The Bidens announce initiatives on health inequity and DARPA-like research for cancer

On a visit to Virginia Commonwealth University Massey Cancer Center Feb. 24, first lady Jill Biden issued an unprecedented presidential call to action on reducing health inequities—specifically, cancer disparities—in demonstration of the White House’s effort to reach and engage underserved communities.

The first lady visited VCU Massey to tour the institution’s facilities and talk to physicians, researchers, and clergy on the frontlines of cancer care.

It’s time for America to take disparities seriously, Biden said.

“What I’ve seen, the research here, what’s going on with cancer and how you’re trying to really address the health disparities in our country, it’s about time that we started getting really serious about this. And this pandemic has really shined this bright hot light on this subject,” she said after a panel discussion with VCU faculty and Richmond community leaders.

NCI Director Ned Sharpless also spoke at the Richmond event.

The next day, President Joe Biden announced a White House effort to develop an “advanced research effort on cancer and other diseases” reminiscent of the Defense Advanced Research Projects Agency, or DARPA—an agency formed during the Space Race of the 20th century and credited with the invention of cutting-edge technologies, including precision weapons and the Internet.

“This administration will follow the science to deliver more breakthroughs. We are doing that to beat COVID-19 and other diseases, like cancer—which is something that’s so personal to so many families, including me and [Vice President] Kamala’s and many of yours,” Biden said at a Feb. 25 event commemorating the 50 millionth COVID-19 vaccine shot. “We’ve asked Dr. Eric Lander, a renowned Harvard-MIT scientist, to serve as my science advisor and head of the Office of Science and Technology Policy and co-lead the Presidential Council on Advisory Science and Technology.

“These are the White House offices that bring together the country’s top scientists to address our most pressing needs, and they’ll be part of the work to develop a DARPA-like advanced research effort on cancer and other diseases, just like we do DARPA in the Defense Department, which develops breakthrough projects to secure our national security.”

At this writing, the organizational structure of the cancer-related DARPA-like effort is not publicly known.

In his remarks, Joe Biden noted the formation of Break Through Cancer, a collaboration of five academic cancer centers that is focused on four hard-to-treat cancer types.

“I’m delighted to see five of the nation’s leading cancer centers are joining forces today to build on the work of the Cancer Moonshot I was able to do during the Obama-Biden administration to help break through silos and barriers in cancer research,” Biden said. “We’re making progress.” (The Cancer Letter, Nov. 13, 2020; To the Moon, 2016-2017)

Read The Cancer Letter‘s conversation with Tyler Jacks, president of Break Through Cancer, announcing the Feb. 25 launch of the foundation.

The National Cancer Act of 1971 places the NCI director in the role of the leader of the National Cancer Program.

Special authorities under that law—the result of compromises made a half a century ago—include presidential appointment of the NCI director, the appointment of members of the President’s Cancer Panel and the National Cancer Advisory Board, and submission of the Bypass Budget.

It’s unclear whether Lander’s new, powerful role as Biden’s top science advisor and cabinet member impacts NCI. It’s also uncertain how the NIH research portfolio may be affected.

A White House version of Facts & Faith Fridays?

A White House initiative aimed at mitigating health disparities may also be in the works.

During her visit to Richmond, Jill Biden said that a a VCU Massey Cancer Center program known as Facts & Faith Fridays could serve as a template for a nationwide effort to engage and educate underserved communities.

“I must say, all over this country, what I have found is that the churches are really bringing the communities together, because—whether it’s education, whether it’s food, whether it’s the vaccinations—you are the centers, because it’s all about trust. It’s all about trust,” the first lady said Feb. 24.

“And so, I think that the communities of color, they trust you. And now, I think it’s important that they learn to trust the federal government again, because we want to partner with them.”

The VCU program, Facts & Faith Fridays, is a series of conference calls started by Massey Cancer Center Director Robert Winn in partnership with Black clergy. In an effort to disseminate timely and accurate information about COVID-19 and cancer, Winn talks to Richmond-area church leaders every Friday. The lineup of guests has included NCI Director Sharpless and Anthony Fauci, the nation’s top infectious diseases expert.

We’ve got to get knowledge, we’ve got to get education. With your Faith & Fridays program, we’re going to do this. We’re going to take it across the nation!

Jill Biden

“You’re right. We’ve got to get the trials out to people. We’ve got to get knowledge, we’ve got to get education. There’s so much we have to do,” Jill Biden said in her concluding remarks at the Feb. 24 event. “But with your Faith & Fridays program, we’re going to do this. We’re going to take it across the nation!

“One of the things that I’ve done for years now, even when Joe was in the Senate and then as vice president, is travel the country and go to the rural areas that you’re talking about. Because they are desperate for help,” she said. “Just maybe two years ago, I was in the Navajo Nation, and I helped open the first chemotherapy center in that nation. People were driving two hours to get treatment, and then driving two hours back. That’s just one small example of rural America and their needs.”

The first lady’s remarks echoed a number of executive orders signed by her husband—at least three were directed at health equity, racial justice and equity in federal regulation, and barriers to opportunity (The Cancer Letter, Jan. 22, 2021).

“It would certainly be wonderful if the White House were to, at a minimum, be able to use their current platform to showcase health equity efforts and inspire others to do so,” Winn said to The Cancer Letter. “Will the White House actually do more than that? I’m not certain, but I think that it was clear from Dr. Biden’s words that she wants to more directly address the disparity issue, and I think we have a program at VCU Massey that could be a model for many.”

Outstanding science can and should exist side by side with the implementation of that science into community, Winn said.

“We at Massey have been unapologetic about that fact. I think that we all sell ourselves short, and particularly our community when we don’t realize that outstanding science has to exist under the same roof as our concerns for the community,” Winn said. “That’s how we are going to start the journey of eradicating cancer health disparities.

“This administration seems fully engaged. I think we all recognize that science can’t exist in a vacuum. I’m convinced that, ultimately, the best science is the science that impacts the lives of everyday people. So, I’m excited.”

Choosing the right city and the right cancer center

Jill Biden and her team didn’t pick Richmond and VCU Massey out of a raffle box in their decision to declare the White House’s standpoint on health inequities.

Richmond, the capital of the Confederate States for most of the American Civil War, continues to be a flash point in the national discourse on Black-white race relations, as statues dedicated to confederate leaders and defenders around the city—and on Monument Avenue, often described as “America’s most controversial street”—were removed or torn down after the killing of George Floyd sparked a massive movement for racial justice.

VCU Massey serves a unique catchment area of about four million racially, ethnically, geographically, and socioeconomically diverse individuals, with 41% of residents identifying as racial or ethnic minorities and 52% identifying as living in rural areas. Compared to whites in the catchment, Blacks experience higher incidence of colon (42 vs. 37) and prostate (178 vs. 91) and higher mortality for breast, colon, and prostate cancers.

VCU Health’s status as a safety net health care system means that it provides a significant level of care to low-income, uninsured and vulnerable populations. Patients diagnosed at Massey Cancer Center are more likely to be minority, female, uninsured, or on Medicaid.

It’s also worth noting that Massey Cancer Center is led by Winn, an outspoken advocate for community outreach and engagement, who, until March 1, is the only Black director of an NCI-designated cancer center (TCL-AACI Leadership Pipeline Survey, The Cancer Letter, Oct. 9, 2020).

Winn’s interview with Adekunle Odunsi, who has been named director of the University of Chicago Medicine Comprehensive Cancer Center, appears in this week’s issue of The Cancer Letter. For Black History Month, Winn is the February guest editor for The Cancer Letter and the Cancer History Project.

Massey Cancer Center’s work illustrates the importance of cancer centers serving their local communities, including underserved populations, NCI’s Sharpless said at the Feb. 24 event.

“This is critical to ensure that cutting-edge cancer prevention, screening and treatments are accessible to all—to ensure that this great progress that we are seeing across cancer care, to see that progress makes it to all Americans, regardless of race, ethnicity or socioeconomic status,” Sharpless said.

“This is a crucial component of the work of NCI: to advance health equity by reducing disparities in the quality of care. Cancer centers like Massey are central to that endeavor—not just by conducting clinical trials and providing high-quality care—but also by training the next generation of cancer researchers.”

Jill Biden’s tour of VCU is her third cancer-related visit within about a month since the presidential inauguration on Jan. 20—an early signal that the Biden administration is likely to pursue an aggressive cancer agenda. She has also visited Whitman-Walker Health, a historic D.C.-based community health center and clinic, and virtually checked in at NCI (The Cancer Letter, Feb. 5, 2021).

“I think that her showing up at VCU Massey, along with Dr. Sharpless, is proof positive the White House and NCI are serious about not only supporting cutting-edge, high-impact, and highly innovative research, but that both institutions are really committed to eradicating cancer and cancer health disparities,” Winn said to The Cancer Letter.

“Dr. Biden’s platform of bringing attention to education, military families, and cancer is a much needed breath of fresh air. President Biden has already pledged his support for our cancer efforts with his support for the Moonshot program.

“I really loved the fact that not only was Dr. Biden’s brilliance on display for all to see, but so was her humanity,” Winn said. “And that is what I appreciated most of all.”

Biden: “Health inequities have hurt communities for far too long”

At the Feb. 24 event, Winn introduced four panelists who would engage the first lady in a discussion on health disparities and the cancer center’s outreach efforts:

• Khalid Matin, professor of medicine, vice-chair of clinical affairs in the Division of Hematology Oncology and Palliative Care, and medical director of Community Oncology and Clinical Research Affiliations at VCU Massey Cancer Center.

• Vanessa Sheppard, Theresa A. Thomas Memorial Chair in Cancer Prevention and Control, associate director of Community Outreach Engagement and Health Disparities at VCU Massey Cancer Center, and chair and professor in the Department of Health Behavior and Policy.

• Rudene Mercer Haynes, a finance lawyer and partner at the Richmond office of Hunton Andrews Kurth LLC, who is active in bar, civic, and community initiatives that advance equity.

• Rev. F. Todd Gray, a fourth-generation preacher, and senior pastor for the Fifth Street Baptist Church in Richmond.

A video of the event is posted here.

“As we’re discussing today, the divide between clinics and communities persists, and for a variety of reasons, many Americans are being left behind in one of the most medically advanced countries in the world,” Jill Biden said. “And the results are health inequities and lives lost. And we owe ourselves better.

“Just this week, we passed a grim milestone: 500,000 Americans gone because of COVID-19. And though we all feel the weight of that number, communities of color are carrying a heavier share of that burden, mourning their loved ones in higher numbers.”

For example, as of Feb. 25, more than 1,000 people have died from COVID-19 in Washington, D.C. Of that number, nearly 75%—750 people—were Black, in a city where 43.9% of residents are Black or African American, according to 2021 data from DC Health Matters. On Feb. 24, D.C. Mayor Muriel Bowser announced her sister, Mercia Bowser, had died of the virus.

“It’s not just this pandemic. Health inequities have hurt communities for far too long. Suffering and pain surround us,” Jill Biden said. “And yet, out of suffering, out of sorrow, you have found purpose.”

Before joining the panel discussion in the McGlothlin Medical Education Center Auditorium, the first lady received a tour of Goodwin Research Laboratory and received briefings from VCU’s cancer researchers:

• Jose Trevino, chair of the Division of Surgical Oncology and Massey surgeon in chief, research—on the disparities that exist in pancreatic cancer.

• Saïd Sebti, associate director for basic research and professor in the Department of Pharmacology and Toxicology—on the mechanisms by which normal cells become cancerous.

• Katherine Tossas, director of Catchment Area Data Alignment in the Office of Health Equity and Disparities Research, and assistant professor and Harrison Endowed Scholar in the Department of Health Behavior and Policy—on her research in cervical cancer, specifically the disparities that exist among Latina and Black women.

• Arnethea Sutton, a postdoctoral fellow in the NCI-funded T32 Cancer Prevention and Control Research Training Program in the Department of Health Behavior and Policy—on the heart health issues of African American breast cancer survivors and how cancer treatments can affect the heart.

VCU Massey Cancer Center will continue to build upon its cancer health disparity programs, Winn said.

“How are we doing that? We are turning more of our attention to our Facts and Faith Friday’s effort,” Winn said to The Cancer Letter. “This effort allows us to integrate faith-based leaders, the Virginia Department of Health, Massey Cancer Center, and the VCU health system to do things like setting up clinic “in a box” approaches to disseminate COVID vaccinations and educate folks about cancer screening.

“Some would ask ‘Why do that?’ Simply put, trust.”

Elderly patients who frequently find travel to be difficult and people from many at-risk neighborhoods don’t trust going to large vaccination events, especially when these events do not take place in the neighborhoods they live in, Winn said.

“Our recent experience has taught us that people tend to be more comfortable and have less vaccine hesitancy when they know they are getting their vaccine at a local church, mosque, or a temple,” Winn said. “Beyond that, this Facts & Faith Friday group is involved with bringing more attention to the negative impact that COVID has on cancer.

“They are helping us to bring more awareness to the need for increased cancer screening. We’re already having great discussions with these faith groups around cancer screening efforts, especially around the most preventable cancer.

“Lastly, this group has become much more comfortable and with data,” Winn said. “And they are now collecting data and putting it together to be useful for folks within their community, with the help of VCU Massey. Those are our next steps.”