Planning and Implementing Strategically

Abstract

At the end of 2020, the National Institute of Neurological Disorders and Stroke, an institute of the NIH, completed an 18-month-long strategic planning process that involved and engaged diverse internal and external biomedical and general stakeholders. The institute published and disseminated its 2021–2026 Strategic Plan online in December 2020. Now, 1 year into its implementation, this progress report presents accomplishments to date, new initiatives and opportunities, and a preview of the metrics and benchmarks we will use to gauge the future progress of the strategic plan's implementation.

In mid-2019, the National Institute of Neurological Disorders and Stroke (NINDS) embarked on formulating a new strategic plan. By the end of 2020, the 2021–2026 was published online.¹ Unlike the externally driven process through which the preceding strategic plan² was developed, the 18-month-long process by which this was performed was initiated from within the NINDS and sought input as it proceeded from a diverse array of outside stakeholders in hopes of formulating a strategic plan that not only serves the NINDS vision and mission and is responsive to the taxpaying scientific and lay constituencies of the NINDS but also reflects the values of NINDS as a funder and performer of the best science as judged by peer members of the scientific community regardless of the topical focus of that science.

The vision, mission, and strategic goals for the NINDS have been previously described¹ and relate directly to the primary role of NINDS in leveraging its discovery and understanding of basic mechanisms to ease the burden of neurologic disorders for all people. Beginning with these high-level targets, a steering committee arrived at crosscutting strategies^3,4 that would guide all the operations of the NINDS over the next 5 years. Subsequently, each of 4 taskforces focused on science, training and diversity, communication, and workforce climate, respectively, in alignment with the 4 strategic goals and armed with 11 crosscutting strategies, was charged with arriving at a list of objectives achievement of which would bring the NINDS closer to attainment of that taskforce's corresponding strategic goal. Now, in year 1 of implementation of our strategic plan, these strategies are reflected in what we have already performed and what we hope to perform. The present progress report presents accomplishments to date, new initiatives and opportunities, and a preview of plans in development for year 2 of the NINDS 2021–2026 Strategic Plan's implementation.

Methods

The objectives for science, scientific training and workforce diversity, communications and dissemination, and workforce culture (Table 1) grew not only out of the deliberations of the respective taskforces but also out of responses to a Request for Information sent broadly to the NINDS's scientific, advocacy, and lay constituencies, and discussion panels that comprised scientists, physicians, patients, disease community advocates, and science media professionals.

Table 1.

Taskforce Objectives

Table 2 outlines some of the metrics we will use to chart the progress, gauge the success, and, if warranted, change the trajectory of attainment of the objectives in each category. Because most of the initiatives discussed in the Results section have just been launched, progress to date is largely process-based and opportunity establishment-based. As such, application of outcome metrics to the progress of our strategic plan awaits future reports.

Table 2.

Sample Outcomes Metrics for Each Group of Objectives

Results

Science Objectives

The relevance of each of the science objectives for specific foci and types of science varies more widely than is the case for the other 3 groups of objectives (Table 1). For this reason, each of the science objectives is discussed individually in the following sections.

Understanding the Healthy Brain, Spinal Cord, and Neuromuscular System

Basic science research enables understanding of normal structure and function of the nervous system. Its products enable discernment of mechanisms of normal processes that allow organisms to perceive and interact with their environments. The NINDS will support research to understand the molecular, cellular, network, and organismal basis of healthy nervous system function and reaffirm the importance of basic neuroscience research. The NINDS will monitor the basic neuroscience enterprise and act to sustain its vigor and robustness.

Implementation of this objective to date is exemplified by the detailed cell atlas of the mammalian motor cortex assembled by the BRAIN Initiative Cell Census Network investigators.⁵ The BRAIN Initiative, a collaboration of 10 NIH Institutes, is jointly led by the NINDS and the National Institute of Mental Health (NIMH); it develops and disseminates tools and data repositories that define in multidisciplinary dimensions the normal structure and function of the nervous system. Other examples, drawn from the NINDS Division of Intramural Research, are the finding that the microbiome contributes to the features of normal aging⁶ and studies aimed at understanding how experience and genetic programming interact to shape structural and functional connectivity during brain development.^7,8 NINDS also issued a Request for Applications through the BRAIN Initiative entitled, “New Technologies and Novel Approaches for Recording and Modulation in the Nervous System,” to develop the tools we will need to better document and analyze electrical signaling in the normal nervous system.

Understanding the Basic Mechanisms of Neurologic Disorders

Basic science research also leverages an understanding of normal structure and function of the nervous system to distinguish normal from abnormal and thereby understand the mechanisms of neurologic disorders. The NINDS will support research to understand what triggers neurologic disorders; how genetic, molecular, cellular, and system changes drive disease progression; and why recovery occurs for some people and not others. The NINDS will encourage collaborative, interdisciplinary, and interprofessional research by engaging basic investigators, clinical scientists, and physicians from multiple disciplines in the research enterprise.

This year, we published funding opportunities, created resources available to the scientific community, and performed studies at the NINDS, which will expand our understanding of the path that leads from normal to abnormal structure and function. For example, this year, the NINDS released a Program Announcement entitled “Prodromal Synaptic and Circuit Changes that Contribute to AD/ADRD Onset and Progression” to encourage applications that examine the role of aberrant cross talk between brain loci in Alzheimer disease and related dementias. In addition, in collaboration with our colleagues at the National Institute on Aging (NIA) and as a signature program of the new Center for Alzheimer's and Related Dementias, we have created isogenic background induced pluripotent stem cells with single gene mutations associated with dementia, now available through Jackson Laboratories.⁹ These cells will enable study of changes induced in brain function by specific mutations without the confounding effects of other genetic differences between control and disease or among different disease states. In the NINDS Division of Intramural Research, basic science work on sodium channel ATPase structure and function has now been extended to expand our understanding of human nervous system disorders of these channels including alternating hemiplegia of childhood, rapid-onset dystonia-parkinsonism, and cerebellar ataxia, areflexia, pes cavus, optic atrophy, sensorineural hearing loss syndrome.¹⁰ Another of our intramural research teams has capitalized on what we know about the role of adenosine receptors in transport across the blood-brain barrier to potentially enhance brain tumor uptake of chemotherapeutic agents.¹¹

Seeing More Precisely—Biomarkers and Outcome Measures

The NINDS will promote the development and validation of diagnostics, biomarkers, and outcome measures by providing targeted support, research resources, and coordination. These are critical elements of the process of translating discovery from the laboratory to the clinic and ensuring accurate, safe, and effective deployment of discovery in service of the human condition. The NINDS has developed several mechanisms that provide funding and partnership opportunities for every stage of this process. For example, this year, the Advisory Council for NINDS has approved in concept publication of a Funding Opportunity Announcement entitled “Identification of Clinical Outcome Assessments to Measure Efficacy through Natural History Studies of Ultra-rare Neurological and Neuromuscular Diseases,” to facilitate future clinical studies of and therapeutic trials in disorders with variable and fluctuating course. The NINDS recently published a Notice of Special Interest entitled “Biomarker Discover and Validation in Functional Neurological Disorders” and a Program Announcement entitled “Clinical and Biological Measures of TBI-related Dementia Including Chronic Traumatic Encephalopathy.” These indications of particular interest for the NINDS are intended to encourage the development of toolkits that can be used to develop meaningful datasets in therapeutic trials for functional neurologic disorders and traumatic brain injury. Examples from the NINDS Division of Intramural Research include the use of high-field MRI as a biomarker through which to follow the course of demyelination and remyelination of lesions in multiple sclerosis.¹² An ongoing study is examining the natural history of post–COVID-19 neurologic sequelae¹³ to facilitate understanding the course and discerning the effectiveness of future interventions for these sequelae.

Improving Treatments

Development and refinement of new or repurposed treatments for neurologic disorders is a risky enterprise. Therapies are years in the making, validating, ensuring of safety, and fulfilling the criteria for regulatory approval. The NINDS will support preclinical and clinical development of therapies, complementing the role of the private sector. The NINDS will thereby “de-risk” therapeutics development for the pharmaceutical, device manufacturing, and academic developers. In this regard, the NINDS will support preclinical development of small-molecule drugs, biologics, and device therapies, using targeted programs that provide milestone-gated funding, expert consultation, and contract resources that are not normally available to academic and small business (US businesses with ≤500 employees including affiliates)¹⁴ researchers. The NINDS will also support a program of clinical trials that advances innovative treatments; new uses of existing interventions; and comparison of the effectiveness of treatment options, prevention, and other critical needs, which complements private sector research and development.

This year, the NINDS launched the Ultra-Rare Gene-targeted Therapies Network to democratize the development and availability of gene-targeted therapies.¹⁵ In addition, our Small Business Innovation Research program released “NINDS Exploratory Clinical Trials for Small Business” to facilitate and de-risk the development of novel treatments and therapeutic devices by small businesses. The NINDS also issued a Request for Applications entitled “Translational Neural Devices” this year. In the NINDS Division of Intramural Research, ongoing therapeutic studies include immunotherapy trials for the uniformly fatal disorder, progressive multifocal leukoencephalopathy,¹⁶ sensory stimulation as adjunctive rehabilitative therapy for stroke,¹⁷ and gene therapies for disorders of the muscles and nerves.^18,19 A focus on neuroethics has enhanced these studies and the clinical evaluation and use of the therapies they develop.^20,21

Preventing Neurologic Disorders

The NINDS already has a long history of defining and promoting practices that prevent stroke. Going forward, the NINDS will sustain the progress made in stroke prevention and advance the prevention of neurodegenerative diseases, TBI, epilepsy, dementia, and other neurologic disorders. In addition, the NINDS will address the persistent health disparities in stroke and the disturbing recent increases in stroke rates among younger people and build on advances in understanding epilepsy, TBI, neurodegenerative diseases, chronic pain, and other neurologic disorders to develop effective preventive interventions.

This year, the NINDS announced intent to publish 2 funding announcements, one of which was specifically aimed at small businesses, entitled “Stroke Preclinical Assessment Network to Support Translational Studies for Acute Cerebroprotection—Interventions.” This initiative is aimed at enhancing the rigor and assessing upfront the reproducibility of studies that focus on preventing extension of and reperfusion injury in stroke. Another opportunity entitled “Clinical Relevance of the Linkage between Environmental Toxicant Exposures and Alzheimer's Disease and Related Dementias” is aimed at eventually preventing dementia by eliminating environmental contributors to their occurrence.

Advancing Health Equity

Neurologic conditions affect people of all ages, races, ethnicities, and sexes and can differentially affect individuals based on these characteristics and geographic, socioeconomic, or other factors. The NINDS is committed to understanding what drives health disparities across the lifespan and to reducing the burden of neurologic disease borne by underserved groups of society, including racial and ethnic minorities, rural population, and socioeconomically disadvantaged populations, by funding a spectrum of research from basic science through clinical studies and through public information programs. Because improving health equity is so important, and progress has been so challenging, the Institute has established a new Office of Global Health and Health Disparities in the Division of Clinical Research. Led by this office, the Institute has embarked on a planning process focused on health equity within the broader framework of the overall NINDS Strategic Plan.

In 2021, the NINDS posted an informational webinar about an upcoming Request for Applications entitled “Advancing Health Equity in Pain Management,” hoping to make pain therapies available to all people. The NINDS also held an outstanding symposium entitled “HEADWAY: Health Disparities and Inequalities in Neurologic Disorders.”²² In addition, NINDS published a funding opportunity entitled “Detecting Cognitive Impairment, Including Dementia, in Primary Care and Other Everyday Clinical Settings for the General Public and Health Equity, Pragmatic Clinical Trials.”

The NINDS has created and implemented workgroups around data science and team science in its extramural funding enterprise and faculty surveys and focus groups around mechanisms for enhancing team science in its intramural enterprise to begin to formulate specific agendas for year 2 of strategic plan implementation.

Scientific Training and Workforce Diversity Objectives

The NINDS is committed to contributing to the rigor and breadth of training and the diversification of the scientific workforce (Table 1). The NINDS will support training across the breadth of basic, translational, and clinical neuroscience research to foster advances and innovation. To accomplish this goal, the NINDS will create incentives for foundational broad knowledge and cross-disciplinary training that will seed innovation, collaboration, and novel discoveries; support targeted programs that address unique needs in training and career development for translational and clinical research; support and develop programs and resources for training in data science, neuroethics, health disparities, and other crosscutting or emerging areas; and enhance coordination and awareness about training programs and policies. The NINDS will also invest in training in principles of rigorous research, experimental design, and quantitative skills.

Furthermore, the NINDS will support programs across all career stages to achieve diversity and inclusion and programs and policies that promote inclusivity and cultural competence. The NINDS will promote mentorship as an essential component of research training and workforce development and foster a holistic approach to professional development for the neuroscience workforce.

This past year, 8 outstanding neuroscience research mentors were named winners of the 2021 Landis Award for Outstanding Mentorship, underscoring the importance to the NINDS of mentoring and nurturing the next generation of neuroscientists. The NINDS also published a funding opportunity entitled “Materials to Enhance Training in Experimental Rigor (METER)” to facilitate the development of curricula and curricular instruments through which to enhance, during training, the understanding and appreciation of rigor as a basic tenet of the conduct and interpretation of scientific research. We have reissued our funding announcement for the “NIH Blueprint for Neuroscience Research Short Courses in Neurotherapeutics Development,” aimed at equipping academic neuroscientists to bring laboratory discoveries and inventions further along toward clinical application. The BRAIN Initiative has published its plan to enhance the effect of diverse perspectives on the development of tools for understanding the nervous system. Our Division of Intramural Research has enriched and enhanced its training programs, with a dedicated Director of Education and Training and, despite the challenges of the pandemic, a robust suite of Summer Internship Programs, including the one focused on Health Disparities in Tribal Communities.

Communication and Dissemination Objectives

The NINDS will expand the reach and effect of its communication efforts (Table 1). The Institute will prioritize communicating timely, clear, and transparent manner on how it operates and makes decisions. Furthermore, it will disseminate research outputs to improve health and instill a broad appreciation for the value of neuroscience research. The following principles will guide attainment of all these objectives: (1) science has no effect until clearly communicated; (2) communication is a powerful tool for transparency and accountability; (3) communication must be bidirectional, with emphasis on engagement and partnerships; (4) the NINDS strives for fairness and equity in access to the Institute and to scientific and policy information; (5) the NINDS endeavors to be a trusted, go-to source of credible, timely information on neuroscience and neurologic disorders; and (6) the NINDS strives to rapidly disseminate scientific discovery and innovation to all stakeholders.

The NINDS communication efforts this year have included prototype development for a planned “Cleared Concepts” website, so scientific and general stakeholders can know in advance what funding, workshop, and training opportunities are on the horizon. The NINDS has redesigned its Division of Intramural Research website²³ to make it easier to search for particular investigators, research topics, and scientific areas and to instantly get a sense of the dynamism and breadth of this neuroscience community. The 2021 NINDS Nonprofit Forum focused on patient engagement and patient and family stories, an outgrowth of the Communications Taskforce's prioritization of inclusion and partnership.

Workforce Culture Objectives

The NINDS will establish effective performance management, with clear procedures, fair policies, and meaningful recognition, accountability, and transparency (Table 1). It will promote a positive and productive work environment and workforce culture with a strong sense of community and promote communication and collaboration within and across NINDS communities. Finally, the NINDS will foster a workforce culture that recognizes work-life needs and supports career goals and satisfaction. We are hopeful that the NINDS will become a model workplace in the national scientific community.

Toward this end, the NINDS has held 2 Town Hall Forums focused on racial equity, diversity, and inclusion. A monthly course entitled “Career Conversations” provided a second year of open discussions of topics related to career development for the NINDS workforce in all positions and at all levels; this year's topics included “Getting comfortable in a brand new job,” “Careers, COVID-19, and other disasters,” and “Opportunities for leadership at every level.” The NINDS continued its monthly orientation course for new employees; this proved especially important during the COVID-19 pandemic because it provided an opportunity for people to “meet” coworkers and supervisors of other sections and departments on a virtual platform. In view of the dearth of serendipitous opportunities to meet and talk in the virtual, remote work environment, the NINDS launched a virtual program entitled “Hallway Chats,” advertised monthly to all the NINDS workforce, for which a virtual channel was opened and whoever “showed up” could chat about whatever topics were brought up. This created a substitute of sorts for the chance meetings at the water fountain or in the checkout line at the cafeteria. Finally, the NINDS has crafted and launched its CORE IDEALS (for Culture Of Respect and Engagement: Inclusion, Diversity, Equity, Agency, and Leadership Support) Program. As the first component of CORE IDEALS, NINDS is in the process of standing up a program of peer mentorship for which volunteer members of its workforce are being trained by experts to serve as navigators for their peers to resources, information, and services provided by the NIH, which can help them solve problems of any magnitude or degree of seriousness.

Discussion

As is the case for most strategic plans, this one is intended as a roadmap for the NINDS workforce to guide and define the work of NINDS over the next 5 years. But we realize both happily and proudly that our constituents—the patients and families living with neurologic diseases; the neuroscience biomedical research community; and the neurology-relevant clinical practice community—will look to this document as one mechanism through which to engage and partner with the NINDS and to understand how best to leverage our resources, priorities, and insights to amplify their own effectiveness and effect. Table 3 offers a summary that we hope will contribute to this partnership and fuel bidirectional exchange with all our constituencies going forward.

Table 3.

Guidelines From the NINDS 2021–2026 Strategic Plan for Specific Readers

We view this strategic plan as a living, evolving document. Over the next year, we anticipate receiving responses to the Requests for Applications and Program Announcements and applications that reflect our expressions of particular interest in the development of new tools and toolkits and the diversification of both clinical trial participants and the scientific workforce. The NINDS continues to welcome comment and partnership in this endeavor and will continue to update the NINDS Strategic Plan 2021–2026 website as components of the plan are implemented and modified. We very much look forward to this scientific and institutional journey in service of easing the burden of neurologic disorders for all people.

Glossary

NIA

National Institute on Aging

NINDS

National Institute of Neurological Disorders and Stroke

TBI

traumatic brain injury

Appendix 1. Authors

Appendix 2. Coinvestigators

Study Funding

The authors report no targeted funding.

Disclosure

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.