Trump selects RFK Jr. to head HHS, and here's what he could accomplish with that authority.

• Donald Trump, the newly elected president, has appointed Robert F. Kennedy Jr., a well-known vaccine skeptic, to head the Department of Health and Human Services.
• The public health community is raising concerns, causing the biotech and pharmaceutical industries to be cautious about potential changes.
• Kennedy's power will be limited due to Congress's potential rejection of some of his proposals.

Robert F. Kennedy Jr. has been appointed by President-elect Donald Trump to head the Department of Health and Human Services, sparking concerns among the public health community and preparing the biotech and pharmaceutical sectors for potential upheavals in drug development.

Trump's announcement on Thursday increases Kennedy's chances of becoming the nation's top health-care official. However, the upcoming Republican-controlled Senate will have the final say on whether to confirm him. Trump has hinted at the possibility of bypassing the Senate through recess appointments.

If confirmed, Kennedy will lead a $1.7 trillion agency responsible for vaccines, medicines, scientific research, public health infrastructure, pandemic preparedness, food and tobacco products, as well as managing government-funded health care for millions of Americans, including seniors, disabled people, and lower-income patients who rely on Medicare, Medicaid, and the Affordable Care Act's markets.

The heads of the Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes of Health, and Centers for Medicare and Medicaid Services all report to the HHS secretary, though Trump has not yet nominated them. Kennedy will likely have some influence over who the president-elect chooses for those roles, health policy experts said.

Experts predict that if Kennedy were to become president, he could increase vaccine skepticism and discourage more Americans from getting recommended shots, potentially cut funding or eliminate entire departments at various agencies, and redirect research and development efforts to focus on alternative treatments or areas of interest to him.

Kennedy's "Make America Healthy Again" platform claims that the alliance between drug and food companies and the federal health agencies that regulate them is responsible for making Americans less healthy. Kennedy has long advocated for reform or a complete overhaul of the HHS agencies, which could involve cutting funding, purging staff, and hiring new employees who share his often unproven views on health and science.

He has stated that he aims to eliminate fluoride from water systems and combat chronic illnesses by enforcing stricter regulations on food and chemical additives, in addition to other initiatives.

Despite a Republican trifecta, Kennedy's power will have limits, and some of his proposals, such as cutting funding, may not easily pass through Congress. Other efforts could lead to expensive and prolonged litigation against the federal government.

Neither Kennedy nor Trump's campaign representatives provided an immediate response to requests for comment from spokespeople.

As HHS secretary, Kennedy may or may not be able to achieve certain things.

Vaccines

Kennedy is a critic of vaccines, which have saved the lives of over 1.1 million children in the U.S. and saved Americans $540 billion in direct health-care costs over the last three decades, according to CDC research released in August.

Kennedy, the founder of the Children's Health Defense, has long made misleading and false statements about the safety of shots, claiming they are linked to autism despite decades of studies that debunk that association.

According to CNBC, several health policy experts stated that an increase in preventable diseases could result from Kennedy's influence on immunization policy.

Gostin stated that he could create significant distrust in vaccines and politicize some vaccines, leading to outbreaks of preventable childhood diseases such as measles, mumps, rubella, and polio, particularly in red states.

Although he has a past, Kennedy stated to NBC News in early November that he has no intention of removing vaccines from anyone in the U.S.

The FDA has the authority to remove a product from the market if subsequent trials after approval do not demonstrate that the clinical benefits of the product outweigh its risks, or if new risks are discovered among patients. However, this has not occurred with the approved vaccines currently available.

"According to Josh Michaud, it would be challenging for a new HHS Secretary to remove vaccines that are already approved and being used and recommended by the government from the market. He emphasized that such a change cannot be made with a simple wave of a wand."

Kennedy has consistently maintained that there is insufficient information on the effects of vaccines. He stated on NPR this month that the Trump administration is committed to conducting scientific studies to enable individuals to make informed decisions regarding their vaccinations and those of their children.

Lawrence Gostin, a health law and policy expert at Georgetown University, stated that as HHS secretary, Kennedy had the ability to manipulate data from government studies and present false information about the safety and effectiveness of vaccines, thereby damaging public trust.

Vaccine misinformation could discourage some Americans from getting certain shots, prompting health officials to consider giving more individual choice on vaccination mandates for certain diseases.

The CDC's advisory committee provides vaccine recommendations to many state health departments and clinicians, specifying who should receive which shots and at what age.

The Affordable Care Act covers vaccines recommended by the advisory panel and approved by the CDC director. Additionally, the CDC administers the Vaccines for Children program, which offers free vaccines to children from low-income families.

Gostin stated that Kennedy could potentially sway the opinions of the CDC advisory committee and a related panel affiliated with the FDA by filling them with individuals who hold anti-vaccine beliefs. As HHS secretary, Kennedy possesses the authority to establish an advisory committee, remove members, and establish the criteria for their selection.

If only some states follow the vaccine recommendations of advisors chosen by Kennedy, it could result in a fragmented vaccine policy in the U.S.

Federal agency funding, staffing

In recent weeks, Kennedy has vowed to eradicate "corporate corruption" at federal health agencies and dismiss staff upon assuming his position in the Trump administration.

The FDA worker who stands in the way of approval of several controversial or dubious treatments should prepare to "pack their bags," as the head of the FDA has stated that he would clear out "entire departments."

Kennedy, prior to withdrawing from the presidential race, stated that he intended to alter NIH's emphasis from infectious diseases to chronic conditions such as obesity for eight years. In September, Kennedy declared that half of NIH's $48 billion budget should be allocated to "preventive, alternative, and holistic approaches to health."

The potential changes at the NIH, the largest funder of biomedical research in the U.S., could have significant consequences for research and the pharmaceutical industry. The NIH supports and conducts research on a wide range of topics, including vaccines, cancer, and new drug targets, providing the foundation for treatments that companies can develop.

Genevieve Kanter, an associate professor of public policy at the University of Southern California, stated that he could allocate funding away from drugs he's not interested in and more towards speculative areas.

Despite evidence from several studies showing that hydroxychloroquine and ivermectin do not work against Covid, Kanter continues to promote these disproven treatments.

Congressional approval would be necessary for any major changes or funding cuts at the NIH, FDA, and CDC. Federal employees are shielded from arbitrary or politically-driven terminations.

Congress's failure to fully fund FDA staff salaries results in additional protection for them. Almost half of the agency's $7.2 billion budget this year comes from "user fees," or payments made by drug and medical device manufacturers to fund the staff resources needed to quickly review their products, conduct inspections, and ensure the safety of clinical studies.

According to Richard Frank, director of the Brookings Schaeffer Initiative on Health Policy, it is unlikely that Kennedy will be able to end the user fee program. However, he may try to influence negotiations on how the program is implemented when Congress decides whether to reauthorize it after 2027.

Gostin stated that other "cuts across the board" at the three agencies are possible, particularly in areas that are "part of the culture wars." Specifically, the CDC could see funding reduced for key functions related to vaccines, chronic disease, sexual and reproductive health, and firearm injury and prevention, according to Gostin.

Kennedy's plan to reform the U.S. food system may result in cuts or elimination of the FDA's nutrition departments.

Cracking down on pharma

Some Wall Street analysts are not as worried about Kennedy's impact on drug approvals and regulation.

Evan Seigerman, a BMO Capital Markets analyst, predicted that RFK would concentrate on the connection between U.S. food policy and chronic illness rather than medicine, according to a note he wrote last week.

Processed food companies, including and , experienced a decline in shares on Friday as investors anticipate a potential crackdown on food policy.

Fewer immediate concerns exist on Wall Street regarding pharmaceutical companies, according to Seigerman, who stated that there is little precedent in recent history for HHS policy influencing FDA drug regulation and approval.

The impact on the biotech and pharmaceutical industry remains uncertain until Trump appoints an FDA commissioner, but the company is optimistic that he will choose a candidate with a strong medical background and industry ties.

According to BioPhy CEO Dave Latshaw, it seems that Kennedy is inclined towards stricter regulations and greater intervention in the biotech and pharmaceutical sector.

The drug development and approval process could pose a greater risk to companies with products in the earlier stages of development than to large pharmaceutical companies, according to Latshaw.

Kennedy might try to regulate the biotech and pharmaceutical industry differently, but it may not yield results.

In 2023, nearly $3 billion was spent by pharmaceutical companies on advertising for the top 10 promoted drugs. He has stated that he intends to prohibit direct-to-consumer television advertisements for drugs.

The First Amendment, which safeguards the right to free speech, would make it challenging for experts to accomplish their task. During his first term, Trump attempted to regulate pharmaceutical advertising by mandating companies to reveal the prices of their products in advertisements. Pharmaceutical companies filed lawsuits against the government, and a federal court halted the rule.

The pharmaceutical industry is challenging in court the provision in the 2022 Inflation Reduction Act that gave Medicare the power to negotiate drug prices with manufacturers for the first time in history, and it is unclear how President Joe Biden feels about this.

The Trump administration will face challenges in dismantling or scaling back the law without Congress' approval. Additionally, it seems unlikely that Kennedy would abandon efforts to lower drug prices, a significant concern for Americans, as stated by Amy Campbell, associate dean for law and health sciences at the University of Illinois Chicago School of Law.

Fluoride, food supply

Kennedy recently suggested that all U.S. water systems should remove fluoride from drinking water, stating that it is a "waste product" linked to various health issues, including thyroid disease and developmental disorders. Trump has since expressed his support for this idea.

Fluoride, a naturally occurring mineral in soil, water, and plants, is widely regarded as one of the greatest public health achievements of the 20th century due to its ability to prevent tooth decay when added to drinking water in low levels.

Kennedy could only advise the removal of fluoride from water because the decision to add it is made at the state and local level, which may result in some states abolishing fluoridation.

Kennedy has been vocal about addressing the root causes of chronic diseases instead of solely relying on pharmaceutical industry drugs for treatment. Although specifics are limited, Kennedy is addressing a significant issue in the U.S.

In America, a growing number of individuals are managing multiple chronic health issues, with approximately 42% of the population having two or more, as per the CDC. Over 40% of school-aged children and adolescents also have at least one chronic condition.

Kennedy's suggestions, including removing ultra-processed foods from school meals and tightening regulations on food dye, have garnered support from both the right and left. However, he has also made misleading statements about the food industry in the U.S., such as claiming that Froot Loops cereal in Canada only contains two or three ingredients when it actually has 17.

Experts suggested that Kennedy could persuade the FDA commissioner to eliminate or reduce the agency's Center for Food Safety and Applied Nutrition. However, experts pointed out that banning the use of approved food additives would necessitate more resources rather than fewer. They explained that the process would entail comprehensive reviews of data and ongoing monitoring of the food supply, among other measures.

The USDA establishes rules for school lunch programs.