Francis Collins, Who Guided N.I.H. Through Covid-19 Crisis, Is Exiting

WASHINGTON — Dr. Francis S. Collins, the director of the National Institutes of Health, holed up in an Airbnb in the countryside in May to ponder leaving the job he had held for more than a decade, over three presidencies.

“I spent a long weekend thinking about this and mapping out timetables and pros and cons,” he said. He prayed over it.

On Tuesday he announced his decision: He would step down by the end of the year.

Dr. Collins’s replacement, once nominated by President Biden, will have to be confirmed in an evenly divided Senate. A division of the Department of Health and Human Services, the N.I.H. describes itself as the largest biomedical research agency in the world. In a statement on Tuesday, Mr. Biden called Dr. Collins “one of the most important scientists of our time.”

“After I was elected president, Dr. Collins was one of the first people I asked to stay in his role with the nation facing one of the worst public health crises in our history,” Mr. Biden said. “Millions of people will never know Dr. Collins saved their lives. Countless researchers will aspire to follow in his footsteps. And I will miss the counsel, expertise and good humor of a brilliant mind and dear friend.”

Dr. Collins, 71, was appointed in 2009 by President Barack Obama after more than a decade leading the National Human Genome Research Institute, which is part of the N.I.H. There, he led the international Human Genome Project, which mapped the genes in human DNA. The N.I.H. said on Tuesday that Dr. Collins would continue to lead his laboratory at the genome institute, which is studying the causes and prevention of Type 2 diabetes and new therapies for Hutchinson-Gilford progeria syndrome, a form of premature aging.

Among the N.I.H.’s accomplishments under Dr. Collins was its support for research into mRNA vaccines, said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases at the N.I.H. Scientists at the health agency then made crucial discoveries that enabled the development of the Moderna and Pfizer-BioNTech vaccines.

In its announcement, the N.I.H. noted that Dr. Collins had increased its substantial budget by more than a third, to $41.3 billion in 2021 from $30 billion in 2009 — the result, his admirers say, of a steady campaign to win over Congress.

“I heard it said that he is the best politician in Washington, and I think it is true,” said Mary-Claire King, professor of medicine and genome sciences at the University of Washington. “He really knows his subject and reads people well. He has kept biomedical research and the N.I.H. in a positive light.”

A geneticist and physician by training, Dr. Collins oversees 18,000 federal employees and a sprawling research program. His agency awarded more than 50,000 grants to more than 300,000 researchers during the 2020 fiscal year alone. Its campus tells the story of its reach, spread across 27 institutes and centers in 75 buildings in Bethesda, Md.

During the pandemic, Dr. Collins helped found a project involving partnerships and collaborations with pharmaceutical and biotech companies that enabled numerous trials of antivirals and other treatments for Covid-19 to run simultaneously.

Some scientists and public health experts have criticized the federal government’s efforts at studying Covid-19 treatments, saying some that ultimately did not show strong results — such as convalescent plasma and hydroxychloroquine — were prioritized over more rigorous research.

Dr. H. Clifford Lane, the clinical director at the allergy and infectious diseases branch of the N.I.H., said that Dr. Collins operated deftly amid a chaotic research environment, quickly mobilizing N.I.H. resources to study more promising treatments, including remdesivir and monoclonal antibodies.

Dr. Fauci said that Dr. Collins made a critical pivot from his expertise to the broader pandemic response. It was, he said, “really extraordinary to get someone who is fundamentally a geneticist, whose diseases involved cystic fibrosis and progeria, who turns out to be a valued colleague in the arena of infectious diseases, pandemics, public health.”

Dr. Collins almost stepped down early last year, Dr. Fauci said. One evening, he visited Dr. Fauci in his office and admitted that he was considering leaving for personal reasons. “I begged him not to step down,” Dr. Fauci recounted, “because, I said, ‘We are in the Trump administration. If you step down, we have no idea who’s going to get appointed as director. So we need you to stay on with us. Don’t leave now.’ And he understood that.”

Dr. Collins received a Ph.D. in physical chemistry from Yale in 1974 but decided molecular biology was more exciting. He spent years training anew. He also wanted to be a doctor, and earned his M.D. at the University of North Carolina.

He was not brought up with religion, but when a patient asked Dr. Collins if he believed in God, he realized, he has said, that he did not know. He began reading widely and was persuaded by the writer and theologian C.S. Lewis, who said faith could be a rational choice. At 27, he became a nondenominational evangelical Christian.

As director of the N.I.H., Dr. Collins said, he had promised that his faith would not affect his choice of projects for the institutes.

“It does guide me a bit in terms of how I approach a challenge in bioethics,” he said during an interview on Tuesday. “But I find I usually come down in the same place on an ethical dilemma as people who are agnostics or even atheists.”

“I admit I prayed about those vaccines,” he added.

Dr. Collins has used his Christianity as an entree into conservative evangelical communities, appearing on Christian radio and speaking to evangelical groups to make the case for getting inoculated. But he admitted on Tuesday that he had not achieved as much progress as he had hoped.

“That’s a heartbreak,” he said. “We are supposed to be people of truth.”

He said in the interview that one of his chief regrets as N.I.H. director was the persistence of vaccine hesitancy during the pandemic. “Culture war has had terrible consequences,” he said. “Was there something else we should have done there in terms of anticipating that? Maybe investing more in the behavioral research side of this, to try and understand the basis of those resistances?”

During the Biden administration, Dr. Collins has stood behind the federal government’s increasingly assertive vaccine policy, endorsing a broad booster shot plan and Mr. Biden’s decision to require federal workers to be vaccinated against the coronavirus.

Dr. Collins has struggled with some persistent problems at the N.I.H., including a lack of reliable funding for young scientists, which forced many to abandon research careers. Although he points to progress, the issue still rankles.

“People don’t look at careers in science as viable anymore,” said Michael B. Eisen, a professor of genetics, genomics and development at the University of California, Berkeley. “An incredible fraction of our best students are going into the private sector. You can’t count on the N.I.H.”

The N.I.H. has also been criticized for not doling out more grants to people of color.

On Tuesday, Dr. Collins said he had doubled the number of women who are institute directors at the N.I.H. He also said that he hoped his replacement would be a woman.

Asked during the interview what had surprised him most during his time leading the N.I.H., he pointed to “the intensity, the unremitting intensity.”

“Every Friday afternoon at 4 was a crisis,” he said, adding that he was working 100 hours a week, leaving him less time to play guitar or ride his motorcycle.

“I do have calluses from playing the guitar,” he said, “but not as deep.”

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