U.S. Senate confirms Monica Bertagnolli as NIH director
After 2-year gap, biomedical research agency has a permanent chief, but she faces many challenges
At last, the world’s largest biomedical research agency has a permanent leader. The U.S. Senate today voted 62-36 to confirm oncologist Monica Bertagnolli to direct the U.S. National Institutes of Health (NIH).
The confirmation of Bertagnolli, who is expected to be sworn in within days and replaces acting Director Lawrence Tabak, brings relief to the biomedical research community. Researchers had been waiting for a new NIH chief since longtime director and geneticist Francis Collins stepped down in December 2021. President Joe Biden nominated Bertagnolli in May.
A cancer surgeon and clinical trial expert, Bertagnolli will be NIH’s 17th director and the second woman to lead the agency. She left Harvard Medical School and affiliated hospitals to head the National Cancer Institute in October 2022. She now takes the reins of the $47 billion NIH as it faces enormous budget and political pressure and with just 15 months remaining until the end of Biden’s term—and perhaps her tenure. “She will have plenty of problems on her plate,” says cancer researcher Harold Varmus, who headed NIH in the 1990s.
For example, the substantial number of Senate votes against Bertagnolli reflects concerns among both conservative and liberal lawmakers about NIH policies. Conservative lawmakers have complained about NIH’s role in funding politically sensitive research such as gender-affirming care and virus studies that some claim led to the COVID-19 pandemic. Two liberal senators, Bernie Sanders (I–VT) and John Fetterman (D–PA), voted against her confirmation because of concerns that NIH is not doing enough to bring down drug prices.
At her confirmation hearing before the Senate health committee last month, Bertagnolli said she wants to bring NIH’s innovations and clinical trials to diverse populations in the United States. One immediate challenge she will face is urging Congress to preserve NIH funding as it works to reconcile a 2024 spending measure passed by the Senate that would slightly increase the agency’s budget with a bill from the House of Representatives calling for deep cuts. “She’s going to have to fight for the least amount of reduction or even a flat budget or maybe a 1% increase,” says former Director Elias Zerhouni, who led NIH in the mid-2000s.
Building support among skeptical lawmakers in Congress will be a priority. Republicans in the House, for example, have used the 2024 House spending bill and an accompanying report released last week to highlight some of their concerns. The measure would defund NIH efforts to promote a diverse biomedical workforce, hormone research on gender-affirming care, an office on sexual and minority health research, and fetal tissue studies. The final consensus bill is not expected to retain those funding bans, Jennifer Zeitzer of the Federation of American Societies for Experimental Biology notes, but Bertagnolli is likely to face ongoing questions about those efforts and potentially risky pathogen research.
The research community hopes Bertagnoli will also address other matters, including reversing NIH’s shift away from basic research toward more applied studies. Also awaiting Bertagnolli is an advisory panel’s report, due in December, on low salaries for postdocs and the increasing difficulty senior scientists face in recruiting that pivotal workforce. She is also expected to be pressed to clarify NIH’s relationship with the Advanced Research Projects Agency for Health, a new independent agency within NIH that Biden created to boost high-risk, high-impact research.
It’s a lot to pack into a tenure that might not last beyond Biden’s term if he fails to win reelection. “It’s a complicated agency” with “a steep learning curve,” says Carrie Wolinetz, a former top NIH official now with the lobbying firm Lewis-Burke Associates. “I admire the fact that she’s willing to take it on.”
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