RFK Jr. was just the start of Trump’s bad public health picks

President-elect Donald Trump’s stunning appointment of Robert F. Kennedy Jr. to lead the Department of Health and Human Services has given way to a slate of nominees for key health agencies that portend worrisome changes in how the US approaches public health.

With the exception of former Florida Representative Dave Weldon, nominated for director of the Centers for Disease Control and Prevention, Trump’s picks to lead Food and Drug Administration, Centers for Medicare and Medicaid Services and surgeon general all lack government experience. And they share a tendency to offer contrarian takes, whether about the risks of COVID or the view that modern medicine is failing us, and our food system is making us sick.

Most disturbing is that Kennedy isn’t the only one among these picks to have expressed a broader distrust of vaccines. That should elicit deep anxiety about what’s to come from our nation’s top health agencies.

“What ties them all together is this shared anti-expert ethos,” says Matthew Motta, a Boston University political scientist who studies vaccine policy. Even though some of the nominees are scientists or doctors, they have positioned themselves on the fringes among most in their fields. “It’s not just that you can’t trust scientific research, but you can’t trust the people who produce it.”

The most conventional choice in the bunch is Dr. Marty Makary, Trump’s pick to head FDA. A surgeon and public policy researcher at Johns Hopkins University and frequent Fox News guest, Makary has sharply criticized the government’s COVID response, challenged modern medical dogma and decried the ills of the American food system.

Still, pharma and biotech executives expressed relief at Makary’s nomination which suggests any efforts to shake up the FDA are likely to focus more on the food rather than the drug side of the agency’s purview. And public health experts largely seem to think Makary will side with science when it comes to critical topics like vaccines.

Among the more leftfield appointments are Dr. Mehmet Oz as CMS administrator and Dr. Janette Nesheiwat as surgeon general. Both have hewed to the establishment on most medical subjects but tend to veer into misinformation and magical thinking on others. Oz has taken heat for promoting miracle cures ranging from the dubious to the dangerous. Meanwhile, Nesheiwat, director of a network of urgent care facilities in New York and New Jersey and frequent Fox News contributor, is hawking a line of supplements and a book that speaks to the “transformative power of prayer.”

We have yet to hear Trump’s pick to lead the National Institutes of Health, though Stanford physician Jay Bhattacharya is considered the top contender. As one of the authors of the Great Barrington Declaration, the now infamous letter criticizing the US government’s response to the pandemic and calling for an end to lockdowns, Bhattacharya fits the contrarian mold.

The most troubling nominee (after Kennedy, whose disqualifying characteristics I’ve previously outlined) is Trump’s choice to lead the CDC. Weldon spent some of his 14 years in Congress questioning the safety of routine childhood vaccines, perpetuating the false claim that thimerosal, a mercury-based preservative used in the measles, mumps and rubella vaccines, causes autism. In 2007, several years after the studies that first raised fears of a connection between MMR and autism had been discredited, he proposed a bill to ban mercury in vaccines.

Like Kennedy, Weldon seems to believe US health agencies, particularly the CDC, are withholding vaccine safety information from the public. He coauthored a failed bill that would have moved vaccine safety research from the CDC to an independent agency within HHS. If confirmed, Weldon would be in charge of the agency responsible for that oversight.

The specter of Kennedy and Weldon working together to craft the CDC’s future is cause for concern. The agency is responsible for setting vaccine recommendations (who should get them and how often they should be administered), decisions that inform states’ policies and public access to the shots.

Even if Trump’s health team doesn’t directly prevent access to vaccines, it can still cause plenty of harm. As Motta points out, giving vaccine skeptics such a loud megaphone at HHS gives license to state lawmakers to act. None of this team is even in office, and we’re already seeing their messaging embolden state health authorities. Less than two weeks after the appointment of Kennedy, who has vowed to ban fluoridation, Florida Surgeon General Joseph Ladapo advised local municipalities to remove fluoride from the water supply and changed the health department’s guidance on the topic.

We shouldn’t be surprised, then, if state-level anti-vaccine laws, already increasing in the years since the pandemic, speed up.

That’s the opposite of what we need to happen amid a rising tide of vaccine hesitancy. Whoever walked into these roles was already facing an uphill battle to restore public trust in vaccines. Instead of a team with a unified message supporting this cornerstone public health tool, we have one that could do long-term harm.

That anti-vaccine messaging could further weaken our defenses against existing threats like measles and would be an absolute disaster amid a future pandemic. That’s not such a far-fetched scenario, given the ongoing spread of H5N1 in dairy and a limited number of humans. (Worries about bird flu ratcheted up slightly last week amid news that the genome of the virus that caused a teenager in British Columbia to become critically ill contained mutations that might make it more infectious to humans.)

During the start of the COVID pandemic, Trump made health agencies’ jobs much harder by routinely undermining their messaging or sowing confusion. Public health leaders had to walk a careful line — some more successful than others — between acknowledging Trump’s fringe ideas and correcting them. It was a diversion that made it hard for the public to focus on the correct information and left people wondering whom to trust — Trump or the experts he’d appointed. It’s fair to wonder how forcefully this slate of health leaders would push back against misinformation — or if they might promote false information alongside the president.

The Senate still can oppose Kennedy’s nomination (and gets a say in appointing Makary and Weldon, too). Putting a more reasoned thinker, one with public health experience and more mainstream, evidence-backed views, in the job would go a long way to alleviating fears of long-term damage — to the agencies themselves, to public trust in science, and to the very health of the nation.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical &Engineering News.