Robert F Kennedy Jr and Donald Trump.
Credit: Reuters Photo
By Lisa Jarvis
The worst-case scenario for health in the US is much closer to reality this week after President-elect Donald Trump said he had chosen Robert F. Kennedy Jr. to lead the Department of Health and Human Services. The environmental lawyer, who has courted conspiracies and traded in anti-science, would oversee key health agencies, including the Food and Drug Administration, Centers for Disease Control and Prevention and the National Institutes of Health.
The Senate will have to give Kennedy its approval (unless Trump follows through on a threat to use recess appointments to circumvent that process). But the fact that Kennedy has gotten this far is enough to wreak havoc on public health.
The list of his disqualifying attributes for HHS secretary is long. There’s his lack of public health expertise or experience navigating, let alone managing, a hulking government agency — one he promises to significantly overhaul, scrapping entire departments and firing hundreds. And then there’s the larger issue of his embrace of anti-vaccine activism, AIDS denialism and offensive theories about transgender children. He’s also suggested that WiFi causes cancer and blamed school shootings on antidepressants.
“We turn to the government for reliable data, public health information and scientific information,” Larry Levitt, executive vice president for health policy at the health research organization KFF, said on a media call last week. “There’s the potential now for the government to be not only not an effective source for health information but, in fact, an accelerant for misinformation.”
Inevitably, there will be some that point to the areas where Kennedy’s views align with health experts as evidence that he’s up to the HHS job. He is correct that the US has a serious problem with childhood obesity, and rates of chronic diseases, such as diabetes and Alzheimer’s, are on the rise. And few would argue against putting more resources into disease prevention or making fundamental changes to improve everyone’s access to healthier, safer food.
But noticing a problem (one many people within HHS, of course, have not only noticed but are actively working on) is one thing. Assessing the evidence to understand the complex sources for our current “sick” state and crafting the appropriate set of evidence-backed solutions to make us all healthier is something entirely different.
Kennedy has repeatedly shown us that his ability to analyze the evidence is deeply flawed. He has amassed a long list of culprits for our nation’s ills, including some things he thinks we need to get rid of (fluoride in water, food dyes and ultra-processed food), others he believes have been unjustly kept from consumers (like raw milk, stem cells, ivermectin, hydroxychloroquine, sunshine and exercise). A few are reasonable, but most are pure junk science — at best, they wouldn’t help anyone, and at worst, they would actively do harm.
Of course, the most prominent and damaging of his flawed analyses has been his well-documented position as an anti-vaccine activist. In an attempt to quiet fears about those positions, Kennedy recently told an NBC reporter that he wasn’t planning to get rid of any shots. “If vaccines are working for somebody, I’m not going to take them away,” he said. “People ought to have choice, and that choice ought to be informed by the best information.”
The word “choice” lays bare the fundamental problem with Kennedy’s ability to manage this role. A tool like vaccination, which a recent analysis found has spared some 154 million lives, is a common good — it only works when everyone agrees to participate in it. Herd immunity has allowed the US to eradicate horrifying diseases like polio and measles.
That the vast majority of Americans participate in vaccination is a testament to the gargantuan effort of the health agencies under the HHS umbrella. Their work includes conducting and funding basic research underpinning new vaccine development, evaluating their safety and efficacy, determining how to apply them at a population level to maximize public health and coordinating with local communities to get shots into arms.
Leaving any of those responsibilities up to Kennedy gives him many opportunities to do direct damage to public health, even while stopping short of banning specific vaccines. As just one example, consider that the HHS secretary appoints members of the committee of external advisers that makes vaccine recommendations —whether they should be used at all, and if so, then who should get them and how often they should be dosed — decisions that affect access, insurance coverage and ultimately the messaging about their value.
We shouldn’t underestimate the consequences of even subtle shifts in messaging about the importance of vaccines. It can cement distrust among those already opposed to them and nudge a larger segment of the public feeling uncertain about their value into that more distrustful camp — after all, those views aren’t fringe anymore; they’ve been spoken into the mainstream by the nominee for HHS secretary.
Speaking this week at the Milken Institute’s Future of Health Summit, CDC Director Mandy Cohen alluded to what is at stake. “I don’t want to see us have to go backward to remind ourselves that vaccines work,” she said. Going backward means enough of a drop in vaccine adherence that we see outbreaks of previously eradicated diseases. Going backward would mean severe complications for some children. It will cost others their lives.
There’s still a remote hope that the Senate will do the sane thing and turn him down (although there’s already reason to worry they won’t). There’s also still hope that if the Senate looks ready to reject him, Trump won’t circumvent the formal confirmation processes to install him anyway. And then there’s the more depressing, last-ditch hope that if he does get the job, he’ll be stymied by the clunky machinations of government and none of his plans will come to fruition.
The CDC, FDA and NIH are not perfect. No government agency is. But a “shake-up” by someone who promotes conspiracies and regularly undermines the tenets of public health is the opposite way to fix their flaws. And the consequences — for the structure of the agency and the health of the population — could be felt for generations to come.