Trump Selects Robert Kennedy Jr. for US Health Secretary - What Does it Mean for Global Health : Tom McDermott

Last week I offered a brief profile of Trump's nomination of Elise Stefanik as US Ambassador to the UN.  This week I look at another appointment with significant international implications: Robert F. Kennedy Jr.'s nomination as Secretary of Health and Human Services. The position carries particular weight for global health and operations of international agencies dealing with health, including UNICEF and WHO.

RFK as Secretary of Health and Human Services

Donald Trump's announcement of Robert F. Kennedy Jr. as his nominee for Secretary of Health and Human Services (HHS) has sent shockwaves through America's medical, public health, and pharmaceutical communities. While domestic reactions have been immediate and sharp, global response remains notably subdued despite the far-reaching international implications of Kennedy's stated positions on health care, particularly vaccination.

International Impact - As HHS Secretary, Kennedy would shape US engagement with global health initiatives through the major agencies under his direction - the CDC, FDA, and NIH. These institutions maintain extensive international networks in research, disease surveillance, and policy development, making his leadership crucial for worldwide public health cooperation.

Pattern of Withdrawal - During his first term Trump followed a 'slow roll' of withdrawals from global institutions: UNFPA (2017), the UN Human Rights Council and UNESCO (2018), the Paris Accords (2019), and WHO (2020). This time analysts expect a much faster withdrawal process beginning in 2025, potentially ending both funding and US expert participation in vital technical networks. Kennedy's role as a possible advocate for continuing US participation in international fora could be important, even if his voice is ultimately drowned out by Trump's political advisors.

A MAGA Approach to the Next Pandemic - a particular target of conservative ire in the US and the UK has been WHO's efforts to draw up an agreement on international cooperation during future epidemics and pandemics.  Conservatives in both countries oppose any agreements requiring sharing of vaccines and expertise with other countries needing assistance.  In addition to opposing a WHO agreement, Trump has already announced that he will disband the US Office of Pandemic Preparedness and Response.  In case of a serious outbreak of disease in the US or elsewhere, Kennedy would be responsible for 'picking up the pieces' and trying to organize a response.  Given his position on vaccines and vaccine mandates, this may be a real challenge.

Complex Leadership Challenge - HHS oversees a vast network of agencies, including the CDC, FDA, NIH, Office of the Surgeon General, Centers for Medicare & Medicaid Services, and numerous other health and welfare organizations. Beyond Kennedy's lack of medical or scientific credentials, his absence of experience managing large organizations raises serious concerns about his ability to lead this complex department.

Confirmation Prospects - The nomination faces significant Senate opposition, leading Trump to consider using the Constitution's recess appointments clause - allowing Kennedy and other controversial appointees to serve until late 2026 without Senate approval.

Kennedyś background - Kennedy's expertise lies in environmental law, not medicine or public health. Born in 1954 as the third of 11 children of Robert Kennedy and Ethel Skakel, he built his career in environmental advocacy. After earning his BA from Harvard in history and literature, followed by a law degree from the University of Virginia and a Masters from Pace University, he established himself as an environmental activist. His work included founding the Environmental Litigation Clinic at Pace University (1987-2017) and establishing the Waterkeeper Alliance (1999-2020). He became more widely known as founder and chairman of the anti-vax organization Children's Health Defence, and as the best known figure in the US anti-vaccination movement."

The Kennedy Clan - As a son of former US Attorney General Robert Kennedy and nephew of President John F. Kennedy, RFK Jr.'s political aspirations might have expected family backing. Instead, in a remarkable 2019 open letter, Kennedy family members denounced his role in "spreading dangerous misinformation" and sowing distrust in vaccine science. His cousin Caroline Kennedy, the current US Ambassador to Australia, recently called his views on vaccines "dangerous" and said "..our family is united in terms of our support for the public health sector and infrastructure and has the greatest admiration for the medical profession in our country, and Bobby Kennedy has got a different set of views".

The Samoa Case - Kennedy's potential negative influence on global health has been demonstrated through the 2018-2020 Samoa measles outbreak. When two children died in 2018 due to a medical error - muscle relaxant mistakenly mixed with MMR vaccine - Kennedy's Children's Health Defence used the deaths to amplify vaccine fears globally, despite clear evidence of the actual cause. During Kennedy's 2019 visit to Samoa, he partnered with an Australian Samoan anti-vaccination activist in a campaign to ΅inform parents of the risks of vaccination". Vaccination rates plummeted from 60-70% to 31%, leading to a devastating epidemic: 5,707 cases and 83 deaths, mostly children under five. As UNICEF and WHO rushed emergency assistance, UNICEF Representative Sheldon Yett told the BBC, "people who are spreading lies and misinformation about vaccinations are killing children." Kennedy denied responsibility, claiming "I had nothing to do with people not vaccinating in Samoa. I never told anybody not to vaccinate."  

A ‘Mixed Bag’ of Policy Positions - Kennedy's positions span a spectrum - from widely supported stances on nutrition and the environment to highly controversial health policies that raise serious concerns.

On Health
* Vaccines and Autism: Despite overwhelming scientific evidence to the contrary, Kennedy continues to promote debunked claims linking vaccines to autism. He particularly focuses on thimerosal, a preservative removed from childhood vaccines in 2001, while also maintaining that government and industry conceal vaccine risks
* School Requirements: Opposes mandatory vaccination for school entry, advocating for parental choice over public health mandates.
* COVID-19 Response: Characterized mass vaccination efforts during the pandemic as a conspiracy benefiting pharmaceutical companies and billionaires. In "The Real Anthony Fauci," he accused the NIAID director of "leading a coup d'état against Western democracy."
* Fluoridation: Advocates removing fluoride from drinking water, claiming it reduces children's IQ - a position rejected by scientific consensus.

* Pharmaceuticals: While supporting lower drug prices, he took an opposite position on Biden's Medicare price negotiations, reflecting his broader opposition to government interventions in healthcare.  He has a long record of pushing to break the power of 'Big Pharma' including the major vaccine producers.  While reducing monopoly power of producers may be a good long-term objective, in the short-term it is likely to cause shortages and increases in prices of essential medicines and vaccines.
* Opioid Crisis: Views the epidemic as evidence of dangerous collaboration between pharmaceutical companies and government regulators.

Alternative Medicine
* FDA Criticism: Accuses the agency of suppressing alternative treatments, including promoting unproven COVID-19 therapies like ivermectin.

* Advocates for various treatments seen by experts as unproven and dangerous:

* Consumption of raw (i.e. unpasteurized) milk consumption

* Stem cell treatments

* Hyperbaric oxygen therapy (sitting in a closed chamber breathing pure oxygen)

* Chelation therapy for autism (a process which supposedly removes heavy metals from the body)

Nutrition and Environmental Positions
* Pesticides: Advocates for their prevention and removal from food supply
* Processed Foods: Links them to a "chronic disease epidemic," supporting:
* Stricter industry regulation of both agriculture and food producers
* Banning processed foods in school lunches
* Limiting children's consumption of grains, seed oils, and sugar

Environment
* Water Quality: Promotes comprehensive open waters protection making water “safe for drinking, swimming, and fishing.
* Opposes most fossil fuel projects
* Supports renewable energy development, especially wind and solar
* Opposes hydro power dams 

Climate Action 

* Supports the 'Green New Deal' - transformation of the economy to tackle both inequality and climate change.

* Supports carbon taxation

* Supports environmental justice initiatives and highlights pollution's disproportionate impact on vulnerable communities

My Final Thoughts

Kennedy's path to confirmation - whether through Senate approval or recess appointment - will shape both his authority and tenure. If he is subject to Senate hearings, he will be publicly confronted by many medical and public health experts, as well as by industry representatives. The results would  likely spotlight the stark contrast between Kennedy's controversial positions and established public health practices.

If confirmed, Kennedy faces two critical challenges. Within the Trump administration, his progressive stances on nutrition and environment will certainly clash with Trump's political advisors, as well as various business lobbyists. Assuming that he will be unable to make any progress on his nutrition and environment agendas, he may find that vaccination policy and alternative medicine are his only areas of influence where he can leave a mark on government policy. 

International organizations - including WHO, UNICEF, UNFPA, GAVI, and the Gates Foundation - face a dual threat: Trump's withdrawal pattern from global commitments and Kennedy's skepticism of mainstream public health practices. While Trump may entirely disengage from some agencies and pressure others through funding cuts, Kennedy's influence remains uncertain. Though he could potentially advocate for global health cooperation, his track record on vaccination and alternative medicine suggests otherwise.

International agencies must prepare contingency plans that can sustain vital health programs with or without US participation. The stakes for global public health could not be higher.