President-elect Trump’s announcement that he plans to nominate Robert F. Kennedy Jr. to lead the Department of Health and Human Services unleashed both applause and alarm on Thursday. If the Senate approves the nomination, RFK Jr. is poised to reshape public health agencies and could usher in a new era for vaccines and medicines.
RFK Jr. said Thursday that he looks “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.”
He plans to do that through a combination of agency restructuring, staff departures, and a potential litany of new demands around vaccine data, drug approvals and research, according to remarks he made during both his and Trump’s presidential campaigns. A number of those plans would take legislative support and could face lawsuits. But RFK Jr. could wield significant and immediate authority over how health agencies are staffed and how they communicate with the public about their work.
“Together we will clean up corruption, stop the revolving door between industry and government, and return our health agencies to their rich tradition of gold-standard, evidence-based science,” RFK Jr. said in his statement after Trump’s announcement.
RFK Jr. has not yet weighed in on a massive part of the HHS mandate: what reforms could come for Medicare, Medicaid, and people covered via the Affordable Care Act’s marketplaces.
STAT compiled this review of RFK Jr.’s top priorities that may give insight into how he would approach his role as Health and Human Services Secretary if he is confirmed.
Food policy and the FDA
Kennedy has repeatedly accused the nation’s food industry of “mass poisoning” and said that improving the food supply is a key component of his “Make America Health Again” agenda.
He has said he’ll immediately remove ultra-processed foods from school lunches and move to limit the use of dyes in food. His stated goal with these changes is to prevent chronic diseases, which affect some 60% of Americans. He’s pushed back on the use of seed oils, such as canola, even though many nutritionists think his claims against them are spurious.
He could put some of his views into practice as early as next year, when the next version of the Dietary Guidelines for Americans, a bulwark of federal food policy, will be published.
STAT reported in July that top Food and Drug Administration officials were considering how to regulate ultra-processed foods, which are estimated to make up roughly 60% of the calories consumed by the typical American. But nutrition experts said doing so will be challenging for several reasons.
For one, there’s no consensus on what counts as ultra-processed, though the most common definition includes sodas, pre-packaged snacks like Twinkies, and most breakfast cereals — but also whole grain breads. And there’s a dearth of rigorous research on their health effects. While there’s a slew of observational trials tying ultra-processed foods to type 2 diabetes and cardiovascular disease, as well as anxiety and depression, those studies merely show a correlation. Only one randomized trial has been published, which found a causal relationship between the diet and excess calorie consumption.
For these reasons, a scientific panel last month decided it would be premature to include ultra-processed foods in the new dietary guidelines.
RFK Jr. has accused the FDA, which regulates food, medicine, tobacco and vaccines, of waging a “war on public health” with “aggressive suppression” of a long list of sometimes questionable — and in some cases, potentially harmful — therapies.
“FDA’s war on public health is about to end,” he wrote in a social media post on Oct. 25. “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”
Unpasteurized or raw milk can harbor pathogens like listeria and E. coli, public health experts note, which can lead to kidney failure or death. His fascination with stem cells worries those who have been seeking more FDA regulation of unscrupulous stem cell clinics, after some patients died or were blinded by the treatments.
Environmental factors
RFK Jr. spent most of his career as an environmental lawyer, fighting companies and governments to shore up protections against pollution and safeguard water supplies. As HHS secretary, most of that would be out of his purview; Trump has also told voters that RFK Jr. “can’t touch” the oil and gas industry.
But there are a number of ways a health secretary can push on water and environmental policies. In the week since Trump’s election, RFK Jr. has ratcheted up his rhetoric about ceasing fluoridation — the practice of adding fluoride to water to improve dental health. While the responsibility to regulate fluoride falls to local and state governments, he can use his pulpit to encourage officials to ban the addition of fluoride to water, which could have consequences for children’s oral health.
Studies have shown water fluoridation saves Americans $6 billion annually in dental work and that children in cities where water is not fluoridated have more cavities. Some experts have said fluoride deserves more study but also emphasized removing it is a health equity issue that should not be done lightly.
RFK Jr.’s influence may be taking hold even before his confirmation hearings start. Officials in Winter Haven, Fla., this week voted to remove fluoride from the city water supply, citing his concerns.
A small, still unfunded HHS office created during the Biden administration could have a chance at survival under RFK Jr. While the nominee has not ever mentioned the tiny Office of Climate and Health Equity, it could become a tool to accomplish some of his health and environmental goals. The office is tasked with mapping environmental hazards to people’s health and exploring regulatory efforts to reduce pollution in the health care sector.
RFK Jr. did not specifically address climate change during his presidential run, and has not raised it during his time as a Trump surrogate. He has alluded to making industry pay for environmental damages, but said he would rather that be through the free market than government policy.
Vaccines
Kennedy has spent decades using cherry-picked studies to push the disproven claim that vaccines cause autism; he founded the nonprofit Children’s Health Defense to look for other health issues he believes are caused by vaccines. He’s said the flu vaccine may be responsible for his spasmodic dysphonia, the neurological disorder that impacts his voice, calling it “my own speculation.”
More recently, he’s been pushing for the government to be more transparent and release more data on harms caused by vaccines, but public health experts have said they are confused about what data he is seeking.
As Kennedy told MSNBC earlier this month: “If vaccines are working for somebody, I’m not going to take them away” and “people ought to have a choice and that choice ought to be informed by the best information.”
STAT previously reported that health officials are concerned that even if Kennedy does not push an outright ban on vaccines or remove them from the market, he could slow uptake by spreading disinformation, loading vaccine advisory boards with fellow skeptics, and seeking to have federal agencies slow down approvals.
After all, noted Leighton Ku, a George Washington University health policy professor, Kennedy is “already having influence in discouraging people from using vaccines, even though he is not part of the government at all right now.”
Many in public health are concerned Kennedy could alter or disrupt the current vaccine schedule recommended by the Centers for Disease Control and Prevention to ensure children receive their vaccines on time.
Public health experts say drops in vaccination rates could lead to outbreaks of measles and other communicable diseases that have been largely in check for decades.
Kennedy has raised ire by comparing rules requiring vaccination to fascism that is worse than what people endured during the Holocaust (he later apologized). In 2022, he released a video showing infectious disease doctor Anthony Fauci in a Hilter mustache and compared public health measures such as mask and vaccine mandates to Nazi propaganda. In 2015, he used the term “holocaust” to describe children he deemed to be hurt by vaccines.
The HHS nominee has also criticized legal protections for vaccine makers. Under current law, people first have to go through a compensation process before they can sue a vaccine maker for most routinely administered vaccines.
Institutional reforms at health and science agencies
RFK Jr. has pledged to end “corporate corruption” at federal health and science agencies, purge their staffs, and tackle what he’s called “perverse incentives” at those institutions. He promised this month to clear out “entire departments” at the FDA and dismiss at least 600 employees at the National Institutes of Health.
He says this planned upheaval would root out “corporate capture” of the FDA, the NIH, and the Centers for Disease Control and Prevention. His examples of potential corruption include the FDA’s user fees, or lump sums that biopharmaceutical companies pay to supplement the agency’s budget. Those fees are not directly tied to drug reviews. They account for just under half of the FDA’s annual budget, and are authorized by Congress.
The NIH, he’s argued, is “just an incubator for pharmaceutical products,” as he said during a speech at Hillsdale College last year, where he highlighted royalties that pharmaceutical companies pay to NIH for commercialized products that emerged from early research done by NIH scientists. The agency tracks those royalty payments and typically distributes them back to institutes and centers’ budgets. RFK Jr. also implied in that speech that CDC employees are incentivized to buy and distribute vaccines because of the agency’s budget.
Experts told STAT that RFK Jr. could demand more data in FDA approvals and fill FDA and CDC advisory committee slots with fellow vaccine skeptics.
Addiction and mental health
Kennedy’s perch atop HHS would give him vast jurisdiction over the country’s addiction treatment and mental health infrastructure — in particular, sub-agencies like the Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse.
Kennedy, himself, is in long-term recovery from heroin addiction. But it is unclear how much his lived experience has shaped his attitudes toward evidence-based addiction medicine. Kennedy, for instance, has no public record on access to methadone and buprenorphine, the common, highly effective medications used to treat opioid use disorder. He has credited his recovery from drugs and alcohol at least in part to decades of attendance at Alcoholics Anonymous meetings.
As a presidential candidate, he suggested that he would hold an AA meeting at the White House. One of his few concrete proposals was the creation of “wellness farms, drug rehabilitation farms, in rural areas all over this country,” he said on a recording of the Latino Capitalist podcast in July. He’d fund the farms, he said, by placing federal taxes on legal marijuana sales.
“I’m going to make it so people can go, if you’re convicted of a drug offense, or if you have a drug problem, you can go to one of these places for free.” Notably, the “drug problems” he was referring to didn’t just include illicit drugs like cocaine, heroin, or fentanyl, but also ADHD medications and antidepressants.
Unscientific views
Kennedy has long espoused views that run counter to mainstream and broadly accepted science: He’s questioned whether the HIV virus causes AIDS, blamed school shootings on antidepressants, and promoted the conspiracy theory that wifi causes cancer. He’s also said chemicals in tap water might be turning children transgender.
He’s pushed alternative treatments like ivermectin and hydroxychloroquine to treat Covid-19 even though they’ve been proven ineffective and has promoted the use of chelation therapy, the process of removing heavy metals from blood, to treat autism. He also raised the baseless idea that the coronavirus was “ethnically targeted” to affect certain races.
Kennedy has undergone chelation treatment himself to remove high levels of mercury from his blood that he attributes to eating a diet rich in tuna. While it’s an accepted treatment for lead poisoning, physicians say it is definitely not a proven or safe treatment for autism. In 2005, a Pennsylvania child died after a physician used chelation in an attempt to cure his autism.
Abortion policy and reproductive rights
RFK Jr.’s stances on abortion policy have rankled conservatives and anti-abortion advocates. He once said he supports abortion access, “even if it’s full term,” but reversed course shortly after that interview this May.
“I’ve been a medical freedom advocate for my entire career and have fought for bodily autonomy, and I trust women’s maternal instincts,” he wrote on X this May. While he questioned whether “a bureaucrat or judge is better equipped than the baby’s own mother to decide,” RFK Jr. committed in that statement to abortion restrictions past the point of a fetus’ viability outside the womb, which is medically considered to be about 23 to 24 weeks of gestation.
Abortion could become a serious liability for RFK Jr. in the confirmation process, as more anti-abortion advocates step out to oppose his nomination. Former Vice President Mike Pence said in a statement that his nomination is an “abrupt departure” from the first administration’s anti-abortion position.
“For the majority of his career, RFK Jr. has defended abortion on demand during all nine months of pregnancy, supports overturning the Dobbs decision and has called for legislation to codify Roe v Wade. If confirmed, RFK, Jr. would be the most pro-abortion Republican appointed,” Pence said.
Susan B. Anthony Pro-Life America, a prominent anti-abortion advocacy group, also quickly expressed concerns in a conversation with Semafor.