Senate Confirms Monica Bertagnolli as Next NIH Director

The Senate voted 62-36 Tuesday to confirm surgical oncologist Monica Bertagnolli, MD, as the next director of the National Institutes of Health (NIH).

In May, President Biden tapped Bertagnolli, currently the director of the National Cancer Institute, to lead the NIH after its previous director, Francis Collins, MD, PhD, stepped down in late 2021.

Prior to the vote, Sen. Patty Murray (D-Wash.) urged her colleagues to support the nomination. “You need a steady hand to be a cancer surgeon after all, and her credentials go far beyond her record of accomplishment as an oncologist,” Murray said, citing Bertagnolli’s experience on the board of directors at the American Society of Clinical Oncology and as CEO of Alliance Foundation Trials, a nonprofit in Boston.

Given the history of underrepresentation of women in biomedical sciences, Murray stressed that it is “truly meaningful” to see Bertagnolli take a position with the power to address long-standing problems such as the lack of clinical trial diversity, sexual harassment, and “other barriers to achievement and equal representation for women in medical research.”

She also argued that Bertagnolli’s personal experiences — growing up in rural Wyoming and observing people struggle to access healthcare, and later being diagnosed with and treated for breast cancer — would inform her work at the NIH. “I know patients will be better for it,” Murray said.

While most Democrats voted to support Bertagnolli’s nomination, Sen. Bernie Sanders (I-Vt.) — chair of the Senate Health, Education, Labor and Pensions (HELP) Committee — was not among them. “Dr. Monica Bertagnolli is an intelligent and caring person, but she has not convinced me that she is prepared to take on the greed and power of the drug companies and the healthcare industry in general,” said Sanders, speaking from the Senate floor on Tuesday. “Nor is she prepared, in my view, to fight for the transformative changes the NIH needs at this critical moment.”

During her confirmation hearing a few weeks earlier, Sanders pressed Bertagnolli and said that his litmus test for an NIH director was someone prepared to “use every tool at his or her disposal to substantially lower the outrageous cost of prescription drugs.” In response, Bertagnolli stressed her commitment to making the benefits of NIH research “affordable and available” but declined to make any specific promises regarding certain measures, including “reasonable pricing clauses” in NIH contracts.

Sanders voted against nominating Bertagnolli both in the 15-6 HELP Committee vote on Oct. 25, and the subsequent floor vote on Tuesday. However, Sen. Bill Cassidy, MD (R-La.), the HELP Committee’s ranking member, voted both times in favor of her nomination.

During the same HELP hearing where Sanders sought support for reasonable pricing clauses, Cassidy sought a pledge from Bertagnolli not to enact such measures arguing that they have “discouraged the uptake of breakthrough discoveries” by the private sector. He stated that this was the reason they were previously rescinded in 1995. Again, Bertagnolli said she could not “commit to any specific action.”

Cassidy also asked Bertagnolli whether she would allow the NIH to use “march-in rights” to attempt to lower drug prices. (Under a decades-old law, the Bayh-Dole Act, the government has the authority to assert control of a drug patent and license it to another company if the drug was developed with government support. To date, the measure has never been used).

Cassidy asked whether Bertagnolli would employ those rights, recalling that Collins, the former NIH director, had always opposed their use purely for the purpose of lowering drug prices, suggesting that to do so was outside the parameters of the law. Bertagnolli said she would “follow all the laws of our land.”

Karen Knudsen, MBA, PhD, the CEO of the American Cancer Society and Cancer Action Network, applauded Bertagnolli’s nomination.

“Her extensive experience as a scientist, physician, and surgeon has granted her first-hand knowledge of the importance of accelerating progress in cancer innovation and a deep understanding of the needs for cancer patients that will provide a strong and unique foundation to guide her tenure. In short, she is a game changer,” Knudsen said in a statement.

Prior to her post at the National Cancer Institute, Bertagnolli was a professor of surgical oncology at Harvard Medical School, a surgeon at Brigham and Women’s Hospital, and a member of the Gastrointestinal Cancer Treatment and Sarcoma Centers at Dana-Farber Cancer Institute, all in Boston.

She earned a bachelor’s degree in engineering from Princeton University in New Jersey and a medical degree from the University of Utah in Salt Lake City. She trained in surgery at Brigham and Women’s Hospital and was a research fellow in tumor immunology at the Dana-Farber.

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