Covid-19 and the Investigator Pipeline | NEJM –

On December 14, 2020, the first person in the United States to be vaccinated against Covid-19 outside of a clinical trial received her first dose of vaccine. Later that week, a trial demonstrated reductions in viral load among patients receiving monoclonal antibodies against SARS-CoV-2.1 By January 1, 2021, less than 10 months after Covid-19 was declared a pandemic, more than 4000 studies related to Covid-19 were registered on, including nearly 1500 involving a drug or vaccine. The speed, depth, and breadth of the response to Covid-19 by the biomedical research community has been unprecedented. At the same time as these advances are on track to save millions of lives, however, the Covid-19 pandemic is dismantling the pipeline of investigators who are essential to the future of biomedical science.

When Covid-19 hit the United States in the spring of 2020, universities and hospitals in affected areas quickly shut down basic science laboratories, in keeping with directions from public health authorities. Experiments were upended, and valuable laboratory animals were sacrificed. With the exception of Covid-related studies, clinical research slowed dramatically, as conducting study visits became nearly impossible and resources were redirected. Investigators saw their staff deployed to support patient care during surges. In many health systems and universities, hiring of new staff and access to institutional funds were restricted or frozen because of projections of sharp reductions in revenue.

Other consequences of Covid-19 created additional challenges for specific groups. Many investigators with young families had to manage remote schooling with children home all day. Investigators in clinical disciplines that were central to pandemic response were pulled to staff clinical services — particularly in critical care, infectious diseases, and hospital medicine. International travel restrictions impeded global health research, with projects sidelined because of the inability to hire and train study staff in other countries. Financial stress was most acute when an investigator’s partner lost income, an institution cut salaries or benefits, or the costs of pandemic-related needs, such as in-home child care, drove up monthly expenses. Some investigators faced illnesses or deaths of family members or other loved ones. The deaths of Breonna Taylor, George Floyd, and many others at the hands of police highlighted the violence and oppression experienced by people of color in the United States. Together with the growing anger over racist federal and state policies, these events led to national anguish, particularly among people from racial and ethnic communities that are underrepresented in the sciences.

By late spring 2020, the implications of Covid-19 for the investigator community were widely recognized, and mitigation efforts began. National Institutes of Health (NIH) program officers reached out to grantees to ask about the pandemic’s effects on their research. Eligibility for some NIH career-development awards was extended so that trainees with more than the usual amount of postdoctoral research experience could apply. Carryover rules for grant funds and grant-application deadlines became more flexible. Many funders created new programs to support Covid-19 research, although most programs relied on supplements to existing grants, which disadvantaged junior investigators.

Academic institutions throughout the United States also responded to the challenges facing investigators. Reopening research laboratories was prioritized, and scientists were able to return to their labs for at least a few hours each day. When possible, telehealth platforms were leveraged to support clinical research efforts, which enabled study visits to restart even while hospital or practice visits were limited. Bridge and pilot funding programs were developed or expanded, often targeting junior investigators who were most at risk for having their careers disrupted because of upheaval in the research and training process. Many universities extended timelines for tenure decisions by a year or more. Some created virtual mentoring programs in which senior faculty reached out to junior investigators to offer grant-writing support and other advice.2

In the Massachusetts General Hospital Department of Medicine, we launched several additional initiatives, which early evidence suggests have had some limited success. Samples from patients with Covid-19 were collected using a centralized biobanking protocol that prioritized access for junior investigators. Junior faculty leveraged their access to build new collaborations, which led to new grants. We developed a Covid-19 clinical trials review process and infrastructure to enable junior faculty without research staff to propose and lead studies.3 Senior investigators who had grants that were eligible for Covid-related supplements included junior investigators in proposals when possible. At the same time, clinical leaders minimized the clinical demands on junior investigators (in part by offering extra payment to people who were interested in additional clinical time and by ensuring that the extent of additional clinical requests was proportional to baseline clinical responsibilities) and maximized flexibility in clinical scheduling to help faculty balance family-related and professional demands. We established a program that provided research-assistant support to junior faculty and internships to college students from disadvantaged backgrounds. With a recent philanthropic gift, we initiated an effort to distribute supplemental funding to investigators with career-development awards and additional salary support to mentored junior faculty who have had to delay their entry into the job market.

Although we were fortunate to be able to leverage Covid-related donations that are unavailable to many institutions, it’s become increasingly clear that even these steps are insufficient. Every week, I hear from senior faculty concerned about losing junior scientists and from junior scientists who are anxious and exhausted. A recent job posting for an investigator position yielded nearly 100 applications, many more than we would have received a year ago. The past year has made it clear how critical the investigator pipeline is for global well-being. More must be done to strengthen it.

Academic institutions and funding agencies have the greatest responsibility for the scientific-investigator pipeline and should support programs and policy changes that could mitigate the pandemic’s effects. At the same time, the Covid-19 vaccine effort highlights the power of the federal government to leverage public–private partnerships during a national crisis. The companies developing and producing Covid-19 vaccines are performing an immense public service. They are also expected to make many billions of dollars selling these vaccines — products that could not have been developed without decades of formative basic and clinical research, including fundamental studies of gene structure and editing and animal and human experiments that used engineered RNA and DNA to induce immune responses. It’s hard to imagine a better rationale for prioritizing public–private investment in the scientific-investigator pipeline.

Building on earlier recommendations, I believe such investment should address financial and other disincentives faced by junior scientists and should help diversify career options for scientists completing their training.4,5 There is no silver bullet, and successfully shoring up the investigator pipeline will require multiple initiatives. At the top of the list should be increasing the flexibility and amount of support associated with training and career-development grants for awardees and mentors (particularly for K awards, which now lead to 25% of new R01 grants and have provided essentially the same amount of funding for decades), establishing programs that create incentives for institutions and principal investigators to hire staff scientists, extending current grants and providing additional funding to help scientists redo experiments that were abandoned or cut short, expanding accountable loan-repayment programs, and fostering partnerships between academic institutions, health systems, government agencies, and private companies such as pharmaceutical companies to promote investment in critical scientific and support infrastructure (including child care) for junior scientists in particular. These efforts can take lessons from pipeline programs in other countries, including the Canada Research Chairs program, which committed $335 million to support Canadian scientists in 2020. Finally, marked disparities in Covid-19 infections and deaths by race and ethnic group emphasize the importance of designing investments in the investigator pipeline to prioritize health equity throughout the biomedical research process.

Emerging infectious diseases and other health threats will continue to pose a danger to the United States and the global community. It’s time to leverage vaccine-development efforts to take on another important Covid-related challenge: stabilizing the investigator pipeline. As recent months have shown, the scientific pipeline is both in jeopardy and central to our ability to address emerging health threats.