99 percent of all new drugs in the US are only available thanks to the NIH. Now Donald Trump has declared war on it.

Mathias Jucker has been waiting for this breakthrough for half a lifetime as a researcher. For 15 years, he and colleagues from all over the world have been collecting data on families whose members are doomed to a frightening fate due to a genetic mutation: At 50 or 45, perhaps even as young as 40, their memory will fail them. Then Alzheimer's disease will strike.

Now, finally, there are medications that could potentially halt the deterioration of their mental abilities. But only if they are taken very early, before the first symptoms appear. As part of the Dian study, scientists now have the opportunity to do just that for the first time: Young family members are being treated ten or twenty years before the first symptoms of dementia are expected. This is a unique opportunity for science. In other Alzheimer's patients, the disease is barely detectable at this early stage.

"I know many of our participants personally, including the adolescents. Thanks to these medications, they could be spared the fate of their parents. That's crazy," says Jucker, who works at the German Center for Neurodegenerative Diseases in Tübingen.

But now it's unclear whether and to what extent the Dian study can be continued. So far, the American National Institutes of Health (NIH) has covered an estimated 80 percent of the costs of monitoring the families, even though many come from other countries and are cared for outside the United States. Now it appears that the biomedical research agency will significantly reduce or even stop its funding. The NIH is currently under intense attack by the Trump administration. Employees have been laid off, funds frozen, and ongoing studies halted.

Many scientists see this as an attempt to destroy the NIH. They say the measures are already slowing down medical progress. The Trump administration, however, argues that it is taking action against waste, fraud, and dangerous ideology.

It's clear that the NIH has a tremendous influence on medical research. Especially in basic research, an area in which pharmaceutical companies invest less, the NIH is by far the world leader. All other public institutions spend far less on health research than the NIH.

It's no wonder, then, that the NIH has made a decisive contribution to most of the medical breakthroughs of recent years. Whether it's weight-loss injections , the coronavirus vaccine , or cancer immunotherapies , the underlying research was funded with NIH money. According to a study, 99 percent of all newly approved drugs in the US between 2010 and 2019 were based on research supported by the NIH.

But it's also true that few people dispute the need for improvement at the NIH. Its structure, with 27 institutes, has grown over decades and is not optimized for maximum efficiency. For example, there are separate institutes for alcohol and drug abuse—even though the research questions, experts, and even patients overlap. There have been attempts to correct this in the past, but so far, all have failed.

In addition, it is often criticized that the agency has overshot its target in its attempt to ensure greater equity and diversity in research. As a result, applicants and applications have been increasingly evaluated less based on merit criteria.

Trump acted quickly. On his very first day in office, he imposed a communications blackout on all NIH employees. And he ordered the agency to review all projects it funds to ensure they align with the new administration's priorities.

The verdict for many studies appears to be negative. Since the beginning of February, new research projects have been announced almost daily whose funding has been abruptly withdrawn. Awarding grants is the NIH's primary responsibility. Few researchers are directly employed there. Most of the money goes to scientists at universities who submit complex applications for funding. The NIH selects the best proposals and allocates its budget among them.

Although millions have already been invested in some of their studies, many researchers are now forced to abandon their projects or take a forced break. According to data from the internet platform "Grant Watch," over 800 research projects are now affected. There is no official overview of the discontinued studies.

To enable long-term research, research funding is usually pledged for four years. Until now, scientists could rely on receiving funding for the promised period, even in the event of a change of government. Stopping ongoing research projects was extremely rare in the past and only permitted in cases of serious misconduct.

Around a third of the canceled studies contain transgender-related keywords in their project descriptions. The government likes to use these examples as evidence of the "gender ideology" promoted by the NIH, which it has declared war on.

In general, the government is taking radical action against anything that sounds "woke." Almost half of all halted research projects contain the keyword "diverse" or "diversity" in the description. These often involve the desire to recruit diverse patient groups for a study. This is always important when a disease affects one population, gender, or age group more than others.

Studies that specifically address the health of individual populations are often affected. For example, the Women's Health Initiative , the world's largest study on women's health, announced at the end of April that the NIH had discontinued its funding. The study has been running for over 30 years and examines thousands of women with the goal of identifying risk factors for diseases in women—particularly after menopause. However, after fierce criticism, funding was resumed.

However, the projects that have been stopped directly are just the tip of the iceberg—they affect approximately 1 percent of all research projects currently funded by the NIH. Jeremy Berg, former director of the NIH Institute of General Medicine, points to another, even bigger problem: The NIH is currently awarding significantly fewer grants than usual. While approximately $10 billion in funding was distributed between January and mid-May last year, this year's figure is only about $7 billion during the same period.

"If they continue at this pace, they won't even be able to spend their full budget," says Berg. The American agency's fiscal year ends on September 30th. The portion of the budget that hasn't been distributed or spent by then will go back to the federal budget. This would effectively amount to a cut in the NIH's budget—even though the government isn't officially authorized to make such cuts. In the U.S., Congress decides on the budgets of federal agencies.

But with a host of measures, the government has made it impossible for the NIH to maintain its normal operations. Over 1,200 employees have been laid off, about 6 percent of the workforce. Meetings where decisions are made about grant allocations have been suspended for weeks.

If the National Institutes of Health actually hasn't spent large portions of its budget at the end of the year, the government could use this as an argument for actual budget cuts. That's what observers like Jeremy Berg fear, at least.

In a recently released budget proposal for next year, the administration has proposed a full 40 percent reduction in the NIH budget. It also proposes reducing the NIH's 27 institutes to only five.

However, experts expect Congress to reject the administration's proposal and reduce the research agency's budget only slightly or not at all. "People won't simply resign themselves to giving up hope for a cure for Alzheimer's and cancer," says Berg.

The new NIH Director, Jay Bhattacharya, wants to refocus the research agency on diseases that truly affect the American population, as he said in an interview with Fox News . According to Bhattacharya, these include cardiovascular disease, diabetes, obesity, and Alzheimer's disease.

But the damage has already been done. Trust in the NIH has likely declined significantly among most scientists. And many projects are still pending. These include numerous projects on topics that, according to Bhattacharya, should continue to be the focus of NIH research.

For example, Mathias Jucker's DIAN study on genetically caused Alzheimer's disease. Last week, an NIH commission was supposed to decide on its future. But the project didn't make it onto the agenda.

Funding is still in place until the end of June, after which, at least according to the American study participants, they can pack up. Jucker talks about putting some of the projects into a kind of energy-saving mode. Patient care will likely continue – but the long-awaited treatment trials cannot begin for the time being. This has consequences for all Alzheimer's patients: "Greater speed in research means greater opportunities for everyone affected to benefit from the findings," says Jucker. Sand in the scientific gears, on the other hand, delays the discovery process and thus also the development of new medications.

An article from the « NZZ am Sonntag »