Appropriations for the 2022 fiscal year increase NIH funding by 4.7% and raise NCI funding by 5.3%. The budget also includes $1 billion to launch the Advanced Research Projects Agency for Health, which will foster potentially groundbreaking research that could improve patient care.

After nearly 6 months of uncertainty, appropriations for the NIH and NCI have been finalized for the 2022 fiscal year (FY) thanks to the passage of an omnibus appropriations bill signed by President Joe Biden on March 15. The bill provides funding increases for NIH and NCI and furnishes start-up money for a new effort that researchers hope will channel the same kind of visionary thinking that led to the Internet and self-driving cars.

The NIH budget of nearly $45 billion represents a net increase of $2.1 billion, or 4.7%, while the NCI's $6.9 billion budget is a 5.3% bump over FY21. The NCI's $353 million increase was more than twice the $173 million that the Biden administration had requested. Of that amount, Congress directed $150 million toward upping the NCI's grant application success rate, currently at 12%.

Congress also appropriated the money authorized for the original Cancer Moonshot, the initiative approved in 2016 to make 10 years of progress in cancer research in half that time. In the next-to-last year of funding for that effort, the NIH and NCI will receive $496 million and $194 million, respectively.

In addition, the bill provides $3.3 billion in discretionary funding for the FDA, an increase of $102 million, and $8.5 billion for the Centers for Disease Control and Prevention, an increase of $582 million, of which $4 million more than in FY21 will be dedicated to cancer programs.

Childhood cancer programs fared well—the STAR Act and the Childhood Cancer Data Initiative were fully funded at $30 million and $50 million, respectively.

In his State of the Union address on March 1, Biden called for the creation of the Advanced Research Projects Agency for Health (ARPA-H), the biomedical equivalent of the Defense Advanced Research Projects Agency (DARPA), which has backed high-risk, high-reward research, some of which paid off with significant breakthroughs—including self-driving cars, the Internet, and the global positioning system. A similar agency willing to “go way out on the limb” is necessary and could revolutionize aspects of cancer medicine, such as early detection, says Chi Van Dang, MD, PhD, scientific director of the Ludwig Institute for Cancer Research in New York, NY. “If we keep doing the same thing, we will probably get the same results.”

The budget receives good marks from Clifford Hudis, MD, chief executive officer of the American Society of Clinical Oncology, because “it shows there is bipartisan support for yearly increases.”

However, David Agus, MD, CEO of the Lawrence J. Ellison Institute for Transformative Medicine of USC in Los Angeles, is lukewarm on the final numbers. “It's an average budget. Nobody's cheering and nobody's crying,” he says. “It will allow us to keep doing what we are doing. But that's not enough.” The budget falls short, he says, on funding for ARPA-H, which garnered $1 billion to fund its launch. However, that sum is $5.5 billion less than the Biden administration had requested.

Dang was also disappointed by what he calls the “meager” funding for ARPA-H. “It's time to make a bet.”

Congress may allocate larger sums for ARPA-H in the years ahead, but other major funding decisions loom. For instance, spending for the first Cancer Moonshot is authorized through FY23, but continuing any of the more than 240 projects started under the initiative may require more money. In addition, on February 2, Biden announced a reignited Moonshot, aimed at reducing cancer mortality by 50% over the next 25 years. However, the administration has not provided details on the cost of this program or how it would be funded. –Mitch Leslie

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