Why has President Biden's administration been staggering when it comes to key scientific appointments? Most noticeably, there has been a failure to confirm a new director of the National Institutes of Health (NIH) since Francis Collins stepped down a year ago. It took nearly a year to nominate the Commissioner of the Food and Drug Administration (FDA), Robert Califf. And regrettably, Biden began his presidency with the nomination of geneticist Eric Lander as the first science adviser to the president and director of the White House Office of Science and Technology Policy (OSTP). A year later, Lander resigned in disgrace because of abusive behavior toward staff. Although recent appointments provide some confidence [including Monica Bertagnolli as director of the National Cancer Institute (NCI), Joni Rutter as director of the National Center for Advancing Translational Sciences, and Arati Prabhakar as the new director of OSTP], the most high-profile biomedical job in the United States-NIH director-remains unfilled.