The White House’s announcement yesterday that it wants to spend $1 billion to jump-start Vice President Joe Biden’s cancer moonshot is music to the ears of cancer researchers. Unclear, however, is how much existing money will be reshuffled at the National Institutes of Health (NIH) to support this year’s moonshot activities, and whether Congress will agree to new funding that the White House has proposed for 2017.
Although researchers are “very excited and enthusiastic” about the $1 billion proposal, they have questions about exactly where the money will come from, says Jon Retzlaff, managing director for science policy and government affairs for the American Association for Cancer Research (AACR) in Philadelphia, Pennsylvania.
A fact sheet says the White House plans to spend $195 million on “new cancer activities” at NIH in the current 2016 fiscal year, which began in October 2015. Presumably, most of the spending will occur at the National Cancer Institute (NCI), which got $264 million in new money this year (part of a $2 billion overall increase for NIH). NCI already funds the research areas that the fact sheet describes—cancer prevention, early detection, immunotherapy, tumor genomics, data sharing, and pediatric cancer. The money appears to be “a shot in the arm” for these existing programs, Retzlaff says.
But one worry for biomedical researchers is that plumping up certain NCI programs partway into the fiscal year will force the institute to divert funds from other programs. For example, the pot of money allocated for investigator-initiated cancer research could grow more slowly; the fact sheet also does not mention what is envisioned for NCI’s cancer centers. Exactly what the moonshot could mean for nonmoonshot activities may become clearer on 11 February at the next meeting of NCI’s National Cancer Advisory Board (NCAB).
Meanwhile, Biden plans to propose continuing the moonshot’s financial momentum in the White House’s FY 2017 budget request, due out 9 February. The White House says it will include a request to steer $75 million to the U.S. Food and Drug Administration (FDA) for moonshot activities, and $680 million for NIH. That could mean a 13% budget boost for NCI.
The plan could be a hard sell in Congress, however, Retzlaff notes. That’s because it calls for using “mandatory funds” to pay for those increases. Mandatory funds aren’t funneled through the regular annual appropriations process. Instead, the money comes from dedicated sources approved by Congress—for example, the 21st Century Cures Act, a House bill to speed the development of new medicines, would give NIH $8.75 billion in new funding over 5 years by selling oil from the U.S. strategic petroleum reserve.
Lawmakers generally don’t like mandatory spending because it preempts their oversight, Retzlaff notes. Another concern is what will happen if such funding ends after a few years. “There could be a cliff” after which the new research programs suddenly lose support, Retzlaff says. AACR’s hope, Retzlaff says, is that any new moonshot funding be sustained into 2018, 2019, and beyond. “We’d love to see a 10-year plan,” he says.
One program outlined in the White House spending plan clearly is new: an FDA Virtual Oncology Center of Excellence that will “leverage the combined skills of regulatory scientists and reviewers” to speed the development of cancer drugs, screening, and diagnostics. Friends of Cancer Research, a patient advocacy group, took credit for that idea, writing that it will “break down decades' old silos within FDA and make for a more efficient agency.” The plan also describes a Vice President’s Exceptional Opportunities in Cancer Research Fund that will fund “high-risk, high-return research” identified with help from researchers, advocates, and industry.
Yesterday, Biden held the first meeting of an interagency task force to plan the moonshot. And NCAB will soon form a blue-ribbon panel to offer guidance.