Trump really could empower RFK Jr. to wreck public health

For the most part, Donald Trump has been mum on who he’d appoint to his administration if he wins.

But he has made one pretty clear promise: Trump has said he’ll let conspiracy theorist and vaccine skeptic Robert F. Kennedy Jr. “go wild” on health, food, and drug regulation. That could have massive consequences for public health and vaccine policy in America. If Kennedy were to completely get his way and deter vaccination, vaccine-preventable diseases like measles and polio could make a comeback.

Kennedy, who ended his third-party presidential run to endorse Trump in August, expects big things. He told supporters at a recent virtual event that Trump “promised” him “control of the public health agencies, which are HHS and its sub-agencies, CDC, FDA, NIH, and a few others,” as well as the Department of Agriculture. Kennedy has also said he’d be “deeply involved in helping to choose the people” heading those agencies.

Trump transition co-chair Howard Lutnick said Wednesday on CNN that Kennedy is “not getting a job” at the Department of Health and Human Services, but Lutnick voiced complete sympathy with Kennedy’s beliefs that vaccines cause autism. “I spent two and a half hours this week with Bobby Kennedy Jr. and it was the most extraordinary thing,” Lutnick said, proceeding to say he believes in the debunked theory that vaccines cause autism.

Though Trump has a muddled stance on the Covid-19 vaccines his administration approved, he’s long been a believer that childhood vaccines cause autism. He reiterated that belief in a call seeking Kennedy’s endorsement this summer (which was recorded and posted publicly by Kennedy’s son): Trump complained that babies now get too many vaccines and then “change radically.” He added: “I’ve seen it too many times.”

It’s hard to make it clearer that Kennedy’s views would have deep sympathy at the top of Trump’s administration. In his first term, experts, scientists, and professionals remained in charge of such issues — hence the Covid vaccine development. But given the right-wing backlash against such experts that the pandemic brought, Trump’s second term could well be quite different. The risk that Kennedy would take a wrecking ball to public health regulation and especially vaccine policy is very real.

Tucker Carlson, appearing at an event with Kennedy this week, was positively gleeful about that prospect. “Can you imagine if you’re at FDA or NIH and Bobby Kennedy all of a sudden” came in, Carlson said, breaking off in laughter. “I mean, they must be dying!”

Public health leaders, including some former GOP and Trump appointees, have been quite alarmed at the prospect of giving Kennedy sway over public health policy. Jerome Adams, who was Trump’s surgeon general in his first term, said Monday this “could further erode people’s willingness to get up to date with recommended vaccines” and that he was “worried” about the impact on Americans’ health.

Others have reacted with skepticism to the prospect of Kennedy getting a top agency job, pointing out that a post like HHS secretary requires Senate confirmation, a prospect that would seem unlikely even if the GOP regains control of the chamber. Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK), the two most moderate Republican senators, serve on the committee that would consider that nomination.

Yet there is a model for how Kennedy could serve in government and exercise vast influence despite not being Senate-confirmed. Call it the Stephen Miller model.

Miller, an extreme anti-immigration ideologue, served as a White House senior adviser (a job that doesn’t require Senate confirmation). But he exercised vast influence at federal agencies that handled immigration policy so much that he was dubbed “the president of immigration.” He berated agency officials to carry out his preferred policies and, when he felt some Trump appointees weren’t getting the job done, he engineered their ouster.

It is entirely possible that Trump could appoint Kennedy to a similar role if he wanted one. It’s far from clear whether Kennedy would prove as effective a bureaucratic operator as Miller, but he certainly matches Miller in obsessive monomania over his particular issue, having argued for two decades that vaccines cause autism, as a writer, an activist, and then as a political candidate.

Another reason Miller had such influence is that it was believed throughout the Trump administration that he was speaking for Trump, that they had a “mind-meld” on immigration. And Trump’s comments have long made it clear he agrees with Kennedy on childhood vaccinations.

Even if Kennedy does not officially join the government, he could still have a major impact on policy. If accurate, his claim that he’ll be “deeply involved” in Trump’s public health appointment decisions means he could choose like-minded allies to try and overhaul public health agencies.

The real question is whether Trump would stake political capital on what would surely be an intensely controversial overhaul of US vaccine policies. Despite his belief in the autism link, Trump simply didn’t choose to really do anything about it in his first term. If he were to win a second term, though, he would owe Kennedy for his support, and anti-vaccine sentiment has been rising on the right.

Perhaps the biggest mystery hanging over a potential Trump second term is just how out of control he has gotten since he left office. The Republican establishment would like to believe that, in practice, Trump will still heavily rely on them and appoint capable people rather than kooks to top posts. But perhaps Trump will feel less beholden to that establishment than ever and more willing to reward his extreme supporters. That’s certainly what Kennedy is betting on.