Many of President-elect Donald Trump’s candidates for federal health agencies have promoted policies and goals that put them at odds with each other or with Trump’s choice to lead the Department of Health and Human Services, Robert F. Kennedy Jr.setting the stage for internal friction over public health initiatives.
The election has different views on issues such as abortion limits, the safety of childhood vaccines, the response to COVID-19 and the use of weight loss drugs. The split pits Trump’s adherence to more traditional and orthodox science, such as longstanding, scientifically supported findings that vaccines are safe, against the often unfounded views advanced by Kennedy and other selectmen who have claimed that the vaccines are linked to autism.
A situation where senior policy makers are part of the same team with such different views could make it difficult to develop and find priorities.
Trump’s transition team and nominees mentioned in this article did not respond to requests for comment.
It’s a potential “opposition team” to government health agencies, said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian policy organization. Kennedy has no medical degree.
Kennedy, he said, is known for dismissing 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 opinions prevail will have it significant power in shaping policyfrom who is appointed to serve on federal vaccine advisory committees to federal authorization of COVID vaccines to abortion drug restrictions. If confirmed as HHS secretary, Kennedy is expected to set much of the agenda.
“If President Trump’s nomination of RFK Jr. to be secretary is confirmed, if you don’t subscribe to his views, it will be very difficult to step up in that department,” said Amesh Adalja, an infectious disease specialist and principal investigator at the Center Johns Hopkins for Health Security. “They will have to suppress their views to fit those of RFK Jr. In this administration, and any administration, independent public dissent is not welcome.”
Kennedy is the president Defense of Children’s Healthan anti-vaccine nonprofit. He has promised to slow down the country hunger for ultra-processed foods and their 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 direct them from the direction of HHS, with a budget of more than $1.7 trillion.
Clashes 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 Trump has chosen to lead the CDC. Weldon, a doctor, is one opponent of abortion who wrote one of the main laws allowing health professionals to opt out of 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 earlier this year for a seat in the Florida House of Representatives.)
Trump has said he would leave abortion decisions up to the states, but the CDC under Weldon could, for example, fund studies of 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’s at odds with the views of Marty Makary, a Johns Hopkins surgeon whom Trump plans to nominate as FDA commissioner. The British-American told Fox News Radio’s “Brian Kilmeade Show” that vaccines “save lives,” though he added that it’s good to question the U.S. vaccine schedule for children.
The American Academy of Pediatrics encourages parents and their children’s doctors to follow the recommended childhood vaccine schedule. “Nonstandard schedules that distribute vaccines or start when a child is older put entire communities at risk of serious illness, including infants and young children,” the group says in guidance for its members.
Jay Bhattacharya, a physician and economist who is Trump’s pick to lead the NIH, has also supported vaccines.
Kennedy has told NPR that federal authorities under his leadership would not “take vaccines away from anybody.” But the FDA oversees vaccine approvals, and under his leadership the agency could put vaccine skeptics on advisory panels or make changes to a program that largely shields vaccine makers from injury lawsuits of consumers
“I think autism comes from vaccines,” Kennedy said in 2023 on Fox News. Many scientific studies have done so discredited the claim that vaccines cause autism.
Ashish Jha, a physician who served as the White House’s COVID response coordinator from 2022 to 2023, noted that Bhattacharya and Makary have had long and distinguished careers in medicine and research and would bring decades of experience to these positions. outstanding work But, he said, “it’s going to be a lot harder than they think” to defend their views in the new administration.
It’s hard to ‘do things that displease your boss, and yes [Kennedy] is confirmed, it will be their boss,” Jha said. “They have their work cut out for them if they want to defend their views on science. If they don’t, it will just demoralize the staff.”
Most of Trump’s picks share the view that federal health agencies botched the response to the pandemic, a stance that resonated with many of the president-elect’s voters and supporters, even though Trump led that response until Joe Biden took office in 2021.
Kennedy said in a 2021 Louisiana House Oversight Meeting that the COVID vaccine was the “deadliest” ever made. He has cited no evidence to support the claim.
Federal health officials say vaccines have saved millions of lives worldwide and offer important protection against COVID. The protection lasts, although its effectiveness decreases over time.
The vaccines’ effectiveness against the infection was 52% after four weeks, according to a May study in The New England Journal of Medicine, and its effectiveness against hospitalization was 67% after four weeks. The vaccines were produced through Operation Warp Speed, a public-private partnership that Trump launched in his first term to speed up shots and other treatments.
Makary criticized the COVID vaccine guideline that called for the vaccines to be given to young children. He argued that for many people, natural immunity from infections could replace the vaccine. Bhattacharya opposed the measures used to curb the spread of COVID in 2020 and advised that all but the most vulnerable continue their lives as usual. The World Health Organization warned that this approach would overwhelm hospitals.
Mehmet Oz, Trump’s choice to run the Centers for Medicare and Medicaid Services, an HHS agency, has said the vaccines were oversold. He promoted the use of the anti-malarial drug hydroxychloroquine as a treatment. In 2020, the FDA revoked hydroxychloroquine’s emergency authorization for COVID, saying it was unlikely to be effective against the virus and the risk of dangerous side effects was too high.
Meanwhile, Janette Nesheiwat, a former Fox News contributor and Trump’s pick for surgeon general, has taken a different stance. The doctor described the COVID vaccines as a godsend in a Fox News op-ed.
Kennedy’s doubts about vaccines are likely to be a central issue early in the administration. He has said he wants federal health agencies to shift their focus from preparing and fighting infectious diseases to addressing chronic diseases.
The shift in focus and questioning of vaccines has some public health leaders worried amid the spread of the H5N1 bird flu virus among dairy cattle. There have been almost 60 human infections reported in the US this year, all but two related to exposure in livestock or poultry.
“Early on, they’re going to have to have a discussion about vaccinating people and animals” against bird flu, said Georges C. Benjamin, executive director of the American Public Health Association. “We all put our opinions on the table. The cohesion policy of a department is driven by the secretary.”
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF — the independent source of health policy research, polling and journalism.