Monica Bertagnolli never had the luxury of easing into her new job as head of the U.S. National Cancer Institute (NCI).

Several weeks after taking over the largest component of the National Institutes of Health (NIH) in October 2022, the then–63-year-old surgical oncologist was diagnosed with early-stage breast cancer and underwent surgery followed by chemotherapy and radiation treatment. Early this month, she unveiled a plan to implement President Joe Biden’s signature Cancer Moonshot initiative. And Biden is expected to cap Bertagnolli’s whirlwind first 7 months in Washington, D.C., by nominating her to become the 17th director of NIH, the federal government’s crown jewel of biomedical research.

Leaders of the U.S. biomedical community are applauding the prospect of soon having a successor to Francis Collins, who stepped down in December 2021. Researchers had fretted as several candidates reportedly on the short list for the job dropped out, and the lack of a permanent NIH leader for the past 16 months has weakened the agency’s ability to respond to harsh criticism from congressional Republicans about its response to the COVID-19 pandemic.

The choice of Bertagnolli “is a terrific solution to the delays that the administration was facing in having to convince someone to work in Washington,” says cancer researcher Harold Varmus, a Nobel laureate and the only person to have run both NCI and NIH. “She’d already agreed to work in Washington. I’m very enthusiastic about her nomination and think she’ll be great.”

“She’s already proven herself to be a leader,” says Ellen Sigal, chair and founder of Friends of Cancer Research, an advocacy group, referring to the 25-page National Cancer Plan Bertagnolli rolled out on 3 April. “And the fact that she’s now a patient adds another perspective to her work as a cancer surgeon.”

If confirmed by the Senate, Bertagnolli would be only the second woman to lead NIH, following Bernadine Healy, who stepped down in 1993.

“I am thrilled,” says Carol Greider, a Nobel Prize–winning biologist at the University of California, Santa Cruz. “Having an accomplished woman leader nominated to this position for the first time in decades is a powerful signal.”

The first woman to lead NCI, Bertagnolli was previously chief of surgical oncology at the Dana-Farber Brigham Cancer Center. Her research on a gene called APC and how inflammation influences its activity “transformed our understanding of how colorectal cancer develops,” NCI said in a statement on the day she began work there in October 2022.

Bertagnolli seems at home managing huge and administratively complex projects. From 2011 to 2022, she led the Alliance for Clinical Trials in Oncology, which conducts large-scale clinical trials to address important cancer treatment questions. Her new national plan reflects her concern that social and economic deprivations increase the risk of cancer, listing increased access to and equity in treatment as two of its eight goals. She also highlighted the lack of access to cancer care in underserved rural populations when she served as president of the American Society of Clinical Oncology in 2018–19.

NIH declined to make Bertagnolli available for an interview “given the speculation in the media about a White House nomination,” a spokesperson said.

If confirmed, Bertagnolli would be the first surgeon to lead NIH. Although all previous directors were also trained as physicians, they were generally best known for contributions to one of the many fields of basic science that NIH supports.

In contrast, Bertagnolli’s main expertise as a cancer surgeon and as a leader of clinical trials has led some doing basic science to wonder whether she might slight fundamental research—or favor NCI in setting NIH priorities. (Biden’s 2024 budget ­request for NIH amplified those concerns by giving NCI a 7% boost, representing more than half of the $920 million in added funding sought for all its 27 institutes and centers.)

Sigal and Varmus say they aren’t worried. “She understands that cancer patients also get Alzheimer’s and Parkinson’s, and that NIH must also lead the way in understanding a host of dreaded diseases,” Sigal says. “I’m confident her interest in how organisms work and how they go awry will be carried over into other areas,” adds Varmus, who says he was won over by her comments during several conversations since she took the NCI job.

Once nominated, her first hurdle will be a hearing before the Senate Health, Education, Labor, and Pensions (HELP) Committee. Bertagnolli has never testified before Congress (and leading NCI doesn’t require Senate confirmation), But Sigal and others predict Bertagnolli will showcase her knack for swaying an audience with her intellect, enthusiasm, and vision.

The HELP panel is chaired by Senator Bernie Sanders (I–VT), who is expected to quiz her on why NIH isn’t doing more to help lower drug prices by claiming patent rights on those developed in part with federal funds. But Sanders’s prodding may seem gentle compared with what Bertagnolli will get from Republicans on the panel. Senators and physicians Bill Cassidy (R–LA) and Rand Paul (R–KY) are expected to push Bertagnolli on the contested theory that the COVID-19 pandemic originated from a lab leak in China and that NIH funded work there to make pathogens deadlier.

Her supporters think she’ll weather that challenge. “She doesn’t have a dog in that fight because she’s not an infectious disease person and she wasn’t [at NIH],” says Sudip Parikh, chair of the advocacy group Research!America and CEO of AAAS, which publishes Science. “NIH may be controversial, but she’s not.”

Because Democrats hold a slim majority in the Senate, insiders predict it’s more a question of when, not whether, she would eventually be confirmed. Biden would then need to name her NCI successor. In the interim, Douglas Lowy, NCI’s principal deputy director, is expected to reprise the role of acting director that he’s played several times over the years to general acclaim.

But getting a permanent NIH director on board needs to be job one, Parikh says. “Congress wants to know where NIH is headed,” he says, “and you need a confirmed leader to lay out that strategy.”

https://www.science.org/content/article/monica-bertagnolli-bidens-pick-lead-nih