​WASHINGTON — Robert F. Kennedy Jr., who is lined up to advise the incoming Trump administration on its health policy agenda, has floated broad plans to “make America healthy again.” But how he will accomplish his wide-ranging agenda is still a question mark.

Kennedy’s suggestions have ranged from gutting parts of the Food and Drug Administration to working to remove fluoride from the water supply.

While it’s still unclear whether he will hold a formal position in Donald Trump’s cabinet or serve as an adviser, here’s a look at the viability of Kennedy’s major ideas.

Vaccines

Kennedy has a long history of vaccine skepticism and has repeatedly suggested a link between childhood vaccination and autism, a claim that is not substantiated by scientific studies. In 2018, he founded the Children’s Health Defense Fund, an organization that has been skeptical of childhood vaccination.

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

“If vaccines are working for somebody, I’m not going to take them away,” he said. “People ought to have choice, and that choice ought to 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 doesn’t have the power to ban vaccines.

Under the Constitution, states hold the authority to make public health decisions such as school vaccine requirements, which could be an important guardrail during the Trump administration, Gostin said. He said if the FDA decided to pull a vaccine from the market for political purposes, even a conservative Supreme Court would likely strike down the decision because the FDA has clear statutory authority to review the safety and efficacy of vaccines.

Instead, Trump’s main influence over vaccination policy would likely happen via agency staffing, 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 panel in the CDC’s process for making immunization recommendations.

“There is a lot of leeway that an administration has, that they don’t need support from Congress to change how things are organized, to change the emphasis,” Jennifer Kates, senior vice president and director of the global health and HIV policy program at KFF, said during a briefing with reporters Friday.

Members of the CDC’s 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.

“That committee could be replaced with different representatives on that committee and people that might have more favorable reviews to, let’s say, an RFK view of concerns about vaccines,” she said.

The FDA’s advisory committees make recommendations to the agency on whether vaccines are safe and effective. The HHS secretary legally has the final decision, although in practice they don’t historically weigh in on individual approvals.

Trump and Kennedy also would have broad latitude to “cherry-pick” information about vaccines, Gostin said.

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

Agency restructuring

Kennedy’s plans to eliminate or restructure portions of federal health agencies could be a substantial area of authority for the president, Gostin said.

During the Wednesday NBC interview, Kennedy suggested wiping out the agency’s nutrition departments, citing concerns over the high ingredient count of processed foods like the cereal “Froot Loops.”

“In some categories there are entire departments, like the nutrition departments at FDA, that have to go, that are not doing their job. They’re not protecting our kids,” he said. He didn’t offer details on whether he would restaff the departments, restructure them or eliminate them completely.

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

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

But Kennedy could undo that. He hinted at firing agency officials who don’t agree with his vision, warning FDA employees in an Oct. 25 tweet to “pack your bags.”

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

“Another guardrail is the fact that we have an enormous well of career scientific professionals who have civil service protection, whistleblower protection, and would fight like hell,” Gostin said.

Industry interests

Kennedy has asserted that federal agencies have become “sock puppets” for industry interests, and he has pledged to change that. Over the past few months, he’s opined over conflicts of interest among NIH grant recipients and said the FDA is controlled by big corporations.

“These conflicts have transformed our regulatory agencies into predators against the American people and particularly our children,” he said at a roundtable 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 via user fees paid by industry sponsors when they apply for the FDA to review their product. The FDA was first granted this authority under the Prescription Drug User Fee Acr, whose first iteration was passed 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’s funds if Kennedy tried to eliminate the program. The user fee program has drawn criticism from some who say it gives industry too much influence in agency affairs. FDA Commissioner Robert Califf has previously said he would prefer if Congress would appropriate sufficient funds so that the FDA wouldn’t 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 in health agencies is valid.

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

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