Donald Trump introduced Thursday that Robert F. Kennedy Jr. can be his nominee to guide the Division of Well being and Human Companies (HHS), setting the stage for a probably radical remaking of the nation’s well being care.
Kennedy’s nomination was not a shock. Final month, Kennedy mentioned Trump had promised him management of the division and its many subagencies, which embrace the Facilities for Illness Management and Prevention (CDC), the Meals and Drug Administration (FDA), the Nationwide Institutes of Well being (NIH), the Facilities for Medicare and Medicaid (CMS), and others. Trump himself pledged in the course of the marketing campaign to let Kennedy “go wild on well being.”
It’s a perplexing decide. Kennedy has spent a long time spreading anti-vaccination pseudoscience, and the group he leads, Youngsters’s Well being Protection, has been one of many foremost anti-vaccine advocacy teams within the US and overseas. His work in help of a Samoan anti-vaccine group helped gasoline a wave of vaccine hesitancy within the island nation, resulting in a 2019 measles epidemic that killed 83 individuals, most of them youngsters.
He’s expressed a variety of different conspiracy-laden concepts about well being: He says fluoride is industrial waste linked to a variety of illnesses, and recommended it needs to be eliminated from all US water methods. He has speculated that gender dysphoria might outcome from herbicide publicity and implied mass shootings are linked to antidepressants.
Kennedy does maintain different views that align with many scientists: He traces America’s excessive ranges of continual illness to the widespread availability of extremely processed, non-nutritious meals, which he and diet coverage specialists blame partly on damaged agriculture coverage. He’s railed in opposition to corruption and conflicts of curiosity within the FDA’s drug approval course of that favor massive pharmaceutical firms over the pursuits of people — one thing economists, scientists, and shopper advocates agree on.
Irrespective of the place an individual stands on the political spectrum, they’ll in all probability discover one thing to agree with Kennedy on. He’s the personification of the rising mistrust of science and “the general public well being institution” that many People have felt within the post-pandemic period.
HHS secretaries are normally seasoned bureaucrats with numerous expertise shifting coverage by authorities businesses — a state insurance coverage commissioner in Barack Obama’s case or a tenured pharma govt in Donald Trump’s first time period. They usually perceive how science is completed and what it means for a well being intervention to be grounded in proof.
Kennedy doesn’t have that résumé — removed from it. Now he’ll be in control of a lot of US well being care, which raises the query: How a lot injury can he really do on this position?
The reply will rely on just a few issues. First, he needs to be confirmed by the Senate (until the White Home makes an attempt to circumvent that chamber’s constitutional “advise and consent” powers) and Republicans have solely a slim majority. Even when Kennedy is confirmed, Trump has different necessary well being care appointments to make — notably for CMS, NIH, FDA, and CDC — and people individuals will maintain sway over the administration’s well being care agenda too. They could possibly be within the Kennedy vein or, as we now have seen with Trump’s overseas coverage picks, a mixture of the standard and the iconoclastic.
For now, nevertheless, Kennedy’s appointment is a watershed second that would portend monumental modifications to the American well being system. Republicans in Congress will management the HHS funds, and Kennedy, if confirmed, might have broad discretion to pursue his “Make America Wholesome Once more” agenda with Trump’s blessing. If the Trump administration makes an attempt to take away civil servants throughout the federal government, together with the well being businesses, a long time of public well being data could possibly be misplaced on the CDC, FDA, and elsewhere. It’s unsure if the Republican-dominated judiciary would step in to cease any of it.
Right here’s what we all know in regards to the Trump well being division’s plans — and what hurdles might await them.
What RFK Jr. can — and might’t — do on vaccines, briefly defined
Over the past 30 years, vaccines have saved the lives of greater than 1.1 million youngsters within the US alone. Over the identical interval, they’ve additionally saved People $540 billion in direct well being care prices and trillions in social prices. Routine vaccines defend American youngsters from 16 illnesses.
Trump himself recommended blocking funding for native faculties with vaccine necessities in the course of the marketing campaign, although the federal authorities has restricted authority to take action. Regardless of Kennedy’s lengthy historical past of anti-vaccine rhetoric, he mentioned in early November he wasn’t planning to take anybody’s vaccines away.
“Individuals should have alternative, and that alternative ought to be told by the most effective data,” Kennedy mentioned in an NBC Information interview. “So I’m going to ensure scientific security research and efficacy are on the market, and folks could make particular person assessments about whether or not that product goes to be good for them.”
Nonetheless, a co-chair of Trump’s transition group not too long ago mentioned Kennedy hoped to entry federal well being knowledge with the aim of proving vaccines are unsafe and pulling them from the US market.
That’s not as straightforward to do because it sounds.
Undoing the approval of an already permitted vaccine would require submitting proof of hurt that meets the FDA’s requirements to show hurt, which merely doesn’t exist. Though a Trump-installed loyalist might theoretically rewrite the FDA’s requirements, that may possible result in opposition from the pharmaceutical firms that produce these vaccines. There can be a wave of pricey and extended lawsuits for the federal authorities.
Drugmakers additionally wield affect in Congress, which writes the regulation that units pharmaceutical trade charges that cowl almost half of the FDA’s funds. That regulation will must be reauthorized earlier than the tip of Trump’s time period, organising a probably vicious struggle if the 2 sides are at odds over vaccines.
There’s a extra life like transfer Kennedy might take to deal with his concern about vaccine uncomfortable side effects: He might resuscitate the Nationwide Vaccine Program Workplace, which monitored vaccine security with specific rigor however was shuttered underneath the primary Trump presidency.
Though it will be tough to drag vaccines from the American market, and Kennedy says he gained’t, there are different methods he might exert affect to cut back vaccine uptake.
Kennedy might attempt to affect the CDC. That company has two necessary roles in selling vaccines within the US: It convenes an Advisory Committee on Immunization Practices to offer knowledgeable suggestions on who ought to get which vaccines and at what age, and it administers the Vaccines for Youngsters program, which supplies free vaccines for kids in low-income households.
The advisory committee shouldn’t be mandated by federal regulation — it’s convened provided that the CDC needs it to be. A vaccine skeptic appointed to run the CDC underneath Kennedy might both employees the committee with anti-vaccination activists or dissolve it fully. That may imply the company would not present extensively accepted tips for vaccination that state well being departments and lots of of 1000’s of clinicians nationwide now depend on.
The Vaccines for Youngsters program is funded by a pot of cash that Congress units apart for the CDC yearly. Kennedy might press Congress and the White Home to easily reduce that funding, ending this system fully. That would depart low-income households having to pay out of pocket to vaccinate their youngsters.
Kennedy may even be finally answerable for two big public insurance coverage applications: Medicare, which covers seniors, and Medicaid, which is overseen by the states and covers low-income individuals.
In each applications, the amount of cash disbursed by the federal authorities is partly decided by how good of a job the states and personal insurers do in vaccinating youngsters and older adults enrolled in these applications. Kennedy might stress the CMS administrator to eradicate that vaccination requirement, one motive Trump’s alternative at CMS will likely be one to look at.
It’s not clear what the timeline can be to perform any of those duties; there’s no precedent for a president and HHS secretary who’re so overtly hostile to US public well being infrastructure assuming management of it. Even when it takes some time, there’s widespread concern that giving such a platform to somebody who denies vaccine science might additional degrade public belief not solely within the vaccines, however within the many different well being suggestions and interventions that collectively comprise American public well being and well being care. Already, extra remoted outbreaks of measles and different illnesses that had beforehand been stamped out by vaccines are occurring on the identical time vaccination charges are slipping.
Paul Offit, a pediatric infectious illness physician who directs the Vaccine Training Heart on the Youngsters’s Hospital of Pennsylvania in Philadelphia, mentioned Kennedy has had such an enormous platform for therefore lengthy that it’s unlikely he’ll be capable of scare individuals about vaccines greater than he already has. It’s in delivering the vaccines by applications like Vaccines for Youngsters the place he might maybe do the injury: “If he have been in a position to disrupt that, that may be an issue.”
Can RFK Jr. actually take away fluoride from US water?
The US started fluoridating ingesting water in 1945. An estimated 209 million People now drink faucet water that incorporates added fluoride. The intervention is taken into account a historic public well being win: It dramatically reduces tooth decay in youngsters and likewise reduces tooth loss in adults.
Kennedy, nevertheless, has mentioned he would instantly advise the removing of fluoride from native water provides. Why? As a result of he’s exaggerating the precise threat.
Many of the fluoride and US faucet water is added by water utility firms, however some faucet water incorporates naturally occurring fluoride it absorbs from the native water desk. The ensuing high-fluoride faucet water, which about 2 million People drink, incorporates about twice the quantity of fluoride the US authorities recommends. Based on a latest report from the US Nationwide Toxicology Program, ingesting high-fluoride water could be linked to barely decrease IQ scores — by 2 to five factors in some youngsters — although IQ scores are an unsure measure of intelligence.
Nonetheless, there isn’t a indication that faucet water containing regular fluoride ranges poses this threat — and its advantages to youngsters’s and grownup’s dental well being are immense.
The choice to fluoridate water is one which occurs on the state and native degree, which is why Kennedy might solely advise fluoride’s removing. Nonetheless, his management at HHS might give a gap to anti-fluoride motion on the state degree, the place Republican leaders are more and more hostile to what had been settled public well being practices.
Kennedy’s “Make America Wholesome Once more” marketing campaign on meals and continual illnesses
Kennedy has known as for a marketing campaign in opposition to continual illness that he’s branded as “Make America Wholesome Once more.” It’s an ambiguous and wide-ranging platform, however the constant theme is undoing what Kennedy sees as Huge Pharma and Huge Agriculture’s undue affect on what People eat and the way they handle their well being over time.
A few of the concepts share the identical pseudoscience as Kennedy’s views on vaccines. Kennedy not too long ago posted on social media that the FDA had “waged a battle on public well being” by “aggressive suppression” of People’ entry to uncooked milk, amongst different issues. States aren’t required to pasteurize milk, however the FDA requires milk bought throughout state traces to be pasteurized. Regardless of uncooked milk’s threat of inflicting life-threatening diarrheal illnesses (and now, hen flu), states can already carve out exceptions that permit their residents to drink it.
A few of Kennedy’s concepts about meals are extra rooted in actuality. For instance, his tackle diet’s position in continual illness: He has appropriately famous that the US has developed a horrible document on stopping diabetes, coronary heart illness, and unhealthy weight, and locations the blame the place dietary specialists do — on permissive authorities insurance policies and dietary tips that promote consuming plenty of ultra-processed meals and low ranges of bodily exercise in faculties.
As a part of his struggle in opposition to ultra-processed meals, Kennedy not too long ago mentioned he needs to cast off whole departments on the FDA, together with the Heart for Meals Security and Utilized Diet. Based on latest reporting in Science, he might certainly stress whoever is appointed to guide the company to eradicate that heart, which makes Trump’s alternative for FDA commissioner a important one in setting his administration’s public well being agenda.
Nonetheless, if Kennedy needs to limit the usage of already-approved meals components, he wants extra assets — not fewer: The method entails rigorous evaluations of knowledge, issuing public warnings, and actively monitoring the meals provide. If Kennedy succeeded in closing the meals security workplace, that would cut back the quantity of people that could possibly be devoted to the job, making it tougher somewhat than simpler to rein in the usage of these merchandise.
Different actions could possibly be taken by the Trump administration to cut back the quantity of ultra-processed meals within the American meals provide, however a lot of them can be taken exterior of HHS. The US Division of Agriculture (USDA) units the rules that govern college lunch applications, which suggests a lot of what youngsters eat is decided by that company; Trump has not but nominated a USDA commissioner. The USDA can be primarily answerable for overseeing manufacturing facility farming, one other trade Kennedy has closely criticized all through his public profession and pledged to focus on if he have been to take a job within the federal authorities. He would possible have to work with the USDA to comply with by.
Kennedy is appropriate that meals security regulation within the US is at present a large number, says David Acheson, an infectious illnesses physician who has led meals security efforts at each the USDA and the FDA. Meat, poultry, and egg vegetation are inspected each day underneath the auspices of the USDA, whereas each different sort of meals manufacturing facility — together with the farms whose produce is answerable for many of the food-borne sickness within the US and the nation’s numerous different industrial meals producers — are inspected by FDA inspectors at most annually.
It will make way more sense to unify these capabilities underneath one company and harmonize the frequency of meals manufacturing facility inspections so none are falling by the cracks. That’s the sort of organizational shake-up that would really make a distinction.
Acheson would additionally wish to see Kennedy tackle the FDA’s course of for regulating dietary supplements, that are at present topic to lax oversight regardless of apparent well being dangers.
What occurs to NIH in a second Trump time period?
At a city corridor earlier this yr, earlier than dropping out of the race for president, Kennedy mentioned that if elected, he’d inform the NIH to pause drug growth and infectious illnesses analysis for eight years and as an alternative give attention to continual illnesses. He additionally pledged throughout his personal marketing campaign for president that he would block “achieve of operate” analysis — wherein scientists purposefully make viruses extra harmful in hopes of studying how you can higher fight them — that has come underneath extra scrutiny because the pandemic.
Other than the truth that the NIH already spends about $20 billion yearly on continual illness, this may be disastrous: The essential analysis the company funds and conducts in its personal institutes lays the groundwork for therapies pharmaceutical firms develop to deal with most medical situations.
Kennedy has known as for firing 600 of the company’s almost 19,000 workers and changing them with new ones, who presumably can be extra eager to hold out his priorities. Conservatives have additionally floated restructuring the NIH, and Trump proposed slicing its $48 billion funds throughout his first time period.