In March 2022, when President Joe Biden needed a COVID-19 response coordinator to help lead the largest vaccination campaign in American history, he tapped a blue chip public health expert: Dr. Ashish Jha. Jha had spent years ascending the summits of evidence-based medicine. He attended Harvard medical school, worked as a practicing physician, and served as the faculty director of the Harvard Global Health Institute. Today, he’s the dean of Brown University’s School of Public Health.
That’s the kind of résumé that has traditionally led to a major federal appointment. Now, however, a different kind of credentialism is taking hold as the incoming Trump administration develops its transition plans to govern American medicine and public health. The new must-haves are: a disdain for the medical establishment, vaccine skepticism, personal branding skills, and—above all—loyalty to the MAGA cause and its standard-bearers.
It is likely, say five sources involved in transition discussions, that Robert F. Kennedy Jr., who has spent decades making unproven claims about vaccine harm, will reign over America’s health agencies.
Reports that Donald Trump was toying with appointing RFK Jr. as secretary of Health and Human Services caused widespread consternation, but sources tell VF his role could be much larger and farther-reaching. “People who said he was going to be HHS secretary are crazy,” says a healthcare expert familiar with transition planning. “Confirmation fights suck. It would create a lot of complications for Republicans. He wants more than just HHS, and it doesn’t make any sense if he wants a bigger role than one department.”
Sources tell VF that RFK Jr. is likely to be offered a role as the White House health czar, with oversight not only of HHS and its subsidiary agencies, including the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health, but also of the US Department of Agriculture and the Environmental Protection Agency.
Sid Miller, the current Texas agriculture commissioner, who is helping the Trump team vet USDA candidates, and has been mentioned as a possible USDA secretary, described his interviewing approach to Vanity Fair. “First thing, I ask them: ‘Are you 110% behind Donald Trump? The second question is: ‘Do you think you could work with Bobby Kennedy and his plan to Make America Healthy Again?’”
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In RFK Jr.’s telling, he would battle chronic disease in America by breaking the stranglehold of the processed food lobby, exposing the flaws in vaccine science, and moving forcefully to “clear out corruption” at America’s health agencies, which could involve eliminating entire departments.
Under a MAHA banner of radical reform, he says, he would empower Americans to make their own health decisions, among them whether to vaccinate their children. For years, Kennedy’s organization, Children’s Health Defense, has made spurious claims suggesting that certain ingredients in vaccines can cause autism and other harms. He has inveighed against legal protections for vaccine makers, viewed as essential to continued manufacturing and development of new vaccines. He has linked the rise in school shootings to the increased use of antidepressants, and stated that COVID-19 may have been engineered to minimize harm to Chinese people and Ashkenazi Jews.
Dr. Gregory Poland, trade editor of the journal Vaccine and president of the Atria Academy of Science and Medicine, says that Kennedy’s “untrue” claims and fire-all-the-experts approach puts at risk “the health, the welfare of an entire population.”
Faced with what could be a radical transformation or even a dismantling of the federal public-health apparatus, some observers are cautiously optimistic that cooler heads will prevail. “Campaign rhetoric is different from governing,” says Richard Besser, CEO of the Robert Wood Johnson Foundation, who served as acting director of the CDC in the early days of Barack Obama’s presidency. “I am on the side of wanting to see what the administration does, now that it is going to be in charge.” He added, “I would be very surprised if the federal government took a stand that led to increased spread of infectious diseases in our country.”
Others are far less sanguine. “My fear is that children and the public will be harmed by an assault on science,” says Sean O’Leary, chair of the committee on infectious diseases for the American Academy of Pediatrics. If vaccination rates decline, “We will see more measles, more pertussis,” also known as whooping cough. “We will have preventable deaths based on politics and misinformation.”
In a statement to Vanity Fair, a Trump transition spokesperson, Karoline Leavitt, says, “The American people reelected President Trump by resounding margins because they trust his judgment and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.”
While plans remain in flux, and the mercurial president-elect could easily throw his healthcare brain trust of the moment overboard, it seems likely that medical renegades will at least get a chance to dramatically rewire America’s health agencies. “There are those ready to burn down the house,” says a regulatory specialist allied with the MAGA movement’s medical leaders, though he hastened to add, “We have to be methodical, workman-like, professional, and take the time to develop consensus before acting on any of these agendas.”
A spokesperson for Kennedy did not respond to emails requesting comment. But Aaron Siri, a plaintiff lawyer he’s worked with for years on healthcare lawsuits, tells Vanity Fair, “Since the 1980s, there has been an explosion of chronic health problems in children. What’s causing that? Genetics don’t change that fast, so you still need some environmental trigger. Man-made substances are presumably causing that rise. Bobby wants to get to the bottom of that.”
That mission has led to a mishmash of policy proposals from the MAHA inner circle. Some, like banning pharma ads on network TV, seem reasonable. Others, in the view of most experts, are seriously reckless. Among the latter: “major, major changes in the way the FDA regulates the pharmaceutical industry,” says the regulatory specialist.
Under current standards, new medicines can be launched only after they’ve been proven safe and effective in rigorous clinical trials. A new idea being floated by MAHA leaders would allow drugs to come to market before meeting those standards, “more aligned with the way the nutraceutical industry runs,” the specialist says, referring to the far less regulated marketplace for nutrition supplements, which is rife with false claims and unproven remedies.
For many who have dedicated their careers to drug safety, marketing a drug before fully testing it is a harrowing prospect. “Totally disregarding” the collection and review of safety data is “not only illegal but incredibly dangerous,” says Dr. Joshua Sharfstein, a former FDA official and distinguished professor of the practice in health policy and management at the Johns Hopkins Bloomberg School of Public Health. He adds, “There are limits to the changes an administration can bring. There are laws about how drugs are regulated, and they are there for a reason: so there is good evidence for whether drugs work, based not on the claims of a company, but on real data.”
Another target is likely to be vaccines, particularly the childhood immunization schedule that is recommended by a federal advisory committee, implemented by the states, and widely mandated as a condition for school attendance. A number of people consulting on the transition went out of their way to emphasize that RFK Jr. is not anti-vaccine. He is simply in favor of openness and transparency, they say, and opposed to vaccine mandates.
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While it may sound reasonable to let each individual choose whether or not to take a given vaccine, the public-health ramifications could be grave. Infectious diseases are quick to roar back into circulation when immunization falls below a certain level. In 2019, RFK Jr. visited the Pacific island of Samoa and amplified doubts about the safety of a measles vaccine. As already shaky vaccination rates continued to plummet after his visit, a measles outbreak ensued that killed 83 people, most of them children. Kennedy has denied that his visit there had anything to do with a decrease in vaccinations.
In the wake of the COVID-19 pandemic, many Americans are frustrated with the perceived failures of the federal public health establishment. But trading it in for a choose-your-own-adventure model could be much worse. “Public health only works when we collectively do a series of things to protect all of us,” says Ashwin Vasan, former commissioner of the New York City Department of Health and Mental Hygiene. “These folks are coming in and saying, ‘Decide for yourself. We’re just going to present you with what we’re saying is the science.’ That attacks the fundamental infrastructure of public health that has kept us safe for the last century.”
Among the names being floated to work under RFK Jr.’s direction, according to several sources:
Dr. Jay Bhattacharya, a Stanford University economist and health policy expert, to helm the CDC or NIH. During the pandemic, Bhattacharya and two coauthors published an open letter called the Great Barrington Declaration, which argued for “focused protection” of the elderly and vulnerable while allowing the virus to spread more freely among the healthy in an attempt to achieve herd immunity. Public health experts widely critiqued the letter as naive and misleading.
Florida surgeon general Joseph A. Ladapo, as possible surgeon general of the United States. Ladapo has advised against the COVID-19 vaccine for children and claimed, in a widely debunked study, that Pfizer and Moderna’s mRNA vaccines elevate the risk of cardiac-related deaths in young men. He was rebuked by the heads of the CDC and FDA for promulgating misinformation. (Ladapo did not respond to an email seeking comment, and Bhattacharya declined to comment.)
Also in the mix are a brother-and-sister duo, Calley and Casey Means. Healthcare entrepreneurs who coauthored the bestselling book Good Energy, they have been lauded by Tucker Carlson. It was Calley who reportedly brokered the rapprochement between Trump and RFK Jr. Casey, who received her medical training at Stanford University, has been floated as a potential pick for surgeon general.
The heavily regulated healthcare industry does not welcome bomb throwers, and “there are a ton of companies that are freaking out,” says a healthcare expert familiar with the transition discussions.
It remains to be seen whether Trump’s chosen reformers will be hampered by pesky things like laws, regulations, and the almost wholesale opposition of the medical establishment.
Dr. Vin Gupta, a critical-care pulmonologist and affiliate faculty at the University of Washington, says Kennedy and the other “reformers” in Trump’s orbit are less interested in public health than they are in selling distrust and generating headlines. “RFK Jr. is a lawyer who doesn’t know the first thing about patient care. A lot of the kooks in this space have a shock jock approach to medical care,” says Gupta. “They will cherry-pick information…and sow distrust between patients and providers.”
And sowing distrust does not require Senate confirmation, a vast budget, or structural change. It just takes a government megaphone. “There is no scenario I can conceive of where vaccine rates don’t plummet and these diseases return as quickly as night follows day,” says Jonathan Howard, an associate professor of neurology and psychiatry at NYU Langone Health, who has written extensively about the anti-vax movement. “The federal government will be pushing anti-vaccine misinformation.”
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