When President Joe Biden appointed Monica Bertagnolli to lead the National Institutes of Health, it seemed like a choice meant to make everyone happy.
A renowned cancer surgeon, Bertagnolli responded to Biden’s personal request that his next NIH chief come from the oncology world he had long admired. Bertagnolli had previously had a stint at the top of the government’s National Cancer Institute, where she was highly regarded by staff scientists and clinicians. And throughout the medical research community, his support was instantaneous and wholehearted.
“We wholeheartedly applaud President Biden’s announcement of this exceptional choice,” Karen Knudsen, CEO of the American Cancer Society, said in a May statement calling for early confirmation of a choice she called of “outstanding surgical oncologist, innovative scientist and leader with a strong track record in transforming organizations.
Yet two months later, what many saw as a slam-dunk selection has become the latest personal headache for a White House that has struggled lately to get its nominees through the tightly divided Senate.
Bertagnolli’s candidacy is stalled indefinitely, caught in a standoff between the administration and Sen. Bernie Sanders (I-Vt.) over Biden’s drug pricing agenda.
A second senator, Elizabeth Warren (D-Mass.), made her own demands, pressuring Bertagnolli to sign expanded ethics agreements that include a ban on working for or on behalf of big pharma during four years after leaving the NIH. So far, Bertagnolli has resisted concerns about the scope of those commitments, two people familiar with the matter said.
It’s a process that has become so unexpected and uncomfortable for Bertagnolli that his allies privately wonder when it’s no longer worth the effort. In addition to juggling full-time duties at the NCI and her bid to lead the NIH, Bertagnolli recently underwent treatment for her own diagnosis of breast cancer.
“Having Democratic caucus members presenting obstacles to getting there is frustrating,” said Harold Varmus, who led the NIH during the Clinton era and is a strong Bertagnolli supporter. “I’ve seen the statements from Senator Sanders and from the White House, and I don’t see these things that are breaking ground.”
Biden has been without a permanent NIH director for a year and a half, alarming medical research groups who say having a confirmed leader ahead of impending budget talks on Capitol Hill is essential — as well as ensuring stability at some point. where public health agencies are under increasing political scrutiny.
The standoff also raised new questions about how the White House staff operates and why she hadn’t anticipated her NIH nominee would encounter roadblocks.
Sanders, who chairs the Senate committee reviewing Bertagnolli’s candidacy, said in a recent interview that he began warning the administration in January that he wanted more unilateral action to reduce drug prices. Frustrated by the lack of response, he decided to go public in a June interview with The Washington Post, vowing to oppose all health care candidates until the White House meets his demands.
Despite these ongoing tensions, the White House did not alert Sanders that it planned to appoint Bertagnolli before the news broke, said the two people familiar with the matter, who were granted anonymity to describe the decision-making. internal. In the weeks following Bertagnolli’s nomination, some Biden officials also expressed internal optimism that Sanders would grant him a hearing in June, the people said.
No hearing took place. Instead, Sanders insists he feels no pressure to accept Bertagnolli’s nomination as long as his demands remain unmet, telling POLITICO “the public is probably more on my side.”
“What the American people want now is not just another agency chief,” he said. “They want policies to address the major crises facing this country.”
The stalemate is just one of many stalemates Biden has encountered when it comes to his candidates. And it’s a sign of how efforts by senators from both parties to use the nominating process to exert leverage have upended expectations that the White House would face an easier time after the Democrats enlarged their majority in the Senate last November.
Biden’s pick to lead the Labor Department, Julie Su, saw her nomination grounded for five months amid skepticism from a trio of senators. Candidates for both the Federal Aviation Administration and the Federal Communications Commission withdrew this year after it became clear they could not win confirmation. In May alone, Biden lost two judicial candidates. Sen. Tommy Tuberville (R-Ala.), meanwhile, single-handedly halted promotions for about 250 military officers, creating vacancies throughout the Pentagon.
In response to questions about Sanders’ claims, the White House declined to comment on the filing.
But a White House official pointed to his passing of the Cut Inflation Act and said the administration remained committed to having Bertagnolli confirmed.
“The president shares the senator’s concerns about drug pricing,” the White House spokesman said, calling the IRA “the most consequential law addressing the high cost of prescription drugs.”
The White House also defended its nomination process, noting that it has confirmed more nominees than the Trump administration has at this stage of the term, despite holding fewer Senate seats at the start of the term. Biden’s presidency.
In Bertagnolli’s case, the fight for his nomination has proven particularly frustrating for Biden officials because it has little to do with his actual qualifications.
Sanders wants the White House to take more aggressive action to rein in drug prices, such as reinstating an NIH requirement that pharmaceutical companies sell a drug at a “reasonable” price when it is developed with help. from the federal government, or seizing drug patents to obtain a license. to other manufacturers to lower their prices.
The NIH researchers had previously concluded that the “reasonable” pricing clause discouraged private sector collaboration with the agency. The Department of Health and Human Services is reviewing its so-called march-in authority, but earlier this year it refused a petition to test that patent seizure power for a cancer drug. prostate.
Biden officials counter Sanders by pointing out that the IRA is already having an impact. The law capped the price of insulin for older Americans starting this year and eventually will allow Medicare to directly negotiate the cost of some drugs, a goal Democrats have pursued for decades.
Sanders, however, dismissed the argument, calling the IRA provisions “a very modest step that doesn’t go far enough.”
Bertagnolli continues to meet with senators in hopes that the White House and Sanders will resolve their standoff. She sat down with Warren on Tuesday to discuss his ethics requirements, though that didn’t result in an agreement. Outside allies have also stepped up lobbying in recent weeks, sending letters to Sanders and Senate leaders seeking his confirmation.
After missing the June window, Varmus said he hoped Bertagnolli could be heard before the August break.
But Biden’s allies have rejected the prospect that the White House would pander to Sanders’ demands just to jump-start Bertagnolli’s confirmation, arguing that despite what the senator says, there’s not much more to it. can realistically do to make a major dent in drug prices.
Sanders, too, remains impassive, having not even scheduled a date with Bertagnolli yet.
“It’s nothing personal,” he said. “The premise here is that we need to address some of the major health care crises in America. That’s what we need to do, and it’s time for the administration to act.”