NIH: The pandemic and the search for a new leader leave the agency at a crossroads

NIH’s identity crisis: The pandemic and the search for a new leader leave the agency at a crossroads Francis Collins’ popularity masked a debate raging in university labs and biotech boardrooms over whether the NIH is living up to its mission — or what its mission should be. Lev Facher STAT

WASHINGTON — Under the reign of Francis Collins, the National Institutes of Health was untouchable.

From virtually the moment President Obama appointed him in 2009, prominent figures in government and science have been enchanted by Collins, the Harley-riding, guitar-playing geneticist who brought newfound attention to the nation’s medical research agency.

In less than a decade, his agency’s budget ballooned from $29 billion to $42 billion. In an era when Democrats and Republicans agreed on nothing, the NIH’s popularity served as a rare unifier under three presidents.

When he retired last year, Collins was celebrated in an hourslong ceremony by Barack Obama, Yo-Yo Ma, George W. Bush, and the Dalai Lama. But his popularity obscured a debate raging in university laboratories and biotech boardrooms across the country: Is the biomedical sciences agency living up to its mission? Or, more fundamentally: What should its mission be?

The Biden administration’s search for Collins’ replacement, accordingly, has taken on outsize importance. It’s not just a key personnel decision: According to many NIH critics, it’s a once-in-a-generation chance to tackle the agency’s shortcomings and turn the government’s science strategy upside down. It’s also a process in which Collins, unexpectedly, will play a significant role: President Biden last month tapped him to serve as his science adviser in the wake of a workplace abuse scandal in the White House’s science office.

“Right now, NIH is a window into the past,” said Greg Simon, a veteran Democratic operative and onetime Pfizer executive who directed the Obama administration’s “Cancer Moonshot” effort in 2016. “It needs to be a window into the future. NIH needs to have an open, publicly involved process to redefine its mission.”

Much of the debate about the NIH centers on whether the agency should focus on “basic science” — fundamental research questions without immediate benefits to society — or on ambitious, instant-impact projects in the mold of Operation Warp Speed, the herculean government effort that developed Covid-19 vaccines in an astonishing nine months. The NIH has emphasized basic science since its inception in 1887, and the mission has largely remained constant even amid political tumult and an evolving scientific landscape.

The debate raises sweeping questions about the division of labor between industry and academia; the government’s role in bringing new medicines to market; and whether federally funded scientists should stay the course or throw out their decades-old playbook entirely. Taken together, the discussions highlight the critical moment for the agency and the future of American science — both in the wake of Covid pandemic, and as Biden searches for the agency’s next director. ...