The world’s largest public funder of biomedical research is in limbo. The National Institutes of Health has, in large part, managed to withstand the Trump administration’s attempts to slash its budget and upend how it distributes grants, thanks to decisions from the courts and Congress. But the agency now faces a growing vacuum in leadership in its top ranks — one that offers the administration a highly unusual opportunity to reshape NIH to its vision. Of the 27 institutes and centers that make