Indian American researcher’s grant mentioned ‘hesitancy.’ Now her funding is gone

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When the National Institutes of Health terminated dozens of research grants that focused on why some people are hesitant to accept vaccines, many researchers were taken aback, outraged, disheartened. Nisha Acharya read her letter in disbelief.

Acharya, an ophthalmologist and professor at the University of California at San Francisco, doesn’t study how to combat vaccine hesitancy or test ways to increase vaccine uptake. Those have become hot-button issues under the new vaccine-skeptical secretary of health and human services, Robert F. Kennedy Jr.

Instead, she studies how well the shingles vaccine works to prevent the painful infection – with a focus on whether the shot also prevents the virus from affecting people’s eyes, risking their sight.

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But Acharya had the misfortune to use the word “hesitancy” one time in a summary of her project and the word “uptake” twice. On Tuesday, she learned that her five-year grant – worth more than $600,000 this year alone – had been canceled, effective immediately.

Three lab workers are likely to be out of jobs, and research that probed how the shingles vaccine performs in the real world – including benefits and harms – was shut down overnight.

“It’s devastating,” Acharya said.

Acharya’s experience highlights the Trump Administration’s sweeping approach to halting vaccine research. On Monday, an internal NIH email showed that dozens of grants had been flagged for termination or cuts because they were aimed at “gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.”

Last week, the Centers for Disease Control and Prevention, another part of HHS, was directed to research possible connections between vaccines and autism, despite well-established research that shows no link between the two.

It’s unclear whether Kennedy had anything to do with either move, but both align with his long-term views.

NIH and the Department of Health and Human Services did not respond to a request for comment on Acharya losing her grant.

The letter Acharya received says, “NIH is obligated to carefully steward grant awards to ensure taxpayer dollars are used in ways that benefit the American people and improve their quality of life. Your project does not satisfy these criteria.”

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Shingles in the eye

One in 3 people in the United States develops shingles. The painful disease is caused when the varicella-zoster virus that lurks in the body after chicken pox in childhood reactivates decades later. In 2017, a highly effective shingles vaccine, Shingrix, was approved by federal regulators.

In 2018, during the first Trump administration, Acharya received a five-year NIH grant to explore how well shingles vaccines worked outside the controlled environment of a clinical trial – with a particular focus on shingles in the eye. About 10 to 20 percent of shingles cases occur in the eye, potentially causing permanent blindness.

“I was really interested in looking at this vaccine from the perspective of how effective is it for preventing ocular involvement. That’s one of the more devastating things that can happen,” said Acharya, whose work utilizes large datasets, such as insurance claims and health records.

NIH has supported this branch of Acharya’s work for seven years. Her first grant was renewed, and she is now midway through a second five-year grant devoted to this research, which would have provided more than $3 million, if it had not been cut short.

Her team has uncovered disparities in who is getting the injections, determined that the coronavirus vaccine doesn’t increase the risk of shingles in the eye and concluded that the shingles shot is associated with a decreased risk of dementia.

Acharya’s work now focuses on measuring how the shingles vaccine performs in the real world – creating basic scientific knowledge that could be used by policymakers to target vaccination efforts. It could identify new age groups that may benefit or people who might be harmed by vaccination.

The letter terminating her project said it had been canceled because it “focuses gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.”

Her project does measure the “uptake” of the vaccine, because to understand whether it is helping or harming people requires knowledge of who is receiving it. Her project summary states, “there is concern that vaccine uptake may be low among specific demographic groups due to early shortages and healthcare disruptions during the COVID-19 pandemic.”

Acharya also looks at concerns that the vaccine may carry harms. An important question she wanted to answer is whether the vaccine could cause shingles in the eye to recur in a subset of people who had already had it.

A survey from her lab had found that cornea specialists – not patients – had “hesitancy” to recommend the vaccine to people who had previously suffered a shingles infection in the eye. Some in the medical community believe that in those patients, the vaccine could trigger recurring inflammation.

Her study set out to determine whether that was warranted.

“Who is this beneficial for and how well does it work – are there subpopulations where there are issues?” Acharya said. “It wasn’t even vaccine hesitancy – literally, I think that’s what got it flagged.”

Keyword searches have been used at the National Science Foundation to flag grants that may be in conflict with executive orders. Inside NIH, people familiar with orders to terminate grants have described an opaque system in which grants are being terminated without the input of scientists who are experts in those areas of research.

What’s happening now is unprecedented, said several people familiar with the grant process who spoke on the condition of anonymity because they were not authorized to speak about it. In the past, grants could be terminated if a scientist was found guilty of research misconduct or sexual harassment, for example.

In the first weeks of the second Trump administration, several hundred grants have been terminated in letters that cite a shift in agency priorities – including funding that supports research at Columbia University, awards that pay for transgender research and more than 40 grants related to vaccine hesitancy or uptake.

The letter Acharya received said that although NIH would typically suspend rather than terminate a grant to allow the scientist to take corrective action, “No corrective action is possible here. The premise of [Acharya’s project] is incompatible with agency priorities, and no modification of the project could align the project with agency priorities.”

An NIH employee, who spoke on the condition of anonymity because they are not authorized to speak on the subject, said that typically it would be up to the agency’s scientists to determine whether the scope of a grant needed to be changed.

“We are not being notified at all,” the employee said. “We have expertise in our areas of science specifically so we can negotiate those changes.”

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Study suggests some ‘hesitancy’ may be warranted

Kennedy has called for more work into the safety of vaccines. Acharya thinks her work does exactly that.

Acharya’s research was the kind of study that could illuminate, for a relatively new vaccine, if there were groups of people who responded differently or whether new issues emerged when the vaccine was used in a larger population.

One of her aims, for example, is to ascertain how well the vaccine works in immunocompromised people, who are at high risk for shingles but were excluded from the original clinical trials.

Last year, she published a paper in the journal JAMA Ophthalmology that found doctors’ caution in recommending the vaccine to some people may be warranted. Her work found higher risk of recurrence of eye inflammation in people who had previous shingles in the eye.

“These findings support consideration that patients with a history of [shingles in the eye] may benefit from monitoring after” vaccination, her study concluded.

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