In recent months, the US has significantly reduced or eliminated funding for numerous agencies responsible for conducting global medical research. How will this affect French, European, and international clinical trials?
Gilles Montalescot, MD, PhD, professor emeritus of cardiology at the Pitié-Salpêtrière University Hospital in Paris, France, and chairman of ACTION Group, the hospital’s academic research organization dedicated to clinical trials in cardiology, shared his insights in an interview with Univadis France, a Medscape Network platform.
The ACTION Group comprises a network of 166 hospitals involved in more than 60 studies.
Could ongoing multicenter clinical trials be jeopardized by the new measures implemented by the US government since January 2025?
Industry-sponsored trials conducted by health companies are likely to continue as usual because these budgets remain unaffected. In the US, most major international pharmaceutical and medical device companies are based there and will continue their development in the future. It is likely that this research will remain consistent.
The research most at risk is academic research funded by the National Institutes of Health (NIH), which has an annual budget of approximately $70 billion (€65 billion). Budget cuts could affect academic laboratories at universities, both large and small. Some NIH institutes specializing in various fields are located in southern states to promote regional development and may also face reductions, leading to job losses and diminished access to care for some Americans in these regions, many of whom supported President Trump’s election. This decision is ideologically driven and could weaken science overall, as well as research at universities that have expressed dissenting opinions.
It is important to note that research in the US is advanced, well-organized, and dynamic. For example, for the past 25 years, I have consistently sent young professionals pursuing academic careers in cardiology to spend at least a year in a US research laboratory. This is essential because there is no equivalent data available elsewhere. In Europe, it is challenging to conduct a year of high-level clinical research as easily as in the US, where resources, ongoing studies, and research organizations are more advanced. Currently, one of my residents is in Boston at Harvard for 2 years, conducting academic research. In November, a young clinical fellow from our team will leave for training in New York.
Every year, we send someone for training because what the US offers has no equivalent in Canada or Europe. It is regrettable that the new direction of US policy sends a negative signal regarding fundamental, clinical, and applied research. In the future, if the situation deteriorates significantly, it is conceivable that young clinical fellows who have completed a master’s degree and are pursuing a thesis for an academic career will face greater challenges in conducting research projects.
You mentioned that the US invests approximately $70 billion in academic research, which has had a major global impact on the field. Is there another country or region capable of taking over US leadership?
It is difficult to imagine, because the best universities are often American. Moreover, the US remains attractive to the international scientific community, including French researchers who often emigrate and sometimes do not return because the resources available in the US surpass those in France. Japanese researchers have followed a path similar to that of Europeans.
With its economic growth, China could reach this level, particularly as academic research in the country is progressing significantly. However, we have not yet reached this stage. Europe could also show more ambition, although the European pharmaceutical industry is currently not thriving. There are few leading pharmaceutical companies in Europe. India and China often subcontract or replicate health products and devices. However, these countries could become more innovative and play a larger global role in the future than they do now.
You seem to be talking about these aspects in the medium or even long term rather than in the short term.
It is true that we should not react impulsively to this issue. However, these new measures negatively affected what was working very well and was a source of pride for the US, admired internationally. There are examples of this greatness in the past: The US National Cancer Act, launched by Richard Nixon to “cure” cancer, saw investments increase from $500 million per year to billions of dollars annually. Although cancer has not yet been cured, this initiative has resulted in significant advances in biology, immunology, and cancer treatment. Scientifically, this was highly profitable, even though the initial goals were not fully achieved.
In Europe, we haven’t seen the implementation of such large-scale initiatives, and cardiovascular diseases remain a low priority.
Aix Marseille University (amU) has decided to host American researchers urgently. What do you think about this initiative?
This initiative sends a strong signal that we are open to continuing collaboration with our American colleagues and are ready to welcome them to France. It is important to note that we will not change the existing flow of researchers between Europe and the US, which has been ongoing for decades. However, it is positive and beneficial for all universities to follow the example of amU.
If other universities manage to attract American researchers seeking temporary experiences at French institutions, it will be advantageous. This dynamic could stimulate researchers in France and foster international collaboration. I am not certain that amU has the resources to host many American researchers. Nevertheless, the idea is worth replicating, and I am unaware of similar initiatives.
During Trump’s first election, Emmanuel Macron expressed his support for hosting American research in France. Do you think this is feasible?
It is important to note that, regarding funding for French academic research, it is more about rationing than about investment. Consequently, it seems unlikely that we could offer lessons to the American research system.
You mentioned that certain universities were particularly targeted, possibly for political reasons. Could other centers remain unaffected?
Everyone will be affected by the NIH funding cuts. Take, for example, immunology and cancer research in Kentucky. Kentucky is a Republican state, yet funding will be cut, just as it will be at Harvard in Massachusetts. These cuts are not limited to East Coast universities; everyone will feel their impact.
Bridging a €5-€10 billion funding gap will require cuts to research budgets across various NIH institutes, including those in poor and rural states where they were first established. Furthermore, the humanities and social sciences, which depend entirely on public funding, are even more at risk, with certain sectors, activities, or research expressions at risk of being censored.
The United States Agency for International Development (USAID) program has been discontinued, affecting health development aid in some developing countries. What are your thoughts?
The first executive order, before the one targeting USAID, involved withdrawal of the US from the World Health Organization (WHO). This severed a critical link in disease surveillance, particularly for infectious diseases, between the Centers for Disease Control and Prevention in Atlanta and the WHO. This connection is essential for monitoring, diagnosing, advising, and managing emerging diseases. With this link severed, it is conceivable that the WHO, based in Europe, could function without US participation.
The second decision regarding USAID is a logical consequence of the first decision. Funds are now to be spent primarily within the US, as if diseases are confined by borders. However, this approach is likely to be costly. Diseases know no borders. For example, measles is spreading in Southern states, and polio is reemerging in the US. This is happening in the context of the US Secretary of Health expressing doubts about the effectiveness of vaccinations.
This article was translated from Univadis France using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.