Bill Cassidy had a blunt question for Robert F. Kennedy Jr.: “What’s it going to be?”
Cassidy was begging for the simplest possible concession from the man President Trump had chosen to serve as the nation’s top health care official. All he asked was that Kennedy declare “unequivocally” that vaccines do not cause autism.
The Republican senator from Louisiana is a doctor, too, and has long prided himself on his knowledge of both health policy and biomedical science. Without Cassidy’s support, Kennedy was unlikely to be confirmed by the Senate. And yet for two days, during a pair of late-January confirmation hearings, Kennedy pointedly refused, effectively doubling down on decades of vaccine skepticism and misinformation campaigns.
It appeared Kennedy’s fate was sealed. Yet on Thursday, when Kennedy’s nomination to lead the Department of Health and Human Services came before the Senate, Cassidy voted yes. So, too, did Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), who had also voiced serious doubts about his nomination. Of the Senate’s 53 Republicans, only Sen. Mitch McConnell (Ky.), the former GOP leader and polio survivor who expressed serious misgivings about Kennedy’s record on vaccines, voted no.
While the vote came as no surprise, it marked a startling turn in fortunes for Kennedy. As recently as May, Trump had referred to him as a “fake” and “radical left liberal.” Kennedy is a lifelong Democrat who once dumped a dead bear in Central Park. He has long supported policies that Republicans despise, including abortion rights and gun control. During his confirmation hearings, one of his cousins penned an open letter labeling him a “predator”; his niece leaked personal emails to STAT showing his continued belief that many vaccines are more harmful than beneficial.
“My support is built on assurances that this will not have to be a concern and that he and I can work together to build an agenda to make America healthy again,” Cassidy said in a prior speech announcing he would vote to confirm Kennedy. “We need a leader at HHS who will guide President Trump’s agenda to make America healthy again.”
Kennedy’s journey from fringe conspiracist to the nation’s top health official required a perfect confluence of factors. They included the skepticism of vaccines and establishment public health officials that grew during the Covid-19 pandemic; the insurgent “Make America Healthy Again” movement; Trump’s near-omnipotence in Washington; and a deluge of controversial nominees that allowed Kennedy’s own selection, to an extent, to be lost in the shuffle.
Kennedy’s confirmation required him to make ethical concessions, albeit underwhelming ones: He announced he would divest his stake in lawsuits against vaccine manufacturers; instead, the money would go to his son. It also required extraordinary compromises with weary Republicans, including an apparent reversal of his own views on abortion rights and a pledge to meet with Cassidy multiple times per month and consult him on decisions related to HHS personnel and vaccine policy.
Cassidy’s support made it official: In confirming Kennedy, Republicans have elevated a longtime vaccine skeptic who has also voiced fringe views about HIV not causing AIDS, cell phones causing cancer, and Covid-19 being genetically engineered to spare certain ethnicities to lead the federal government’s efforts on health and biomedical science.
Kennedy’s new perch gives him sweeping control not just over HHS itself, but also over the many agencies it oversees, including the Food and Drug Administration, Centers for Disease Control and Prevention, and the National Institutes of Health. In effect, Kennedy now controls policy related to vaccine access, safety-net programs like Medicaid, and biomedical research.
Despite the stakes, and the controversies that have long dogged Kennedy, the Senate vote contained surprisingly little drama. Mere weeks ago, much of Washington expected Kennedy to squeak by with a 50-50 margin, with Vice President J.D. Vance serving as tiebreaker.
As Kennedy faced continued skepticism from Collins, Murkowski, McConnell, and Cassidy, as well as Sen. Thom Tillis (R-N.C.), others wondered whether he would be confirmed at all. Even weeks after Trump announced his pick, a popular betting website viewed the odds of Kennedy ultimately serving as health secretary at less than 60%.
Instead, he was confirmed by a Republican-led Senate that, beyond having bought unquestioningly into Trump’s agenda, has leaned into the surging energy surrounding the “Make America Healthy Again” movement.
Remarkably, despite his long history of casting doubt on vaccine safety, Kennedy was confirmed amid a conspicuous silence from leading medical groups like the American Medical Association and American Hospitals Association. Even the American Academy of Pediatrics, which views childhood vaccination as a marquee issue, was tepid in its response.
Kennedy’s confirmation as health secretary caps a remarkable ascent that arguably began during a January 2017 meeting in Trump Tower. Then, Kennedy was still seen as a fringe figure. Still, upon exiting the meeting, he told reporters that Trump had named him the chair of a new committee on vaccine safety. Trump officials immediately shot down his claim. No committee ever materialized.
Trump’s third run for president, however, provided Kennedy with an opening. As an independent candidate with no realistic chance of winning even a single electoral vote, Kennedy leveraged his sliver of support into a late-summer deal. On Aug. 23, he dropped out of the presidential race. He endorsed Trump. And soon after, Trump gave Kennedy license to — in the president’s own words — “go wild on health.”
In winning confirmation, however, Kennedy appears to have gone to extraordinary lengths to mollify skeptics — Cassidy in particular.
In a statement last week announcing his support for Kennedy, Cassidy wrote that the pair would speak multiple times per month and have an “unprecedently close collaborative working relationship.”
His statement served as a shot across the bow on vaccines in particular.
“I will use my authority as chairman of the Senate committee with oversight of HHS to rebuff any attempts to remove the public’s access to life-saving vaccines without ironclad, causational scientific evidence,” Cassidy wrote. He added: “[Kennedy] has also committed that he would work within the current vaccine approval and safety monitoring systems, and not establish parallel systems.”
Alongside Cassidy, other Republican senators expressed unease and even outrage at Kennedy’s nomination, and his past history promoting unsubstantiated or disproven claims about vaccine-related injuries or the link between vaccines and autism. McConnell appeared particularly disturbed by reports that a lawyer affiliated with Kennedy had petitioned the FDA to revoke approvals for the polio vaccine.
Despite Kennedy’s later assurances that he “won’t take away anybody’s vaccines,” McConnell was not assured.
“Efforts to undermine public confidence in proven cures are not just uninformed — they’re dangerous,” McConnell said in a statement in December. “Anyone seeking the Senate’s consent to serve in the incoming Administration would do well to steer clear of even the appearance of association with such efforts.”
Ultimately, however, Trump’s bully pulpit made it impossible for Kennedy’s confirmation to fail.
Other significant factors included the MAHA movement, whose followers espouse a variety of beliefs on curbing chronic disease and improving the food supply but have almost uniformly supported Kennedy. One MAHA influencer, Calley Means, even worked to amplify Kennedy’s misleading attack that Sen. Bernie Sanders (I-Vt.) received substantial political support from the pharmaceutical industry, though in reality, no drug manufacturer’s political action committees or executives have contributed to his campaigns.
Notably, Kennedy also escaped Republicans’ wrath on perhaps the defining health care issue of the decade: abortion rights.
Initially, his nomination met instant resistance from religious conservatives concerned with his evolving stance on abortion. Until late last year, when he tethered his political future to Trump, Kennedy had said reproductive choices including abortion belong with the pregnant person.
Former Vice President Mike Pence’s conservative group, Americans for Advancing Freedom, soon launched an ad campaign blasting his nomination and dispatched letters to Republican senators urging them to vote against him. The advocacy group warned that the nominee was “completely out of step” with the first Trump administration’s anti-abortion stance and while he’s made “certain overtures” to conservatives, they cannot be trusted.
Republican Sens. Josh Hawley (Mo.) and James Lankford (Okla.) took up the mantle, too, pressing Kennedy for commitments to restrict abortion access and re-evaluate the safety of mifepristone, a medication used to terminate early-stage pregnancies.
Kennedy, for his part, repeated at least five times during confirmation hearings that “abortion is a tragedy.”
For the Republicans who had begun as skeptics, that was enough reassurance for them to put RFK Jr. in charge of the nation’s health.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.