By Dan Diamond, Lauren Weber, Lena H. Sun and Rachel Roubein Washington Post
Robert F. Kennedy Jr. has spent years questioning the federal agencies in charge of vaccine production and safety. Now he is poised to potentially oversee those agencies in a second Trump administration, giving him a major platform to amplify his skepticism of the lifesaving shots and shape what Americans learn about them.
Kennedy is among the people huddling this week in Mar-a-Lago with the Trump transition team, although his responsibilities have yet to be defined, according to six people who spoke on the condition of anonymity to describe internal conversations. Kennedy himself has offered only vague outlines of his ambitions, saying that he wants to study vaccine data and make recommendations.
"We're not going to take vaccines away from anybody," Kennedy told NPR this week. "The science on vaccine safety, particularly, has huge deficits, and we're going to make sure those scientific studies are done and that people can make informed choices about their vaccinations and their children's vaccinations."
The Washington Post reported last week that Kennedy could be tapped as a political appointee leading an agency or in a prominent White House role overseeing aspects of health and food policy.
The longtime anti-vaccine activist and former independent presidential candidate threw his support to Donald Trump in August in exchange for a key role in Trump's administration. Kennedy, Trump and their allies have since touted Kennedy's "Make America Healthy Again" (MAHA) agenda, which promises to tackle the root causes of chronic disease and does not include proposals to overhaul vaccine production and oversight.
But Kennedy, founder of one of the country's most prominent anti-vaccine groups, has long criticized the CDC's recommended list of childhood immunizations, promoting debunked claims about vaccines' link to autism. He has argued that federal agencies have not done enough research on the shots that hundreds of millions of Americans have received to protect them from measles, flu and other infectious diseases.
"There is virtually no science assessing the overall health effects of the vaccination schedule or its component vaccines," Kennedy and his co-author wrote in their 2023 book, "Vax-Unvax: Let the Science Speak," criticizing the Centers for Disease Control and Prevention's recommended list of vaccines for children. "This means it can't know whether these vaccines actually cause harm and certainly can't honestly say that they don't."
The CDC and other agencies involved with vaccine production and oversight have countered with years of data showing the shots' safety and protective powers. Public health experts have credited vaccination as the single greatest public health achievement of the 20th century, concluding that vaccines have helped stamp out diseases such as polio in the United States and saved more than 150 million lives around the world.
Kennedy's rhetoric has unnerved public health officials and immunization experts. Vaccines go through several stages of clinical trials, and they are studied in thousands of people to determine their safety and effectiveness before they are allowed to come to the market.
"RFK Jr. holds a series of false, non-scientifically backed beliefs, which are held with the strength of a religious conviction ... even though data shows he's wrong," said Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia. "So for that kind of person to have any sort of input on agencies that are based on science is a contradiction."
But some Republicans have said that it is time to revisit federal vaccine policy. Project 2025, the conservative Heritage Foundation's blueprint intended to guide a second Trump administration, called for an end to the CDC making any vaccine recommendations, arguing that those recommendations could be used as the basis of mandates.
"The CDC should not be the nation's pediatrician," said Roger Severino, vice president of domestic policy at the Heritage Foundation and a former Trump health official, who helped write Project 2025.
A Kennedy spokeswoman did not respond to a request for comment. Kennedy's representatives have previously denied to the Post that he is anti-vaccine.
Karoline Leavitt, spokeswoman for the Trump-Vance transition, said, "The American people reelected President Trump by resounding margins because they trust his judgment and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr."
Overhauling the vaccine approval process would be difficult, but Kennedy could exert new pressures in other ways. He could slow production of existing vaccines or thwart the approval of new ones, according to three former Trump health officials. The vaccine approval process, overseen by the Food and Drug Administration, involves several stages during which political leaders could intervene.
For instance, the FDA must inspect vaccine production facilities to ensure they are safe and comply with federal requirements - and a Kennedy-led health agency could delay those inspections, said Chris Meekins, a former Health and Human Services official and managing director at Raymond James, a financial services firm. Kennedy could also request additional data and reviews on vaccine safety, forcing staff to conduct extra research and prepare presentations that would delay approvals, Meekins said.
Kennedy could influence the vaccine approval and recommendation process by steering vaccine skeptics onto advisory committees to the FDA and the CDC. The FDA approves vaccines; the CDC and its vaccine advisory group recommend who should receive them.
Kennedy also is playing a role in selecting the next HHS secretary, who approves advisory committee members, and the next CDC director, who gives final approval to vaccine recommendations. While advisory committees' recommendations are not binding, they influence public perception.
Insurers decide whether to cover vaccines based on recommendations from the CDC's vaccine advisory committee. People are less likely to receive vaccines if they have to bear the costs. The Affordable Care Act requires most health insurance plans to cover the full cost of recommended immunizations.
The FDA exerts tight controls over the development and licensing of vaccines, and once they hit the market, multiple FDA and CDC safety systems exist to flag adverse events, according to Kawsar Talaat, an associate professor at Johns Hopkins Bloomberg School of Public Health. "Once a vaccine is out in the public, its safety is continually monitored," she said.
It would be difficult for Kennedy to remove an approved vaccine from the market unless there is an imminent hazard to the health of the general public, according to a vaccine expert and a former FDA official. Doing so would involve a complicated and intensive administrative process that usually includes a hearing and copious amounts of documentation, they said.
"It's much more complicated than just waving a magic wand and saying we want this or that," said a former FDA official who spoke on the condition of anonymity to be candid.
But health officials and public health experts say giving Kennedy any role in federal vaccine policy could sow doubt and confusion about vaccines. They contend that could lead states to weaken vaccine requirements to enroll in school, resulting in lower vaccination rates among children.
"It gives executive leaders within a state, especially in red states, and lawmakers the license to go ahead and completely dismantle and annihilate those public health guardrails that we've had for decades," said Rekha Lakshmanan, chief strategy officer for the Immunization Partnership, a Texas-based group of doctors and vaccine advocates. "We will see more schools suffering vaccine preventable outbreaks, we're going to see more children sick, we could potentially see more children being hospitalized, and, God forbid, children dying from things that are preventable."
Already, the share of kindergartners exempted from vaccine requirements rose to a high of 3.3% last school year, compared with 2.5% five years prior, a trend experts say is driven in part by vaccine hesitancy and anti-vaccine sentiment. All states allow exemptions for children with medical conditions that prevent them from receiving certain vaccines. And most also permit exemptions for religious or other nonmedical reasons.
Religious exemptions for vaccines have skyrocketed by nearly 22% in Mecklenburg County in North Carolina over the last five school years, said Raynard Washington, director of the public health department. Vaccine-preventable diseases have followed suit: Cases of pertussis, known as whooping cough, jumped from four last year to 64 so far this year. Chickenpox cases have tripled to at least 15.
The numbers could rise even more if local, state and federal public health officials start sending conflicting messages about vaccines, Washington said. "We certainly don't want to do something to exacerbate the issue, fueling more disinformation about what I think is settled science - that these vaccines are effective," he said.
In Idaho, a regional health board recently banned health department clinics serving six counties in southwest Idaho from offering coronavirus vaccines after hearing public testimony from physicians known for spreading misinformation about the vaccines' safety.
The October decision marks the first time access to a medical product has been limited at a local level due to misinformation, said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials. People can still receive coronavirus vaccines at doctors' offices or from other health-care providers.
Kennedy's persistent questions about vaccines have also raised tensions within the fledgling Trump transition team, according to three people who spoke on the condition of anonymity to describe private conversations.
Some Trump staff and Kennedy allies were frustrated when Howard Lutnick, co-chairman of the transition team, echoed Kennedy's vaccine skepticism in a CNN interview last week in which Lutnick credited a 2½-hour conversation with Kennedy with instilling doubt in his mind about vaccine safety and effectiveness, according to people with knowledge of the private conversations. The campaign quickly deployed Trump allies to reassure reporters that Lutnick did not speak for Trump.
"There are guardrails to protect against truly fringe ideas that are built into the current scientific system, not the least of which is that the CDC director and HHS secretary have to be Senate-confirmed," said a former Trump health policy adviser who spoke on the condition of anonymity to discuss private concerns about Kennedy. "The fringe people are unlikely to be in positions of real power."
It is unclear whether the incoming Republican-controlled Senate would approve Kennedy or any of his allies for senior health roles, although some GOP senators have said that Trump's victory - in both the electoral college as well as in the popular vote - has given him a mandate.
Trump's own record on vaccines is mixed. While his administration is responsible for the development of the coronavirus vaccine, he has expressed skepticism of the childhood vaccine schedule, falsely claimed vaccines are linked to autism and threatened to withhold federal funding for schools with vaccine mandates.
While Trump allies say they do not want to engage in a major initiative re-litigating vaccine safety, they are receptive to some of Kennedy's concerns, such as his questions about whether newborns should receive the hepatitis B vaccine, said two people who spoke on the condition of anonymity to discuss private conversations. The CDC recommends children receive a series of HepB vaccines, designed to protect against liver infections, beginning within 24 hours of birth and continuing across the subsequent 18 months.
Trump, in 2017, had briefly considered appointing Kennedy to lead a federal commission that would have investigated vaccine safety before experts and allies talked Trump out of it.
This year Kennedy's allies have preferred to focus on MAHA, which plans to tackle Americans' reliance on ultra-processed food and reduce the food and pharmaceutical industries' influence in Washington. The platform that Kennedy laid out in a September Wall Street Journal op-ed does not mention efforts to overhaul vaccines, disappointing some of Kennedy's anti-vaccine supporters who have accused him of backing away from a longtime priority in exchange for a possible government leadership role.
The overwhelming majority of Americans - about 90% - believe the benefits of childhood vaccines for measles, mumps and rubella outweigh the risks, according to a Pew Research poll released in May 2023.