Sixteen of the 27 National Institutes of Health (NIH) institutes and centers in the US operate without permanent directors.[2][3][4] These positions are filled by interim directors due to layoffs, resignations, and retirements.[2][3] Those affected include the Institutes of Allergy and Infectious Diseases, Child Health and Human Development, Clinical Research, Complementary and Integrative Health, Dental and Cranial Research, General Medical Sciences, Heart, Lung, and Blood, Human Genomics, Fogarty International Research, Library of Medicine, Mental Health, Minority Health and Health Disparities, Neurological Disorders and Stroke, Nursing Research, and Scientific Review.[2] For example, the director of the National Institute of Arthritis, Musculoskeletal and Skin Diseases, Lindsey Criswell, announced that her five-year term was not extended by the Department of Health.[3] Gary H. Gibbons retired as head of the Heart, Lung, and Blood Institute at the end of January.[2] NIH has open tenders for most of the 16 vacant positions.[3]