What the National Institutes of Health (NIH) Does

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The National Institutes of Health (NIH) is the United States’ premier biomedical research agency and one of the most influential health organizations in the world. As part of the U.S. Department of Health and Human Services, the NIH leads the nation’s efforts to understand diseases, improve health, and save lives. Founded over a century ago and growing into a powerhouse of science, the NIH today stands as the largest public funder of biomedical research globally, fueling decades of medical advances that have improved health and society.

NIH Mission and Historical Evolution

The NIH’s core mission is “to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.” This guiding purpose has its roots in the late 19th century and has evolved greatly over time. The NIH traces its origins to 1887, when a one-room laboratory was established on Staten Island as part of the Marine Hospital Service (a precursor to the U.S. Public Health Service). This humble “Hygienic Laboratory” initially focused on studying infectious diseases and public health threats. In 1930, the U.S. Congress, through the Ransdell Act, expanded and renamed the lab the National Institute of Health (singular), signaling a broader commitment to medical research.

Over the ensuing decades, the NIH grew from a single institute into a collection of specialized research institutes. Several new institutes were founded in the 1930s and 1940s, and after World War II the NIH entered a “golden era” of expansion. The focus shifted toward supporting research across the country through a robust grants program. By funding scientists at universities and medical centers nationwide, the NIH greatly expanded the scope of U.S. biomedical research. Today, the name “National Institutes of Health” reflects its makeup of 27 distinct institutes and centers, each focusing on particular health topics or research areas (from cancer and heart disease to mental health and infectious diseases).

Despite its growth, the NIH has maintained a consistent vision. It remains, at its heart, an institution dedicated to turning scientific discovery into better health for all. The Intramural Research Program (IRP) – the NIH’s in-house laboratories in Maryland – has endured as a central part of its mission, providing a stable environment for high-risk, high-reward research that might be hard to pursue elsewhere. In parallel, the NIH’s mission has expanded to training new researchers and sharing health information with the public, ensuring that knowledge gained in the lab translates into improved medical care and prevention. Over more than a century, what began as a small hygiene lab has evolved into a sprawling modern institution – but one still driven by the same fundamental goal of improving lives through science.

Key Roles and Functions of the NIH

The NIH fulfills its mission through several key roles and functions. Broadly, these include funding biomedical research across the country, conducting research at its own facilities, training scientists, and supporting major health initiatives and information dissemination. Below are some of the NIH’s primary functions:

• Funding Extramural Research: The NIH is best known as a funding agency. It provides grants and financial support to researchers in universities, medical schools, hospitals, and other institutions in every state. In fact, over 80% of the NIH’s budget goes to this extramural research program – supporting tens of thousands of research projects each year. This makes the NIH the world’s largest public sponsor of biomedical research, investing on the order of $40–50 billion annually in studies ranging from basic biology to clinical trials. Through a competitive peer-review process, the NIH funds cutting-edge science that leads to new discoveries, medications, and therapies. These grants have built and sustained a vast biomedical research enterprise in the U.S., which in turn benefits global health.
• Conducting Intramural Research: Alongside funding external scientists, the NIH also conducts research in its own laboratories and clinics. This intramural research program consists of NIH’s campuses (most notably in Bethesda, Maryland) where NIH-employed scientists study everything from molecular genetics to epidemiology. A centerpiece of this effort is the NIH Clinical Center (Building 10) – the nation’s largest research hospital – where clinical trials and long-term studies are carried out in-house. The NIH Clinical Center in Bethesda, MD – the world’s largest hospital devoted entirely to clinical research. Opened in 1953, this facility enables NIH scientists to translate laboratory discoveries into innovative treatments. The intramural program allows NIH to pursue long-term, high-impact projects with stable funding. NIH’s own researchers have the freedom to tackle ambitious challenges and respond quickly to emerging health threats. This combination of internal research and external funding gives the NIH a dual capacity to both “do” science and enable others to do so, amplifying its overall impact.
• Training the Next Generation of Scientists: A critical part of the NIH’s role is education and training. The agency funds numerous fellowships, training grants, and career development awards to cultivate young scientists and clinicians. NIH’s extramural grants often support graduate students and postdoctoral researchers, while its intramural labs host many trainees and interns. Through initiatives like the Medical Research Scholars Program and various summer internships, NIH provides hands-on research opportunities. This commitment to training helps ensure a pipeline of skilled biomedical researchers who can carry forward the mission of improving health. Many leaders in medicine and science received NIH support early in their careers, underscoring the agency’s role in building human capital for research.
• Supporting Health Initiatives and Partnerships: The NIH frequently spearheads large-scale health research initiatives to tackle urgent health challenges or capitalize on new scientific opportunities. It works in partnership with other government agencies, industry, and patient organizations on special programs that go beyond individual grants. For example, the All of Us Research Program (part of the Precision Medicine Initiative) is an NIH-led effort to enroll one million diverse volunteers and gather extensive health data, with the goal of accelerating precision medicine – more personalized approaches to care. NIH has also led the BRAIN Initiative (launched in 2013) to map the human brain and develop new tools for neuroscience, and the Cancer Moonshot to accelerate cancer research. In 2022, a new agency called the Advanced Research Projects Agency for Health (ARPA-H) was established within the NIH to support “high-risk, high-impact” biomedical research, modeled after the defense DARPA program. These initiatives illustrate how NIH sets research priorities and mobilizes resources to address national health needs. Additionally, the NIH plays a key role in responding to public health emergencies – for instance, by rapidly launching research networks and clinical trials during outbreaks (Ebola, Zika, and most recently COVID-19).
• Disseminating Health Information: Part of the NIH’s function is to share research findings and health information with the public, health professionals, and policymakers. NIH produces educational materials, health guidelines, and runs websites like MedlinePlus and ClinicalTrials.gov to inform people about health and ongoing research. The agency’s commitment to open science is also evident in its policies: NIH requires that the results of NIH-funded research be made publicly available, recently strengthening its policy to ensure faster public access to scientific data and papers (eliminating the former 12-month publication embargo). By disseminating knowledge, NIH helps translate research into practice – so doctors can use the latest evidence-based treatments and individuals can make informed health decisions. NIH leaders and experts often communicate directly with the public as well, especially during health crises, to share reliable scientific information.

In all these roles, the NIH serves as the backbone of American biomedical research. It coordinates and supports a vast ecosystem of science – from laboratory bench to bedside – with the overarching goal of improving health outcomes.

Impact on Medical Science and Public Health

The NIH’s work has had a profound impact on medical science and the health of the public, both in the United States and worldwide. Discoveries made by NIH scientists and NIH-funded researchers have expanded our fundamental understanding of biology and led to practical breakthroughs that save lives. In fact, NIH-supported research has contributed to many of the major medical advances of the last century, transforming once-deadly diseases into treatable conditions and opening entirely new fields of science. To date, 174 NIH-funded researchers have received Nobel Prizes for their contributions – a testament to the agency’s role in fostering high-impact science. In this section, we highlight some of the key ways NIH-driven research has advanced medicine and recent developments that underscore the NIH’s continuing influence.

Breakthroughs in Medicine and Science

NIH’s impact can be seen in breakthrough treatments, vaccines, and diagnostics that have become part of modern healthcare. Many therapies that are standard today exist thanks in part to NIH funding or research:

• Life-Saving Treatments: NIH-funded studies have led to new treatments for many of the most common and dangerous diseases. For example, research supported by NIH has produced groundbreaking therapies for heart disease, cancer, and HIV/AIDS, among others. The development of antiretroviral drug combinations in the 1990s – which turned HIV infection from a death sentence into a manageable chronic condition – was driven by NIH-backed clinical trials and lab research. Advances in cancer treatment, such as targeted drugs and immunotherapies, also trace back to years of NIH-supported science in understanding cancer biology and the immune system. These innovations have been credited with increasing life expectancy and preventing millions of deaths over time. A recent American Heart Association analysis noted that decades of NIH-supported medical research contributed significantly to the dramatic reductions in cardiovascular disease and stroke mortality, highlighting how consistent investment in NIH yields healthier, longer lives.
• Vaccines and Disease Prevention: The NIH has played a pivotal role in the development of vaccines that protect people from infectious diseases. “NIH has led the world in the identification of viral pathogens and subsequent development and testing of vaccines,” with NIH researchers integral to roughly half of all vaccines approved by the FDA. This long history of vaccine work — spanning illnesses from diphtheria and smallpox decades ago to more recent threats — has saved countless lives. For instance, NIH research underpinned the creation of the human papillomavirus (HPV) vaccine, which is nearly 100% effective in preventing the strains of HPV that cause cervical cancer. Thanks to this work, countries worldwide now recommend routine HPV vaccination for adolescents, a policy expected to eventually reduce cervical cancer rates dramatically. More recently, NIH science was crucial in the fight against COVID-19: decades of NIH-supported research (including prior work on HIV and coronavirus biology) revolutionized vaccine development, leading to the first two FDA-approved vaccines for COVID-19. Notably, both the Moderna and Pfizer-BioNTech COVID-19 vaccines used an mRNA design that incorporated a stabilized coronavirus spike protein developed by NIH scientists. This collaboration between NIH and industry produced highly effective vaccines in record time, a feat that undoubtedly saved millions of lives during the pandemic. In 2023, another milestone was reached when the FDA approved the first vaccine for Respiratory Syncytial Virus (RSV) — after 60+ years of NIH-supported research on that virus. These examples illustrate how NIH’s sustained investments in basic and translational science yield real-world tools to prevent disease.
• Genetic and Scientific Innovations: NIH research has driven innovations that have revolutionized the very way science is done. A prime example is the field of genetics and genomics. NIH led the Human Genome Project, completed in 2003, which mapped the entire human DNA sequence and opened the door to genomic medicine. Building on that foundation, NIH-funded advances have enabled powerful new technologies like gene editing. New gene-editing techniques, developed through NIH-supported research, are faster, cheaper, and more efficient, with the potential to correct the DNA code inside living cells. Tools such as CRISPR-Cas9 – the “molecular scissors” that can snip and replace genes – were refined with NIH support and are now being tested to cure genetic diseases that were once incurable. Similarly, NIH-backed discoveries like green fluorescent protein (GFP) (a tool that earned a Nobel Prize) have become standard in labs everywhere, allowing scientists to visualize cellular processes in real time. In medicine, NIH’s embrace of precision medicine is yielding new diagnostic tests and personalized treatments. For example, NIH research recently led to a simple blood test that can help diagnose Alzheimer’s disease years earlier than was previously possible – a crucial step for intervening sooner. Each of these breakthroughs, from vaccines to gene editing, often represents the culmination of many years of NIH-funded inquiry. Together, they have not only improved individual lives but also fundamentally expanded our scientific horizons.

Major Research Initiatives Driving Progress

In addition to individual discoveries, the NIH amplifies its impact through major research initiatives that concentrate resources and expertise on critical challenges. In recent years, several flagship NIH initiatives have been launched or expanded, leading to significant progress:

• Precision Medicine – All of Us: In 2015, the NIH kicked off the Precision Medicine Initiative, aimed at tailoring medical care to individuals’ genetics, environment, and lifestyle. The cornerstone of this effort is the All of Us Research Program, “a long-term NIH initiative to enroll one million or more participants who will share health data” to fuel research. Officially launched in 2018, All of Us is building one of the largest and most diverse health databases ever. Participants contribute genetic samples, electronic health records, survey information, and more. The goal is to help researchers understand how to deliver the right treatments to the right person at the right time – for example, discovering why certain drugs work well for some people but not others, or finding early markers of disease in subgroups of the population. By late 2022, All of Us had already enrolled over 500,000 participants, with a special focus on including minorities and underrepresented communities in research. In the coming years, this rich data resource is expected to spur breakthroughs in disease prevention and personalized therapies that benefit all populations.
• BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies): The NIH BRAIN Initiative was launched in 2013 as a bold effort to revolutionize our understanding of the human brain. This large-scale program develops new tools to map brain circuits and record brain activity, with the ultimate aim of treating brain disorders like Alzheimer’s, schizophrenia, autism, epilepsy, and others. The BRAIN Initiative has already delivered advanced technologies – such as wireless brain implants and high-resolution brain imaging methods – that were once the stuff of science fiction. With Congress boosting its funding (over $400 million in 2018 alone), the initiative has enabled collaborations across neuroscience, engineering, and computer science. BRAIN-funded researchers have, for example, identified new types of brain cells and uncovered neural pathways involved in behaviors and disease. This knowledge sets the stage for novel treatments, like brain stimulation devices for Parkinson’s or next-generation neuroprosthetics for paralysis. The initiative demonstrates NIH’s convening power to accelerate progress at the intersection of technology and biology, keeping the U.S. at the forefront of neuroscience research.
• Cancer Moonshot: Originally announced in 2016 (and reignited in 2022 with new goals), the Cancer Moonshot is a high-profile initiative to dramatically speed up cancer research. The NIH’s National Cancer Institute (NCI) leads this effort, which seeks to foster greater collaboration, data sharing, and funding for promising but challenging areas of oncology. The Cancer Moonshot has bolstered research into cancer immunotherapy (helping the immune system attack tumors), genomics (like the Cancer Genome Atlas mapping cancer mutations), and prevention methods. It also emphasizes patient engagement and equity in cancer care. Early outcomes of this initiative include the development of more personalized cancer vaccines, better tools for early detection (such as liquid biopsies that find cancer DNA in blood), and new clinical trial networks. While cancer is a collection of hundreds of diseases, the Moonshot aims to make 10 years’ worth of progress in 5 years, and its renewed phase sets sights on reducing the death rate from cancer by at least 50% over the next 25 years. This ambitious program exemplifies how NIH responds to Presidential calls-to-action with scientific leadership and resource mobilization.
• HEAL Initiative (Helping to End Addiction Long-term): Responding to the opioid epidemic, the NIH launched the HEAL Initiative in 2018. This all-hands-on-deck effort channels research toward two linked crises: opioid misuse/addiction and chronic pain. HEAL funds a wide range of studies – from developing non-addictive pain medications and improved pain management strategies, to testing new treatments for opioid use disorder and overdose reversal. For example, HEAL is supporting the development of an opioid vaccine that might prevent addictive drugs from entering the brain. It’s also running the largest-ever study on how to effectively treat babies born with neonatal abstinence syndrome (from in-utero opioid exposure). By uniting many NIH institutes under one initiative, HEAL aims to coordinate scientific solutions that can curb opioid overdose deaths and provide safer options for the millions of Americans suffering from chronic pain. This illustrates NIH’s capacity to pivot toward urgent public health emergencies with targeted research programs.
• ARPA-H (Advanced Research Projects Agency for Health): A very recent development in NIH’s evolution is the creation of ARPA-H in 2022. ARPA-H is an independent agency within NIH (with a structure akin to the famed DARPA in defense) charged with funding “high-risk, high-reward” biomedical and health research. The idea is to support transformative projects that might be too ambitious or interdisciplinary for traditional grant mechanisms – for example, groundbreaking technologies for early cancer detection, radical new approaches to fighting neurodegenerative diseases, or portable diagnostics and treatments that could be easily distributed. ARPA-H has a distinct culture and flexibility to take on bold ideas and drive innovation quickly, complementing NIH’s existing portfolio. While brand new, ARPA-H represents a policy innovation acknowledging that certain breakthroughs in health (like an HIV vaccine or a cure for multiple sclerosis) may require a more directed, agile approach. Housed at NIH, ARPA-H will draw on NIH’s vast scientific community while also reaching out to innovators in industry and academia. Its establishment underscores NIH’s commitment to continually adapt and find new ways to catalyze progress against illness.

Through these and other major initiatives, the NIH not only funds isolated studies but also builds frameworks that unite scientists, encourage data sharing, and focus efforts on big-picture goals. This approach has a multiplying effect on discovery. The NIH’s strategic projects often lead to new research fields, improved policies, and, ultimately, tangible improvements in health for the public.

Influence on Public Health and Policy

Beyond research labs and journals, the NIH’s influence extends into the realm of public health practice and policy-making. The knowledge and innovations generated under NIH support have repeatedly informed health guidelines, medical practice standards, and public health interventions. In addition, NIH’s own policies and leadership have helped shape the culture of biomedical research and ensure that it serves society’s needs. Here are a few ways the NIH impacts health policy and public health:

• Translating Research into Health Guidelines: Discoveries made through NIH-funded research often become the basis for new public health recommendations or clinical guidelines. A striking example is the HPV vaccine mentioned earlier – NIH-supported research proved that vaccinating against human papillomavirus could prevent cervical cancer, which led public health authorities worldwide to recommend HPV vaccination for all adolescents. Similarly, NIH research demonstrating the effectiveness of lowering blood pressure targets in high-risk patients influenced guidelines for hypertension management, and NIH-funded trials showing the benefits of early HIV treatment shaped policies on HIV care globally. In many cases, the U.S. Centers for Disease Control and Prevention (CDC) and professional medical societies rely on evidence from NIH studies to issue guidelines on everything from cancer screenings to nutrition and exercise. In this way, the NIH serves as a foundation for evidence-based medicine – turning scientific findings into practical steps that doctors and the public can take to improve health.
• Public Health Leadership in Crises: During national and global health emergencies, NIH experts often play a crucial role in guiding the response and informing policy. For instance, during the COVID-19 pandemic, NIH scientists not only conducted research on vaccines and treatments but also became prominent public voices. Leaders like Dr. Anthony Fauci (director of NIH’s NIAID) provided regular, science-based guidance to government officials and the public. NIH leadership was “a public face of the federal government during the pandemic”, communicating health and scientific information at press conferences and interviews. This helped shape policies on measures like vaccination campaigns and research-driven pandemic interventions. The NIH’s ability to rapidly stand up initiatives like the COVID-19 Prevention Network (for vaccine trials) and the RADx program (to accelerate diagnostic testing) aided public health authorities in containing the virus. Past crises show similar NIH involvement: during the Ebola outbreak of 2014, NIH ran trials for vaccines/treatments in record time; during the 1980s AIDS crisis, NIH research paved the way for blood screening and informed safe-sex education campaigns. Such engagement illustrates how NIH serves as a bridge between the scientific community and public health action, ensuring that policy decisions are grounded in the best available evidence.
• Promoting Equity and Inclusion in Research: The NIH also influences policy through its own standards and requirements for the research it funds. For example, NIH policy now mandates the inclusion of women and minority groups in clinical research unless there is a valid justification for exclusion. This policy, established in the 1990s and strengthened over time, was designed to correct historical imbalances where clinical trials often focused on male participants. Thanks to NIH’s stance, it’s now routine that studies include diverse populations – a practice increasingly adopted worldwide to ensure that research findings are applicable to all. By insisting on diversity in research cohorts, NIH has influenced how trials are designed (a policy impact on the research enterprise itself) and helped generate more equitable health data. Another area is open science: NIH’s push for data sharing and open-access publication (as noted with the new 2024 policy) has set a tone for transparency that other funders and journals follow. This makes scientific knowledge a public good, aligning with broader policy goals to democratize information.
• Economic and Societal Impacts: While not a health policy per se, it’s worth noting that NIH’s influence extends to economic and innovation policy. Investments in NIH research have been shown to stimulate the economy by generating jobs, new companies, and pharmaceutical breakthroughs. A recent analysis highlighted that public investment in NIH “supports more than 400,000 jobs and $93 billion in economic activity” across the U.S., and each $1 of NIH funding can spur over $8 in additional private R&D investment. This data often informs government budgeting decisions and science policy, with lawmakers citing NIH’s high return on investment as rationale for sustained or increased funding. In short, strong support for the NIH has become an element of policy discussions about maintaining America’s leadership in science and innovation. The NIH in turn engages with policymakers by advising on emerging scientific issues (for example, the ethics of gene editing or responding to emerging drug-resistant diseases), ensuring that legislation and regulations consider the scientific perspective.

In summary, the NIH doesn’t operate in an ivory tower – its work continually influences and is influenced by public health policies and needs. From shaping clinical practice guidelines to leading by example in research ethics and inclusivity, the NIH serves as a key architect in the interface between science and public welfare. Its ability to generate trusted knowledge and convey that knowledge to decision-makers means that the NIH often serves as a scientific compass for health policy, helping society navigate challenges using evidence and research.

Conclusion

From its modest beginnings in 1887 to its current status as a global leader in biomedical research, the National Institutes of Health has stayed true to its mission of turning discovery into health. The NIH’s evolving roles – as a funder, a researcher, a trainer, and a catalyst for big initiatives – have all contributed to an extraordinary legacy of scientific and medical progress. Thanks in large part to NIH-supported research, diseases that once ravaged populations are now preventable or treatable, and our fundamental understanding of life science has deepened immeasurably. The impact of the NIH is evident in longer life expectancies, new cures and vaccines, and improved quality of life for millions of people. In recent years, the NIH has shown its nimbleness by tackling emerging health crises like COVID-19 and launching forward-looking programs in precision medicine, neuroscience, and more. It has also influenced the broader landscape of research and health policy – promoting practices that make science more inclusive, open, and aligned with public needs.

Yet, the NIH’s story is ongoing. Medical challenges such as Alzheimer’s disease, pandemics, health disparities, and chronic illnesses require continued innovation and investment. The NIH stands at the center of these efforts, with a clear mandate: to foster the discoveries that will keep pushing the frontiers of medicine.