With an annual budget of $6.3 billion, NIAID is the second largest of the NIH's 27 institutes and centres, after the National Cancer InstituteCancer Institute. Acting NIH director Lawrence Tabak stated that Marrazzo "brings a wealth of leadership experience from leading international clinical trials and translational research, managing a complex organisational budget that includes research funding and mentoring trainees in all stages of professional development." NIAID supports research at universities and research organisations around the US and across the unit's 21 laboratories, including the Vaccine Research Center where Ted Pierson was recently appointed director. It is also mandated to respond to emerging and re-emerging public health threats in the US and abroad. Hugh Auchincloss has been acting director of NIAID since Fauci's departure at the end of last year. The NIH can install Marrazzo in the post without a presidential appointment or confirmation by the US Senate. Meanwhile, the Biden administration has not been able to secure a permanent appointment to run the broader NIH agency after long-time director Francis Collins stepped down at the end of 2021. Monica Bertagnolli was nominated in May, but Senator Bernie Sanders has said he will not hold a hearing on any health nominee until he sees a "robust" plan from the White House about lowering drug prices.