Robert F. Kennedy Jr.’s tumultuous tenure as health secretary came to a head on Thursday as he faced tough questions during a hearing before the Senate Finance Committee.
During his nearly seven months in office, Mr. Kennedy has upended the Department of Health and Human Services, overseeing widespread changes to the institutes under his leadership. None has been hit harder than the Centers for Disease Control and Prevention, which recommends vaccines for Americans.
Mr. Kennedy, a longtime vaccine skeptic, has undermined immunizations; fired the C.D.C.’s independent advisers on vaccines and replaced them with vaccine critics; and ousted the center’s director less than a month into the job after she refused to fire top officials and rubber-stamp decisions from the advisers he had appointed.
Over three loud and contentious hours, Mr. Kennedy was remarkably combative and dismissive with senators, refusing to budge from his stance on vaccines, autism, Medicaid and the C.D.C.
Here are five takeaways from the hearing:
1. Both Republicans and Democrats pressed Mr. Kennedy on vaccine access.
“It’s been obvious from the start that Robert Kennedy’s primary interest is to take vaccines away from Americans,” said Senator Ron Wyden of Oregon, the committee’s ranking Democrat. “His actions reveal a steadfast commitment to elevating junk science and fringe conspiracies.”
He and other senators pushed Mr. Kennedy on the health secretary’s attempts to restrict access to vaccines. Under Mr. Kennedy’s leadership, health officials have narrowed who is eligible for updated Covid vaccines. Several senators, including Senator Bill Cassidy, Republican of Louisiana, pointed to the obstacles some Americans are facing in accessing the vaccines. Major pharmacies in some states are currently requiring that even people who are at high risk get prescriptions for the shots.
“Effectively, we’re denying people vaccine,” said Mr. Cassidy. He supported Mr. Kennedy’s confirmation, despite some misgivings, but has become increasingly critical of him in recent weeks.
Several senators pushed Mr. Kennedy on his opposition to mRNA technology — used for the first time in the Covid vaccines made by Pfizer and Moderna — asking him to reconcile his criticisms with President Trump’s championing of those vaccines through Operation Warp Speed.
Mr. Kennedy has canceled $500 million in mRNA research and has falsely claimed the mRNA Covid shots are the “deadliest” vaccines ever made. But during the hearing he maintained both that Mr. Trump deserved a Nobel Prize for his efforts and that mRNA vaccines were harmful.
Senators also assailed Mr. Kennedy’s firing of all 17 advisers on the C.D.C. vaccine recommendation panel in June. Mr. Kennedy handpicked new members of the committee, several of whom have cast skepticism on vaccines and Covid shots in particular. He plans to appoint seven additional new members to the committee, which is scheduled to meet later this month. Some senators expressed alarm that the committee may vote to change recommendations on routine childhood immunizations like the hepatitis B vaccine.
2. Mr. Kennedy stood his ground.
The hearing was punctuated with heated back-and-forth exchanges, with Mr. Kennedy effectively getting into shouting matches with several senators.
He yelled that Senator Maggie Hassan, Democrat of New Hampshire, was “just making stuff up” after she said that Mr. Kennedy had made it harder for Americans to get vaccines.
Senators read aloud Mr. Kennedy’s words from previous hearings, noting that he had promised not to take anyone’s vaccines away and that he would empower agency scientists to do their work. Many said he had done neither. Senator Tina Smith, Democrat of Minnesota, said Mr. Kennedy had made contradictory statements.
“When were you lying, sir?” she said. “When you told this committee that you were not anti-vax, or when you told Americans that there’s no safe and effective vaccine?”
Mr. Kennedy replied: “Both things are true.”
Senator Ben Ray Luján, Democrat of New Mexico, pressed Mr. Kennedy to provide protocols for studies meant to find a cause for autism. In a tense exchange, Mr. Kennedy claimed not to understand the request: “You’re talking gibberish,” he said to Mr. Luján.
In one contentious exchange with Senator Mark Warner, Democrat of Virginia, Mr. Kennedy said he did not know how many Americans had died of Covid and whether the vaccines prevented Covid-related deaths. “The problem is they didn’t have the data,” he said, prompting the senator to reply: “You are sitting as secretary of health and human services. How can you be that ignorant?”
In fact, the data are readily available. Hundreds of reports have tracked the efficacy of the vaccines since they debuted in 2021. The shots have saved millions of lives in the United States and elsewhere, dozens of studies have estimated.
3. The turmoil at the C.D.C. is likely to worsen.
Since Mr. Kennedy took office, the C.D.C. has been in a state of chaos. Thousands of employees were fired, and many others left. The agency was also the target of a shooting in August.
Mr. Kennedy suggested he was not done with the agency, accusing it of corruption and claiming that it was responsible for the rise of chronic diseases in the United States and for Covid’s toll on Americans.
“What we’re going to do is reorganize C.D.C.,” he said, adding, “I need to fire some of those people.”
In his opening remarks, Mr. Kennedy nodded to the shooting outside the agency’s headquarters in Atlanta, but C.D.C. employees have said they were furious that Mr. Kennedy gave interviews after the incident, in which he called into question their integrity.
The gunman is thought to have been motivated by a belief that the Covid vaccine caused him to be ill. Many C.D.C. employees hold Mr. Kennedy directly responsible for such misinformation.
4. Conflicts of interest were a hot topic.
Mr. Kennedy has said he fired all the members of the vaccine panel because they had financial conflicts of interest, a claim that has repeatedly been refuted. Members of the panel are carefully vetted for potential conflicts; when members may have indirect conflicts, they recuse themselves from the relevant discussions.
But many of the new members Mr. Kennedy appointed to the panel have biases of their own. They include people who have filed court declarations in cases challenging vaccines or mandates. New members include a doctor who has served as an expert witness on behalf of people who claimed they were harmed by vaccines, and another doctor who, in a testimony before state lawmakers, compared Covid vaccines to thalidomide, a drug that decades ago caused serious birth defects.
5. Rural hospitals and pharmacy benefit managers rounded out the discussion.
Concerns about the fate of rural health care in the aftermath of Mr. Trump’s domestic policy bill and sweeping cuts to Medicaid also surfaced. Republican senators pushed Mr. Kennedy to discuss the $50 billion in funding targeted to hospitals and clinics in rural areas, which have been struggling to stay afloat.
“We’re infusing more than 50 percent increase in the amount of money that is going to rural communities over the next five years,” Mr. Kennedy said.
But Senator Bernie Sanders, independent of Vermont, pushed back, noting that the legislation was expected to result in a net loss of $100 billion in funding as millions of Americans lose their insurance because of the legislation’s rollback of the program. Advocates estimate dozens of hospitals could be at risk of closing and many more will cut vital services like labor and delivery.
Mr. Kennedy was also pushed by Republicans to support bipartisan legislation aimed at better regulating giant pharmacy benefit managers, which are owned by three health care conglomerates, CVS Health, Cigna and UnitedHealth Group.
He assured senators he would support such efforts, noting Mr. Trump’s support, and said he had been in discussions with the companies about reforms.
Senator Peter Welch, Democrat of Vermont, also raised longstanding concerns about rising health care costs.
He argued Americans faced an “affordability crisis.”
Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.
Dani Blum is a health reporter for The Times.
Christina Jewett covers the Food and Drug Administration, which means keeping a close eye on drugs, medical devices, food safety and tobacco policy.
Reed Abelson covers the business of health care, focusing on how financial incentives are affecting the delivery of care, from the costs to consumers to the profits to providers.
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