Concern 2: Discriminatory policies are worsening disparities

Why It Matters

As the nation's premier health research institution, the NIH must remain accessible to the best scientists of every demographic group and address the health of all people in our country. This approach is supported by both U.S. law and scientific evidence.

• The law. Discrimination based on race, color, religion, sex, national origin, or another protected characteristic (including gender identity) remains unlawful in the United States under the Civil Rights Act of 1964. The Public Health Service Act, the foundational statute for the NIH, requires the NIH director to: encourage grantees to “utilize diverse study populations,” develop a strategic plan that considers “biological, social, and other determinants of health that contribute to health disparities” and “encourage efforts to improve research related to the health of sexual and gender minority populations” (42 U.S.C. § 6A). The 21st Century Cures Act further mandates that the NIH Director shall “develop, modify, or prioritize policies, as needed, within the National Institutes of Health to promote opportunities for new researchers and earlier research independence, such as policies to increase opportunities for new researchers to receive funding, enhance training and mentorship programs for researchers, and enhance workforce diversity”(Pub. L. No. 114-255, 130 Stat. 1033, 2016).

• The evidence. Variation is central to health research, providing the necessary differences to create knowledge through comparison and ensure that research findings are generalizable. Excluding diversity along any axis (e.g., race, ethnicity, gender, ability, geography) removes the opportunity to learn from differences and makes findings less relevant and applicable in the real world. People from racial and ethnic minority groups, rural populations, LGBTQIA+ people, under-resourced communities, and people with disabilities often experience social and structural barriers, such as transportation challenges, inflexible work hours, lack of childcare, and mistrust driven by historical and present-day traumas. These barriers contribute to poor health outcomes and limit participation in research to improve those outcomes. Including diverse populations in research requires intentional and focused recruitment, particularly of small populations, to study and overcome these barriers. Similarly, addressing health disparities requires research that both explicitly focuses on populations that experience worse health outcomes and considers the contribution of social and structural challenges. Finally, peer-reviewed research shows that diverse teams of people with different backgrounds outperform uniform teams, as they are more likely to question assumptions, reveal blindspots, and generate innovation. This perhaps explains why diverse teams publish more frequently and receive more citations. Prior to 2025, NIH policies supported broadening the NIH workforce by encouraging the mentorship, participation, and inclusion of people from diverse backgrounds, but never by determining funding based on any individual characteristic.

Despite the evidence in support of diverse study populations and researchers, under Director Bhattacharya, NIH has implemented policies that weaponize a poorly defined “DEI” (diversity, equity, and inclusion) label to eliminate a broad range of science-related efforts the administration finds convenient to target: inclusive study participation, minority health and health disparities research, and scientific workforce diversity.

Examples

A discriminatory screening tool is censoring NIH-funded research. Despite his oft-repeated assertion that “there are no banned words,” NIH Director JayBhattacharya has mandated a screening and “renegotiation” process across NIH that is applied to every grant or application prior to receiving its first or subsequent installment of NIH funding. This screening process is being applied retroactively to grants that have already gone through a rigorous multi-level peer and programmatic review process in which they were evaluated as being innovative, scientifically meritorious, relevant to the health of the public, and worthy of funding. There are several hundreds of words being screened in this process. Funded projects affected by “renegotiation” have often been producing results for several years. The “renegotiation” process involves a “computational text analysis tool” that screens grants for “terms that may potentially be associated with misalignment with the agency’s priorities.” Any grants containing “misaligned” terms must undergo manual review by NIH program staff who must provide written justification for inclusion of the terms or engage in “renegotiation” with investigators and grantee institutions to remove the terms prior to initial or continued funding. On June 16, 2025, Reagan-appointed U.S. District Judge William G. Young issued a ruling on earlier, similar keyword-based screening processes at NIH, calling them an “effort to rubber stamp an ideological purge” and declaring: “I am hesitant to draw this conclusion, but I have an unflinching obligation to draw it – that this represents racial discrimination. And discrimination against America’s LGBTQ community,” “I’ve sat on this bench now for 40 years. I’ve never seen government racial discrimination like this,” and “My duty is to call it out.”

Notably, the set of “misaligned” terms is not provided to the scientific community, nor is it provided to the majority of scientific program staff (including Program Officers and Grants Management Officials) within NIH. The set of terms has also evolved over time. NIH staff have compiled every “misaligned” term flagged by the tool between fall 2025 and early 2026 across four NIH institutes and provided the list to Congress. Terms the administration considered to “potentially be associated with misalignment with the agency’s priorities” during that period included “African American,” “Hispanic American,” and “Asian American.” (Notably, no grants were flagged for including “white American” or “European American.”) Grants are also flagged for terms such as “gender,” “health disparities,” “diverse,” “racial/ethnic minority,” and “Latinx.” These terms directly contradict the framework for federal public health programs and services set for NIH by Congress. In some cases, NIH scientific program officers are able to successfully justify these terms, but often their expert opinions are rejected. In addition, the heightened scrutiny introduces delays that disproportionately affect health disparities research and workforce diversity programs, each of which is required in NIH’s foundational statute. The screening process and threat of award termination or delay often pushes the scientific community to self-censor their research for fear of being caught up in this discriminatory and cumbersome process. Concern about getting flagged in this screening process has caused some scientists to avoid health disparities research and programs designed to train the diverse workforce needed for excellent science and required by law. 

Civil rights law is weaponized against research on racial and ethnic minority populations. On February 10, 2025, a memo from then Acting Secretary of the Department of Health and Human Services Dorothy Fink stated: “The Department of Health and Human Services has an obligation to ensure that taxpayer dollars are used to advance the best interests of the government. This includes avoiding the expenditure of federal funds on programs, or with contractors or vendors, that promote or take part in diversity, equity, or inclusion (‘DEI’) initiatives or any other initiatives that discriminate on the basis of race, color, religion, sex, national origin, or another protected characteristic.” As a direct result of this memo, and in the absence of repeatedly requested clarification on policy from HHS, the NIH Director, and OER, some institutes and centers systematically delayed funding for any grants that focused on racial and ethnic minority populations, regardless of the scientific justification. To receive funding, grants were required to expand their study populations, even if the associated costs could not be justified by the scientific question or health concern. These delays lasted throughout fiscal year 2025, extending into 2026. While this hold has been lifted in some institutes, it continues in others, and a year of confusion and misguided policies has impeded or interfered with the scope of studies focused on health conditions specific to people of color. 

Termination of research addressing health disparities and health equity. In 2025, NIH terminated more than 2,700 grants addressing health disparities and/or the health of racial, ethnic, and gender minority populations. The U.S. District Court found the processes that led to these terminations illegal, a decision that the Supreme Court declined to overturn. While terminations in 2026 are infrequent, more than 1,000 grants terminated in 2025 have not been reinstated. The threat of terminations remains present, driving compliance with the discriminatory grant screening and censorship processes that disproportionately exclude racial, ethnic and gender minority populations from research (described in the prior section), and largely mirrors the processes the courts already found unlawful. 

Termination of research conducted internationally. As discussed in Concern 8, the NIH suddenly and retroactively changed policies regarding foreign research collaboration in 2025, leading to the unexpected termination or disruption of ongoing clinical trials conducted abroad. Research participants, who had generously participated in science to help the health of others around the globe, were abruptly removed from medical protocols or in some cases left with unmonitored devices in their bodies in complete disregard for their safety. When studies were conducted in regions lacking robust public health infrastructure, these participants were left with little recourse. This was a gross violation of ethical research standards (as discussed in Concern 3), often minimized simply because it happened beyond our borders.   

Termination of research training programs designed to broaden the research workforce. Based on compelling evidence demonstrating the advantages of a diverse research workforce, and as directed by Congress in the 21st Century Cures Act (Pub. L. No. 114-255, 130 Stat. 1033, 2016), NIH developed multiple training programs to attract meritorious scientists from a variety of backgrounds. These included programs such as the Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research, which supported individualized, mentored research training of predoctoral students, and the Maximizing Opportunities for Scientific and Academic Independent Careers (MOSAIC) program, which provided 5-year awards to support postdoctoral scientists transitioning into independent faculty roles. Importantly, both programs awarded grants to highly qualified applicants identified through rigorous competition. Neither program limited participation based on any protected characteristic (e.g., race, ethnicity, sex, gender). In 2025, NIH not only ended these programs but also terminated all active grants funded under these programs, regardless of the merit, progress, or scope of the science. In the case of many NRSA awardees, NIH terminated awards to scientists from underrepresented backgrounds whose applications had received better scores than those of retained awardees who had applied via the standard pathway. In doing so, NIH cut off active health research, leaving trainees without a clear path forward in science and increasing the likelihood of these talented individuals leaving science. 

Recommendations

• Ensure no groups, regardless of background or identity, are excluded from the benefits of NIH research. NIH research is funded by taxpayer dollars, and thus it should benefit all Americans, including those from racial, ethnic, sexual, and gender minority backgrounds. In addition, Green Card holders (lawful permanent residents), immigrants in the United States on work visas, and the majority of undocumented immigrants all pay taxes and should be included in federally funded research. Yet, the policies and practices of this administration have systematically excluded these groups from NIH-funded research. As contributing members of the American public, these groups deserve to participate in, and benefit from, NIH research. 

• Stop the discriminatory censorship of NIH grants. The internal “alignment” screening process must be stopped. In addition, the NIH Director must publicly acknowledge the harm caused by these discriminatory practices, apologize to those who have been excluded from research, and confirm that research will no longer be screened and censored based on discriminatory keywords. Absent a clear apology and commitment, the research community may continue to self-censor their own research.  

• Ensure all research participants, regardless of demographic background, identity or location, receive the respect, safety, and dignity they deserve for generously donating their time and bodies to research, as also noted in Concerns 3 and 8. 

• Ensure NIH meets its statutory obligation to broaden participation in the research workforce. 

  • External research suggests a disproportionate impact of these terminations on groups already underrepresented in science. NIH should assess how grant terminations have affected the demographic makeup of NIH-funded researchers, especially early career investigators. These data should then be shared with the public. 

  • NIH should reinstate prior programs and develop new programs to address persistent racial, ethnic, socioeconomic, regional, sexual orientation, and gender disparities in the research workforce, as mandated by Congress. Congress should enact measures to ensure these programs are not targeted again by future politically motivated actions.

• Ensure NIH meets its statutory obligation to address health disparities and the health of sexual and gender minority populations, including consideration of social determinants of health, as mandated by Congress. NIH should ensure that new agency priorities do not undermine those established and maintained by Congress for NIH.