three tests for the next NIH leader

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Outgoing NIH Director Francis Collins works with the leaders and staff of the agency’s 27 institutes and centers.Credit: Andrew Harnik / Getty

Francis Collins will leave big shoes to fill when he steps down later this year, after 12 years as director of the world’s largest public funder for biomedical research. By then, he should have secured bipartisan support for a funding increase that would bring the US National Institutes of Health (NIH) budget to $ 43 billion in fiscal 2021; when he took the job, in 2009, it was $ 30 billion. His scientific credentials as a physician and geneticist – which include leading the public effort to sequence the human genome in the 1990s and early 2000s – positioned him to put in place a number of research initiatives. great biology within the agency. These have enabled the NIH to maintain its position as a global research powerhouse.

The challenge now is to replace it – a process that involves an appointment by the president, followed by hearings and a vote in the Senate. Whoever takes on this role should be able to work with presidents and members of Congress, and possess the requisite scientific and administrative skills. The work also has a large diplomatic component, involving liaising with heads of international governments, as well as business leaders and leaders of philanthropic foundations, who are a growing force in many areas of research.

The new head of the agency will face a myriad of challenges, including directing biomedical research during and after the COVID-19 pandemic; tackle systemic racism and inequity in science; and navigate scientific cooperation with China. This is in addition to its central role: to secure the agency’s budget and to be ever more creative in advocating for support for fundamental research. The director’s choice should reflect an increasingly diverse nation. For all but 2 years of its 134-year history, the NIH has been run by a man; Cardiologist Bernadine Healy, who led the NIH from 1991 to 1993, is the only woman to lead the agency. It’s time to change.

COVID response

The NIH director oversees the agency’s 27 institutes and centers, which together employ more than 20,000 people, including 1,200 principal investigators and more than 4,000 post-docs. But the agency’s reach extends far beyond its headquarters in Bethesda, Maryland. Over 80% of NIH funding supports hundreds of thousands of researchers in laboratories in the United States and around the world.

The pandemic is an immediate priority. COVID-19 prompted the NIH, under Collins, to speed up some of its grant delivery systems and initiate rapid-response research into tests, vaccines and therapies for SARS-CoV-2. The success of mRNA vaccines against the virus stems, in part, from the preparatory work done before the pandemic by NIH-funded research. The agency also launched a four-year, $ 1.15 billion research investigation – one of the most ambitious in the world to date – into the long-running COVID.

The next director must build on these initiatives and find the best way for the NIH to support basic research on efforts to end the current pandemic – and prepare for the next one. One of the biggest challenges will be balancing this need with the other priorities and disease burdens for which the NIH is set up.

Racism and fairness

As one of many organizations facing discrimination, the NIH has had mixed results in its efforts to foster diversity, equity, and inclusion in the biosciences and its workforce. Under Collins, the agency announced that it would end its over-reliance on animals and male cells and factor gender into the design of biomedical studies. But the NIH has been slower than other U.S. federal agencies to adopt strict reporting guidelines when grant recipients are found to have violated an institution’s policies on sexual harassment.

Work against racism must be a priority for Collins’ successor. Black applicants received just 1.8% of NIH scholarships in 2020, a number that has barely budged since 2013 – and their pass rate is lower than applicants from White, Hispanic and Asian communities. Earlier this year, the NIH launched an initiative called UNITE, aimed at ending structural racism in biomedical science. The agency plans to spend $ 90 million on projects aimed at reducing health disparities and studying how structural racism affects the health of minority communities. This work must also be based on the latest social sciences.

These are welcome steps, but much more funding and commitment is needed to address the persistent under-representation of black researchers among agency grant recipients. It is imperative that the next director tackles the real systemic barriers.

Diplomacy

The ability to work effectively with elected officials is a crucial aspect of the role of the NIH Director – it involves responding to known and foreseeable diplomatic and political challenges, as well as reacting quickly to new situations as they arise.

One of those situations is the fear of the United States that the Chinese government is using research collaborations as a means of spying on American research institutions. The NIH is among a number of scientific agencies involved in allegations relating to these concerns, and some NIH-funded scientists with ties to China have lost their jobs. Civil rights groups say many have been unfairly targeted, in part because of the deteriorating relationship between the United States and China. The next NIH chief is expected to advocate for clearer rules that allow American and Chinese researchers to be supported by each other’s funding agencies – as universities demand.

The president calls

The size and scale of the NIH, and its importance to American science, means that the director of the NIH works closely with the office of the president. President Joe Biden has a deep personal interest in biomedical research, having worked extensively with research advocates, particularly in the field of cancer, when he served in the Senate and as vice president of the former President Barack Obama.

The NIH will need to advance other priorities Biden pointed out, including an ambitious vision to redesign the country’s science and technology enterprise, and the creation of an Advanced Research Projects Agency, or ARPA, focused on health. (ARPA-H). This would follow ARPA’s widely touted model of defense, DARPA, by funding innovative and high-risk research projects.

Biden has offered to allocate $ 6.5 billion towards the creation of ARPA-H, although it is not yet clear to what extent Congress will accept this request. Questions the new NIH director will face will include whether ARPA-H should reside within the NIH – as Collins advocated – or whether he should sit elsewhere in the U.S. government. Wherever it finds a home, ARPA-H must have sufficient authority and independence to avoid getting bogged down in the typical sluggishness of NIH operations.

Collins also served during the four years of Donald Trump’s administration, which returned him to this post. It’s a reminder that the head of the NIH must have a constructive working relationship with the ruling party. This relationship is often challenged, especially when it comes to research priorities. Collins supported the need for research involving fetal tissue, which results from elective abortions. But that wasn’t enough to stop the Trump administration from drastically restricting research on fetal tissue. Although the Biden administration overturned the decision, the next NIH director must prepare the case and form coalitions against future restrictions in this area.

The next NIH director will not be working alone – he will be able to draw on the expertise and wisdom of staff across the agency, as well as the national and international research community. They need to create opportunities and space to listen to diverse voices and perspectives. The pandemic has demonstrated the critical importance of basic biomedical research in solving global problems and improving health. Today, the world’s leading biomedical research organization must position itself to tackle many other issues – chronic diseases, health inequalities and the health dimensions of climate change – for which solutions have so far remained. stubbornly out of reach.


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