How come no one wants to lead the National Institutes of Health?

The National Institutes of Health is still without a director more than one year after Francis Collins, MD, PhD, retired from the role, The Wall Street Journal reported March 13. 

Lawrence Tabak, PhD, a longtime NIH administrator and its former principal deputy director, has been serving as acting director — a term that has stretched on as the White House struggles to find a replacement for Dr. Collins. 

At least two potential choices for director have walked away from the role, including Mary Klotman, MD, dean of Duke School of Medicine in Durham, N.C., people familiar with the matter told the Journal. She withdrew her name from the process last year, reportedly because it was taking too long. 

The NIH director was once a coveted, prestigious role, and has been held by numerous Nobel prize winners. The NIH has conducted groundbreaking research into cancer, infectious diseases and drug abuse, and made major medical advancements. During the early stages of the COVID-19 pandemic, the NIH collaborated with vaccine-makers to help develop mRNA shots. 

But there are multiple reasons why no one is eager to step up this year, according to the Journal

  • The role pays around $200,000 per year. This is less than most candidates currently earn leading medical schools or serving in life sciences positions. It is also less than the salaries of the people leading the agency's various research institutes.

  • Republican lawmakers have discussed curbing government spending. This could detract from NIH funding, especially since many avid supporters of the agency have retired from Congress.

  • The agency is under fire for its support of virus research labs in China — particularly as lawmakers continue to question the pandemic's origins.

  • Sen. Bernie Sanders directs the Senate Health Committee, and is expected to disapprove of any nomination with pharmaceutical ties. Additionally, the White House is seeking leaders with new perspectives since most past directors have been white men — but like all stipulations, this could narrow the pool.

  • The administration might change, depending on the results of the 2024 election. This could force a new director out before they have had a chance to establish themselves. 

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