Department of Health and Human Services, Director, National Institutes of Health

Department/Agency: Department of Health and Human Services

Position:

Director, National Institutes of Health

Executive Schedule: Executive Level IV - Presidential Appointment with Senate Confirmation

Major Responsibilities:

Run the nation's premiere biomedical and behavioral research organization
Fund intramural and extramural research to help people live healthier lives and reduce the burdens of illness and disability
Plan, manage and coordinate programs and activities of all 27 NIH Institutes and Centers
Support medical researchers across the U.S. and around the world
Advise the President and help shape the federal medical research agenda

Key Competencies and Preferred Qualifications:

Medical degree
Extensive background in health care policy
Senior executive experience in government or academe
Medical research background

Insight:

Budget: $29.5 billion (FY 2009)

Staff: 18,000

President George W. Bush was 14 months into his first term as president before he nominated Elias Zerhouni, M.D., a prominent Johns Hopkins University radiologist and dean, to direct the National Institutes of Health. The previous director, Harold Varmus, M.D., a cancer researcher and Nobel laureate, had vacated the post 27 months earlier to run Memorial Sloan-Kettering Cancer Center in New York. Varmus left NIH in capable hands - Deputy Director Ruth Kirschstein, M.D., served as acting director until Zerhouni was confirmed in May 2002. But it was still unusual that the job was left vacant for that long. As a lame duck president, Clinton faced difficulties getting nominees through the Republican Senate; it also had taken him more than three years to find a surgeon general acceptable to the Senate. Varmus helped convince Congress to double the NIH budget and broke ground on three new buildings, including Hatfield Clinical Research Center, the nation's largest hospital dedicated to clinical research.

President Bush's delay in finding a suitable successor was due principally to the difficulty of finding a distinguished academic administrator and medical scientist who supported the new administration's restrictions on federal funding of embryonic stem cell. Zerhouni skirted the stem cell issue during his confirmation hearing, saying only that he felt "the NIH Director should actively promote necessary research within the policy guidelines laid out by the president and in strict compliance with all laws passed by Congress."

As a senator and presidential candidate, Barack Obama was sharply critical of the Bush administration's restrictions on stem cell research, saying they "have handcuffed our scientists and hindered our ability to compete with other nations." In response to questions posed by scientists, Obama said, "As president, I will lift the current administration's ban on federal funding of research on embryonic stem cell lines created after August 9, 2001, through executive order, and I will ensure that all research on stem cells is conducted ethically and with rigorous oversight." He also is unlikely to wait 14 months to nominate the next NIH director. With an expanded and emboldened Democratic majority in the Senate, smooth sailing is almost guaranteed for his nominee.

The NIH director leads a complex biomedical and behavioral research enterprise that investigates the causes, treatments and preventive strategies for diseases, both common and rare. There are 27 research institutes and centers at NIH, most housed on its campus in suburban Bethesda, Maryland, across from the Bethesda Naval Center, where the president goes for check-ups and where Army and Navy physicians heal the wounds of America's warriors. The director presides over a budget of nearly $30 billion and a staff of more than 18,000, including 6,000 scientists conducting research in NIH's own laboratories. The in-house scientists include several Nobel laureates and Anthony Fauci, M.D., who has played a leading role in AIDS research and policy making since the first Bush administration, all while directing the National Institute on Allergies and Infectious Diseases. But most of the NIH budget -- $5 in every $6 - goes toward what is called "extramural" research, that is conducted by top scientists in labs and universities across the United States and around the world. That money, awarded through nearly 50,000 competitive grants, supports the work of more than 325,000 scientists and their research support staff. The intramural research gets a 10 percent share of the NIH budget.

With Zerhouni at the helm, President Bush got Congress to approve only the third NIH reauthorization in the agency's history and the first since 1993 (its programs had been funded in earlier years through omnibus bills). The National Institutes of Health Reform Act of 2006 signaled a renewed confidence in the NIH mission and its employees. The new law expanded the director's authority to manage the agency and encouraged more collaborations across NIH institutes and centers. Zerhouni also developed a $2 billion strategic plan called the NIH Roadmap for Medical Research. He created an Office of Portfolio Analysis and Strategic Initiatives to help the agency find and fund cutting-edge research and identify emerging public health challenges. He made fighting obesity a priority and ensured for the first time that the American public gets open access to medical journal articles on the fruits of research funded by NIH.

NIH also was rocked by ethical scandals and investigations in recent years. Zerhouni imposed stricter ethics rules and restrictions on relationships between NIH scientists and drug and biotech companies in the wake of the scandals. After the heady doubling of the NIH budget that took place in the late 1990s and early 2000s, Zerhouni had to stir NIH through some lean budget years. Now, even with the fragile economy and gaping federal deficits, NIH likely will be one of the beneficiaries from President-elect Obama's promised efforts to boost R&D as an investment not only in Americans' health, but their economic future.

The Future of NIH
In his 2009 budget request before the Senate Committee on Health, Education, Labor and Pensions, Zerhouni outlined several challenges that lie ahead. He stated that the agency needed to renew its focus on fundamental research and also do more to meet the threats of bioterrorism pathogens. One of the most pressing challenges is helping "generate and maintain the trained and creative biomedical workforce necessary to tackle the converging and daunting research questions of this century," he said.

Key Relationships – Within the Department or Agency:

Principal Deputy Director
Deputy Director for Extramural Research
Deputy Director for Intramural Research
Deputy Director of Management and Chief Financial Officer
Deputy Director for Portfolio Analysis and Strategic Initiatives (OPASI)
Council of Councils and Executive Secretariat
Institute and Center directors

Key Relationships – Within the Government:

Deputy Secretary
Assistant Secretary for Health, who oversees the Public Health Service
Director, Centers for Disease Control and Prevention
Commissioner, Food and Drug Administration
Director, Office of Science and Technology Policy, The White House
Associate Director for Human Resources, Office of Management and Budget
Director, National Science Foundation
President, National Academies of Science

Key Relationships – Outside the Government:

Association of State and Territorial Health Officials
Association of American Medical Colleges
World Health Organization
Accreditation Council for Graduate Medical Education
Pharmaceutical Research and Manufacturers Association
American Medical Association; other medical specialty groups
American Hospital Association and Federation of American Hospitals
American Public Health Association
American Heart Association and other voluntary organizations

Nomination Referred to:

Senate Committee on Health, Education, Labor and Pensions

Current Position Profile:

1. Francis S. Collins (Confirmed: Aug 7, 2009). Team Member, Department of Health and Human Services Review Team, President-Elect Obama Transition Team, Executive Office of the President (2008-2009). Director, National Human Genome Research Institute, National Institutes of Health, United States Department of Health and Human Services (1993-2008). Investigator, Howard Hughes Medical Institute (1991-1993).

Recent Position Profiles:

2. Steven G. Bradbury, J.D. (Acting 2005 - 2007). Principal deputy assistant attorney general since 2004 and de facto head of the office during President George W. Bush's second term. Former associate at Covington & Burling. Graduate of Stanford University and University of Michigan Law School.

3. Elias A. Zerhouni, M.D. (2002-2008). Fifteenth NIH director. Diagnostic radiologist. Former executive vice dean, chair of the radiology department, professor of biomedical engineering, and vice dean for research at Johns Hopkins University School of Medicine. Emigrated to U.S. from Algeria after medical school and completed residency at Johns Hopkins.

4. Ruth Kirschstein, M.D. (Acting 2000-2002). Pathologist and expert on vaccine safety. Deputy director and first woman institute director at NIH as director of National Institute of General Medical Sciences from 1974 to 1993. Tested vaccines for polio, measles and rubella. Helped mobilize AIDS research team in early years of epidemic.

5. Harold E. Varmus, M.A., M.D. (1993-1999). Physician and cancer researcher. Shared 1989 Nobel Prize in physiology or medicine for demonstrating that cancer genes can arise from normal genes. Former professor of microbiology, biochemistry, biophysics and virology at University of California; San Francisco. Now president of Memorial Sloan-Kettering Cancer Center.

6. Dr. Bernadine Healey, M.D. (1991-1993). Cardiologist. Directed the Cleveland Clinic's Research Institute. Deputy director of the White House Office of Science and Technology Policy during the Reagan administration. Later directed American Red Cross.