Biden’s Cancer Moonshot’s Last Acts: Easing Pediatric Drug Shortage

The Wall Street Journal – Monday, October 28, 2024
By Brianna Abbott

The Biden administration took steps to alleviate shortages of cancer drugs for children, part of a final push for one of the president’s domestic priorities: reducing the nation’s cancer burden.

The federal government is testing a new way to prevent treatment disruptions for seven pediatric cancer drugs by improving communication between hospitals, nonprofits and wholesalers. Shortages of cancer medicines regularly plague hospitals and patients, sometimes forcing them to delay or change care.

“No one in this country should struggle for access to the treatment they need, but kids and families facing cancer in particular,” said Danielle Carnival, an adviser to Biden who leads his “Cancer Moonshot” effort.

The Cancer Moonshot is one of Biden’s signature efforts and important to his legacy as he leaves a lifetime of public service. Cancer experts said that despite modest funding, it spurred new cooperation and some gains against the second leading cause of death in the U.S., behind heart disease.

“When was it this level of presidential priority, except Nixon?” said Karen Knudsen, chief executive officer at the American Cancer Society.

Biden introduced the effort as vice president in 2016. The year before, his son Beau died at 46 from glioblastoma, an aggressive brain cancer against which doctors haven’t made as much progress as other forms of the disease.

As president, Biden added a goal of reducing the U.S. cancer death rate by at least half by 2047 and put more emphasis on prevention and access to care. The cancer death rate in the U.S. has dropped by a third since 1991.

Congress in 2016 allocated $1.8 billion to the plan over seven years through the National Cancer Institute for research including new drugs and early detection technologies. Last year, spending on the plan accounted for $216 million of the NCI’s $7.2 billion budget.

Other agencies executed and funded parts of the plan, too, including a biomedical research agency created under its auspices, called ARPA-H, and the Environmental Protection Agency. The work included funding for early-career scientists, expanded cancer screenings and antismoking programs as well as insurance reimbursement for services that help patients navigate treatment.

“They can tangibly take some credit in reducing some cancer disparities within the U.S.,” said Dr. Robert Winn, director of the VCU Massey Comprehensive Cancer Center in Richmond, Va.

Some pharmaceutical executives said progress for patients was undermined by drug-price negotiations the Biden administration implemented in legislation called the Inflation Reduction Act. They said the negotiations will stifle innovation in drug development.

“The administration has made very important progress in setting cancer as a national policy priority,” said David Fredrickson, executive vice president of AstraZeneca’s oncology business unit. “Those steps forward have been taken backwards by the shadow of the IRA.”

Biden has introduced more work on cancer since dropping his re-election bid. He visited Tulane University in New Orleans in August to dedicate $150 million in ARPA-H funds to develop methods for precision cancer surgery. In September, he expanded policies to reduce cervical cancer in the Indo-Pacific.

“I will keep fighting for my Cancer Moonshot, so we can end cancer as we know it, because we can do it,” Biden said from the Oval Office in July when he dropped out of the presidential campaign.

Cancer drug shortages, the problem the administration set plans to alleviate on Monday, are common. Low margins on cheap, generic drugs including chemotherapies have resulted in a fragile supply chain. When something goes wrong, some hospitals hoard supply, while others delay or scale back treatment.

“It’s almost every hospital by itself, and that’s what we’re really trying to get away from,” said Brian O’Neal, a senior vice president at Children’s Mercy Kansas City.

The hospital is one of several that will closely track and flag the status of their drug supplies with a green, yellow or red stoplight system. Each color will correspond to specific steps to reduce excess buying and prevent disruptions in treatment. A nonprofit called the End Drug Shortages Alliance will coordinate the system and publish the findings. The hope is to add more hospitals and manufacturers after the six-month trial period.

“That could really make a difference,” said Dr. James Amatruda, chief of pediatric hematology-oncology at Children’s Hospital Los Angeles, which isn’t involved in the pilot.

Blanca Alvarado of Wichita, Kan., was on a family vacation in 2023 when the youngest of her three children developed leg pains, fevers and a stiff neck. Days later, her daughter Giana was diagnosed with acute lymphoblastic leukemia, at age 7. A few months later, her pharmacist said there was a chance the chemotherapy drug methotrexate wouldn’t be available for Giana’s next appointment.

Alvarado panicked. But the hospital soon told her that Giana’s next dose would be there.

Giana is now in the third grade, loves to draw and is expected to finish treatment in July 2025. She takes an oral chemotherapy drug every day. Alvarado worries constantly about whether she will be able to get as much as she needs.

“It’s scary to not know what we’re going to be facing tomorrow,” Alvarado said.

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