NIH director nominee asks questions

Monica Bertagnoli answered questions for nearly two hours on Oct. 18 about how she would respond to various scenarios as head of the US National Institutes of Health.Credit: Tom Williams/CQ-Roll Call via Getty


Monica Bertagnoli, US President Joe Biden’s pick to lead the National Institutes of Health (NIH), hinted today during a long-awaited Senate committee hearing what her priorities would be for the biomedical agency if confirmed. At the top of the list is improving the diversity of clinical trial participants, strengthening collaboration among NIH’s 27 institutes and centers, and restoring public trust in scientists and the agency.

Before the COVID-19 pandemic, NIH typically saw annual budget increases and enjoyed bipartisan support for its mission. The hearing made clear how politically charged the agency’s research portfolio has become since then, highlighting the challenges Bertagnoli may face as its director. The growing institution is the largest public funder of biomedical research in the world, with an annual budget of approximately US$47 billion.

“If confirmed, I will work every day to improve health, extend life and reduce disease for all Americans,” Bertagnoli said at an Oct. 18 Senate committee hearing.

Clash with drug prices

The confirmation hearing comes nearly two years after former NIH director, geneticist Francis Collins, stepped down after more than 12 years in the role. (Lawrence Tabak is acting director.)

Biden nominated Bertagnoli, who is the current head of the US National Cancer Institute (NCI), to lead the NIH in May 2023. But Bernie Sanders, an independent senator from Vermont who is not affiliated with any political party and who chairs the committee on Health, Education, Labor and Pensions, responsible for Bertagnoli’s confirmation, has delayed holding that hearing until he can secure a promise from the Biden administration to lower prescription drug prices in the US. In September, Sanders finally said he would move forward with Bertagnoli’s nomination after the administration struck a deal with Tarrytown, N.Y.-based Regeneron Pharmaceuticals to cap the cost of a next-generation monoclonal antibody to treat COVID-19.

Bertagnoli is the first female director of the NCI, and if her new position is confirmed, she will be the second permanent female director of the NIH. A cancer surgeon, Bertagnoli was also the first woman to head the Department of Surgery and Oncology at the Dana-Farber Cancer Institute in Boston, Massachusetts.

Loss of unanimous support

During the hearing, although senators from across the political spectrum praised Bertagnoli’s qualifications for the job, many pressed her on hot-button issues. In contrast, when Collins became NIH director in 2009, he had unanimous support from the US Senate and no confirmation hearing was held.

Things changed for the agency during the COVID-19 pandemic after some Republican lawmakers made unsubstantiated claims that NIH funding of coronavirus research in China may have played a role in causing the global crisis. Their colleagues in the US House of Representatives are holding hearings on the origins of the virus, which are investigating Collins and the former head of the NIH’s Division of Infectious Diseases, Anthony Fauci.

“The NIH has become a lightning rod for partisan debate during the COVID-19 pandemic, and that has eroded trust between the NIH and the public,” Bill Cassidy, a Republican senator from Louisiana, told Bertagnoli during the hearing. “You will be tasked with restoring relations with Congress.”

Expressing confidence in her abilities, the scientific community rallied behind Bertagnoli: more than 120 nonprofits representing scientists, patients and institutions supported her confirmation in a letter sent to Senate leaders on Oct. 17.

Beyond the origins of COVID-19, Sanders pushed Bertagnoli to commit to lowering prescription drug prices in the United States, and several Republican senators questioned whether the NIH should invest taxpayer dollars in fetal tissue research or health care for transsexuals.

Many senators asked Bertagnoli to promise to advance research on a wide range of topics, including menopause, childhood cancer, antibiotic resistance and children’s screen time. “The hearing was almost entirely a list of personal concerns based on each senator’s constituency, family members or interest groups,” said Stuart Buck, who is based in Houston, Texas, and runs the Good Science Project, an advocacy organization. to improve the funding and practice of science. Instead, Buck wishes the hearing had focused more on Bertagnolli’s plans to address structural problems at NIH, such as how to hire early-career scientists and whether the agency encourages enough high-risk, transformational research instead of incremental research.

The committee will meet again on Oct. 25 to decide whether to advance Bertagnoli’s nomination to a full Senate vote.

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