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One month ago, then President-elect Donald Trump told reporters at Mar-a-Lago that Robert F. Kennedy Jr., an ardent vaccine critic and his nominee to become the nation’s health secretary, would be “much less radical than you would think.” But the new administration’s first round of health policy moves have alarmed physicians and public health experts on both sides of the aisle. With RFK Jr.’s confirmation hearing now scheduled for Wednesday, here are four worrying developments that stood out amid the “purposeful chaos and ambiguity,” as one former Health and Human Services official put it.

Communications Blackout

Under normal procedure, the government health care apparatus churns out important announcements all day: guidance, notices, advisories, regulatory updates. Last week, that machine went dark, after the HHS acting secretary ordered a halt to publication of any document until it had been “reviewed and approved by a Presidential appointee,” according to an internal memo issued Tuesday. Ditto for public speaking engagements and official correspondence.

But the memo sparked chaos. At the National Institutes of Health, grant-review meetings and scientific travel halted, the purchase of laboratory supplies stopped, and negative headlines proliferated. “Trump Admin Obstructs Cancer Research” was just one of many.

“This is Project 2025 being implemented in record time and it’s catching everyone off guard.”

By Monday, the White House was struggling to course correct and cast blame. A White House official told Vanity Fair that the overly broad interpretation of the memo was the fault not of the Trump administration but of a legacy NIH official. An internal memo sent Monday to NIH staff by acting director Matthew Memoli, first reported by STAT, emphasized that clinical trials, procurement of supplies, and submission of research papers to scientific journals could continue.

Nonetheless, employees at numerous health agencies were left in a state of bewilderment and panic. At the FDA, no one seemed to know whether notifications about food recalls, warning letters about unsafe manufacturing plants, or import alerts halting dangerous products from overseas were safe to post or not, according to two employees there.

Calling it “unprecedented for sure,” one of the employees says of the FDA, “It is a madhouse and a crazy place right now. People are frightened and scared.” The person added, “This is Project 2025 being implemented in record time and it’s catching everyone off guard.”

WHO Withdrawal?

On his first day in office, President Trump signed an executive order officially giving notice that the US would withdraw from the World Health Organization, citing the organization’s “mishandling of the COVID-19 pandemic.”

It also said the US would pull out of negotiations on a worldwide pandemic treaty being hammered out under the WHO’s auspices, aimed in part at ensuring that countries rapidly and transparently share data on emerging viruses—one of the early problems that bedeviled the COVID-19 response.

The WHO isn’t perfect, but it’s the world’s foremost coordinating body for public health emergencies and has played a critical role in landmark achievements from the development of an Ebola virus vaccine to the near eradication of polio. “WHO prevents health emergencies from coming to our shores, and it does it every day,” says Lawrence O. Gostin, the O’Neill chair of global health law at Georgetown University and director of the WHO Collaborating Center on National and Global Health Law. “I can’t think of a single way that [a withdrawal] advances America’s national interest or security.”

The move is likely to harm American interests in more basic ways, such as limiting access to the global health data that drug firms draw on each year to manufacture more effective flu vaccines.

Whether Trump’s executive order actually becomes policy or faces legal challenges remains to be seen. By law, it appears, the US can’t withdraw without fully paying its dues or providing a year’s notice to the United Nations Secretary-General, Antonio Guterres, according to a 2020 congressional report.

If the US does withdraw, the results could be disastrous. “This is not like immigration, where you can just shut down the Southern border,” says Gostin. “You can’t build a wall against a germ, and that’s why you need the world working cooperatively.”

RFK Jr.’s Strange Ethics Agreement

As of last week, RFK Jr.’s confirmation hearing appeared to be stalled, as federal auditors turned up a bevy of financial discrepancies.

First, his claims that his anti-vaccine work at Children’s Health Defense was “unpaid” and the “opposite of a profit motive” proved to be untrue. In fact, he’d received a total of $1.2 million from the nonprofit, as the Daily Beast first reported. The “oversight,” according to a Trump transition spokesperson, led RFK Jr. to amend his financial disclosure.

But the prolonged pause around his confirmation hearing came into clearer view last week with the news that he’d reached an unusual agreement with the Office of Government Ethics. He would retain a 10% stake in litigation he’d helped develop against Merck and its Gardasil vaccine, which protects against the human papillomavirus, which can cause cervical and other cancers.

Ethics experts were stunned by the deal, which would allow him to profit, even while serving as the top regulator over not just Merck but the entire vaccine industry. The arrangement “would suggest that he has little to no regard for government ethics,” says former diplomat Norman Eisen, who also served as President Barack Obama’s special counsel for ethics and government reform.

A Kennedy spokesperson did not respond to a request for comment.

Calling the arrangement “hugely unusual,” Richard Painter, a University of Minnesota law professor and former chief White House ethics lawyer, says this alone should merit a “No” vote in senate confirmation hearings.

Brain Drain

President Trump has made little secret of his desire to purge the federal government’s career civil servants and replace them with political loyalists, regardless of their qualifications.

On his first day in office, he signed an executive order that reinstates what is called “Schedule F,” which reclassifies thousands of federal workers as political hires and make them easier to fire.

In a transition meeting at NIH, Trump officials had told staff there, according to notes taken by a former HHS official: “For NIH personnel who have been there 20 years or more, consider taking early retirement with severance. Twenty years is too long, and they believe that contributes to the lack of innovation observed at the NIH.”

But at highly technical science and health agencies, the well-honed experience essential to operations cannot simply be swapped in. “The entire institutional knowledge of all of those institutions will be decimated,” says the former official. “I was just blown away.”

The HHS inspector general, along with independent watchdogs from 17 other agencies, were tossed into the scrap heap, along with security details for former officials who’d previously incurred Trump’s wrath, among them Anthony Fauci, the former head of the National Institute of Allergy and Infectious Diseases, who has been targeted by MAGA zealots.

A White House spokesman, Kush Desai, tells Vanity Fair that these moves are the start of “needed reforms” to a “medical apparatus that let us down during the COVID pandemic and oversaw an unprecedented explosion in chronic illnesses and ailments. President Trump was elected with a resounding mandate to Make America Healthy Again by restoring confidence, competence, and accountability in health care, and the Trump-Vance administration will continue…to implement needed reforms.”

While some experts see malice in these early moves, others see incompetence. Whatever the root cause, it’s worth remembering that it was his administration’s poor handling of a health crisis—the COVID-19 pandemic that he wants to blame on the public health establishment—that arguably cost Donald Trump the election in 2020.

“When public health works, it’s silent,” says Gostin. “When it doesn’t work, it’s devastating. And why would you want to take the risk?”