Robert F. Kennedy Jr., who is expected to advise the incoming Trump administration on its health policy agenda, has launched sweeping plans to “make America healthy again.” But the way in which he intends to carry out his vast program remains a question mark.

Kennedy’s suggestions range from abolishing parts of the Food and Drug Administration to eliminating fluoride from the water supply.

While it’s not yet clear whether he will take an official position in Donald Trump’s cabinet or serve as an advisor, here’s a look at the viability of Kennedy’s key ideas.

Vaccines

Kennedy has a long history of vaccine skepticism and has repeatedly suggested a link between childhood vaccination and autism, claims this is not justified by scientific studies. In 2018, he based the Children’s Health Defense Fund, an organization that has been skeptical about vaccinating children.

Howard Lutnick, co-chair of the Trump-Vance transition team, said on CNN the week before the election, Kennedy seeks federal data to prove that vaccines should be taken off the market. Kennedy seemed to water down this position in an interview with NBC on Wednesday, saying he has never been anti-vaccine.

“If vaccines work for someone, I’m not going to take them away,” he said. “People should have a choice, and that choice should be informed by the best information. »

Lawrence O. Gostin, a health law and policy expert at Georgetown University, said in an interview with CQ Roll Call that the president does not have the authority to ban vaccines.

Under the Constitution, states hold the authority to make public health decisions, such as school vaccination requirements, which could provide an important safeguard under the Trump administration, Gostin said. He said that if the FDA decided to remove a vaccine from the market for political purposes, even a conservative Supreme Court would likely overturn the decision, because the FDA has clear statutory authority to review the safety and effectiveness of vaccines.

Instead, Trump’s main influence on vaccination policy would likely be through agency personnel, Gostin said. For example, Trump could appoint loyalists to the Centers for Disease Control and Prevention and its Advisory Committee on Immunization Practices, a key group in the CDC’s process for making vaccination recommendations.

“An administration has a lot of room to maneuver, it doesn’t need support from Congress to change the way things are organized, to change the emphasis,” Jennifer Kates, senior vice president and program director global policy on health and HIV. at KFF, said Friday during a press briefing with journalists.

Members of the CDC Advisory Committee on Immunization Practices are chosen by the Secretary of Health and Human Services. The Trump White House could have similar influence over the FDA’s vaccine advisory committee, Kates said.

“This committee could be replaced by different representatives within this committee and by people who might have more favorable views, let’s say, of RFK’s views on vaccine concerns,” she said.

FDA advisory committees make recommendations to the agency on the safety and effectiveness of vaccines. The HHS Secretary legally has the final decision, although in practice he has not historically intervened on individual approvals.

Trump and Kennedy would also have wide latitude to “cherry-pick” vaccine information, Gostin said.

“It would really destroy trust in public health agencies,” he said.

Restructuring of the agency

Kennedy’s plans to eliminate or restructure parts of federal health agencies could be an important area of ​​authority for the president, Gostin said.

During Wednesday’s NBC interview, Kennedy suggested eliminating the agency’s nutrition departments, citing concerns about the high number of ingredients in processed foods like “Froot Loops” cereal.

“In some categories, there are entire departments, like the FDA nutrition departments, that have to go, that are not doing their job. They are not protecting our children,” he said. He did not give details on whether he would rehire the departments, restructure them or eliminate them altogether.

The FDA has spent nearly two years restructuring its food oversight operations, triggered by the 2022 infant formula shortage that began after contamination problems were discovered at an Abbott nutrition plant in Sturgis, Michigan.

Under the new organizationThe agency combined the functions of the Center for Food Safety and Applied Nutrition with its Office of Food Policy and Response to form its new “Human Food Program” led by a single human food commissioner. The move was intended to streamline communication and decision-making, issues that were identified during the agency’s response to the infant formula shortage.

But Kennedy could overturn that. He hinted at firing agency officials who disagree with his vision, warning FDA employees in an Oct. 25 statement. tweet to “pack your bags”.

Gostin said Trump could also have broad power over agency structure, either by cutting funding or reorganizing parts of the CDC, National Institutes of Health and FDA. But he added that some agency centers, like the FDA’s Center for Tobacco Products, are defined by Congress, in which case the president could not eliminate them without working with Congress to change the statute.

“Another safeguard is the fact that we have a huge pool of career scientific professionals who have civil service protection, whistleblower protection and who would fight like hell,” he said. declared Gostin.

Industry interests

Kennedy claimed that federal agencies had become “puppetes” serving industry interests, and he pledged to change that. In recent months, he has spoken out about conflicts of interest among NIH grant recipients and said the FDA is controlled by big corporations.

“These conflicts have turned our regulatory agencies into predators against the American people and particularly against our children,” he said during a roundtable discussion last month.

NIH data obtained by ProPublica in 2019 revealed that NIH researchers had disclosed more than 8,000 “significant” financial contributions from industry and academia, totaling $188 million since 2012.

The FDA receives about half of its annual budget through user fees paid by industry sponsors when they ask the FDA to review their product. The FDA was granted for the first time this authority under the Prescription Drug User Fee Acr, the first iteration of which was adopted in 1992. The agency has similar programs for generic drugs, biosimilars, medical devices, and tobacco.

It’s unclear what, if anything, would replace the user fee program funds if Kennedy tried to eliminate the program. The user fee program attracted criticism from some who say it gives the industry too much influence in agency affairs. FDA Commissioner Robert Califf already said he would prefer that Congress appropriate sufficient funds so that the FDA does not have to rely on user fees to operate.

Ezekiel Emanuel, vice provost for global initiatives at the University of Pennsylvania, said Kennedy’s concerns about industry influence over health agencies were valid.

“The conflict of interest of people making recommendations, those things are OK,” Emanuel said. “But I think he put that into a whole worldview of conspiracy theories, experts are always trying to fool people, it’s just totally wrong.”

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