What will happen to biomedical research and health care in the aftermath of the 2024 election? The differences in outcomes couldn’t be more stark.
Vice President Kamala Harris, who became the Democratic frontrunner on July 21 after President Joe Biden announced his decision not to seek reelection, is expected to pursue a science agenda consistent with that of the Biden administration, most observers agree.
Should Republicans win the White House, observers say that the second Trump administration will treat science differently than the first.
“I think that in a second term, there would probably be more recognition of the importance of controlling the administrative agencies,” Scott Gottlieb, Trump’s first FDA commissioner, said at a Friends of Cancer Research event on Feb. 1. “So, I think there may be less autonomy than there was in the first term.”
Ideology aside, the Trump administration appointed solid, mainstream leaders to NIH, NCI, and FDA, leaving some observers to wonder whether the president and his closest advisors cared very much about these agencies.
By the time Trump lost the election—amid the COVID-19 pandemic—there was no question that he had become keenly aware of these biomedical research agencies’ existence.
At this writing, polls suggest that the election is a tossup, and the prognoses of what Trump will do should he return to the White House largely depend on interpretations of a 900-page document titled “The 2025 Presidential Transition Project,” which has become better known as “Project 2025.”
Authored by the Heritage Foundation, a conservative think tank that had a close relationship with the Trump presidency, Project 2025 is a wish list of conservative policies. These policies are presented as priorities for a potential Republican administration.
Trump recently denied knowing about Project 2025 or the players behind it. But in 2022, Trump lauded the Heritage Foundation and its pre-Project 2025 efforts to, in his words, “lay the groundwork and detail plans for exactly what our movement will do.” According to reports, at least 140 people involved in Trump’s former administration helped to create the political playbook.
“He does have a political antenna,” Jeff Allen, president and CEO of Friends of Cancer Research, said to The Cancer Letter. “With elements of Project 2025 having a polarizing aspect to them, he was probably trying to take a bit more of a moderate public tone in the context of a major public rollout in the convention.”
Vice President Harris, first as a U.S. senator and most recently in her current role, has been a staunch supporter of access to care and has supported robust and sustained increases in funding for cancer research.
Lisa A. Lacasse
Although the guidebook is technically just a “soft starter” for shaping potential priorities, including imposing conservative ideologies on reproductive health, minimizing federal involvement in research and health care, and discouraging public-private partnerships, there are reasons to be deeply concerned about its contents, Allen said.
“Oftentimes, prior administration officials are tasked again for subsequent administrations of the same party, and so, that could very well happen, particularly if it’s the same person,” Allen said.
Separately, Trump and the GOP have published a 16-page platform that contains no specifics on NIH, NCI, FDA, or CDC, but broadly promises to make health care affordable.
More telling is a recent proposal by some House GOP leaders to streamline NIH’s 27 institutes and centers into 15 (The Cancer Letter, June 21, 2024).
Similarly, the Project 2025 section on revamping the Department of Health and Human Services, written by Roger Severino, who was the director of the Office of Civil Rights at HHS from 2017 to 2021, suggests splitting the Centers for Disease Control and Prevention into two agencies with a “firewall” between them.
If enacted, one component of what is now CDC would gather data while the other develops public health policy recommendations.
Severino expresses his frustration with what he describes as CDC’s lack of published COVID-19 data during the pandemic as a reason for this bifurcation. “In February 2022, for example, it was reported that ‘[t]wo full years into the pandemic, the agency leading the country’s response to the public health emergency has published only a tiny fraction of the data it has collected,’ much of which ‘could [have helped] state and local health offcials better target their efforts to bring the virus under control,’” Severino writes in Project 2025.
The House Republicans’ NIH streamlining proposal includes term limits for all directors, including the NCI director, which Project 2025 endorses for the agency’s “top career leaders.” Further, the political roadmap proposes curbing NIH’s grant-funding authority and allowing states to conduct peer review and allocate funding—without recommendations for insulating the process from political and ideological influence.
Notably, Project 2025 aims to abolish the NIH Office of Equity, Diversity, and Inclusion, efforts to include more women speakers at scientific conferences, and the funding of transgender health studies.
The Heritage Foundation wish list includes getting rid of private sources of funding—including from biopharmaceutical companies—across NIH, CDC, and FDA. “In this realm, ‘public-private partnerships’ is a euphemism for agency capture, a thin veneer for corporatism,” Project 2025 states.
“I think that oncology has certainly shown that having various sectors involved in aspects of research and development have been a positive thing, given the complicated nature behind oncology and many other sciences,” Allen said. “It takes that level of collaborative science in order to leverage resources and expertise and drive success to the field.”
The disdain for public-private partnerships is likely rooted in motivations to lower drug prices, Allen said.
That is apparent in Project 2025’s focus on increasing the availability of generic drugs. The document suggests removing laws that prioritize brand-name medications.
The Biden-Harris administration has worked to lower the cost of prescription drugs. The Inflation Reduction Act of 2022 requires drug manufacturers to pay rebates to Medicare when drug prices increase faster than the rate of inflation, and allows the federal government to negotiate prices for some drugs covered by Medicare (The Cancer Letter, Sept. 8, 2023).
Project 2025 proposes a repeal of the federal government’s authority to negotiate drug prices.
The Biden-Harris administration is also exploring “march-in rights,” which would allow the federal government to intervene if it deems a publicly-funded patented product—including prescription drugs—to be too expensive.
Women’s health is a key issue in this election. Harris has been a vocal advocate for reproductive rights and for reinstating Roe v. Wade.
Project 2025, by contrast, states that abortion is not health care and proposes that the FDA reverse its approval of drugs indicated for medical abortion.
Through the end of his presidency, Biden said he will remain a steadfast advocate for cancer research. “I will keep fighting for my Cancer Moonshot so we can end cancer as we know it, because we can do it,” Biden said in his July 24 remarks from the Oval Office, addressing his decision to end his reelection campaign.
I know that the big news at the moment is definitely Harris taking over and seeing what she’ll want to put forward in terms of her policies, and we would hope that the Cancer Moonshot initiative would be continued. And we would hope that the Cancer Moonshot initiative would be continued as well under former President Trump, if he’s elected.
Jon Retzlaff
Harris is expected to ensure continuity for the Cancer Moonshot if she wins the presidential race, sources said to The Cancer Letter. The effort was first launched in 2016, during the Obama-Biden administration, to increase resources and collaboration to advance cancer research, and was “reignited” in 2022 under the Biden-Harris administration with the goal of halving the death rate from cancer over the next 25 years(The Cancer Letter, Feb. 4, 2022; Jan. 16, 2016; To The Moon).
“Vice President Harris, first as a U.S. senator and most recently in her current role, has been a staunch supporter of access to care and has supported robust and sustained increases in funding for cancer research,” Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network, said to The Cancer Letter. “As the vice president knows well, everyone has been touched by this disease. Her mother was a cancer researcher before she lost her life to colon cancer.”
That background has given Harris a strong appreciation for the importance of cancer research, said Jon Retzlaff, chief policy officer and vice president of science policy and government affairs at the American Association for Cancer Research.
“I know that the big news at the moment is definitely Harris taking over and seeing what she’ll want to put forward in terms of her policies, and we would hope that the Cancer Moonshot initiative would be continued,” Retzlaff said to The Cancer Letter.
“And we would hope that the Cancer Moonshot initiative would be continued as well under former President Trump, if he’s elected,” Retzlaff said.
“Cancer is a nonpartisan issue.”
