President-elect Donald Trump has started to make appointments to his future cabinet, and many are waiting to see what role Trump will have for Robert F. Kennedy Jr., his one-time competition for president and current ally.
After all, Trump announced at a rally in late October that he would let Kennedy “go wild” on healthcare in the country. “I’m gonna let him go wild on health. I’m gonna let him go wild on the food. I’m gonna let him go wild on medicines,” Trump said.
Kennedy later said that Trump “asked me to end the chronic disease epidemic in this country. And he said, ‘I want to see results, measurable results in the diminishment of chronic disease within two years.’ And I said, ‘Mr. President, I will do that.’”
Kennedy is a longtime anti-vaccine activist who has repeatedly expressed views about health that conflict with scientific evidence. He has created a plan endorsed by Trump called “Make America Healthy Again” (MAHA), which is a broad-ranging series of proposed policies that the politician claims online is “more powerful than Wall Street, Big Tech, Big Pharma, Big Food and the War Machine.”
It’s not clear what official role Kennedy will have in the second Trump administration, if any. But there have been whispers of him being nominated for a top position at a federal health agency, like head of the Department of Health and Human Services (HHS), Food and Drug Administration (FDA), or Centers for Disease Control and Prevention (CDC). The latter two roles are typically held by someone with a medical degree, which Kennedy doesn’t have.
What could his health leadership mean for the future of U.S. healthcare and health policy? Four health policy experts explain.
He may target fluoride in drinking water
Kennedy has repeatedly spoken out about his concerns with the public health practice of adding fluoride to drinking water. Fluoride, a mineral that strengthens teeth and reduces the risk of cavities, has been added to drinking water since 1945 to promote good tooth health in children. Data show that adding fluoride to water lowers the amount of tooth decay in young kids by 35%. This practice is currently listed by the Centers for Disease Control and Prevention (CDC) as one of the greatest public health achievements of the 20th century.
A government report released in August found that fluoride in drinking water at twice the recommended limit is linked with lower IQ in children. The report found with “moderate” confidence that a link exists between higher levels of fluoride and lower IQs in kids. But the CDC said in a statement that expert panels in the U.S. and abroad “have not found convincing scientific evidence linking community water fluoridation with any potential adverse health effect or systemic disorder such as an increased risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer disease, or allergic reactions.”
Kennedy said in an interview with NPR that he thinks fluoride should be removed from drinking water. “Now we have fluoride in toothpaste,” he said. In another interview with NPR, Kennedy said, “we don’t need fluoride in our water. It’s a very bad way to deliver it into our systems.”
But public policy experts say he’s unlikely to make much of a change with fluoride in water. “The issue of whether water is fluoridated is made by state and local authorities—it’s not a federal issue,” says Leighton Ku, Ph.D., M.P.H., professor and director of the Center for Health Policy Research at George Washington University’s Milken Institute School of Public Health. Ku says it’s possible that the federal government could make new standards around the fluoridation of water, “but that would take a long time to happen.”
In order to stop the fluoridation of water from a federal standpoint, “Congress would have to pass a law outlawing the use of fluoridation or perhaps the EPA would have to put fluoridation of water on a dangerous chemical list,” says Gerald Kominski, Ph.D., senior fellow at the UCLA Center for Health Policy Research. But Kominski says that Kennedy may have influence “through public persuasion and the authority of whatever position he might have to encourage municipalities to go ahead and stop using fluoride.”
He’s likely to try to influence vaccination policies
Kennedy is a longtime anti-vaccine advocate. “There’s no vaccine that is safe and effective,” he said on the Lex Fridman podcast in 2023. Among other things, Kennedy has linked vaccines with autism, a claim that has been debunked by the scientific community. Kennedy also said in 2021 that it was “criminal medical malpractice” to give the COVID-19 vaccine to children.
In an NPR interview, Kennedy said that he would “immediately” work on changing vaccine regulations and research. “Of course, we’re not going to take vaccines away from anybody,” he said. “We are going to make sure that Americans have good information about vaccines and vaccine safety.”
Kennedy said that the science on vaccine safety “has huge deficits and we’re going to make sure those scientific studies are done and that people can make informed choices about their vaccinations and their children’s vaccinations.”
His assertions are concerning to experts. “He claims that vaccine safety data is ‘hidden’—it is not—and that no placebo controlled studies have been done with respect to vaccines. They have,” says Katrine Wallace, Ph.D., epidemiologist and adjunct assistant professor at the University of Illinois at Chicago School of Public Health. “He also spread COVID-19 misinformation and sowed doubt about vaccines during the pandemic. He doesn’t change course when actual evidence is presented, or when flaws in his logic are explained.”
Wallace says she’s concerned about what will happen if Kennedy is put in a position of power with authority over vaccines. “An administration that is supportive of anti-science rhetoric and misinformation will only cause the vaccine coverage to decrease further, and we will see more vaccine-preventable illness, death, and disability,” she says.
Ku says that Kennedy could have some influence around vaccines if he was in charge of the FDA, which approves vaccines, or the CDC, which recommends how vaccines are used by the public. Vaccines that are approved are provided to low-income children for free through the government, and there is the potential to impact that, Ku says. “But there are a lot of rules that are well-accepted at the FDA and CDC about how they do their business,” he says. “It’s not entirely clear that even the president himself can make changes to things like that on a quick basis.”
If Kennedy was appointed as the head of the HHS, he could try to use pressure and influence to remove some substances from vaccines that he feels are harmful, Ku says. “But I would suspect that people would push back, if there is data to support what he is trying to remove,” he says.
Kominski points out that Kennedy has “floated the idea” that schools with vaccine requirements should be defunded, although it’s unclear if he could actually do that. “This is not an intelligent, evidence-based way to improve childhood safety and childhood health,” he says. “He has some dangerous ideas and appears to be largely anti-science, which is terrifying when it comes to appointing someone who will have authority over public health.”
He may try to change how things are done at the FDA
Kennedy has been very clear about his dissatisfaction with the way things are run at the FDA. In late October, he wrote on X that the “FDA’s war on public health is about to end.”
“This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals, and anything else that advances human health and can’t be patented by Pharma,” he continued. “If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”
But despite all of his threats against the FDA, Kennedy is unlikely to enact that much change, even if he was appointed the head of the FDA or HHS, says Dan Troy, former FDA chief counsel and managing director of BRG. “It is difficult for any one person to drive seismic change within the context of a law-constrained bureaucracy such as the FDA,” he says.
Troy points out that changing a rule “takes years,” adding “a notice of proposed rule-making is dozens, if not hundreds of papers. It requires an economic analysis. It’s a team sport and it requires a lot of collaboration.”
“One cannot just sit in the White House and issue pronouncements and expect that policy is going to change,” Troy continues. “That’s just not the way it works. It takes time, energy, effort, and working with the staff and in the system to really make dramatic changes.”
When it comes to the approval of products like vaccines—or antidepressants, which Kennedy has linked to mass shootings—Kennedy is unlikely to be able to remove existing products. “You can’t just revoke an approval because you don’t like it or because you don’t think there was an adequate basis for it,” Troy says.
Troy points to the FDA under the previous Trump administration, noting that “it’s hard to think of anything seismic that was done there.” He adds, “there’s just a limited amount that you can actually get done.”
He may attempt to ban certain foods and promote others
Kennedy said at a virtual event in late October that Trump promised him “control of the public health agencies,” including the HHS, CDC, FDA, and NIH. “And then also the USDA which, you know, is key to making America healthy because we’ve got to get off of seed oils and we’ve got to get off of pesticide-intensive agriculture,” he added.
What he’d like to see Americans consume more of, he’s said, is raw milk, which proponents of say has more nutrients and healthy enzymes due to being unpasteurized. But it’s something often associated with outbreaks of illnesses, including from a possibly-deadly strain of E. coli, and is even riskier now due to the bird flu outbreak among dairy cows, experts told the New York Times.
But Ku says it’s “less clear” what Kennedy wants to do in this area of food. “He certainly has some interest in trying to have people eat healthier diets, and that may include moving away from certain additives in foods and trying to change how people eat,” he says. “Those recommendations from the government have some impact, but there are still people who eat what they want, no matter what the government recommends.”
Even if Kennedy was appointed secretary of agriculture, Ku says that’s a “divided” role. “On the one hand, this person has a duty to be supportive of agriculture and the food industry in general; on the other, they have to be supportive of dietary habits of Americans, like school food programs,” he says. Ku cites the example of encouraging Americans to eat more plant-based foods, which can upset producers. “And they are a major constituency of the Department of Agriculture,” Ku says. “Some of these things are a little tough.”
Overall, Kaminski says it will be “challenging” to have Kennedy in a position of power at a federal health agency. “Science and facts are under attack,” he says. “We need to keep producing the science and the data that will guide policy in the future.”
But while Ku says that it’s “reasonable to be concerned” about a future with Kennedy in charge of a health agency, he stresses that the medical and scientific community will continue to speak up if proposed policies are without merit.
He also stresses that the government has a system of checks and balances in place for a reason. “It’s not as though if RFK Jr. were appointed to a high level position, he could wave his magic wand and change policy,” he says. “Even Trump when he was president could not do that.”
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