The head of the National Institutes of Health said Wednesday that although each of the 27 institutes and centers at NIH would have to cut 5.1 percent under sequester provisions of the budget control law, the directors of those entities could decide how to apportion the reduction within each institute. NIH faces a cut of some $1.5 billion from its $30 billion budget under sequester provisions scheduled to take effect March 1. Individual institute directors at NIH faced with 5 percent cuts “have to figure out how to distribute that amongst the many different kind of mechanisms, grants and centers, in terms of the intramural program, but everything will take a hit,” director Francis Collins said. “There is at least some flexibility within the institute.” Collins addressed reporters after a tour of NIH facilities with Sen. Barbara A. Mikulski, D-Md., a longtime champion of the medical research agency who seemingly has leverage to defend its budget given her new role as chairwoman of the Senate Appropriations Committee.

Mikulski, who used the tour to highlight the harm she said the sequester would do to patients, families, researchers and the economy, dismissed the value of the limited flexibility Collins outlined.

“Let me tell you how I feel about flexibility,” she told reporters. “The sequester is like the Titanic hitting an iceberg. Flexibility essentially says, you’re on a ship that’s sinking, what deck do want to be on? As you go down, do you want to be closer to the kitchen? Do you want to be closer to the band while we hum ‘Nearer My God to Thee’?

“What we need to do is not hit that iceberg. We have until next Friday. We could pass legislation. We’ve been known to do it,” she said.

Collins said NIH will “try to prioritize to things that seem most promising, most critical to public health, but there’s no question there will be across-the-board damage to virtually everything. We would pursue it, but we won’t go as fast as we can.”

Patients and their families counting on NIH to find new cures and treatments for their diseases will be harmed, Collins said, and progress will be slowed in research to fight diseases such as Alzheimer’s, cancer, AIDS, diabetes and heart ailments. “Cuts will mean a delay, for instance, in developing a universal vaccine against influenza, a project that is going extremely well,” he said.

But Collins said “perhaps the greatest concern that all of us have” is the effect on young scientists. “Our training grants are going to get cut,” he said. “This is not a spigot we turn off and then just turn it back on again blithely a year later. If we lose the talents of this up-and-coming generation with all their dreams and visions they’re not coming back.”

Carol Greider, a Nobel Prize winner who chairs the molecular biology and genetics department at Johns Hopkins University, also emphasized the effect of the sequester on young researchers. Under the sequester, the rate at which grant applications are funded at NIH would fall to half the 30 percent rate of successful grant applications that existed when she was a young researcher, she said, adding that it’s possible that under today’s difficult fiscal climate the research she did that led to the Nobel Prize would not have been funded.

Mikulski said Johns Hopkins stands to lose about $60 million in funding this year if the sequester occurs.

There will be “an impact on 15,000 Marylanders, who work either at NIH or who benefit from the research funding at other research institutions,” such as Johns Hopkins and the University of Maryland, Mikulski added. Those Marylanders face cuts in their research or in some cases may lose their jobs, she said.

“We are also looking at March 27th when the continuing resolution expires,” Mikulski noted. That would create a legislative vehicle “to solve the problem of sequester to get us beyond the CR and to give certainty for this year and then focus on fiscal year ’14 appropriations while the president hopes to seek, with other leadership, a grand bargain.”

Lobbyists for disease groups had little good to say about the kind of flexibility that would exist under a sequester, even though individual institutes handle funding for a large number of diseases and presumably could give priority to some while cutting research into others more deeply.

In some instances that flexibility could be helpful for lobbyists for a particular disease, said Dick Woodruff, vice president of federal relations for the American Cancer Society. But he said his organization is not in the business of telling the National Cancer Institute which research program to fund and which not to fund.

“That’s their job to figure out how to do that” based on their scientific expertise, he said. “I think that would be robbing Peter to pay Paul.”

Most disease groups are focused on preventing the sequester, he said. If it does occur, “there will be a blow-back” from the public to restore funding, and an occasion to do so could come with the expiring of the continuing resolution (PL 112-175), he said.

“That’s optimistic, but I think it depends on how severely the members of Congress feel the impact,” he said.

Cynthia Bens, vice president of public policy at the Alliance for Aging Research, likewise suggested that her organization would defer to the director of the institute about which it is most concerned: the National Institute on Aging. Individual directors “do know where the particular vulnerabilities are” in research programs, Bens said. “What’s concerning to us is the financial position of every institute.”

Bens indicated that the National Institute on Aging has been relatively underfunded in the past. The alliance was hoping to play catchup and called for an actual increase in that institute’s funding, particularly because of new research needed under a national plan prepared by the Department of Health and Human Services to counter Alzheimer’s disease, she said. But the sequester would require the same overall cut at every institute.

“It’s really terrible,” she said.