The Senate Confirmed RFK Jr. as Health Secretary. Now What?

America’s well being secretaries, virtually as a rule, have résumés manicured to some extent of frictionlessness. Now and again one will appeal to scandal of their tenure; see Tom Worth’s reported fondness for chartered jets. However anybody who has garnered sufficient cachet to be nominated to move the Division of Well being and Human Providers tends to reach in entrance of the Senate with such impeccable credentials that discovering something which may disqualify them from the place is troublesome.

Donald Trump’s collection of Robert F. Kennedy Jr., who was confirmed at the moment as America’s latest well being secretary, was particularly supposed to interrupt that mould. Kennedy positioned himself as a reality teller decided to uproot the “company seize” and “tyrannical insensate bureaucracies” that had taken maintain of the nation’s public-health companies. Even so, it’s outstanding simply how unimaginable his affirmation would have been in any political second aside from at the moment’s, when a web based reactionary has been given a high-level position within the Justice Division and an adolescent often known as “Big Balls” is advising the State Division. Kennedy holds broadly interesting views on combatting corruption and serving to People overcome persistent illness. However he’s additionally, to an virtually cartoonish diploma, not impeccably credentialed. He has trafficked in innumerable unproven and harmful conspiracy theories about vaccines, AIDS, anthrax, President John F. Kennedy’s assassination, COVID-19, daylight, gender dysphoria, and 5G. He has potential financial conflicts of interest. He has spoken a couple of worm eating part of his brain and about dumping a dead bear in Central Park. He has been accused of sexual assault. (In his affirmation listening to, Kennedy denied the allegation and stated it was “debunked.”)

In the long run, none of it mattered. Whereas Senate Democrats unanimously opposed Kennedy’s affirmation, he sailed by the Senate’s vote this morning after dropping only one Republican vote, Senator Mitch McConnell of Kentucky, a polio survivor who seems to have taken subject with Kennedy’s anti-vaccine activism. Kennedy did, nevertheless, earn the assist of Senator Invoice Cassidy, a doctor who till final week gave the impression to be the Republican lawmaker most involved in regards to the potential injury of elevating an anti-vaccine conspiracy theorist to the nation’s highest perch in public well being. Kennedy’s affirmation is a victory for Trump, and a transparent message that Senate Republicans are keen to embrace pseudoscience of their unwavering deference to him. People’ well being is in Kennedy’s arms.

So what occurs subsequent? Spokespeople for Kennedy didn’t reply to my request to speak with him about his agenda. However, Kennedy’s first weeks in workplace will seemingly be hectic ones, including to the chaos of Trump’s nonstop govt orders and Elon Musk’s crackdowns on quite a few federal companies. As HHS head, Kennedy will oversee 13 completely different companies, together with the CDC, FDA, and Nationwide Institutes of Well being. Previous to being appointed, Kennedy stated he believed that 600 workers would have to be fired on the NIH and changed with workers extra aligned with Trump’s views. (The NIH employs roughly 20,000 individuals, so such a lower at the very least can be minor in contrast with the Division of Authorities Effectivity’s extra sweeping strikes.) He has additionally implied that everybody on the FDA’s meals middle could possibly be handed pink slips. Extra usually, he has stated he’ll “take away the monetary conflicts of curiosity in our companies,” however he hasn’t spelled out precisely who he believes is so conflicted that they need to be out of a job.

At NIH specifically, any sudden strikes by Kennedy would compound modifications already unfolding underneath the auspices of DOGE. Musk’s crew has attempted to dramatically cut the quantity of administrative funding sometimes doled out by the company to universities in assist of scientific analysis. Deliberate conferences about these funds had been additionally abruptly canceled final month. (The funding cuts have been briefly halted by a federal choose, and funding conferences seem to have resumed.) It’s simple to imagine that Kennedy would assist these efforts, given his aspirations to fireside federal bureaucrats. However the DOGE effort might in reality undermine his bigger targets, organising some potential rigidity between Kennedy and Musk. Analysis funding is crucial to Kennedy’s pursuit of unraveling the causes of America’s chronic-disease disaster; he has suggested devoting extra of the NIH’s assets to investigating “preventive, various, and holistic approaches to well being.”

On the coverage entrance, in each the fast and long run, persistent illnesses will seemingly occupy Kennedy’s consideration probably the most. He has referred to as that subject an existential risk to america, and it’s the clearest a part of Kennedy’s agenda that has bipartisan assist. Nevertheless, precisely what he can do on this subject is unsure. Lots of the insurance policies he’s advocated for, akin to eradicating junk meals from faculty lunches, actually fall to a different agency: the U.S. Division of Agriculture. The one food-related coverage he’s usually touted that he has the facility to enact is banning sure chemical components within the meals provide. Even so, banning a meals additive is usually a laboriously sluggish authorized course of.

His public statements present different, vaguer hints about points that he’ll seemingly deal with throughout his time period. On abortion, he has stated that he’ll direct the FDA and NIH to carefully scrutinize the protection of the abortion tablet mifepristone. (Trump has beforehand instructed that his administration would defend entry to abortion drugs, although the president’s place is murky at best.) On the value of medicine, Kennedy has stated that he desires to crack down on the middlemen who negotiate them for insurance coverage firms. However by and enormous Kennedy has stated little about how he’ll sort out the complicated regulatory points which are historically the main target of the well being secretary. He may merely not have that a lot to say. Kennedy has implied that he cares far much less about these subjects than about weight-reduction plan and persistent illness. Throughout his affirmation listening to, he instructed senators that specializing in points akin to insurance coverage funds with out decreasing the speed of persistent sickness can be akin to “shifting deck chairs round on the Titanic.”

The largest and most consequential query mark is how Kennedy will method vaccines. If he had been to chip away at People’ entry to pictures, and even merely at People’ readiness to obtain them, he may degrade the nation’s protections towards an array of diseases and, in the end, be the reason for individuals’s deaths. Kennedy’s anti-vaccine advocacy was the topic of a number of the most intense scrutiny throughout his affirmation hearings. “In the event you come out unequivocally, ‘Vaccines are protected; it doesn’t trigger autism,’ that may have an unimaginable influence. That’s your energy. So what’s it going to be?” Cassidy requested. Kennedy pledged that he wouldn’t deprioritize or delay approval of recent vaccines, and never muck up the federal government’s vaccine-approval requirements. All through the method, he tried to distance himself from his previous vaccine positions, which embody an assertion that the federal officers supporting the U.S. childhood-vaccine program had been akin to leaders within the Catholic Church overlaying up pedophilia amongst clergymen. However his solutions to senators’ questions on his previous remarks and whether or not vaccines trigger autism had been persistently evasive. And a few of his plans play into the anti-vaccine camp’s arms. He has promised, for instance, to push for government-funded research to be launched with their full uncooked knowledge—a transfer that seemingly would please transparency advocates, although additionally would act as an olive department to anti-vaccine activists who’ve needed to sue federal companies lately for sure vaccine knowledge.

Final week, after Cassidy solid a decisive committee vote that allowed Kennedy’s nomination to advance to full Senate consideration, he stated in a speech on the Senate flooring that he had pressure-tested Kennedy sufficient to really feel assured that he may rebuild belief in public well being. (Cassidy didn’t point out that advancing Kennedy was additionally in his political curiosity. A spokesperson for Cassidy declined my requests for an interview.) Kennedy holds an virtually biblical standing amongst his supporters, and a good portion of these individuals mistrust federal well being companies. Cassidy’s professed perception in Kennedy’s management affords a soothing imaginative and prescient: Think about People whose views on the public-health institution have been deeply eroded over time, all with their religion restored in one of many world’s most rigorous scientific establishments due to a radical outsider.

However think about the logic right here. By voting to verify Kennedy, the U.S. Senate is wagering the way forward for our public-health system on a prayer {that a} conspiracy theorist can construct again up the companies that he and his supporters have spent years breaking down. A extra real looking consequence could also be that Kennedy leaves public well being extra damaged than ever earlier than. Though many People are skeptical of the federal government’s scientific establishments, polls present that comparatively few have the form of deep-seated contempt for public-health companies that Kennedy has espoused. By pandering to that fraction of voters, Kennedy dangers alienating the a lot bigger portion of People who may not agree with every part the CDC has completed lately, but additionally don’t assume that the company’s vaccine program is similar to a Nazi demise camp, as Kennedy has claimed.

If Kennedy did go as far as to disavow any connection between autism and vaccines, that itself may result in bother. Jennifer Reich, a professor on the College of Colorado at Denver who has studied vaccine skepticism, instructed me that the autism subject is only one half of a bigger, far more diffuse set of considerations shared by mother and father who query vaccinating their youngsters. For RFK to disavow all of his vaccine antagonism, he would basically must abandon his prima facie skepticism towards science extra usually. Such an apology would seemingly do extra to show a few of his most ardent supporters towards him than change their views, argues Alison Buttenheim, an professional on vaccine skepticism on the College of Pennsylvania. “Folks will do wonderful leaps and cartwheels to not have their beliefs and their behaviors in battle,” she instructed me.

If Kennedy genuinely desires to revive religion in public well being, he’ll must win over his fellow conspiracists whereas sustaining the belief of the many individuals who already thought the companies had been doing a high quality job earlier than he arrived. Maybe he’ll strive. However proclaiming, as he did in October, that the “FDA’s struggle on public well being is about to finish” is just not a good way to start out.