Even in times of federal budget tightening, cancer research has garnered bipartisan congressional support, combining with private sector funding to drive significant scientific progress in the fight against the killer disease.
“Cancer has escaped the political gravitational pull,” said Lawrence Gostin, professor of global health law at Georgetown University School of Law.
But this year could be different, as Democratic lawmakers and research advocates sound the alarm that the new debt ceiling deal could dramatically slow future growth in NIH spending.
The legislation, which President Biden recently signed, keeps non-defense discretionary spending roughly flat through 2024 and offers only a 1 percent increase in 2025. Health agencies could see cuts to maintain the non-defense budget of the government below $652 billion.
Special report: Curing cancer
Sen. Tammy Baldwin (D-Wis.), chairwoman of the Senate Appropriations subcommittee that oversees funding for the Department of Health and Human Services, said she is concerned the new budget constraints will have a negative impact on research funding against cancer
“The deal that was approved would result in flat funding” for the next two years, Baldwin told The Hill, adding that he anticipates crafting an appropriations bill will be “challenging” because of the caps.
In the House, the top Democrat on the Appropriations Committee, Rep. Rosa DeLauro (Conn.), noted that the level of nondefense spending in the cap is about $9 billion below current levels, of so the money will have to come from somewhere.
“$9 billion is a cut. So where does it come from? 12 appropriations bills,” DeLauro said.
But Republicans are downplaying those concerns.
“I see no reason why [the spending caps] would jeopardize it at all,” said Rep. Mike Kelly (R-Pa.), co-chair of the House Cancer Caucus, during a cancer care event sponsored by The Hill. “You can’t ban cancer… But what you can do is secure funding.”
Rep. Tom Cole (R-Okla.), a member of the Appropriations Committee who previously supported the NIH as the leading Republican on the Labor-HHS-Education subcommittee, said that because Republicans have fewer spending priorities than Democrats, the NIH legislation will. it doesn’t get bogged down with other issues.
Still, he said he anticipates a tough appropriations process.
“I don’t think he will [NIH] be shortened, but I would expect all the Labor-H [Labor, Health and Human Services] budget to be under a lot of pressure,” Cole said.
President Biden has said he wants to build on bipartisan progress in the fight against America’s No. 2 killer and has made the fight against cancer a priority of his administration by relaunching the “cancer moonshot.”
The first iteration of the moonshot was created in 2016, at the end of the Obama administration when Biden was vice president.
“We had a broad goal of accelerating impact, accelerating progress on anything that affected patients. And a lot was done in that time. But it was the last year of an administration. And so we were in a sprint.” , said Danielle Carnival, the White House moon coordinator.
Carnival said it helps to have a president who wants to prioritize cancer research, but the change in administrations didn’t slow down the work being done. The National Cancer Institute (NCI), which oversees the initiative, says it has already spent $1 billion on more than 240 research projects.
“It was important to have sustained funding, specifically for cancer initiatives,” Carnival said.
“We worked very hard with agencies and departments to make sure that even if there wasn’t a central White House office like there was in 2016, and there is now, focused on that effort, that the work would continue and that the collaboration continues” the government, Carnaval added.
Carnival said funding for cancer research has always been a bipartisan effort, and he wasn’t concerned that Congress would cut it going forward.
Last year, Biden announced his intention to “supercharge” the moon with a plan to reduce the cancer death rate by at least 50 percent over the next 25 years.
Biden also asked Congress to reauthorize the National Cancer Act, which officials said would help build new clinical trial networks and modernize data collection to improve detection and treatment.
The moonshot provides a significant injection of funding, but also aims to go beyond drug and treatment research.
Carnival said the new plan emphasizes the role the public can play by returning to cancer screenings that have been missed during the pandemic, quitting smoking and participating in trials.
In April, the administration released its National Cancer Plan to “end cancer as we know it,” a roadmap for the moonshot and a call to action to improve all facets of cancer care.
The plan emphasized eight specific goals, including eliminating disparities in prevention, treatment, and even research.
Cancer is very well funded, especially compared to other diseases and threats to public health. The federal government, pharmaceutical companies and nonprofits have poured hundreds of billions of dollars into the effort.
But there are concerns about how it is spent. Some of the most well-funded cancers are the most likely to survive, while the most lethal cancers receive the least amount of money for research.
“You’re going to have certain cancers that are extraordinarily high-profile and there’s a lot of public support for funding them broadly. And I think Congress and even the NIH are sensitive to that. So there’s a real correlation between advocacy, the public claim of a particular disease and support from Congress and the NIH,” said Gostin, who is also a member of the National Cancer Institute’s National Cancer Advisory Council.
“All things being equal, funding should reflect the real burden of disease. And that funding should go to the things that cause the most harm to the most people, rather than any political calculation or things that break the bank. [at] the heart strings,” Gostin said.
Cervical, ovarian, and uterine cancers have consistently ranked at the bottom of the National Cancer Institute’s funding spectrum. Experts have said the impact of this can be seen in fewer clinical trials available to patients and decreased trial enrollment in those available, resulting in fewer high-level treatment options .
For example, the NCI funded just under $121 million in ovarian cancer studies in fiscal year 2018, the most recent data available. Meanwhile, breast cancer received nearly $575 million. Money disparities will make it difficult, if not impossible, for research into these underfunded cancers to catch up.
Suneel Kamath, a GI medical oncologist at the Cleveland Clinic who has researched funding disparities in cancer, said the federal government, and specifically Cancer Moon, can step in to try to reverse longstanding inequities.
“Your research on hard-to-treat diseases is not going to be a five-year plan, you know, it’s going to be a 20-year, 30-year investment, and I think that’s something that a federal agency can do, whereas private entities, if” You don’t get enough return on the investment in a given period of time, that money could dry up,” Kamath said.
The federal government provides much of the money for early-stage basic research and generally turns it over to the private sector to fund the development of treatments and take them through late-stage clinical trials and eventually a presentation to the Food and Drugs. administration
The pharmaceutical industry has an incentive to pour money into lucrative therapies and treatments, which can distort investments in specific cancers.
A to study last year found that among the world’s 10 largest drug companies, revenue generated by the sale of cancer drugs rose 70 percent between 2010 and 2019, to $95.1 billion .
Ezekiel Emanuel, an oncologist, University of Pennsylvania professor and former White House adviser, said industry has a bias, but he doesn’t necessarily see an overreliance on industry money in research.
Government can shape research priorities with incentives such as orphan drug designation and pediatric exclusivity. Agencies just need to make sure companies don’t exploit them.
“Pharmaceutical companies do something very important. I don’t mean to minimize what they do. That doesn’t mean you pay a king’s ransom for what they do,” Emanuel said.
Research funding is well aligned with incidence rates, how often a disease affects people, but very poorly aligned with the death rate, Kamath said.
A more significant factor is the success of early research and trials. “If the win is going to be, you know, really delayed or maybe not going to happen at all, that’s going to take away the funding and unfortunately it becomes this kind of feeding cycle,” Kamath said.
If the initial results are poor, that particular disease will not get the money needed to better understand it and develop something that will have an impact and reverse the cycle.
“From a federal and government perspective, this is an opportunity to plug that hole. We don’t have to have the same ROI in a short period of time,” Kamath said.
“We can choose to say this is important to people in our society and our community. We’re going to continue to fund this even though you know, we’re not getting the dividends yet. Because it’s important.”
