How RFK Jr. is Upending Public Health

Dan Gorenstein: From the first whisper that Robert F. Kennedy Jr. could become America’s top health official, questions started flying.

Clip: Do we know how RFK Jr. is expected to reform Health and Human Services? 

What would Kennedy actually do as secretary of HHS?

Clip: His nomination has drawn criticism from a host of public health leaders.

DG: He’s a vocal critic of vaccines … 

Clip: …there were some questions about Kennedy’s stance on vaccines…

DG: and agencies that regulate our drug and food supply.

Clip: …including about what millions of Americans eat and drink each day…

DG: Months went by with more speculation than clear answers.

Now eight weeks into Kennedy’s tenure at HHS, we are getting answers and they’re coming fast.

Today, we take stock of Kennedy’s first decisions at HHS and explore how they are transforming health in America. 

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

DG:  We’re talking today about RFK Jr.’s early weeks as HHS Secretary. He’s made big changes. We will start with jobs and spending. Kennedy has cut both across HHS. 

Producer Melanie Evans has been working to keep tabs on the scope of what’s happening. 

Hi Melanie. How’s it going?

Melanie Evans: Dan, I’m trying to keep up, but cuts Kennedy made have been sprawling.  

Here is what I can safely say: Kennedy has embraced the Trump White House ethos of sweeping, blunt, abrupt changes.

You spoke last week to Julie Rovner from KFF Health News about Kennedy’s restructuring of HHS. I think she used the word “sledgehammer”? 

DG: She did. More than once. 

As you know, last week HHS laid off some 10,000 people, closed regional offices and eliminated entire departments. 

Kennedy said he is streamlining the agency, saving $1.8 billion a year without sacrificing essential services like Medicare and Medicaid. 

But we know Kennedy is doing more than handing out pink slips.

ME: That’s right. 

HHS has also canceled more than $11 billion in funding to states. This is money they were using to fight disease outbreaks, prepare for emergencies, treat mental illness and substance abuse. 

This is money Congress had set aside during the pandemic, to help with the response. State and local governments still had time to spend the money.

HHS instead abruptly rescinded the funding, saying the pandemic is over. 

It was out of the blue. And it left public health agencies with no time to plan for the fallout, like at the Dallas County Health and Human Services Department. 

Phil Huang: No preparation, no advance warning. This particular grant that we received directly, was rescinded, effective, the day before. So it’s, like, done. It’s a done deal.

ME: That’s Dr. Phil Huang who runs the department.

He found out this grant had disappeared on a Tuesday morning around 6 a.m. by email. 

Phil quickly started trying to figure out what was going on. 

PH: I was a little uncertain about it, and I think I forwarded it to some other people. I said, you know, what is this? 

ME: He texted people he knows in Texas government. He emailed health directors in other states. 

He soon realized that one grant wasn’t the end of it. 

PH: And it started to trickle in that this is happening, you know, it is what’s happening across the country.

ME: Ultimately, Dallas County lost federal funding from three cancelled grants. The agency immediately laid off staff. Twenty one people. 

Dan, they mostly worked in disease control. This includes epidemiologists and immunization staff. 

DG: Wait. Texas is at the center of a growing measles outbreak. Two children have died. The latest number of infections is now 505. At least 57 have been hospitalized. Nearly all are unvaccinated. 

ME: Yes, and Phil has been making a push to boost vaccinations in kids. 

PH: I contacted all of the superintendents for all the public school districts in Dallas County and then also all the superintendents for the private school districts that had low vaccination rates, as well as all the daycare centers. 

ME: He signed a letter about vaccinations to schools to hand out to parents. 

And he offered to bring pop-up vaccine clinics to schools. 

DG: How’s Phil going to do that now? 

ME: He can’t. 

PH: We’re having to tell them we don’t have now the staff to be able to do what we were talking about doing.

ME: Dan, what is happening in Dallas County is happening across the country. 

The HHS grants that were canceled flowed to local health departments, sometimes directly, sometimes through states. States also relied on funding. The money went to salaries for epidemiologists, lab technicians, technology staff. It paid for new equipment to upgrade diagnostic laboratories and subcontractors to help states prepare for emergencies. 

DG: So, as Phil described, Melanie, with the money gone, I’m assuming that means so are jobs and services?

ME: Well … people are trying to figure out how to keep some programs going, but the financial hit is just too big to avoid losing some staff and services. 

An organization that represents 35 of the biggest cities in the country said its members lost more than a half of a billion dollars. 

Utah has cut 37 jobs. Maine let 40 people go. 

North Carolina said it lost funding for more than 80 jobs, including epidemiologists to help with disease control. 

Ryan Jury: It’s been intense. Because on the other end of these are my neighbors and members of our community, like government workers are people in our community who also deeply care about our communities and serve them.

ME: That is Ryan Jury. He’s North Carolina’s acting senior deputy for the Division of Public Health.  

North Carolina lost an estimated $230 million when HHS canceled the grants on March 25. Ryan been kinda shellshocked. 

RJ: It’s just been a really intense couple of days, weeks and lots of long hours. I’ve lost track of what the days are and the week, to be honest.

ME: So, Ryan in North Carolina and Phil in Dallas are reeling from what seems to be a lack of forethought in the cuts. Overnight, they are racing to plug gaps … gaps like North Carolina’s ability to investigate disease outbreaks, Dan.

In the wake of all this, people are just kind of baffled and really worried. 

Chrissie Juliano, at the Big Cities Health Coalition, summed it up best to me. 

Chrissie Juliano: I do not think anyone expected the dismantling of the federal public health infrastructure to be so dramatic and so quick and so haphazard. And I think that is, it’s going to cost lives. It’s going to cost real money. 

ME: It is important to say, Dan, that Chrissie and others told me that agencies should look for ways to improve their efficiency. They don’t object to a reorganization. But what they’re seeing is more chaotic.

CJ: This is not just a routine reorganization to be more efficient. Like, this is the least efficient thing that is happening in Washington.

ME: The day I spoke with Chrissie, a judge temporarily froze action by HHS after 23 states sued to keep the funding. 

DG: Melanie, we’ve been talking about roughly $11 billion dollars that HHS canceled to states at the end of March. It strikes me that these aren’t the only HHS grants to be abruptly cut off. 

ME: That’s right, Dan. Budget cuts across HHS under Kennedy are also part of the Trump White House’s broader agenda to terminate federal spending for diversity, equity and inclusion efforts and, more broadly, shrink the budget. 

That’s led to canceled grants and contracts under the National Institutes of Health. 

DG: Yeah, a few weeks ago, we did a show where two researchers at Johns Hopkins were talking about the uncertainty and fear they have about their work being shut down.

When we come back, we look at where Kennedy has made moves in two closely watched areas of health policy: food and vaccines. 

MIDROLL

DG: Welcome back. 

We’re taking stock of RFK Jr’.s early decisions as secretary. 

Kennedy is moving quickly to remake HHS. He has laid off and pushed out experts across agencies, closed departments and cut spending. 

But he has also made moves on another front: policy. 

Kennedy has taken some early steps on food and vaccine policy. These are two areas where Kennedy’s personal views raised questions about his priorities. 

Melanie is back to walk us through it.  

ME: Hi Dan. 

DG: Hello. Let’s start with food, perhaps the one area where RFK Jr. has pretty wide support, right? 

ME: Yes, he has long gone after processed foods and food additives as contributors to poor health. 

DG: This is core to the Make America Healthy Again. That movement. Taking on food production and nutrition to go after chronic disease.  

ME: Yes, and he has moved very quickly on this front. 

Kennedy last month directed the FDA to explore ways to close a regulatory loophole for subsistences in food. 

Emily Broad Leib at Harvard University told me that companies can include a substance if the companies say it’s safe.  

Emily Broad Leib: There are a lot of things being used in food that it’s very hard to know what they are for, both because the company hasn’t ever told FDA, and because some of them, depending on what they are, may or may not really have to be mentioned on the label even.

ME: Emily told me she’s hopeful Kennedy will tighten this loophole.

The next step could be a proposed rule, Dan.  

DG: Ok. So he is pushing ahead on food policy. This is one area where Kennedy’s views are welcome by pretty much everybody apart from Big Food, the industry.

Now, vaccines. Kennedy’s long history of vaccine skepticism prompted a lot of people to wonder what policies he might go after. 

What has he done there?

ME: So Dan, Reuters and other news outlets reported HHS under Kennedy is planning a large study of vaccines and autism. 

DG: Let me pause you for a second. It’s important to say: Many prior studies have debunked the idea that vaccines cause autism, though Kennedy has repeatedly linked them.  

ME: Correct. 

Kennedy’s new study is being criticized as irresponsible by scientists and autism groups for that reason. 

Clip: The country’s deadly measles outbreak is getting worse

ME: So is his response to the measles outbreak underway in Texas.

Clip: Health Secretary RFK Jr is expected to travel to Texas today, where there have been nearly 500 cases since January.

Clip: 57 of those patients have been hospitalized, and we know now there have been 2 fatalities. 

ME: Dr. Tom Frieden ran the CDC for eight years, including during a measles outbreak. 

Tom Frieden: When there’s a measles outbreak, there’s a tried and true way of stopping it. You increase vaccination rates. You engage with communities. You listen to what the concerns are. You promote vaccination among those at risk.

ME: Tom and others have come down hard on Kennedy for his public response to what’s happening in Texas … like a comment he made at a Cabinet meeting in February.  

Robert F. Kennedy Jr.: “It’s not unusual. We have measles outbreaks every year.”

ME: As cases have climbed , Dan, public health and infectious disease experts have wanted to hear from Kennedy, what they want to hear from any HHS Secretary. 

An urgent call to slow the outbreak through vaccination. 

Instead, he’s made comments like this, speaking on Fox News with Sean Hannity.

RFK Jr.: We should have transparency. We should have informed choice. There are adverse events from the vaccine. It does cause deaths every year. It causes all the illnesses that measles itself causes, encephalitis, blindness, etcetera. People ought to be able to make that choice for themselves. What we need to do is give them the best information. Encourage them to vaccinate. The vaccine does stop the spread of the disease.” 

DG: I mean, he acknowledges that the vaccine helps, but that’s anything but urgent, Melanie. 

ME: More than that … the comments are misleading. The vaccine is safe. Kennedy left out essential context. There are no deaths from the vaccine in healthy people. Rare cases of death from side effects have occurred in immune-compromised children. Dan, the vaccine is not recommended for these children. 

DG: A second child has died in the outbreak. And this weekend, Kennedy said the vaccine is the most effective way to stop infections from spreading.  

ME: Yes, and Tom Frieden and infectious disease specialists said they welcomed Kennedy’s comment. 

Tom still sees a real risk to public trust in vaccines from Kennedy’s early actions. 

TF: We’ve seen very misguided discussion of cod liver oil and steroids and antibiotics. These are not ways to prevent measles. The only effective way to protect people from measles is with vaccination.

DG: This really speaks to maybe the biggest question many had about Kennedy in the role of HHS secretary. People wondered how he would use his role to influence public opinion on vaccination. 

ME: Over the weekend, Republican Senator Bill Cassidy from Louisiana went on social media to say everyone should be vaccinated. Those were his exact words. 

Cassidy also said top health officials should be clear on this, before another child dies.

DG: That seems like a comment aimed right at Kennedy. 

ME: Public health advocates are closely watching RFK Jr. right now, Dan. 
There’s a lot of concern over what he’s doing with the CDC’s Advisory Committee on Immunization Practices. 

DG: Sure. We talked in January about this obscure committee, the ACIP. Its members are typically clinicians and scientists, and they evaluate and recommend who should get vaccines. 

ME: Right. A lot of people trust and follow those recommendations, including doctors, states and, typically, the CDC. 

Not Kennedy. He’s criticized many committee members as being beholden to pharmaceutical companies. 

DG: Right, in early March, the CDC launched a new website that lists the conflicts of interests disclosed by current and former ACIP members. 

ME: Yes, Kennedy often describes the committee as compromised. He has also said he wants to root out conflicts. But Dan, let me be clear, the ACIP already requires members to declare conflicts and recuse themselves from votes.  

Tom sees this as a move to delegitimize the credibility of the committee. 

TF: For RFK Jr. to say that the ACIP is severely conflicted is false. It undermines our confidence in vaccine recommendations.

ME: I spoke to some people whose names are listed on that website who agreed with Tom. The ACIP for years has operated in the public eye, with a clear policy on conflicts of interest. They do all of this to build trust in their decisions. 

DG: So where is this headed, Melanie?

ME: Well, as secretary, he has power to make fundamental changes to the ACIP. He can remove and name members of the committee at will. 

He hasn’t taken any steps like that. 

The first public meeting of ACIP this year is later this month, in April. I know people are going to be watching for any sign of his approach to vaccines. 

DG: So Melanie, at the top of the show, we talked about all these questions about what MAHA would look like. 

With vaccines, in particular, many have worried we’ll see a full-scale assault. Is that where this is headed?

ME: It’s hard to say, Dan, what will happen next with vaccine policy, but I do believe we will know soon. One thing that’s been clear as I’ve covered Kennedy these last five months is that when it comes to his priorities, he doesn’t hold back. 

DG: Thank you, Melanie.

ME: You’re welcome, Dan.