Welcome to POLITICO’s West Wing Playbook, your guide to the people and power centers in the Biden administration. With help from Allie Bice. Send tips | Subscribe here| Email Eli | Email Lauren When President JOE BIDEN unveiled his budget last week, it included a startling $12 billion request for a new initiative with the lofty goal of eradicating Hepatitis C. The proposal, the size and scope of which caught even longtime Hep C researchers by surprise, represented the culmination of a relentless campaign waged primarily by one man: FRANCIS COLLINS. Collins is best known as the mustachioed, guitar-playing, motorcycle-riding longtime head of the National Institutes of Health, which he led for over a decade before taking a senior White House role in early 2022. But over the last several years, he developed a personal fascination with eliminating Hepatitis C — an eminently treatable disease that nevertheless kills more than 15,000 people a year through liver infections that lead to conditions like cirrhosis and cancer. “The development of safe and highly effective oral medicines for Hep C is one of the great achievements of medical research in the last 20 years,” Collins told West Wing Playbook. But limited access to testing and affordable treatment, he said, means those therapeutics are “simply not reaching millions of people who need the cure.” Collins’ fixation on the disease was borne in large part out of personal experience. Years before scientists found a treatment, Collins’ brother-in-law found out he had Hepatitis C. Despite receiving a liver transplant, he developed cancer, resulting in what Collins recounted recently to PBS Newshour as a “terribly awful, difficult death.” Collins studied a range of smaller Hepatitis C eradication initiatives, including programs at the VA and in states like Louisiana and Washington. When it came time to compile the White House budget, he launched what aides described as an internal crusade to get his plan prioritized. The budget-building process can be cutthroat among agencies each advocating for their own pet projects. Collins came armed with reams of data showing those smaller-scale efforts were capable of quickly expanding treatment — even among harder-to-reach populations that are disproportionately affected by Hep C. He argued that the long-term savings from fewer liver transplants and cases of liver and kidney failure would exceed the sizable up-front cost. At one point, a person familiar with the discussions said, Collins went as far as drawing up his own communications plan for how the White House might roll out the initiative. Perhaps most important to winning Biden’s approval, Collins tied Hepatitis C eradication to the president’s own Cancer Moonshot, citing the potential for preventing liver cancer. Collins’ push also extended to Capitol Hill, where he's personally tried to recruit allies on both sides of the aisle. One of his top targets was Sen. BILL CASSIDY (R-La.), who expressed support for the Hepatitis C initiative because of his own background studying the issue. “I think it’s quite plausible that we will save direct health care costs if you get the appropriate price for the drug — and by the way, you save a lot of lives,” said Cassidy, who said he’s talked “a lot” with Collins lately. “He’s asked me for insights, as well as potentially for advocacy.” Collins ultimately got his wish: a single line item on page 144 of the White House budget funding a health department-wide Hepatitis C initiative. For all that effort, however, he's still unlikely to get the bipartisan buy-in needed to turn the idea into a reality. Congress typically dismisses the White House blueprint as little more than a wish list, and there are already signs the Hepatitis C program faces insurmountable opposition from House Republicans. A senior GOP aide told West Wing Playbook there is deep skepticism over the price tag, despite the administration’s insistence that expected savings would eventually reduce the program’s net cost to roughly $5 billion over a decade. In the meantime, Republicans are preparing to use the proposal as a cudgel, arguing that Biden’s wider plan to crack down on pharmaceutical companies over their drug prices stands to hurt the very companies he wants to partner with on expanding treatments for Hepatitis C. “While the plan makes for a nice talking point, in reality the Biden administration is actively undercutting any meaningful commitment to finding cures,” said the senior GOP aide. MESSAGE US — Are you LAWRENCE TABAK, the acting NIH director? Or someone interested in becoming the next NIH director? We want to hear from you. And we’ll keep you anonymous! Email us at westwingtips@politico.com. Did someone forward this email to you? Subscribe here!
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