June 17, 2024

Sanders ‘game of chicken’ over NIH nominee warns health advocates

Sen. Bernie Sanders (I-Vt.) is at loggerheads with the White House over drug pricing, frustrated and confused public health experts worried about his claims are blocking the Biden administration’s nominee to lead the National Institutes of Health (NIH).

Monica Bertagnolli is a renowned cancer surgeon who currently heads the National Cancer Institute. It has the support of a broad cross-section of the medical research community, which is lobbying for its ratification.

Bertagnolli was nominated in May, but Sanders said he won’t hold a hearing on any health nominee until he sees a “strong” plan from the White House to lower drug prices.

So far, that has not happened.

“We have not received a pricing plan from the administration,” Sanders said recently. “The high cost of prescription drugs is a major crisis for American health care now and in the future. We have to deal with it.”

The White House did not respond to a question about whether anyone had contacted Sanders to discuss a way forward. Sanders and Biden met with young labor organizers at the White House on Monday, but the senator said the topic of Bertagnolli’s nomination did not come up.

In response to previous questions, the White House has said that President Biden is concerned about drug prices, and pointed to Medicare drug price negotiations passed in the Inflation Reduction Act, as well as the $35 cap on insulin for Medicare beneficiaries.

With more than a week before the August break, health advocates and Bertagnolli’s allies are growing concerned. They think the White House should put more pressure on the Vermont Independent.

Harold Varmus, who headed the NIH during the Clinton administration and is a close friend of Bertagnolli, said the underlying reason for lowering drug prices may be “honorable,” but that it has nothing to do with the nomination in question.

“My concern is that we’re interfering with the functioning of government … and this doesn’t seem like the occasion to try to solve the issues through a kind of game of chicken,” Varmus said.

“With the party that runs the White House holding up its own nominations, that’s not the way to succeed in developing a strong administration,” Varmus said.

The top NIH job has been vacant since Francis Collins left the agency in December 2021. Lawrence Tabak has been acting director for more than 18 months.

Bertagnolli was nominated in May, but now the earliest possible chance for a hearing is September, when the congressional calendar will be filled with appropriations bills and wrangling to avoid a government shutdown – actions that a confirmed leader could help navigate.

Sanders is the chairman of the Senate Health, Education, Labor and Pensions Committee, so the administration will not be able to confirm any health nominee without his support. Currently NIH is the only health agency with a Senate confirmation vacancy at the top.

Sanders wants the administration to take steps beyond those in the Deflation Act; in a statement when the law was passed last summer, Sanders said he considers the drug transaction provision a “small step,” especially since it only starts with 10 drugs and doesn’t kick in until 2026.

He wants specific policies, such as reinstating an NIH requirement that forces companies to sell a drug at a “reasonable” price when it is developed with research help from the federal government, taking into account its production cost, public need, and taxpayer investment.

That policy was in place for several years in the early 1990s, but Varmus revoked it in 1995, when pharmaceutical companies stopped cooperating with the agency. He said the NIH is not a regulatory agency and should not be involved in pricing.

Sanders also wants the federal government to exercise its “marching rights” to seize drug patents in order to license them to other manufacturers to lower their prices, something the administration has repeatedly refused to do.

The most recent example was in March, when the Department of Health and Human Services refused to infringe the patent of the prostate cancer drug Xtandi.

But health advocates have said the issues are tangential at best for the NIH and should not be used as leverage.

Outside of NIH, advocates also worry that Sanders’ move could set a trend for future politicization of uncontroversial health nominees. For example, the director of the Centers for Disease Control and Prevention (CDC) will need to be certified starting in January 2025.

“This is an example of what we should expect to happen to the certification of the CDC director,” said Georges Benjamin, executive director of the American Public Health Association.

“It politicizes the process, in that it could limit people who want to do the job, who are qualified enough to do the job, but don’t want to go through the hassle of that certification process,” Benjamin said.

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