By President-elect Donald Trump’s choice of Robert F. Kennedy Jr. to lead the US Department of Health and Human Services sent a shudder through the global health community. If confirmed as HHS secretary, Kennedy will hold considerable sway over US health policies, and his reach will extend well beyond the nation’s borders.
Kennedy has listed multiple domestic issues he wants to take on in the federal government — food supplies, fluoride, raw milk and psychedelics among them — but hasn’t said much publicly about his plans for the global mission of HHS.
Health experts fear that he could undercut decades of work to control the spread of infectious diseases such as measles, polio and HIV; hamper international research collaborations; and scuttle current efforts to increase global coordination and cooperation ahead of future pandemics.
In addition to concern that Kennedy will continue to share false or harmful information, health experts said that many of his stated beliefs run counter to longstanding global health goals and that as head of HHS, he could slash the agency’s budget.
The US is the world’s largest funder of global health programs, according to the nonprofit health policy and research group KFF. In fiscal year 2024, the US spent $12.3 billion on global health, and roughly one-seventh of that – about $1.6 billion – was funneled through agencies within HHS, including the US Centers for Disease Control and Prevention and the National Institutes of Health.
“Ultimately, the secretary is the CEO of the largest health, medical and scientific enterprise in the world,” said Dr. Richard Carmona, who served as US surgeon general under President George W. Bush.
“The world depends on us, for our science, for our emergency capabilities, for our ability to surge and help others,” Carmona said.
Dr. Carlos del Rio, an infectious disease specialist at Emory University, says that funding is critical for at least three reasons: friendship with other nations, defense and early warning against threats that could come into the US, and development.
Healthy populations, he points out, buy American goods.
“Global health is not charity. Global health is really strategic investment,” del Rio added, saying he hoped Kennedy would find a way to maintain those investments.
Anti-vaccine views on an international stage
Kennedy is an environmental lawyer turned medical science and vaccine skeptic. He has promoted false claims about vaccination for years and founded the nonprofit Children’s Health Defense, which promotes anti-vaccine material.
He tempered his talking points on the campaign trail, saying that people who want vaccines should be able to get them, but still suggests that safety and risk information is hidden when it’s summarized on government websites such as the CDC’s and the US Food and Drug Administration’s.
As recently as last summer, Kennedy claimed in interviews that thimerosal, a preservative in some vaccines, was linked to brain damage and autism in children. The CDC notes that studies have not found any evidence of harm caused by the low doses of thimerosal in vaccines.
He has taken aim at vaccines used outside the United States, too.
In an interview with the podcaster Joe Rogan last year, Kennedy called the whole-cell DTP vaccine — a vaccine for diphtheria, tetanus and pertussis that’s no longer used in the US but is used in many other countries such as India and those in Africa — “very dangerous,” an assertion that is not supported by science.
“There’s already some pockets of skepticism and people who are deeply into conspiracy theories, but having an official from the United States make those statements over and over again could have just drastic and terrible impact,” said Kathleen Sebelius, who served as HHS secretary under President Barack Obama.
Some experts said that despite his softer message on the campaign trail, there’s no sign that Kennedy’s views on vaccines have changed.
“He is probably the most anti-vaccine person I’ve ever spoken to,” said Dr. Peter Hotez , a professor of pediatrics and molecular virology and microbiology at the Baylor College of Medicine.
In 2017, shortly after Kennedy announced that Trump had asked him to chair a commission on vaccine safety and integrity — an assignment that never materialized — Hotez was asked by NIH leaders to speak with Kennedy about his stance on vaccines.
Hotez’s daughter, Rachel, has autism, and he is the author of a book explaining why vaccines did not cause her condition. Hotez said he began a series of long but futile phone calls with Kennedy about vaccines.
“He just was not interested in any real facts. He had his mind made up. You couldn’t convince him of anything. It was just an exercise of frustration,” Hotez said.
Reduced efforts against infectious disease?
In 2023, Kennedy said he would tell the nation’s health agencies to give “infectious diseases a break,” according to NBC News, and instead focus on tackling chronic diseases like diabetes and cardiovascular disease.
But one of the main assertions of Kennedy’s book “The Real Anthony Fauci” and of the health freedom movement he embraces is that the risk of infectious diseases and pandemics is exaggerated by pharmaceutical companies and scientists who are on their payrolls for profit. Over the years, Fauci has received royalty payments for therapies they has invented, but he has said that he donates those payments to charity to avoid any potential conflict of interest.
Mary Holland, CEO of Children’s Health Defense, the organization Kennedy founded, says Kennedy’s goal of focusing on chronic diseases at home will probably extend to the rest of the world, too.
“People are sick with chronic health conditions, and I think that will be his focus, is chronic health problems, not focusing on what might be the next infectious disease outbreak,” she said.
Critics say Kennedy’s previous statements make them suspect he might abandon important infectious disease efforts that affect the globe, like the fight against HIV and AIDS.
Kennedy has said he doesn’t think AIDS is caused by the human immunodeficiency virus, or HIV. Instead, he says, AIDS comes from wearing down the immune system with drug use, which is not true.
About half of the nation’s global health budget is spent on HIV/AIDS prevention and treatment, according to KFF.
Critics say that having Kennedy at the helm of the HHS would almost certainly erode vaccine coverage further, allowing infectious diseases that had been tamped down to make a comeback.
Measles is a case in point. Measles is highly contagious and can be fatal, but vaccines are highly effective at preventing infection. Despite this success, the Covid-19 pandemic and misinformation have caused vaccination rates to drop, threatening progress toward eliminating the disease. Worldwide, measles cases rose 20% from 2022 to 2023, according to the latest report from the World Health Organization.
Kennedy is no fan of Covid-19 vaccines, either. In 2023, he tweeted that the Covid shots are “a crime against humanity.”
Studies have estimated that in their first year of use, the Covid-19 vaccines – an achievement under the first Trump administration – saved more than 14 million lives worldwide.
Through February, the United States has donated nearly 700 million doses of Covid-19 vaccines to 117 countries, according to the US State Department. It’s not clear whether the US would continue these kinds of vaccine donations under a second Trump administration.
“He will cause disease and death if he is allowed to be confirmed,” Sebelius said of Kennedy.
She points to the emerging H5N1 bird flu epidemic as one particularly precarious situation.
“Avian flu is already jumping from birds to livestock and from livestock to farm workers in the United States, and it is spreading,” Sebelius said.
At HHS, Sebelius said, she doesn’t see Kennedy accelerating efforts to find effective tests, treatments and vaccines. “If anything, he’s going to slow it down or dispute it or disregard what the scientists are telling him is coming,” and the US could export the next pandemic to the world, she said.
Backing away from pandemic preparedness
Many experts fear that Kennedy, like Trump, will favor ending US support for WHO, which coordinated the international response to the Covid-19 pandemic as well as many other health initiatives around the world. The US is one of its largest funders.
If the US stopped funding WHO, “it would really hollow out the organization,” said Lawrence Gostin, a professor and chair of global health law at Georgetown University.
Kennedy reportedly wrote a letter this year congratulating Slovakian officials who refused to join 190 other countries in signing updated International Health Regulations in May. The IHR is a legally binding agreement governing how countries are expected respond and cooperate in the face of public health threats, including pandemics.
The independent Slovak news site Dennik N reported in October that Kennedy sent a letter praising Peter Kotlar and Slovak Prime Minister Robert Fico for “their decision to protect Slovak sovereignty.” Kotlar, an orthopedist, issued a pandemic review report this year questioning the safety of Covid vaccines as well as the origins of the pandemic.
“I commend their call for an investigation into the origins of covid-19 and their advocacy of stopping vaccination against covid-19,” Kennedy wrote, according to Dennik N.
Neither Kennedy’s spokesperson nor Trump’s transition team responded to requests for comment.
Although the International Health Regulations were updated — a major step toward better pandemic preparedness — another effort to harmonize the international response to future pandemics, called the Pandemic Treaty, is still being negotiated.
According to Gostin, who helped draft the treaty, wealthy countries want greater speed and transparency from developing nations in sharing information and biological samples during a pandemic, while poorer nations are asking for technology transfer and help with infrastructure like vaccine manufacturing facilities so they can have equal access to vaccines and treatments during future outbreaks.
“Right now in Geneva, there’s a pall on the negotiations and deep anxiety,” Gostin said.
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If the details can’t be worked out before Inauguration Day, he said, the effort could collapse.
“There’s a very strong belief in international diplomatic venues that Trump will just simply withdraw the United States and also try to convince our allies or other authoritarian leaders to pull out,” Gostin said. “Which might mean that after three years of intense negotiations and all the suffering we had with Covid, that we’d have nothing to show for it.”
Holland agreed that Kennedy probably wouldn’t support the pandemic treaty, and in the view of Children’s Health Defense, some elements could “make a pandemic more likely.”
“It sounds nice, like a treaty to cooperate against pandemics,” she said. “But some of the iterations were really to increase high-security biological laboratories around the world, which we know leaps happen all the time from these labs.”
If a new pandemic emerges with Kennedy at the helm of HHS, Gostin says, the world almost certainly won’t be prepared.
“The whole point of a treaty is to prepare and to have vaccines, which he is against,” Gostin said.
“He lacks the major qualification for being an HHS secretary, which is fidelity to science and to health, and he can’t be the steward of the nation’s largest health agency.”