RFK Jr. pick sets off alarms in public health

The big picture: RFK Jr. rose to prominence on an anti-vaccine platform, and has spearheaded the "Make America Health Again" movement, which taps into public concern about corporate medicine and food but also veers into ideas like blaming school shootings on antidepressant use.

• "He is a purveyor of falsehoods and he has nothing but contempt for people who work in agencies and have devoted their careers to using science to improve health," Josh Sharfstein, a former FDA deputy commissioner and public health professor at Johns Hopkins University, told Axios.

State of play: Public health and policy experts took to social media to air concerns that Kennedy's nomination would be a major setback to American health care.

• That's despite the fact that his views on many day-to-day health policy issues he'd preside over, if confirmed, are unknown.
• HHS' sprawling bureaucracy would also put Kennedy in charge of immigration policies, through agencies like the Office of Refugee Resettlement, which became a major friction point during the first Trump administration.
• "Kennedy is an unqualified know-nothing. He is dangerous to the health and well being of every American," Donna Shalala, who served as HHS secretary for all eight years of the Clinton administration, wrote on X.

Madhukar Pai, chair of McGill University's global and public health department, posted that Kennedy's appointment could be the "biggest setback to global vaccination programs since Andrew Wakefield," referring to the British scientist who published false (and later retracted) research linking vaccines to autism.

• "To put it plainly, RFK Jr. is deeply unqualified, deeply unserious, and deeply dangerous. This nomination would be a joke if it wasn't so deadly serious and every United States Senator who cares about the health of their constituents should oppose it," Brad Woodhouse, executive director of the advocacy group Protect Our Care, said in a statement.

Kennedy took to X to thank Trump on Thursday, saying the nation has "a generational opportunity to bring together the greatest minds in science, medicine, industry, and government to put an end to the chronic disease epidemic."

Between the lines: One of the key concerns is the level of vaccine skepticism Kennedy has espoused over the years.

• The fear is he would support policy that unravels the social contract underlying public health and make vaccination no more than a matter of personal choice, said Richard Besser, a pediatrician and CEO of the Robert Wood Johnson Foundation.
• "One of the reasons parents can feel comfortable sending their children to kindergarten is in knowing that their their child is not going to get measles or whooping cough from the child sitting next to them because they had to be vaccinated," Besser said.
• "It breaks down the notion that, in a society, we are asked to do things not just for own good, but for the good of the community and their families," he said.

The other side: Kennedy has some unlikely allies. Colorado Gov. Jared Polis, a Democrat who worked with Kennedy to block a proposed vaccine requirement in the state in 2019, said Thursday that he's excited at the prospect of Kennedy helming HHS.

• "I hope he leans into personal choice on vaccines rather than bans (which I think are terrible, just like mandates) but what I'm most optimistic about is taking on big pharma and the corporate ag oligopoly to improve our health," Polis wrote on X.

Zoom out: While his views on drug, food and infectious disease prevention are well-known, Kennedy hasn't given many clues as to how he'd run Medicare and Medicaid, said Larry Levitt, executive vice president for policy at KFF.

• The giant health programs, which come under HHS, together cost the federal government more than $1.75 trillion. Medicare alone makes up about 14% of the federal budget.

What to watch: Whether Kennedy can get confirmed by the Senate remains an open question — assuming Trump doesn't use recess appointments to get around the confirmation process.

• "I would implore everyone in the Senate to ask the question around this nomination: 'Will having Robert F. Kennedy Jr as secretary of health improve the health of people in my state or potentially put people at risk?' Besser said.
• Bill Cassidy, the Louisiana Republican who is due to chair the Senate health committee next year, noted Kennedy's advocacy of healthy foods and the need for greater transparency in the public health infrastructure, and said he looked forward to learning about his other policy positions.

The bottom line: "RFK Jr has a complex cocktail of views on health care, some of which span the political spectrum," Levitt said. "Many of his ideas are incredibly anti-science and rife with misinformation, but, you know, others have a lot of support from both the left and the right."