The Bethesda Declaration: One Year Later Introduction and Concern 1

On the One Year Anniversary of the Bethesda Declaration, 70+ former and current NIH workers authored a document outlining the continued concerns.

Jun 09, 2026

27 UNIHTED is breaking up the Bethesda Declaration: One Year Later into multiple sections which will be released over the next few weeks. You can read the entire document on 27 UNIHTED’s website along with the original Bethesda Declaration.

Introduction

Founded in 1887, the National Institutes of Health (NIH) is still the world’s largest funder of biomedical research after more than a century. Currently, NIH has been at the forefront of scientific and technological advances that meaningfully improve the health of Americans and people across the globe: novel medications that prevent transmission of HIV; innovative technologies like CRISPR gene editing, AI-driven drug design, digital health technologies, and tissues on a chip; life-saving therapeutics for cystic fibrosis; a vaccine to prevent cancer; and cutting-edge treatments for diabetes, depression, Alzheimer’s disease and obesity, among many others.

For over half a century, these NIH-led scientific advances have been fueled by consistent public funding from Congress, expert input from scientists, and global recruitment of top talent. Economists estimate that every dollar invested in NIH returns $2.57 in economic activity per year and more than $8.38 in private sector research and development over 8 years.

Last year, NIH Director Dr. Jayanta Bhattacharya released scientific priorities that claim to build on this success. Yet, Director Bhattacharya has repeatedly implemented policies and practices that not only undercut these stated priorities, but endanger the standing of the United States as a global leader in biomedical research.

One year ago, on June 9, 2025, we released the Bethesda Declaration, an open letter of concern to Director Bhattacharya, Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., and Congress. Signed by more than 600 NIH staff and 32,000 external scientists, patients, and members of the general public, the Declaration raised concerns about harmful policies that undermine the NIH mission, waste public resources, compromise the ethical imperatives of our profession, and threaten the health of Americans and people across the globe. These concerns include i) the politicization of NIH-funded science; ii) the interruption of global collaboration; iii) the undermining of peer review; iv) capping infrastructure support that is critical to science; and v) cuts in mission-critical personnel.

We hoped our Declaration might engender policy changes to prevent harm, improve public health, and ensure appropriate stewardship of public funds. When Director Bhattacharya held a roundtable with Bethesda Declaration signers on July 21, 2025, we had some optimism that we might together correct some of the most egregious threats to NIH. Ultimately, however, Director Bhattacharya largely ignored the concerns raised in our declaration and discussed during the roundtable.

Today, on June 9, 2026, we provide an update to members of Congress and the public on the current status of NIH, one year after the Bethesda Declaration. The chaos of 2025 has been replaced with coordinated, systematic, institutionalized destruction in 2026. NIH policy directed by HHS and the Office of Management and Budget (OMB) and implemented by Director Bhattacharya continues to flout ethical, statutory, and legal standards, including stipulations in the Public Health Service Act (42 U.S. Code Chapter 6A) for NIH to include diverse populations in research, address health disparities, conduct research related to the health of sexual and gender minority populations, and enhance workforce diversity. Our initial concerns have only deepened as we’ve seen the consequences of this administration’s policies: a 24% decrease in new research funded by NIH in fiscal year (FY) 2025 compared to FY24; project terminations that have discarded investments in multi-year studies and disproportionately impacted early career investigators from minority racial, ethnic and gender groups; extreme staff shortages; and dramatic delays in research awards. A May 29, 2026, proposed rule on the Regulation for Federal Financial Assistance from the OMB promises a return to the chaos of early 2025, codifying into regulation the policies and practices that enabled these harms. Despite the clearly documented negative consequences of such policies, Director Bhattacharya continues to gaslight the scientific community and members of Congress, insisting these challenges are just “political noise.”

In this report, we expand on and provide further evidence that the five initial concerns outlined in the Bethesda Declaration remain critically urgent. The concerns include:

We remain committed to the NIH mission, the United States Constitution, and the health and wellbeing of the American public. We sincerely hope that by continuing to shine a light on the harmful policies of current NIH leadership, we can advance meaningful reforms that will enable us to carry out the NIH mission: “to seek and apply fundamental knowledge to enhance health, lengthen life, and reduce illness and disability.”

Concern 1: An anti-science agenda is disrupting research for health advances and cures

Why It Matters

Health advances require stable, long-term investment across multiple sectors and phases of the scientific process. Good stewardship of this investment demands constant monitoring and mid-course correction. Scientific expertise guides the weight given to innovative ideas – neither overvaluing original concepts in the face of robust evidence to the contrary, nor ignoring them simply because they are novel.

To find this balance, NIH has traditionally relied on two layers of peer review combined with programmatic guidance and oversight:

First level peer review: a merit-based review process involving external scientific experts. NIH’s peer review process occurs at multiple levels. In the first level, external scientists, who have a strong record of scientific accomplishment and are approved by NIH staff in the Center for Scientific Review (CSR), volunteer their time and expertise to judge the scientific merit of proposed research projects based on long-standing, regulatorily defined review criteria (42 C.F.R. § 52h).
Programmatic review by highly trained, nonpartisan civil servant scientists with expert knowledge in their fields. These knowledgeable and experienced NIH scientific program staff are involved in the development of funding opportunities and funding recommendations. Specifically, program staff identify scientific gap areas where additional research is needed. They take input from external scientific advisory boards with relevant expertise (including patient advocates) as they develop funding opportunities to address identified research needs. They also make funding recommendations regarding applications in their area of expertise, informed substantially by the missions and strategic priorities of their NIH institute or center, scientific merit as judged independently by peer review, and scientific gaps and opportunities that guide NIH investment to improve public health. The funding recommendation process typically involves discussion among scientific program staff at the branch or division level, with Branch or Division Directors arbitrating the process and making final recommendations to the Institute or Center Director.
Second level peer review: Advisory Council Review by working scientists and patient advocates. Each NIH institute works with a set of external scientific experts and individuals with lived experience, established through the Federal Advisory Committee Act (5 U.S.C. § 1009). Advisory Councils of scientific experts and community stakeholders guide programmatic decisions by NIH scientists, including development of funding opportunities and funding recommendations. The roles, requirements and functions of these advisory councils are defined in statute and regulation (42 U.S.C. § 284a, 42 C.F.R. § 52a and 42 C.F.R. § 52h).

Historically, the checks provided by this thorough and considered process have largely curbed the interference of politically appointed non-experts, maintaining the stability and nonpartisan nature of scientific funding across changing political administrations. This stability is what has allowed scientists to do the long-term work required to develop treatments, optimize health, and save lives, positioning the United States as a world leader in biomedical research.

Currently, however, the system needs reinforcement. NIH is implementing policies that devalue scientific expertise in favor of politically motivated decision-making. NIH is circumventing merit-based peer review, expanding the number and power of political personnel in positions of decision-making power at NIH, reducing the civil servant protections that enable a nonpartisan civil service to honestly share their scientific judgement, failing to ensure appropriate leadership across the NIH institutes and centers, with 14 of 27 directorships unfilled, and neglecting or replacing scientific advisory councils.

Devaluing scientific expertise not only breaks the long-established trust that researchers had in the federal science funding structure, but also erodes the American public’s trust in science. Undermining peer review with a partisan, anti-science agenda wastes time and resources, shifts investments toward political allies rather than the most meritorious candidates, and damages the NIH’s ability to support science that will improve the health of all Americans.

Examples

Grant terminations and political review undercut evaluations of scientific merit. Every grant funded by the NIH undergoes multiple levels of extensive and rigorous peer review involving external and internal scientists. In recent decades, research applications are typically only funded when they score within the top 20%, with few, unique exceptions. In early 2025, a small team of political appointees undermined this extensive, rigorous and transparent process by abruptly terminating ongoing science. Initially, these terminations were carried out by the Department of Government Efficiency (DOGE). But by April 2025, orders from Director Bhattacharya and Deputy Director Matthew J. Memoli compelled NIH civil servants to terminate existing grants. NIH terminated 5,522 grants, even though they had been deemed meritorious by the rigorous and competitive review process. NIH terminated grants without regard to the content, quality, progress, or potential health impact of the science. Instead, terminations were based on alleged discrimination supposedly committed by the grantee institution or simply the presence of words or concepts that political leaders disliked. While terminations have become far less frequent, the threat of termination persists. All awards now must include a statement that the grant can be terminated based on misalignment with “agency priorities” that actually refer to terms deemed objectionable by the current administration. The context of how those terms are used does not matter. The existence of such terms in an application matters. Thus, grantees are compelled to comply with censorship from the Department of Health and Human Services and NIH, resulting in alteration of studies deemed important, rigorous, and feasible by peer review. Currently, practices controlled by the Office of Extramural Research (OER) within the NIH Office of the Director subject program staff and external investigators to a discriminatory and cumbersome screening and “renegotiation” process. NIH leadership has justified these acts by establishing the ill-defined concept of “Gold Standard Science” and then claiming that any research project that doesn’t align with the administration’s political priorities does not meet the standard. The process is reminiscent of how the tobacco industry weaponized “sound science” to undermine research linking cigarettes to cancer.

New policies undermine the first level of peer review. Following an Executive Order from President Trump that suggested political appointees could override peer review, Director Bhattacharya issued his “Unified Funding Strategy,” instructing NIH institutes to reduce the influence of peer review scores and expert feedback on funding decisions. The recent OMB proposed rule goes further, seeking to codify the minimization of peer review into regulations that carry the weight of law. NIH will soon seek public comment on a proposal to replace numerical peer review scores with a binning system that would cluster applications into three bins: “most competitive” (top 25%), “competitive” (26–50%), and “not discussed” (bottom 50% or unscored). The peer review score would be calculated, but withheld from program staff, Advisory Councils, institute and center leadership, and applicants, making a top-scoring first percentile grant indistinguishable from a grant at the 25th percentile. While data do suggest that scores within tight ranges may not reflect meaningful differences in science quality, binning scores across such broad ranges is not well supported by evidence and has not been piloted inside NIH. This system will remove valuable information from the peer review process, reduce transparency in funding decisions, and enable funneling of resources to NIH decision-makers’ more favored pet projects, even if they are not deemed scientifically meritorious by peer review.

Diminished roles of external scientific advisory boards reduce oversight. To ensure NIH funding decisions are scientifically sound, advisory committee members must demonstrate integrity, be free from conflicts of interest, and have appropriate expertise. During the time-intensive process of appointing advisory committee members, NIH staff make every effort to ensure the committee not only has necessary scientific expertise but also is representative of the nation as a whole. Despite the critical importance of these committees, current NIH leadership has allowed the membership of many institute Advisory Boards or Councils to dwindle. Because official concurrence from an Advisory Council legally requires a quorum, this poses a serious threat to the ability of NIH ICs to award grants at all. In addition, Director Bhattacharya completely disbanded the long-running Advisory Council to the Director. The NIH similarly dismissed all 28 members of the National Cancer Institute’s Board of Scientific Advisors, which for decades reviewed research and education projects. Other institutes abruptly removed individual members from Boards of Scientific Advisors, with dismissals primarily affecting non-U.S. citizens, women, people from racial and ethnic minority groups, and scientists focusing on topics disliked by the administration. Recent appointments to these Councils, such as Kristine Blanche, wife of Acting Attorney General and former Trump lawyer Todd Blanche, raise concerns about partisan cronyism.

Notices of funding opportunity (NOFOs) are delayed by political review. Notices of funding opportunity are an essential tool for NIH to invite research applications addressing emerging or understudied research areas. Before publication, NOFOs undergo rigorous review by scientific program staff, institute and center leadership, and Advisory Councils. Prior to 2025, NIH typically released more than 700 NOFOs each year. As of March 25, halfway through fiscal year 2026, NIH released just 17. This decrease is due to the insertion of new layers of political review by NIH, HHS, and OMB, as well as OER directives limiting the number of NOFOs allowed. In some cases, notices drafted in January 2025 have yet to be released, because they are still awaiting political approval or political appointees have denied them. Having very few NOFOs delays opportunities to advance cutting-edge science and has forced NIH staff to choose between disrupting long-running programs that provide critical research services to the community or extending these programs without competition to ensure service delivery.

A culture of fear silences scientific input from NIH staff. NIH now suffers from a culture of fear and low morale as a result of threats to and retaliation against civil servant staff, as described in Concern 9. This has constrained the ability of NIH staff to deliver accurate and appropriate scientific feedback or highlight evidence to NIH leadership that conflicts with current Administration priorities. NIH staff fear will only escalate as NIH begins to transition career civil servant staff to career/policy designations that make their employment “at will,” as these changes enable politically motivated staff dismissals.

Recommendations

Restore and bolster the outputs of first-level peer review at NIH wherein expert panels impartially deliberate on the scientific merits of grant applications by 1) maintaining the availability of numeric scores, 2) ensuring that any binning systems provide sufficient levels of granularity and are piloted prior to broadscale implementation, and 3) ensuring funding decisions reflect input from peer review.
Safeguard the input of NIH scientific staff with expertise in relevant research areas on funding decisions, ensuring that those who are charged with carrying out disbursement of public funds do so in a transparent, legal, and efficient manner. This will require an environment where staff can safely speak honestly. Sound funding decisions cannot realistically come from a few political appointees, even if they had relevant scientific expertise, as no individual alone can have the depth and breadth of expertise to cover all areas of health research within the NIH mission.
Support academic freedom at NIH for both intramural and extramural research staff. Support the agency and authority of institute and center leadership and insulate these leaders from political winds. For individual intramural labs, support high-quality, curiosity-driven inquiries as reviewed by peer scientists. Deepening our understanding of biological processes through excellent fundamental research consistently leads to medical advances that arise from unexpected areas of inquiry. For extramural staff, ensure staff feel safe sharing their honest scientific judgement and aren’t penalized for raising scientific concerns.
Reconstitute and fully staff NIH Institutes’ Scientific Advisory Councils and Boards. Such boards should include scientists and patient advocates from relevant fields who have been well vetted for potential conflicts of interest, which include close connections with members of the administration or related financial stakes.
Restart and deepen collaboration with patients and other affected communities, such as people living with or at risk for relevant health conditions and their caregivers, to ensure NIH research supports patient-centered outcomes. This should include continued participation of relevant community members on advisory boards serving institute Advisory Councils, as well as community advisory boards to NIH-funded clinical studies.
Ensure future grant terminations only occur when justified by scientific or ethical concerns, such as study futility, early determinations of efficacy, irreparably poor progress, unexpected participant harm, or investigator misconduct. Study terminations should not be allowed based on lack of alignment with politicized agency censoring set by any administration, as these will inevitably change every 4 to 8 years, creating whiplash in the scientific community and allowing completion of very few studies.

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