Introduction

The Clinical and Translational Science Awards (CTSA) program serves as the catalyst of the National Institutes of Health's efforts to accelerate the translation of scientific discoveries into improved patient care and population health outcomes.

This federal investment supports an unparalleled breadth of critical functions spanning the entire translational research spectrum, from basic laboratory discoveries through clinical trials to community implementation and dissemination of evidence-based interventions. Unlike any other NIH program, the CTSA initiative provides comprehensive infrastructure support for research design and biostatistics, regulatory knowledge and support, community engagement, workforce development, and collaborative networks that are essential for transforming scientific breakthroughs into real-world health solutions. The program's transformative impact extends far beyond traditional research powerhouses, enabling institutions across the nation—including those in underserved regions and emerging research environments—to build robust translational research capabilities and contribute meaningfully to the national mission of improving health outcomes.

Without the CTSA program's unique and comprehensive approach, the leading US research institutions would lack the specialized resources, expertise, and collaborative networks necessary to bridge the critical gap between scientific discovery and clinical application, ultimately limiting the nation's capacity to translate research investments into tangible health benefits for patients and communities.

Clinical Research Forum has growing concerns about the health of CTSAs, due to the Administration’s recent activities which have resulted in confusion, grant delays, and funding cuts. To that end, Clinical Research Forum conducted a survey of all Clinical and Translational Science Awards (CTSA) grantees in August 2025. This survey reveals significant disruptions to CTSA research activities, with widespread funding delays, budget reductions, and operational challenges affecting research institutions nationwide. The survey of 41 respondents (out of 60 funded programs) highlights systemic issues that have compromised research continuity and institutional planning.

According to NIH’s website,” … the Clinical and Translational Science Awards (CTSA) Program supports a national network of medical institutions that speeds the translation of research discoveries into improved care. Currently, more than 60 leading medical institutions across the nation receive CTSA Program funding. The institutions offer expertise, resources and partnerships at the national and local levels to improve the health of individuals and communities. The CTSA Program also nurtures the field of translational science through education, training and career support at all levels.”

One final note: the CTSA program has long been supported with direct, line-item appropriations by Congress and is currently funded at $629.5 million.

Key Findings

Award Delays and Processing Issues

Multiple institutions reported substantial delays in receiving Notice of Awards (NOAs), with delays ranging from 36 days to 4 months. One respondent noted that "award notices for U and K were delayed for almost 4 months," while another reported their "award was delayed 36 days, causing unnecessary angst across the institution."

The delay extended beyond initial awards to administrative processes. One institution reported requesting carryover for awards in January/March but "not until July" did they receive approval, describing it as "a very long process."

Funding Reductions

U Awards Impact

With the Administration removing DEI and health equity related activities from already awarded NIH support, CTSA U Awards, the core funding for CTSA hubs that provides institutions with translational science resources, services, and education, experienced the most significant financial impact, with 26 (65%) institutions reporting funding cuts:

• There was a wide range of reductions, from $40,000 to $1.3 million per year.
• Grant cuts were as high as 13%, with most cuts between 2% to 7%.

• Since U Awards are large hub grants, these reductions, which apply to the current and all subsequent years of the grant, add up to millions of dollars lost over the life

  of the grant, which is typically 5 to 7 years. For example, the CTSA hub that lost $1.3 million per year starting in year three of seven, will lose $5.2 million over their grant.

  K Awards Impact

  CTSA faculty development K Awards had smaller but still significant reductions:

• Cuts ranged from 0.4% to 5% of total grant value, $7,722 to $39,000 annually.
• Administrative burden: Multiple respondents noted ongoing uncertainty, with several stating that they were waiting for their delayed Notice of Award

  NIH K awards provide salary, research, and training support for scientists at various career stages, and are designed to ensure a robust and diverse pool of researchers who can

  address the nation's health needs.

  K awards represent strategic workforce development for scientific areas crucial to national security, including pandemic preparedness, biodefense, and medical countermeasures.

  Cutting these programs weakens America’s ability to respond to biological threats and maintain scientific leadership in areas where adversaries are making significant investments.

  Research Activity Disruptions

  The survey revealed multiple dimensions of research impact, in personnel, training program disruptions, pilot program complications, and operational uncertainty.

• One institution reported that "faculty and staff had to take FTE reductions

  (reductions from full-time) or furloughs" due to the 4-month delay in award notices.

• The prohibition of pre-award spending on TL1 awards was specifically noted as having "significant negative effects on Trainees," highlighting how administrative delays directly impact early-career researchers.
• One respondent noted that "Pilot awards were more complicated and delayed this year," affecting institutions' ability to launch new research initiatives.
• Institutions implemented "cautionary measures with expenditures to limit financial risk exposure.”

Institutional Responses and Concerns

Short-term Response

Research institutions implemented risk mitigation strategies that came at operational costs. Some institutions managed to maintain what they deemed "essential operations" despite funding uncertainty.

Respondents reported a lack of transparency. To some institutions, “cuts seem arbitrary and vary substantially from hub to hub, despite all of us doing highly similar work.” The uncertainty created additional administrative challenges, with program officers frequently having to revise their instructions, or ask their superiors for clarification. The lack of having a voice or being able to participate in any discussions was also cited.

Long-term Concerns: Multiplier Effects on Research Funding

The economic multiplier effect of CTSA cuts extends far beyond the direct dollar amounts. Each CTSA hub typically leverages its federal funding to support research projects totaling many times the original investment. When CTSA resources are reduced:

• Grant Competitiveness Declines: Researchers lose access to the biostatistical, regulatory, and administrative support that makes their grant applications competitive, leading to reduced success rates for other NIH and foundation funding.
• Industry Partnerships Dissolve: CTSA Program institutions work with their own

  technology transfer offices, NIH Research Evaluation and Commercialization Hubs (REACH), community partners and external groups to navigate regulatory processes. These partnerships often bring significant non-federal resources that are lost when CTSA support disappears.

• Clinical Trial Capacity Shrinks: Fewer federal reviewers, fewer funded sites, and fewer scientific grants mean a slower, less responsive research ecosystem.
• Direct Employment Loss: Each CTSA hub employs biostatisticians, clinical research coordinators, regulatory specialists, data managers, and administrative staff whose positions depend directly on CTSA funding. These are often highly

  specialized professionals whose skills are difficult to replace once lost from the system.

   

• Early Career Disruption: CTSA programs provide crucial training opportunities for postdoctoral researchers, clinical fellows, and junior faculty. Cuts to these

programs create bottlenecks in career development that have long-lasting effects on research capacity.

• Faculty Research Disruption: Senior researchers who have built their programs around CTSA-supported infrastructure face the prospect of having to drastically scale back their research or relocate to institutions with intact CTSA support,

disrupting established research teams and ongoing studies.

Conclusion

Clinical and translational research has a multi-stage pipeline that typically spans 10-20 years from initial discovery to widespread implementation. When promising basic research findings can't move into translational studies, or when early-phase clinical trials can't advance to larger efficacy studies, the entire pipeline stalls. Unlike manufacturing, where you can resume production after a funding gap, research momentum is difficult to recover—failed studies can't be easily restarted, and scientific knowledge becomes outdated.

Clinical and translational research requires a unique workforce of physician-scientists, clinical research coordinators, biostatisticians, and regulatory specialists who take years to train. K awards and similar career development programs are specifically designed to support researchers during the vulnerable transition from trainee to independent investigator. When this support disappears, talented individuals leave for more stable careers in clinical practice, industry, or other fields. Unlike other sectors where workers can be quickly rehired, rebuilding scientific expertise takes decades—a researcher who leaves science at age 35 rarely returns at 45. Students, fellows, and junior faculty whose support is delayed by hold-ups in T or K award funding must move on, and they and their contributions are lost to the translational research pipeline.

Finally, clinical research depends on specialized infrastructure that is supported by CTSA U awards. Clinical research centers, core laboratories, patient registries, and research networks that took years to establish and validate. These facilities require consistent funding to maintain staff, equipment, and regulatory compliance. When funding cuts force their closure or downsizing, this infrastructure can't be quickly rebuilt. The clinical research networks that enabled rapid COVID-19 vaccine trials, for example, represent decades of investment in relationships, protocols, and data systems that would be extremely difficult to recreate.