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Robert F. Kennedy Jr.'s designs on revamping federal health agencies, including threats to slash the FDA workforce, could put Congress in a tight spot.
Why it matters: President-elect Trump has made it clear that he wants Kennedy's input on health matters, meaning that the vaccine skeptic will likely have the sway to make critical decisions about health agencies.
- That would involve working in tandem with authorizing committees and appropriators in Congress, who have overlapping constituencies and priorities of their own.
Between the lines: Republicans in Congress have clashed with the FDA over such matters as its plan to regulate lab-developed tests, but they haven't weighed a large-scale reorganization of the workforce, as they did for NIH and CDC.
- Lawmakers have shown an interest in how well the FDA is handling recruitment and retention issues.
- And delays around reauthorizing the Pandemic All Hazards and Preparedness Act stemmed from disagreements between House Republicans and Democrats on whether to give the FDA more authority to respond to drug shortages.
State of play: Kennedy told MSNBC on Wednesday that "entire departments" at the FDA "have to go" since they're "not protecting our kids."
- He pointed to nutrition regulators who preside over items like "Froot Loops … that have 18 or 19 ingredients," while in Canada the same product has only a few ingredients.
Kennedy ally Calley Means, who is also close to the Trump transition team, told Axios last week that he believed the FDA user fee system should be eliminated.
- "75% of the FDA drug approval department is funded by pharma. That makes no sense," said Means, adding that Congress should fund the agency fully on its own.
- Key user fee programs won't be on Congress' plate until 2027, when they're next up for reauthorization. But negotiations on fees to fund reviews of prescription drugs, medical devices and biosimilars are due to begin next year.
On vaccines, Kennedy told MSNBC that he's "not going to take anybody's vaccines.… If vaccines are working for somebody, I'm not going to take them away."
- Although states determine which vaccines are mandated or limited for children, the Trump administration would be able to influence what vaccines are recommended for the childhood vaccine schedule, which then determines whether insurers cover them.
- Kennedy also posted on X over the weekend that on the first day of the second Trump administration, all U.S. water systems would be advised to remove fluoride from the water.
The bottom line: It's not clear whether Trump would nominate Kennedy for a role like HHS secretary. It seems more likely that he'd fill an advisory role that wouldn't require Senate confirmation.
