Although Congress preserved NIH funding from proposed cuts, the agency is operating with acting leaders in more than half of its 27 institutes and centers, raising questions about strategic direction and grant decision continuity. The Trump‑era leadership shakeups and terminations have left many senior posts unfilled, according to reporting on NIH leadership gaps. Acting directors can manage day‑to‑day operations but may lack authority for long‑term strategic choices, slowing responses to evolving research priorities and complicating university grant planning. Campus research offices and PIs should flag contingency plans for review timelines and expect potential shifts in institute priorities as permanent appointments are made. Academic leaders say sustained uncertainty at NIH could affect recruitment of top researchers, timing of major initiatives and coordination with federal science policy, underscoring the need for transparent appointment processes.