A lot from newly elected President Donald Trump candidates for federal health agencies have promoted policies and goals that put them at odds with each other or with Trump’s pick to lead the Department of Health and Human Services, Robert F. Kennedy Jr.paving the way for internal friction over public health initiatives.
The choices have different views on issues such as restrictions on abortion, the safety of vaccines for children, the response to COVID-19 and the use of weight-loss drugs. The divide that picks Trump, who adheres to more traditional and orthodox science, such as the long-standing, scientifically supported findings that vaccines are safe, pits itself against often unsubstantiated views of Kennedy and other picks claiming that vaccines are linked to autism .
A situation where senior policymakers are on the same team with such different views could make it more difficult to develop and pursue priorities.
The Trump transition team and the nominees mentioned in this article did not respond to requests for comment.
It’s a potential “adversary team” in government health agencies, said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian policy organization. Kennedy does not have a medical degree.
Kennedy, he said, is known for rejecting opposing views when confronted with science.
“The heads of the FDA and the NIH will spend all their time explaining to their boss what a confidence interval is,” Cannon said, referring to a statistical term used in medical studies.
Those whose views prevail will get it considerable power in shaping policyfrom who is appointed to serve on federal vaccine advisory committees to federal authorization of COVID vaccines to restrictions on abortion medications. If confirmed as HHS secretary, Kennedy is expected to set much of the agenda.
“If the appointment of RFK Jr. if secretary is confirmed by President Trump and if you don’t support his views, it will be very difficult to rise in that department,” said Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security. “They will have to suppress their views to match those of RFK Jr. In this government, or in any government, independent public dissent is not welcome.”
Kennedy is chairman of Children’s Health Defense, an anti-vaccine nonprofit. He has promised to curb the situation of the country hunger for ultra-processed foods and the incidence of chronic diseases. He helped select Trump’s picks to lead the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health. If confirmed, he would lead them from the helm of HHS, with a budget of more than $1.7 trillion.
Collisions are likely. Kennedy has supported access to abortion until a fetus is viable. That puts him at odds with Dave Weldon, the former Florida congressman chosen by Trump to lead the CDC. Weldon, a physician, is one opponent of abortion who authored one of the most important laws allowing healthcare workers to opt out of participating in the procedure.
Weldon would lead an agency that has been in the crosshairs of conservatives since the start of the COVID pandemic. He has touted his “100% pro-life voting record” on his campaign website. (He ran unsuccessfully for a seat in the Florida House of Representatives earlier this year.)
Trump has said he would leave abortion decisions to the states, but the CDC under Weldon, for example, could fund studies on abortion risks. The agency could require states to provide information about abortions performed within their borders to the federal government or risk losing federal funds.
Weldon, like Kennedy, has questioned the safety of vaccines and said he believes they can cause autism. That runs counter to the views of Marty Makary, a Johns Hopkins surgeon whom Trump plans to nominate for FDA commissioner. The British-American said on the “Brian Kilmeade Show” on Fox News Radio that vaccines “save lives,” although he added that it is right to question the U.S. childhood vaccination program.
The American Academy of Pediatricians encourages parents and their children’s doctors to adhere to the recommended schedule for childhood vaccinations. “Non-standard schedules that distribute vaccines or begin when a child is older place entire communities at risk of serious illness, including infants and young children,” the group says as guidance for its members.
Jay Bhattacharya, a physician and economist picked by Trump to lead the NIH, has also supported vaccines.
Kennedy said on NPR that federal authorities under his leadership “wouldn’t take vaccines away from anyone.” But the FDA oversees vaccine approvals, and under its leadership the agency could place vaccine skeptics on advisory panels or make changes to a program that largely protects vaccine makers from consumer harm lawsuits.
“I really believe that autism comes from vaccines,” Kennedy said on Fox News in 2023. Many scientific studies have discredited the claim that vaccines cause autism.
Ashish Jha, a physician who served as the White House COVID response coordinator from 2022 to 2023, noted that Bhattacharya and Makary have had long and distinguished careers in medicine and research and that they bring decades of experience in these top positions would put in. But, he said, it will be “a lot harder than they think” to stand up for their views in the new government.
It’s hard to do things that don’t please your boss [Kennedy] If confirmed, he will be their boss,” Jha said. ‘They have a lot of work to do if they want to stand up for their views on science. Failure to do so will only demoralize the workforce.”
Most of Trump’s picks share the view that federal health agencies bungled the pandemic response, a position that resonated with many voters and supporters of the president-elect — even though Trump led that response until Joe Biden took office in 2021.
Kennedy said during a 2021 Louisiana House oversight meeting that the COVID vaccine was the “deadliest” ever created. He provided no evidence to support the claim.
Federal health officials say the vaccines have saved millions of lives around the world and provide important protection against COVID. The protection lasts, even if its effectiveness decreases over time.
The vaccines’ effectiveness against infections was 52% after four weeks, according to a May study in The New England Journal of Medicine, and their effectiveness against hospitalizations was about 67% after four weeks. The vaccines were produced through Operation Warp Speed, a public-private partnership Trump launched in his first term to speed up vaccinations and other treatments.
Makary criticized the COVID vaccine guidelines, which called for young children to be given the shot. He argued that for many people, natural immunity against infections could replace the vaccine. Bhattacharya opposed the measures used to curb the spread of COVID in 2020 and advised all but the most vulnerable to live their lives normally. The World Health Organization warned that such an approach would overwhelm hospitals.
Mehmet Oz, Trump’s choice head of the Centers for Medicare & Medicaid Services, an agency within HHS, has said the vaccines have been oversold. He promoted the use of the antimalarial drug hydroxychloroquine as a treatment. The FDA revoked emergency authorization for hydroxychloroquine for COVID in 2020, saying it was unlikely to be effective against the virus and the risk of dangerous side effects was too high.
Janette Nesheiwat, a former Fox News contributor and Trump’s pick for surgeon general, has taken a different position. The doctor described COVID vaccines as a gift from God in a Fox News op-ed.
Kennedy’s doubts about vaccines are likely to be a central theme early in the administration. He has said he wants federal health agencies to shift their focus from preparing for and combating infectious diseases to tackling chronic diseases.
The shifting focus and question marks over vaccines are worrying some public health leaders amid the spread of the H5N1 avian flu virus among dairy cattle. There have been nearly 60 human infections reported in the U.S. this year, all but two linked to exposure to livestock or poultry.
“They’re going to have to have a discussion early on about vaccinating people and animals” against bird flu, said Georges C. Benjamin, executive director of the American Public Health Association. “We all bring our opinions to the table. The coherent policy of a department is driven by the secretary.”
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