The biomedical research ecosystem has delivered advances that not long ago would have been inconceivable, exemplified by highly effective COVID-19 vaccines developed by global partners and approved in less than a year. The United States stands at a moment of unprecedented scientific promise and is challenged to ask: What more can we do to accelerate the pace of breakthroughs to transform medicine and health? Toward that end, President Biden recently proposed to create a new entity, the Advanced Research Projects Agency for Health (ARPA-H), within the National Institutes of Health (NIH) “to develop breakthroughs—to prevent, detect, and treat diseases like Alzheimer's, diabetes, and cancer,” requesting $6.5 billion in the fiscal year 2022 budget (1). The idea is inspired by the Defense Advanced Research Projects Agency (DARPA), which follows a flexible and nimble strategy, undeterred by the possibility of failure, and has driven breakthrough advances for the Department of Defense (DOD) for more than 60 years. To design ARPA-H, it is critical to understand what is working well within the biomedical ecosystem, where there are crucial gaps, and the key principles of DARPA's success.

生物医学研究生态系统取得了不久前不可想象的进步，例如由全球合作伙伴开发并在不到一年内获得批准的高效 COVID-19 疫苗。美国正处于科学前景空前的时刻，并面临着这样的挑战：我们还能做些什么来加快医学和健康变革的突破步伐？为此，拜登总统最近提议在美国国立卫生研究院 (NIH) 内设立一个新实体——卫生高级研究计划署 (ARPA-H)，“以取得突破——预防、检测和治疗疾病，例如阿尔茨海默氏症、糖尿病和癌症”，在 2022 财年预算中要求 65 亿美元（1）。这一想法受到国防高级研究计划局 (DARPA) 的启发，该局遵循灵活敏捷的战略，不受失败可能性的影响，60 多年来一直推动国防部 (DOD) 取得突破性进展。要设计 ARPA-H，了解生物医学生态系统中哪些方面运行良好、哪些方面存在重大差距以及 DARPA 成功的关键原则至关重要。