NIH director for life? Francis Collins doesn’t think so, but he’s also not ready to leave yet.
“It has been a great privilege to continue to do this, but I’m 69 years old,” he said. “It’s probably good for organizations that need to innovate—and to be challenging—to have a turnover in leadership on some sort of regular basis.”
Collins is in the unique position of having been appointed by President Barack Obama and then reappointed under President Donald Trump to lead the National Institutes of Health.
“You know, it’s been fine,” Collins said of working for both presidents. The enthusiasm for what medical research can accomplish has support from all corners. “So we are somewhat insulated from some of the difficulties that otherwise afflict our political process.”
The back-to-back appointments from Democratic and Republican administrations mirror his popularity among the majority of lawmakers on Capitol Hill. His confirmation breezed through the Senate in 2009, going from nomination to a unanimous Senate confirmation in about a month with no hearings.
Aug. 17 marks Collins’ 10-year anniversary as head of the world’s largest biomedical research agency. He is the longest-serving NIH director since that position became a presidential appointment in 1971. James A. Shannon served as director from 1955 to 1968, when the U.S. surgeon general made that appointment.
“This is a breathtaking time for progress in biomedical research. Things that I did not dream would happen in my lifetime are now coming true,” Collins said.
More Than ‘the Genome Guy’
Collins led the NIH’s National Human Genome Research Institute from 1993 to 2008, stepping down for about a year before coming back Aug. 17, 2009, to lead the entire agency.
In his first speech as NIH director, he sought to assuage any concerns he would just be “the genome guy” and laid out five agency-wide priorities: developing new technologies; translating basic research into clinical benefit; generating reliable, useful clinical data; ensuring there’s a diverse biomedical research workforce; and global health.
Today, Collins said he wouldn’t change those priorities, but what would fit into those five buckets is different from what he imaged a decade ago.
The landmark paper for the gene-editing technique known as CRISPR-Cas9 came out in 2012. CRISPR-Cas9 essentially allows scientists to cut out unwanted sections of DNA and replace them with desirable sequences. It has been hailed as an advancement that allows gene editing to be done more quickly, accurately, and for less money.
Likewise, artificial intelligence has burst onto the scene to analyze images, genomics, and electronic health record data.
“Would I have said 10 years ago that was going to be one of the most important areas for NIH to invest in? I don’t think so,” he said. “The course of progress, the pace of progress, has been unbelievable.”
Science Marches On
As he looks to the future, Collins wants to continue improving gene editing to help patients suffering from one of 6,500 diseases caused by a misspelling in their DNA.
A current project aims to build what he describes as “delivery trucks” for introducing gene editing technologies into the body so they’re safe, effective, and can be applied to thousands of genetic diseases. Then it wouldn’t take 20 or 30 years of trying to develop a small molecule drug for those conditions, which are so rare there’s no large market demand.
He’s also focused on bringing industry, academia, and government voices to the same table under the Accelerating Medicines Partnership to address challenges in getting new diagnostics and therapies for patients while shortening the time and costs to develop them.
Collins wants to see universal flu and HIV vaccines come to fruition before he leaves the agency.
“I know I drive people a little crazy,” he said. “The timelines that I want to see are always a little shorter than what they think they can achieve.”
But goals should be audacious and part of the NIH director’s job is to “try to inspire people to be reaching a little further than they thought they could,” he said.
Collins has led some of those audacious goals himself, completing the first map of the human genome—under time and under budget—when he led the NIH’s genome institute.
“I guess it helps when I’m pushing forward audacious goals to say, ‘I didn’t just show up yesterday, from some place that’s never really tackled anything hard.’”
The tools and opportunities make this the best time to pursue a career in the biomedical sciences, he said.
“This is the moment, if you want to change the world for the better and to help people who are struggling with illness.”