President Joe Biden’s nomination of Monica Bertagnolli to lead the National Institutes of Health (NIH) initially appeared to be a widely acclaimed choice. As a respected cancer surgeon and former head of the National Cancer Institute (NCI), Bertagnolli had garnered support from the medical research community and fulfilled Biden’s desire for an NIH chief with an oncology background. However, her confirmation process has become the latest challenge for an administration struggling to navigate Senate hurdles and satisfy competing demands.
Bertagnolli’s candidacy has been mired in a deadlock between the White House and Senator Bernie Sanders (I-Vt.) over Biden’s drug pricing agenda. Additionally, Senator Elizabeth Warren (D-Mass.) has pressed for Bertagnolli to sign expanded ethics agreements, including a commitment to refrain from working for or on behalf of major pharmaceutical companies for four years after leaving the NIH. So far, Bertagnolli has resisted, citing concerns about the extent of these commitments.
The protracted and uncomfortable process has led some of Bertagnolli’s allies to question the feasibility of continuing. Managing her full-time responsibilities at the NCI, her candidacy for the NIH position, and undergoing treatment for breast cancer has taken its toll. The situation raises concerns about the point at which the challenges outweigh the benefits for Bertagnolli.
Biden has been without a confirmed NIH director for a year and a half, worrying medical research groups who emphasize the importance of a leader ahead of upcoming budget negotiations on Capitol Hill and the need for stability in public health agencies facing increased political scrutiny.
The nomination impasse highlights the White House’s personnel operation and its failure to anticipate roadblocks for its nominees. Sanders, who chairs the Senate committee responsible for vetting Bertagnolli, had reportedly alerted the administration in January about his desire for more decisive actions to lower drug prices. Frustrated by the lack of response, Sanders publicly voiced his opposition to all health nominees until the White House addressed his demands.
Surprisingly, the White House did not inform Sanders of its plan to nominate Bertagnolli before the news broke, and there were expectations within the Biden administration that Sanders would grant her a hearing in June. However, no hearing has been scheduled, and Sanders remains steadfast in his position until his requests are met.
The standoff adds to the list of obstacles faced by the Biden administration in confirming its nominees, underscoring the increased leverage senators from both parties wield during the nomination process. The White House has encountered challenges in securing confirmations for nominees, including Julie Su for the Labor Department, as skeptical senators raise their concerns and use their positions to exert influence.
In response to questions about Sanders’ demands, the White House declined to comment on the record but highlighted the Inflation Reduction Act (IRA) as a significant step toward addressing high prescription drug costs. The White House spokesperson reaffirmed Biden’s commitment to getting Bertagnolli confirmed and emphasized the administration’s progress in comparison to the Trump administration’s nominee confirmations at this stage.
While the nomination battle for Bertagnolli is frustrating for Biden officials, they believe it is unrelated to her qualifications. Sanders seeks more assertive measures to curb drug prices, including reinstating an NIH requirement for reasonable pricing and exploring the option of seizing drug patents for licensing to lower costs.
Biden officials argue that the IRA is already making an impact, citing its provisions to cap insulin prices for older Americans and allow Medicare to negotiate drug costs. However, Sanders considers the IRA’s provisions insufficient and believes more significant action is necessary to address healthcare crises.
Bertagnolli continues to engage with senators and hopes for a resolution between the White House and Sanders. She recently met with Senator Warren to discuss her ethics demands, but an agreement was not reached. Outside allies have intensified their lobbying efforts, urging Sanders and Senate leadership to prioritize Bertagnolli’s confirmation.
As the window for a June hearing has passed, supporters, including former NIH Director Harold Varmus, hope that Bertagnolli will receive a hearing before the August recess. Nevertheless, Biden allies remain skeptical that the White House will yield to Sanders’ demands solely to accelerate the confirmation process. Both sides appear resolute in their positions, leaving the future of Bertagnolli’s nomination uncertain.
The ongoing stalemate reflects the challenges faced by the Biden administration in navigating Senate dynamics, satisfying competing demands, and advancing its policy agenda through personnel appointments.
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