Dr. Collins reflects on career at NIH, COVID response effort, work on genome sequencing

Judy Woodruff speaks to Dr. Francis Collins, who is retiring from his role as director of the National Institutes of Health after more than a decade, about his career. He warned that the U.S. may face a million COVID cases a day this winter if it doesn't take precautions. Before he became NIH director, he was known for his work on genetics and helped map the finished sequence of the human genome.

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  • Judy Woodruff:

    Now let's return to the challenges of COVID and the perspective of the director of the National Institutes of Health.

    Dr. Francis Collins is retiring from that position after more than a decade. And he is warning that, if the country doesn't take all the necessary measures, we could face a million cases a day in the U.S. this winter.

    Before he became NIH director, he was known for his work on genetics. He helped discover the gene that causes cystic fibrosis, and then he led the government's efforts to map the finished sequence of the human genome, the instructions in our DNA. As NIH director, he led efforts to grow its budget to $50 billion annually.

    I sat down with him recently at the NIH.

    Dr. Francis Collins, thank you very much for talking with us.

    Dr. Francis Collins, Director, National Institutes of Health: Glad to be with you right here at NIH.

  • Judy Woodruff:

    So, Dr. Collins, here we are in the middle of the worst pandemic this country has faced in a century, and you have announced you are retiring as the head of this essential medical public health institution, NIH.

    Does that compute?

    (LAUGHTER)

  • Dr. Francis Collins:

    Well, it better because it's happening.

    I think it does, Judy. There will never be a perfect time to say it's time to step down. I have been NIH director now for more than 12 years, serving three presidents. That's never happened before. NIH directors are appointed by the president, and they generally leave when the president does.

    So, I have outlasted my shelf life by about a factor of two. And I decided back a few months ago that, if I wasn't going to stick it out for the indefinite future, I need to give a chance for President Biden to identify a new director and nominate that person.

    And let me reassure you, as far as COVID, the science that NIH has done in the last two years has been astounding, but the people leading that effort, they're not going anywhere. And the team is just rock-solid, dedicated, committed, smart. We will be OK here at NIH.

  • Judy Woodruff:

    Well, I wanted to ask you about that.

    I mean, what — if you had to pin down the main contribution NIH has made during this COVID pandemic?

  • Dr. Francis Collins:

    The most visible one, the vaccines, development of those mRNA vaccines, Pfizer and Moderna, based on 25 years of really hard-won basic science advances that nobody was really paying much attention, to get that approved by the FDA.

    We were smack in the middle of that. That would never have happened without all the NIH efforts.

    Therapeutics. I worked with industry building an unprecedented partnership that brought 20 companies, all of the NIH institutes, the FDA and the CDC around the same table, designing master protocols, figuring out how to prioritize which things ought to be tested first. And ultimately out of that came monoclonal antibodies that do work therapeutically.

    And then diagnostics. The fact that there are diagnostic tests on the pharmacy shelves, we had a lot to do with that. The fact that today there will be about two million tests that are run, we had a lot to do with that.

  • Judy Woodruff:

    And is there something you would wish you could have emerged from NIH?

  • Dr. Francis Collins:

    You know, maybe we underinvested in research on human behavior.

    I never imagined a year ago, when those vaccines were just proving to be fantastically safe and effective, that we would still have 60 million people who had not taken advantage of them because of misinformation and disinformation that somehow dominated all of the ways in which people were getting their answers.

    And a lot of those answers were, in fact, false. And we have lost so much as a result of that.

  • Judy Woodruff:

    Your specialty going back many years is genetics, a physician researcher. You started working in that area decades ago.

    You have done, what, groundbreaking work, work that led to cracking the human genome. What has that meant to you?

  • Dr. Francis Collins:

    It was an amazing adventure that I did with 2,400 other scientists in six countries, because that's what it took to read out that first copy of the human genome, those three billion letters of our own instruction book.

    It had this sense of significance, of history, that we are crossing a bridge into a territory where we know our own instruction book. For all of history, we haven't known that. Now, it's written in a language we're still trying to figure out how to read accurately, so the work on the human genome will be going on for a long time.

    But we had it. And it was public. It was on the Internet. We made sure of that too. It's our shared inheritance.

  • Judy Woodruff:

    You mentioned how far we have come, that it's going to go on for years.

    There was a lot of talk in the beginning, a lot of promise, I think, that it would lead to breakthroughs right away in a number of illnesses, diseases. That's taken longer than originally thought, hasn't it?

  • Dr. Francis Collins:

    Than some would have thought.

    You know, there's something called the first law of technology, that when there is a breakthrough discovery, and it really is something significant, people will always overestimate its short-term consequences and underestimate its long-term consequences.

    I think the Genome Project is a perfect example. There were some statements — I hope I didn't make them — saying, OK, when you go to your doctor next week, it's all going to be different.

    No. But look at where we are now and where we may be 20 or 30 years from now. It's transformative. By the way, you go to any research lab, like mine across the way here, we couldn't do anything without the genome and its technologies. I mean, everybody who's working in human medicine is basing a lot of what they're doing on that as an anchor.

  • Judy Woodruff:

    You are known, Dr. Collins, to pay a lot of attention to moral and ethical considerations around the genome questions, genetic research.

    You have been critical of the way the gene editing technology has been used unethically before, this technique CRISPR, not necessarily that, per se, but as some scientist outside the United States have used it. But do you worry that we may get too far down that path at some point soon?

  • Dr. Francis Collins:

    I worry.

    I think we already saw one example, where a Chinese scientist, despite the pretty general international agreement that gene editing should not be used for human embryos, did so anyway. I don't think that's happened since because of the strong outcry.

    This is such a paradox, though, Judy, because gene editing applied in other places, not to embryos, but to people with sickle cell disease to fix what's causing their disease by editing their bone marrow, is like one of the most exciting, most amazing developments in the last five years, one that I'm wildly enthusiastic about, and have put a lot of NIH resources into it.

    But that's very different. That doesn't get into the hereditary DNA that's going to get passed to the next generation. If you're doing hereditary DNA on humans, you have crossed a line into territory that I don't think we are smart enough to go into and that has consequences, both in terms of safety, but also in terms of theology and philosophy about, are we going to reinvent who we are?

    I don't think we're ready to do that.

  • Judy Woodruff:

    Your faith. You have been very open about your Christian faith. How has it changed your work, do you think?

  • Dr. Francis Collins:

    I think I'm really fortunate to be somebody who has both a scientific approach to understanding how nature works and a spiritual approach to understanding things that science doesn't help me much with, like, why am I here, what is the nature of morality?

    For me as a scientist, though, it takes on additional consequences when a new discovery happens, because I see God as the author of all that we have been given. That means that the laboratory is also potentially a cathedral, because what we're doing is to learn how to be even more amazed at what we have been given as human beings surrounded by a beautiful world.

  • Judy Woodruff:

    Dr. Francis Collins, thank you very much for talking with us. We appreciate it.

  • Dr. Francis Collins:

    Thanks, Judy.

    And may I say, it has been an absolute privilege to serve the National Institutes of Health for these 12-plus years. I love the NIH. I have loved my job. I love what medical research has been able to do and will continue to do.

  • Judy Woodruff:

    Thank you.

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