While NIH’s accomplishments have been impressive, its continued global leadership is at risk. In 2000, U.S. research spending was eight-fold greater than China’s. By 2017, China’s spending was nearly equal to that of the U.S., having grown at almost double the pace of U.S. spending over that interval. The U.S. share of world R&D expenditure fell from 38% in 2000 to 25% in 2017, while that of East and Southeast Asia, including China, India, Japan and South Korea rose from 25% to 41%. China surpassed the United States in 2007 as the world’s largest producer of doctoral degrees in natural sciences and engineering (excluding social and behavior- al sciences) and has remained in the lead ever since. Perhaps reflecting the relatively flat federal spending on NIH research, fewer foreign recipients of U.S. graduate degrees are remaining in the U.S. after graduation and the U.S. is attracting a declining share of foreign students seeking degrees in science and technology.
The significance of U.S. primacy in the global competition for innovation cannot be overstated. Here we recommend seven changes in policy and investment that will ensure that NIH continues to lead in our ever more dynamic and competitive international health enterprise. The first three recommendations seek to better recognize and support especially creative and impactful NIH research. The remaining four recommendations address the neces- sity to build, empower and maintain the strongest biomedical workforce. In some cases, increased funding is justified to meet an urgent need to realize dramatic returns, but notably, some of our recommendations would be budget neutral or even reduce costs, while leading to greater impact. Whatever the budgetary implications, each of our recommendations will require an investment of political will to overcome inertia and adversity to risk, empowering relevant stakeholders to pilot and implement bold new approaches.
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