Biden’s new health challenge: Find another Francis Collins

“We’re now at a deficit: we have the largest health agency in the world, the NIH, without a leader and the FDA,” said Ellen Sigal, chair and founder of Friends of Cancer Research, which also chairs the committee Foundation public-private partnerships for the NIH. “These positions are problematic, especially when we are in the middle of a pandemic.”

Assistant Principal Director Lawrence Tabak, Collins’ longtime No. 2, is likely to serve as Assistant Director in the meantime. But he’s unlikely to be Biden’s choice for a permanent leader, according to two people familiar with the early discussions. Collins said Bloomberg Law On Tuesday he wanted to see a woman as his successor.

Each candidate, if approved by the Senate, must skillfully prioritize such as overseeing dozens of studies of coronavirus treatments and vaccines while defending and explaining the government’s pandemic response to the public and lawmakers on Capitol Hill. The next director will also face GOP-fueled allegations that the NIH funded risky “gain in functionality” virus research related to the unproven theory that the coronavirus leaked from a laboratory in Wuhan, China.

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

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

The 71-year-old Collins mastered such turbulence with clear, sometimes happy ease. He appeared frequently at hearings about the pandemic response with a giant replica of the coronavirus and avoided the brickbats aimed at other high-level Biden health officials like infectious disease expert Anthony Fauci.

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

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

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

But Collins told Biden he wouldn’t stay for the next four years.

Now that he has announced his intention to step down “by the end of the year,” the White House expects to choose his successor before he leaves.

“In the meantime, the American people can count on the NIH and department heads to have strong leadership – dealing with the Covid-19 pandemic and more,” White House deputy spokeswoman Karine Jean-Pierre told reporters Boarded Air Force One on Tuesday.

The star-studded opening has the potential to be a headache for the Biden government, which continues to grapple with pandemic news as it choreographs the launch of vaccine boosters.

However, Ann Cashion, who spent eight years at the National Institute of Nursing Research within the NIH – including serving as an associate director – said Biden “has the right administrative advisors to do it without a lot of headaches.”

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

Health and Human Services Minister Xavier Becerra said in an email to staff Tuesday that “it is an understatement to say”. [Collins] will be sorely missed, “added,” Few people could come close to what Dr. Collins achieved during his tenure at NIH. “

Others, however, point out that the timing might be right to bring in a leader who can revitalize the comprehensive 27-institute science agency and lay the groundwork for ARPA-H, whose foundation the sometimes slow culture created by more than two, should bother – dozen other research centers.

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

He adds that there are too few scholarships for black researchers and the average age of scholarship holders has increased.

“That’s not good for innovation,” said Emanuel.

Some ARPA-H proponents have long been suspicious of Collins, particularly because of his early reluctance to accept the new agency.

“This is a seismic change in government, so of course there will be a ripple effect,” said Liz Feld, president of the Suzanne Wright Foundation, which has advocated an ARPA-H model for years. But the change could “open up other ways and means of doing things and a new approach to things we can do in the health sector”.

The only risk, Feld and others said, is that the ARPA-H will lose momentum because Collins, who is very popular with lawmakers who are currently setting budget priorities, left during the debate.

Collins will continue to work in his laboratory on the NIH campus and return to his roots as a longtime geneticist. People close to him say that in addition to his other pursuits, he enjoys spending more time in science – including a rock band, the Affordable Rock ‘N Roll Act, performing at NIH events to raise funds for the agency.

“He’s truly a renaissance man in every way,” said David Skorton, president of the Association of American Medical Colleges, who rehearsed with the band.

Fauci, who has become one of the most recognizable faces of the coronavirus response, told POLITICO that he will “absolutely not” be the director of the NIH and that his priorities are with the Institute of Infectious Diseases, which he leads, which conducts studies for Covid-19. Vaccines and treatments are carried out on an ongoing basis.

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

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