President Joe Biden on Monday announced he will nominate National Cancer Institute Director Monica Bertagnolli to lead the National Institutes of Health, a position that has been open since December 2021 when longtime director Francis Collins retired.

The nomination underscores the administration’s focus on the cancer moonshot. Bertagnolli, a cancer surgeon who rose to the top ranks of the National Cancer Institute last fall, was diagnosed with breast cancer in December 2022.

“Dr. Bertagnolli has spent her career pioneering scientific discovery and pushing the boundaries of what is possible to improve cancer prevention and treatment for patients, and ensuring that patients in every community have access to quality care,” Biden said in a statement.

If confirmed, she would be the second woman to lead the sprawling medical research agency on a permanent basis.

Bertagnolli was confirmed as director of the National Cancer Institute in October and has made health equity a cornerstone of her tenure as director.

On April 17, at the American Association for Cancer Research Conference in Orlando, she spoke of the need for the NIH to address health equity and modernize clinical trials to drive results in cancer research.

“Doing more of what we already have today is not enough,” she said.

If confirmed, she would follow Collins, a man known for his bipartisan relationships across administrations and Capitol Hill.

Bertagnolli has less Capitol Hill experience than Collins. Prior to her appointment to lead the National Cancer Institute, she was a surgical oncology professor at Harvard Medical School.

But some policy watchers noted that her knowledge and “charming” nature could easily win over lawmakers.

“Obviously, Dr. Collins was Dr. Collins, but Monica Bertagnolli is a new chapter. And she’s got pretty, pretty big shoes in and of herself,” said Julie Nickson, the director of federal relations for the American Cancer Society Cancer Action Network.

One of her first challenges as NIH director will be boosting the agency’s fiscal 2024 funding as Republicans look to cut spending levels.

The White House’s fiscal 2024 budget requests $46.4 billion in discretionary spending for the NIH, compared to $46.1 billion enacted — a comparatively small increase compared to recent years.

During an April 19 House Labor-HHS-Education Appropriations Subcommittee hearing, subcommittee ranking member Rosa DeLauro, D-Conn., called for more funding for the NIH, saying the president’s proposed increase is too small.

Trial by Senate

Several of Biden’s health care nominees have faced partisan divides in their Senate confirmation processes — Food and Drug Administration Commissioner Robert Califf and Health and Human Services Secretary Xavier Becerra.

But Bertagnolli was vetted by the administration when she was appointed to lead the NCI, so this could make her confirmation process easier, said Erik Fatemi, a former staff director of the Senate Labor-HHS-Education Appropriations Subcommittee who is now a principal at Cornerstone Government Affairs.

And a few issues related to the agency face some political contention, including Republican investigations into the origins of COVID-19 and Democratic uproar over the administration not granting march-in rights for the cancer drug Xtandi.

But Bertagnolli’s focus on cancer and lack of fingerprints on NIH’s more controversial issues could help assuage some lawmakers, said Sudip Parikh, CEO of the American Association for the Advancement of Science.

“I see it as a moment when we have to influence that conversation. We need a reset,” Parikh said, pointing to the eroding trust in public health institutions after the COVID-19 pandemic.

Ellie Dehoney, vice president of policy and advocacy at Research America, a nonprofit medical and health research advocacy alliance, said Bertagnolli’s nomination “is not really the right nomination to politicize or to attach to other agendas and that they will move forward and approve her nomination.”