President Joe Biden’s reignited moonshot to halve cancer deaths, improve care and eventually end the disease gives a lift to one of his longest-held and most personal goals — but the mission hasn’t been refueled.
Missing from the ambitious plan to boost screening, reduce inequities and strengthen prevention efforts is a funding boost to the existing moonshot, which is in the sixth year of a $1.8 billion, seven-year allotment from Congress.
The new moonshot lands one year into Biden’s presidency, giving the administration a long runaway to steer its progress, but it also comes amid growing frustration from cancer advocates and those inside the White House, who are upset with Congress for not authorizing boosted health care budgets and new spending for a separate Biden proposal seen as a critical partner to the relaunched moonshot — the Advanced Research Projects Agency for Health.
“It needs resources, no question,” said Ellen Sigal, chair of Friends of Cancer Research, who has worked closely with the moonshot program for years. “All the goals are achievable, but there will have to be funding mechanisms to achieve them.”
The American Association for Cancer Research in a Thursday morning letter to lawmakers pressed for 2022 health agency budgets — including a House-proposed $400 million boost to the National Cancer Institute budget — to be approved, stressing that critical new studies could be left without financial support.
“Right now we’re facing a crisis within the cancer research enterprise,” said AACR Chief of Policy Jon Retzlaff, who added that roughly one in eight research grants submitted to NCI last year were funded and that the institute has reduced overall funding levels. “Young investigators are getting frustrated by the chances of receiving grants, with [this] new generation of scientists potentially not being there to work towards President Biden’s goals.”
White House officials insist that Wednesday’s announcement is more than just a fresh coat of paint on the 2016 effort, which was heavily focused on research. This latest iteration, they say, extends into practical medicine with calls for more screening, which millions of people skipped because of the Covid-19 pandemic, improving data sharing and electronic record access and eventually preventing certain cancers entirely through lifestyle change.
“While the cancer moonshot in 2016 wasn’t just about research, the funding was for [the National Cancer Institute]” said Danielle Carnival, who Biden tapped to helm the new effort after she served as one of the moonshot’s original advisers.
“What we’re doing here is zooming back out and putting targets in prevention and early detection, in equity, in targeting treatments to the right patients,” she told POLITICO. “There’s a lot of aspects here in different parts of the government.”
That in part is why the administration has not presented a dollar figure, Office of Science and Technology Policy Director Eric Lander, told POLITICO. The plan is still being sketched out, the president is appointing a so-called cancer cabinet to shape priorities and convening cancer care advocates to hear their concerns.
“Look, there is still a residual year of funding in the original cancer moonshot,” Lander said. “I am extremely confident there will be robust funding for it because there’s nothing more bipartisan, whatever else you can say about Washington.”
But others are skeptical that funding, even when it is requested, will come given how Congress has failed to find money for Biden’s other health research priorities — even the ones with bipartisan support.
Momentum for Biden’s $6.5 billion plan for ARPA-H, a new agency that takes a Pentagon-like approach to some of the world’s biggest medical challenges, like cancer, has stalled amid budget battles and divisions over the Build Back Better Act. Similarly, 2022 boosts to other health agencies are stuck in a cycle of continuing resolutions that extend existing funding levels without any increase — begging the question of where more moonshot money lies.
House appropriators have allotted $3 billion for ARPA-H and a $6.5 billion overall boost for NIH, both falling short of Biden’s goals. The Senate Appropriations Committee allotted less. Lander — the administration’s most vocal supporter of the proposed agency after its other champion, NIH Director Francis Collins stepped down in December — testifies at a House committee hearing about ARPA-H next week.
“I’m not opposed to $6.5 [billion] for ARPA-H but I don’t think there’s any chance you could spend $6.5 [billion] on an unauthorized program between now and September the 30th,” ARPA-H supporter Sen. Roy Blunt (R-Mo.), told POLITICO, referring to the looming deadline for a new fiscal year budget.
Some of the new moonshot’s goals can be hit quickly even without new money, advocates said. More accessible screening standards, for example, could rapidly be issued and rolled into existing patients’ care regimens. But national messaging on those same standards — especially to people and communities without regular access to care or health communications — will be complicated without financial support.
The first item on the to-do list is establishing a nuanced approach to communicating the need to screen for certain cancers, said John Williams, a breast cancer doctor and member of the President’s Cancer Panel. The group of advisers on Wednesday published a report stressing the need for screening surges in breast, cervical, colorectal and lung cancer.
“We need to be able to better communicate,” Williams said. “We also have to go into communities and find a funding mechanism for community health workers to take the message of cancer screening to those who do not get it … [workers] who know the community, know the people, speak their language.”
Even if Congress reaches consensus on funding the administration’s priorities, it could be a year or more before any project or researcher sees a dime. Money for the first moonshot took more than a year even as then-Vice President Biden steered a task force that enlisted more than 20 federal agencies and secured broad congressional backing, including GOP heavyweight Sens. Orrin Hatch and John McCain.
Congress allotted $1.8 billion in December, 2016, but within weeks, Donald Trump was inaugurated and cancer advocates say White House interest in the project waned.
Biden’s recommitment to the initiative is his opportunity to build a foundation that cannot be moved by shifting political sands, advocates say.
“Let there be no doubt. Now that I am president, this is a presidential, White House priority, period,” he said Wednesday in a speech that mirrored his emotional announcement of the original project nearly six years ago. Speaking of his son Beau’s death the year before, Biden said at the time: “If I could be anything, I would have wanted to have been the president that ended cancer, because it’s possible.”