The White House has announced an expansion of the Cancer Moonshot’s mission beyond its initial focus on accelerating research and data sharing in oncology—with promises of renewed funding for an array of ambitious presidential initiatives.
President Joe Biden and First Lady Jill Biden Feb. 2 declared plans to reduce cancer mortality rates by at least 50% over the next 25 years and address inequities in access to cancer screening, diagnostics, and treatment.
The call to action comes five years after Congress authorized $1.8 billion for the Beau Biden Cancer Moonshot in December 2016—with then-Vice President Joe Biden at the helm—that provided NCI with seven years of new cancer research funds. The initial moonshot money, which was folded into the 21st Century Cures Act, will sunset at the end of FY2023 (The Cancer Letter, To The Moon).
Biden’s advocacy in 2016 generated a groundswell in oncology, catalyzing unprecedented momentum in the development of real-world evidence and cancer informatics. Oncology leaders say they expect Biden’s 2022 efforts to have the same rallying effect.
“I committed to this fight when I was vice president. It’s one of the reasons why, quite frankly, I ran for president,” Biden said at the White House Cancer Moonshot event Feb. 2. “Let there be no doubt: now that I am president, this is a presidential White House priority, period.
“It’s bold, it’s ambitious, but it’s completely doable. Just as we harnessed the science to develop cutting-edge COVID-19 vaccines and treatments, we’ll bring a fierce sense of urgency to the fight against cancer,” Biden said.
“The goal is to cut the cancer death rate in half in the next 25 years, at least by 50%, and to turn more cancers from death sentences into chronic diseases that people can live with, to create a more supportive experience for patients and their families, and, by doing these things and more, to end cancer as we know it.”
The White House event was packed with at least 200 cancer luminaries, lawmakers, Washington power brokers, and advocates. Each individual was asked to report for COVID-19 testing at 708 Jackson Pl NW in the morning, before entering the White House grounds.
Insiders say the event amounted to a “COVID coming out party”—that the White House could be sending a signal that the administration is ready to live alongside COVID-19, and that the ongoing cancer epidemic is enough of a priority to warrant a fully attended presidential event.
Biden’s goals for the reignited moonshot include:
- Creating a Cancer Cabinet, which will assemble at least 18 federal departments, agencies, and offices;
- Hosting a White House Cancer Moonshot Summit, bringing together leaders in advocacy, industry, research, public health, and government;
- Building on a White House Cancer Roundtable Conversation Series, which the Bidens have hosted over the last six months;
- Ensuring equitable access to screening and prevention through at-home screening, mobile screening, and community health networks;
- Organizing NCI cancer centers and NCI Community Oncology Research Network—through NCI—to offer new access points to compensate for millions of delayed cancer screenings due to COVID-19; and
- Mobilizing federal agencies via NCI to develop a focused program to study and evaluate multicancer detection tests.
Senior Biden administration officials describe this second phase of the moonshot as a “re-establishment” of White House leadership on cancer. In the intervening years since Biden’s work on the 2016 Cancer Moonshot, the Trump administration had proposed cutting federal budgets for biomedical research, and disseminated disinformation on Biden’s cancer efforts (The Cancer Letter, Nov. 6, Nov. 16, 2020).
“What we’re really talking about from the administration side is mobilizing the entire government behind this effort as a presidential priority,” senior Biden administration officials said on a press call Feb. 1. “Under the Biden-Harris administration, with the Cancer Moonshot specifically, we’ll re-establish White House leadership with a focused White House Cancer Moonshot coordinator in the Office of the President.
“This will demonstrate the president and first lady’s personal commitment to making progress and to really leverage this whole-of-government approach and national response that the challenge of cancer demands.”
It’s unclear whether the Biden administration’s new goals would be supported through appropriations—there is no specific funding commitment tied to Biden’s reignited moonshot—but insiders expect the White House to request additional cancer-specific funds for FY23.
“I will do my part on funding and using my authorities as president to break logjams and speed breakthroughs,” Biden said. “I challenge and encourage all of you to continue to do your part.”
I will do my part on funding and using my authorities as president to break logjams and speed breakthroughs. I challenge and encourage all of you to continue to do your part.
Joe Biden
Biden named specific members of Congress who hold the keys to funding this leg of the Cancer Moonshot: Sens. Patrick Leahy (D-VT), Michael Bennet (D-CO), Amy Klobuchar (D-MN), Chris van Hollen (D-MD), Sanford Bishop (D-GA); Reps. Joyce Beatty (D-OH), Barbara Lee (D-CA), Jim McGovern (D-MA), Donald Payne (D-NJ), Debbie Wasserman Schultz (D-FL), Bonnie Watson Coleman (D-NJ), Tom Cole (R-OK), Brian Higgins (D-NY), and Terri Sewell (D-AL).
“The bipartisan members of Congress—and I don’t want to start, because I’ll leave somebody out, but Congress is here,” Biden said. “This can be truly an American moment.”
Senior administration officials said this iteration of the Cancer Moonshot could emerge unscathed by partisan conflict in Congress.
“I am very confident that there will be robust funding going forward because I have to say, in these times of disagreements, there’s certainly one thing on which we all agree on across parties, across everything, which is the effect of cancer on lives,” an official said.
Biden can accomplish much with a presidential bully pulpit, but these new goals will require coordination and money, Washington insiders say. At this writing, details are scarce on the White House’s plans for achieving the 50% reduction in cancer death rates within 25 years.
“We were delighted to be in the White House for the president’s historic announcement, and just as we supported the first moonshot, we very much support this bold & visionary all-of-government approach to fighting cancer,” Jed Manocherian, founder and chairman of ACT for NIH, said to The Cancer Letter. “This is the greatest time in history for scientific advancement, especially in the cancer field.
“At this time, the National Cancer Institute can only fund an abysmal one in eight meritorious cancer research applications. For this moonshot to be successful, robust and sustained funding for cancer research is critical to provide the foundation for progress across many fronts to reduce cancer death rates by 50%,” Manocherian said.
“We will continue to work on a bipartisan basis with biomedical research’s many champions in Congress to boost funding for NIH and the National Cancer Institute. There are too many patients to be patient.”
While NCI may have played a central role as steward of the 2016-2023 Cancer Moonshot funds, the next phase calls for a broader coalition of agencies—of which NCI would be one member.
“Some of these things are squarely in the remit of the NCI, but there’ll be other things,” a senior official said in response to a question from The Cancer Letter. “Other agencies have a critical role, and if we’re going to be deploying, let’s say, vaccines that can prevent cervical cancer and head and neck cancer, HPV vaccines, other agencies will be playing that role; the CDC, for example.”
The cabinet will include representatives from the Department of Health and Human Services, Department of Veterans Affairs, Department of Defense, Department of Energy, Department of Agriculture, Environmental Protection Agency, NIH, NCI, FDA, Centers for Medicare & Medicaid Services, CDC, Office of Science and Technology Policy, Domestic Policy Council, Office of the First Lady, Office of the Vice President, Office of Management and Budget, Office of Public Engagement, and Office of Legislative Affairs, among others.
“We are fortunate that advocacy for cancer research and care from the White House has never been stronger than it is now,” NCI Director Ned Sharpless said in a Feb. 2 email to the institute staff. “We look forward to what lies ahead. Nothing Will Stop Us.”
In the reinvigorated Cancer Moonshot, some tasks will remain under the jurisdiction of NCI, but the Cancer Cabinet will draw on expertise across the federal government.
“Some of these questions about making sure everybody has access to clinical trials, and can be reimbursed for their out-of-pocket-costs and other things, might involve CMS,” the official said. “So, I think NCI could not be more central, but the idea that this is just limited to cancer research rather than all of the agencies and not just the agencies in HHS, I think VA, DOD, DOE—obviously, huge work at NCI, but we’re pulling together a cancer cabinet to make sure that we get the benefit of all the levers that might be pulled.”
This chapter of the moonshot will require a multidisciplinary, collaborative approach, Jill Biden said.
“A cancer diagnosis today may still leave us feeling hopeless, but we are not hopeless,” Jill Biden said. “And we are not helpless. We are living in a golden age of research and discovery. We can end this terror, and all of us have a role to play, because this isn’t just about hoping that one person will decipher the answers alone.
“It’s about listening to patients and survivors and their families, and easing the burden they face. It’s about the individual choices we can make to stop this disease before it’s too late to get screenings, to be vigilant with our health. It’s about federal and state governments, the business community, and nonprofit organizations, all helping to make those screenings more available and accessible.
“It’s about bringing the brightest minds and the fiercest hearts to the table to learn and to collaborate and to discover together that, yes, cancer has the power to rewrite our lives, but we have the power to more than we even know.”
A transcript and video of President Biden’s speech, with introductions by Jill Biden, Vice President Kamala Harris, and Edjah K. Nduom, associate professor in the Department of Neurosurgery at Emory University School of Medicine, are available online.
“We applaud @POTUS, @VP, and @FLOTUS for their leadership in the fight to end cancer as we know it,” Sharpless tweeted Feb. 2. “We are pleased to see this administration supercharging the #CancerMoonshot with new initiatives and a whole-of-government approach to fighting cancer. #EndCancerAsWeKnowIt.”
“We had to keep it going”
After Beau Biden died of glioblastoma at 46 in 2015, the Bidens announced that they would “end cancer as we know it.”
Biden led the launch of the Cancer Moonshot in 2016, with Congress authorizing $1.8 billion for the initiative through the 21st Century Cures Act. The initial Cancer Moonshot was designed to achieve a decade’s worth of progress in five years (The Cancer Letter, Feb. 12, 2016).
Within two weeks of returning to the White House in 2021, Jill Biden visited NCI to reaffirm the Bidens’ support for cancer research (The Cancer Letter, Feb. 5, 2021).
So, where does the Cancer Moonshot stand now, five years and one Trump administration later?
“When we left office, Jill and I knew we had to keep it going,” Biden said. “We focused on turning the moonshot into a movement to create the cancer research and care system that most people think we already have and that they all deserve, but they don’t know we don’t have it until they try to deal with it.
“Everywhere we’d go, people would share their stories—in grocery stores, airports, rope lines. While we heard stories of loss and despair, the stories began to change just a little bit. A change of feeling—real hope—but not because of me and Jill, but because of all of you in this room and so many more at home. Doctors, researchers, advocates, caregivers, patients, survivors. That’s why, today, I’m proud to announce our plan to supercharge the Cancer Moonshot as a central effort of the Biden-Harris administration.”
The original moonshot accomplished its goal of supporting significant strides in cancer research—but the reignited moonshot draws on advancing knowledge and technologies, said Ellen Sigal, chair and founder of Friends of Cancer Research.
“The original moonshot demonstrated that it was possible to compress a decade’s worth of progress into a few short years,” Sigal said in a statement. “We can’t afford to not make that opportunity a reality again. Death rates for certain cancers are improving, and technologies and treatments are emerging to accomplish this across many more. I hope this is the recommitment to make that goal a reality across all cancers.”
Senior administration officials said research breakthroughs and emerging technologies, like cancer vaccines and multi-cancer early detection tests, have made it possible to re-envision the Cancer Moonshot with even more ambitious targets.
“I would say it’s fair to say that we saw a decade’s worth of research advances occur in those past five years,” an official said. “And it’s precisely because of that I think we can talk about setting goals, like actually decreasing death rates from cancer over the next 25 years.”
Alas, authorization and funding for “supercharging” the Cancer Moonshot—which insiders say are unlikely in FY22—depend on ongoing spending talks. Congress has frozen new government spending until at least Feb. 18, 2022, when the current continuing resolution expires.
The House is proposing $6.992 billion for NCI in FY22, an increase of $432.2 million from FY21, including $194 million for the Cancer Moonshot. The Senate is proposing $6.772 billion for NCI, an increase of $212.6 million. Biden had requested $6.733 billion for NCI, an increase of $173.45 million (The Cancer Letter, Nov. 12).
There are also several bills underway that would fund Biden’s proposed Advanced Research Projects Agency for Health (ARPA-H), a DARPA-like agency that would accelerate high-risk, high-reward biomedical research (The Cancer Letter, Dec. 10, 2021).
Biden again called on Congress to fund ARPA-H during his speech Feb. 2.
“I think there’s strong bipartisan support for this, but it costs money,” Biden said. “These are the best dollars we could spend. So, we’ve got to get it done. We’ve got to get it done now, not wait any longer.”
“Ending cancer as we know it”
A major focus of the reignited Cancer Moonshot will be cancer prevention and screening, according to the president and the first lady.
“For each of the ways we know cancer today, we know we can change its trajectory,” Biden said. “For example, to prevent cancer—scientists are exploring if the new mRNA vaccine technology that brought us safe and effective COVID-19 vaccines could also be used to stop cancer cells when they first arrive.”
America has to get “back on track” after COVID-19 led to more than 9 million missed cancer screenings, Biden said (The Cancer Letter, Sept. 17, 2021). Scenarios run by NCI and affiliated modeling groups predict that delays in screening for and diagnosis of breast and colorectal cancers will lead to a 1% increase in deaths through 2030. This translates into 10,000 additional deaths, on top of the expected one million deaths resulting from these two cancers (The Cancer Letter, June 19, 2020).
The White House effort to boost cancer screening will center around the research and public health efforts of NCI and HHS.
“Today, I’m announcing a call to action for cancer screening and early detection,” Biden said. “If you were supposed to get a cancer screening during the pandemic, call your primary care doctor today. If you are that doctor, talk to your patients, get a screening scheduled, whether it’s in the office at home or through a telehealth visit, because the Affordable Care Act now will cover most private insurance plans, as well as Medicare and Medicaid, to cover the recommended preventative care screening, free of charge. I’m calling on companies, healthcare providers, nonprofits, and others to step up, including developing mobile units and popup clinics to reach people where they live.”
The President’s Cancer Panel Feb. 2 released a report, “Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access,” which echoes Biden’s call for more effective and equitable implementation of cancer screening. More on the report can be found here
Biden said targeted treatments will play a key role in improving cancer outcomes and disease management.
“We’re learning more about how to use genetics, immune response, and other factors to tell which combinations of treatments are likely to work best for a particular individual,” Biden said.
Another guiding principle for the reignited Cancer Moonshot will be learning from patients’ and caregivers’ experiences—and, critically, making patient data more widely available.
“When we first started this work, one of the first things we did was make sure that doctors and researchers work together, share information, allow patients to share their data with other doctors and researchers to help others,” Biden said. “But there’s so much more to do. I remember we were going through this in the moonshot and, in my saying that—I was told that, ‘Well, patients don’t want to share their data.’ They all want to share their data. Sometimes y’all don’t want to share what you know.”
But none of these Cancer Moonshot goals, Biden said, will be accomplished equitably without a deliberate focus on addressing health disparities.
“Stark inequities based on race disparity, ZIP code, sexual orientation, gender identity, and other factors still persist,” Biden said. “We can target prevention, detection, and treatment efforts so that all Americans, whether urban, rural, or tribal communities, have equal access to cancer diagnosis, therapeutics, and clinical trials.”
Senior administration officials said the White House is not using the term “cure cancer” in describing the moonshot because there are over 200 types of cancer, making a single “cure” impossible.
“I think we’re speaking with precision, but along that way to 50%, there will be a lot of cures,” an official said. “So, it’s not walking back, but using words carefully and precisely so that we can hold ourselves accountable.”
The White House is comfortable, however, with saying that cures do exist.
“We have immunotherapies right now that it’s fair to say are cures,” the official said. “We do not have recurrence in five years, 10 years. You never want to use the word ‘cure,’ but those are cures. We are going to bite this off piece by piece.
“We need to get therapies to work and therapies that extend life long enough to turn into cures to work, but we focused on this very measurable thing of decreasing that death rate 50%.”
“A seat at the table”
Biden said cutting cancer mortality in half over the next 25 years will take effort from all stakeholders, not just the White House or Congress.
“I’m also calling on the scientific and medical communities to bring the boldest thinking to this fight,” Biden said. “I’m calling on the private sector to develop and test new treatments, make drugs more affordable, and share more data and knowledge that can inform the public and benefit every company’s research. And, I’m respectfully calling on people living with cancer and caregivers to keep sharing their experiences and pushing for progress. You’ll have a voice and a seat at the table, I promise you.”
Part of this multidisciplinary effort will be the president’s Cancer Cabinet, which will include representatives from across the federal government.
“They’ll drive a whole-of-government effort to unleash every possibility within our power, within their jurisdictions,” Biden said of the Cancer Cabinet. “The White House Office of Science and Technology Policy, led by senior scientist and advisor Dr. Eric Lander, sitting on the end, will chart the path for the Cancer Moonshot for 2022 and beyond.”
Jill Biden will also play a key role in guiding the Cancer Moonshot forward, senior administration officials said.
“She has been out there with public health messages since the start of the administration,” an official said. “She has spent some time in the last year doing work specifically on cancer, especially around cancer screening and early detection. We expect not only in that area, but we expect her to have some leadership role there with more to come.”
Biden closed his Feb. 2 speech by encouraging those in the audience to “spread the faith.”
“For survivors and caregivers who carry the physical and mental scars of treatments and recovery, and for those who have lost and for the ones we can still save, let’s end cancer as we know it,” Biden said. “I refuse to believe this is beyond our capacity. I refuse to believe it.
“My challenge to everyone involved in this fight against cancer: take a hard look at your practice. Ask yourself if you’re practicing perfectly. Am I practicing to make the old way permanent? Old practices created data silos, minimized the role of patients, fostered the wrong kind of competition instead of the right kind of collaboration.
“I know we can get this right. I’m positive we can, by not losing sight of the ultimate goal—the patient’s health—and by not losing sight of something else I also believe. America is the single place on Earth, the single country, that can be defined, as I told Xi Jinping, by one word: possibilities.”
Cancer groups respond
American Society of Clinical Oncology statement:
Since the Beau Biden Cancer Moonshot was announced in 2016, the National Cancer Institute has provided more than $1 billion to more than 240 research projects to speed advances in cancer prevention, diagnosis, and treatment. A reinvigorated Cancer Moonshot could help us make even greater progress towards these goals, and drive action on new opportunities.
American Association for Cancer Research statement:
The reignited Cancer Moonshot will provide an important framework to help improve cancer prevention strategies, increase cancer screenings and early detection, reduce cancer disparities, and propel new lifesaving cures for patients with cancer.
However, if we are to achieve the goals that the president outlined for us today, it is going to require that the president work with Congress to finalize the fiscal year (FY) 2022 appropriations process with robust funding increases for NIH and NCI, as well as announce significant investments in cancer research as part of his FY2023 budget request.
Association of American Cancer Institutes statement:
AACI applauds the Biden administration for reigniting the Cancer Moonshot initiative. But as those of us in the cancer community know, funding is key to accelerating progress. Our hope is that the renewed focus on cancer will ensure a robust, long-term investment in research—including regular increases to the National Cancer Institute payline— to support scientific discovery and save lives.
American Cancer Society statement:
Cancer affects everyone, but it doesn’t affect everyone equally. There is significant progress that must be made to ensure everyone has a fair and just opportunity to prevent, detect, treat and survive cancer.
This includes guaranteeing everyone has access to proven prevention strategies, including lifesaving screenings like mammograms, pap tests and colonoscopies, and accelerating discovery to improve prevention measures and develop screening and detection tests for cancers for which we don’t currently have answers. We must also ensure everyone has access to affordable, comprehensive health care coverage and can take a significant step toward that goal by closing the Medicaid coverage gap.
Finally, we must work to ensure no matter how much money you make, the color of your skin, your sexual orientation, your gender identity, your disability status or where you live, you have equal opportunity to benefit from discovery. No one should be disadvantaged in their fight against this disease.
American Society for Radiation Oncology statement:
On behalf of radiation oncologists who treat people with cancer every day, we support the Biden-Harris administration’s move to drastically reduce the number of cancer deaths in the United States and improve the lives of people diagnosed with this disease.
We believe the administration’s commitment to expand cancer prevention efforts and to increase equitable access to screenings and treatments will help mitigate some of the negative impact of the COVID-19 pandemic.
American College of Surgeons statement:
We applaud the president’s commitment to increasing screening as part of his renewed effort to improve outcomes for cancer patients across the nation. We stand ready to do our part to support this critically important work.
Our cancer screening efforts show how important it is to have a plan ready that’s hard wired to deal with adverse circumstances, such as those we’ve encountered during the pandemic. While we don’t yet know what the full downstream effect will be from screening delays, we are confident that these efforts will make an impact and help improve outcomes for patients.
The ACS welcomes the opportunity to join with other stakeholders in this collective effort to improve screenings, reduce disparities, and end cancer as we know it.
