Two decades ago, a president’s choices for leaders of public health agencies like the Food and Drug Administration would not likely have generated much controversy. But in the years after the Covid-19 pandemic that spurred lasting skepticism from some segments of the American public, that is no longer the case. Especially for president-elect Donald Trump. Over the past month Trump has made nominations for the FDA, Centers for Disease Control and Prevention, National Institutes of Health, and the Office of the Surgeon General, and several of his picks have gotten intense scrutiny and a generated good deal of concern.

Among Trump’s most controversial nominations were presidential candidate dropout Robert F. Kennedy Jr. for the Department of Health and Human Services and celebrity doctor Mehmet Oz for the Centers for Medicare and Medicaid. He has also chosen Jay Bhattacharya, a medical doctor and well-known critic of the Biden administration’s pandemic response, to head up the NIH. These nominations, and the results of the election more generally, are believed by some observers to represent a cultural shift in the United States. The desire for a technocracy in which like-minded experts produce “scientific” policies appears over, as voters move rightward both socially and politically.

With the selection of RFK Jr. to lead the Department of Health and Human Services, Trump completes his attack on the establishment and scientific expertise. His other nominations, while unconventional, are at least within the range of comprehension. Some are actual medical doctors and scientists. Even Dr. Oz has health credentials (he is a former surgeon and professor emeritus of cardiothoracic surgery at Columbia). Kennedy, on the other hand, is an environmental lawyer who is perhaps most well-known for his opposition to vaccines over the past two decades. He ran for president on a third-party ticket against Trump and Harris before endorsing Trump in August, despite previously stating that he would never endorse Trump and that Trump was a “terrible human being” and a “sociopath.” These old comments have yet to come back to haunt him, as Trump promptly offered him a role in his administration. The secretary of health and human services is an important cabinet position, with the responsibility to advise the president on all health matters and oversee multiple government health organizations such as the FDA and the CDC.

This is not the first time RFK Jr. has been considered for such a political post. Though he has aligned himself with Republicans and is now being constantly criticized by the left, Kennedy was a staunch Democratic activist for many years and was considered by the Obama administration for the role of EPA Administrator. In a now-forgotten irony he was taken out of consideration because the Obama administration feared that he was too left-wing and would not garner Republican support. Since 2007, Kennedy has also chaired Children’s Health Defense, a nonprofit activist organization that promotes an anti-vaccine agenda. He has become one of the most well-known “anti-vaxxers” in the United States, helping to popularize formerly fringe views not only about vaccines but also about water fluoridation and the supposed dangers of wireless technology. Poised to head the Department of Health and Human Services, Kennedy may have the opportunity to realize some of his beliefs through policy.

Among Kennedy’s plans are to pause the NIH’s drug development and infectious disease research and “shift its focus to chronic disease,” slash entire departments of the FDA, and promote research into the relationship between some vaccines and autism. Kennedy’s nomination requires confirmation by the Senate, so there is the possibility that he fails to accede to the post. Even though Republicans have a majority in the Senate, it is not clear they will give Trump carte blanche. And even if Kennedy is confirmed, it will be difficult for him to remake entirely such massive and complex organizations such as the NIH or the FDA. He will likely face institutional and bureaucratic pressures as well as resistance from other leaders within these organizations. But as one of the public faces of American health policy, Kennedy can perhaps wield the influence of “soft power” – he can engage in media campaigns that shift Americans’ views on a variety of health issues.

What does Kennedy actually believe? He has stated multiple times that he is not “anti-vaccine” but has nonetheless said that no vaccines are safe and effective and that they may cause autism in young children. He has made confusing and contradictory claims about the polio vaccine, saying that he is “all for the polio vaccine” while at the same time apparently directing his lawyer to ask the FDA to revoke the vaccine’s approval. He says he does not want to remove access to any vaccines, but how can one take him at his word? Kennedy has made a number of other claims about food safety, including the benefits of raw milk (despite the potential for raw milk to carry dangerous bacteria) and the dangers of fluoridated water. Given that he could possibly oversee the FDA, Kennedy could direct the agency to change their policies or safety measures regarding pasteurization regulation or regulate more heavily ultraprocessed foods, another of his stump speech topics. But given Kennedy’s slippery rhetoric, he may only further reduce trust that Americans have in their government and health agencies.

The data on public trust in government agencies and health officials are not encouraging. According to a study in Health Affairs published in 2023, only around 30% of U.S. adults place a great deal of trust in the FDA. Less than 40% trust the CDC or NIH to the same degree. America’s health organizations are dealing with low levels of trust and confidence across the board – but there is a partisan aspect to it. The aforementioned study featured data collected in 2022, about two years into the pandemic. Respondents who admitted lower levels of trust cited feeling that health agencies had become “politically motivated.” Republicans surveyed expressed lower levels of trust than Democrats, possibly because Republicans viewed the Biden administration’s health officials as mere mouthpieces for the Biden administration. There is little doubt, of course, that Democrats will express far less trust in health agencies once Trump takes office, particularly if RFK Jr. is confirmed. But, then again, in some sense, even if RFK Jr. becomes HHS secretary, that will be the least of our problems.