Monica Bertagnolli is the new NIH director, and she’ll likely face more scrutiny

Monica Bertagnolli has finally won Senate confirmation as the new director of the National Institutes of Health, but she had to overcome some resistance from lawmakers.

Monica Bertagnolli has been confirmed as the director of the National Institutes of Health. (Photo: NIH)

Bertagnolli began her first day on the job Thursday. The Senate confirmed her nomination with a 62-36 vote Tuesday, potentially foreshadowing some of the scrutiny she will receive from lawmakers. With a budget of about $48 billion, the NIH is the federal government’s primary source of funds for medical research.

Most of those voting against Bertagnolli’s nomination were Republicans, but opposition also came from two of the Senate’s most liberal members. Both U.S. Sens. Bernie Sanders (I-Vt.) and John Fetterman (D-Pa.) voted against her confirmation, saying they were skeptical that she would fight against drug companies and their pricing practices.

“Dr. Monica Bertagnolli is an intelligent and caring person, but has not convinced me that she is prepared to take on the greed and power of the drug companies and health care industry and fight for the transformative changes the NIH needs at this critical moment,” Sanders said in a statement explaining his opposition. Sanders also blocked the confirmation hearing for weeks until the White House made a commitment to lower prescription drug prices, The Washington Post reported.

Similarly, Fetterman said, “While I believe that Dr. Bertagnolli is highly qualified to serve in this role, I’m not convinced that she will take on Big Pharma.”

Bertagnolli is the second woman to lead the NIH. U.S. Sen. Elizabeth Warren, D-Mass., said that she was glad to vote for Bertagnolli, a resident of her state.

“She’s made historic ethics commitments to help shut the revolving door and build public trust,” Warren wrote on X, formerly known as Twitter. “I look forward to watching her lead NIH’s critical work to advance scientific research & save lives.”

President Biden nominated Bertagnolli in May, just months after she took over as director of the National Cancer Institute. In December, Bertagnolli disclosed that she was battling breast cancer. In a hearing on her nomination before a Senate committee last month, Bertagnolli said, “My prognosis is very favorable. I was fortunate to have my cancer detected early.”

Healthcare and science organizations praised Biden’s nomination of Bertagnolli. In June, more than 100 science organizations wrote a letter to Senate leaders urging them to confirm her nomination.

Mary Woolley, president and CEO of Research!America, hailed the Senate’s confirmation of Bertagnolli.

“A renowned oncologist, cancer researcher and educator, Dr. Bertagnolli is the right leader at the right time to ensure NIH excels in fulfilling its unique and crucial role as a global leader in health research,” Woolley said in a statement this week.

The NIH has typically enjoyed strong support from Republican and Democratic lawmakers, but the number of senators voting against Bertagnolli’s confirmation suggests she may face tough questions from lawmakers in the future. Nonetheless, at a time of bitter partisanship, 13 Republicans joined with Democrats to approve her confirmation.

More than in previous years, the NIH may find it difficult to get funding increases. The debt ceiling agreement approved over the summer limits spending on civilian programs, so the agency faces more uncertainty in funding than in the past.

Republicans have derided the NIH’s response to the COVID-19 pandemic. Republican Sen. Marco Rubio of Florida has also criticized the NIH’s diversity efforts and support of gender-affirming care.

It’s also unclear how long Bertagnolli will hold the post, with a presidential election taking place a year from now. If Biden should lose the election, the next president could choose a different leader for the agency.

For now, the NIH has its first permanent leader in nearly two years. Bertagnolli succeeds Lawrence Tabak, who has led the NIH in an interim capacity since the retirement of longtime NIH Director Francis Collins in December 2021.

Xavier Becerra, U.S. Secretary of Health and Human Services, said in a statement that he is confident Bertagnolli “will reimagine the boundaries of what is possible when it comes to what the NIH can achieve.”

“Dr. Bertagnolli has spent her career working to improve the health and well-being of Americans,” Becerra said in his statement. “She has built a reputation for her willingness to take on the deadliest diseases facing patients and as a powerful advocate for cancer patients, working to end cancer as we know it. That same tireless energy and clear vision will serve her well as NIH director.”

The American Association for Cancer Research also praised Bertagnolli’s confirmation.

“Her wealth of experience as a researcher, clinician, and leader will help ensure that NIH continues to foster pathbreaking biomedical research that improves the health and well-being of millions and saves lives from cancer and countless other diseases,” the AACR said in a statement.

In her testimony before the Senate Committee on Health, Education, Labor, and Pensions, Bertagnolli vowed to increase the diversity of participants in clinical trials. She also said, “We must ensure that we deploy NIH’s research further, and wider, and that we deliver results that work for everyone.”

Bertagnolli also pledged to work to improve the reputation of the agency and help Americans have more trust in science.

“We must restore faith and trust in our nation’s top scientists. NIH is the steward of our nation’s medical research, and I am committed to ensuring that NIH continues to be a force of innovation and discovery,” Bertagnolli said. “To do that, we need to make science accessible to all communities and inspire young people to become doctors and scientists, to continue this critically important work for generations.”

Bertagnolli served as an attending surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center before joining Harvard Medical School and Dana-Farber Cancer Institute in 1999.

She has served as vice president of Coalition of Cancer Cooperative Groups; group chair of the Alliance for Clinical Trials in Oncology; president of the Alliance for Clinical Trials in Oncology Foundation; and CEO of Alliance Foundation Trials. She served as president of the American Society of Clinical Oncology in 2018-19 and was elected to the National Academy of Medicine in 2021.