When President Joe Biden nominated Monica Bertagnolli to run the National Institutes of Health, it seemed like a choice meant to make everyone happy.
A renowned cancer surgeon, Bertagnolli fulfilled Biden’s personal demand that his next NIH chief come from the oncology world he’s long admired. Bertagnolli had already done a stint atop the government’s National Cancer Institute, where she was well-liked by staff scientists and clinicians. And throughout the broader medical research community, support for her was instant and full-throated.
“We wholeheartedly applaud the announcement from President Biden for this outstanding choice,” Karen Knudsen, the CEO of the American Cancer Society, said in a May statement urging swift confirmation for a pick she called “an exceptional surgical oncologist, innovative scientist and leader with a strong track record of transforming organizations.”
Yet two months later, what many viewed as a slam-dunk selection has become the latest personnel headache for a White House that’s struggled mightily of late to get its nominees through the narrowly divided Senate.
Bertagnolli’s candidacy is stalled indefinitely, caught up 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.), has made her own demands, pressuring Bertagnolli to sign expanded ethics agreements that include swearing off working for or on behalf of major drug companies for four years after leaving NIH. Bertagnolli has so far resisted over concerns about the scope of those commitments, two people familiar with the matter said.
It’s a process that’s become so unexpectedly drawn out and uncomfortable for Bertagnolli that her allies privately question at what point it’s no longer worth the hassle. In addition to juggling full-time duties at NCI and her candidacy to run NIH, Bertagnolli recently underwent treatment for her own breast cancer diagnosis.
“To have members of the Democratic caucus presenting obstacles to getting this done, it’s frustrating,” said Harold Varmus, who ran the NIH during the Clinton era, and is a strong supporter of Bertagnolli. “I’ve seen the statements by Sen. Sanders and by the White House, and I don’t see those unblocking things.”
Biden has been without a permanent NIH director for a year-and-a-half, alarming medical research groups who believe it’s critical to have a confirmed leader ahead of looming budget negotiations on Capitol Hill — as well to provide stability at a time when public health agencies are under increasing political scrutiny.
The logjam has also raised fresh questions about the White House’s personnel operation, and why it didn’t anticipate that its NIH nominee would run into roadblocks.
Sanders, who chairs the Senate committee responsible for vetting Bertagnolli’s candidacy, said in a recent interview that he began warning the administration in January that he wanted more unilateral actions to slash 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 nominees until the White House met his demands.
Despite those running tensions, the White House did not alert Sanders it planned to nominate Bertagnolli before the news broke, said the two people familiar with the matter, who were granted anonymity to describe internal decision making. In the weeks after Bertagnolli’s nomination, some Biden officials also expressed internal optimism that Sanders would grant her a hearing in June, the people said.
No hearing has been held. Instead, Sanders insists he feels no pressure to move on Bertagnolli’s nomination as long his requests remain unmet, telling POLITICO “the public is probably more on my side.”
“What the American people want now is not just another head of an agency,” he said. “They want policies to address the major crises facing this country.”
The impasse is just one of several Biden has encountered with respect to his nominees. And it’s a sign of how efforts by senators in both parties to use the nominations process to exercise leverage has upended expectations that the White House would face an easier time after Democrats expanded their Senate majority last November.
Biden’s pick to run the Labor Department, Julie Su, has seen her nomination founder for five months amid skepticism from a trio of senators. Nominees for both the Federal Aviation Administration and Federal Communications Commission withdrew this year after it became clear they couldn’t win confirmation. In May alone, Biden lost two judicial nominees. Sen. Tommy Tuberville (R-Ala.), meanwhile, has singlehandedly halted the promotions of around 250 military officers, resulting in vacancies across the Pentagon.
In response to questions about Sanders’ demands, the White House declined to comment on the record.
But a White House official pointed to its passage of the Inflation Reduction Act and said the administration remains committed to getting Bertagnolli confirmed.
“The President shares the Senator’s concerns on drug pricing,” the White House spokesperson said, calling the IRA “the most consequential law addressing the high cost of prescription drugs.”
The White House also defended its nominations process by noting it’s confirmed more nominees than the Trump administration had to this point in the term, despite holding fewer Senate seats at the beginning of Biden’s presidency.
In Bertagnolli’s case, the fight over her nomination has proved particularly frustrating for Biden officials because it has little to do with her actual qualifications.
Sanders wants the White House to take more aggressive steps to rein in drug prices, such as reinstating an NIH requirement that drug companies sell a medicine at a “reasonable” price when it’s developed with help from the federal government, or seizing drug patents to license them out to other manufacturers to lower their prices.
NIH researchers previously concluded the “reasonable” pricing clause discouraged private-sector collaboration with the agency. The Health and Human Services Department is reviewing its so-called march-in authority, but earlier this year declined a petition to test that patent-seizing power for a prostate cancer drug.
Biden officials counter Sanders by stressing that the IRA is already having an impact. The law capped the price of insulin for older Americans starting this year, and will eventually allow Medicare to directly negotiate the cost of certain drugs, a goal Democrats pursued for decades.
Sanders, though, waved away the argument, calling the IRA’s provisions “a very modest step that doesn’t go anywhere near far enough.”
Bertagnolli continues to meet with senators in hopes the White House and Sanders resolve their standoff. She sat down on Tuesday with Warren to discuss her ethics demands, although it did not result in an agreement. Outside allies have also ramped up their lobbying in recent weeks, sending letters to Sanders and Senate leadership pushing for her confirmation.
After missing the June window, Varmus said his hope is that Bertagnolli can get a hearing before the August recess.
But Biden allies dismissed the prospect that the White House would bend to Sanders’ demands just to jumpstart Bertagnolli’s confirmation, arguing that despite what the senator says, there’s little more it can realistically do to make a major dent in drug prices.
Sanders, too, remains unmoved, having yet to even scheduling a meeting with Bertagnolli.
“It’s nothing personal,” he said. “The principle here is that we have got to address some of the major health care crises in America. That’s what we’ve got to do, and it’s time for the administration to act.”