Independent presidential candidate Robert F. Kennedy Jr. makes an announcement on the future of his campaign in Phoenix, Arizona, U.S. August 23, 2024.
Thomas Machowicz | Reuters
President-elect Donald Trump has tapped Robert F. Kennedy Jr. to lead the Department of Health and Human Services – a selection that is raising fears in the public health community and leaving the biotech and pharmaceutical industries bracing for disruptions to drug development.
Trump’s announcement on Thursday gives Kennedy, a notorious vaccine skeptic, a good chance of securing the nation’s top health-care job. The coming Republican-held Senate will ultimately decide whether to confirm him, though Trump has raised the prospect of sidestepping that process with recess appointments.
If confirmed, Kennedy will take the reins of a $1.7 trillion agency that oversees vaccines and other medicines, scientific research, public health infrastructure, pandemic preparedness, food and tobacco products. HHS also manages government-funded health care for millions of Americans – including seniors, disabled people and lower-income patients who rely on Medicare, Medicaid, and the Affordable Care Act’s markets.
The heads of the Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes of Health and Centers for Medicare and Medicaid Services all report to the HHS secretary, though Trump has yet to nominate them. Kennedy will likely have some influence over who the president-elect chooses for those roles, health policy experts said.
Some health policy experts told CNBC that Kennedy could elevate vaccine skepticism and deter more Americans from taking recommended shots, attempt to cut funding or entire departments at different agencies and shift research and development toward more alternative treatments or disease areas of interest to him, among other efforts.
Kennedy’s so-called “Make America Healthy Again” platform argues a corrupt alliance of drug and food companies and the federal health agencies that regulate them are making Americans less healthy. Kennedy has long argued that the agencies that HHS oversees need reform or a sweeping overhaul, part which could mean cutting funding, purging staff and hiring new employees who share his often disproven views on health and science.
He has also said he wants to remove fluoride from drinking water systems and target chronic diseases by cracking down on food and chemical additives, among other efforts.
But there will be some limits to Kennedy’s power – even with a Republican government trifecta. Some of his proposals, such as cutting funding, may not easily pass through Congress. Other efforts could spark expensive and prolonged litigation against the federal government.
Spokespeople for Kennedy and Trump’s campaign did not immediately respond to requests for comment.
Here are some of the things that Kennedy may – or may not – be able to accomplish as HHS secretary.
$540 billion in direct health-care costs over the last three decades, according to CDC research released in August.
He has long made misleading and false statements about the safety of shots. He has claimed they are linked to autism despite decades of studies that debunk that association. Kennedy is also the founder of the nonprofit Children’s Health Defense, the most well-funded anti-vaccine organization in the U.S.
Ultimately, Kennedy’s influence over immunization policy could lead to an increase in diseases preventable by vaccines, several health policy experts told CNBC.
“He could create considerable distrust in vaccines and make some vaccines highly politicized, so in particularly red states, we could see outbreaks of fully preventable childhood diseases,” Gostin said. That includes measles, mumps, rubella and polio.
Despite his history, Kennedy told NBC News in early November that he isn’t planning to take anyone’s vaccines away in the U.S.
That would be a difficult task, experts said. The FDA can pull a product from the market if further trials after approval fail to confirm that its clinical benefits outweigh its risks, or if unexpected risks are detected among patients. That has not been the case with the approved shots on the market.
“It would be hard to imagine that a new HHS Secretary would be able to immediately remove vaccines that are already approved and already being used and recommended by the government from the market,” said Josh Michaud, associate director of global health policy at KFF, a health policy research organization. “He can’t just make that change with a simple wave of a wand.”
Still, Kennedy has repeatedly argued that there is not enough data on vaccines and their effects. He told NPR earlier this month that the Trump administration is going to “make sure those scientific studies are done and that people can make informed choices about their vaccinations and their children’s vaccinations.”
As HHS secretary, Kennedy could “cherry pick” data from additional government studies and release misleading results that undermine trust in the safety and efficacy of vaccines, said Lawrence Gostin, a health law and policy expert at Georgetown University.
That misinformation could deter some Americans from receiving certain shots. Michaud added vaccine misinformation could push health officials on the state and local level to “perhaps allow for more individual choice rather than mandating routine vaccination” for certain diseases.
Many state health departments and clinicians rely on vaccine recommendations from an advisory committee to the CDC. Those include who should get what shots and at what age.
Those guidelines have broader implications for public health. Vaccines recommended by that advisory panel and approved by the CDC director are covered under the Affordable Care Act. The agency also administers the Vaccines for Children program, which provides free vaccines for children in low-income families.
Kennedy could attempt to influence that CDC advisory committee and a similar panel linked to the FDA by stacking them with people who hold anti-vaccine views, Gostin said. The HHS secretary has the power to form an advisory committee, remove members and set the terms and qualifications for them.
That could produce more limited vaccine recommendations that aren’t firmly rooted in science, he added. It could also translate to a “fragmentation of vaccine policy” across the U.S. if only some states accept recommendations from advisors selected by Kennedy.
“pack their bags.”
Kennedy, before dropping out of the presidential race, also said he wanted to shift NIH’s focus away from infectious disease and toward chronic diseases like obesity for eight years. In September, Kennedy said half of the NIH’s $48 billion budget should go toward “preventive, alternative and holistic approaches to health.”
A shakeup at the NIH – the largest public funder of biomedical research in the U.S. – could have major implications for research and the pharmaceutical industry. The NIH funds and conducts research on everything from vaccines and cancer to new drug targets, laying the groundwork for treatments that companies can develop.
“He could certainly allocate funding away from drugs that he’s not interested in and more towards maybe areas that are more speculative,” said Genevieve Kanter, associate professor of public policy at the University of Southern California.
Kanter pointed to his long history of embracing disproven treatments, such as claiming that hydroxychloroquine and ivermectin work against Covid, even though several studies say they do not. Hydroxychloroquine is an immunosuppressive drug, while ivermectin is used to treat infections caused by parasites.
Major changes or funding cuts at the NIH, FDA and CDC would require congressional approval. Federal employees are also protected against arbitrary or politically-motivated firing.
FDA staff are further shielded because Congress does not fully fund their salaries. Nearly half of the agency’s $7.2 billion budget this year came from so-called “user fees,” or payments made by drug and medical device manufacturers to fund the staff resources needed to quickly review their products, conduct inspections and ensure the safety of clinical studies.
It seems “unlikely” that Kennedy would be able to end that user fee program, according to Richard Frank, director of the Brookings Schaeffer Initiative on Health Policy. But he may attempt to influence negotiations around how the program is implemented when Congress decides whether to reauthorize it after 2027, Frank said.
Gostin said other “cuts across the board” at the three agencies are possible, especially in areas that are “part of the culture wars.” The CDC could see funding reduced for key functions related to vaccines, chronic disease, sexual and reproductive health and firearm injury and prevention, according to Gostin.
He added that the FDA’s nutrition departments could also see cuts or be “on the chopping block” altogether, given Kennedy’s intent to change what he calls the “broken” U.S. food system.
