What to expect from Joe Biden

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Now that Joseph R. Biden Jr. is inaugurated and safely ensconced in the White House, cancer groups expect him to pick up where he left off as vice president four years ago—pursuing a sober and ambitious agenda for accelerating progress in cancer research.

The Biden administration is, first and foremost, focused on mitigating the spread of SARS-CoV-2, pursuant to his promises to mount a robust federal response to the pandemic.

“Few periods in our nation’s history have been more challenging or difficult than the one we are in now. It’s taken as many lives in one year as America lost in all of World War II,” Biden said in his inaugural address as the 46th president of the United States. “A cry for racial justice some 400 years in the making moves us. The dream of justice for all will be deferred no longer. And now, a rise in political extremism, white supremacy, domestic terrorism that we must confront and we will defeat.

“This is a time of testing. We face an attack on democracy and on truth. A raging virus. Growing inequity. The sting of systemic racism. A climate in crisis. America’s role in the world. Any one of these would be enough to challenge us in profound ways.

“Now we must step up. All of us.”

Bernie

To say that Washingtonians are elated at Biden’s return to the White House would be a severe understatement—many unclenched a four-year lockjaw, poured libations, and turned pots and pans into veritable church bells as the presidential transition concluded without incident on Wednesday. Those of us in health care—science writers included—hit our battle stations on Thursday morning with renewed urgency.

Oncology groups have a special reason to be upbeat: Biden has proven to be a visionary leader to cancer research, and the power of the White House to move things along—in the right hands—is unmatched.

To wit, as vice president in 2016, within 12 months, Biden managed to secure $1.8 billion for the Beau Biden Cancer Moonshot (The Cancer Letter, Nov. 13, 2020, To the Moon, 2016-2017).

To gauge the temperature of the community, The Cancer Letter asked leaders at six oncology organizations—professional societies, advocacy groups, and think tanks—to describe what they are looking for in a new era.

Their responses appear in full here.

“Science is what is going to lead us out of this national—and international—nightmare, and President Biden possesses a willingness to listen to the experts on important matters in science,” Jon Retzlaff, chief policy officer and vice president of science policy and government affairs at the American Association for Cancer Research, said to The Cancer Letter.

Cancer groups expect the Biden White House to soon turn the spotlight on oncology and build on his Moonshot legacy—including boosting overall funding for biomedical research.

“President Biden is a man of compassion and a champion of science,” Jed Manocherian, founder and chairman of ACT for NIH, said to The Cancer Letter. “We are thrilled for the opportunity to work with both Congress and the Biden administration to substantially boost research funding for all dreaded diseases and conditions.

“President Biden discussed his efforts to ‘end cancer as we know it’ through the Cancer Moonshot,” Manocherian said. “He noted that one regret he had about not running in 2016 had been that he wouldn’t be the president to preside over curing cancer, and said that now he was going to do ‘everything I can to get that done.’”

GormanBiden’s team is yet to announce the presidential cancer agenda, but many organizations are gearing up for an unprecedented opportunity in the history of oncology to harness the authority of the highest office in the land for cancer research.

“I do expect that the Biden administration will do a lot for cancer research and delivery, and obviously regulatory as well as prevention, but it’s not going to happen right away,” Ellen Sigal, founder and chair of Friends of Cancer Research, said to The Cancer Letter. “COVID is overwhelming and it’s certainly disproportionately hurting cancer patients.

“So, I don’t think you’re going to have a cancer drive the first three, four months, but I fully expect that they will definitely move on from the Moonshot and definitely work towards new frontiers, new opportunities.”

Leaders at cancer organizations unanimously express confidence in Biden’s ability to control the pandemic, expedite vaccine delivery, and address cancer.

“Absolutely, and I am so relieved,” Nancy Goodman, founder and executive director of Kids v Cancer, said to The Cancer Letter.

“President Biden—and it feels so great to say that—has already announced his continued commitment to cancer research,” Goodman said. “The announcement by the Biden administration that Broad Institute President Eric Lander would be nominated to run the Office of Science and Technology Policy, and the elevation of that office to a Cabinet position spells an increased commitment to science and specifically to cancer research.”

Janet Woodcock has been named FDA acting commissioner, replacing Stephen Hahn. Norris Cochran was appointed HHS secretary, and Francis Collins was asked to stay on as NIH director. No announcement has been made about the NCI directorship, but Ned Sharpless appears to remain in the job, at least in the interim.

Cancer groups are looking for the new evidence-based administration to take an aggressive stance on several priorities in health care:

  • Access and equity
    “Several states have implemented—or are pursuing—Medicaid policies that could jeopardize care for patients with cancer. We are eager to work with the new administration to assure that access to care is not harmed,” Monica Bertagnolli, board chair of the Association for Clinical Oncology, an affiliate of the American Society of Clinical Oncology, said to The Cancer Letter.

  • Insurance coverage and rising healthcare costs
    “Good health care is out of reach of so many Americans who do not have health insurance, or who cannot afford to use their health insurance,” said Goodman, of Kids v Cancer. “I hope the Biden administration strengthens the Affordable Care Act.”

  • Telehealth and data infrastructure
    “Expanding coverage of telehealth and ensuring insurance coverage parity,” Karen Knudsen, president of the Association of American Cancer Institutes and enterprise director of the Sidney Kimmel Cancer Center at Jefferson, said to The Cancer Letter. “Strengthening the underfunded aspects of the previous administration’s pediatric cancer initiatives and data system.”

  • Cancer disparities and systemic racism
    “We would like to see the Biden administration also act to prioritize efforts to eliminate cancer disparities in racial and ethnic minorities and other underserved populations,” AACR’s Retzlaff said. “The AACR is also fully committed to taking on a much bigger role in confronting and combating systemic racism and racial inequities across the entire cancer research and patient care enterprise, and we would be happy to contribute to the initiatives and policies that we expect the president to propose.”

  • FDA’s Oncology Center of Excellence and real-world evidence
    “Now that it has been implemented, now that we have history, is it working, is it a work in progress? What changes need to be made to that?” said Sigal, of Friends of Cancer Research. “Obviously, the integration of cancer is not only important to the field, but it’s really important at the FDA and, one of the primary things that we worked on for 21st Century Cures and Moonshot was really the regulatory environment for cancer.”

  • Grant success rates
    “We are delaying and discarding the majority of highly merited research at the greatest time in history for scientific advancement,” Act for NIH’s Manocherian said. “We will continue our efforts with Congress on our mission to restore and then double the budgets of NIH and NCI.”

Observers point to a slew of executive orders Biden signed within the first two days of his presidency as an early indication of his conviction and decisive leadership—many aimed at undoing ex-president Donald Trump’s legacy.

In addition to directives on immigration, student loans, travel bans,and the climate crisis, Biden has signed multiple orders that have broad implications for health care, and which directly dovetail with priorities in oncology.

Biden’s executive orders address the following problems:

  • Freeze regulatory action at federal agencies—especially those related to health, safety, environmental, financial, or national security—until a Biden appointee or designee has reviewed new proposals or rules.

  • Revoke “harmful policies and directives,” including six Trump EOs on federal regulation that “threaten to frustrate” the federal government’s ability to address national priorities.

  • Modernize and improve processes for reviewing federal regulations to promote “public health and safety, economic growth, social welfare, racial justice, environmental stewardship, human dignity, equity, and the interests of future generations.”

  • Create the position of Coordinator of the COVID-19 Response and Counselor to the President, who will report directly to the president and coordinate the federal government’s response to the pandemic.

  • Provide “targeted surge assistance” to critical care and long-term care facilities, accelerate development of novel therapies, and increase the capacity of the healthcare workforce.

  • Direct federal agencies to immediately assess the inventory of response supplies and identify emergency needs; and build long-term capability to manufacture supplies for future pandemics and biological threats.

  • Form a COVID-19 Health Equity Task Force, which is charged with allocating COVID-19 resources “in light of disproportionately high rates of COVID-19 infection, hospitalization, and mortality in certain communities and disparities in COVID-19 outcomes by race, ethnicity, and other factors.”

  • Protect healthcare workers from COVID-19 under the Occupational Safety and Health Act.

  • Restore the National Security Council Directorate for Global Health Security and Biodefense; enhance the U.S. global response to the pandemic; and establish a COVID-19 Pandemic Testing Board as well as a Public Health Workforce Program.

  • Require the federal workforce, federal contractors, and all individuals on federal property—as well as in airports, planes, trains, ships, and intercity buses—to comply with mask-wearing, social distancing, and other related precautionary measures recommended by the Centers for Disease Control and Prevention.

  • Maintain the United States’s status as a “full participant and a global leader” within the World Health Organization.

  • Instruct federal agencies to undertake a baseline review of the state of equity within their agency and deliver an action plan within 200 days to address unequal barriers to opportunity in agency policies and programs—and engage with communities who have been historically underrepresented, underserved, and harmed by federal policies.

  • Rescind Trump’s “1776 Commission” and revoke other “damaging” executive orders that limit the ability of federal government agencies, contractors, and grantees from implementing diversity and inclusion training.

  • Enforce prohibitions on sex discrimination on the basis of gender identity or sexual orientation, ordering leaders of each agency to develop an implementation plan within 100 days.

  • Contractually commit all appointees to an ethics pledge that bans them from—among other enforceable provisions—receiving gifts from lobbyists and engaging in certain types of employment, lobbying activity, and foreign interests for a period of time after leaving the federal government, as well as requiring appointees to recruit based on qualifications, competence, and experience.

In her remarks at the Celebration of America event after sunset on Jan. 20, Kamala Harris, the first woman, Black, and South Asian American vice president in U.S history, said:

“In many ways, this moment embodies our character as a nation. It demonstrates who we are. Even in dark times—we not only dream. We do.

“This is what President Joe Biden has called upon us to summon now. The courage to see beyond crisis. To do what is hard. To do what is good.”

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