Bloomberg Law
Oct. 6, 2022, 9:25 AM

Lag in Biden’s NIH Nominee Creates Tougher Confirmation Scenario

Jeannie Baumann
Jeannie Baumann

Biomedical research and the NIH check off a lot of firsts for the Biden administration.

One of the first numbers President Joe Biden said he dialed after the election belonged to Francis S. Collins, the longtime director of the National Institutes of Health, to ask him to stay.

One of the first visits he made as president was to the NIH’s sprawling, 310-acre campus in Bethesda, Md., within three weeks of moving into the Oval Office. He returned last December.

The first biomedical innovation center known as the Advanced Research Projects Agency for Health, or ARPA-H, started under his leadership.

Yet when it comes to appointing a new NIH director, it’s one of the last major science roles Biden needs to fill, one year after Collins said he’s stepping down.

“It’s incredibly important to have someone,” Brett Meeks, a vice president at Horizon Government Affairs who served as deputy health policy director for the now retired Sen. Lamar Alexander (R-Tenn.) when he led the Senate Health, Education, Labor and Pensions Committee. “You have a lot of money that goes through NIH for important research. And we’re still in the middle of a public health emergency with others potentially on the horizon.”

Congressional Timeframe Narrows

Whomever Biden puts forward will likely face a tougher confirmation process than under the current Senate makeup, with Democrats in charge and a bipartisan pair at the helm of the committee that would need to shepherd that nomination through the chamber. But the odds of installing a new NIH director before the end of the year—and before a new Congress begins—appear to be slipping away.

“Time is not on anybody’s side right now, in terms of getting it through the remainder of this year,” said Bobby Clark, a principal at health-care advocacy firm Pyxis Partners who was part of the Health and Human Services senior leadership team under the Obama administration. “Anything’s possible. But it’s coming on a heap of other things that people are already looking at and talking about.”

The Senate won’t reconvene until after the Nov. 8 midterm elections. When senators return they’ll have a full plate, including 2023 spending bills before the current stopgap funding measure expires Dec. 16.

Lawmakers still want to advance policy reforms for the Food and Drug Administration that didn’t make it into the clean user fee reauthorization package as part of the stopgap spending law (Pub. L. 117-180). The FDA reforms fall squarely into the jurisdiction of the HELP Committee, Clark noted. “Those are a lot of the same people that would be thinking and having to process a nomination for the NIH.”

But there’s also pandemic preparedness, mental health, potential cuts in Medicare payments that physicians groups are trying to avert—and those are just some of the health-care priorities for Congress.

If the White House puts forward a name in the next few weeks, it’s possible for Senate HELP to squeeze out a nomination by the end of the year, said Erik Fatemi, a principal at Cornerstone Government Affairs who specialized in NIH appropriations when he was a Senate Democratic staffer.

“If the name came quickly, HELP would move heaven and earth to try to make that happen,” Fatemi said. “Certainly anything beyond two or three weeks, it’s going to be almost impossible to get it done this year.”

Waiting until next year leaves a lot of unknowns. A number of variables will likely make it more challenging for the Biden administration to move its pick for an NIH director, even if it’s an uncontroversial choice.

Senate HELP Chair Patty Murray (D-Wash.) and ranking member Richard Burr (R-N.C.) are longtime supporters of NIH with decades of committee experience.

“They could get it done by the end of the year, because they know how to do things quickly” if the nominee is bipartisan, Meeks said.

Sen. Richard Burr (R-N.C.), ranking member of the Senate Health, Education, Labor and Pensions Committee, left, speaks with Senate HELP Chair Patty Murray (D-Wash.).
Photographer: Stefani Reynolds/The New York Times/Bloomberg

But Murray is next in line to serve as the top Democrat of the powerful Appropriations Committee, which would mean giving up HELP. Burr will retire at the end of the year.

“If I’m in a pro-science administration, I would have already had a list of people for NIH. And I would have tried to move it before,” Meeks said. “Next year, it will be much more difficult.”

Anytime there’s a change in chair and ranking members, those new leaders will have to come up to speed on the issues of the committee and build up their staff, Sudip Parikh, CEO of the American Association for the Advancement of Science, said. “It just takes a little while to get up to speed. That’s the part that just generally would be hard.”

With Murray and Burr off HELP, that leaves Sens. Bernie Sanders (I-Vt.) , Rand Paul (R-Ky.), or Bill Cassidy (R-La.) as the likely candidates to lead the committee in the next Congress. “You’ve got people that don’t know the process as well and also may not be interested in moving a nominee as quickly,” Meeks said.

Paul has feuded publicly with Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, throughout the pandemic.

“If that scenario does play out,” Clark said, “that would be a factor, I would have to imagine, in terms of who would be able to go in front of that committee and win favor with a Chairman Rand Paul.”

Regardless of who takes over, confirming the NIH director will probably not top their priority list, Fatemi said. “We’re looking at probably going months into next year before we have a new permanent NIH director.”

The White House recently filled other science leadership positions, swearing in Monica M. Bertagnolli as director of the National Cancer Institute and Arati Prabhakar as the president’s science adviser and director of the Office of Science and Technology Policy the week of Oct. 3. Renee Wegrzyn also has been appointed as the first director of ARPA-H but she hadn’t been sworn in as of Oct 5.

“There’s been good news at OSTP, at NCI, ARPA-H. We’re seeing those names. But there is a lot of frustration that we don’t have a name yet for the NIH director,” Fatemi said.

Better to Be Right Than Fast

It’s not a bad thing that Biden is taking his time, Ellie Dehoney, vice president of policy and advocacy for Research!America, said. There are advances in genomics, Alzheimer’s disease, and pandemic preparedness that the NIH will play a key role in shaping. Biden’s nominee also will have to fill the shoes of Collins, a deft scientist and policymaker whom Sen. Roy Blunt (R-Mo.) has dubbed one of the best politicians in Washington for his ability to navigate both parties on Capitol Hill while serving three administrations, as the NIH’s budget grew about 49% over the last seven years.

“This could usher in an era like we’ve never seen before, with a person in that role who has an outsized presence. But you don’t come by those people all that easily. So let him take his time,” Dehoney said. “I’d rather them get it right than get it done fast.”

The White House said in a statement that “The role of NIH director is critically important, especially as we tackle a range of critical public health issues right now and plan for the future. We have strong acting leadership in place that is playing an important role, and look forward to sharing a nominee with the requisite expertise and leadership for this job.”

Biden’s nominee would likely face a tougher process compared to past nominees for an agency that has generally enjoyed bipartisan support. The committee hasn’t even convened an NIH confirmation hearing in more than two decades.

Dehoney and others said Lawrence Tabak offers a steady hand leading the agency in the interim. He’s been the NIH’s second-in-command for a dozen years. “While it would be great to have a permanent director in there, we have one of the best, not just acting directors, but directors in NIH’s history at the helm now,” she said.

Parikh said he remains optimistic there’s a “wonderfully qualified scientist out there” who can help settle down the roil that’s happened over the past few years. “There’s still an opportunity for that in this transition. I really hope whoever it is that ends up being nominated can lower the temperature by taking the time to build a relationship, if at all possible with the oversight committees, with the appropriators—and take some time to do that before the next crisis.”

To contact the reporter on this story: Jeannie Baumann in Washington at

To contact the editors responsible for this story: Cheryl Saenz at; Karl Hardy at

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