WASHINGTON — Barely five months after his son’s death from brain cancer, a bereaved Vice President Joe Biden announced to the nation he would not run for president in 2016 — and immediately pinpointed his deepest regret.
“If I could be anything, I would have wanted to be the president that ended cancer,” he said in a Rose Garden address in October 2015. “Because it’s possible.”
Biden’s announcement that he will run for president in 2020, however, has resurfaced his dream: a White House that makes cancer a signature issue, backed by a politician whose life was so publicly upended by the disease. With much of the early debate in the Democratic primary centering on health care, Biden’s stint as cancer-advocate-in-chief and orchestrator of the Obama administration’s “Cancer Moonshot” could give him the opportunity to make the disease, its treatments, and his own grief central to the presidential election.
After leaving office, Biden structured his cancer-fighting efforts in a way that could suit a possible campaign. The Biden Cancer Initiative — the pillar of Biden’s policy work since leaving office — raised $10 million in the year following its incorporation. The nonprofit did not accept contributions from pharmaceutical companies, in an effort both to preserve independence and avoid the political pitfalls associated with an increasingly vilified drug industry.
The Bidens have fostered collaboration between stakeholders “at the foundation level, the patient advocacy level, the scientific level, and the government level,” said Dr. Elizabeth Jaffee, a Johns Hopkins researcher who sits on the Biden Cancer Initiative’s board.
An examination by STAT of Biden’s efforts to address cancer research since he left office, particularly at the Biden Cancer Initiative, found that Biden has been deeply involved in efforts to encourage collaboration among medical researchers, patient advocates and government officials, to pressure drug companies to lower the price of cancer medications, and improve the patient experience.
“This was not going on before Vice President Biden and President Obama put forward the moonshot,’’ Jaffee said. “Biden just took it from there.’’
The question for Biden, according to interviews with many Democrats in the world of health care, is how his cancer initiatives and advocacy will be viewed in a field of candidates who are expected to advance policy approaches, namely Medicare for All, that may be considered more progressive — and appealing — to Democrats who vote in primaries.
Another question is Biden’s stance with pharmaceutical companies. Historically, Biden has been seen as less than tough on the drug industry, but since leaving office he has surprised some cancer research advocates with his willingness to castigate drug companies for the high cost of some cancer medications.
Biden’s backers offer a grand vision for what the former vice president could do to battle cancer. Chris Jennings, a veteran Democratic health policy advisor to the Obama administration, said a Biden presidency could bring the cancer fight full circle, from Richard Nixon’s famous “War on Cancer” in 1971, the year before Biden was first elected to the Senate at age 29, to Biden’s ability to spotlight his cancer-care agenda.
“In that period of time, he’s seen another president raise this issue,” Jennings said. “He’s seen dramatic developments in terms of diagnostics and treatments. He’s a man who wears his heart on his sleeve, and he believes that he has and can continue to make major contributions to bringing people together for efficient use of information and data” to combat cancer.
When Joe Biden assembled a room full of cancer researchers and executives from major drug manufacturers in 2018, he unleashed an unexpected scolding.
“He sat there,” Jaffee recalled, “and he said to them: ‘The drug prices are ridiculous. We have to make sure the patients have access and aren’t having to sell their homes to get drugs for their family members or themselves.’ ”
The meeting, which took place at the Biden Cancer Initiative’s annual cancer summit, was a wake-up call — and not only to the drug industry figures present.
“I have never seen that before,” Jaffee said. “He just said this has to happen. He wasn’t president, he wasn’t vice president. He was just a person who cares.”
It was a call to action that mirrored a series of pledges Biden made upon leaving office to lower the cost of cancer drugs and “to find solutions that will double the rate of progress against cancer.”
But the antagonistic tone in that meeting — and in those initial, post-vice presidency pledges— is not indicative of the tack Biden has taken since leaving office.
Instead, the Biden Cancer Initiative has taken a more demure, research-focused route toward affecting change in the health care landscape. The nonprofit, which Biden founded in June 2017 with his wife, Jill Biden, has spent the past two years attempting to set a course for cancer research and foster collaboration between major biomedical institutes, pharmaceutical companies.
It also secured commitments from non-medical organizations: from AirBnB to house cancer patients during treatment, from Lyft to transport them, and from WeWork to allow for “collaboration centers” for use by researchers across the country. It has worked with drugmakers like AbbVie, among others, using a $5 million contribution meant to help “alleviate the financial burden of cancer” on pediatric patients and families.
While the Bidens were not involved in the organization’s operation on a daily basis, they would attend quarterly meetings in person and maintained a deep level of engagement with its work, longtime Biden adviser Greg Simon, who is now the organization’s president, said in an interview.
Researchers inside and outside Biden’s orbit told STAT they have been largely impressed with the Biden Cancer Initiative’s work, particularly on one of Joe Biden’s key issues: clinical trials.
Dr. Karen Knudsen, the director of the Sidney Kimmel Cancer Center in Philadelphia, called Biden’s advocacy behind 21st Century Cures and the moonshot “one of the most transformative things that’s happened since Nixon’s “War on Cancer” in 1971 and the ensuing National Cancer Act.
Much of that work, Knudsen said, has centered on spreading the message that clinical trials are not real-world human experiments but, in fact, often the best means of accessing cutting-edge care. Among Biden’s more technical pushes while in office, Knudsen recalled, was his call for a revamp of clinicaltrials.gov — a federal log of clinical trials that allows patients to match with clinical trials fitting their cancer, and vice versa.
“But there was significant skepticism from patients about going on clinical trials, because they thought they were becoming guinea pigs,” Knudsen said. “In fact, you either get the standard of care or the standard of care plus something else. His dialogue, even if he’d done nothing else, helped us have those conversations with patients about getting into the most advanced care, which is through clinical trials.”
The Bidens announced they would resign as co-chairs of the cancer initiative when Joe Biden announced his 2020 candidacy.
The organization’s infrastructure has remained. Simon, who led the White House Cancer Moonshot, is remaining as the leader with veteran policy aide Danielle Carnival as vice president. Next month, the Biden Cancer Initiative will hold a colloquium at a cancer conference focused on “breaking the 5% threshold once and for all,” referring to the rate at which adult patients enroll in clinical trials.
To some Democrats on the party’s ascendant left flank, Biden’s tough words for pharma at last year’s cancer summit embodied a sign of the times politically. Most Democratic campaigns in the early 2020 cycle have relied on harsh rhetoric for the pharmaceutical industry and sweeping plans to lower drug costs.
In his first speech as a 2020 candidate, Biden made almost no mention of cancer, using the world only in a cursory mention alongside addiction and diabetes as diseases worthy of more research investment. He similarly did not touch high drug prices, and spoke little of high health care costs — other than emphasizing his view that “health care is a right, not a privilege.” Other presidential candidates, like Sens. Amy Klobuchar of Minnesota, Bernie Sanders of Vermont, and Elizabeth Warren of Massachusetts, made explicit mention drug prices in their announcement speeches. Sen. Kamala Harris of California, another high-profile candidate, has taken to frequently citing her mother’s career as a cancer researcher.
Biden, whose campaign is still in its infancy, has not yet rolled out specific policy pertaining to drug prices, health insurance, or addressing the nation’s addiction crisis, even as other candidates have made those issues central to their platforms.
Nonetheless, his pleas for making cancer drugs more accessible were taken by some progressives as a sign that the longtime senator from Delaware, among the country’s pharmaceutical industry hotbeds, would sing the same tune.
Biden’s health-care policies, however, have often highlighted a fundamental divide between his school of moderate Democrat and a new progressive wave. Most notably, Biden is seen as unlikely to endorse the type of sweeping single-payer health plan favored by candidates including Sens. Bernie Sanders of Vermont, Elizabeth Warren of Massachusetts, and Kamala Harris of California.
Separately, some progressives have criticized Biden for his role safeguarding U.S. drug companies’ intellectual property, particularly in India, where he played a key role in pressuring the Indian government to stop issuing compulsory licenses to allow poor cancer patients to access cancer drugs manufactured by multinational drug companies and not yet available in generic form.
A small handful of progressives — Warren and Sanders among them — even voted no on what is seen in Washington as one of Biden’s signature achievements as vice president: the 21st Century Cures Act, the bill that authorized the cancer moonshot, on the basis that it favored industry profits and new drug approvals over patient safety.
Should Biden choose to put health care at the center of his candidacy, he will be sure to emphasize not only his achievements in furthering cancer research — chief among them, his work on the cancer moonshot — but also the personal toll the disease has exacted.
After years of watching his son undergo treatment — Beau Biden, the former attorney general of Delaware, was first diagnosed in 2013, at MD Anderson Cancer Center in Houston — Biden developed both an appreciation for the logistical hardships of cancer care as well as its technical realities.
To one leading cancer researcher, a single 2015 conversation served as a key inflection point. In a meeting with the vice president, Dr. Ron DePinho, who at the time served as the MD Anderson’s president, outlined a “Moon Shots Program” that the cancer center had begun in 2012. The $3 million effort, DePinho recalled telling Biden, aimed to dramatically extend life expectancy for a specific set of cancers, including chronic lymphocytic leukemia.
Soon after Biden’s meeting with DePinho, Obama bestowed him with the power to oversee the interagency task force. And in one of Congress’s final acts before Obama and Biden left office, it was the Senate Majority Leader Mitch McConnell, a Republican, who renamed the cancer-specific sections of the 21st Century Cures Act the “Beau Biden Cancer Moonshot,” as Biden presided over the Senate and aides watched from a nearby office.
Immediately, Biden set out to hire a director for the federal government’s ambitious, swing-for-the-fences effort that came to dominate his final year in office. Simon, a former policy advisor to Al Gore and onetime patient engagement executive at Pfizer, quickly emerged as the leading candidate.
Simon’s hiring came quickly, he recalled. But he faced a final obstacle when he was invited to Washington for a final interview: Simon had been diagnosed one year prior with chronic lymphocytic leukemia, had only just finished a round of chemotherapy, and was awaiting a final check-up.
“The irony is that when I was asked to come interview with Vice President Biden, I had to cancel my last appointment,” Simon said. “My doctor said: You’re an idiot, don’t come see me! Go see Biden.”
With Simon as the federal initiative’s director and a new policy aide, Carnival, Biden pushed the cancer moonshot forward relentlessly until his final days in office. One of the moonshot’s largest accomplishments to date — a National Cancer Institute collaboration with a dozen major pharmaceutical companies to speed clinical trial availability — came online just nine days before Trump’s inauguration.
So tireless was his advocacy, many longtime Biden associates recalled, that outside cancer researchers delivered Biden a simple message: he could not allow departing office to put a stop to his cancer work, especially in light of Trump’s election and the ensuing health-care unpredictability.
It was a success, Jaffee said, that speaks to the vice president’s ability to organize like a politician — even in an apolitical arena.
“He has developed a grassroots initiative over the past few years that’s like no other I’ve ever seen in cancer research,” she said.