ARPA-H: Accelerating biomedical breakthroughs

The biomedical research ecosystem has delivered advances that not long ago would have been inconceivable, exemplified by highly effective COVID-19 vaccines developed by global partners and approved in less than a year. The United States stands at a moment of unprecedented scientific promise and is challenged to ask: What more can we do to accelerate the pace of breakthroughs to transform medicine and health? Toward that end, President Biden recently proposed to create a new entity, the Advanced Research Projects Agency for Health (ARPA-H), within the National Institutes of Health (NIH) “to develop breakthroughs—to prevent, detect, and treat diseases like Alzheimer’s, diabetes, and cancer,” requesting $6.5 billion in the fiscal year 2022 budget (1). The idea is inspired by the Defense Advanced Research Projects Agency (DARPA), which follows a flexible and nimble strategy, undeterred by the possibility of failure, and has driven breakthrough advances for the Department of Defense (DOD) for more than 60 years. To design ARPA-H, it is critical to understand what is working well within the biomedical ecosystem, where there are crucial gaps, and the key principles of DARPA’s success.

Progress in medicine and health in recent decades has been driven by two powerful forces: pathbreaking fundamental research and a vibrant commercial biotechnology sector. Fundamental research is typically performed in university, nonprofit, and government labs. In the United States, it is mostly funded by the federal government, largely through the NIH. By steadily pursuing important fundamental questions in biology and medicine, scientists have made great progress in discovering the molecular and cellular mechanisms underlying health and disease—often suggesting new ideas for clinical treatment. Such fundamental research is what economists term a public good, in that it produces knowledge available to everyone and thus requires public investment. Some have estimated that every dollar of federal investment yields at least $8 in economic growth, and suggested that every new therapeutic approved by the US Food and Drug Administration (FDA) can be traced, in part, to fundamental discoveries supported by NIH (2, 3). Given its outsized impact, robust federal investment in fundamental research remains crucial to health and to the economy.

Leave a Comment