Trump's picks for top health care jobs are not just a team of rivals but a 'team of naysayers'

Many of President-elect Donald Trump's nominees to federal health agencies promoted policies and goals that put them at odds with each other or with Trump's choice to lead the Department of Health and Human Services, Robert F . Kennedy Jr., paving the way for internal friction over public health initiatives.

The picks have differing views on issues such as the limits of abortion, the safety of childhood vaccines, the response to COVID-19 and the use of weight-loss drugs. The divide pits Trump's picks that adhere to more traditional and orthodox science, such as long-standing, scientifically supported conclusions that vaccines are safe, against the often unsubstantiated views advanced by Kennedy and other picks who have claimed that vaccines were linked to autism.

A situation in which senior policy makers are on the same team with such different views could make it more difficult to develop and pursue priorities.

The Trump transition team and nominees mentioned in this article did not respond to requests for comment.

This is a potential “team of naysayers” within government health agencies, said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian policy organization. Kennedy does not have a medical degree.

Kennedy, he said, is known for rejecting opposing views when confronted with science.

“FDA and NIH executives will spend all their time explaining to their boss what a confidence interval is,” Cannon said, referring to a statistical term used in medical studies.

Those whose views prevail will have significant power in shaping policy, from appointments to federal vaccine advisory committees to federal authorization of COVID vaccines to restrictions on abortion drugs. If confirmed as HHS secretary, Kennedy is expected to set much of the agenda.

“If President Trump's nomination of RFK Jr. for secretary is confirmed, if you don't subscribe to his views, it will be very difficult to make progress in this department,” said Amesh Adalja, an infectious disease specialist and researcher. principal at the Johns Hopkins Center for Health Security. “They will have to suppress their views to align with those of RFK Jr. In this administration, as in any administration, independent public disagreement is not welcome.”

Kennedy is president of Children's Health Defense, an anti-vaccine nonprofit. He pledged to curb the country's appetite for ultra-processed foods and the incidence of chronic disease. He contributed to Trump's picks to lead the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health. If confirmed, he would lead them from the head of HHS, with its budget of more than $1.7 trillion.

Clashes are likely. Kennedy supported access to abortion until a fetus is viable. That puts him at odds with Dave Weldon, the former Florida congressman who Trump picked to lead the CDC. Weldon, a physician, is an abortion opponent who authored one of the key laws allowing medical professionals to refuse to participate in the procedure.

Weldon would lead an agency that has been in the crosshairs of conservatives since the start of the COVID pandemic. He touted his “100% pro-life voting record” on his campaign website. (He ran unsuccessfully earlier this year for a seat in the Florida House of Representatives.)

Trump said he would leave decisions about abortion to the states, but Weldon's CDC could, for example, fund studies on the risks of abortion. The agency could require states to provide the federal government with information on abortions performed within their borders or risk losing federal funds.

Weldon, like Kennedy, questioned the safety of vaccines and said he believed they could cause autism. This is at odds with the view of Marty Makary, a Johns Hopkins surgeon whom Trump plans to nominate as FDA commissioner. The British-American said on Fox News Radio's “Brian Kilmeade Show” that vaccines “save lives,” while adding that it was good to question America's vaccination schedule for children.

The American Academy of Pediatricians encourages parents and their children's doctors to follow the recommended childhood immunization schedule. “Non-standard schedules that stagger vaccines or start when a child is older expose entire communities to serious illness, including infants and young children,” the group says in its guidance to its members .

Jay Bhattacharya, the doctor and economist Trump picked to lead the NIH, also supported vaccines.

Kennedy said on NPR that federal officials under his leadership would not “take vaccines away from anyone.” But the FDA oversees vaccine approval, and under its leadership the agency could place vaccine skeptics on advisory committees or make changes to a program that largely protects vaccine makers from lawsuits for harm caused to consumers.

“I believe autism comes from vaccines,” Kennedy said in 2023 on Fox News. Numerous scientific studies have discredited the claim that vaccines cause autism.

Ashish Jha, a physician who served as White House COVID response coordinator from 2022 to 2023, noted that Bhattacharya and Makary have had long and distinguished careers in medicine and research and would bring decades of experience in these high-level positions. But, he added, it “will be a lot harder than they think” to defend their views in the new administration.

It is difficult “to do things that displease your boss, and if [Kennedy] is confirmed, he will be their boss,” Jha said. “They have their work cut out for them if they want to defend their opinions on science. If they don't, it will only demoralize the staff. »

Most of Trump's picks share the view that federal health agencies have botched the response to the pandemic, a position that has resonated with many of the president-elect's voters and supporters — even though Trump has led that response to 'when Joe Biden takes office in 2021.

Kennedy told a 2021 Louisiana House oversight meeting that the COVID vaccine was the “deadliest” ever made. He cited no evidence to support this claim.

Federal health officials say vaccines have saved millions of lives around the world and provide important protection against COVID. The protection lasts even if their effectiveness decreases over time.

The vaccines' effectiveness against infection was 52% after four weeks, according to a study published in May in the New England Journal of Medicine, and their effectiveness against hospitalization was about 67% after four weeks. The vaccines were produced under Operation Warp Speed, a public-private partnership launched by Trump during his first term to speed up injections as well as other treatments.

Makary criticized COVID vaccine guidelines that called for giving the shots to young children. He argued that, for many people, natural immunity against infections could replace the vaccine. Bhattacharya opposed the measures used to curb the spread of COVID in 2020 and advised everyone except the most vulnerable to go about their lives as usual. The World Health Organization has warned that such an approach would overwhelm hospitals.

Mehmet Oz, Trump's pick to head the Centers for Medicare & Medicaid Services, an HHS agency, said vaccines were oversold. He promoted the use of the antimalarial drug hydroxychloroquine as a treatment. The FDA in 2020 revoked the emergency authorization of hydroxychloroquine for COVID, saying it was unlikely to be effective against the virus and the risk of dangerous side effects was too high.

Janette Nesheiwat, a former Fox News contributor and Trump's pick for surgeon general, took a different stance. The doctor described COVID vaccines as a gift from God in a Fox News opinion piece.

Kennedy's vaccine hesitancy will likely be a central issue early in his administration. He said he wants federal health agencies to shift their focus from preparing for and fighting infectious diseases to fighting chronic diseases.

The shift in focus and questioning of vaccines is worrying some public health officials amid the spread of the H5N1 avian flu virus among dairy cattle. Nearly 60 human infections have been reported in the United States this year, all but two linked to exposure to livestock or poultry.

“From the beginning, they are going to have to discuss vaccinating people and animals” against bird flu, said Georges C. Benjamin, executive director of the American Public Health Association. “We all contribute our opinions. The cohesion policy of a ministry is led by the secretary.”

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the primary operating programs of KFF, the independent source for health policy research, polling and journalism.

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