ABSTRACT
ObjectiveThis study aims to characterize and evaluate the NIHs grant allocation pattern of COVID-19 research. DesignCross sectional study SettingCOVID-19 NIH RePORTER Dataset was used to identify COVID-19 relevant grants. Participants1,108 grants allocated to COVID-19 research. Main Outcomes and MeasuresThe primary outcome was to determine the number of grants and funding amount the NIH allocated for COVID-19 by research type and clinical/scientific area. The secondary outcome was to calculate the time from the funding opportunity announcement to the award notice date. ResultsThe NIH awarded a total of 56,169 grants in 2020, of which 2.0% (n=1,108) were allocated for COVID-19 research. The NIH had a $42 billion budget that year, of which 5.3% ($2.2 billion) was allocated to COVID-19 research. The most common clinical/scientific areas were social determinants of health (n=278, 8.5% of COVID-19 funding), immunology (n=211, 25.8%), and pharmaceutical interventions research (n=208, 47.6%). There were 104 grants studying COVID-19 non-pharmaceutical interventions, of which 2 grants studied the efficacy of face masks and 6 studied the efficacy of social distancing. Of the 83 COVID-19 funded grants on transmission, 5 were awarded to study airborne transmission of COVID-19, and 2 grants on transmission of COVID-19 in schools. The average time from the funding opportunity announcement to the award notice date was 151 days (SD: {+/-}57.9). ConclusionIn the first year of the pandemic, the NIH diverted a small fraction of its budget to COVID-19 research. Future health emergencies will require research funding to pivot in a timely fashion and funding levels to be proportional to the anticipated burden of disease in the population.
ABSTRACT
The paper explores the reasons why states differ in their Medicaid coverage of the at-risk population, focusing in particular on the large disparities in Medicaid spending associated with these differences.Two distinct sources for these disparities in spending are examined. First, they may be the result of two factors largely beyond state control: differences in state wealth (or "fiscal capacity"), and differences in the generosity of federal funding. Second, they may be the result of differences in state "fiscal effort," as measured by the ratio of state Medicaid spending to capacity.
