When the Biden administration first proposed establishing the Advanced Research Project Agency for Health (ARPA-H) in 2021, there was some controversy over where it would live and how it would be funded.
Modeled after the U.S. military research agency Defense Advanced Research Projects Agency (DARPA), ARPA-H was envisioned as a powerhouse resource for research and technological advancements in a variety of major diseases — including cancer, Alzheimer’s disease and infectious diseases. The administration initially asked for a budget of $6.5 billion for 2022, but Congress only pushed through $1 billion in its health spending bill in March.
Despite concerns over the necessity of another health agency, ARPA-H has officially been established within the National Institutes of Health as an independent entity. And it has its first employee: Adam Russell, who will work as acting deputy director.
According to an ARPA-H fact sheet, the agency may pursue projects that involve developing cancer mRNA vaccines as preventive measures, creating inexpensive and non-intrusive wearable monitors for blood pressure, and fighting racial disparities in maternal mortality rates. The sheet also notes that, despite the controversy over housing the new agency within NIH, doing so “makes sense because the ARPA-H mission falls squarely within the overall NIH mission… and because it is important that ARPA-H be closely coupled to the vast range of biomedical and health knowledge, expertise and activities within the NIH.”
Developing breakthroughs for major diseases and causes of death is an ambitious goal, especially given how COVID-19 exposed holes and gaps in the U.S. public health infrastructure. One recent report determined that it would require $36.7 billion in funding to modernize public health infrastructure over the next 10 years in order to avoid another catastrophic health crisis response.
When announcing ARPA-H last year, Biden emphasized how the U.S. is falling behind on the public health front. The agency, he claimed, would help turbocharge the effort.
“We will see more technological change in the next 10 years than we saw in the last 50 years,” Biden said in an address to Congress in 2021. “We’re falling behind in that competition… ARPA-H [would] develop breakthroughs. I can think of no more worthy investment, and I know of nothing more bipartisan.”
But ARPA-H’s potential impact depends largely on funding. So far, it’s been given a fraction of the original proposed budget of $6.5 billion; the House Energy and Commerce Committee has proposed giving the agency only $500 million per year from 2023 to 2027.
Even that budget is controversial, with some public health experts arguing it will take away from the NIH’s basic research funding. In a blog post for the American Society for Biochemistry and Molecular Biology, Sarina Neote wrote that most of the NIH funding requested in Biden’s 2023 budget proposal would go towards ARPA-H, with only a $275 million raise to NIH’s base budget.
“Such a nominal increase will not keep up with inflation or the rising costs of conducting research, so, if Biden’s request for fiscal 2023 comes to pass, we can expect the American research enterprise’s output to decline and the careers of scientists and training of the next generation of researchers to stall,” Neote wrote.
Terry Haines, founder of healthcare consultancy Pangaea Policy, believes the smaller budget allotted for ARPA-H points to a lack of purpose for the agency.
“This agency is only barely established, without a specific purpose and barely a specific budget,” Haines said. “The contrast with DARPA couldn’t be greater: DARPA never lacked for a specific mission or appropriate funding.”
Haines added that “application and implementation of health breakthroughs is broad and nonspecific,… the first thing new agency leadership is going to have to do is think, talk and develop specific, relevant missions and build out from there.”