“Grateful” and “delighted.” That’s how National Institutes of Health (NIH) director Monica Bertagnolli feels about her 14 months leading the world’s largest biomedical research funding agency—a post she will exit at the end of this week, she announced today. Incoming President Donald Trump, who takes office on 20 January, has nominated his own NIH director, Stanford University health economist Jay Bhattacharya, who has said he wants to see major reforms at the agency.
Bertagnolli, who briefly led the National Cancer Institute (NCI) before she was tapped to become the 17th director of the $47.4 billion NIH in May 2023, told Science last week she feels particularly good about progress toward two signature initiatives: bringing clinical trials to primary health care providers in rural and underserved areas, and combining patients’ clinical records from across federal agencies for research.
“I’m so delighted that the team at NIH were able to run with so many ideas that I came in with very quickly,” Bertagnolli says. “Never let anybody say, ‘NIH is slow.’”
Former NIH Director Elias Zerhouni says Bertagnolli did well under the circumstances. “She inherited thorny issues and a somewhat hostile anti-NIH environment [in Congress] that she navigated as well as could be.” In his view, her tenure was “a promising beginning cut short.”
It took President Joe Biden 17 months after longtime NIH Director Francis Collins stepped down to nominate Bertagnolli, a cancer surgeon and clinical trial expert who had left Harvard Medical School and affiliated hospitals 7 months earlier to lead NCI. Her confirmation hearing was then held up for several months by Senator Bernie Sanders (I–VT) over drug pricing policy.
Her tenure is the shortest ever for a permanent NIH director. The prior record was 20 months, by Robert Stone in the early 1970s. Bernadine Healy, the first woman to serve as NIH director, also had a relatively short stint of just over 2 years in the early 1990s. (Bertagnolli is the second woman to hold the post.)
Bertagnolli is nevertheless pleased with her accomplishments. The Communities Advancing Research Equity for Health network she created will soon be up to six “hubs,” she notes. And NIH is making progress on what she calls a “biomedical research data ecosystem” at the National Library of Medicine. She also points to the RECOVER study of Long Covid, including expanded treatment trials, and her work on Biden’s Initiative on Women’s Health Research, which has led to $200 million in NIH funding this year for cross-cutting research and a strategic plan.
Bertagnolli spent much of the past year working to shore up support from Congress after it flagged during the COVID-19 pandemic. “I have never felt that, as NIH director, I have not been supported by both Republicans and Democrats,” she says. But she has pushed back on proposals from Republicans to overhaul the agency in part by shrinking its 27 institutes and centers to a smaller number.
“We are operating incredibly effectively” in the agency’s current configuration, she insists. She says having many institutes named for a disease or population provides an “open door” to many disease communities and patient advocacy groups.
One institute’s name could be expanded, she says: the Eunice Kennedy Shriver National Institute of Child Health and Human Development, where much maternal health research is housed. Last week, she suggested to one of her advisory boards that Congress rename it the Shriver National Institute for Women, Children, and Disability Research to provide “a visible front door for the community that really care about women’s health.” If that title had been in place, she suggests, a recent National Academies of Sciences, Engineering, and Medicine panel would not have needed to propose an entirely new institute for women’s health research.
NIH Principal Deputy Director Lawrence Tabak, who has been working with the Trump transition team, will oversee NIH operations until the new administration designates an acting director to serve while the Senate considers Bhattacharya’s nomination. Trump’s incoming health team also includes Robert F. Kennedy Jr. to lead NIH’s parent agency, the Department of Health and Human Services. Kennedy is a vaccine skeptic who has called for suspending infectious disease research at NIH.
Bertagnolli defended this part of NIH’s portfolio at a November 2024 congressional hearing, pointing to “serious threats” such as the H5N1 bird flu infecting cows in the United States. “Research on infectious disease is, frankly, one of our greatest obligations,” she says.
Bertagnolli declined to take a position on other Kennedy proposals, such as beefing up research on chronic diseases and prevention. “The areas that the new administration is thinking about are important,” she says. But, “I can’t comment on their strategies” for funding these areas.
Bertagnolli, 65, says she’s returning to the Boston area to ponder her next steps, but she does not expect to rejoin Harvard. “I’m so grateful for everything that I’ve learned and for everything we’ve been able to accomplish,” she says. “I am certainly not going to retire.”
