National Institutes of Health Director Monica Bertagnolli wishes she’d had the opportunity to help shape GOP plans to overhaul her agency. "I found that once we got in a room together and really sat down and discussed the pros and cons of different approaches, we made great progress working together,” Bertagnolli told Erin on Tuesday, after she announced she’s leaving the agency on Friday. Bertagnolli definitely isn’t endorsing some of congressional Republicans’ more far-reaching plans, like consolidating the agency’s divisions, and certainly not Robert F. Kennedy Jr.’s threat to fire hundreds of NIH workers. But she does see reason for a serious-minded rethink of the way the $47 billion agency pursues health care breakthroughs. "I had a great relationship with Sen. Cassidy," she said, referencing Bill Cassidy, the Louisiana Republican who now oversees the agency as chair of the Health, Education, Labor and Pensions Committee. Cassidy put out an NIH overhaul plan last year. Bertagnolli calls their conversations “very positive" and "very productive." She said she’d hoped to have the same opportunity to work with Republicans in the House who are pursuing their own plans for the agency. Those plans include balancing the NIH’s portfolio of early- and late-stage research, streamlining the grant review process, instituting term limits on NIH leaders and consolidating the agency from 27 institutes and centers – the divisions responsible for research in specific areas of disease and health – to 15. There were areas of agreement in both proposals, she pointed out, some of which she’d already moved to implement. "One of the first things I did on taking over the position was to stand up the Scientific Management Review Board," she said, referring to the board Congress created in the 2006 NIH Reform Act and charged with evaluating the agency’s structure and research portfolio and making recommendations to the NIH director. Reviving it was a key part of the GOP proposals. The board fell dormant under Bertagnolli’s predecessor, Francis Collins, sparking criticism from House and Senate Republicans interested in increasing NIH oversight and a directive in the 2024 omnibus appropriations law to restart it. "I was looking forward to working with Congress on those recommendations and I feel we could have made great progress and made some very good improvements," she said. Not all of the current GOP proposals sit well with Bertagnolli. During the review board meetings she attended, she spoke against the House proposal to consolidate the agency. She also defended the agency on Tuesday against a more radical suggestion from Kennedy, Trump’s pick to lead the Department of Health and Human Services: firing hundreds of NIH staffers. Given those workers’ civil service protections, that will be hard to do without Congress passing a law. Only two people at the agency — the director and the head of the cancer institute — are appointed by the president. Protections aside, Bertagnolli thinks firing her staff is short-sighted. "The brain trust here is unparalleled worldwide. I very much hope that whoever comes in as the new director preserves that," she said.
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