When Biden first announced ARPA-H (Advanced Research Projects Agency for Health) I was skeptical. At the time the proposal was to make ARPA-H a normal agency within the NIH. When critics argued that the NIH bureaucracy would likely reduce the amount of innovation that ARPA-H could produce the administration listened and US health secretary Xavier Becerra decided to make ARPA-H an independent entity within the NIH.

Appointing Renee Wegrzyn as the head of ARPA-H is an excellent choice. Having previously worked at DARPA and IARPA and not in the NIH makes her a good person to copy the structure of how DARPA and IARPA get things done.

Being 45, she is twenty years younger than the average director of an institute at the NIH who is 65. When science sometimes evolves from gravestone to gravestone, it’s great to see a director for the ARPA-H who’s in her forties. Especially, in contrast to the newly appointed NIH director Lawrence A. Tabak who is a 71-year-old (a fact that his NIH biography omits) having a 45-year-old lead ARPA-H is a welcome surprise.

While at DARPA, Wegrzyn worked on biosecurity and even gave a talk about the importance of biosecurity to the Long Now Foundation. It’s valuable to have people who care about biosecurity at the top of organizations that direct a lot of research dollars. 

A lot of the research focuses either on directly curing diseases or on basic research but the research that focuses on producing tools for better research is historically underfunded. Wegrzyn experience as vice president of business development at Gingko Bioworks which is a unicorn biotech company that historically doesn’t focus on curing diseases directly but providing tools to help other companies, gives me hope that ARPA-H will be able to fund research into producing better tools to deal with biological problems. During COVID-19 they worked on producing COVID tests which was likely a lesson in the flaws of government bureaucracy holding back innovation.

In an interview she described her own research as being guided by the question of ‘what do we know about protein folding that can help us develop a totally new type of diagnostic?’ I’m happy to see that and think it will lead to better research paths than having someone who focuses more on creating FDA approved drugs in charge of allocating research funding.

She coedited Alzheimer’s Disease Targets for New Clinical Diagnostic and Therapeutic Strategies in 2012. It seems to me that one of the more important issues in Alzheimers research funding is the overinvestment in the amyloid cascade hypothesis. The book gets that issue right when it argues “Until recently, the amyloid cascade hypothesis had been the predominant working hypothesis for AD pathogenesis. However, this hypothesis has been supplanted by what some have called the oligomer cascade hypothesis, which posits that Aβ oligomers, rather than fibrils, are the proximate neurotoxic agents in AD” I think she showed excellent judgment by writing a book that argued for directing our Alzheimer research dollar to other paths than the amyloid cascade hypothesis (that part isn’t written by her directly).

In the essay that she wrote herself, she argues “Drug discovery and development for the treatment of Alzheimer’s disease would greatly benefit from biomarkers that are predictive of clinical outcomes to inform the selection of effective drug candidates, monitor dose safety and efficacy on treated cohorts, and identify or confirm the mechanisms of drug action in hopes of developing treatments that go beyond symptomatic relief and are disease modifying. The ability to monitor disease progression longitudinally during patient treatment will also be key to the development of effective Alzheimer’s disease therapies.“. 

I agree with her that focusing a larger share of the research dollars on diagnostics will allow better drug development. If ARPA gives out 5-year grants of single digits millions to individual projects that is an amount of money that’s not enough to develop a new drug and bring it to market but it might allow diagnostic projects to be successfully completed.  

I’m generally very critical of government health policy, but in this case, I couldn’t imagine someone with a better background for the job and I applaud the appointment of Renee Wegrzyn as director of ARPA-H. I wish her a long tenure and that congress will fund ARPA-H well.