In President Biden’s address to the nation after dropping out of the election race, he said he would “keep fighting for my Cancer Moonshot.” He will, at least, for his remaining six months in office. Biden’s impending exit from the political stage leaves uncertainty hanging over the future of this signature health initiative, which Biden began first as vice president under Barack Obama and later renewed as president.
Some advocates said there was a concern that if former President Donald Trump defeats Vice President Kamala Harris, Biden’s presumptive successor, this November, cancer research and care could become deemphasized and the moonshot might at a minimum be rebranded. Still, many cancer experts and advocates also expressed optimism that no matter who enters the White House, cancer would remain a priority in the next government.
“We’ve seen strong bipartisan support throughout administrations, including the previous administration, including for cancer research funding,” said Karen Knudsen, the CEO of the American Cancer Society and the ACS Cancer Action Network. “We stand a very good chance of continuing this momentum against cancer. We have to.”
The Biden Cancer Moonshot has been a “galvanizing” force for cancer research, health care, and patient communities to drive solutions forward, cancer advocates said, and emphasized now is a critical time to preserve that momentum. For one, cancer incidence is on the rise, including among younger adults, giving urgency to the moonshot’s goal of improving screening and prevention, Knudsen said. The year 2025 also comes with key federal budget decisions that could have lasting impacts on the future of cancer research. For the first moonshot, The 21st Century Cures Act, signed by Obama in 2016, authorized $1.8 billion dollars, which carried through to Biden’s presidency. Last year, the Advanced Research Projects Agency for Health allocated an additional $240 million to moonshot-related projects, and Biden proposed $2 billion more for the moonshot in his President’s Budget this year.
Biden’s cancer policies haven’t been without critics. Some have argued that the moonshot has been hamstrung by controversial policies like government drug price setting to improve access to medicines, which pharmaceutical industry representatives have said could stifle drug innovation. Cancer advocates have also said that the second moonshot, which Biden brought into his term as president, lacked clear success metrics and failed to bring additional funding to cancer research and care efforts. The White House Office of Science and Technology Policy did not respond to a request to comment.
But most agree that the Cancer Moonshot has been an important initiative, and one that has brought much greater focus to early detection and prevention and championed efforts to “shift” cancer diagnoses to earlier stages. That led to significant policy changes that advocates say have made progress towards the initiative’s ultimate goal of reducing cancer deaths by 50% before 2050. “Cancer is 200 different diseases. We don’t have good early detection and prevention for all of them, but for those we do, we have to stage-shift to early detection,” Knudsen said. “That’s what this moonshot is about.”
Knudsen said she attributed two new policies directly to the Cancer Moonshot. One was making colorectal cancer screening more accessible by removing financial penalties for needed follow-up colonoscopies after a positive stool-based cancer screening. “As of January 2023, people scoring positive at home can go and do the right thing. These are policy changes that can save lives,” Knudsen said.
The other was making patient navigation — professional health care guidance and support for patients — a reimbursable component of cancer care for Medicare and Medicaid beneficiaries. “Patients who are navigated understand their care and complete their care. They have a lower cost of care, and overall have a higher outcome. But outside of philanthropy, there was no way to get this navigation covered. As of January 1, 2024, patient navigators became reimbursable,” Knudsen said. “I do credit the moonshot effort. That’s where those conversations went.”
The Cancer Moonshot has also energized the cancer advocacy field and helped coordinate efforts across government, researchers, and patients, said Jon Retzlaff, the chief policy officer at the American Association for Cancer Research. “The 100%, all-of-government approach to focusing on what are the needs and issues of cancer has been a major help to bring communities together,” Retzlaff said. “An unprecedented level of collaboration, I’d say that.”
Even if the moonshot fades or becomes rebranded as Biden’s time as president comes to a close, Retzlaff said the advocacy community is hoping to keep that momentum moving forward. “If it’s called something else, the goal will be to maintain the focus on fighting cancer,” he said. “It’s more important now than ever.”
The moonshot’s uncertain future coincides with another key moment this coming year, Retzlaff said. The federal debt limit suspension is expiring in January, and how Congress acts could substantially impact federal funding for biomedical research, including cancer research. “It’s a tremendous opportunity to talk about the excitement in the cancer research community for fighting cancer and other diseases. The timing is extremely important for the advocacy community to come together in 2025,” he said.
Not everyone is as optimistic as Retzlaff and Knudsen that cancer’s history as a bipartisan issue will propel policy forward regardless of the election’s outcome this November. During his first administration, Trump proposed deep cuts to the National Institutes of Health. Gary Puckrein, president of the nonprofit National Minority Quality Forum which has worked with the Cancer Moonshot, said he believed that the notion of disinvestment from health and medicine persisted.
“I don’t recall that being a priority in the first Trump administration. Nothing that was a priority for cancer care,” Puckrein said. “I’m not sure that those who are suffering from cancer would understand exactly what kind of investment would be made here.”
On the other hand, Puckrein said, he believed Vice President Kamala Harris has shown a commitment to cancer care and research. “We’re comfortable that the Cancer Moonshot would be safe in an administration she might lead,” he said. “She visited Flint, Michigan, a few years ago and became deeply aware of the water crisis and concerns about cancer in the community. Her office reached out to us to see if we could help, and out of that, we’ve launched a cancer stage-shifting initiative.”
Harris also has a personal history with cancer. Her mother, Shyamala Gopalan, was a prominent cancer researcher who was best known for her contributions to understanding the role of progesterone in the development of breast cancer and who died of colorectal cancer herself. In her 2019 memoir “The Truths We Hold: An American Journey,” Harris wrote about her mother, adding, “If we want our children to have cures for humanity’s most terrible diseases, we should invest in our national medical researchers, instead of relying on companies that would rather funnel money to their shareholders.”
Still, it may not matter as much who controls the White House as long as cancer research continues to have support on both sides of the aisle in Congress. Congress staved off Trump’s proposed cuts to the NIH and science funding during his administration, AACR’s Retzlaff said. “Whoever is the president, we will be working closely with Congress,” he said. “Because Congress appropriates the dollars.”