Leading Beyond the Lab: Dr. Francis Collins on Building Consensus for Bold Policy Proposals

On Friday, February 20, Dr. Francis Collins, preeminent genomic researcher, former Director of the National Institutes of Health (NIH), and a UVA alumnus, joined UVA Batten Professor Melanie Anne Egorin in Garrett Hall for a conversation on how to rethink complex policy challenges – and how to sway others to your side. 

Egorin was serving as the Assistant Secretary for Legislation at the United States Department of Health and Human Services in Washington when she and Collins, then the science advisor for President Biden, built a policy proposal to expand access to Hepatitis C treatment nationwide.

“Dr. Collins was NIH Director when we first met, but his proposal to bring Hepatitis C treatment to millions of Americans is when we truly got to work side-by-side in the policy process,” Egorin noted. “His enthusiasm for a big idea and deep commitment to those often forgotten by our healthcare system won me over.”

Collins’ belief that the nation has a moral imperative to address the Hepatitis C health crisis motivated his tireless work to develop policies, build an implementation plan, and secure buy-in that could pave the way for eliminating the virus. 

When Egorin asked Collins what he found most surprising about the policy development work, he said, “I think I was surprised by how detailed your approach ends up having to be if you’re going to have any chance of making something happen. It’s one thing to paint a broad picture, but it ultimately comes down to what are the words in that legislative proposal.” 

Collins shared a modified version of the presentation he and Egorin used to brief members of Congress and senior staff, the Congressional Budget Office, and other key stakeholders and partners as they endeavored to socialize their bold federal policy proposal.  

In it, Collins laid the foundation for the problem – that roughly four million people in the U.S. live with Hepatitis C and CDC research indicates that only one in three diagnosed with the virus are cured, even though a one-pill-a-day treatment exists. They wanted to know, why isn’t the cure reaching everyone who needs it? 

They analyzed treatment barriers, notably high drug costs and restrictive insurance authorization requirements, and developed solutions to address them, which led to the Biden Administration’s National Initiative on Hepatitis C, proposed in March 2023.  

The administration called on Congress to embrace the proposed five-year program, and Egorin and Collins worked to build a broad coalition of support with other federal agencies and advocate organizations who sent signed letters to Hill leadership. Their efforts ultimately led Senators Bill Cassidy and Chris Van Hollen to introduce bipartisan legislation. 

Egorin and Collins also took the innovative approach of working with the Congressional Budget Office to project the estimated cost savings from increased treatment rates, which marked an important milestone in achieving additional support on the Hill. In a November 2024 evaluation, the Congressional Budget Office projected $6.6 billion in federal savings over 10 years. 

Both leaders noted that relationship building was critically important to their success. Although the bill hasn’t passed yet, Collins remains hopeful and continues to make progress in implementing the national initiative to eliminate Hepatitis C.  

Egorin also asked Collins to reflect on his time as a Hoo (‘70 B.S.) and what some of the best career advice he received was when he first started out in his career.  

“Seek out, find, and attach yourself to mentors,” Collins said. “Find experts and ask them to help you…and you’ll make friends along the way. If you have a chance, pick projects that you are both passionate about and that could be truly significant, even if there’s some risk involved.”