By LIA DEGROOT, CQ Roll Call (TNS)
WASHINGTON – Robert F. Kennedy Jr., tasked with advising the brand new Trump administration on its health policy agenda, has laid out sweeping plans to “Make America Healthy Again.” But how he’ll implement his far-reaching agenda remains to be questionable.
Kennedy's proposals ranged from gutting parts of the Food and Drug Administration to removing fluoride from the water supply.
While it remains to be unclear whether he’ll hold a proper position in Donald Trump's Cabinet or function an adviser, here’s a take a look at the viability of Kennedy's key ideas.
Vaccinations
Kennedy has an extended history of vaccine skepticism and has repeatedly suggested a link between childhood vaccinations and autism, a claim that is just not proven through scientific studies. In 2018 he has founded the Children's Health Defense Fund, a corporation skeptical of childhood vaccinations.
Howard Lutnick, co-chair of the Trump-Vance transition team, said on CNN In the week before the election, Kennedy called for federal data to prove that vaccines must be pulled from the market. Kennedy appeared to melt this stance in an interview He told NBC on Wednesday that he has never been an anti-vaxxer.
“If vaccines work for someone, I won’t take them away,” he said. “People should have a choice, and that choice should be based on 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 authority to ban vaccines.
Under the Constitution, states have the authority to make public health decisions, equivalent to requiring vaccinations in schools, which may very well be a very important guideline through the Trump administration, Gostin said. He said that if the FDA decided to withdraw a vaccine from the marketplace for political reasons, even a conservative Supreme Court would likely overturn the choice since the FDA has clear legal authority to review the protection and effectiveness of vaccines.
Instead, Trump's major influence on vaccination policy would likely come through 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 within the CDC's process for making vaccination recommendations.
“There's a lot of latitude that an administration has so that it doesn't need support from Congress to change the way things are organized, to change the focus,” says Jennifer Kates, senior vp and director of the worldwide health and HIV policy program at KFF, said during a briefing with reporters on Friday.
Members of the CDC Advisory Committee on Immunization Practices are elected from the Secretary of Health and Human Services. The Trump White House could have an identical influence on the FDA's vaccine advisory committee, Kates said.
“This committee could be replaced by other representatives on this committee and people who might, for example, have a more positive opinion on the RFK's concerns about vaccines,” she said.
The FDA's advisory committees make recommendations to the agency about whether vaccines are secure and effective. The HHS Secretary legally has the ultimate decision, although in practice he has historically had no influence over individual approvals.
Trump and Kennedy also had wide latitude to decide on details about vaccines, Gostin said.
“It would really destroy trust in public health authorities,” he said.
Agency restructuring
Kennedy's plans to abolish or restructure parts of the federal health agencies could represent significant power for the president, Gostin said.
During Wednesday's NBC interview, Kennedy suggested eliminating the agency's nutrition divisions, citing concerns concerning the high ingredient count of processed foods just like the Froot Loops cereal.
“In some categories, there are entire departments, like the FDA's nutrition departments, that have to go and don't do their jobs. They are not protecting our children,” he said. He didn’t say whether he would restaff, restructure or eliminate the departments entirely.
The FDA has spent nearly two years restructuring its food inspection activities, triggered by the 2022 infant formula shortage that began after contamination problems were discovered at an Abbott nutrition factory in Sturgis, Michigan.
Under the brand new organizationThe agency combined functions of the Center for Food Safety and Applied Nutrition with its Office of Food Policy and Response to form its latest “Human Foods Program,” led by a single Human Foods Commissioner. The move was intended to streamline communication and decision-making, problems identified within the agency's response to the infant formula shortage.
But Kennedy could reverse that. He hinted at firing agency officials who disagreed together with his vision and warned FDA employees on Oct. 25 tweet “Pack your bags.”
Gostin said Trump could also gain broad power over agency structure, either by cutting funding or reorganizing parts of the CDC, the National Institutes of Health and the FDA. However, he said some agency centers, equivalent to the FDA's Tobacco Products Center, are designated by Congress. In that case, the president wouldn’t find a way to abolish it without working with Congress to vary the statute.
“Another guardrail is the fact that we have an enormous number of scientific professionals who have public service and whistleblower protections and would fight tooth and nail,” Gostin said.
Industry interests
Kennedy has claimed that federal agencies have develop into “sock puppets” for industrial interests, and he has promised to vary that. In recent months, he has spoken out about conflicts of interest amongst NIH grantees and said the FDA is controlled by big corporations.
“These conflicts have turned our regulators into predators against the American people and especially our children,” he said at a roundtable last month.
NIH data obtained from ProPublica In 2019, it was revealed that NIH researchers had disclosed greater than 8,000 “significant” financial contributions from industry and academia totaling $188 million since 2012.
The FDA receives about half of its annual budget from user fees paid by industry sponsors once they request FDA review of their product. The FDA was issued for the primary time This authority is governed by the Prescription Drug User Fee Act, the primary version of which was passed in 1992. The agency has similar programs for generic drugs, biosimilars, medical devices and tobacco.
It is unclear what, if anything, would replace the user fee program funds if Kennedy sought to eliminate this system. The user fee program has provoked criticism by some who say it gives industry an excessive amount of influence over agency affairs. FDA Commissioner Robert Califf has already said He would like that Congress provide sufficient funding in order that the FDA wouldn’t need to depend on user fees to operate.
Ezekiel Emanuel, vice provost for global initiatives on the University of Pennsylvania, said Kennedy's concerns about industry influence on health officials are legitimate.
“The conflict of interest of people making recommendations, that’s right,” Emanuel said. “But I think he framed it in a whole worldview full of conspiracy theories, experts are always trying to deceive people, that’s just completely wrong.”
Originally published:
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