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Lander, Collins Offer Vision for Advanced Research Projects Agency for Health

NEW YORK — A vision for a new science entity, called the Advanced Research Projects Agency for Health, or ARPA-H, was presented by White House Office of Science and Technology Policy Director Eric Lander and National Institutes of Health Director Francis Collins in Science on Tuesday.

Earlier this year, President Joe Biden requested $6.5 billion in fiscal 2022 funding to establish the ARPA-H within the NIH in order to develop breakthroughs for the prevention, detection, and treatment of diseases like Alzheimer's disease, diabetes, and cancer.

The agency, Biden said, should be modeled on the Defense Advanced Research Projects Agency, which is focused solely on new technologies to enhance national security. In their commentary, Lander and Collins noted that DARPA has a "distinctive organization and culture that contrasts with traditional approaches in biomedical research."

DARPA, they wrote, is driven by program managers, or PMs, and office directors who "typically bring bold, risky ideas, and … are given the independence and sufficient resources to pursue them, mitigating risk through metric-driven accountability and by pursuing multiple approaches to achieve a quantifiable goal."

Using DARPA as a template, ARPA-H's mission could be "to make pivotal investments in breakthrough technologies and broadly applicable platforms, capabilities, resources, and solutions that have the potential to transform important areas of medicine and health for the benefit of all patients and that cannot readily be accomplished through traditional research or commercial activity," Lander and Collins stated.

ARPA-H's focus should also be broad, ranging from molecular to societal, because breakthrough technologies are needed and are possible at many levels. Potential projects for ARPA-H could include the development of accurate and affordable biomonitors, vaccines to prevent most cancers, approaches to accelerate the discovery of blood biomarkers of Alzheimer's disease, and new manufacturing processes for personalized T-cell cancer therapies.

And, like DARPA, its organization should be "flat, lean, and nimble," with a culture that values "bold goals with big potential impact over incremental progress." PMs should come from diverse backgrounds in academia and industry, be term limited, and be empowered to take risks and responsibility for project outcomes.

Still, DARPA isn't a perfect model for biomedical and health research, Lander and Collins cautioned. DARPA has a single customer — the US Department of Defense — and its projects typically involve engineering teams. Health breakthroughs, in contrast, "interact with biological systems that are much more complex and more poorly understood than engineered systems." They also interact with a complex world involving customers, patients, physicians, hospitals, biopharma companies, and payors; interact in complex ways with human behavior and social factors; and require navigating a complex regulatory landscape.

"ARPA-H can learn from DARPA, but will need to pioneer new approaches," Lander and Collins added.

Lander and Collins also noted that it will be critical for ARPA-H to "engage with the broader biomedical community, including patients and their caregivers, researchers, industry, and others, to understand the full range of problems and the practical considerations that need to be addressed for all groups and populations."

"Through bold, ambitious ideas and approaches, ARPA-H can help shape the future of health and medicine by transforming the seemingly impossible into reality," they concluded. "The time to do this is now."

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