Sanders’s ‘game of chicken’ over NIH nominee alarms health advocates

Sen. Bernie Sanders (I-Vt.) is in a standoff with the White House over drug pricing, frustrating and confusing public health experts who worry his demands will stymie the Biden administration’s nominee to lead the National Institutes of Health (NIH). 

Monica Bertagnolli is a renowned cancer surgeon who currently leads the National Cancer Institute. She has the support of a broad cross section of the medical research community, which has been lobbying for her confirmation. 

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

So far, that hasn’t happened.  

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

The White House did not respond to a question on whether anyone has reached out to Sanders to discuss a path forward. Sanders and Biden met with young labor organizers at the White House on Monday, but the senator said the matter of Bertagnolli’s nomination did not come up.  

In response to previous questions, the White House has said President Biden shares Sanders’s concerns over drug prices, and pointed to Medicare drug price negotiation passed in the Inflation Reduction Act, as well as the $35 cap on insulin for Medicare beneficiaries. 

With just more than a week before the August recess, health advocates and allies of Bertagnolli are growing concerned. They think the White House should exert more pressure on the Vermont Independent.

Harold Varmus, who led the NIH during the Clinton administration and is a close ally of Bertagnolli, said the underlying cause of lowering drug prices may be “honorable,” but it is unrelated to the nomination in question. 

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

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

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

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

Sanders is chairman of the Senate Health, Education, Labor and Pensions Committee, so the administration won’t be able to confirm any health nominees without his support. NIH is currently the only health agency with a Senate-confirmable vacancy at the top.

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

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

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

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

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

But health advocates have said the issues are tangential at best to the NIH and shouldn’t be used as leverage.

Outside of NIH, advocates are also worried Sanders’s move could set a trend to politicize future noncontroversial health nominees. For example, the director of the Centers for Disease Control and Prevention (CDC) will need to be confirmed beginning in January 2025. 

“This is an example of what we should anticipate happening for the confirmation for the CDC director,” said Georges Benjamin, executive director of the American Public Health Association.

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