How RFK Jr.'s MAHA movement could shake up public health

The big picture: The MAHA campaign blends generally mainstream views on policing food additives or expanding health savings accounts with more conspiracy-tinged ideas about corruption within the Food and Drug Administration, fluoride in water and vaccine recommendations.

• While President-elect Trump only embraced its tenets late in his campaign, Kennedy and other movement leaders are now in a position to influence federal health policy.
• Trump's other picks to lead health agencies — or, as Kennedy has suggested, purge swaths of their workforce — could be announced within days.
• That's sending shivers through segments of the public health community, with Centers for Disease Control and Prevention director Mandy Cohen publicly warning on Wednesday about the threat of curtailing vaccination efforts, per Bloomberg News.
• FDA commissioner Robert Califf likewise sounded alarms at a cancer conference, Stat reported.

The big picture: The movement taps into frustration with corporate influences in the U.S. medical system and what it claims is an overriding public health focus on infectious diseases.

• The United States spends more on health care than any other country, but our life expectancy is significantly lower than in peer countries like Australia, Japan and the U.K.
• Kennedy and a cadre of influencers, entrepreneurs and others behind the movement propose addressing that contradiction in a variety of ways.
• Kennedy has called for outlawing food dyes and additives that aren't allowed abroad. He wants to devote half of the National Institutes of Health budget to researching alternative health care. And he's pressing for more transparency and data on vaccines while pledging not to take any away.

Zoom in: The movement has two central goals, said health care entrepreneur Calley Means, who with his physician sister, Casey, are leading proponents.

• The first is to change the focus of health care research. More federal funding should be directed to determining why people get sick, he told Axios.
• The second is to adjust federal health policies to give patients more options. Americans can still get medications if they want, but Medicare and Medicaid should also cover alternatives like visits to functional medicine doctors, who focus on nutrition and exercise over pharmaceuticals, Means said.

Yes, but: Certain shifts run counter to some conservatives' past calls for a federal health bureaucracy that's more focused on infectious diseases.

• Project 2025's rollbacks to dietary guidelines would make it harder to fight ultra-processed foods, experts said.

And some of the MAHA movement's ideas veer into the conspiratorial. Kennedy has said he wants to end "the FDA's war on public health" and stop the agency's "aggressive suppression" of raw milk, ivermectin, sunshine and other things.

• He told MSNBC last week that current vaccine safety science "has huge deficits in it." (Vaccines approved by the FDA currently must go through rigorous clinical trials and are subject to real-time quality testing.)
• "One of the more concerning things that could happen is just the perpetuation of misinformation and disinformation," said Richard Hughes, a health care lawyer at Epstein Becker Green. "In RFK Jr., you have someone that does not follow mainstream science."

Reality check: Even with Trump's focus on government efficiency, political appointees may find that rules around the federal bureaucracy complicate major policy change, said Chris Meekins, an analyst at Raymond James who worked at Health and Human Services in the first Trump administration.

• "I think it's much more likely for the career staff in the bureaucracy to support what [RFK Jr. is] attempting to do on the healthy food side than he is on the drug side," Meekins added.
• That said, spreading fears of a voluntary exodus of staff at the FDA and other divisions of HHS could make that less of a factor.

Between the lines: The idea of big changes to the food and pharmaceutical industries have captured Americans' interest, especially mothers concerned about their children's health.

• RFK Jr.-aligned influencers such as Jessica Reed Kraus, who has more than 1.3 million Instagram followers, boosted Trump's popularity online. They helped the campaign grow its base of women and mothers, a social media executive who worked on the campaign told Axios' Sara Fischer.

But the lasting political momentum of these broader health reforms is uncertain.

• Public health and chronic illness weren't the major motivators that propelled voters toward Trump, according to Robert Blendon, a polling expert and professor emeritus of health policy and political analysis at Harvard.
• Outside of vaccines, which fire up public sentiment in different ways, public health isn't a very politically visible topic right now, he said. It may not get much attention from the White House.
• "When you look at the exit polls, health care is not in the top five for people who voted for Trump. It just didn't play a role," he said.

Editor's note: This story was updated after Trump announced RFK Jr. as his HHS pick.