Why racial disparities in NIH funding persist and what might fix the problem

The murder of George Floyd in 2020 sparked conversations about entrenched and systemic racism in every profession. In a Facebook group of women biomedical engineering faculty, one member posted a paper about long-standing US National Institutes of Health funding disparities between Black and White researchers with just one word: “Sigh.”

That led others to share their experiences and frustrations, followed by the creation of a dedicated online forum for discussions among more than 260 women faculty. The exchanges culminated in the publication of “Fund Black Scientists,” a commentary in the journal Cell from 19 participants (2021, DOI: 10.1016/j.cell.2021.01.011).

“Over the past few months, we have exchanged >24,000 messages discussing racial inequities that pervade our profession,” they wrote. “One issue keeps rising to the top throughout these discussions: our Black colleagues’ grief about insufficient National Institutes of Health (NIH) funding for their research laboratories.” The commentary’s authors calculated that in 2019 alone, inequitably awarded funds amounted to a $32 million gap between Black and White researchers.

The paper that sparked the dialogue was from 2011, when University of Kansas economist Donna Ginther and her colleagues found that, after controlling for other factors, Black researchers were 10 percentage points less likely than White researchers to be awarded NIH research funding in the form of the agency’s standard independent research project grants, known as R01s (Science, DOI: 10.1126/science.1196783). The statistic rattled many in the scientific community while affirming what many Black scientists already knew: research funding is not a level playing field.

In a March 1, 2021, statement, the NIH’s director at the time, Francis S. Collins, acknowledged and apologized for what he called structural racism in biomedical research. “The events of 2020 highlighted the reality of our nation’s racial injustices that have been allowed to endure over four centuries and that significantly disadvantage the lives of so many,” Collins said. “The time for upholding our values and taking an active stance against racism, in all its insidious forms, is long overdue.”

But the question remains: Why does the racial disparity continue to exist? Understanding that may provide clues to how to end it.

One theory—typically offered without evidence—is that, discouraged by rejection, Black principal investigators (PIs) stop applying or significantly limit the number of grants for which they apply. Edward Botchwey, a professor of biomedical engineering at the Georgia Institute of Technology, says the evidence disproves that hypothesis. “While we might feel discouraged when our proposals get rejected, I don’t know anybody who stopped submitting proposals,” he says. Botchwey believes that he and his Black colleagues submit “more proposals than average, and certainly not less.”

“I’ve heard it said, ‘Maybe their work is not as good,’ ” says Lola Eniola-Adefeso, a University of Michigan chemical engineering professor and one of the Cell commentary authors. She has witnessed White PIs get funding when proposals with higher scores led by Black PIs were skipped. “Part of why I contributed to [the Cell commentary] is because I have the privilege of being an R01-funded investigator with current R01 funding. I can say, ‘I have played the game and I’ve been able to stay with the pack, but there are many more who are impacted significantly in the negative by this funding gap.’ ”

Subjective review

Close observers say the problem lies in the review process itself. Ginther’s 2011 analysis found that funding decisions are influenced by a number of random factors that have little to do with the science and that work against people from racial and ethnic groups that are underrepresented in science—such as Black, Latino, and Native American people. These factors include reviewers’ perception of scientific merit, a lack of diversity among grant reviewers, and where an applicant went to school. A 2019 analysis conducted by the NIH on its own grant review process found that three key areas contribute to funding Black R01 applicants at a lower rate than White ones: reviewers’ decision to discuss the proposal, the impact score they give to a proposal, and researchers’ topic choice (Sci. Adv., DOI: 10.1126/sciadv.aaw7238).

The NIH selects reviewers on their area of expertise and gives them a modest stipend for their participation. Botchwey estimates that each year, he serves on three to four grant application review panels for the NIH. And annually for the past 12 years, he has been a member of at least one specific study section, which looks at the scientific merit of a proposal. This experience gives him substantial insight into the process.

According to NIH guidelines, reviewers first score grant proposals according to three criteria: the project’s potential scientific impact on or contribution to the research field, possible research opportunities for students, and the ability to strengthen the research environment at the applicant’s institution.

But Botchwey says that in his experience, the scoring sometimes depends on the investigator more than the science, with well-known or White PIs getting the benefit of the doubt. Reviewers sometimes comment that a proposal lacks detail but the PI is a strong scientist and will figure it out. He says that sometimes a project proposal from applicants from underrepresented racial and ethnic groups will be summarily dismissed, while very similar proposals from White PIs are reviewed favorably. “The only difference is whose name is on it,” he says.

Eniola-Adefeso agrees. “The same people who’ve always gotten the grants or the funding continue to get the grants and the funding, even if a proposal is deemed lacking,” she says. “There is a presumption that the majority [White] PI’s work is better and more important, while there is a tendency to be more skeptical of proposals coming from Black PIs. They’re not likely to just get the same trust, and are asked for more data and proof that [their proposal] will work.”

While every proposal gets reviewed, only those scored in the upper 50th percentile are discussed. Botchwey says proposals from PIs from underrepresented racial and ethnic groups are more likely to be assigned to the lower 50th percentile and therefore not considered for funding at the same rate as proposals from White PIs.

Even if applications from PIs of underrepresented racial and ethnic groups make it through the scoring round, the proposals take another hit in discussions. “Once a grant is elevated to the level of discussion by our peers, anything can happen because reviewers often argue in favor of a proposal, which can significantly elevate their score,” Botchwey says. “Every proposal needs a champion; more often than not, our champion is just not in that room.”

Karmella Ann Haynes, an associate professor of biomedical engineering at Emory University, says that some voices clearly carry more weight than others.

Haynes recalls identifying the flawed science in one proposal that was squarely in her area of expertise. “I knew exactly what the person was trying to do, and a couple of these aims violated the basic rules [of the science],” she says. She gave the proposal a low score, and two other reviewers scored it highly. Haynes initially thought her fellow reviewers would reevaluate the proposal once she explained the flaw in the proposal, but they refused to budge and ultimately approved the grant.

“This really blew my mind,” Haynes says. “I was the only Black woman on the panel, and what’s really disheartening is that even as a reviewer, I felt straight up disrespected.”

Sherry Molock, an associate professor of clinical psychology at the George Washington University, says she knows why none of the grant proposals she’s written in the past 10 years have been funded: research area. Molock studies suicide prevention in Black adolescents and young adults. But she can’t say she wasn’t warned that it would impact her ability to attract research funding.

When Molock was a graduate student at the University of Maryland, College Park, in the 1980s, a professor told her she would get “pigeonholed” for doing research on Black people. Her first department chair at GW also said she would hurt her chances of earning full professorship unless she changed her research focus or added a study area unaffiliated with the Black community.

As a group, Black scientists are more likely than applicants overall to request funding to research health disparities and patient-focused interventions. The 2019 NIH analysis found that these topics are funded at a lower rate even among White researchers and account for more than 20% of the funding gap between Black and White researchers. The bias against funding research on communities of color means that research questions vital to these communities and society at large are not being asked or answered.

“One of the reasons why COVID-19 is impacting more negatively on communities of color is because of health disparities, and that’s research that needs to be done,” Molock says. “And yet, if you do that research, you’re less likely to get tenure, you’re less likely to get a grant.”

Promotion and tenure committees frequently use research grants, especially those like the NIH R01, to gauge the long-term viability of an investigator’s research program. Thus, the racial disparity in NIH R01 awards can lead to failed tenure for Black faculty. Others burn out and exit academia before they even apply for tenure.

What’s the solution?

Black scientists want solutions. Shirley Malcom, for example, believes the NIH review process could benefit from copying the US National Science Foundation process she helped enact in the 1990s when she led the agency’s Minority Institutions Science Improvement Program. Malcom is now director of STEMM Equity Achievement Change, an initiative by the American Association for the Advancement of Science to enhance diversity in science, technology, engineering, mathematics, and medicine. Under the NSF process, grant proposals are evaluated both on technical merit and broader impact, such as how they might train more researchers, improve education, or build the workforce.

“The foundation has been interested in figuring out how to make sure it can promote and measure and be accountable” around broader impact, Malcom says. “There were people who groused all over the place, but it has become embedded in the culture. I’ve had people say it was transformative for them because they can have different kinds of conversations and discussions about whether [a particular grant proposal] was worth doing.”

The Cell commentary authors estimate that the NIH’s funding gap between Black and White researchers could be eliminated if each of the NIH’s institutes and centers awarded two additional R01 grants to Black researchers annually. They see the NIH early-stage investigator (ESI) program, which does not pit newer researchers against established ones, as a possible model to get there. The ESI program was developed to make funding fairer by approving additional R01 applications from early-stage researchers. The goal was to have similar success rates for established and new investigators.

The NIH’s Collins, in his 2021 announcement, promised “new ways to support diversity, equity, and inclusion” and introduced Unite, an initiative that later laid out a list of actions to take, including appointing a diversity officer at each of the NIH’s institutes and centers and making more demographic data about staff and grant recipients public. Unite will also spend $60 million over 5 years for research focused on health disparities and health equity. Eniola-Adefeso says this approach is promising, although she worries that it will further pigeonhole Black researchers into health equity research.

Another initiative, the Faculty Institutional Recruitment for Sustainable Transformation (FIRST) program, “aims to facilitate institutions in their building a self-reinforcing community of scientists, through recruitment of a critical mass of early-career faculty who have a demonstrated commitment to inclusive excellence,” according to FIRST’s website. But “there is no guarantee that this will result in improving racial diversity . . . since the goal is to hire only individuals with a demonstrated commitment to inclusive excellence. Who gets to determine what is inclusive excellence? When academia is given the room to define the bar, it almost always gets it wrong,” Eniola-Adefeso says. “Unless the NIH FIRST addresses the racial funding disparity identified over a decade ago, racially underrepresented faculty hired via FIRST are being set up for failure.”

Some people are concerned that because Collins retired in December, the NIH won’t follow through on its fledgling commitment to bridge the research funding gap between Black and White researchers. And they have some justification.

In May 2021, the National Institute of Neurological Disorders and Stroke, National Institute on Drug Abuse, and National Institute on Alcohol Abuse and Alcoholism urged applicants from groups underrepresented in science to note the information on their grant applications. If the proposal came close to but missed the scoring cutoff for funding, the program officer could still recommend it. But on Oct. 25, the NIH shut down that effort, switching instead to encouraging applications from scientists from underrepresented groups without having them note it on applications.

The NIH’s mission is “to enhance health, lengthen life, and reduce illness and disability.” For the agency to fulfill that goal for the nation’s increasingly diverse population, it must find ways to create a more equitable funding process, people from underrepresented groups in the sciences say. Academic researchers who make their campus culture hostile to diverse faculty “carry these attitudes into the grant review and award process,’’ Botchwey says. “There’s a lot that goes into decision-making where folks can bring their own biases into the process. When that happens, you’re going to get the same results.”

Melba Newsome is a freelance writer based in Charlotte, North Carolina, who frequently covers science, health, and the environment.