A Vox reader asks: Why is some soap labeled antibiotic? Is there a soap that is friendly to germs, viruses, etc.? I thought the whole idea was to get rid of germs and viruses.

There really are too many varieties of soap out there. Too many brands, too many fragrances and colors, too many claims about their hand-softening, nail-beautifying, nostalgia-enhancing qualities to keep it all straight. And that’s before you even consider whether a product actually gets rid of disease-causing microbes. If this seems like too much, you’re not wrong; the market is overwhelming.

You may be surprised to learn that most “plain” soap doesn’t actually kill germs. Here’s what it actually does: When combined with water, it surrounds germs in slippery globs that make them literally slide off your hands and down the drain. Not lethal to microbes, but still a pretty efficient way to clean them off your hands.

Soap labeled as antimicrobial does more damage to microbes than just whisking them away — it does actually murder them by breaking up the outer layers of bacterial or viral cells and causing them to spill out their guts. These soaps contain additional ingredients that are particularly effective at slicing up the fatty compounds in germs’ outer walls, exposing the tiny organ-like structures on their insides and rendering them dead. 

When it comes to getting rid of germs, it might seem that deadlier is better… right? Not necessarily. Antimicrobial soaps are indeed better at lowering the amount of germs on a person’s hands than plain soap — but in most situations, the risks aren’t worth that benefit. 

One concern consumer safety experts at the Food and Drug Administration have had is that people who used certain antimicrobial soaps too often — specifically, soaps that contain any of nearly two dozen antiseptics historically used in consumer cleaning and handwashing products — might absorb some of those germ-killing ingredients into their bloodstreams. These chemicals tend to do the same thing to skin that they do to germs: break up the outer layers, causing damage and irritation. 

The FDA was worried specifically about triclosan and triclocarban, the most widely used of these antiseptics. Animal studies suggested they could be absorbed from the skin into the blood, where they could go on to have hormone-like effects on the thyroid and on sex hormones. For other antiseptics, there was no good data proving they didn’t have these effects. The body of evidence raised questions about what might happen if a very zealous person took regular baths in a readily available antimicrobial soap.

The FDA also worried using antimicrobial soaps too frequently could create more microscopic superbugs that are harder to kill with common antibiotics. This isn’t just a theoretical concern: In one study, people who used a triclosan-containing antibacterial soap at home were more likely to have skin bacteria resistant both to the germ-killing ingredients in the soaps and to common oral antibiotics. Not great!

The risks of antimicrobial soap so dramatically outweighed their benefits that in 2016, the FDA banned most germ-killing ingredients from consumer products. 

Why is some hand soap labeled antibiotic, but others aren’t?  

While they were conducting their review of antibiotic soaps, the FDA found that a handful of antimicrobials were actually safe enough to use at home: benzalkonium chloride, benzethonium chloride, and chloroxylenol. That doesn’t mean they have an advantage over plain soap in preventing infections — they don’t. It just gives manufacturers permission to market them to you. You can still find these in soaps labeled “antimicrobial” or “antibacterial” on store shelves today. 

Manufacturers aren’t allowed to use those words to describe soap that doesn’t contain these ingredients, so most soaps don’t.

Why haven’t germs evolved to resist plain hand soap?

The key is in the killing, or lack thereof. 

Germs often develop immunity by chance: They mutate pretty often as they reproduce, and occasionally, those mutations will give a handful of germ babies a survival advantage. 

As an example, let’s say your bacteria-eliminating weapon of choice is a blowtorch. Given the frequency of bacterial mutation, five out of 100 bacteria living happily on a tiny section of your skin might have a mutation that makes them resistant to blowtorching. So if you try to clean that skin by blowtorching those bugs, you’ll end up with five living, blowtorch-resistant germs — each of which now has more space and resources to procreate and zero competition. Those elite germs will fill that space with their progeny, and the next time you want to clear that spot of bacteria, a blowtorch won’t cut it: Every member of this new, stronger bacterial population is already blowtorch-resistant.

Using a strategy that removes germs without killing them doesn’t create the same environment for those lucky mutants to thrive, so they stay small in number. That’s one of the major reasons why using plain soap is better for most situations than antimicrobial soap.

Is there anything better than soap?

You didn’t ask about alcohol, but I’ll tell you this: Unless you have visibly dirty hands, or have norovirus or certain kinds of infectious diarrhea, alcohol-based sanitizers are a better choice than any soap. 

They don’t get absorbed into the bloodstream through the skin. (Just don’t inhale them!) They also kill bacteria and many viruses more reliably than even antibacterial soaps, in large part because we apply them in the same concentration every time we use them. (Soap gets diluted by water, so it’s harder to be sure people are getting the same ratio of soap to skin.) That means superbug evolution isn’t a concern with these products.

Alcohol-based hand sanitizer is so much better than soap that the Centers for Disease Control and Prevention actually recommends sanitizer over antibacterial soap in most health care settings. One exception is before surgery: Because antibacterial soaps are still the best at removing bacteria from the skin just below the surface, surgeons still have to scrub with germ-killing soap and water before gloving and gowning up for surgery.

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get early access to member-exclusive stories every month, join the Vox Membership program today.

With the arrival of cooler weather, the season of hacking and sniffling is here. Once again, haggard-looking people roam the aisles of American pharmacies, clutching tissues and looking for relief — and often coming up empty-handed.

Last year, the FDA recommended that phenylephrine, a decongestant in many popular cold medicines that’s been proven to be ineffective when taken orally, be removed from pharmacy shelves. (It’ll take a while for that to happen, which explains why you might still find the ingredient in NyQuil and other cold medicines.) But that doesn’t mean all the other syrups and gels and tablets available for purchase are effective. In fact, most over-the-counter cold medicines do very little to reduce the symptoms that cause us the most misery during respiratory virus season.

Still, there are a few exceptions worth knowing about, plus several non-pharmaceutical interventions that may slightly reduce your suffering while you wait things out. And it’s smart to be aware of ways to avoid catching the ick to begin with, or spreading it to others. 

Let’s get this out of the way: You can prevent and treat some viral causes of cold symptoms

Cold symptoms are often caused by viruses for which we don’t have vaccines, simple or cheap tests, and antiviral medications. However, there are some important exceptions: Covid and the flu can be prevented with vaccines, and there are RSV immunizations for babies and adults 65 and up. Testing can identify all of these viruses, and there are medications — like Tamiflu (oseltamivir) and Paxlovid (nirmatrelvir-ritonavir) — to help reduce the severity of flu and Covid infections, respectively, in certain groups of people. Talk to a clinician to find out if these are right for you. 

Taking some preventive steps is also worthwhile. Handwashing, ventilating and filtering air in shared spaces, strategic masking, and staying away from sick people can all help prevent illness. Even if these practices only lower the viral dose you take in, that can still make for a less uncomfortable cold season; with many viral illnesses, the dose makes the poison.

Reach for this, not that

It’s not a requirement that people with colds take medication. Unless you have a fever lasting more than three days or other concerning symptoms like shortness of breath, cold symptoms aren’t generally a sign of an underlying illness that needs to be treated. However, lots of people want to feel better when they have a cold, and they especially want to get better rest than a stuffed nose or a gnarly cough allows them. 

If that’s you, it’s smart to be selective when choosing a cold medicine, as not everything marketed to you is equally likely to be helpful. Here’s what’s been proven to work:

Pain and fever reducers

Drugs that reduce pain and inflammation — the Tylenol or ibuprofen you typically reach for when you have a headache — can relieve the fevers, aches, and pains that accompany colds, along with some of the exhaustion and even some of the sneezing. Children, including babies, can safely take these medications in weight-appropriate doses; check the packaging to ensure you’re giving the correct amount.

Decongestants and antihistamines

For adults with stuffy noses, the only decongestant to bother with is pseudoephedrine, the active ingredient in regular Sudafed. Confusingly, this is not the active ingredient in Sudafed PE, which contains the soon-to-be-discontinued phenylephrine. Because of its illicit use in producing methamphetamine, pseudoephedrine is held behind counters and sold in only limited quantities to consumers. You’ll have to ask the pharmacist for it.

There’s evidence pseudoephedrine might work better to address snot-related symptoms when combined with an antihistamine. But the antihistamines in your allergy medication (Zyrtec, Allegra, and Claritin) won’t be as effective for a cold; the varieties in most combination cold medicines are usually older ones, which seem to work better for nasal symptoms caused by viruses.

Decongestants and antihistamines aren’t safe for kids under 6 and need to be used with caution in older children.

It’s not uncommon for people using these medications to have side effects like drowsiness, dry mouth, and trouble sleeping. Additionally, they’re not safe for use in people with high blood pressure, glaucoma, kidney disease, and other conditions. People with preexisting conditions and those taking certain medications, including some antidepressants, should check with a health care clinician or pharmacist before taking these medications.

Nasal sprays and inhalers

Nasal sprays or inhalers containing certain anti-runny-nose components have been proven to make coughs and colds somewhat less miserable. The active ingredients to look for are cromolyn sodium (in over-the-counter brands like Nasalcrom) and ipratropium bromide (available as the prescription-only Atrovent). These haven’t been studied in kids under 6, so again, only use them per package directions in older children.

A lot of people also get relief from saline nasal sprays and nasal irrigation, but make sure you follow the package directions to avoid other infection risks.

Cough medicines

When it comes to cough medicines in particular, a 2014 review study found little evidence to suggest they’re effective. This category includes drugs advertised as cough suppressants (e.g., dextromethorphan, which is supposed to lower the frequency of cough) or expectorants (e.g., guaifenesin, which theoretically helps make coughing more effective at getting the gunk out). Plus, these medications can be dangerous to young children, and aren’t recommended for kids under 6. 

It’s worth noting that in small but well-designed studies, one of which was conducted by pharmaceutical companies, dextromethorphan slightly decreased coughing in both adults and older children. Overdoses can be dangerous, though, and the benefit is so small that most experts don’t think it’s worth the trade-off so don’t recommend it to patients generally. However, if you find this medication helpful, it’s safe to use in moderation. Just opt for formulations that contain only dextromethorphan (rather than combination medications) and take it according to the package directions.

Honey, zinc, and vitamin C

There’s evidence that a couple teaspoons of honey reduces nighttime coughing, making it a safer and more cost-effective choice than cough medicine for most people (note that honey is not safe for babies less than a year old). Additionally, oral zinc might shorten the time some people experience cold symptoms after infection, although its nasty taste and the nausea it causes some people may not be worth the benefit. (Avoid nasally administered zinc; overdoses can lead to a permanent loss of smell.) There’s also some evidence that very active people taking big doses of vitamin C — a gram a day for a week — have shorter and less severe colds, but it’s not totally clear whether the effect translates to people who have normal activity levels.

There’s help beyond the cold medicines

Some of the most effective treatments for colds are things you can do for free, more or less. Sleeping propped up on lots of pillows can help reduce nighttime cough and congestion by allowing gravity to drain all that extra gunk downward from your nose, sinuses, and throat. You can even elevate the head of your bed by putting bricks or cinder blocks under the top legs.

Getting plenty of rest on a regular basis — eight hours or more a night — may make cold symptoms less severe if you do get infected, and can help you fight off colds by boosting your immune system. Drink plenty of fluids to avoid dehydration, keep your mucous membranes nice and moist, and loosen all the sticky stuff.

Routine viral coughs and colds are typically the worst for the first three to five days, and you might have a fever for the first two to three. However, it’s very common for mild symptoms to linger, even if they don’t signify anything nefarious: Runny noses and congestion can hang around for seven to 10 days, and a post-viral cough (usually caused by persistent irritation) can last up to three weeks. 

If things don’t get better, it might be time to get professional help. See a health care provider — whether it be your primary care physician or someone at your neighborhood urgent care clinic — if you have a fever that lasts for more than three days or if you have severe symptoms like shortness of breath, a throat so sore you can’t stay hydrated, persistent dizziness, or trouble getting out of bed. 

Conditions other than viral infections can cause cold symptoms: Seasonal allergies can also strike in winter, and bacterial infections in the ears, sinuses, upper airways, and lungs can start with symptoms that look a lot like a nasty cold. So if you have anything else going on that feels atypical or concerning to you, check in with a provider to determine whether it’s something that needs more than the usual home care. 

Not to brag, but I’m pretty good in the kitchen; I love a complex pastry project, ferment things with relish (sorry), and am probably above-average at emulsifying a sauce. But there is one scenario involving cooking for others that strikes dread in my heart: getting them sick.

I’m a doctor with specialty medical training in infectious diseases and public health. If I prepared a meal that sent a crowd of my friends and loved ones running for the bathroom, I might never emerge from the shame hole.

I thought I knew everything I needed to know about food safety to avoid eternal public humiliation. Still, as I came to understand while researching this story, even know-it-alls like me have a lot to learn about handwashing, cleaning surfaces and food, storing leftovers, and reducing non-germ risks.

Thanksgiving, and the holidays more broadly, are different from other times of the year. People are preparing more dishes for more people than they typically would, says Ben Chapman, a food safety expert who leads the Agricultural and Human Sciences at North Carolina State University. The resulting chaos means less control in the kitchen — which often leads to higher risk for both cooks and eaters. 

Here’s the stuff you need to sweat — and don’t — as you take on your next big holiday dinner.

Proper handwashing and drying is essential

DO wash your hands – a lot. Raw whole turkeys are highly likely to be contaminated with germs that can make people sick, most commonly campylobacter and salmonella. The big risk of touching raw meat in the kitchen is that you’ll move those germs to surfaces that other people will also be touching a lot. That raises the chance people will get nasties on their hands — and in their mouths — even if they didn’t directly handle the thawing turkey.

For that reason, Chapman recommends washing your hands more than you think you need to when preparing a meal for a lot of people. Clean your hands immediately after touching raw meat — and don’t forget that even a partially thawed turkey can transmit germs. 

Plain soap and water works fine — it doesn’t have to be antimicrobial soap to do the job, but you do need to rub the skin all over the hands to get them really clean, including the backs of hands, between fingers, and under the nails. But the real shocker here, at least to me, was when Chapman told me alcohol-based hand sanitizers are actually better for most situations, even if you have watery turkey juice on your mitts. (One situation where sanitizer is inferior to soap: after touching lots of really fatty meat, like sausage or pork. In those situations, use soap to make sure you’re cutting through the grease to get at all the germs mixed in.)

DON’T skip drying ’em. It’s not just the actual handwashing that’s important for removing germs from your fingers, Chapman says: Drying hands after washing removes up to 90 percent of the bacteria on the skin’s surface, so don’t ignore this important step.

There’s no need to waste tons of paper towels drying off. Chapman suggests keeping different dish towels in different parts of the kitchen for different purposes, if at all possible. For example: You could keep one “dirty” towel in a kitchen corner for drying off hands you’ve washed them after say, holding a raw turkey. On a hook elsewhere in the kitchen, you could keep a “clean” towel you use for wiping up sauce spills or other less germy messes. 

Any system can easily break down when random people drift in and out of your kitchen while you’re cooking. It’s not a bad idea to just chuck used dish towels directly in the wash after mopping up spills of raw meat juices or drying off particularly gross hands. “I might go through 10 dish towels on Thanksgiving Day,” Chapman says.

Clean this, not that

DON’T worry about washing your produce. Washing produce removes physical debris, like soil, sand, and dirt. However, it rarely removes germs that make people sick. The reason: When produce is contaminated with pathogens, they often attach just under the surface, within tiny pores in the fruit or vegetable that protect it from being washed away. 

“Fresh produce, unfortunately for us, is our No. 1 source of foodborne illness in the US,” Chapman says. “And also unfortunately for us as consumers, by the time it gets to me, there’s very little I can do.”

DO take special care if you’re going to wash your turkey. There’s no food safety reason to wash your turkey, but a lot of people like to anyway because of personal preference. Chapman prefers wiping debris off with a hand towel (which he then throws straight into the washing machine). However, if you opt to wash your turkey, he suggests being especially fastidious about cleaning your sink afterward.

“The sink is a food preparation area,” Chapman says, as people often rinse lettuce or other vegetables in the sink, and water bouncing off a contaminated basin can splash pathogens onto food that does not later get cooked. 

So if you’re a poultry washer, just make sure to clean and sanitize the sink afterward, including the bottom, sides, and rim around the basin.

DO frequently sanitize your kitchen counters and other surfaces. Because turkey is particularly high-risk for contamination with disease-causing germs, Chapman is “bleach forward” about sanitizing his kitchen’s surfaces on Thanksgiving, and he favors a pre-packaged bleach spray (like the ones made by Clorox or Lysol) for getting the job done. If you’re really worried about damaging clothes, “that’s part of the reason why aprons exist,” he says. However, you can also use sanitizers that contain quaternary ammonium, which is in most non-bleach disinfectant sprays. As a bonus, it’s also easier on stainless steel and utensils — and alcohol-based cleaners are also quite good. 

Just don’t mix different cleaners together or spray them on the same surface at the same time, as doing so can release toxic gases that can cause serious illnesses or even death. Whatever you choose, stick with it — at least for the day.

Check your temperatures

DO cook your turkey (and whatever’s inside it) to 165 degrees Fahrenheit. Turkey and everything inside it should be heated to at least 165 degrees before serving to kill any disease-causing germs. It’s fine to cook stuffing on the inside as long as it reaches this temperature. Yes, doing this without turning out a dry turkey requires some finessing; Chapman roasts his stuffed bird at a lower temperature of 325 for a longer time and also strategically deploys foil. 

DO keep your fridge cold enough. The right refrigerator temperature is cool enough to slow spoilage, but not so cold it freezes milk, lettuce, and other foods high in water content. Chapman sets his to 38 degrees, which he says keeps leftovers good for about a week. He suggests buying a cheap refrigerator thermometer to ensure yours has the perfect climate if it doesn’t have a built-in one you can calibrate. 

DON’T bother cooling leftovers before refrigeration. The old rule about bringing leftovers to room temperature before putting them in the fridge is from a time of older refrigerators, when they occasionally allowed interior temperatures to rise above safe levels for food storage. Modern refrigerators don’t work that way, so feel free to put leftovers in the fridge while they’re still warm, Chapman says. 

DON’T bother reheating leftovers, unless you want to. So long as food was cooked to the appropriate temperature at the time of your feast and was not left out on the counter for hours before refrigeration, there’s no need to reheat leftovers to any particular temperature.

Avoid toxins in your cookware and your air

DO choose non-nonstick cookware and wood, silicone, or stainless steel cooking utensils. The best bet for cookware is to use products made of glass, stainless or carbon steel, or cast iron. That’s because a lot of nonstick cookware is made with “forever chemicals,” the shorthand term for per- and polyfluorinated substances (PFAS) that have been linked with a range of cancers and other health conditions. Teflon is one of them, but there are other PFASes out there, and manufacturers aren’t always transparent about which of the broad panoply of these chemicals are or aren’t in their products.

If you love nonstick cookware, a good bet is to use a pan with a ceramic coating. And if you end up using a nonstick pan coated either with Teflon or another PFAS, you can minimize the release of these chemicals by using only soft (e.g., non-metal) utensils when cooking, avoid heating it while empty, and wash them by hand using gentle cleansers and sponges.

And for stirring whatever’s in your pot, it’s a better idea to use wood, silicone, or stainless steel rather than black plastic utensils. There’s a chance — albeit a small one — these may be made from recycled electronic waste, so avoid them if you’re risk-averse.

DO ventilate and filter your air while cooking — especially with gas. Gas stoves create a lot of pollutants, which is why they typically must be installed with range hoods. Other kinds of cooking can also create pollutants — for example, cooking with nonstick pans, grilling, and frying. 

Unfortunately, range hoods don’t always vent the air outdoors — sometimes, they just recirculate it inside. So if you’re cooking with gas, it’s a great idea to open a window and turn on a fan if you have those options, and a portable air purifier can also help.

A little knowledge can go a long way toward maximizing what makes hosting fun and minimizing the worry your feast will lead to a lifetime of dishonor. Go forth and feed your people!

Donald Trump announced Thursday that Robert F. Kennedy Jr. would be his nominee to lead the Department of Health and Human Services (HHS), setting the stage for a potentially radical remaking of the nation’s health care. 

Kennedy’s nomination was not a surprise. Last month, Kennedy said Trump had promised him control of the department and its many subagencies, which include the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Centers for Medicare and Medicaid (CMS), and others. Trump himself pledged during the campaign to let Kennedy “go wild on health.”

It’s a perplexing pick. Kennedy has spent decades spreading anti-vaccination pseudoscience, and the organization he leads, Children’s Health Defense, has been one of the foremost anti-vaccine advocacy groups in the US and abroad. His work in support of a Samoan anti-vaccine group helped fuel a wave of vaccine hesitancy in the island nation, leading to a 2019 measles epidemic that killed 83 people, most of them children.

He’s expressed a range of other conspiracy-laden ideas about health: He says fluoride is industrial waste linked to a range of diseases, and suggested it should be removed from all US water systems. He has speculated that gender dysphoria may result from herbicide exposure and implied mass shootings are linked to antidepressants. 

Kennedy does hold other views that align with many scientists: He traces America’s high levels of chronic disease to the widespread availability of highly processed, non-nutritious food, which he and nutrition policy experts blame in part on broken agriculture policy. He’s railed against corruption and conflicts of interest in the FDA’s drug approval process that favor big pharmaceutical companies over the interests of individuals — something economists, scientists, and consumer advocates agree on. 

No matter where a person stands on the political spectrum, they can probably find something to agree with Kennedy on. He is the personification of the growing distrust of science and “the public health establishment” that many Americans have felt in the post-pandemic era.

HHS secretaries are usually seasoned bureaucrats with a lot of experience moving policy through government agencies — a state insurance commissioner in Barack Obama’s case or a tenured pharma executive in Donald Trump’s first term. They typically understand how science is done and what it means for a health intervention to be grounded in evidence. 

Kennedy doesn’t have that résumé — far from it. Now he’ll be in charge of much of US health care, which raises the question: How much damage can he actually do in this role?

The answer will depend on a few things. First, he has to be confirmed by the Senate (unless the White House attempts to circumvent that chamber’s constitutional “advise and consent” powers) and Republicans have only a narrow majority. Even if Kennedy is confirmed, Trump has other important health care appointments to make — particularly for CMS, NIH, FDA, and CDC — and those people will hold sway over the administration’s health care agenda too. They could be in the Kennedy vein or, as we have seen with Trump’s foreign policy picks, a mix of the conventional and the iconoclastic. 

For now, however, Kennedy’s appointment is a watershed moment that could portend enormous changes to the American health system. Republicans in Congress will control the HHS budget, and Kennedy, if confirmed, could have broad discretion to pursue his “Make America Healthy Again” agenda with Trump’s blessing. If the Trump administration attempts to remove civil servants across the government, including the health agencies, decades of public health knowledge could be lost at the CDC, FDA, and elsewhere. It is uncertain if the Republican-dominated judiciary would step in to stop any of it.

Here’s what we know about the Trump health department’s plans — and what hurdles may await them.

What RFK Jr. can — and can’t — do on vaccines, briefly explained

Over the last 30 years, vaccines have saved the lives of more than 1.1 million children in the US alone. Over the same period, they’ve also saved Americans $540 billion in direct health care costs and trillions in social costs. Routine vaccines protect American children from 16 diseases.

Trump himself suggested blocking funding for local schools with vaccine requirements during the campaign, though the federal government has limited authority to do so. Despite Kennedy’s long history of anti-vaccine rhetoric, he said in early November he wasn’t planning to take anyone’s vaccines away. 

“People ought to have choice, and that choice ought to be informed by the best information,” Kennedy said in an NBC News interview. “So I’m going to make sure scientific safety studies and efficacy are out there, and people can make individual assessments about whether that product is going to be good for them.” 

However, a co-chair of Trump’s transition team recently said Kennedy hoped to access federal health data with the goal of proving vaccines are unsafe and pulling them from the US market.

That’s not as easy to do as it sounds. 

Undoing the approval of an already approved vaccine would require submitting evidence of harm that meets the FDA’s standards to prove harm, which simply doesn’t exist. Although a Trump-installed loyalist could theoretically rewrite the FDA’s standards, that would likely lead to opposition from the pharmaceutical companies that produce these vaccines. There would be a wave of expensive and prolonged lawsuits for the federal government. 

Drugmakers also wield influence in Congress, which writes the law that sets pharmaceutical industry fees that cover nearly half of the FDA’s budget. That law will need to be reauthorized before the end of Trump’s term, setting up a potentially vicious fight if the two sides are at odds over vaccines. 

There is a more realistic move Kennedy could take to address his concern about vaccine side effects: He could resuscitate the National Vaccine Program Office, which monitored vaccine safety with particular rigor but was shuttered under the first Trump presidency.

Although it would be difficult to pull vaccines from the American market, and Kennedy says he won’t, there are other ways he could exert influence to reduce vaccine uptake. 

Kennedy could try to influence the CDC. That agency has two important roles in promoting vaccines in the US: It convenes an Advisory Committee on Immunization Practices to provide expert recommendations on who should get which vaccines and at what age, and it administers the Vaccines for Children program, which provides free vaccines for children in low-income families. 

The advisory committee is not mandated by federal law — it is convened only if the CDC wants it to be. A vaccine skeptic appointed to run the CDC under Kennedy could either staff the committee with anti-vaccination activists or dissolve it entirely. That would mean the agency would no longer provide widely accepted guidelines for vaccination that state health departments and hundreds of thousands of clinicians nationwide now rely on. 

The Vaccines for Children program is funded by a pot of money that Congress sets aside for the CDC every year. Kennedy could press Congress and the White House to simply cut that funding, ending the program entirely. That would leave low-income families having to pay out of pocket to vaccinate their children.

Kennedy will also be ultimately responsible for two giant public insurance programs: Medicare, which covers seniors, and Medicaid, which is overseen by the states and covers low-income people.

In both programs, the amount of money disbursed by the federal government is in part determined by how good of a job the states and private insurers do in vaccinating children and older adults enrolled in these programs. Kennedy could pressure the CMS administrator to eliminate that vaccination requirement, one reason Trump’s choice at CMS will be one to watch. 

It’s not clear what the timeline would be to accomplish any of these tasks; there’s no precedent for a president and HHS secretary who are so openly hostile to US public health infrastructure assuming control of it. Even if it takes a while, there’s widespread concern that giving such a platform to someone who denies vaccine science could further degrade public trust not only in the vaccines, but in the many other health recommendations and interventions that together comprise American public health and health care. Already, more isolated outbreaks of measles and other diseases that had previously been stamped out by vaccines are occurring at the same time vaccination rates are slipping.

Paul Offit, a pediatric infectious disease doctor who directs the Vaccine Education Center at the Children’s Hospital of Pennsylvania in Philadelphia, said Kennedy has had such a big platform for so long that it’s unlikely he’ll be able to scare people about vaccines more than he already has. It’s in delivering the vaccines through programs like Vaccines for Children where he could perhaps do the damage: “If he were able to disrupt that, that would be a problem.”

Can RFK Jr. really remove fluoride from US water?

The US began fluoridating drinking water in 1945. An estimated 209 million Americans now drink tap water that contains added fluoride. The intervention is considered a historic public health win: It dramatically reduces tooth decay in children and also reduces tooth loss in adults. 

Kennedy, however, has said he would immediately advise the removal of fluoride from local water supplies. Why? Because he is exaggerating the actual risk.  

Most of the fluoride and US tap water is added by water utility companies, but some tap water contains naturally occurring fluoride it absorbs from the local water table. The resulting high-fluoride tap water, which about 2 million Americans drink, contains about twice the amount of fluoride the US government recommends. According to a recent report from the US National Toxicology Program, drinking high-fluoride water might be linked to slightly lower IQ scores — by 2 to 5 points in some children — though IQ scores are an uncertain measure of intelligence. 

However, there is no indication that tap water containing normal fluoride levels poses this risk — and its benefits to children’s and adult’s dental health are immense.

The decision to fluoridate water is one that happens at the state and local level, which is why Kennedy could only advise fluoride’s removal. However, his leadership at HHS could give an opening to anti-fluoride action at the state level, where Republican leaders are increasingly hostile to what had been settled public health practices.

Kennedy’s “Make America Healthy Again” campaign on food and chronic diseases

Kennedy has called for a campaign against chronic disease that he’s branded as “Make America Healthy Again.” It is an ambiguous and wide-ranging platform, but the consistent theme is undoing what Kennedy sees as Big Pharma and Big Agriculture’s undue influence on what Americans eat and how they manage their health over time.

Some of the ideas share the same pseudoscience as Kennedy’s views on vaccines. Kennedy recently posted on social media that the FDA had “waged a war on public health” by “aggressive suppression” of Americans’ access to raw milk, among other things. States aren’t required to pasteurize milk, but the FDA requires milk sold across state lines to be pasteurized. Despite raw milk’s risk of causing life-threatening diarrheal diseases (and now, bird flu), states can already carve out exceptions that allow their residents to drink it. 

Some of Kennedy’s ideas about food are more rooted in reality. For example, his take on nutrition’s role in chronic disease: He has correctly noted that the US has developed a terrible record on preventing diabetes, heart disease, and unhealthy weight, and places the blame where nutritional experts do — on permissive government policies and dietary guidelines that promote eating lots of ultra-processed foods and low levels of physical activity in schools. 

As part of his fight against ultra-processed foods, Kennedy recently said he wants to do away with entire departments at the FDA, including the Center for Food Safety and Applied Nutrition. According to recent reporting in Science, he could indeed pressure whoever is appointed to lead the agency to eliminate that center, which makes Trump’s choice for FDA commissioner a critical one in setting his administration’s public health agenda. 

However, if Kennedy wants to restrict the use of already-approved food additives, he needs more resources — not fewer: The process involves rigorous reviews of data, issuing public warnings, and actively monitoring the food supply. If Kennedy succeeded in closing the food safety office, that would reduce the number of people who could be dedicated to the job, making it harder rather than easier to rein in the use of these products.

Other actions could be taken by the Trump administration to reduce the amount of ultra-processed food in the American food supply, but many of them would be taken outside of HHS. The US Department of Agriculture (USDA) sets the guidelines that govern school lunch programs, which means much of what children eat is determined by that agency; Trump has not yet nominated a USDA commissioner. The USDA is also primarily responsible for overseeing factory farming, another industry Kennedy has heavily criticized throughout his public career and pledged to target if he were to take a role in the federal government. He would likely need to work with the USDA to follow through. 

Kennedy is correct that food safety regulation in the US is currently a mess, says David Acheson, an infectious diseases doctor who has led food safety efforts at both the USDA and the FDA. Meat, poultry, and egg plants are inspected daily under the auspices of the USDA, while every other kind of food production facility — including the farms whose produce is responsible for most of the food-borne illness in the US and the nation’s countless other industrial food manufacturers — are inspected by FDA inspectors at most once a year. 

It would make far more sense to unify these functions under one agency and harmonize the frequency of food production facility inspections so none are falling through the cracks. That is the kind of organizational shake-up that could actually make a difference.  

Acheson would also like to see Kennedy take on the FDA’s process for regulating supplements, which are currently subject to lax oversight despite obvious health risks.

What happens to NIH in a second Trump term?

At a town hall earlier this year, before dropping out of the race for president, Kennedy said that if elected, he’d tell the NIH to pause drug development and infectious diseases research for eight years and instead focus on chronic diseases. He also pledged during his own campaign for president that he would block “gain of function” research — in which scientists purposefully make viruses more dangerous in hopes of learning how to better combat them — that has come under more scrutiny since the pandemic. 

Apart from the fact that the NIH already spends about $20 billion annually on chronic disease, this would be disastrous: The basic research the agency funds and conducts in its own institutes lays the groundwork for therapies pharmaceutical companies develop to treat most medical conditions. 

Kennedy has called for firing 600 of the agency’s nearly 19,000 employees and replacing them with new ones, who presumably would be more keen to carry out his priorities. Conservatives have also floated restructuring the NIH, and Trump proposed cutting its $48 billion budget during his first term.