Four challenges facing Biden’s nominee for NIH director

Four challenges facing Biden’s nominee for NIH director

Cancer researcher Monica Bertagnolli will need to be confirmed by the US Senate to become the next head of the US National Institutes of Health.Credit: Ricky Carioti/The Washington Post via Getty

After nearly a month of anticipation, US President Joe Biden has officially tapped cancer surgeon Monica Bertagnolli to lead the US National Institutes of Health (NIH). Media outlets, including Nature, had reported in April that Bertagnolli, the current head of the US National Cancer Institute (NCI), was the likely nominee.

Bertagnolli now has a number of challenges ahead of her as the NIH, which has an annual budget of about US$47 billion, faces considerable scrutiny. Since winning a majority in the US House of Representatives during the 2022 mid-term elections, Republicans have launched investigations into the NIH’s response to the COVID-19 pandemic and its funding of risky pathogen research. Republicans have also proposed cutting federal spending, some of which might come from the NIH’s budget, as the US government approaches a deadline to raise its debt ceiling. And researchers have been calling for the agency to diversify the biomedical workforce in the United States and to make sure that grants are equitably distributed.

Researchers who spoke to Nature are relieved that there might finally be someone in the NIH director role, which has been vacant since geneticist Francis Collins stepped down in December 2021, after more than 12 years on the job. But they recognize that “it’s been a hot minute” since Collins took office, and times have changed, says Jennifer Zeitzer, director of public affairs at the Federation of American Societies for Experimental Biology, headquartered in Rockville, Maryland. For one thing, politicization of science has gotten “way worse”, she says. As a result, Bertagnolli will also have to grapple with a dip in public trust in science.

Running the gauntlet

A first test for Bertagnolli will be her confirmation hearings with the US Senate. Government watchers expect her to be approved, given that Democrats — Biden’s party — hold a slim majority in the Senate. Her ability to handle intense questioning from the US Congress is relatively untested. “There is a certain art to going to Capitol Hill and taking friendly and unfriendly fire from Congress,” Zeitzer says. “But I have unwavering faith in her ability to do so.”

Bertagnolli will probably encounter tough questions from policymakers on both sides of the political aisle. For instance, Senator Bernie Sanders of Vermont, who caucuses with Democrats and chairs the Senate committee that will review Bertagnolli’s nomination, has said that he would oppose health agency nominees who won’t “stand up and fight” the drug industry to “significantly lower the price of prescription drugs”.

Republicans might grill her over unproven claims that the NIH’s funding of coronavirus research in China could have played a part in causing the COVID-19 pandemic. Their colleagues in the House have been holding hearings about the origins of COVID-19 that have put the spotlight on Collins and former head of the NIH’s infectious diseases branch, Anthony Fauci.

Funding advocate

If Bertagnolli makes it through the gauntlet, one of her first big tasks will be to strongly advocate for NIH funding. House Republicans recently put forward a spending bill that, if enacted, would slash the biomedical agency’s funding by billions of dollars. (The bill is all but certain to fail in the Democrat-led Senate, however.)

Their proposal comes as the United States sits on the precipice of defaulting on its debts, possibly in June. House Republicans have said they will not vote to raise the debt ceiling unless the Biden administration cuts federal spending. As negotiations are ongoing, Zeitzer says it’s worth considering how the next NIH director would manage a significant funding cut if thrust into that unsavoury position.

In addition to advocating for funding, researchers hope Bertagnolli will take to heart lessons the agency can learn from its response to the COVID-19 pandemic. For example, Zeitzer says the next NIH director will need to acknowledge that public support for science took a hit during the pandemic, and it will be important for the director to take steps to shore it up. That means publicly reinforcing the idea that policies can and must change as new scientific evidence arises — a fundamental part of how the scientific process works — especially in a public-health emergency such as the COVID-19 crisis, she says.

Moving the needle

Bertagnolli was the first female NCI director and would be the second permanent female director of the NIH if confirmed. “She has long been breaking glass ceilings and doing so based on her own merit,” says Chandrajit Raut, the chief of surgical oncology at Brigham and Women’s Hospital in Boston, Massachusetts, who has worked with Bertagnolli.

Researchers hope that means that, under her leadership, diversity and equity will be key priorities for the agency, which has struggled with these issues since a 2010 landmark analysis found that white researchers applying for NIH grants are much more likely than Black researchers to win them1. These disparities have persisted over the past decade; a study published in February2 pointed out that the agency has been awarding funding more and more to a small group of ‘super investigators’ who are overwhelmingly male and white. James Ntambi, a metabolic-diseases specialist at the University of Wisconsin-Madison, says, “I’ve been in research for many years, and I have seen little progress in the right direction.”

Raut says that Bertagnolli “has always been concerned with making sure that clinical trials and state-of-the-art treatments are available to anyone, wherever they are”, he says, and he thinks that resolve will translate to the NIH at large. “She’s going to be a change-making director.”

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