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Across NIH, because most of the agency’s budget goes to annual payments for ongoing grants, a nearly 20% cut could leave virtually no funding for new awards in fiscal year 2018, Hudson says. “The nation would lose research and researchers in a way that would not be recoverable,” Hudson says. “It is pretty terrifying.”

The Trump budget proposal also “includes a major reorganization” of NIH’s 27 institutes and centers “to help focus resources on the highest priority research and training activities,” the document says. In addition to folding AHRQ into NIH, that includes “eliminating the Fogarty International Center” at NIH.

The Fogarty is a tiny piece of NIH, funded at $70 million in 2016. But it has an outsize impact because its mission is “entirely to train people” to do research mostly in low-income countries, says bioethicist Nancy Kass of Johns Hopkins University in Baltimore, Maryland, a Fogarty grantee.

Although the Fogarty may have come into the White House’s crosshairs because of “international” in its title, the work it does helps guard the health of Americans from emerging diseases, Kass says. “One of the best protectants is to have people in Africa trained in science and ethics who can detect, measure, and do research on a new infection,” Kass says. “They are our first eyes and ears on the ground.” The Infectious Diseases Society of America issued a statement expressing “serious concerns” about the proposal to abolish the Fogarty center.

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