Francis Collins on his new life as White House science adviser

WASHINGTON — Francis Collins’ 2022 hasn’t exactly gone according to plan.

The mustachioed, Harley-riding geneticist had looked forward to some respite after serving 12 years as director of the National Institutes of Health. Instead, Collins is more involved than ever in federal science policy. Since February, he’s served as President Biden’s interim science adviser — a position made vacant by Eric Lander’s resignation amid a workplace-abuse scandal.

Since arriving at the White House, Collins has taken over major portions of Lander’s portfolio: namely, standing up the new high-stakes research agency known as ARPA-H; helping to oversee the recently revived Cancer Moonshot, and recruiting the next generation of US scientific leaders.

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Collins sat down with STAT earlier this month to discuss his latest adventure: one that includes daily confabs with Alondra Nelson, the temporary director of the White House Office of Science and Technology Policy, and racking up a massive tab on Uber to avoid the frustration of commute-hour traffic.

The following conversation has been edited for length and clarity.

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What was the process for you ending up here, in this role?

Eric resigned on a Monday evening. Ron Klain called me on Tuesday morning at about 7 am to say the president would like you to consider coming on board as the science adviser.

Was there any deliberation?

When the president says, “I need you to come and be my science adviser, at least on an interim basis,” you can’t say no.

Is it really on an interim basis? How long do you expect to stay?

Well, the agreement was that I’m not coming on as the permanent person, which would require Senate confirmation and a long, drawn-out process, and presumably a commitment at least through the end of the term.

I said I was happy to come in and do what I can while the president identifies who he wants to nominate for the full job that Eric had, which was to be OSTP director and a member of the Cabinet.

So what’s your portfolio in this new role? Are you still involved in the Covid response?

My interactions with the president have really been more about the Cancer Moonshot, which of course he cares about deeply, and also about the need for recruitments for leading science positions. And ARPA-H.

On the recruitment front, there are four major jobs that are yet to be filled: a new NIH director, an inaugural director for ARPA-H, Eric Lander’s long-term replacement as OSTP director and science adviser, and a new director for the National Cancer Institute. Is there a priority among those?

In terms of priorities, obviously finding an NIH director requires Senate confirmation, which means you don’t want to wait too long and have the clock run out on this calendar year. That was already underway when I arrived — Eric had done quite a lot prioritizing ideas about possible leaders that had been submitted by lots and lots of groups. But I needed to pick it up with the full participation of the White House personnel office.

There’s no standard way, it seems, to do those kinds of searches. There’s no formal search committee, because it’s all got to be deeply confidential. So NIH has been a high priority, as have the other two.

ARPA-H, once the Omnibus [spending bill] passed and there was enough authorization to say yes, we could start to hire a director, that immediately moved up very high because that’s a very high presidential priority. And of course, somewhat selfishly, I’m also hoping to find the next person to go through Senate confirmation as the OSTP director, science adviser, and my get-out-of-jail free card.

All of those are going pretty well.

So what’s your sense of timing?

We’re pretty well along with three of the four, recognizing of course the NCI vacancy came later — Ned Sharpless didn’t leave until April 29. So that one is a few steps behind. The others are moving along quite well.

Is it a matter of weeks, months?

I would hope it’s a few weeks.

The administration has made diversity a priority — can we expect to see women and/or people of color fill those roles?

Back when I was NIH director, I had said I hope when they do a search for my successor, they’d choose a woman, person of color, or both. I think the talent is absolutely there, in all of the areas we just talked about.

It’s still the case that the good old boy network seems to primarily put forward ideas about who could be leaders of this sort who are white men. Once you get past that and say: “Wait a minute, let’s really look at the talent that’s out there,” it’s clear that there are plenty of remarkable leaders, and it’s time to give them a chance.

What do you mean by “good old boy network”?

He would be mostly academic senior leaders who are full professors or deans. In their generation — which is my generation as well, I’m not just talking about other people — the recollection of who your colleagues were, because of the history here, is largely people who look like them. That’s so dated, and unfortunate here in terms of identifying where the talent really lies.

Have you read the recent book by Tom Insel, the former director of the National Institute of Mental Health, in which he lamented the lack of clinical improvement in mental health care despite the immense investments made by NIH? What did you think?

I have not. It’s sitting on my shelf. But I had a conversation with Tom about something else, and he was upset: He felt like the only thing people had noticed about his book was a criticism of NIH.

What do you make of the broader criticism, though — that for all the fantastic work NIH does, it doesn’t always translate, or translate quickly, to actual improvements in health care delivery?

One has to take all critically seriously. I think NIH is the finest biomedical research enterprise in the world, but it could always be better. I’m also impatient when things seem to take too long to go from discovery to its implementation in clinical practice, or sometimes don’t even get there at all.

It was certainly interesting going through the Covid experience, when there was absolutely no tolerance from me or anyone else for that kind of delay. It was pretty impressive to see NIH rise to the occasion, with the development of vaccines in 11 months, the formation of the ACTIV public-private partnership [on Covid therapeutics] and the RADx initiative to develop home testing, which now everybody takes for granted.

When it comes to the translational part, that’s been my impatience, which is why my first big effort when I became NIH director was the National Center for Advancing Translational Science.

But I’m even more impatient than that, which is why the ARPA-H program — championed by President Biden — fits into that niche that I think was still not being attended to. So if people are complaining that we still don’t have the perfect situation, I’m saying I agree, so let’s get ARPA-H up and running and fund it appropriately.

Does your departure from NIH mean your band, the Affordable Rock ‘n’ Roll Act, is no more?

Covid has put us on hold, I must say. We were going to have a rehearsal last night, outdoors … but three members of the band said they had Covid.

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