, where women and
    people who become pregnant are especially impacted and racial
    disparities have deepened.

            (a). Do you have any interest in having NIH address health
            inequity?

            (b). If confirmed, how will you ensure that NIH research and
            grants continue to consider race and gender?

            (c). If all mention of race and gender are erased, how do you
            plan to address inequities in health outcomes?

        Answer 23(a)--(c). If confirmed, I am committed to improving
    healthcare quality and outcomes for all Americans and doing so with
    radical transparency.

        Question 24. HHS Secretary Robert F. Kennedy, Jr. has indicated his
    intent to ``give infectious disease [research] a break for about 8
    years.''

            (a). Will you commit to supporting a strong portfolio of
            infectious disease research?

            (b). Will you communicate to him and to the American public
            that chronic disease and infectious agents are inextricably
            linked, and that funding for both is crucial to understanding
            the mechanisms that underlie disease, developing treatments and
            cures, and improving human health?

        Answer 24(a)--(b). If confirmed, I will ensure NIH continues
    research into both chronic disease and infectious agents.

        Question 25. The Executive Order establishing the Make America
    Healthy Again Commission directs the NIH to ``prioritize gold-standard
    research''--what is your interpretation of ``gold-standard research''
    and how do you see that deviating from existing practices in federally
    funded medical research?

        Answer 25. NIH supported science should be replicable,
    reproducible, and generalizable. Like Secretary Kennedy and President
    Trump, I also support radical transparency as a way of restoring faith
    in public health.

        Question 26. How do you plan to address the disruption caused by
    the recent freeze and subsequent reinstatement of DEI-related funding,
    especially considering the NIH's role in supporting diverse research
    initiatives?

        Answer 26. I am not aware of any negative impacts as a result of
    recent fiscal initiatives but will inquire further if confirmed.

        Question 27. Recent executive branch actions, including reductions
    in the workforce, funding freezes, and the inability to move forward
    with peer review activities, have had a chilling effect on research
    across the United States. Understandably, there is concern about the
    future of the NIH. As Director, how would you strengthen the NIH and
    ensure that our Nation continues to lead the world in driving medical
    progress?

        Answer 27. If I'm confirmed as NIH director, I fully commit to
    making sure that all the scientists at the NIH and the scientists that
    the NIH supports have the resources they need to meet the mission of
    the NIH.

        Question 28. On Friday, Secretary Kennedy issued a public register
    notice indicating he'd revoke the Richardson waiver, which requires a
    period of notice and an opportunity for public comment on decisions
    related to ``agency management or personnel or to public property,
    loans, grants, benefits, or contracts.'' Needless to say, there are
    many of these types of decisions you'll need to make as NIH Director.
    I'd like to know your plans for moving forward on changes in these
    areas at the NIH, and whether or not you plan to seek public comment.

        Answer 28. If confirmed, I will seek input from various
    stakeholders prior to making these types of decisions.

        Question 29. Since the inauguration of President Donald Trump,
    there has been a dramatic slowdown in the normal pace of decision-
    making and awards for NIH research grants, and the agency is nearly a
    billion dollars behind in making research awards as compared to last
    year.

            (a). Is this the new normal?

            (b). What can I expect from NIH under your leadership in terms
            of process around grantmaking?

            (c). Should I anticipate a departure from the current level of
            support for scientific research in spite of Congress's
            longstanding, bipartisan efforts to bolster investment in NIH?

        Answer 29(a)--(c). If confirmed, I will look into the process of
    how decisions are made and grants awarded. My goal is for the U.S. to
    be the global leader in breakthrough, transparent health research.

        Question 30. On February 7, the NIH announced cuts to funding for
    major research institutions, specifically targeting Facilities and
    Administrative (F&A) support. These cuts threaten to dismantle critical
    research infrastructure and delay the development of life-saving cures.
    They also jeopardize the future of scientific training and hinder the
    growth of the biotechnology industry, a key driver of economic growth.
    The Federal Government's support for F&A costs has been vital in
    building the world-class research infrastructure that keeps America at
    the forefront of global innovation. F&A costs cover essential
    components like labs, security, and Federal compliance, enabling our
    institutions to conduct cutting-edge research and bring novel
    treatments to Americans first. Importantly, while the government
    reimburses part of these costs, universities already cover a
    significant portion, including $6.8 billion in unreimbursed F&A
    expenses. These proposed F&A cuts will cripple research, undermine
    national priorities, and erode U.S. global competitiveness--ultimately
    raising costs for Americans and slowing economic growth.

            (a). Will you proceed with cuts that will cripple U.S. research
            capabilities?

            (b). Do you have concerns that undermining our Nation's
            research institutions will stall scientific progress and harm
            long-term economic growth, especially as global competition
            accelerates from our adversaries like China?

            (c). What message does this send to the millions of Americans
            waiting for life-saving treatments and cures, who will now face
            even longer delays?

        Answer 30(a)--(c). I support the Administration's efforts to find
    efficiencies, be fiscally responsible, and reduce bloat in government.
    While this effort is underway, critical research will continue to
    happen at NIH.

        Question 31. As you know there is a strong drive to reduce
    inefficiencies and costs in the Federal Government. Do you think NIH is
    overfunded today and, if so, what process would you use to decide on
    reductions?

        Answer 31. I support the Administration's efforts to find
    efficiencies and be fiscally responsible. If confirmed, I will assess
    NIH funding levels and work with relevant parties such as Congress to
    make necessary adjustments.

        Question 32. What do you see as the benefits and risks of making
    block grants to states for biomedical research?

        Answer 32. If I'm confirmed as Director, I will assess any and all
    approaches to more efficiently support biomedical research in the
    United States.

        Question 33. As you know, historically, budget reductions at NIH
    have led to a loss of scientific talent--especially young, up-and-
    coming scientists. It is estimated that for every 2 percent reduction
    in NIH funding, about more than 7,500 scientists will leave the U.S.
    workforce, many of them headed overseas. How do you intend to prevent
    these losses while other countries are actively growing their science
    and technology workforce?

        Answer 33. If shortages exist in the NIH science and technology
    workforce that prevent NIH from successfully achieving its mission, I
    will work with the Trump administration to address such shortages.

        Question 34. What research would you support to better protect the
    American people against the next pandemic?

        Answer 34. I believe the NIH must vigorously regulate research
    using pathogens that can lead to the next pandemic. If confirmed, I
    will carefully review all policies to ensure research is appropriate
    and conducted safely and responsibly.

        Question 35. Over 20 million Americans have Long COVID, including
    children, and there are no FDA-approved treatments. People with Long
    COVID are unable to work, socialize, take care of their kids, and
    participate in society as they want to. Research has made progress over
    the last 5 years in identifying promising hypotheses for mechanisms and
    treatments, but scientists are still a ways off from finding a
    treatment that works for everyone. How will you ensure that the
    momentum into Long COVID research is not lost and that researchers have
    the resources they need to identify the mechanisms and find cures?

        Answer 35. Long COVID is a condition that affects many Americans
    that deserve answers. I support additional research into Long COVID,
    but the research needs to yield results.

        Question 36. One area of research where issues of trust and
    effectiveness have been paramount in recent years is Long COVID. Long
    COVID is a very complex and often chronic condition, and even after 5
    years since it emerged scientists have no established treatments. A key
    to this research being as effective as possible is for there to be
    solid and robust patient engagement. That ensures a focus on the
    treatments that are most meaningful and impactful, and there's an
    effort to build trust among researchers, clinicians, and patients. Do
    you commit to working with patients and addressing the Long COVID
    crisis with the urgency it warrants?

        Answer 36. If confirmed, I look forward to working with Congress to
    address novel research and appropriate clinical trials for long COVID.

        Question 37. In the Great Barrington Declaration that you co-
    authored, you said that ``Those who are not vulnerable should
    immediately be allowed to resume life as normal.'' Studies have found,
    though, that all Americans may be vulnerable to Long COVID, with it
    impacting over 17 million Americans currently and that number
    increasing as COVID continues to spread and reinfections increasing
    your risk of Long COVID. Now, millions of Americans are out of work and
    unable to participate in society because of the type of strategy
    promoted in your declaration. Why didn't you account for the risks of
    developing a chronic condition after an infection when you wrote this?

        Answer 37. In 2020, when the Great Barrington Declaration was
    authored, avoiding mortality was the most important priority. The
    lockdowns were ineffective, at best, from protecting anyone from
    getting COVID and therefore Long COVID. See: ``Institute of Economic
    Affairs. (n.d.). Did lockdowns work? The verdict on COVID restrictions.
    Retrieved March 7, 2025, from https://iea.org.uk/publications/
    did=lockdowns-work-the-verdict-on-covid-restrictions/.

        Question 38. Rather than addressing the actual needs of Americans,
    such as reducing the rising costs of healthcare, President Trump issued
    a day 1 executive order that directly targets transgender and intersex
    Americans. He and RFK have subsequently set out to disrupt the
    provision of medically necessary and evidence-based care to
    adolescents, terminate LGBTQI+ civil servants, contradict the
    objectives of the 21st Century Cures Act, freeze the funding of
    lifesaving research, pull LGBTQI+-inclusive public health data from the
    internet, disrupt critical research funding, particularly if it is
    LGBTQI+-inclusive, and undermine the Administrative Procedures Act. If
    appointed, would you take a principled stand against this
    Administration's discriminatory attacks on the health and safety of
    marginalized communities? Or would you be yet another yes-man to
    rubber-stamp President Trump's ideas?

        Answer 38. If confirmed, I will follow the law and the President's
    Executive Orders on this matter and ensure that we make all Americans
    healthy again.

        Question 39. The state of children's mental and behavioral health
    continues to be a national emergency. In 2023, 29 percent of
    adolescents reported experiencing poor mental health and 1 in 5
    reported having seriously contemplated suicide, in the past year. As
    this wide-spread mental health crisis persists, cross-institute
    research on preventing and treating youth mental health and substance
    use disorders is urgently needed. How will you bolster support for
    pediatric mental and behavioral research across NIH and ensure that
    research is based in evidence and not directed by the baseless views of
    the Secretary of HHS?

        Answer 39. Americans are suffering unprecedented rates of
    addiction. If confirmed, I look forward to working with you and your
    colleagues to approach this crisis with the attention it deserves,
    working with SAMHSA and other Departments to both treat addiction and
    promote recovery.

        Question 40. The peer review process for NIH grants is a
    cornerstone of ensuring that the best scientific research is funded and
    able to move forward. However, there have been growing concerns that no
    grant review meetings have been able to proceed since Federal Register
    notices for the meetings were halted, potentially delaying critical
    research. With the global competition in biosciences, particularly with
    China, it is vital that the U.S. remains at the forefront of scientific
    innovation. Nominee, how do you plan to address the halt of grant
    review study sections, and what steps will you take to ensure that the
    NIH continues to fund critical research without further setbacks?

        Answer 40. If confirmed, I will ensure peer-reviewed evidence-based
    science continues at NIH.
                                 senator murray
        Question 1. How will you prioritize translational research at NIH,
    moving from evidence that is generated in laboratories into real-world
    interventions that save people's lives?

        Answer 1. If I am confirmed, I will assess the available
    information in order to determine how to appropriately prioritize the
    NIH portfolio.

        Question 2. Scientists often talk about the funding cliffs that
    occur when doing translational research. What funding cliffs do you see
    between T2 (clinical trials) and T3 research (testing research in
    clinical practice)?

            (a). How will you support NIH funding so that these cliffs do
            not occur?

        Answer 2--(a). I'll need to fully analyze the data if I am
    confirmed in order to adequately answer the question. However, I
    believe that researchers should have the resources needed to continue
    their work.

        Question 3. Moving research from T3 (testing in clinical practice)
    to T4 (achieving population health) is often viewed as a ``holy grail''
    for scientists and researchers. How will you use your role at NIH to
    further the field of implementation science so that more science has a
    public health impact?

        Answer 3. I'll need to fully analyze the data if I am confirmed in
    order to adequately answer the question. However, I believe that
    researchers should have the resources needed to continue their work.

        Question 4. You have suggested that NIH study sections are afraid
    of scoring ``high risk, high reward'' grant proposals. What steps will
    you take to ensure that these innovative studies are given a fair
    scientific review?

            (a). How do you view the role of ARPA-H versus the role of NIH
            in conducting or funding ``high risk, high reward'' research?

        Answer 4--(a). I believe NIH must recommit to its mission to fund
    the most innovative biomedical research agenda possible to improve
    American health.

        I believe NIH must recommit to its mission to fund the most
    innovative biomedical research agenda possible to improve American
    health. I have not considered specific priorities for ARPA-H, but look
    forward to working with you to ensure that every dollar the American
    government spends on healthcare is making people healthier.

        Question 5. Prospective, longitudinal studies consist of the most
    rigorous science, yet these studies cost the most to conduct. How will
    the NIH invest in long-term, rigorous research that will allow for
    analysis of changing demographics and genomic factors?

        Answer 5. Conducting robust and replicable research is essential.
    If confirmed as the NIH Director, I will work to ensure that NIH-funded
    research is thorough, reproducible, and translatable.

        Question 6. You have mentioned that early career scientists are
    excluded from NIH study sections. However, any existing study section
    member can suggest an early career scientist as a member to the NIH
    Scientific Review Officer. What evidence do you have to demonstrate
    that early career scientists are indeed excluded from the NIH study
    section process?

        Answer 6. I have never stated that early career scientists are
    excluded. Rather, I have said it is difficult for early career
    investigators to be standing members of NIH study sections.

        Question 7. As NIH Director, how would you prioritize study section
    composition to include early career scientists?

            (a). If so, what would be the criteria for their inclusion?

            (b). What would be the criteria for their exclusion, at this
            stage of their career?

        Answer 7(a)--(b). I would expand the existing programs within the
    NIH that recruit early career scientists and require a larger fraction
    of the study section membership to have standing members early in their
    career.

        Question 8. Do you believe cuts in staffing or funding at NIH are
    needed? If yes, where would you support cuts?

            (a). Do you think NIH is overfunded or underfunded as a Federal
            agency? Please explain your reasoning for your answer.

        Answer 8--(a). I support the Administration's efforts to find
    efficiencies, be fiscally responsible, and reduce bloat in government.
    If confirmed, I will assess NIH funding levels and work with relevant
    parties such as Congress to make any necessary adjustments.

        Question 9. There are many challenges to the U.S. health care
    system. Do you see a role for the NIH to play in addressing our health
    system access and payment issues?

        Answer 9. Conducting robust and replicable research is essential.
    If confirmed, I will work with agencies to uphold the gold standard of
    scientific and evidence-based research. My goal is for the U.S. to be
    the global leader in breakthrough, transparent health research
    accountable to the American people.

        Question 10. NIH intramural scientists who are on renewable term
    appointments are now being told that their positions will not be
    renewed. This will decimate the NIH intramural research program which
    supports thousands of the country's best and brightest early career
    scientists.

            (a). What do you think about the NIH losing its intramural
            research program?

            (b). As NIH Director, would you continue to end the renewals
            these early career scientists in the intramural research
            program? Or would you seek to reinstate these senior level
            staff scientists and tenure-track researchers at NIH?

        Answer 10(a)--(b). If confirmed, I intend to review all such
    research programs and determine their value to the American people.

        Question 11. The NIH Clinical Center is one of the only places for
    Americans with rare diseases to participate in clinical trials, as a
    last-ditch effort to receive life-saving treatment. How will the NIH
    continue its Clinical Center work when over 1,200 NIH staff have been
    fired, and intramural scientists are being laid off?

            (a). As NIH Director, would you continue to fire staff at NIH's
            Clinical Center? Or would you seek to protect them from further
            Reductions in Force (RIFs)?

        Answer 10--(a). If staff shortages exist that prevent NIH from
    successfully fulfilling its mission, I will work with the
    Administration to address them.

        I will make staffing decisions so as to ensure optimum and
    successful operations at NIH.

        Question 12. NIH-funded scientists across the country have been
    notified that their studies focused on improving health, including
    mental health and dementia outcomes, among research populations that
    include the transgender community, have been terminated. Was
    terminating these grants the right decision for the NIH?

        Answer 12. If confirmed, I intend to review all such research
    programs and determine their value to the American people.

        Question 13. Do transgender individuals deserve to have the best
    possible health and health care?

        Answer 13. All citizens deserve to have the best possible health
    and healthcare.

        Question 14. Transgender populations have the highest suicide risk
    of any population in the United States. Do you agree with the Trump
    administration's attempts to defund research aiming to improve the
    mental health of transgender individuals?

        Answer 14. If confirmed, I look forward to addressing the Nation's
    mental health crisis and ensuring that we make all Americans healthy
    again.

        Question 15. Many universities and research institutions across the
    country are rescinding faculty and graduate admissions offers. Thus,
    early career scientists are not able to start their independent
    research careers, since postdoctoral fellowships are no longer
    available to them. How will future scientists be trained in the U.S. if
    the NIH stops funding research at these institutions?

        Answer 15. If confirmed, I will work with agencies to uphold the
    gold standard of scientific and evidence-based research. My goal is for
    the U.S. to be the global leader in breakthrough, transparent health
    research accountable to the American people.

        Question 16. You have been a critic of the NIH's approach to
    science during the COVID-19 pandemic. As NIH Director, how would you
    balance the need for maintaining rigorous research standards with the
    need for flexibility and responsiveness in a rapidly changing research
    environment, such as an infectious disease pandemic?

        Answer 16. I would encourage respectful debate among people with
    very different views. Especially in times of uncertainty and crises,
    this is the only way to get the truth.
        Question 17. If confirmed as NIH Director, what steps will you take
    to ensure women's health is taken seriously as a research priority at
    NIH?

        Answer 17. If I am confirmed, I will work with colleagues at the
    NIH to ensure that NIH is adequately supporting women's health
    research.

        Question 18. No new funding notices have been announced in 2025
    from the NIH Office of Research on Women's Health (ORWH). What will you
    do as NIH Director to continue to support ORWH programs and
    initiatives, as well as its grant making authority, which is provided
    by Congress in the annual Appropriations bill?

        Answer 18. If confirmed, I will work with colleagues to ensure that
    research on women's health continues.

        Question 19. A National Academies of Sciences, Engineering and
    Medicine (NASEM) task force released a report this year stating that
    there is severely limited funding for women's health research across
    NIH Institutes and Centers (ICs). How will you ensure increased
    spending for women's health research across ALL NIH ICs?

            (a). While NIH spending has increased, funding for women's
            health research did not, so the actual total funding for
            women's health research has gone down. What would you do as NIH
            Director to ensure that investment in women's health research
            is sustained, and not a ``one and done'' investment, which the
            NASEM report warns against?

        Answer 19--(a). If confirmed as the NIH Director, I will institute
    a priority review of all research grants across all ICs to ensure we
    are funding gold-standard science.

        Question 20. One of the specific research areas that lacks NIH
    investment is research into menopause and women's midlife health. Would
    you, as NIH Director, prioritize resources for research into menopause
    and women's midlife health? If yes, how will you accomplish this?

        Answer 20. If I am confirmed, I will work with colleagues at the
    NIH to ensure that NIH is adequately supporting women's health
    research.

        Question 21. NIH grant proposals are now being vetted for words
    that are considered to promote diversity, equity, and inclusion in NIH
    funded studies. Some of these targeted words are ``female'' and
    ``women''. Do you think ``female'' and ``women'' should be forbidden
    words in NIH research proposals and funded studies?

            (a). Do you believe researchers who study women's health issues
            should be penalized, or barred from receiving NIH research
            funding?

        Answer 21--(a). No.

        Question 22. What does the Federal trust responsibility to Tribes
    mean to you?

        Answer 22. If confirmed, I will work with you to ensure that the
    Indian Health Service has necessary exceptions to honor our treaty and
    trust obligations and also keep American Indian and Alaskan Native
    patients healthy.

        Question 23. What role do you believe the NIH plays in fulfilling
    the Federal trust responsibility?

        Answer 23. With regard to research, NIH must work with Tribes
    transparently, morally, and respectfully.

        Question 24. Will you commit to respecting tribal sovereignty?

        Answer 24. I commit to follow all US laws and treaties.

        Question 25. How do you plan to work with Tribes, Urban Indian
    Organizations, Tribal Epidemiology Centers, and the Indian Health
    Service to advance Tribal health research priorities?

        Answer 25. If confirmed as NIH director, I commit to working with
    established entities, including the NIH Tribal Health Research Office,
    to advance the well-being of Native Americans.

        Question 26. Tribal Epidemiology Centers play a key role conducting
    research and providing Tribes and Urban Indian Organizations with the
    data they need to support the health and well-being of American Indians
    and Alaska Natives. Will you commit to increasing funding opportunities
    for Tribal Epidemiology Centers?

        Answer 26. I will commit to assessing and ensuring adequate
    resources for the Tribal Epidemiology Centers.

        Question 27. Tribal Epidemiology Centers frequently receive grant
    funding through intermediaries, which can reduce the amount of research
    they are able to support. Will you commit to distributing grant funding
    directly to Tribal Epidemiology Centers when appropriate?

        Answer 27. If confirmed as NIH Director, I am open to considering
    all mechanisms for funding.
                                senator baldwin
        NIH has terminated existing, ongoing grants made to scientists
    studying LGBTQ+ health. Researchers were told that it is the policy of
    NIH not to prioritize these research programs. I am concerned that
    these terminations are a result of the President's executive orders
    targeting LGBTQ+ populations. NIH should not be ignoring court orders
    on the President's actions.

            Question 1. Do you agree that the NIH should end ongoing
            research with no warning?

            Question 2. If confirmed, will you honor ongoing funding
            agreements with researchers?

            Question 3. If confirmed, will you provide my office with
            information regarding which grants were terminated and for what
            reason?

        Answer 1--3. I support the Administration's efforts to find
    efficiencies, be fiscally responsible, and reduce bloat in government.
    If confirmed, I will assess NIH funding levels and work with relevant
    parties such as Congress to make any necessary adjustments.

            Question 4. Do you commit to complying with all existing and
            future court orders pertaining to the President's executive
            orders, including temporary restraining orders and/or
            preliminary injunctions on executive orders related to gender
            identity or diversity, equity, and inclusion (DEI)?

            Question 5. If confirmed, would you terminate other existing
            research grants that deal with gender, such as research
            relating to women's health?

        Answer 4--5. If confirmed, I will follow the law and the
    President's Executive Orders on this matter and ensure that we make all
    Americans healthy again.
                                 senator kaine
        Question 1. Long COVID is a chronic condition impacting quality of
    life and functional status of nearly 17 million Americans. In fact, as
    of last fall, nearly 18 percent of U.S. adults had experienced Long
    COVID at some point over the last 5 years. Even with this pressing
    need, the Trump administration is rolling back protections for people
    with Long COVID. In 2020, Congress appropriated $1.15 billion for the
    RECOVER Initiative at the National Institutes of Health (NIH). NIH has
    since allocated an additional $662 million to support RECOVER's
    continuing work. The RECOVER Initiative is doing important longitudinal
    work to not only understand how and why people get Long COVID, but also
    how to treat Long COVID. If confirmed, do you commit to:

            (a). Continuing the work of the NIH's RECOVER Initiative,
            without a reduction or reprogramming of funding?

            (b). Meeting with myself and Senator Young to outline your
            plans to support the NIH's robust Long COVID research,
            including a discussion on how you will coordinate with agencies
            outside of NIH on this work?

        Answer 1(a)--(b). If confirmed, I look forward to working with
    Congress to address novel research and appropriate clinical trials for
    long COVID.

        If confirmed as NIH Director, I look forward to working with you
    and other Members of Congress on Long COVID research.

        Question 2. Your predecessor, Dr. Monica Bertagnolli, went beyond
    what was required under ethics law, the Presidential ethics pledge, and
    even agreements with the Office of Government Ethics to minimize
    potential conflicts of interest before assuming her role as Director of
    the National Institutes of Health (NIH). I urge you to do the same.
    Accordingly, I have the following questions:

            (a). Will you commit to recuse from all particular matters
            involving your former clients and employers for at least 4
            years?

            (b). Will you commit to not seek employment or board membership
            with, or another form of compensation from, a company that you
            regulate or otherwise interact with while in government, for at
            least 4 years after leaving office?

            (c). Will you commit to not lobby the NIH--including through
            work as an informal ``shadow lobbyist''--for at least 4 years
            after leaving office?

        Answer 1(a)--(c). I am proud to be on the Lown List of Industry-
    Independent Health Experts. I fully intend to remain industry-
    independent and commit to not becoming a lobbyist.

        Question 3. Nearly 30 percent of medical students receive training
    through osteopathic medical schools with 50 percent of graduates
    entering primary care, a critical area of need for ensuring access to
    essential health services nationwide. Training in osteopathic medicine
    is a particularly critical pathway to address health workforce
    shortages, especially those in rural and underserved areas. If
    confirmed, do you commit to meeting with leaders of osteopathic
    medicine to learn more about the role of the osteopathic physician
    within the health care system and to discuss opportunities for future
    collaboration?

        Answer 3. If confirmed as the NIH Director, I will thoughtfully
    consider any opportunities to meet with osteopathic medical schools to
    improve health care in the country. As you may be aware, Secretary
    Kennedy recently met with the AOA.
                              senator hickenlooper
        Question 1. The Trump administration announced an abrupt directive
    that all indirect fees for NIH grants must be capped. As you know, this
    proposed cap is currently paused awaiting litigation. This cap would
    not only impact future NIH funding, but would slash current NIH funding
    supporting research projects all across the country. While I know you
    are not yet at NIH, is there any justification that the Administration
    could provide that would satisfy you as to why these dramatic funding
    cuts needed to impact existing NIH funding, creating mass chaos and
    confusion for researchers across the country?

        Answer 1. I support the Administration's efforts to find
    efficiencies and be fiscally responsible. If confirmed, I will assess
    NIH funding levels and work with relevant parties to make any necessary
    adjustments.

        Question 2. Dr. Bhattacharya, you have extensive experience with
    research into Alzheimer's and dementia from your time at Stanford. The
    NIH Center for Alzheimer's and Related Dementias was recently subject
    to mass firings by the Trump administration. The Acting Director of the
    Center was included in the firings. The nearly 7 million people with
    Alzheimer's in the U.S., and the millions more who care for them every
    day, I'm certain, have questions about the logic behind these firings.
    As a former researcher, are you concerned that these extensive cuts
    will limit our ability to make progress on critical research?

        Answer 2. If confirmed, I will ensure NIH continues critical
    research into Alzheimer's disease.

        Question 3. Due to increased vaccine skepticism, this past school
    year, the percentage of kindergarteners exempted from one or more
    routine vaccinations rose to the highest levels recorded. Is the rising
    skepticism of vaccines making vaccine-related research at the NIH less
    of a priority? If confirmed, how will you balance the need to focus on
    research into chronic diseases, with the need to invest in research on
    viruses with pandemic potential?

        Answer 3. If confirmed, I will ensure NIH continues research into
    both chronic disease and infectious agents.

        Question 4. Providing quality and accessible mental health care
    remains a tremendous challenge for many states and cities across the
    country. With the existing dire need for additional mental health
    research, what role do you expect it to play at the NIH, and how will
    you specifically address the need for additional research and care of
    underserved populations currently living in ``mental health deserts''
    without proper access to care?

        Answer 4. The mental health crisis remains a pressing challenge and
    making sure that all Americans are benefiting from research is crucial.
    If confirmed, I will look very closely on how we can address this
    important issue.

        Question 5. The NIH has a long history of coordinating with other
    Federal agencies, such as the National Science Foundation, Department
    of Defense, and Department of Veterans Affairs to address shared
    research interests. Under your leadership, where do you see the value
    in interagency collaboration, and in which areas would you like NIH to
    begin or expand this practice moving forward?

        Answer 5. I fully support coordinating with other agencies to
    ensure that we're using taxpayer dollars effectively and not
    duplicating efforts. If confirmed, I would carefully review existing
    mechanisms for collaboration and areas where we could further increase
    efficiencies and coordination between different Federal research
    components.
                                 senator markey
                                    Funding
        Question 1. Will you commit to ensuring that all Federal grant
    dollars are released to their recipients?

        Question 2. Will you commit to ensuring that lifesaving NIH
    projects are able to move forward, including previously allocated funds
    and new grants applications for congressionally appropriated funding?

        Question 3. What is your plan to restart the peer review process,
    address the backlog of proposals, and ensure that those who have seen
    their sections and councils canceled do not miss out on the opportunity
    to compete for funding this cycle?

        Question 4. Will you commit to ending the NIH hold on posting
    meeting in the Federal Register and allowing NIH to post meeting
    notices immediately?

        Question 5. Will you commit to working with the larger NIH
    stakeholder community instead of acting unilaterally to determine how
    best to support the total cost of conducting research for the Federal
    Government and to enhance transparency of direct and indirect
    activities?

        Question 6. How do you plan to grow research done at and funded by
    the NIH?

        Question 7. How will you ensure the education and training of the
    next generation of scientists and health workers who rely on an NIH.

        Answer 1--7. If confirmed as the NIH Director, I will institute a
    priority review of all research grants across all ICs to ensure we are
    funding gold-standard science.
                              Quality of Research
        Question 8. If confirmed, what specific steps would you take to
    encourage research on the effectiveness of NIH's funding mechanisms?

            (a). Would you consider establishing a dedicated science-of-
            science unit within the Director's Office to experimentally
            test reforms that could improve returns on investment across
            all institutes?

        Answer 8--(a). If confirmed, I will work with agencies to uphold
    the gold standard of scientific and evidence-based research. My goal is
    for the U.S. to be the global leader in breakthrough, transparent
    health research accountable to the American people.

        Question 9. Under your leadership, how would NIH identify and
    prioritize research areas where market failures are most pronounced--
    particularly those with large social benefits but limited private-
    sector incentives?

            (a). What concrete steps would you take to enhance coordination
            across NIH institutes and reallocate funding to support these
            neglected but critical research areas?

        Answer 9--(a). One of my priorities is ensuring NIH is funding the
    most innovative agenda possible and that includes ensuring that NIH is
    focusing on the diseases that are impacting the American people. If
    confirmed, I will work to facilitate better coordination across NIH to
    make sure our agenda is aligned with the areas where NIH can make a
    large impact.

        Question 10. If confirmed, what changes to NIH peer review would
    you pursue to reduce penalties for scientific risk-taking?

            (a). How would you address barriers facing early career
            investigators, given evidence that scientific progress often
            depends on young researchers who explore new ideas and bring
            fresh perspectives?

        Answer 10--(a). If confirmed, one of my goals will be to foster a
    culture of free speech at NIH to generate real opportunities for all
    researchers who may have fresh perspectives. Fostering the next
    generation of investigators is crucial and I would be happy to work
    with Congress on this important matter.

        Question 11. What are your thoughts on the current balance between
    project-specific and person-specific funding at NIH?

            (a). As director, how would you encourage the use of activity
            codes that support the most innovative, flexible grant models?

        Answer 11--(a). I would expand activity codes like the R-21
    mechanism to allow for more rapid application for specific projects.
    And I would allow institutions to apply for training grants through the
    T activity codes to streamline support for post-docs and other early
    career scientists.

        Question 12. As director, what specific changes to the indirect
    rate policy will you focus on to better align institution's incentives
    with maximizing scientific output? What measurable outcome would you
    use to determine whether changes to indirect cost policy are
    successful?

        Answer 12. I support the Administration's effort to find
    efficiencies and be fiscally responsible. If confirmed, I will review
    policies such as the indirect rate to ensure they align with those
    efforts.
                            NIH/ARPA-H Relationship
        Question 13. How do you envision working with leadership
    counterparts at ARPA-H to ensure success for each agency without
    duplication of effort?

        Answer 13. I intend to work proactively with the leadership
    counterparts at ARPA-H to best ensure mission success at NIH.

        Question 14. How do you envision that ARPA-H and NIH will both work
    together and differentiate themselves from each other in the projects
    that are separate and overlap?

            (a). Do you see room for collaboration?

        Answer 14--(a). I anticipate working with ARPA-H to avoid
    unnecessary mission overlaps so as to promote both efficiency and
    effectiveness of both agencies.
                          COVID and Infectious Disease
        Question 15. If confirmed as NIH Director, you would be working
    under the oversight and direction of HHS Secretary Kennedy, who has
    stated he wants to shift the NIH's focus away from studying infectious
    diseases. This would weaken our Country's preparedness for the next
    pandemic. Do you agree that the NIH should continue to prioritize
    studying emerging infectious diseases to be better equipped to respond
    in the future?

        Answer 15. NIH will be central to Secretary Kennedy's mission to
    make America healthy again, and research priorities including on
    chronic diseases and infectious diseases and conditions will be among
    the priorities of NIH.

        Question 16. During the pandemic, you co-authored ``the Great
    Barrington Declaration,'' which claimed that it was more
    ``compassionate'' to reach herd immunity by allowing those who are at
    minimal risk of death to live their lives normally to buildup immunity
    to the virus through natural infection. Do you agree that herd immunity
    is not possible for every disease, especially not with new, emerging
    diseases that change rapidly and that we may not know enough about, as
    was the case with the coronavirus?

            (a). During the pandemic, you stated that a lockdown ``may not
            be worth the costs it imposes on the economy, community and
            individual mental and physical health.'' Today the total deaths
            due to Covid infection in the U.S. is over 1.2 million people.
            Are the economic costs of an appropriate public health response
            worth more than the lives of millions of people?

        Answer 16--(a). Herd immunity is a simple, mathematical fact for
    any infectious disease that produces immunity, even short-lived
    immunity. Managing a pandemic requires thinking about herd immunity as
    an epidemiological fact when designing the appropriate strategy for
    managing the disease.

        The evidence indicates that the lockdowns saved the lives of very,
    very few people, if any. See: Institute of Economic Affairs. (n.d.).
    Did lockdowns work? The verdict on COVID restrictions. Retrieved March
    7, 2025, from https://iea.org.uk/publications/did-lockdowns-work-the-
    verdict-on-covid-restrictions/.

        Question 17. Do you support following the precautionary principle
    in public health and health care settings? Do you support the Federal
    Government ensuring that health care employers are following the
    precautionary principle and protecting health care workers in their
    place of employment?

        Answer 17. The precautionary principle remains a critical component
    of public health, as do benefit-harm analyses. If confirmed, I look
    forward to fostering a rigorous climate of research around this topic.

        Question 18. You noted that you share Secretary Kennedy's goal of
    ending America's ``chronic disease epidemic''. Researchers now know
    Long COVID is a chronic illness triggered by acute COVID infection. How
    do you plan to ensure the over 17 million Americans impacted by Long
    COVID get the research and care they urgently need?

            (a). Do you agree that prioritizing research into treating long
            COVID is important to public health?

            (b). As NIH director, how do you plan to prioritize and
            accelerate interventional trials for long COVID?

            (c). Over 1 million U.S. children and adolescents had Long
            COVID in 2023, with serious impacts to their education and
            development. As NIH Director, how will you ensure RECOVER-TLC
            continues research that will help impacted children impacted by
            long COVID and their families?

            (d). A Lancet 2024 study showed that a quarter of previously
            healthy U.S. Marines had signs of Long COVID. As NIH Director,
            do you plan to collaborate with Dept. of Defense research
            programs to advance Long COVID research that will ensure force
            readiness and the health of our warfighters? If so, how?

            (e). Recent and recurring research findings point to Long COVID
            potentially being a persistent infection, with viral reservoirs
            that may require anti-retroviral drug cocktails or other
            specialized medications. To better serve clinical research
            evaluation and help patients with diagnosis and treatment, how
            can the NIH best accelerate the development of a reliable,
            highly sensitive Long COVID test and other biomarkers?

            (f). As NIH Director, will you work across the Trump
            administration to develop a new, safer, and more effective
            COVID vaccine?

            (g). CURE-ID has been a cost-effective, public-private
            partnership that's helped utilize patient reports to further
            research options for Long COVID drug repurposing and
            treatments. As NIH Director, will you support continuing and
            accelerating CURE-ID's critical work?

        Answer 18(a)--(g). The mission of NIH is to make America healthy
    and that includes focusing research on diseases that are impacting
    Americans. Understanding long COVID is part of the NIH research agenda,
    and I will look closely at how NIH can ensure it is funding innovative
    research that is reproducible and will advance our understanding of
    diseases such as long COVID.

        If confirmed, I will make sure that NIH is funding the most
    innovative science possible to invest in big advances and get answers
    for the American people.
        If confirmed, I will institute a priority review of grants across
    the all ICs to ensure NIH is funding gold-standard science and work to
    make sure that NIH is pursuing quality, innovative science that can
    produce answers and results for the American people.

        If confirmed, I would carefully review existing mechanisms for
    collaboration and areas where we could further increase efficiencies
    and coordination between different Federal agencies. The mission of NIH
    is to make Americans healthy, and I will support research that helps
    ensure American interests are protected.

        If confirmed, one of my goals is to ensure that NIH is pursuing
    quality, innovative science that can produce real answers and results
    for the American people. I will look closely at how that goal aligns
    with NIH's research portfolio and what opportunities there might be to
    pursue additional research in key areas like identifying biomarkers and
    diagnostics.

        As NIH Director, I will work both at NIH and across the Trump
    administration to improve vaccines and therapeutics based on the
    urgency to address public health needs.

        As NIH Director, I will work both at NIH and across the Trump
    administration to lead research for several diseases based on the
    urgency to address public health needs.
                       New Funding Models and Mechanisms
        Question 19. In recent years NIH has experimented with funding
    models beyond the standard research grant to address pressing public
    health challenges quickly and more efficiently. One model, the
    ``innovation funnel'', has been proven successful and is being applied
    to various areas of research. What specific areas do you think could
    benefit from applying nontraditional approaches, like the innovation
    funnel model?

        Answer 19. If confirmed, I will take a close look at all research
    funding mechanisms. One of my priorities is ensuring that NIH is
    funding the most innovative research possible, and I am committed to
    considering a variety of solutions to make that a reality to improve
    the health of all Americans. I will consult with agency experts to
    identify additional areas that could benefit from innovative
    strategies.

        Question 20. NIH has expanded the scope of its prize competitions
    in recent years including by creating opportunities for institutional
    prizes that reward innovations in systems and processes rather than
    just research. How does NIH measure the success of these competitions?
    Do you plan to continue this increase in prizes as NIH Director and
    what areas might benefit from such awards?

        Answer 20. If confirmed, I will take a close look at all research
    funding mechanisms. One of my priorities is ensuring that NIH is
    funding the most innovative research possible to best benefit the
    health of all Americans, and I am committed to considering a variety of
    solutions to make that a reality to improve the public's health. I will
    consult with agency experts to develop a strategy that results in
    reliable, gold standard science that advances the health of Americans.
                                 Qualifications
        Question 21. Is it fair to say that your academic background is not
    in public health or specialized science such as epidemiology, but in
    the studying the economics of the U.S. health care system?

        Answer 21. I was a fully tenured Professor at Stanford Medical
    School for 24 years and a research associate at the National Bureau of
    Economics Research, among other positions. I have published 180
    articles in top peer-reviewed journals in medicine, economics, health
    policy, law, statistics, epidemiology, infectious disease epidemiology,
    pediatrics, demography, and other fields. My research on the pandemic
    was joined by a Nobel laureate from Stanford as well as scientists from
    Oxford, Harvard, and other top institutions.
                                 Trans-equality
        Question 22. President Trump issued a day 1 executive order that
    directly targets transgender and intersex Americans. The provision of
    medically necessary and evidence-based care to adolescents has been
    disrupted, the funding of critical research has been discontinued,
    LGBTQI+-inclusive public health data has been removed from the
    internet, and the Administrative Procedures Act has been undermined.

        If appointed, would you take a stand against this Administration's
    discriminatory and anti-science attacks on the health and safety of
    marginalized communities?

        Answer 22. As NIH Director, I will work at NIH and across the Trump
    administration to support evidence-based peer-reviewed scientific
    research.
                               Anti DEI questions
        The term health disparities refers to the significant difference in
    health outcomes that adversely affect disadvantaged populations, such
    as racial and ethnic minorities, people with lower socioeconomic
    status, and rural communities, when compared to the general population.
    Every NIH institute and center supports research into the causes and
    potential intervention to address health disparities in their mission
    areas.

        Question 23. Is it your belief that research to address public
    health issues affecting all populations in the U.S. is an important
    part of NIH's mission?

        Answer 23. Yes.

        Question 24. Will you continue to support health disparities
    research at NIH?

        Answer 24. If confirmed, I will support evidence-based scientific
    research so as to promote healthy outcomes for all Americans.

        Question 25. Women's health has historically been underfunded and
    under-researched. How do you intend to address this disparity,
    especially considering that the Trump administration has flagged the
    use of word ``women'' and targeted it for halting funding.

        Answer 25. If confirmed, I will support evidence-based scientific
    research so as to promote healthy outcomes for all Americans.

        Question 26. The Administration wants to ban words like women,
    Black, etc, from fed research. However, health disparities exist in
    people of color and in women that are different from white men. How do
    you plan to pursue a scientific approach with the DEI ban in place?

        Answer 26. If confirmed, I will support evidence-based scientific
    research so as to promote healthy outcomes for all Americans.

        Question 27. Women make up 50 percent of the population but <10
    percent of NIH funding. Endometrioses affects 1 in 10 women but gets
    $2/patient per year from NIH or 0.038 percent of the NIH budget. Do you
    commit to ensuring that research into women's health is advanced under
    your tenure?

        Answer 27. If confirmed, I will support evidence-based scientific
    research so as to promote healthy outcomes for all Americans.
                                 Mental Health
        Question 28. Do you see any basis for concern about SSRI
    medications that so many people rely on and benefit from without
    negative consequences?

        Answer 28. If confirmed, I commit to looking at this issue and
    providing further information.
                                  NIH Research
        Question 29. Senator Collins, Warner and I passed bipartisan
    legislation to extend the National Alzheimer's Plan Act, a whole-of-
    government approach to curing Alzheimer's to 2035.

              If confirmed, will you commit to working with the
            participating agencies to advance prevention, early detection
            and diagnosis, and therapeutics and cures?

              If confirmed, will you commit to maintaining
            appropriate staffing and funding at NIH to continue research
            into treatment and cures for Alzheimer's?

        Answer 29. If confirmed, I commit to working with you, Senator
    Collins, Senator Warner, and all of Congress to address continued
    resources for Alzheimer's disease research.

        Question 30. Senator Collins, Warner and I passed bipartisan
    legislation into law last fall, the Alzheimer's Accountability and
    Investment Act, which would require the National Institutes of Health
    to report to Congress each year the budget they would need to cure
    Alzheimer's by 2035. This requirement is only shared by cancer and HIV.

              Will you commit to supporting a budget report to
            Congress that includes the full amount identified by the
            National Institutes of Health as necessary to cure Alzheimer's
            by 2035?

              Will you commit to, at minimum, maintaining current
            levels of support of funding for Alzheimer's research across
            the National Institutes of Health?

        Answer 30. If confirmed, I commit to working with you, Senator
    Collins, Senator Warner, and all of Congress to address continued
    resources for Alzheimer's disease research.

        Question 31. There are proposals to reduce the number of institutes
    at the National Institutes of Health from 27 to 15.

              Do you support these proposals?

              Will you commit to ensuring that if the number of
            institutes of health are reduced, that Alzheimer's and related
            diseases research funding is maintained or increased as
            compared to the Fiscal Year 2024 appropriated levels?

        Answer 31. Congress determines NIH funding. If confirmed, my goal
    is for NIH to be the global leader in breakthrough, transparent
    research accountable to the American people. If confirmed, I commit to
    working with all of Congress to address continued resources for
    Alzheimer's research.

        Question 32. Broad Institute: ``Chronic diseases remain the leading
    cause of death in the U.S. and a major driver of healthcare costs.
    Sustaining and fully funding programs like All of Us is essential to
    reversing this epidemic, enabling groundbreaking discoveries, and
    delivering on the Nation's commitment to equitable healthcare and
    research innovation.

              Chronic diseases are the leading cause of death in
            the U.S. and a significant burden on the healthcare system. How
            do you plan to leverage national programs like All of Us to
            accelerate breakthroughs in prevention, treatment, and health
            equity for chronic disease management?

              How will you advocate for long-term, bipartisan
            support in Congress to secure adequate funding for programs
            like All of Us, and what role do you see Federal healthcare
            leadership playing in ensuring the stability of national
            research initiatives?''

        Answer 32. I believe that chronic disease should receive
    significant attention. If confirmed, I look forward to working with
    Congress to address chronic disease.
                          Federal Control of Research
        Question 33. On Day 1 of his second term, President Trump signed an
    Executive Order titled ``Ending Radical And Wasteful Government DEI
    Programs And Referencing''.

            (a). Do you support restricting NIH, CDC, or other Federal
            health research funding from going to universities identified
            on a list per the executive order?

            (b). Do you support restricting Federal health research funding
            from going to academic health centers that provide care to
            communities of color?

            (c). NIH grant recipients have received termination notices on
            the basis of explicitly including LGBTQ+ people in their
            research. Will you commit to reviewing and reinstating those
            terminations?

        Answer 33. If confirmed, I will follow the law and the President's
    Executive Orders on these matters and ensure that we make all Americans
    healthy again.
                          Mental and Behavioral Health
        Question 34. It is estimated that in 2021 around 2.5 million adults
    in the U.S. had an opioid use disorder. Medication treatment for opioid
    use disorder (OUD) is safe and effective, yet research published in
    August 2023 in the Journal of the American Medical Association found
    that only 1 in 5 adults received MAT to treat their OUD. During the
    Senate HELP hearing, you included methadone among ``critical
    interventions'' that ``should be available as a treatment option'' and
    ``medically necessary.''

            (a). Do you support expanding access to medication assisted
            treatment, including but not limited to methadone, for opioid
            use disorder?

            (b). Do you support revising Federal regulations to allow
            methadone for OUD treatment to be prescribed by providers in
            treatment settings other than opioid treatment programs (OTPs),
            including residential addiction treatment programs, hospitals,
            and federally qualified health centers?

            (c). Will you commit to working with partners at the Department
            of Justice and the Drug Enforcement Agency to ensure patients
            have greater access to methadone to treat opioid use disorder?

        Answer 34. If confirmed I look forward to collaborating with
    Federal partners on important issues such as substance abuse disorder
    and working to ensure that NIH is providing necessary information for
    them make decisions in accordance with all relevant laws and
    regulations.
             The Following Questions We Received From Constituents
        Question 35. Do you support efforts by this Administration to make
    broad cuts to the Federal workforce and will you advocate against
    efforts to do this in your agency?

            (a). How exactly do you intend to keep your agency/dept
            functional after Musk and DOGE have indiscriminately fired most
            of your highly qualified workforce?

            (b). How will you keep your agency or department running when
            the Federal Government is intent on eliminating it?

        Answer 35. I will work with the agency and Administration to ensure
    the NIH workforce is able to meet NIH's mission.

        Question 36. The Trump administration has fired almost 1,200
    probationary NIH employees, with more layoffs likely to follow. Many of
    these employees were conducting or assisting with important research.

            (a). Are you concerned about this type of disinvestment by the
            Trump administration in the agency you will be tasked with
            directing?

            (b). If confirmed, will you push the Trump administration to
            reinstate these workers?

        Answer 36. I will work with the agency and Administration to ensure
    the NIH workforce is able to meet NIH's mission.

        Question 37. The current Administration is exploiting a loophole to
    continue to block NIH from actively reviewing and funding new grants,
    despite the current restraining order ordering grant funding to
    continue.

            (a). How do you plan to resolve this so NIH can continue its
            congressionally mandated obligations to fund new research?

            (b). What do you plan to do about the current freeze of the
            Federal Register? It has completely impeded grant review and
            funding activities at NIH

            (c). Given the recent NIH funding cuts and policy changes, how
            do plan to address the resultant reduction of advanced medical
            fellowships and residency training opportunities that will
            ultimately worsening physician shortages and limit patient
            access to care--especially in underserved communities?

        Answer 37. If confirmed, I will ensure NIH uses the funding
    mechanisms at its disposal to advance gold standard research that
    inspires a new generation of medical professionals and improves the
    health of Americans.

        Question 38. Would you imagine changing the formal and standardized
    practice of peer review and institutional review groups for grant
    applications submitted to NIH institutes? If yes, how?

        Answer 38. If confirmed, I will assess the current practice of
    reviewing applications and determine if change to that practice is
    required.

        Question 39. Will you commit to ensuring that NIH science is
    evaluated by peers and not be political appointees?

        Answer 39. I will support evidence-based peer-reviewed scientific
    research so as to promote healthy outcomes for all Americans.

        Question 40. How important is the political independence of your
    agency and what will you do to protect it?

        Answer 40. I will support evidence-based peer-reviewed scientific
    research free from bias so as to promote healthy outcomes for all
    Americans.

        Question 41. What is the government's role in advancing science and
    healthcare?

        Answer 41. NIH has a significant role in advancing health and
    science. If confirmed, I will work to ensure the gold standard research
    supported by NIH supports is replicable, reproducible, transparent and
    innovative. This is crucial to restore trust and credibility to NIH.

        Question 42. What is the role of basic research in the mission of
    NIH and how much should it be supported?

        Answer 42. Basic research is an important part of the research
    mission of NIH and if I am confirmed, I will examine NIH's research
    portfolio and ensure that NIH is supporting research that focuses on
    the pressing issues facing Americans and delivers transparent and
    reproducible results.

        Question 1. Do you plan to reorganize NIH's current 27 Institutes
    and Centers?, If so, along what lines and by what processes?

            (a). Initiatives such as the National Center for Advancing
            Translational Science (NCATS) are under control of the office
            of the director. Do you plan to continue them, terminate them,
            or reform them?

            (b). Do you agree with the NIH Reform Act that would split
            NIAID into 3 institutes?

        Answer 1(a)--(b). The National Center for Advancing Translational
    Science is one of the 27 Institutes and Centers that make up the
    National Institutes of Health. If confirmed, I will look closely at the
    ways NIH can continue to advance an innovative research portfolio that
    delivers results for the American people.

        It is premature for me to make such a judgment. If confirmed, I
    will look further into the NIH Reform Act and NIAID's structure.

        Question 2. Do you think that program officers at the NIH
    institutes should have some discretion in recommending projects for
    funding that might lie just outside the pay-lines for those institutes?
    If so, what criteria should they use?

        Answer 2. If confirmed, one of my goals will be to ensure that NIH
    is funding the innovative, gold standard research. In support of that
    goal, I will look closely at the authorities and mechanisms that can be
    utilized across NIH.

        Question 3. It has been suggested that the biggest problem with NIH
    funding of research is that obtaining such funds is too slow, often
    requiring one or more years of reviews and resubmissions from the first
    application. Do you agree, and if you do, what can be done about it?
    How do the current funding cuts affect these timelines?

        Answer 3. If confirmed, I will examine mechanisms to increase the
    timeliness of research application reviews.

        Question 4. Publicly available records show that some top
    universities and medical centers stand to lose $100 million or more a
    year if the 15 percent cap is implemented--including prestigious
    institutions in conservative states that voted for President Trump. The
    Administration said the cuts would save the government $4 billion a
    year. The NIH budget is about $50 billion a year, so that supposed
    savings is 8 percent. ($4 billion savings would reduce the Federal
    deficit by less than 0.2 percent). Do you think this is really about
    saving money, or is it an effort to cripple American universities and
    science?

        Answer 4. I support the Administration's efforts to find
    efficiencies and be fiscally responsible. I do not think those efforts
    are intended to cripple American universities or science. If confirmed,
    I will assess NIH funding levels and work with relevant parties to make
    any necessary adjustments.

        Question 5. In considering public health, it is necessary to
    conduct research to understand and reduce health disparities, such as
    those by age, veteran status, race, or rural residency. How will you
    ensure that scientists from historically underrepresented groups do not
    face new disadvantages due to canceling programs that had supporting
    such scientists as their aim?

        Answer 5. The goal of making America healthy again can only be
    achieved by making all Americans healthy. Addressing the health of
    minority populations is of vital importance and if confirmed, I will
    work to foster a culture of free speech and transparency that will
    prioritize listening to a wide range of voices.

        Question 6. It is important for America to have a robust research
    and development force in both science and healthcare. What is the role
    of immigration in providing that workforce and what is your position on
    the Administration's policy on immigration?

        Answer 6. If confirmed, I will support the Administration's policy
    to welcome scientific research by qualified scientists immigrating to
    the United States.

        Question 7. What is the importance of gender and ethnicity
    considerations in selecting subjects for clinical trials and research
    in many diseases, and does that conflict with the Administration's
    efforts against DEI?

        Answer 7. If confirmed, as the NIH Director, I will support
    evidence-based peer-reviewed scientific research so as to promote
    healthy outcomes for all Americans.

        Question 8. How important is diversity in the scientific workforce
    itself? Do you support efforts to increase it?

        Answer 8. If confirmed, one of my priorities as the NIH Director
    will be to ensure that NIH is fostering a culture of respect for free
    speech and scientific dissent, which is crucial for effective science
    and includes ensuring a diverse set of ideas are included and that
    people are allowed to disagree respectfully.

        Question 9. The combined with terminations at the NIH and firings
    at the Center for Alzheimer's and Related Dementias (CARD)--amplified
    by the sudden cancellation of grant reviews and council meetings, and
    the freezing of the Federal Register to prevent rescheduling these
    meetings--will decimate research programs and critical national
    infrastructures needed to advance prevention, diagnosis, treatment, and
    care of those with dementia. These disruptions put critical progress at
    risk. Scientific progress is delicate and demands stability and
    sustained funding--breakthroughs rely on rigorous long-term studies,
    continuous collaboration, and the retention of highly trained
    researchers. Without it, these disruptions will set back years of
    progress with devastating downstream impacts on patients, caregivers,
    and the future of dementia research. Here are five solution-oriented
    questions for the Senator to ask the NIH Director, emphasizing
    remediation efforts and preventing irreparable harm to the NIA IMPACT
    Collaboratory and research to improve dementia care for millions of
    Americans:

            (a). What is the plan to accelerate the administration of
            backlogged grants that have been impacted by the pause in
            Federal funding?

            (b). Please describe immediate steps that the NIH will take to
            remediate the funding disruptions affecting America's
            investment in research programs, including the NIA IMPACT
            Collaboratory and prevent the loss of critical ongoing
            pragmatic trials in dementia care?

            (c). What specific strategies can NIH employ--either through
            reallocation, emergency funds, or Congressional support--to
            rapidly restore funding and prevent setbacks in developing and
            scaling evidence-based dementia care models?

            (d). How will the NIH ensure that early career researchers and
            clinician-scientists who depend on the Collaboratory's training
            and mentorship do not experience career setbacks or face loss
            of jobs due to these funding pauses and challenges?

            (e). What actions is NIH implementing to prevent irreparable
            harm to national data-sharing networks and research
            collaborations that support real-world dementia care
            interventions?

            (f). How is NIH prioritizing sustained and stable funding to
            safeguard their long-term investments, including the
            infrastructure of the IMPACT Collaboratory, ensuring that
            research continues without disruption?

            (g). How do you propose to attract, train, and retain the best
            and brightest young scientists in this country whose research
            careers are critical to finding cures for cancer, Alzheimer's
            disease, and many other disabling and life threatening
            conditions that confront most Americans as they age?

        Answer 9. If confirmed, I will use the available funding mechanisms
    to advance NIH's research priorities and promote the evidence-based
    science that attracts top talent, which will include research related
    to Alzheimer's disease, dementia and other medical conditions that
    confront aging Americans.

        Question 10. Your record of publications and scientific
    accomplishments is quite unremarkable compared to previous NIH
    directors.

        Answer 10. No response.

        Question 11. What actions will you take to fully understand the
    landscape of research at NIH and how will your priorities align with
    the missions of the institutes and centers?

        Answer 11. If confirmed I plan to meet with each NIH center and
    institute director and various stakeholders as well as the advisory
    committees including SMRB, as required by Congress.

        Question 12. Do you consider healthcare a human right or only for
    those who can afford it? Why?

        Answer 12. NIH is a research institution, and is not a healthcare
    program. The mission of the NIH is to provide research that makes
    everyone healthier.

        Question 13. Can you describe how you will leverage the resources
    of NIH to support research on the prevention of chronic disease,
    including a better understanding of the role that environmental factors
    may play?

        Answer 13. If confirmed as the NIH Director, I will support
    evidence-based scientific peer-reviewed research so as to promote
    healthy outcomes for all Americans, which would include examining a
    wide variety of factors and variables that may result in and exacerbate
    chronic disease.

        Question 14. Will you, and the Trump administration, commit to
    upholding the Bayh-Dole law's protection of IP for tech-transfer?

        Answer 14. I commit to complying with Federal law.

                               senator alsobrooks
                           Diverse Research Workforce
        Question 1. Studies have shown that researchers from
    underrepresented backgrounds face systemic barriers in securing NIH
    funding. If the Administration deprioritizes initiatives aimed at
    expanding the pipeline for diverse researchers and removes targeted
    funding streams meant to support diverse researchers and institutions,
    it will further entrench these disparities.

            (a). What steps will NIH take to ensure that funding
            opportunities remain equitable and that early career
            researchers, particularly those from historically underfunded
            institutions, are not further disadvantaged?

            (b). Can you commit to preserving grant mechanisms that support
            diversity in the research workforce?

        Answer 1. If confirmed, I will commit to promoting research based
    on quality and merit so as to ensure highest quality outcomes that
    promote national public health goals. These decisions will be made on a
    case-by-case basis while considering public health goals in the
    aggregate.

        Question 2. As we discussed yesterday, you co-direct the Center for
    Advancing Sociodemographic and Economic Study of Alzheimer's Disease
    and Related Dementias (CeASES-ADRD). The Center has a strong connection
    to a Resource Center for Minority Aging Research grant focused
    specifically on building the field of investigators who are
    underrepresented in science.

            (a). Under this Administration's Executive Order, will this
            Minority Aging Research Grant still exist? Why was it important
            to the Center's work?

        Answer 2. If confirmed, I will commit to promoting research based
    on quality and merit so as to ensure highest quality outcomes that
    promote national public health goals. These decisions will be made on a
    case-by-case basis while considering public health goals in the
    aggregate.

        Question 3. The NIH's Maximizing Access to Research Careers
    Program--which develops diverse post-grad researchers--has been shut
    down under this Administration. The University of Maryland had one of
    these programs. Do you agree with this decision?

        Answer 3. If confirmed, I will commit to promoting research based
    on quality and merit so as to ensure highest quality outcomes that
    promote national public health goals. These decisions will be made on a
    case-by-case basis while considering public health goals in the
    aggregate.

        Question 4. Will you commit to restarting the MARC program at NIH?

        Answer 4. If confirmed, I will commit to promoting research based
    on quality and merit so as to ensure highest quality outcomes that
    promote national public health goals. These decisions will be made on a
    case-by-case basis while considering public health goals in the
    aggregate.
                      NIH Workforce / Political Influence
        Question 5. Will you ensure that NIH scientists and staff are free
    from political interference and intimidation, including by third party
    organizations like the American Accountability Foundation?

        Answer 5. If confirmed, I will support evidence-based peer-reviewed
    scientific research free from outside pressure or bias so as to promote
    healthy outcomes for all Americans.

        Question 6. Will you disavow any efforts from third party
    organizations to intimidate, target, or dox civil servants at the NIH
    because of the political donations they made, or political parties or
    candidates they supported?

        Answer 6. If confirmed, I will follow all applicable employment
    laws and departmental practices. I support evidence-based peer-reviewed
    scientific research free from outside pressure or bias so as to promote
    healthy outcomes for all Americans, support the First Amendment freedom
    of speech, and will not tolerate attempts to willfully intimidate NIH
    employees.

        Question 7. How will you protect researchers from being pressured
    to alter findings or suppress data for political reasons?

        Answer 7. If confirmed, I will follow all applicable employment
    laws and departmental practices. I support evidence-based peer-reviewed
    scientific research free from outside pressure or bias so as to promote
    healthy outcomes for all Americans, support the First Amendment freedom
    of speech, and will not tolerate attempts to willfully intimidate NIH
    employees.

        Question 8. Do you support mass firings at NIH as part of an effort
    to reshape the agency?

        Answer 8. If confirmed I look forward to conducting a fulsome
    review of the NIH's workforce needs. I commit to fostering a workplace
    committed to ensuring that NIH fulfills its mission, and that any
    potential staffing changes will not compromise the mission-critical
    functions.

        Question 9. How will you ensure that career scientists and public
    health experts are not targeted or forced out due to their research on
    issues like vaccine efficacy or health disparities?

        Answer 9. If confirmed, I will support evidence-based peer-reviewed
    scientific research free from outside pressure or bias so as to promote
    healthy outcomes for all Americans.

        Question 10. Will you commit to connecting all employees targeted
    by these third-party lists to law-enforcement and Federal Protective
    Services?

        Answer 10. If confirmed, I will follow all applicable employment
    laws and departmental practices. I support evidence-based peer-reviewed
    scientific research free from outside pressure or bias so as to promote
    healthy outcomes for all Americans, support the First Amendment freedom
    of speech, and will not tolerate attempts to willfully intimidate NIH
    employees.

        Question 11. Some researchers have raised concerns that NIH funding
    decisions could be influenced by political rather than scientific
    considerations. How will you ensure that research funding decisions
    remain independent of political influence and are based purely on
    scientific merit?

        Answer 11. If confirmed, I will commit to promoting research based
    on quality and merit so as to ensure highest quality outcomes that
    promote national public health goals. These decisions will be made on a
    case-by-case basis while considering public health goals in the
    aggregate.

        Question 12. Will you commit to protecting NIH employees who come
    forward with concerns about political interference in scientific
    research?

        Answer 12. Yes.

        Question 13. Will you provide Congress with regular reports on any
    complaints of workforce intimidation, political coercion, or improper
    research suppression, upon request?

        Answer 13. If confirmed, I will comply with all required reporting
    to Congress.

        Question 14. Have you received any directives from HHS or the White
    House regarding limits on what NIH scientists can study?

        Answer 14. No.

        Question 15. Who will have the final say on NIH hiring, firings,
    and research priorities--you, or DOGE?

        Answer 15. It has been widely reported that President Trump has
    asked that agency leadership oversee organizational and staffing
    matters.

        Question 16. If DOGE orders mass terminations of NIH scientists,
    will you resist those orders?

        Answer 16. It has been widely reported that President Trump has
    asked that agency leadership oversee organizational and staffing
    matters.

        Question 17. Will you commit to ensuring that NIH grants are
    awarded solely based on scientific merit, not political ideology?

        Answer 17. If confirmed, I will commit to promoting research based
    on quality and merit so as to ensure highest quality outcomes that
    promote national public health goals. These decisions will be made on a
    case-by-case basis while considering public health goals in the
    aggregate.

        Question 18. Will you commit that NIH employees who worked on
    COVID-19 research, vaccine development, and public health guidance will
    not face retaliation under your leadership?

        Answer 18. If confirmed, I agree to follow the law.

        Question 19. Will you commit to respecting NIH employee union
    rights and engaging in good-faith negotiations with employee
    representatives?

        Answer 19. If confirmed, I agree to follow the law.

        Question 20. Will you oppose any efforts to strip workplace
    protections from NIH employees, including scientists and administrative
    staff?

        Answer 20. If confirmed, I agree to follow the law.

        Question 21. If directed to weaken worker protections at NIH, will
    you resist such efforts?

        Answer 21. If confirmed, I agree to follow the law.
                               Following the Law
        Reporting from NIH e-mails indicates that NIH leadership is
    currently using a hold on Federal Register notices to work around the
    court pause on NIH funding freeze. As you know, updates to the Federal
    Register are required for the scheduling of study sections and advisory
    councils. Yet these updates are on hold indefinitely.

        Question 22. Will you end this hold on publication to the Federal
    Register?

        Answer 22. I commit to looking into the issue.

        Question 23. Will you commit to not using the Federal Register
    communications freeze as a means to avoid compliance with directives
    from the courts?

        Answer 23. I agree to follow the law.

        Question 24. As NIH Director, will you commit to following the law
    and fully complying with court orders?

        Answer 24. I agree to follow the law.

        Question 25. How will you ensure that NIH complies with all Federal
    regulations and ethical guidelines in its research and administrative
    practices?

        Answer 25. I will consult the HHS general counsel and office of
    ethics to ensure compliance with all Federal regulations and ethical
    guidelines.

        Question 26. What measures will you implement to ensure
    transparency in NIH's decision-making processes, particularly
    concerning funding allocations and research priorities?

        Answer 26. I support Secretary Kennedy's call for HHS-wide
    ``radical transparency.'' Accordingly, I will consult the HHS general
    counsel and office of ethics to ensure compliance with all Federal
    regulations and ethical guidelines with respect to ensuring maximum
    transparency in NIH decision-making.
                                 Indirect Costs
        Question 27. The Administration has proposed capping indirect costs
    for NIH research grants at 15 percent, potentially reducing funding for
    life-saving research. I lead the Maryland delegation in sending a
    letter to the HHS Secretary and Acting Director of the NIH asking for
    the immediate recission of the February NIH Indirect Cost Rate
    Guidance, explaining the disproportionate impact to the state of
    Maryland. Will you commit to examining the state specific economic
    impact to this guidance, including the impact to my state of Maryland,
    and sharing an evaluation of the economic cost of this guidance with
    Congress?

            (a). Will you commit to responding to this letter within 2
            weeks of your confirmation?

        Answer 27. If confirmed, I will assess NIH funding levels and work
    with relevant parties to make any necessary adjustments. I look forward
    to working with Congress on this and other matters.

        Question 28. Do you believe indirect costs are critical to
    expanding research?

        Answer 28. I believe that there are costs necessary for expanding
    research. If confirmed, I will assess NIH funding levels and work with
    relevant parties to make any necessary adjustments.

        Question 29. Through your aforementioned National Institutes on
    Aging CeASES-ADRD Center, your project received $320,000 in taxpayer
    dollars for indirect costs. Can you explain what these indirect costs
    were for and why they were important to the Center's work and research?

        Answer 29. As the researcher, I received and account for the direct
    research costs: computers, hiring of biostatisticians, etc. The
    indirect cost portion of the grant--which is additional money provided
    on top of the research component of the grant--went to the university
    administration. The university administration would have to account for
    the amount you reference.

        Question 30. NIH funding is highly competitive, with many high-
    quality grant proposals going unfunded due to budget constraints. Given
    the Administration's proposals to cap indirect costs and shift research
    priorities, how will you ensure that promising research is not left
    unfunded due to these constraints?

        Answer 30. If confirmed, I will assess NIH funding levels and work
    with relevant parties to make any necessary adjustments.

        Question 31. During questioning at yesterday's hearing, you said
    that there needed to be increased transparency in the indirect cost
    process, and that it amounted to essentially a ``tip'' for research
    institutions. You also said that too many research institutions on
    ``the coasts'' receive research funding versus flyover states. As you
    well know, universities and the Federal Government engage in complex
    negotiation processes to set their indirect cost rates, which are also
    subject to regular audits. Institutions have to transparently document
    their indirect cost needs as part of these negotiations. What about
    this indirect cost negotiation process needs to be more transparent?

        Answer 31. If confirmed as the NIH Director, I will look further
    into mechanisms to increase transparency into indirect cost negotiation
    process.

        Question 32. As noted by several colleagues yesterday, the Fiscal
    Year 2018 LHHS bill included a general provision prohibiting NIH from
    developing or implementing changes to its indirect cost rates policies,
    which has been included in the bill ever since. This provision
    continues under the Continuing Resolution as a term and condition of
    the Fiscal Year 2024 appropriation. Do you agree that any changes to
    the indirect cost rate policies are against the law?

        Answer 32. If confirmed, I look forward to reviewing the provision
    with guidance from agency counsel.
                               Reduction in Force
        Question 33. Over the past few weeks, NIH staff have been getting
    termination e-mails through DOGE's efforts to slash the workforce. The
    e-mail they received read ``Unfortunately, the agency finds that you
    are not fit for continued employment because your ability, knowledge
    and skills do not fit the agency's current needs, and your performance
    has not been adequate to justify further employment.'' Do you believe
    that the NIH has hired inept or poor performing staff?

        Answer 33. If confirmed I look forward to conducting a fulsome
    review of the NIH's workforce needs. I commit to fostering a workplace
    committed to ensuring that NIH fulfills its mission, and that any
    potential staffing changes will not compromise the mission-critical
    functions.

        Question 34. The vast majority of these civil servants have served
    the agency with distinction and stellar records of performance. Will
    you commit to rehiring civil servants at NIH with strong records of
    performance?

        Answer 34. If circumstances require hiring staff to NIH, I commit
    to inviting applicants so as to encourage top scientists and staff to
    seek employment at NIH.

        Question 35. Will you commit to rehiring veterans that served as
    NIH civil servants?

        Answer 35. If circumstances require hiring staff to NIH, I commit
    to inviting applicants so as to encourage top scientists and staff to
    seek employment at NIH. Further, I commit to following the law and
    Federal policies with respect to hiring veterans.

        Question 36. OPM sent a memo to Federal agencies last week,
    ordering them to submit Reduction in Force and reorganization plans.
    The memo asked Agency Heads to complete these force reduction plans by
    March 13. OPM then issued clarifying guidance saying that final
    decisions on workforce reductions rested with agency heads. Do you have
    any concern that the agency you have been asked to lead will make
    decisions related to force reductions and reorganization before you
    even step foot in the door?

        Answer 36. If confirmed I look forward to conducting a fulsome
    review of the NIH's workforce needs. I commit to fostering a workplace
    committed to ensuring that NIH fulfills its mission, and that any
    potential staffing changes will not compromise the mission-critical
    functions.

        Question 37. Now that it is clearly in your power to prevent
    further cuts to the workforce at NIH, will you commit to preventing
    further reductions to the workforce at NIH?

        Answer 37. If confirmed I look forward to conducting a fulsome
    review of the NIH's workforce needs. I commit to fostering a workplace
    committed to ensuring that NIH fulfills its mission, and that any
    potential staffing changes will not compromise the mission-critical
    functions.

        Question 38. Can you commit to preventing further reductions at the
    NIH Clinical Center, which would compromise patient care?

        Answer 38. If confirmed I look forward to conducting a fulsome
    review of the NIH's workforce needs. I commit to fostering a workplace
    committed to ensuring that NIH fulfills its mission, and that any
    potential staffing changes will not compromise the mission-critical
    functions, like patient care.
                        Clinical Trials and Public Trust
        Question 39. What strategies will you implement to enhance
    diversity in clinical trial participation, ensuring that research
    findings are applicable to all populations?

        Answer 39. I am committed to ensuring scientifically rigorous
    processes and supporting research that addresses the health needs of
    every American no matter their race, color, or sex.

        Question 40. Given your previous critiques of public health
    measures, how do you plan to build and maintain public trust in NIH's
    guidance and research outputs?

        Answer 40. NIH supported science should be replicable,
    reproducible, and generalizable. Like Secretary Kennedy and President
    Trump, I also support radical transparency as a way of restoring faith
    in public health.

        Question 41. Your prepared remarks endorse shifting NIH's focus
    toward the causes and treatment of chronic diseases. How do you plan to
    balance this shift with the need to maintain robust research programs
    in infectious diseases and pandemic preparedness?

        Answer 41. NIH research priorities should support the health needs
    of the American people. This will include research on infectious
    disease as well as a heightened emphasis on research related to chronic
    disease, treatment, and cure.
                           Women's Health Disparities
        Question 42. Black women are three times more likely than white
    women to die from pregnancy-related complications. What actions will
    you take to address this disparity, and how will you involve Maryland's
    healthcare community in these efforts?

        Answer 42. I am committed to supporting high-quality research that
    addresses the health needs of every American. If confirmed, I look
    forward to working with you on this important issue and looking at how
    NIH can best utilize all possible resources and expertise, including
    from your state.

        Question 43. How will you prioritize NIH funding for research into
    pregnancy-related complications that disproportionately affect women of
    color?

        Answer 43. I am committed to supporting high-quality research that
    addresses the health needs of every American.

        Question 44. Historically, women's health issues--including
    endometriosis, PCOS, and menopause--have been underfunded and
    understudied. What steps will you take to ensure that women's health
    research receives equitable NIH funding?

        Answer 44. I am committed to supporting high-quality research that
    addresses the health needs of every American.

        Question 45. How will NIH address the gender gap in clinical
    trials, ensuring women are adequately represented in medical research?

        Answer 45. If confirmed, I will support investment into the
    highest-quality research, which requires accurate representation of
    disease communities in clinical trials. I am committed to supporting a
    wide range of scientific viewpoints and ensuring that NIH research
    supports the health needs of all Americans.
                                     ______

      Responses by Dr. Jay Bhattacharya to Questions of Senator Collins,
     Senator Murkowski, Senator Marshall, Senator Scott and, Senator Banks.
                                senator collins
        Question 1. I agree with you that we need to be encouraging NIH and
    other funding entities to invest in more creative research projects
    that challenge conventional thinking. For my entire career in the
    Senate, I have been a champion for Alzheimer's disease research and
    funding. I have long suspected that the cause of Alzheimer's disease is
    multi-faceted and that we should be exploring not just the effects of
    amyloid plaque in the brain, but also the role that factors such as
    inflammation, tau proteins, and even lifestyle may play. We have to
    accept that research is still valuable if it proves that a factor is
    not a cause. NIH's latest clinical trials portfolio shows the trials of
    drug candidates for Alzheimer's disease are more diverse than ever
    before in both targets and disease stages and most trials now are for
    drug candidates that have targets other than amyloid.

            (a). If confirmed, what steps will you commit to taking to
            further outside the box research and innovation in Alzheimer's
            disease?

        Answer 1--(a). Alzheimer's disease is a devastating illness
    impacting millions of Americans and their families each year. If
    confirmed, I am committed to considering a wide range of viewpoints and
    ensuring that scientists who have new ideas have their research
    considered, even if the scientific community may not support the new
    ideas.

        Question 2. As a founder and co-chair of the Senate Diabetes
    Caucus, I have been a strong proponent of providing the National
    Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) with
    sufficient resources to accelerate the design and implementation of
    clinical trials to prevent, treat, and cure Type 1 diabetes. Last year,
    I led the reauthorization of the Special Diabetes Program (SDP) at an
    annual rate of approximately $160 million per year--the first funding
    increase in 20 years. The Special Diabetes Program has made significant
    scientific progress toward the goal of preventing, treating, and
    ultimately curing Type 1 diabetes.

            (a). Will you commit to prioritizing diabetes research,
            particularly for Type 1 where we have seen promising disease
            modifying therapies such as islet cell transplants?

        Answer 2--(a). As I stated in the hearing, NIH research should
    focus on research to solve the American chronic disease crisis,
    including into cures for diabetes. If confirmed, I look forward to
    supporting research to address these terrible, chronic diseases and
    ensuring productive collaboration among scientists with a wide range of
    opinions.

        Question 3. On January 21, the Administration directed NIH to
    temporarily pause issuing documents and public communications, which
    had the impact of canceling a number of advisory council meetings that
    were planned to consider renewals of grant funding. These delays in
    meetings to consider funding renewals has now led to potential lapses
    in funding for 14 Alzheimer's disease Research Centers who were
    originally to be considered for renewal in January. Some of those
    institutions will start to have a lapse in funding this week and all of
    them will run out of funding by April 30th without further action by
    NIH.

            (a). If confirmed, will you commit to restarting advisory
            councils to review grant applications and particularly these
            Alzheimer's research center renewals?

        Answer 3--(a). Alzheimer's disease is a devastating illness
    impacting millions of Americans and their families each year. If
    confirmed, I commit to rapidly evaluating the state of Alzheimer's
    disease research center funding and their renewal applications. I am
    committed to fostering a workplace committed to promoting evidence-
    based peer-reviewed science throughout the NIH, with advisory input
    from councils and other groups as appropriate.

        Question 4. There is no investment that pays greater dividends to
    American families than our investments in biomedical research both from
    a health perspective but also to protect our national security. The
    Administration is taking steps to reduce the size of our Federal
    workforce, but indiscriminate firing of probationary staff and now
    reportedly a pause on renewing contracts for many NIH intramural
    researchers seems to have a goal of simply reducing the NIH workforce
    without any thought to the quality of the staff in question. I'm
    further concerned by reports that foreign adversaries such as China are
    looking to hire U.S. Federal workers that have been fired--which they
    have been trying to do with our NIH researchers for years.

            (a). How would you make sure NIH maintains a workforce and
            continues to hire the best and brightest researchers, including
            early career researchers?

        Answer 4--(a). If confirmed, I commit to conducting a fulsome
    evaluation of the current workforce needs of the NIH. If circumstances
    require hiring additional staff to support the NIH's research
    portfolio, I commit to coordinate with the Trump administration to
    invite applicants and encourage top scientists and staff to seek
    employment at NIH.
                               senator murkowski
        Question 1. The NIH supports research on health care outcomes
    across different demographics, yet Alaska Native people continue to
    face longstanding health inequities. Research initiatives examining
    these disparities are limited and often lack direct input from Alaska
    Native communities. Further, rural populations, like those in Alaska,
    face significant barriers to participating in clinical trials. Alaska
    Native people have some of the highest rates of colorectal cancer and a
    higher prevalence of diabetes in our native communities.

            (a). How will you as NIH Director help ensure rural and AI/AN
            populations are represented in research?

            (b). Will you commit to prioritizing research initiatives that
            are designed in collaboration with Alaska Native peoples,
            targeting chronic diseases that are significantly impacting
            these communities?

        Answer 1(a)--(b). The role of NIH is to select and support research
    to benefit the health of all Americans. If confirmed, I look forward to
    working with you to ensure that the unique health needs of Alaskans are
    represented in the NIH research portfolio.

        As I said in the hearing, NIH research should focus on research to
    solve the American chronic disease crisis. If confirmed, I look forward
    to working with you to ensure that the unique health needs of Alaskans
    are represented in the NIH research portfolio.

        Question 2. In 2023, the NIH--through the National Institute of
    Neurological Disorders and Stroke (NINDS), published a report outlining
    the priorities of the ALS Strategic Planning working group. The report
    focused on accelerating research on ALS biology, enabling faster and
    more efficient clinical trials, and how to best translate research to
    therapy.

            (a). With a focus on validation and replication of research,
            how would you ensure the NIH remains a leader in the promotion
            of new and innovative research?

            (b). How will you work to enhance a data-sharing framework and
            foster collaboration between academia, industry, and
            organizations for people affected by ALS?

        Answer 2(a)--(b). ALS is a devastating illness and I look forward
    to supporting research into science to combat the disease. The goals of
    replication and innovation are not mutually exclusive, and if I am
    confirmed, I will support objective processes for evaluating and
    issuing awards to the best research to improve the health of Americans,
    including Americans with ALS.
        If confirmed, I am committed to evaluating current processes to
    improve facilitation of strong communication and coordination between
    the government, private industry, and universities to best serve
    patients and make sure that the United States remains the leader in
    biomedical research.

        Question 3. I continue to be concerned about the erosion of public
    trust in the healthcare system. You said that it would be your top
    priority to incentivize replication and verification of studies to
    regain people's trust in the research and healthcare agencies.

            (a). What areas of research would be early targets for
            validation?

            (b). When do studies need to be repeated and when does such
            repetition become a misuse of funds?

        Answer 3(a)--(b). If confirmed, one of my goals as NIH Director is
    for each institute to have validation and replication at the core of
    their operation. If confirmed, I will help guide each institute
    director to develop a plan for how validation can be implemented,
    supported, and measured for all research supported by each institute.

        Impactful research studies that influence future research or
    involve patient care should be able to be replicated. The scientific
    and medical communities should contribute suggestions for highest
    priorities.

        Question 4. Recently NIH has experienced significant staff
    reductions, including at the Center for Alzheimer's and Related
    Dementias, as well as a new policy preventing renewals of Title 42
    positions that affects up to 80 percent of NIH's senior scientists.

            (a). How will you balance workforce reduction directives with
            the need to maintain critical scientific expertise and research
            continuity at NIH?

            (b). What specific criteria would you use to determine which
            scientific positions are essential to protect from reduction
            efforts, and how would you ensure those determinations are
            based on scientific merit rather than other factors?

        Answer 4(a)--(b). If confirmed, I commit to conducting a fulsome
    evaluation of the current workforce needs of the NIH. If circumstances
    require hiring additional staff to support the NIH's research
    portfolio, I commit to coordinate with the Trump administration to
    invite applicants and encourage top scientists and staff to seek
    employment at NIH.

        As I said in the hearing, the NIH is the crown jewel of American
    biomedical science and, if confirmed, I would work to bring the
    highest-quality science and transparency to all its operations,
    including workforce determinations.

        Question 5. The NIH's intramural training programs, including the
    post baccalaureate program that employs approximately 1,600 recent
    college graduates and the summer internship programs, have reportedly
    been suspended. These programs are critical for developing the next
    generation of biomedical researchers.

            (a). What is your assessment of the value these training
            programs provide to the biomedical research enterprise, and
            what would be your approach to potentially reinstating them?

            (b). How would you address the potential long-term impact on
            the biomedical workforce pipeline if these programs remain
            suspended for an extended period?

        Answer 5(a)--(b). I share your view on the importance of engaging
    of young scientists and, if confirmed, I commit to evaluating the
    training programs for continuation.

        I share your view on the importance of engaging young scientists
    and, if confirmed, I commit to evaluating the training programs for
    continuation.

        Question 6. While the vast majority of researchers participating in
    NIH-funded grants are honest, hardworking contributors to scientific
    progress that benefits society, concerns persist about foreign
    government interference in federally funded research. The NIH itself
    has identified ``undisclosed sources of foreign research support'' as
    an issue. In some cases, researchers have received NIH funding while
    simultaneously accepting financial support from foreign governments,
    institutions, or talent recruitment programs--without properly
    disclosing these affiliations. Notably, countries like China have
    established talent recruitment programs aimed at attracting
    researchers, including those involved in U.S. government-funded
    projects. These programs raise concerns about intellectual property
    theft, conflicts of interest, and national security risks?

            (a). What steps are you taking to safeguard federally funded
            research from foreign influence and ensure transparency in any
            foreign affiliations?

        Answer 6--(a). While NIH has made some effort to educate the its
    workforce regarding foreign influence threats, if confirmed, I am
    committed to consulting with law enforcement and the intelligence
    community to evaluate the extent of the threat to NIH scientists and,
    if necessary, initiate mandatory training of intramural and extramural
    scientists.

        Question 7. There has been a lot of conversation and concern around
    the utilization of vaccines. Alaska recently had a measles case, and
    there are several outbreaks currently within the country. In our
    meeting, you shared that you had confidence in the studies that
    demonstrated that vaccines do not cause autism.

            (a). Will you repeat your confidence in these studies for the
            record?

        Answer 7--(a). Yes.
                                senator marshall
        Food is medicine research funding:

        Diet-related chronic conditions, such as cardiovascular disease,
    diabetes, and obesity, are leading contributors to death, disability,
    and health care costs; an estimated 45 percent of deaths from
    cardiovascular disease are diet-related.

        Food is medicine interventions, including medically tailored meals,
    medically tailored groceries, and produce prescription programs, have
    demonstrated significant potential to improve health outcomes and can
    be cost effective, but much more research is needed to address
    remaining evidence gaps and scale these programs nationwide.

        Despite the significant potential population health impact, current
    NIH funding for food is medicine research is only about $8.5 million,
    and overall nutrition research has been critically underfunded at only
    4 percent of NIH's total research budget.

        Question 1. How would you better prioritize food is medicine
    research to reduce the burden of diet-related chronic diseases?

        Answer 1. I am committed to evaluating opportunities for
    collaboration and to support food is medicine research to reduce the
    burden of diet-related chronic diseases.

        Gain-of-function research:

        Gain-of-function (GOF) research aims to genetically alter a virus
    or organism to gain or lose function on its transmissibility or
    pathogenicity. Most evidence suggests the COVID-19 virus is more than
    likely the product of GOF research conducted in a Wuhan, China
    laboratory funded by Dr. Fauci's National Institute of Allergy and
    Infectious Disease (NIAID) and the U.S. Agency for International
    Development. Experts agree that GOF poses unnecessary risks and that
    safer alternatives are available.

        Question 2. Do you commit to immediately halting all present and
    future NIH-funded gain-of-function research?

        Answer 2. As I said in the hearing, the NIH must vigorously
    regulate risky research that has the possibility of causing a pandemic.
    It should embrace transparency in all its operations. While the vast
    majority of biomedical research poses no risk of harm to research
    subjects or the public, the NIH must ensure that it never supports work
    that causes harm. If confirmed, I will work with Congress and the
    Administration to guarantee that happen.

        March-in:

        President Biden proposed to expand the Bayh-Dole Act's March-In
    rights beyond its legislative intent and subsequently weaken IP
    protections on the basis of drug prices, likely causing a chilling
    effect on innovation. In President Trump's first term, a petition to
    exercise this authority was denied; he upheld the intent of the law as
    Kansas Senator Bob Dole has made clear and Secretary Kennedy recently
    confirmed his similar interpretation of the law as well.

        Question 3. If confirmed, will you commit to maintaining that
    position to protect the life sciences ecosystem?

        Answer 3. I commit to conferring with the HHS Office of General
    Counsel on legal matters and following the law.

        National Plan to End Parkinson's:

        Recent scientific advancements tell us that neurodegenerative
    diseases (NDDs) like Parkinson's, Alzheimer's, and other related
    dementias have more commonality than difference when it comes to how
    they present inside the human brain. However, NDD research is currently
    spread across two primary NIH institutes and an additional 8 supporting
    institutes--a structure which inhibits scientific collaboration and
    efficiencies.

        Question 4. When confirmed, please describe how you will lead NIH
    in funding coordinated research to uncover and further define these
    shared aspects.

        Answer 4. Neurodegenerative illnesses like Parkinson's and
    Alzheimer's are devastating for millions of American families with
    afflicted loved ones. If confirmed, I look forward to reviewing how NIH
    policies and procedures can be optimized to support the highest-quality
    research possible.
                                 senator scott
        Question 1. Dr. Bhattacharya, I really enjoyed our meeting earlier
    this week, in which we talked about U.S. life expectancy flatlining
    between 2012 to 2019 and plummeting during the pandemic. South Carolina
    has a high burden of chronic diseases, such as S.C. having the seventh-
    highest stroke death rate in the country as well as heart disease being
    the state's leading cause of death. I'm proud of the work that the
    University of South Carolina is doing in both lifestyle medicine
    through the U.S.C. School of Medicine Greenville and also through their
    new Brain Health Network to help connect South Carolinians to specialty
    neurology care to help with memory care and stroke services.

            (a). If confirmed, how would you incentivize NIH to invest in
            chronic disease research, especially at universities that are
            in states with a higher burden?

        Answer 1--(a). If confirmed, I am committed to making sure that NIH
    funds are invested wisely to address America's chronic health needs. As
    I discussed in my confirmation hearing, research into potential
    treatments for chronic diseases has not fully been explored but I
    commit to ensuring NIH is doing research in support of the public good
    and chronic disease needs.

        Question 2. Throughout my time in the Senate as the Ranking Member
    of the Senate Aging Committee as well as a Member of both this
    Committee and the Senate Finance Committee, I have worked on trying to
    find solutions to our chronic disease crisis. Last year, over 1 in 8
    South Carolinians were diagnosed with diabetes compared to 1 in 10 in
    Europe. It is the 8th leading cause of death for people in my state. My
    PREVENT DIABETES Act delivers life-saving results for older Americans
    in the Palmetto State and across the country through allowing for CDC-
    certified virtual care options in the Medicare Diabetes Prevention
    Program. I strongly agree with Secretary Kennedy, that as a country we
    must take the necessary steps to address our chronic disease burden.

            (a). As Director of NIH, how would you support research into
            all of the factors that play into chronic diseases, such as
            obesity and diabetes?

        Answer 2--(a). The goal of the NIH is to make Americans healthy and
    to support research that makes Americans healthy again. If I am
    confirmed, I will support research into the broadest set of ideas in
    order to address the problem of chronic disease and all of its related
    factors.

        Question 3. The Medical University of South Carolina (MUSC) has
    been a leader in both cell and gene therapies. MUSC is making its own
    CAR-T cell therapies for lymphoma in Charleston while also being the
    licensed site for the two FDA-approved sickle cell disease gene
    therapies. These therapies hold tremendous potential to revolutionize
    the treatment of many life-threatening diseases, offering hope to
    patients who previously had limited options. As these therapies move
    from research to wider spread applications for cancer and rare diseases
    like sickle cell anemia, it is crucial that we ensure appropriate
    funding mechanisms to support the institutions leading their
    development. The NIHs recent guidance threatened to cut indirect grant
    support and jeopardize the possibility of research institutions to
    fully engage in and support cutting-edge studies progress.

            (a). Dr. Bhattacharya, if confirmed as NIH Director, would you
            commit to figuring out the best path forward to allow research
            universities to use limited resources effectively through
            indirect costs?

        Answer 3--(a). I support the Administration's efforts to find
    efficiencies and be fiscally responsible. If confirmed, I will assess
    NIH funding levels and work with relevant parties to make any necessary
    adjustments.

        Question 4. As we move closer to realizing the full potential of
    cell and gene therapies, it is essential that we have strong
    collaborative efforts to accelerate progress.

            (a). Dr. Bhattacharya, can you speak to your views on the
            bespoke gene therapy consortium and how you will leverage this
            initiative to support the development of personalized
            treatments for patients?

            (b). Dr. Bhattacharya, can you outline how you will prioritize
            investments in basic research to ensure that we continue to
            make breakthroughs that can fuel the next generation of cell
            and gene therapies?

        Answer 4(a)--(b). If confirmed, I look forward to learning about
    the work of the consortium. I share the goal of accelerating gene
    therapies for rare diseases and will work with all stakeholders to
    advance this priority.

        If confirmed I intend to support both basic science on gene
    therapies as well as translational clinical science to help discover
    more cures.

        Question 5. The incidence of Parkinson's disease is expected to
    increase 50-100 percent in the next 20 years and could reach 1.61
    million patients by 2037. MUSC's Murray Center is a nationally
    recognized multidisciplinary center that supports campus-wide research
    on Parkinson's Disease and Related Disorders with the ultimate vision
    of developing novel therapies for these conditions. The Murray Center
    does amazing work to improve care for South Carolinians with
    Parkinson's disease.

            (a). Would you work with me to ensure that one of MUSC's
            subject matter experts from the Murray Center is considered to
            be a member of the National Plan to End Parkinson's Advisory
            Council?

        Answer 5--(a). Parkinson's is a devastating illness and, if
    confirmed, I look forward to evaluating how the NIH can best assist HHS
    in implementing the Dr. Emmanuel Bilirakis and Honorable Jennifer
    Wexton National Plan to End Parkinson's Act, which creates an Advisory
    Council on Parkinson's Research, Care, and Services. I commit to
    working with you on this important issue and looking at how NIH can
    best utilize all possible resources and expertise.
                                 senator banks
        Question 1. Under Director Collins, NIH allocated record levels of
    funding to experimentation on aborted babies. One particularly shocking
    experiment involved researchers grafting fetal scalps onto lab rats. If
    confirmed, what will you do to ensure that research is not done using
    means that many Americans find morally and religiously abhorrent?

        Answer 1. Yes, as I stated in the hearing, I think it is important
    that products of science are ethically acceptable to Americans.

        Question 2. Is fetal tissue actually necessary to conduct research?
    What alternatives are available?

        Answer 2. As I stated in the hearing, I think it is important that
    products of science are ethically acceptable to Americans. There are
    alternatives to fetal tissue that can be used as effectively as fetal
    tissue to conduct research.

        Question 3. Antibiotic resistance is a serious and growing threat
    to national security and Americans' health. Extensive use of human
    antibiotics in food-producing animals in countries like China is
    contributing to this rise, as well as naturally increasing resistance
    due to our overreliance on certain classes of antibiotics. This rise in
    resistance comes at a time when private investment in antibiotic R&D
    has lagged behind other drug classes. At the same time, China is
    investing heavily in innovation to create its own new antibiotics and
    exploiting the current weakness of the U.S. industry to secure rights
    to U.S.-invented products. NIAID support for antibiotic innovators has
    been crucial, and many of the new antibiotics that NIAID funds have
    utility as medical countermeasures against bacterial threat pathogens,
    ensuring the safety of our citizens and warfighters in the event of an
    attack. What is NIH's plan to partner with domestic product developers
    to enable them to combat antibiotic resistance and retain America's
    leading role in antibiotic development?

        Answer 3. The United States is the leader in scientific research
    and development and I agree with you about the importance of combating
    antibiotic resistance. If confirmed, I look forward to evaluating the
    existing NIH research portfolio with respect to antibiotic resistance.
    Further, I am committed to facilitating strong communication and
    coordination between NIH and private industry in order to deliver
    results for the American people.

        Question 4. NIH invests nearly $50 billion annually in scientific
    advancement, yet it conducts surprisingly little research on the
    effectiveness of its own funding mechanisms and processes. If
    confirmed, what specific steps would you take to encourage research on
    the effectiveness of NIH's funding mechanisms? Would you consider
    establishing a dedicated unit to test reforms that could improve
    returns on investment across all institutes?

        Answer 4. If confirmed, I look forward to evaluating the efficacy
    of existing NIH practices and procedures. I will work across the
    Administration to ensure taxpayer dollars are spent responsibly and
    efficiently.

        Question 5. If confirmed, how would you direct NIH identify and
    prioritize research areas where market failures are most pronounced,
    particularly those with large social benefits but limited private-
    sector incentives? What concrete steps would you take to enhance
    coordination across NIH institutes and reallocate funding to support
    these neglected but critical research areas?

        Answer 5. The NIH is committed to conducting research on rare
    diseases and if confirmed, I am committed to working to ensure that our
    biomedical research enterprise benefits all Americans.

        Question 6. If confirmed, what changes would you pursue to reduce
    penalties for scientific risk-taking? How would you address barriers
    facing early career investigators, given evidence that scientific
    progress often depends on young researchers who explore new ideas and
    bring fresh perspectives?

        Answer 6. If confirmed, I look forward to fostering a scientific
    environment that welcomes transparent, fact-based debate of dissenting
    opinions. As someone who was personally subject to censorship by the
    previous Administration and NIH leadership, I know that science needs
    free speech to succeed and I am committed to ensuring that we allow
    people to speak with each other openly, even when their ideas are
    controversial.

        Question 7. If confirmed, what specific changes to the indirect
    rate policy will you focus on to better align NIH's incentives with
    maximizing scientific output? What measurable outcome would you use to
    determine whether changes to indirect cost policy are successful?

        Answer 7. I support the Administration's efforts to find
    efficiencies and be fiscally responsible. If confirmed, I will assess
    NIH funding levels and work with relevant parties to make any necessary
    adjustments.
                                     ______

        [Whereupon, at 12:05 p.m., the hearing was adjourned.]

                                      [all]