Monica Bertagnolli, the Boston cancer surgeon President Biden picked on Monday to lead the National Institutes of Health, faces a daunting job at the nation’s premier health research agency: restoring faith in science.
Before she gets that chance, she will have to face Republican senators who are deeply skeptical of the NIH following its politicization during the Covid pandemic.
“She’s going to be faced, and the NIH is going to be faced, with a growing anti-science sentiment in this country,” said Anthony Fauci, the former head of the National Institute of Allergy and Infectious Diseases and the country’s leading Covid lightning rod.
If confirmed, Bertagnolli will replace Francis Collins, the doctor who led the NIH for a dozen years but was perhaps best known for his work studying the human genome. After Covid arrived, he found himself under withering fire from Republicans for his handling of the debate over Covid’s origins and the country’s response to the pandemic.
Bertagnolli will have to decide how to respond to GOP concerns about research on potentially dangerous viruses, and Independent Sen. Bernie Sanders’ view that the agency could do more to combat high drug prices.
But in announcing her nomination, Biden steered clear of those controversies. Instead, he cited her work as head of the National Cancer Institute, an NIH agency. “Dr. Bertagnolli has advanced my Cancer Moonshot to end cancer as we know it. She has brought together partners and resources from different sectors to launch groundbreaking efforts in cancer prevention and early detection, a national navigation program for childhood cancers, and additional programs to bring clinical trials to more Americans,” the president said in a statement.
Bertagnolli has a reputation for unflappability and broad support in the scientific community.
While Collins was known for his consistent leadership, Bertagnolli is expected to push the $45 billion agency, the leading funder of health researchers in the country, into the future. The White House declined to make Bertagnolli available for an interview.
She’ll chart a new path, those who’ve worked with her said.
“Francis was sort of the Eisenhower administration. Nothing too drastic, constant, reliable, friendly — but nobody expected it to try really wild things,” said Greg Simon, former president of the nonprofit Biden Cancer Initiative. “This will be more like the Kennedy administration.”
Bertagnolli may not have a choice but to be different. While the NIH has traditionally enjoyed bipartisan support from Congress, she’ll run a health research organization in an era when alternative truths and alternative facts are normalized, even at the congressional level.
Still, Fauci thinks Bertagnolli is both up to the task and in it for the right reasons. “I was one of the ones that strongly suggested that she be considered for the director of NIH,” he said. “Being somebody who has benefited from NIH support for so many years, I believe she had a strong feeling of responsibility of wanting to pay back, which I think is a very noble rationale for taking a job like this.”
A clear vision
Bertagnolli, 64, started her training as a cancer surgeon in the 1980s when it was still a boy’s club, but racked up accolades and leadership roles. She was chief of surgical oncology at Dana-Farber Brigham Cancer Center, and led both the Alliance for Clinical Trials in Oncology and the American Society of Clinical Oncology.
She became the first female head of the National Cancer Institute when she took the job in October. If confirmed as head of NIH, she’ll be just the second woman to lead it, after Bernadine Healy.
“She’s a female leader in oncology. There are not as many of us as there could be,” said Karen Knudsen, CEO of the American Cancer Society, where Bertagnolli has served on the board.
Having thick skin and a clear vision propelled Bertagnolli as a leader, Knudsen explained. “We would not have gotten to this point in our career if we let chatter or distractions keep us from doing our job.”
While easy to get along with, she’s no pushover, those who’ve worked with her said. “She can even give you a velvet no,” said Ellen Sigal, founder of the advocacy group Friends of Cancer Research. “What you’re going to hear from her is the truth.”
U.S. Agency for International Development Assistant Administrator for Global Health Atul Gawande worked with Bertagnolli for nearly 30 years before he joined the Biden administration, training under her and then working for her when she led Brigham’s surgical oncology department. Bertagnolli took on the hardest surgical oncology cases, Gawande said, like rare tumors that other surgeons didn’t want to do.
“She did the most difficult, messiest ones, where you have to find solutions to hairy problems,” he said, all the while running a tight, focused — and somehow joyful — operating room. “She comes into the operating room and she’s happy every day,” said Gawande.
Bertagnolli has also faced health trials that all Americans dread.
She received an early-stage breast cancer diagnosis just months into her new job at the National Cancer Institute. While it’s a highly treatable cancer when caught early, “It’s one thing to know about cancer as a physician, but it is another to experience it firsthand as a patient,” she wrote at the time. “To anyone with cancer today: I am truly in this together with you.”
It was a humbling window into the patient experience, but not her first view of it: Bertagnolli’s son has autism.
“She has been dealing with the health system and challenges and limits of knowledge and uncertainty through life with her own child,” Gawande said.
‘Never turn down an invitation’
People who’ve worked there said that leading the sprawling NIH — among the world’s largest scientific research organizations with 27 insular and independent institutes and centers, each with its own budget — is one of the country’s most difficult government management jobs.
“They want to do what they’ve been doing for 20 years. They don’t want to do something new,” Simon said of the institute heads.
To win them over, or at least herd them, NIH directors have to be credible and respected by the scientific community.
Even with a career’s worth of achievements in science, Bertagnolli’s surgical background isn’t typical training for an NIH head.
NIH’s director also has to know the ways of Washington, and Bertagnolli has spent only seven months in preparation at the National Cancer Institute.
In a Q&A on the agency’s website after announcing his departure, Collins laid out the advice he’d give his successor.
“Never turn down an invitation to meet with a member of Congress, even if you’re really busy,” Collins stressed, estimating he’d logged more than a thousand one-on-ones with representatives and senators.
Unpretentious and a good listener, Bertagnolli has the skills to learn the Hill, according to George Demetri, a medical oncologist and director of the Sarcoma Center at Dana-Farber who worked with Bertagnolli for more than two decades.
“Monica is Monica. People don’t call her Dr. Bertagnolli. She’s Monica. She can take full advantage of that,” Demetri said.
Raised on a ranch in Wyoming, Bertagnolli stands out for wearing cowboy boots and for her vintage Ford Mustang, which she has a reputation for driving fast.
Being from Wyoming may give her credibility with congressional Republicans. “Geography helps build trust,” said Sudip Parikh, CEO of the American Association for the Advancement of Science. “When you’re from a place where you understand how people approach the world, even if you don’t come to the same conclusions, being able to start with some shared history, man, that helps.”
A test of her ability to connect will come soon: Senate confirmation hearings.
There, two contentious issues are likely to take center stage: the origins of Covid and the cost of drugs.
Republican lawmakers, who are investigating NIH, are expected to grill Bertagnolli on their theory that NIH grants to a group called EcoHealth Alliance, which collaborated with Chinese researchers on virus studies, caused the pandemic.
Shelley Moore Capito (R-W.Va.) pressed NIH Acting Director Lawrence Tabak for a formal review of the agency’s Covid response and spending during a recent Senate Appropriations Committee hearing, suggesting the topic is sure to come up.
From across the aisle, Sanders, who chairs the Senate Health, Education, Labor and Pensions Committee, is likely to question Bertagnolli about why, given the NIH’s investment in drug development, it doesn’t do more to keep prices down.
In a recent letter obtained by POLITICO, Sanders reminded Biden that he’d voted against confirming Robert Califf to head the FDA: “I will strongly oppose any future nominee to a major federal health agency who is not prepared to significantly lower the price of prescription drugs.”
Bertagnolli may do well to lean on her apolitical roots in cancer surgery and science, said Demetri: “She would be smart enough to, I hate to say this, but to stay in the lane of ‘It’s a discovery institution. It’s a health-science, health-research institution.’”
As for the pressure-cooker dynamic, “I don’t think she’ll have trouble handling that,” said Fauci. As a surgeon, “You have somebody’s life in your hands, almost on a daily basis — that’s a high-pressure situation.”