NIH cancels RECOVER grants for long COVID projects

President Donald J. Trump’s administration this week abruptly terminated funding for a slew of studies designed to learn how to better treat the postviral condition long COVID. They include studies funded through the National Institutes of Health (NIH) initiative called Researching COVID to Enhance Recovery, or RECOVER, a $1.7 billion program that serves as the single largest federal funding mechanism for long COVID research.

According to Megan Fitzgerald, a researcher and advocate who works closely with RECOVER-funded researchers and who has long COVID herself, all grants for pathobiology studies that RECOVER funded in 2022 and 2023 were canceled this week. That amounts to 45 different studies that were designed to uncover the biological mechanisms that may drive various manifestations of long COVID.

Fitzgerald emphasizes that these studies were nearly complete. In most cases, researchers had already finished data collection. They needed only to analyze those data and publish their findings.

“It’s crazy to cut off a study at this point,” Fitzgerald tells C&EN. “I know there’s pushback, saying we need to have more fiscal responsibility. But this is the opposite of fiscal responsibility. You’re just burning dollars here.”

David Warburton is a pediatrician at the University of Southern California (USC) Keck School of Medicine who was running two RECOVER-funded studies as a principal investigator at the Children’s Hospital of Los Angeles.

One study was aimed at uncovering whether people with long COVID have any underlying genetic particularities that make them susceptible to the condition, which is a chronic, systemic illness that can involve persistent inflammation, circulatory issues, and extreme, debilitating fatigue that leaves people bedbound in the most severe cases. Warburton’s other study, which involved teens and young adults, was designed to look at the physiology of brain fog—a common phrase for cognitive difficulties that include memory and recall issues and tiredness—as well as learn what might cause the participants’ inability to regulate their blood circulation.

“The upshot is that these kids have trouble paying attention, staying in school, doing their homework,” Warburton tells C&EN. “There’s a major impact on their lifetime learnings due to long COVID. So we were going to try to figure out what the problem is.”

RECOVER funded both studies to the tune of about $1 million each, Warburton says. He and his colleagues had already enrolled teenagers and performed tests, with statistical analyses to come later, hopefully shedding some light on the poorly understood condition.

But on Tuesday, Warburton received a notice from the NIH: both grants were terminated, effective immediately. He says the agency did not offer any rationale.

“We were trying to find some answers for all these kids and their parents,” Warburton says. He may not even be able to complete statistical analyses of the data he’s already collected. “Stopping the projects in the middle is really a waste of the money we’ve spent already.”

Pathobiology studies like Warburton’s are the key to understanding how long COVID operates. While other research has offered clues into the disease’s mechanisms, scientists have yet to uncover a concrete biomarker that could be the basis for a diagnostic test or for drug discovery and development. Most pharmaceutical companies have shied away from attempting to develop treatments for long COVID because they don’t have a clear target yet.

If findings from the RECOVER-funded pathobiology studies go unpublished, Fitzgerald worries it could kneecap future efforts to treat the disease.

“These are the studies that were going to tell researchers, tell clinicians worldwide, this is what long COVID looks like in the human body,” Fitzgerald says. “These are the areas we need to focus on in order to treat it. This work is incredibly important. It’s a predecessor to clinical trials. It’s a predecessor to drug development.”

The US Department of Health and Human Services (HHS), which oversees the NIH, has canceled funding for COVID-19-related projects more broadly at both the NIH and the US Centers for Disease Control and Prevention (CDC).

“The COVID-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago,” HHS spokesperson Emily Hilliard says in an email to C&EN, invoking the Make America Healthy Again, or MAHA, movement spearheaded by HHS secretary Robert F. Kennedy Jr. “HHS is prioritizing funding projects that will deliver on President Trump’s mandate to address our chronic disease epidemic and Make America Healthy Again.”

Hilliard did not respond to any of C&EN’s questions about projects related to long COVID, which is a chronic disease, lasting months or even years for many people. Well over 400 million people have been afflicted with the postviral condition globally since the beginning of the COVID-19 pandemic (Nat. Med. 2024, DOI: 10.1038/s41591-024-03173-6).

RECOVER has not been without pitfalls. Patient advocates’ single largest criticism is that it focused for too long on observational studies designed to learn more about long COVID, to the exclusion of clinical trials testing specific treatments. RECOVER has also tested very few pharmaceutical interventions to date. Its next phase, RECOVER-TLC—short for “treating long COVID”—was designed to address those problems.

Fitzgerald spent part of her day Wednesday on a call with pediatric researchers whose RECOVER grants were terminated. She says they are very worried about the future of the program.

“For a lot of the researchers on the call, they kind of felt like this was a death knell for RECOVER entirely,” Fitzgerald says.

An uncertain path for long COVID research

Other long COVID–related programs appear to be at risk as well.

Since 2022, the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) has funded nine research centers called Antiviral Drug Discovery (AViDD) Centers for Pathogens of Pandemic Concern. NIAID allocated about $577 million over 3 years for research on new antivirals for coronaviruses including SARS-CoV-2, but also for paramyxoviruses, bunyaviruses, togaviruses, filoviruses, picornaviruses, and flaviviruses.

The AViDD Centers were designed as 5-year projects, meaning that the final 2 years of funding would come later, but when Congress took back unspent COVID-19 pandemic relief funds, that last round of funding never materialized. Instead, NIAID provided a 1-year, no-cost extension.

“Most AViDD Centers have unused funds that they had been told by NIH could be carried over for another year,” says Michael Z. Lin, a neurobiologist and bioengineer at Stanford University and a researcher at the AViDD Center housed there. “It always takes several months to hire people and set up experimental systems, purchase all the equipment and reagents, so almost all grants are underspent in the first year.”

But this week, Lin and his colleagues received notices from the NIH indicating that they would not be able to roll over those funds through a no-cost extension after all. “The end of the pandemic provides cause to terminate COVID-related grant funds,” reads a notice Lin shared with C&EN.

“This is really pulling the rug out for many groups,” Lin says. Although he was not focused on long COVID, Lin had hoped that new antivirals for SARS-CoV-2 might eventually be repurposed as long COVID treatments, since many researchers hypothesize that the virus hides in reservoirs throughout the body, escaping existing treatment options and causing chronic inflammation.

Other long COVID researchers and clinicians feel they are on notice. Since September 2023, the HHS has funded long COVID clinics around the country through its Agency for Healthcare Research and Quality (AHRQ). The agency is small, but it’s reportedly a target for funding and workforce cuts because much of its work deals with health equity—systemic barriers to accessing health care.

A doctor at an AHRQ-funded long COVID clinic in the Midwest, who spoke on the condition of anonymity for fear of professional repercussions, says it’s “hard to fully relax” with the NIH and CDC canceling funds for other COVID-19-related projects. “We expect that some Long COVID clinics would have to close entirely,” the doctor says in a message to C&EN.

Cuts to long COVID research and health care are in some ways baffling. The doctor points out that their clinic’s work should be “aligned with the MAHA campaign,” because people with chronic diseases are more likely to develop long COVID and because long COVID is itself a chronic illness. Kennedy committed to directing research funds toward long COVID in response to a question from Sen. Todd Young (R-IN) during a hearing in January. But Kennedy also appears to believe that infectious diseases were too prominent a focus for HHS agencies prior to his leadership, and long COVID and COVID-19 are closely related in the public psyche.

“I do believe that COVID-19 continues to be an important topic of investigation, as more people are still dying of COVID-19 than the flu, old cases of long COVID are not well treated, and new cases of long COVID still occur,” Lin says. But the termination of programs like AViDD, he says, “is taking a hammer, not a scalpel, to our efforts to defend against many viral threats, not just COVID-19 and SARS-CoV-2.”