President-elect Donald Trump’s announcement yesterday that he will nominate Robert F. Kennedy Jr. to head the $1.8 trillion Department of Health and Human Services (HHS) sent shock, disbelief, jitters, and even panic through the public health and scientific community. Kennedy has a long history of elevating debunked antivaccine claims, raising alarms about the safety of foods and medicines, and decrying what he sees as corruption at the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC), agencies he would oversee.
“It’s like having somebody who believes the Earth is flat as head of NASA,” says Paul Offit, a vaccinologist at the University of Pennsylvania who has served on a vaccine advisory committee at CDC and currently serves on one at FDA.
“I thought [Kennedy] was unthinkable as HHS Sec,” global health legal specialist Lawrence Gostin of Georgetown University wrote on the social media platform X. “But all this seems very real now. He would control all our gold standard scientific agencies like FDA, CDC, and NIH. And politically poison them.”
Normally, the Senate would have to confirm Kennedy’s nomination—a process that might founder on his controversial views and actions. But Trump has told the Senate he wants to bypass that requirement for his Cabinet choices using recess appointments. Whether senators will bend to this is unclear. “All hands should be on deck, working to persuade Republican senators to oppose this threat to health and science,” says former NIH Director Harold Varmus.
At least one Republican senator, physician Bill Cassidy (LA), offered early support to the nominee, writing on X: “[Kennedy] has championed issues like healthy foods and the need for greater transparency in our public health infrastructure. I look forward to learning more about his other policy positions and how they will support a conservative, pro-American agenda.”
But some Republican senators, who will hold a 53-vote majority, may balk at another Kennedy stance: his support for abortion rights, which antiabortion groups were already highlighting yesterday. “There’s no question that we need a pro-life HHS secretary, and of course, we have concerns about Robert F. Kennedy Jr.,” said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America.
Trump said days before he won the election that he would let Kennedy, an environmental lawyer, “go wild” on health, food, and medicines. But until now, it was unclear whether Kennedy would have an official position in the new administration. Transition co-chair Howard Lutnick even stated bluntly last month that Kennedy would not be HHS secretary.
Lutnick has been overruled. “I am thrilled to announce Robert F. Kennedy Jr. as The United States Secretary of Health and Human Services (HHS),” Trump wrote in his //truthsocial.com/@realDonaldTrump/posts/113483366471340943" style="box-sizing: border-box; color: rgb(202, 32, 21); text-decoration: underline; background-color: transparent; word-break: break-word;">announcement on Truth Social. “For too long, Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health.”
Since his star began to rise with Trump, after he dropped out of the presidential race in August and threw his support to the Republican, Kennedy has made a succession of pronouncements about his plans. He’s said he wants to see the end of fluoridation of water—a state and local prerogative—and to review all vaccine safety data with a view to the market removal of those he finds unsafe—both prospects that Trump on 3 November said he was open to. (Vaccines pass vigorous safety and efficacy reviews by panels of experts at FDA before they are approved for market. Scientific advisers to CDC then review data before recommending who should receive them.)
Kennedy’s views on vaccines concern current CDC Director Mandy Cohen: “I don’t want to go backwards and see children or adults suffer or lose their lives to remind us that vaccines work,” she said in an email to Science today.
Kennedy’s largest focus of late has been on noninfectious diseases such as diabetes and cancer and their risk factors such as obesity. On News Nation on 1 November, Kennedy said his goal was “to end the chronic disease epidemic in this country,” including measurable reductions in illness “in our children within 2 years.” To that end he said Trump had asked him to reorganize FDA, CDC, NIH, and parts of the U.S. Department of Agriculture. (The latter is not part of HHS and would not be under Kennedy’s purview as its secretary.) His remit was to “clean up the corruption,” “end the conflicts of interest,” and “return those agencies to their rich tradition of gold standard, empirically based, evidence-based science, evidence-based medicine,” Kennedy said.
At FDA, Kennedy has warned staffers to “preserve your records” and “pack your bags” and said “entire departments” at that agency have “got to go.” A few days ago, he said he planned to dismiss 600 NIH employees on 20 January 2025.
Kennedy named FDA’s Center for Food Safety and Applied Nutrition, which oversees food safety, as a key target for dissolution. FDA has broad statutory authority to ensure food safety, but the center, created in the early 1980s, is not explicitly protected by statute, and could in principle be dismantled by executive action. In addition, Kennedy, an enemy of ultraprocessed foods, would arrive in the Trump administration in time to influence key dietary guidance: The Dietary Guidelines for Americans, a magnet for lobbying by the food industry and healthy diet proponents alike, are rewritten by the executive branch every 5 years, and an update to the 2020 version is set to be published in 2025.
Some public health advocates find merit in certain Kennedy stances, or at least say they are worth further scrutiny—several European countries eschew fluoridation, for example. International scientific and medical reaction to Trump’s pick has also been largely negative but some have mixed feelings.
Pediatrician David Elliman of the Great Ormond Street Hospital for Children worries about the impact of Kennedy’s antivaccine views on vaccination programs “around the world.” However, he calls Kennedy’s focus on battling obesity and chronic diseases “commendable” and adds that the HHS nominee “directing his energies to the ‘industrial food complex’ would be no bad thing, as would ensuring more transparency from pharmaceutical companies.”
Philip Krause, until 2021 the deputy director of the Office of Vaccines Research and Review at FDA, argues Kennedy’s stated intentions for FDA and his goals for a healthy food supply appear to be in conflict. “He wants to remove preservatives from food. On the other hand, he has stated his desire to eliminate the FDA office that implements those regulations. His goals seem like they would be better served by strengthening, not weakening the FDA,” Krause says.
Krause adds that Kennedy might also find himself at odds with his boss on vaccines. “President Trump presided over one of the most important vaccine development efforts in history. Mr. Kennedy has sharply criticized the COVID vaccines.” If similar conflicts arise during a second Trump term, Krause says, “I don’t really expect Mr. Kennedy to do things that President Trump disagrees with.”
The biomedical agencies in Kennedy’s sights are just a small sliver of the huge HHS budget, more than 90% of which goes to mandatory programs such as Medicaid, Medicare, and Affordable Care Act programs. But by overseeing FDA, CDC, and NIH, he could have an enormous influence on public health policies and possibly research funding.
Kennedy described some of the ideas for broader reform in a commentary in The Wall Street Journal in September. They range from cutting an FDA program popular with companies that uses fees they pay to help fund drug reviews to putting half of NIH’s research budget into “preventive, alternative and holistic approaches to health.” (NIH’s National Center for Complementary and Integrative Health has a $170 million budget, about 0.36% of the agency’s $47.4 billion budget.)
Onlookers note there are limits to what he could accomplish. Congress, which authorizes and funds NIH, would have to sign off on major shifts in the agency’s funding. And his plans to fire agency employees en masse will run into federal protections and the slow process for dismissing government workers.
Former NIH Director Elias Zerhouni offered a measured view of Kennedy: “I do not know him and have no idea if he will follow his political campaign positions or adjust to govern the complexities of HHS missions once in the job. Time will tell.” But he expects Congress to serve as a buffer: “The bipartisan support for the key agencies of HHS is likely to continue in my opinion.”
