The State of the U.S. Biomedical and Health Research Enterprise: Strategies for Achieving a Healthier America

A U.S. biomedical research enterprise advisory body, created by the President of the United States and Congress, to galvanize national leadership, develop a national strategic vision, and coordinate efforts and resources.

This advisory body could:

• Be composed of leading scientists from a wide variety of disciplines, such as life, physical, social, and behavioral sciences; engineering; economics; and the humanities to ensure a convergence science approach to addressing all emerging needs;
• Engage with multiple relevant federal agencies;
• Be established with long terms;
• Be empowered to set national goals and benchmarks;
• Provide input on resource allocation that matches strategy;
• Consider, examine, and utilize global best practices in all aspects of its work, but especially as guidance for developing the national strategic vision;
• Include patients, caregivers, and members of the public to provide transparency and public engagement;
• Have clear, measurable goals and timelines;
• Coordinate with the National Economic Policy Council and the Domestic Policy Council to ensure the engagement of all relevant stakeholders; and
• Monitor their progress and report to Congress and the American public annually on their work.

The advisory body’s national strategic vision could:

• Directly address the current fragmentation in funding and agenda-setting present in the U.S. biomedical research enterprise. The national strategic vision cannot succeed without coordination and alignment of funding and agenda-setting, which, conversely, cannot be coordinated and aligned without the guidance of a national strategic vision. These Actions cannot be separated.
• Set priorities for the use of convergence science and implement a roadmap for bringing together relevant agencies and scientific disciplines to achieve this collaborative approach.
• Consider and propose funding to address:
  • Existing and emerging health challenges;
  • Future health threats such as increasing risks of extreme heat and other natural disasters due to climate change and emerging or existing infectious diseases;
  • Public engagement in the entire U.S. biomedical research enterprise, but especially focused on increased participation in clinical trials;
  • Deteriorating public trust in science and medicine;
  • Prioritization and development of new and innovative research approaches to reduce and eliminate health disparities; and
  • The needs of the U.S. biomedical research enterprise workforce, including adjusting historical pathways to employment or tenure as emerging health challenges, approaches to science, or the needs of the American public change.

A federally established national biomedical research funding collaborative, guided by best practices from existing international models, and federal determinations of how best to organize and allocate shared investments from the government, private sector, and philanthropy. The funding collaborative could be empowered to:

• Analyze successful existing models to develop best practices for the implementation of new methods for financing and accelerating biomedical research;
• Create a large-scale funding model to address the health challenges identified in the national strategic vision;
• Develop new philanthropic collectives to encourage pooled, strategic gifts that can make a large impact.

Federally developed initiatives and funding strategies to specifically address the issue of the “funding valley of death” to translate promising basic research into breakthrough therapies, diagnostics, and treatments—helping to ensure that the full value of the U.S. biomedical research enterprise reaches all patients equitably.

Federal prioritization of research that informs solutions for achieving health equity in the United States, including those focused on the social determinants of health, diversifying the workforce, and the U.S. biomedical research enterprise itself. These research areas could include:

• Increasing trust in medicine, science, and the U.S. biomedical research enterprise itself;
• Mitigating structural and systemic discrimination;
• Delivering care to patients and the communities where they reside, using advances in implementation science to guide these solutions;
• Improving the communication of scientific and medical information; and
• Bolstering community engagement and effective bidirectional dialogue.

Federal prioritization of research on the “health equity valley of death”—closing the last mile—to understand and eliminate barriers that are preventing the most vulnerable populations in the United States from receiving and accessing comprehensive, high-quality, culturally appropriate care. Specific research areas could include:

• The digital divide;
• Improving access to health care, specifically for individuals who cannot afford adequate or any insurance coverage;
• Transportation barriers;
• “Health care deserts,” or a lack of health care providers—primary and specialty—in a given geographic area;
• Improving trust in science, medicine, and practitioners of both;
• Providing care outside of clinics and hospitals to meet individuals where they are, and;
• Reducing racism, sexism, and other discriminatory practices that may keep individuals from seeking care.

Federal requirement and facilitation of necessary and essential coordination across government agencies, especially the National Institutes of Health and the National Science Foundation, as well as external parties, to enable the use of convergence science, coordinate funding and strategy, adequately address the increasingly complex and interconnected health challenges facing the nation, and promote information sharing.

Federal promotion and use of convergence science in all appropriate projects receiving federal funding.

Steps by the federal government and Congress to increase the competitiveness of the U.S. biomedical research enterprise workforce, including the following key priorities:

• Align the U.S. biomedical research enterprise’s national strategic vision with the needs of its workforce and set goals to meet those needs;
• Incentivize and implement appropriate, specialized, and necessary education and training for all levels of the U.S. biomedical research workforce—including a reinvigorated focus on K–12 science, technology, engineering, and mathematics education to reinforce the pipeline at its earliest stages
• Remove barriers that may prevent full accommodation and integration of international scientists into the U.S. biomedical research enterprise workforce, including expanding eligibility for federal research funding to temporary visa holders;
• Expand Early-Stage Investigator funding opportunities, particularly for physician-scientists, to help stabilize the career-launch phase of becoming an independent investigator;
• Reclassify federally funded postdoctoral scholars as employees and provide full benefits to remove unpredictability and make these positions more attractive;
• Prioritize and implement innovative approaches to recruiting and retaining the specialized workforce, including by expanding student loan forgiveness, providing new funding modalities for postdoctoral trainees, and creating early career development awards for new investigators seeking to pursue research fields prioritized by the national strategic vision