MSF responds to NIH director nomination

The new director should adopt policies and practices that ensure equitable access to lifesaving medical products.

A frontline health worker at a nursing home in Chlifa Baalbak receives her vaccine from an MSF medical staff member.

Lebanon 2021 © Tariq Keblaoui/MSF

NEW YORK, MAY 16, 2023—The Biden administration announced this week its nomination of Dr. Monica Bertagnolli to head the National Institutes of Health (NIH). If her nomination is approved by the US Senate, Dr. Bertagnolli should commit to better aligning the agency’s medical research and development (R&D) agenda with the world’s most pressing public health needs and ensuring that people have access to any new medicines, vaccines, and diagnostics that hit the market, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

Currently, many medicines, vaccines, and diagnostics aren’t accessible for the people who need them most—if these products exist at all. With low- and middle-income countries disproportionately affected by these inequities, MSF teams witness daily the deadly consequences of people being unable to access the medical products they need.

As the world’s largest funder of biomedical research, the NIH plays a significant role in creating lifesaving new medical tools. Its new director should adopt policies and practices that ensure equitable access to these medical products for people everywhere in the world and fulfill its mission to protect and improve health.

Mihir Mankad, MSF global health advocacy and policy senior advisor, said of the nomination:

“As the NIH is the largest funder of biomedical research in the world, its director has a responsibility to make sure that the research it supports truly aligns with public health needs and benefits people here and abroad.

“In her previous role as director of the National Cancer Institute, Dr. Bertagnolli was considered a champion of equity, diversity, and inclusion (DEI) in R&D. If confirmed, Dr. Bertagnolli must remain committed to DEI principles and ensure equitable access to products developed with NIH funding.

“Dr. Bertagnolli’s first step as the new NIH director should be to increase transparency around R&D costs and give people, governments, and treatment providers like MSF more leverage to advocate for reasonable prices. Currently, pharmaceutical companies and other developers that receive public funding aren’t obligated to tell us what they spend on R&D, including the costs of clinical trials—the most expensive part of bringing drugs to market. Drugmakers take advantage of this lack of transparency and use these concealed costs to justify high prices.

"In addition to making the costs of NIH-funded clinical trials public, Dr. Bertagnolli should support the passage of the bipartisan Pharmaceutical Research Transparency Act, which would mandate pharmaceutical corporations and other drug developers disclose the costs of all future clinical trials.

“If confirmed as NIH director, Dr. Bertagnolli should also make sure that NIH funding agreements with pharmaceutical corporations include access conditions. The NIH grants tens of billions of taxpayer dollars to pharmaceutical corporations and other developers for R&D each year, yet it fails to attach strong conditions to this funding.

“Any funding NIH doles out to pharmaceutical companies should include conditions that would allow other manufacturers to help rapidly boost the global supply of a product in the case of a pandemic, prevent companies from signing exclusive licenses, and allow agreements to be revoked if companies charge too much for their products.

“As R&D stands now, pharmaceutical companies don’t invest in research and development of new medicines and diagnostics unless there is a lucrative market, so we often don’t have adequate medicines and treatments to offer our patients. And when pharma does develop something that benefits broad public health needs, these products are often overpriced and are sometimes hoarded.

“From the inequitable global rollout of COVID-19 vaccines to expensive tuberculosis drugs, we’ve seen time and time again the harm that comes from medicines, vaccines, and diagnostics being unavailable or priced out of the reach of those who need them most. We can’t keep letting history repeat itself.”