Do America’s Top Health Research Officials Stick Around Too Long?

When Anthony Fauci stepped down as director of the National Institute of Allergy and Infectious Diseases in 2022, he had been in the role for 38 years. He had served under seven different presidents and overseen more than $100 billion of federal spending; a young infectious disease researcher beginning a Ph.D. program when Fauci took office could easily be a graying professor emeritus by the time he left.

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Fauci was an outlier, but the pattern is widely acknowledged: Unlike the leaders of some other federal science programs, top officials at the National Institutes of Health tend to stick around (at least until recently, when many lost their jobs during the second Donald Trump administration).

Those roles have heft. The NIH is the world’s largest medical research funder, and the directors of its 27 institutes and centers wield power not only over the day-to-day operations of NIH, but over entire scientific fields. Many oversee annual budgets in excess of $1 billion. Other than the director of the National Cancer Institute, who is a presidential appointee, they are career government employees. There is no fixed limit to how long they can serve, and some stay in the role for decades.

Observers have long debated whether or not this poses a problem. On one hand, experience can be an asset, and exceptional leaders — when they appear — aren’t easy to replace. But over the years, a diverse array of scientists and policymakers have worried that long tenures are stifling innovation at the agency. As far back as 2003, a report by the National Academies of Sciences, Engineering, and Medicine recommended term limits for key NIH leadership positions, arguing that turnover “is critical for sustaining the vitality of a research organization.”

More recently, the issue has been championed by Republican lawmakers seeking reforms after the Covid-19 pandemic. A senior government official, who spoke on condition of anonymity because they were not authorized to grant interviews, told Undark that term limits for institute directors and lower-level division directors are currently under discussion at the Department of Health and Human Services, which oversees NIH. (It’s likely that HHS could implement this policy now, though making it durable could require an act of Congress.) Spokespeople for NIH and HHS did not respond on-the-record to requests for comment.

 

“You really need term limits. You need fresh new blood,” the official said.

Experts and former institute directors who spoke with Undark did not disagree on the benefits of bringing in new people with fresh perspectives. Walter Koroshetz, for example, who directed the National Institute of Neurological Disorders and Stroke from 2014 until this past January, suggested that somewhere between 10 and 15 years might be the ideal timeframe for an institute director. Still, he added, the most important leadership quality isn’t years on the job. “The key thing at NIH,” he said, “is that you’re supposed to be pushing the science to the cutting edge.”

The 2003 National Academies report was written at the request of Congress, which wanted to know whether the scientific agency — by then, more than 100 years old — was optimally structured to keep up with the rapidly evolving science of health and disease. The report’s authors put forth numerous recommendations, including that all institute directors should be appointed for no more than two five-year terms. The NIH director, meanwhile, would be limited to two six-year terms. These proposals were never adopted, however. Currently, institute directors serve five-year terms, which can be renewed indefinitely.

“So my guess is that NIH leadership basically didn’t think the term limit was a good idea and let it dangle out there without acting on it, much as they handled discussions about NIH structure,” wrote Robert Cook-Deegan, a professor at Arizona State University who has written on NIH history, in an email to Undark.

Other attempts to limit tenure of senior staff have also foundered. In 2019, according to reporting in Science, the NIH announced 12-year term limits for the 272 lab and branch chiefs who oversee the agency’s in-house research, in an effort to increase gender and ethnic diversity among their ranks. But as of last September, the policy had not been implemented, said Nina Schor, who led NIH’s Office of Intramural Research from 2022 to 2025.

The issue of leadership tenure remains active. In a 2024 report, some House Republicans called for institute directors to serve a maximum of two five-year terms. A 2025 report from the Paragon Health Institute, a think tank with ties to President Donald Trump’s administration, also recommends term limits.

There are advantages to having institute directors serve open-ended tenures, potentially for a decade or more. The job, former directors say, takes time to master. Leadership turnover can stall vital projects and bleed organizations of institutional memory. And fixed term limits run the risk of pushing out someone who may, by many metrics, be excelling in their job.

If an institute director is succeeding, “I don’t see why you want to get rid of them at the end of five years” — for example — “just to get rid of them,” said Story Landis, who ran the National Institute of Neurological Disorders and Stroke from 2003 to 2014. Landis argued that regular and rigorous review of institute directors is essential — and could perhaps be more robust — but she described more hesitation about putting in a hard-and-fast rule kicking people out of the job. (In a follow-up email to Undark, she said she was coming to support limiting directors to a maximum of 10 years, writing that it “shouldn’t be a forever career.”)

Shorter tenures might also increase the risk of politicization, with each new administration viewing the turnover as an opportunity to install leaders based on party loyalty rather than scientific expertise. Some people close to the agency think this is already happening, regardless of term limits; the Trump administration has fired, reassigned, or declined to renew at least eight institute directors in the past year.

Even people who see benefits in longer tenures acknowledge that some institute directors have probably stayed too long. A review of NIH employment data shows that the average tenure has gradually grown longer. Of the 17 institute directors who started in the 1960s, only three served more than a decade. By contrast, of the 16 who started in the 1990s, seven lasted more than a decade, including National Institute on Aging director Richard Hodes, who is still in office after 32 years. (Those figures omit the National Cancer Institute.)

Over time, an individual leader’s policies can ossify, said Cook-Deegan, who favors term limits. He cited Claude Lenfant, who led the National Heart, Lung, and Blood Institute from 1982 to 2003. Lenfant’s agency did very little to support tobacco control research, particularly when compared with the support such research received from the National Cancer Institute, said Cook-Deegan. And this is despite the fact that tobacco use is more likely to kill people by causing heart and lung disease than by causing cancer.

Koroshetz noted that program staff and division directors tend to stay at the agency a long time — often two decades or more — and their view of science may be heavily based on experiences they had prior to coming to NIH. “If they’re sitting in an office five days a week, reading grants and stuff, it’s a little difficult to be totally abreast of the science,” he said. New directors may be particularly well positioned to come in and push staff to try something different, he said. Those fresh perspectives can guard against what Koroshetz described as “magical thinking, where people think something because of some milieu they’re involved in, but it’s not accurate.”

And then there’s the matter of power and influence.

“In general, in any government agency that controls large budgets, there accumulates over time soft power, and potentially a lack of ability to see things in a different way,” said Joseph Marine, a cardiologist and professor at the Johns Hopkins University School of Medicine. (Marine has advocated for NIH reforms, and last year he co-authored a pandemic policy article with NIH director Jay Bhattacharya.) In Marine’s view, this was particularly problematic during the Covid-19 pandemic, when “Dr. Fauci wielded an enormous amount of power, and people were very reluctant to contradict him because their entire careers depend upon NIH funding” and on the support of the academic medical community.

Some other U.S. science agencies have taken a different approach. At the Defense Advanced Research Projects Agency, or DARPA, scientific leaders are generally limited to three two-year terms. A 2016 document from the agency titled “Innovation at DARPA” describes “short tenure and continual rotation” as “the most important contributors to continuing innovation.”

The National Science Foundation, which spends its $9 billion budget on basic research in biology, computer science, and other fields, has historically assigned many senior roles to people called rotators, who come in from academia or industry, stay for a fixed term of a few years, and then leave. The NSF’s directorates — roughly analogous to NIH institutes — have in the past often been overseen by scientists who serve for a maximum of four years. (According to reporting in Science, the Trump administration has cut down on the number of rotators and made all directorate leaders career staff, as part of a larger reorganization of the agency. Michelle Negrón, an NSF media officer, wrote in an email to Undark that the agency declined to comment.)

That system had disadvantages. At least in the past, NSF has matched rotators’ salaries in the outside world, making the program costly. And an NSF inspector general told a House committee in 2015 that the flow of new people can be bring “personnel management challenges,” including issues with managing conflicts of interest.

Jim Olds, a science policy expert and a professor at George Mason University, spent nearly a decade as an NIH scientist, and went on to run the NSF’s Biological Sciences Directorate from 2014 to 2018, overseeing more than $700 million in scientific spending each year. The system at NSF, Olds told Undark, worked well overall — and, he suggested, NIH might benefit from replicating it. “On the NIH side, you really need to make the job shorter, less tenured, and increase the compensation, following the Singapore model of high compensation and very low tolerance for corruption,” he said.

The long tenures at NIH, he argued, have helped promote a more risk-averse culture at the agency.

“I think when you’ve been on the job 30 years, things get pretty static,” Olds said. “I mean, that’s not true just in science. It’s true in general.”

Michael Schulson is a contributing editor for Undark. His work has also been published by Aeon, NPR, Pacific Standard, Scientific American, Slate, and Wired, among other publications.