Biden’s New Health Challenge: Find Another Francis Collins

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“We now find ourselves in deficit: we have the largest health care agency in the world, the NIH, without a leader and the FDA at the same time,” said Ellen Sigal, president and founder of Friends of Cancer Research. who also chaired the Foundation’s Public-Private Partnerships Committee for the NIH. “These positions are problematic, especially when we are in the process of ending a pandemic.”

Senior Deputy Principal Lawrence Tabak, Collins’ longtime No.2, is most likely to serve as interim interim manager. But he’s unlikely to be Biden’s choice for a permanent leader, according to two people familiar with the early talks. Collins says Bloomberg Law Tuesday that he wanted to see a woman succeed him.

Any candidate, if confirmed by the Senate, will need to skillfully navigate priorities such as overseeing dozens of coronavirus treatment and vaccine trials while defending and explaining the administration’s response to the pandemic. to the public and lawmakers of Capitol Hill. The next director will also face GOP-fueled accusations that the NIH funded risky research on ‘gain-of-function’ viruses, linked to the unproven theory that the coronavirus has leaked from a laboratory in Wuhan. , in China.

Collins’ successor will also have to manage a multibillion-dollar priority of President Joe Biden: the Advanced Research Projects Agency for Health, a new institute within the NIH that still needs congressional support.

Biden originally envisioned the so-called ARPA-H as a $ 6.5 billion research initiative to address major healthcare challenges like Alzheimer’s, diabetes, and cancer. But lawmakers have already cut its proposed budget by more than half, with the result now tied to the fragile budget process in Congress.

Collins, 71, has managed to weather such turbulence with frank, sometimes joyful ease. He has frequently shown up at pandemic response hearings with a giant aftershock of the coronavirus and has avoided the bricks directed at other top Biden health officials, such as infectious disease expert Anthony Fauci.

“Francis is a gifted communicator,” said Kathy Hudson, a former NIH official who has remained close to Collins. “When he became director of the NIH, the research community lamented that there were no NIH champions on the hill. Francis cultivated them by the dozen, with the leaders of both parties becoming tireless advocates of the NIH. “

Collins had been considering his departure for months, Fauci told POLITICO in an interview. Collins visited his longtime friend and colleague – with whom he has worked since becoming director of the National Human Genome Research Institute in 1993 – in Bethesda de Fauci, Md., Office this winter and said he felt it was time for him to leave.

“I literally begged him not to do this,” Fauci said. This was during a spate of Covid-19 cases and the final months of the Trump presidency. “I said… ‘You have to hold on.’ He did. To his credit, he felt he owed it to the institution to ensure that there was stability. “

But Collins told Biden he won’t be staying for the next four years.

Now that he has announced his intention to step down “by the end of the year,” the White House says it expects to select its replacement before he leaves.

“In the meantime, the American people can rest assured that there is strong leadership within the NIH and the leadership of the department – handling the Covid-19 pandemic and more,” Karine Jean told reporters. Pierre, Principal Deputy Secretary of the White House press aboard Air Force One. Tuesday.

The high-profile opening has the potential to cause headaches for the Biden administration, which continues to struggle with messages about the pandemic as it choreographs the roll-out of vaccine boosters.

However, Ann Cashion, who spent eight years at the NIH’s National Institute for Nursing Research – including as interim director – said Biden “has the right administrative advisers in place to get him treated. without too many headaches “.

“It is always difficult to find the right person with the right qualities to lead the NIH,” she wrote in an email, adding that the administration “has been keenly aware of the need for good science. “.

Health and Human Services Secretary Xavier Becerra said in an email to staff on Tuesday that “it is an understatement to say [Collins] will be sorely missed, “adding,” few could achieve in a lifetime what Dr. Collins achieved during his tenure at NIH. “

But others point out that the time may have come to bring in a leader who can revitalize the scientific agency of 27 institutes and lay the foundations for ARPA-H, whose creation was aimed at disrupting the sometimes slow culture. created by more than two-ten other research centers.

Ezekiel Emanuel, a University of Pennsylvania bioethicist who spent 12 years at NIH, told POLITICO that Collins’ departure offers an opportunity to “rethink the agency,” whose efforts may be too fragmented and lead to gaps or inefficiencies in research. .

He adds that there are too few grants given to black researchers and that the average age of grant recipients has increased.

“It’s not a good thing for innovation,” Emanuel said.

Some ARPA-H advocates have long been suspicious of Collins, especially because of his early reservations about the new agency.

“This is a radical change in government, so there will naturally be a ripple effect,” said Liz Feld, president of the Suzanne Wright Foundation, which has been advocating an ARPA-H model for years. But the change could “open up other opportunities and ways of doing things, and a new approach to things we can tackle in the health space.”

The only risk, Feld and others said, is that ARPA-H loses momentum because Collins, well-liked by lawmakers currently clashing over budget priorities, left during the debate.

Collins will continue to work in his lab on the NIH campus, returning to his roots as a longtime geneticist. His relatives say he is happy to devote more time to science with his other activities, including a rock band, the Affordable Rock ‘N Roll Act, which performs at NIH events to raise funds for the agency.

“He is truly a Renaissance man in every way,” said Association of American Medical Colleges president David Skorton, who rehearsed with the group.

Fauci, who has become one of the most recognizable faces in the coronavirus response, told POLITICO he would “absolutely not” be director of the NIH and that his priorities were the Institute of Infectious Diseases he heads , where trials of Covid-19 vaccines and treatments are underway.

“As much as I will miss Francis as a director, he will always be in his lab,” he said. “He is a very close colleague and a very good friend. You know, we’ve been through a lot together.


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