How Radical Can RFK Jr. Be as America’s Top Health Official?
Authority of HHS secretary ranges from drug approvals to Medicare
Robert F. Kennedy Jr. has pledged to make sweeping changes to public health if he is confirmed as the nation’s top health official. He might hit some roadblocks along the way.
As secretary of the Health and Human Services Department, Kennedy would oversee 13 operating divisions with more than 80,000 employees, including the Food and Drug Administration, National Institutes of Health and the Centers for Disease Control and Prevention.
The agencies set scientific standards and policies that are widely relied on by state and local authorities as well as international bodies. He would have “the power to reshape and reorganize every single agency under his jurisdiction,” said Lawrence Gostin, co-faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University.
“He would be able to strongly influence the public health recommendations that come out of those agencies,” Gostin said.
The president and HHS secretary can shape priorities with the budgets they propose for federal health agencies to Congress. Kennedy could influence new appointments to advisory committees, such as one that advises the CDC on vaccination policy.
But the 70-year-old environmental lawyer and vaccine critic is likely to face a tough confirmation process in the Senate. If he is confirmed, Kennedy would likely be forced to contend with legal limits, challenges and pushback from companies, scientists and doctors on some things he has promised, legal and public health experts said.
“It is very difficult to drive seismic change quickly in a rulebound, lawbound bureaucracy,” said Dan Troy, who was a chief counsel of the FDA under President George W. Bush.
Kennedy has criticized fluoride in drinking water and chemicals in food, and questioned the safety of vaccines. He has said he would fire FDA officials and curtail what he calls the food and pharmaceutical industries’ unhealthy influence on policy. He has said the moves would curtail the nation’s chronic-disease epidemic and contribute to his goal of reducing levels of pediatric illness within two years.
Most public-health decisions in the U.S., including whether to fluoridate public tap water and which vaccines to recommend, are made by state and local authorities using federal guidance. About 72% of the U.S. population with access to public-water supplies in 2022 had fluoride levels that prevent tooth decay in their drinking water, according to the CDC.
“It leaves a lot of latitude for jurisdictions,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health and author of the book “Crisis Averted,” about the role of public health in fighting outbreaks.
Still, as HHS secretary, Kennedy would have a pulpit from which to influence state officials, said Dr. Ezekiel Emanuel, a bioethicist who serves as vice provost for global initiatives at the University of Pennsylvania.
“It’s going to rearrange what states do in terms of vaccinations. What states might do in terms of distribution of raw milk,” he said. Kennedy has encouraged people to drink raw milk, which the FDA and CDC have warned can contain dangerous pathogens including E. coli.
Some of Kennedy’s ideas are popular, such as making foods healthier and fighting high rates of chronic diseases. But his proposed elevation has rattled drug and vaccine makers.
“They need to have predictability because it takes 10-12 years to develop these things,” Emanuel said.
John Crowley, chief executive officer of the Biotechnology Innovation Organization, a trade group, said he was eager to hear more of Kennedy’s current views. “Everyone should recall that under President Trump’s leadership we had remarkable success with Operation Warp Speed in the development of vaccines that literally saved the world,” he said. “I’m confident that we can find common ground and work together ahead.”
Kennedy would have power to make some but not all changes he has said he wants to make at the FDA. He could overrule the agency’s decisions about drug approvals. It is a rare step, but in 2011, HHS Secretary Kathleen Sebelius overruled an FDA decision to allow an emergency contraceptive to be sold without a prescription to all women and girls, regardless of age. The matter landed in federal court, which ordered a lifting of age restrictions.
Kennedy has criticized fees that companies pay to the FDA for review of drug applications. The arrangement ensures that the FDA has the staff needed for speedy reviews, according to industry executives, who say the fees are like a tax and don’t buy favor with the FDA, as Kennedy has suggested.
Eliminating it would require congressional action. Negotiations for a reauthorization of the Prescription Drug User Fee Act begin next year, and Kennedy could stall them, executives worry.
Kennedy has said he wants to fire FDA officials or eliminate its nutrition office. Civil servants have workplace protections. But Trump has said he aims to revive an effort started in his first administration to exempt some civil-service workers from such protections.
Troy, the former FDA chief counsel, stressed that at the agency only a tiny number of workers are typically political appointees. He said that writing a rule is a labor-intensive process that can take years and that removing a drug from the market can happen only through an “extensive legal process.”
Changing nutrition labels would be labor and time-intensive, Troy said, noting: “It took the FDA 15 years to define peanut butter.”
“I don’t really buy into the catastrophism on either side,” he said.