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Francis Collins’ resignation could complicate the fight over funding for ARPA-H

Francis Collins’ announcement last week that he will soon step down as National Institutes of Health director could complicate the Biden administration’s plans to launch ARPA-H, arguably the largest initiative the agency has undertaken in decades.

Collins, who has led NIH since 2009, is set to depart by the end of the year, leaving the White House just months to find a new leader for the $41 billion science agency. Beyond leaving the larger research office in flux, however, Collins’ retirement adds uncertainty to the process surrounding ARPA-H, a proposed $6.5 billion agency aimed at, in President Biden’s words, tackling major diseases like Alzheimer’s and diabetes and “ending cancer as we know it.”

Since the Biden administration first announced its proposal in April to create ARPA-H, Collins has played a central role. He has participated in a number of “listening sessions” orchestrated by NIH and the White House science office; publicly outlined a vision for the new agency with Eric Lander, Biden’s science adviser; and endorsed the concept in a series of interviews and speeches.

“It’s aimed to take on [these] really big, bold, hairy, audacious goals that are amenable to a new way of doing science, where you have very bold plans but very specific milestones,” Collins told STAT in July.

Two of Collins’ closest deputies moved to the White House science office soon after President Biden was inaugurated in January, likely giving him visibility into Lander’s office and the ARPA-H design process. One, Carrie Wolinetz, is the top life sciences policy official under Lander. The other, Tara Schwetz, is focused specifically on designing and standing up the ambitious new agency.

Collins’ departure, however, comes as Congress continues to debate a bill that would enact a number of new social programs and separate legislation to fund the government, which could contain both authorizing language and new funds for ARPA-H. Collins is known across Washington as a supremely effective NIH advocate: The agency’s budget has increased by roughly $11 billion in his decade-plus as director.

His departure, some fretted, could further complicate the debate over how much new funding the NIH and ARPA-H should receive, and whether the two agencies could end up in a de facto battle for the same pot of research money. Already, some lawmakers have moved to scale down Biden’s proposal, offering just $3 billion in startup money for the new agency, less than half of the $6.5 billion sum proposed by the White House. Congress, instead, set aside more new money for the NIH itself in the bill currently being debated.

“I believe the NIH appropriation will be solid, and I hope it grows more,” said David Skorton, the president of the Association of American Medical Colleges, which represents medical schools and teaching hospitals. “My only concern … is that the funding for ARPA-H should not compete with the funding for the basic budget of the NIH.”

Even if Collins’ absence, itself, doesn’t hinder ARPA-H’s momentum, longtime agency insiders say it adds more uncertainty to the already unclear path forward for the agency.

It remains to be seen how the ARPA-H director would even be selected. Most of Washington’s research advocacy community believe that the president will appoint the new agency’s leader. By contrast, the directors of most NIH institutes are hired directly by the NIH director, and are not subject to Senate confirmation.

The ARPA-H concept is also in flux more broadly. While the idea is generally popular on Capitol Hill, major questions remain about whether and when Congress will authorize the new agency, how much money it will receive, and whether it will be housed within NIH or as a standalone body. If the agency is authorized as part of the NIH, the absence of Collins at the helm could complicate the search for a director, some agency insiders argue.

“There is a remote possibility that the ARPA-H legislation could get finalized, and if located within NIH, that Francis could have a role in helping identify its leader,” said Kathy Hudson, the agency’s deputy director for science policy from 2010 to 2017. “If it is in NIH, and Francis is gone, I think it will be more difficult to recruit a good ARPA-H leader.”

Many major backers of the concept, like the Suzanne Wright Foundation’s Liz Feld and the geneticist Michael Stebbins, have pushed to create ARPA-H as a wholly distinct entity from NIH, much in the mold of DARPA, the Pentagon’s quasi-autonomous research arm.

Collins and Lander have publicly pushed Congress to make the agency “a distinct division within NIH,” but pledged, too, that it would maintain a large degree of autonomy. Initially, lawmakers and many research advocates sided with Collins’ recommendation, setting aside $3 billion in a draft spending bill for ARPA-H as a “distinct Institute” within NIH.

Recently, though, the tide may have turned: A more recent version of the language authorizing ARPA-H, currently pending before Congress, didn’t specify whether the agency will stand alone or be part of the broader NIH enterprise.

An NIH summary of a recent meeting also suggested that a top research advocate, Act for NIH CEO Richard Turman, was pushing for ARPA-H to be a “distinct and independent entity from NIH.” Turman, however, pushed back on that summary, saying he had argued for something less than full independence.

His prepared remarks suggest that he said, “the more distinct and independent ARPA-H is, the better its goals can be met.”

It remains unclear, also, where ARPA-H will be located geographically. During an interview at the STAT Breakthrough Science Summit in July, Collins said he would be “willing to listen” to proposals to house the new agency far from the NIH’s campus in Bethesda, Md., listing Boston and San Diego as potential destinations. House Democrats, too, have pushed for ARPA-H’s new office to be located outside Bethesda.

Broadly, however, Washington’s research advocacy community appears unshaken by the news of Collins’ impending retirement.

“We salute Dr. Collins for taking a leadership role in standing up this new agency,” Ellie Dehoney, the vice president of research and policy for the advocacy group Research!America, told STAT in a statement. “We are confident ARPA-H will be authorized and funded in the near future.”