ພົບກັບນັກວິທະຍາສາດປະສານງານ Moonshot ມະເຮັງໃໝ່ຂອງ Joe Biden

No matter what you think of President Joe Biden, it’s hard not to empathize with him for the loss of his son Beau Biden to brain cancer in 2015. Biden was able to turn his personal loss into a constructive mission when then President Barrack Obama in his 2016 State of the Union Address put him in charge of the Cancer Moonshot Initiative, an effort aimed at advancing cancer research and improve results for patients.

The program itself didn’t formally have an early lifespan – Obama left office in January 2017. Yet funding for dozens of projects will continue until 2023. Biden went on to personally keep his involvement in the fight against cancer going after Donald Trump was elected president, forming the Biden Cancer Initiative in 2017 to advance collaboration and writing a book, “Promise Me, Dad” about his son’s battle. Biden halted the Biden Cancer Initiative in mid-2019 when he said he’d run for president.

This year, now-President Biden in a high-profile White House ceremony in February with Jill Biden relaunched the Cancer Moonshot program, taking on one of the world’s leading killers with a goal of cutting the cancer death rate by half in the next 25 years.

Leading the battle inside of the White House as Moonshot coordinator is Danielle Carnival. The Troy, New York native knows the fight well. After working to promote science education in a White House job for five years, she was in 2016 named as chief of staff to work closely with then long-time DC insider and White House Cancer Moonshot Executive Director Greg Simon. The two continued to work together at the Biden Cancer Initiative in 2017-2019, where Simon was president and Carnival was vice president.

Carnival sees a lot of unfinished work to pursue given the longer time horizon of the new Moonshot. “With the first (Moonshot), we were at the end of an administration. We had a great opportunity with President Obama announcing the Cancer Moonshot in the State of the Union, but we were in a sprint,” she recalled in a Forbes interview. “We knew we weren’t going to accomplish the mission in those nine months, and so really tried to set out a trajectory that even beyond that administration would continue. And I think we were successful in that.”

“This time, the president has committed to this as a priority for him as president, Carnival said. “We’ve really set out some measurable quantifiable goals that not only will extend and improve lives, but change the experience of people who get this diagnosis. We’re doing in-depth work that wasn’t possible in the amount of time we had the first time around.”

Success will come from casting a wide net for new approaches, Carnival says. “We really have an open door for folks to say, ‘This is how I think we can make progress.’” Against that backdrop, international collaboration is also “a really important aspect,” she said. “We’ve seen that through the pandemic. That being able to move quickly but safely in the evaluation of new treatments and new preventive measures,” Carnival said. “The global community is really important in that.”

The U.S. has been fighting cancer at the federal government level since then President Richard Nixon signed the National Cancer Act in 1971. Cancer is a top killer worldwide, uniting U.S. with China, the world’s No. 1 and No. 2 in cancer deaths annually. National cancer costs in the U.S. will reach $236 billion by 2030, up from $183 billion, according to figures in a new book, “A New War on Cancer: Lessons From A 50 Year War.”

Earlier in the battle in the 1980s, Carnival was working her way through the Troy school system and building an interest in the STEM (science, technology, engineering and math) world. “I was really interested in math and science. It was just kind of how my brain clicked,” she said. Rensselaer Polytechnical Institute was “the only model that I had at that time” because her high school was located nearby. And yet, she said, “I didn’t know anyone who worked there or who went there at the time.”

Carnival graduated from Boston College down the Massachusetts Turnpike from Albany in 2005 with a degree in biochemistry and the knowledge that she didn’t want to be a medical doctor. “My only model for what you did if you were good at math and science was to become a medical doctor. I was on that path for a long time before realizing that that wasn’t exactly where I wanted to land. It took me all the way through undergrad to find medical research,” she said. “I didn’t want to be a practicing physician, and the best course for me was to switch course to a PhD program once my eyes were opened to the fact that existed.”

She went on to earn a PhD in neuroscience at Georgetown University in Washington, where she still had her maiden name – Evers – and became the first doctorate thesis student of Daniel Pak, a professor in the pharmacology and physiology department. The title: “Homeostatic control of AMPA receptor strength and subunit composition by Polo-like kinase 2.”

“She was a really great one to start with,” Pak recalls. “She had a vision, and then she just did whatever it took to make that come to conclusion. Graduate students are often very casual and relaxed in their demeanor, but she was really polished, poised and mature. She just had this aura about her that she was very high powered,” he said. “I remember thinking one time she is really going to become a CEO one day.”

“I could tell that she wasn’t going to stay in science, though she was a good scientist and had a high-impact paper that came out of her work. It was clear that’s not really what her heart was in, as she was obviously more interested in policy and directing the science into ways that she thought it should be going,” Pak said, who hasn’t been in contact with Carnival for several years.

Knowing by the time she earned a doctorate that she “wanted to extend beyond laboratory research,” Carnival found a fellowship through American Association for the Advancement of Science, and landed at the White House in the Office of Science and Technology Policy, making a mark with White House Science Fairs, College Opportunity Days of Action, and Computer Science for All and Diversity in STEM initiatives. It was her draft paper for the creating of the first Cancer Moonshot that impressed her future boss Greg Simon.

“Danielle wrote the presidential memorandum that established the first White House Cancer Moonshot in the vice president’s office,” Simon said. “That was important. It wasn’t just because it was Biden and they wanted to do something nice,” he said. “Why wasn’t the Moonshot in the National Cancer Institute or National Institutes of Health writ large or HHS (Department of Health and Human Services) writ large? And the answer is that’s part of the problem. The NCI culture, the NIH culture were part of the problem that we were trying to address.”

Aside from Carnival’s bureaucratic insights, Simon also recalled her drive. “She is tenacious. She is indefatigable. She’s very bright. She is discerning, by which I mean

she doesn’t suffer fools gladly. She has very high standards and is capable of what I would call moral outrage, which I think is a good thing. We literally sat across from each other for 3.5 years. Every day, I saw how she operated.”

Carnival was temporarily out of a government job in 2017 after Trump’s election win, and stayed on with Simon to help lead the Biden Cancer Initiative. That ended two years later when Biden formally decided to run for president. Carnival in Sept. 2019 joined “I AM ALS,” a DC-based patient-led, patient-centric community that aims to reshape public understanding of ALS, provides resources, and creates opportunities for patients to lead the fight against ALS and search for cures.

Later, after Biden was back in the White House, he called Carnival with an ask. “The president called me and said, ‘Can you come back and work on this again?’” Carnival recalled. “I jumped at the chance,” she said, knowing of Biden’s personal interest and understanding of the “mechanistic and systems issues.”

Ex-boss Simon, 70, says he supported his former No. 2 as coordinator. “I was a huge fan of Danielle being the one to run this because she is totally capable, and we need diversity and we need youth. A guy like me can be very helpful from outside, but we don’t need to bring in more 70-year-old men to work in the White House. It’s time to pass the torch.”

To date, the Moonshot has set priorities and laid the groundwork for a bigger push in the next budget year. A “Cancer Cabinet” of leaders from involved agencies and departments across the federal government aims to bring experts and resources to address cancer on multiple fronts. In July it added three new elite members to the President’s Cancer Panel, a group of outside advisors appointed by the president to advise him on how to decrease the burden of cancer in the United States: Dr. Elizabeth Jaffee, the Deputy Director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Dr. Mitchel Berger, a professor and brain surgeon at the Department of Neurological Surgery at the University of California at San Francisco and Dr. Carol Brown, a gynecologic oncologist who is the senior vice president and Chief Health Equity Officer at Memorial Sloan Kettering Cancer Center in New York.

The White House also in July also unveiled “priority actions” for the Moonshot effort: close the screening gap, understand and address environmental exposure, decrease the impact of preventable cancers, bring cutting edge research through the pipeline to patients and communities, and support patients and caregivers.

The setting of “priority actions” shows that part of the work of the Cancer Cabinet is already under way, and that agencies will work to support the five areas starting this year. In addition, Carnival said, the Cabinet will work on “the budget impact we really hope to see” in 2024 and beyond. Initial funding for accelerated federal cancer research has been put in place with Congressional approval of the 21^st Century Cures Act in 2016, creating a budget of $1.8 billion to be used over seven years. Biden got another $1 billion in funding to kick it off the new Moonshot program last year.”

One new goal is to create an entity called APRA-H – Advanced Research Projects Agency for Health, which would be modeled on a military-related government effort – DAPRA (Defense Advanced Research Projects Agency) and seek to improve health including cancer protection and treatment. Working to “leverage the incredible model of DARPA to really deliver new ways to prevent, detect, and treat cancer and other diseases” is the goal of APRA-H, Carnival explained.

International partners will also help, she noted. “There is a lot of interest from international partners. There’s been a lot of work over the last decade, not only in the U.S. as part of the Cancer Moonshot, but in many countries to set up goals and really an agenda around how they want to take on cancer. We look forward to interacting with those,” she said. “We’re working on how exactly (to proceed) with the right partners and timing to do that.” (See related Forbes China event here.)

“I think one of the best outcomes of the Cancer Moonshot in 2016 was the Oncology Center of Excellence at the FDA,” Carnival said. Noting its leader Richard Pazdur, the organization founded in 2017 started Project Orbis which has collaborated with international regulators on 26 drug approvals. Project Orbis added partners such as the Israel Ministry of Health Pharmaceutical Administration and the United Kingdom’s Medicines and Healthcare Products Regulatory Agency in 2021. “The work that they’ve been leading in talking to regulators in other countries and really developing those lines of communication, I think, is going to have a huge impact,” Carnival said. Looking ahead, she said, “The bold goals the president has laid out for us are only achievable if the entire oncology community really steps up and does their part,” Carnival said. Success will require all of the domestic and international policy smarts this American scientist can muster.

@rflannerychina