Public Health, Medical Research and the Cancer Moonshot: A Collaboration to Change the World

Historical Context & Scientific Inflection Point

• 1954 Gallup Poll: 62% of Americans predicted the moon landing would not occur in the century; 38% predicted it would.
• 1957 Gallup Poll: 81% believed cancer would be conquered in the century following the polio vaccine; 19% were skeptical.
• 1969: The moon was landed only 15 years after the 1957 Sputnik launch accelerated the timeline.
• 1971: President Nixon signed the National Cancer Act.
• Current Status: Vice President Biden identifies an "inflection point" due to scientific coalescence in the last 3–4 years, requiring a shift from siloed research to collaborative, data-driven approaches.

The "Cancer Moonshot" Strategic Framework

• Metaphor Clarification: Dr. Francis Collins notes the "Moonshot" term is imperfect; unlike the singular engineering goal of the moon landing, cancer comprises hundreds of distinct diseases requiring varied strategies, with progress likely measurable within 10 years but a "cure" potentially centuries away.
• Seven Strategic Themes:
  • Prevention: Focus on cancer vaccines and public health interventions.
  • Early Detection: Development of highly sensitive blood tests for screening, specifically targeting difficult cancers like pancreatic cancer.
  • Single Cell Analysis: Moving from averaging tumor data to analyzing individual cell evolution, immune interactions, and vascular cells within the tumor.
  • Immunotherapy: Expanding successes in leukemia, lymphoma, and melanoma to solid tumors (pancreatic, prostate, breast) via checkpoint inhibitors and CAR-T cells.
  • Pediatric Cancer: Targeting specific solid tumors in children (e.g., rhabdomyosarcoma, DIPG) where current outcomes remain poor.
  • Data Sharing: Dismantling "silos" through regulatory "carrots and sticks" to enable big data analysis across clinical trials.
  • Exceptional Opportunities Fund: A one-year fund to support high-risk, out-of-the-box ideas for revolutionary breakthroughs.

Funding & Timeline

• President's FY18 Budget Proposal: $680 million for NIH and $75 million for the FDA to launch the initiative.
• Implementation Schedule: Expectation to mature the scientific agenda by summer, with full execution planned for Fiscal Year 2017 (starting October).
• Context: This follows a rare $2 billion NIH budget increase over the last decade, reversing a long-term downward trend.

Industry & Public-Private Partnerships

• Pharmaceutical Role: Bob (representing big pharma) acknowledges the $100 billion annual industry R&D spend but argues the Moonshot's value lies in leadership, prioritization, and preventing duplication rather than just financial injection.
• Accelerating Medicines Partnership (AMP): Cited as a successful precedent (50/50 NIH/pharma funding) currently operating for diabetes, Alzheimer's, rheumatoid arthritis, and lupus; a similar model is proposed for cancer, focusing on pre-competitive basic science and shared clinical trial biomarkers.
• Access to Care: Bob emphasizes that innovation must be coupled with access, noting significant delays (e.g., 5–6 years) for drug availability in Canada/Australia compared to the U.S. due to pricing/reimbursement structures.
• Logistical Barriers: Frida highlights that "zip code" and systemic logistics (biopsy handling, transport times, clinician knowledge) often prevent patients from accessing existing targeted therapies like those for ALK-positive lung cancer.

Public Health & Prevention Strategy

• Schools of Public Health: Linda Fried (representing 106 schools) asserts public health science must be integral to the Moonshot to address environmental drivers, community risk factors, and "precision prevention."
• Prevention vs. Treatment: Emphasis on the fact that 80–90% of lung cancers are smoking-related; prevention requires addressing behavioral and environmental risks, not just treating individuals.
• Longitudinal Data: References the Framingham Heart Study (started 1948) to argue that decades of data collection are necessary to understand gene-environment interactions, justifying the new Precision Medicine Initiative.

Precision Medicine Initiative (PMI)

• Scope: A project to enroll 1 million Americans over three years in a prospective cohort.
• Data Integration: Participants will share electronic health records, undergo lab tests, and use wearable sensors to track environmental exposures and body performance.
• Data Scale: Expected to generate a dataset 40 times larger than the Framingham cohort.
• Recruitment Strategy: Partnership between Vanderbilt and Verily (Google Life Sciences) to leverage Silicon Valley technology for enrollment; pilot phase funding announced 10 days prior to the panel.
• Cost Estimates: Estimated cost of several hundred dollars per person, with discussions on potential philanthropic funding models (e.g., $1,000 per person covered by donors).

Communication & Public Engagement

• The "Moonshot" Perception Risk: Panelists warn against overpromising a specific end date for a cure, noting that 45 years after the 1971 Act, public expectations remain managed by a history of "failed" announcements.
• Patient Autonomy: 70% of cancer patients previously indicated willingness to waive HIPAA protections if their data could aid research.
• Global Collaboration: Acknowledgment of international efforts, including China's Kadoorie Study (500,000–1,000,000 participants) and the UK Biobank (500,000 participants), with a push to knit these data sources together.
• Employer Role: Pharma leaders advocate for corporate wellness programs (e.g., Pfizer's smoking cessation, fitness initiatives) to control long-term healthcare costs and drive health outcomes.

Audience Interaction & Trivia

• Vaccination Rate: The panel identified Mississippi as the U.S. state with the highest rate of childhood vaccinations, attributed to lower wealth populations prioritizing vaccine access.
• Longevity Gender Gap: In a demonstration, the panel revealed that 80% of Americans over age 100 are women.
• Future Inquiry: The panel committed to investigating the biological and environmental reasons for the high disparity in longevity between men and women in the 100+ age bracket.