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A RENEWED AND REVITALIZED U.S. BIOMEDICAL RESEARCH ENTERPRISE IS POSSIBLE

The U.S. biomedical research enterprise has advanced science nationally and globally; contributed to increased life expectancy and improved health spans for hundreds of thousands of individuals and their families; and most recently, supported the discovery science underlying, and led the charge in developing and distributing, life-saving vaccines that ended the worst pandemic of the past century. The enterprise supports—directly and indirectly—millions of jobs nationally and globally and welcomes thousands of international scholars to learn, live, and work in America every year. Biomedical research is also a major engine for the U.S. economy, contributing significantly to America’s gross domestic product (GDP).

The U.S. biomedical research enterprise has contributed much to the nation and the world in its current state. However, its existing structure, incentives, and modes of operation are quickly becoming barriers keeping the enterprise from reaching its full potential (see Figure 7-1). The future state, efficient operation, and maximum output of the biomedical enterprise are critically important for three main reasons (see Figure 7-2).

Other countries are beginning to contribute significantly more—financially and in terms of workforce—to their own biomedical research enterprises. Although the United States currently contributes the most money toward our enterprise, in terms of overall national GDP, many peer nations are investing proportionally more of their GDPs, signifying an increasing commitment to strengthening their national research efforts. The United States has long been the global leader in scientific innovation, medical breakthroughs, and advancing basic science. Without refocused attention and investment in our biomedical research enterprise, we stand to lose our place of leadership.

The most critical and deadly health challenges threatening our nation are complex and interconnected, and will only be solved with convergence science. The U.S. biomedical research enterprise has made great strides in reducing morbidity and mortality for many threats to American health—notably, cancer, cardiovascular disease, and HIV/AIDS. However, the health threats that are currently most damaging and fatal to the American people are increasingly complicated, interconnected with other health issues, and influenced by social determinants of health. Therefore, these threats can only be addressed through collaboration between and among many different fields of biomedical science, social science, and medicine. The U.S. biomedical research enterprise, in its current state, is not positioned to facilitate and encourage convergence science at the scale necessary to make true and lasting headway on improving American health in the long term, and as such, needs to be reimagined and restructured.

A more effective and efficient enterprise will contribute to and grow the U.S. economy. The U.S. biomedical research enterprise spent more than $245 billion on research and development in 2020, a full 3.4% of the total U.S. GDP (Anderson and Moris, 2023; Research!America and Teconomy Partners, LLC, 2022). Despite this massive investment, because of the siloed and fragmented nature of the enterprise, initiatives investigating the same questions are launched in parallel, agendas are dictated by funding rather than need, and projects that could benefit most Americans may not be pursued if they are not profitable. A reimagined system, with a national strategic vision guiding decision making and funding, would contribute more directly to growing the U.S. economy, feed the nation’s GDP, and indirectly benefit the economy and GDP by providing more years of healthful life to all Americans.

The authors of this Special Publication believe in the strength, power, and impact of the U.S. biomedical research enterprise to power the economy and improve health for all. The actions laid out in this Special Publication, when taken together, will provide the foundation for the U.S. biomedical research enterprise of the future. As a nation, we have already contributed so much—financially, professionally, and personally—to support and advance the enterprise. We owe it to ourselves—and our children and grandchildren—to ensure that biomedical research, conducted effectively, efficiently, and strategically, benefits all of America.