Donald Trump has named Robert F Kennedy Jr as his choice for US health secretary, putting the controversial anti-vaccine activist and environmental lawyer in line to control some of the world’s most influential health agencies.

Kennedy shot to political prominence during the COVID-19 pandemic when his organisation, Children’s Health Defense, became a leading global voice questioning vaccine safety and efficacy. His appointment, which requires Senate confirmation, comes after Kennedy dropped his independent presidential bid to back Trump.

“He’s going to help make America healthy again,” Trump said in a speech at Mar-a-Lago following his election victory. “He wants to do some things, and we’re going to let him get to it.”

Trump described the role atop HHS as “the most important role of any administration”, adding that Kennedy “will play a big role in helping ensure that everybody will be protected from harmful chemicals, pollutants, pesticides, pharmaceutical products, and food additives that have contributed to the overwhelming Health Crisis in this Country”.

I am thrilled to announce Robert F. Kennedy Jr. as The United States Secretary of Health and Human Services (HHS). 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…

— Donald J. Trump (@realDonaldTrump) November 14, 2024

If confirmed, Kennedy would oversee a sprawling $1.8 trillion department with 10 health agencies and three human services agencies. 

His leadership of HHS would include the administration of Medicare, Medicaid and the Affordable Care Act while setting priorities for America’s three most powerful health agencies: the Centers for Disease Control and Prevention (CDC), which tracks disease outbreaks and sets public health guidance; the Food and Drug Administration (FDA), which approves medicines and medical devices; and the National Institutes of Health (NIH), the world’s largest public funder of medical research.

“I look forward to working with the more than 80,000 employees at HHS to free the agencies from the smothering cloud of corporate capture so they can pursue their mission to make Americans once again the healthiest people on Earth,” Kennedy said. 

Global health fallout

Beyond domestic agencies, the Trump administration is also expected to reshape America’s role in global health.

In his last term, Trump withdrew funding from the World Health Organization over its COVID-19 response and slashed funding to UN agencies, leaving a multi-billion dollar gap in the UN health agency’s budget. With Kennedy – who has questioned global health orthodoxies – by his side, experts expect this isolationist stance to deepen.

This could affect millions who rely on HIV/AIDS funding through PEPFAR, a $7 billion US program providing HIV treatment in over 50 countries, the CDC’s network of 65 international offices, and State Department health diplomacy efforts.

WHO officials told Health Policy Watch last month they face “a huge fear factor” over potential US funding withdrawal, warning the agency would enter “a dramatically bad crisis” without American support.

The Biden administration’s global health security team referred Health Policy Watch to the Trump transition team when asked for comment.

Beyond the mainstream

Kennedy’s stated priorities for America’s health system veer from broadly supported reforms to debunked anti-scientific claims that have alarmed health experts.

In recent weeks, he has called for removing fluoride from US drinking water – which he claims causes brain disease – reviewing vaccine safety data with an eye to withdrawing some from the market, eliminating “entire departments” at the FDA, and immediately dismissing 600 NIH employees.

His controversial positions include claims repeatedly rejected by scientists: that vaccines cause autism in children, that AIDS is not caused by HIV, that antidepressants are responsible for mass school shootings, and that atrazine, a widely used herbicide, triggers gender dysphoria and has led to increases in young people identifying as transgender.

Kennedy’s unconventional streak isn’t limited to medicine. In the run-up to November’s election, Kennedy said doctors found a worm had eaten part of his brain, video footage revealed him to be the key to a decade-old New York City mystery of a dead bear in Central Park – he dumped it there on his way to the airport – and came under investigation for decapitating a whale.

Lawrence Gostin, a global health expert at Georgetown University, called the Kennedy pick “the darkest day for public health and science in my lifetime.”

“Trump’s pick of RFK Jr as HHS Secretary is disastrous for public health,” Gostin said. “Having a person sceptical of science and evidence at HHS will make America unhealthy.”

Public health victories at risk

Public health victories like vaccines and drinking water fluoridation have led to dramatic increases in life expectancy. The World Health Organization estimates vaccines save five million lives annually, with global immunization efforts having saved at least 154 million lives over the past 50 years.

Yet Kennedy has repeatedly challenged these achievements by questioning vaccine safety and stating that fluoride is linked to “neurodevelopmental disorders.”

The real-world impact of vaccine scepticism is already visible in the US, with the CDC reporting vaccination rates for children dropping for all available vaccines last year and vaccine exemptions for religious reasons rising across the past decade.

“Religion doesn’t change that fast,” said Dr Michael Mendoza, a former county Public Health Commissioner in New York State. “This is about ideology and misinformation – and we’re seeing a direct impact in the number of kids unvaccinated.”

“We’re at risk of widespread distrust in evidence-based treatments and vaccines,” Mendoza added, noting how health misinformation has directly influenced the increase in risky medical decisions. “Our elected and appointed officials have an obligation to promote experts and guidelines that are grounded in established scientific evidence.”

Within the federal workforce, many remain optimistic that little will change. Agencies like the Biomedical Advanced Research and Development Authority (BARDA), which funded the development of COVID-19 vaccines, traditionally receive bipartisan support, resulting in little change across administrations.

An HHS employee, speaking to Health Policy Watch on the condition of anonymity to safeguard their job security, noted that the negative perception of the new administration has yet to filter into many agencies.

Room for agreement 

Less controversial is Kennedy’s opposition to the well-documented “revolving door” between the industry and government, where officials frequently switch between regulating companies and working for them – a system he argues has led to the “corporate capture” of US health agencies. 

In a country that spends more on healthcare than any other developed nation, has one of the world’s highest obesity rates, and whose largest public health crisis – the opioid epidemic – was engineered by pharmaceutical giant Purdue Pharma, his critiques of the system have found resonance.

The concern about industry influence has merit: since 2000, every FDA commissioner has taken industry positions after leaving office. Nine out of the last ten, representing 40 years of leadership, have done the same. The pattern continued with Trump’s previous HHS secretary, Scott Gottlieb, who departed to a board seat at Pfizer in 2020.

Kennedy’s stance against pharmaceutical interests sets up a likely clash with fellow Republicans, many of whom receive significant industry funding. Several GOP lawmakers have already pledged to dismantle President Joe Biden’s signature Medicare drug price negotiation law, which allows the government to negotiate fairer prices on behalf of its senior citizens, claiming it stifles innovation.

Yet Kennedy has promised a direct confrontation with the industry, causing shares of major vaccine makers to plunge after Trump’s announcement of Kennedy’s selection.

“Together we will clean up corruption, stop the revolving door between industry and government,” Kennedy said.  

Kennedy’s promised crusade against chronic diseases and processed foods has also found broad support among public health officials – setting up yet another clash with a major industry traditionally aligned with Republican politics.

His pledge to strip ultra-processed foods from school lunches and crack down on food dyes has drawn bipartisan backing, though industry groups warn such moves could increase grocery prices Trump has vowed to reduce. 

“Senators may say, well, RFK Jr has good ideas like tackling chronic disease and regulating Big Food, but RFK Jr is not to be trusted after a career of peddling falsehoods,” Gostin said. “What we need is nutritional warnings on unhealthy foods, bans on targeting kids, and reduced salt and sugar.” 

Even some nutrition advocates who oppose Kennedy’s broader agenda acknowledge the need for stricter oversight of the food industry. The FDA has identified concerns about ultra-processed foods’ health impacts, though the agency says more research is needed.

The challenge, experts say, will be implementing evidence-based reforms while avoiding Kennedy’s tendency toward unproven theories about food safety.

Environmental hero to anti-vaccine empire

Kennedy began his career as a celebrated environmental lawyer, fighting corporate polluters and championing indigenous communities whose lands had been poisoned by industry. His aggressive prosecution of polluters helped restore the Hudson River to health, earning him Time magazine’s “Hero for the Planet” designation.

He maintains some of this environmental ethos, promising in his presidential campaign before bowing out to back Trump to tackle unsafe PFAS levels and microplastic contamination.

But his path took a sharp turn in 2015 when he took over the struggling World Mercury Project, rebranding it as Children’s Health Defense (CHD) in 2018.

Under Kennedy’s leadership, CHD became a global anti-vaccine juggernaut. The organization’s revenue skyrocketed from $1.1 million in 2018 to $23.5 million in 2022, with Kennedy himself earning more than $510,000 in 2022, the last year where filings are available. 

In mainstream interviews and congressional appearances, Kennedy has worked to promote his least controversial views. He has attempted to moderate his image, telling NBC News: “I’m not going to take away anybody’s vaccines, I’ve never been anti-vaccine.”

Yet the organization he led until his presidential campaign – and where he remains a lawyer – continues to fund and promote numerous anti-scientific positions.

During the pandemic, CHD’s vaccine-related posts were shared more frequently on Twitter than content from CNN, Fox News, NPR and the CDC combined – occasionally eclipsing the readership of the New York Times and Washington Post. The Center for Countering Digital Hate named Kennedy one of the “Disinformation Dozen,” identifying him and CHD as among the top spreaders of vaccine misinformation online.

CHD also played a role in coordinating international protests for anti-vaccine movements around the world – with deadly consequences. In 2019, Kennedy’s organization flooded American Samoa with vaccine misinformation and lobbied the government against the use of the MMR vaccine, resulting in a devastating measles outbreak. 

This week, CHD’s news arm, The Defender, published claims that COVID-19 vaccines pose a “112,000% greater risk of brain clots and strokes than flu shots” – research based on misuse of VAERS, a federal database that records unverified reports of adverse events. The study’s authors include supplement company affiliates and anti-vaccine activists who openly coordinate with Kennedy’s organization. 

One author chairs a Texas-based organization that tagged Kennedy in a Twitter post on Tuesday calling for the “immediate withdrawal of all COVID-19 vaccines from the market” and the “repeal of the 1986” national childhood vaccination act. 

In his 2021 book, which sold over a million copies and sat on the New York TImes bestseller list for 17 weeks, Kennedy expands on the ethos behind CDH, calling Anthony Fauci, who led the US response to the COVID-19 pandemic, “the powerful technocrat who helped orchestrate and execute 2020’s historic coup d’état against Western democracy,” claiming his “remedies” – including Covid vaccines – were “often more lethal than the diseases they pretend to treat.”

The book also champions Alan Duesberg, praising as “elegant” and “compelling” the discredited scientist’s claims that AIDS is not caused by HIV. Such theories had deadly consequences: 330,000 people died prematurely after being denied life-saving HIV treatment when South Africa’s government embraced view championed by Duesberg in the early 2000s, according to Harvard researchers.

Path to Senate confirmation

.@RobertKennedyJr 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.

— U.S. Senator Bill Cassidy, M.D. (@SenBillCassidy) November 14, 2024

Kennedy’s path to confirmation runs through a Republican-led Senate, where he needs a simple majority of 51 votes. While some Republicans have expressed cautious support, experts point to Trump’s other nominees as the President-elect’s “tests” for Senate loyalty, suggesting the incoming president may bypass the traditional confirmation process entirely.

“Any Republican Senator seeking the coveted LEADERSHIP position in the United States Senate must agree to Recess Appointments (in the Senate!), without which we will not be able to get people confirmed in a timely manner,” Trump posted on Sunday. “We need positions filled IMMEDIATELY!”

If the Republican-majority Senate agrees to recess appointments – where the President appoints officials when Congress is not in session – Trump’s cabinet picks could stay until the end of 2026.

Kennedy joins other iconoclastic nominees. Trump tapped former Democratic Representative Tulsi Gabbard for Director of National Security, noted for her opposition to US support for Ukraine and promoting debunked Russian claims about US-funded biolabs there. He also named Florida Representative Matt Gaetz, who had been facing a congressional ethics investigation over allegations of sex trafficking a minor, as Attorney General.

Image Credits: Gage Skidmore.