What does Robert F Kennedy Jr's nomination to Trump's cabinet mean for US pandemic plans?

US president-elect Donald Trump nominated anti-vaccine activist Robert F Kennedy Jr as his health secretary this week, expressing confidence he will “make America healthy again”. With the Covid pandemic having struck only a few years ago and new health threats on the rise, Mr Kennedy's nomination is considered a cause for concern by some. “As far as pandemic preparedness goes, this is likely to be a negative,” Dr Abraar Karan, an infectious diseases doctor at Stanford University, told The National . “RFK has already said he wants to take focus away from infectious disease threats at a time when threats are increasing. This suggests to me that he really has no idea about what is actually going on here.” If Mr Kennedy is confirmed by the Senate, he will oversee the US Centres for Disease Control and Prevention, Food and Drug Administration, National Institutes of Health and other agencies. “On top of this, if he is going to be firing tonnes of government scientists, then it is unlikely that he will be informed by people who do know what is going on, which is an even bigger problem,” Dr Karan said, referring to Mr Trump's plans to cut government costs by slashing federal jobs. Covid may no longer be a large-scale threat, but other potential pandemics may be brewing. Bird flu (H5N1) has been reported among cow herds in several US states, in addition to a small but growing number of human cases by those with close contact to the animals. There is concern among health experts of a possible jump to human-to-human transmission. Dr Karan said that “H5N1 is the most concerning” threat at the moment. With H5N1 spreading and the start of the seasonal influenza season, there is the prospect of re-assortment – when two viruses mix – he said, pointing to the rapid spread of swine flu in 2009. Globally, the World Health Organisation has two public health emergencies of international concern: polio in East Asia and mpox in Central Africa. Polio was most recently detected in New York City wastewater in 2022 and mpox spread in cities such as New York and San Francisco that same year. Both diseases can be prevented by vaccines . “Mpox clade 1 strains that have started to be detected outside of sub-Saharan Africa in Europe and are likely to move to the US as well,” Dr Karan said, warning that the new variant is more transmissible . Mr Kennedy asserts he is not against vaccines, but he has led anti-vaccine organisation Children's Health Defence , publicly arguing that “there's no vaccine that is safe and effective” and spreading debunked theories that vaccines cause autism. He was outspoken in his opposition to the Covid-19 vaccine when it first came out in 2021, and urged people to “resist” guidance calling for children receive it. Mr Kennedy also spread racial claims about Covid that were not rooted in scientific evidence. “The comments casting doubt on vaccines are not helpful, especially when we have many vaccine-preventable diseases that cause serious harms in children who are unvaccinated,” Dr Karan said. Childhood vaccinations have decreased since 2020. Mr Kennedy said in a town hall when he was running as an independent presidential candidate that he would tell the NIH to pause drug development and infectious diseases work to focus on chronic disease. The CDC says more than 40 per cent of school-age children and teenagers have a chronic disease – including asthma, obesity and other physical or behavioural conditions. Mr Kennedy says he wants to address that with tackling chemicals in food and the environment, as well as potentially taking fluoride out of public tap water. Experts say that traces of fluoride help prevent tooth decay and improve oral health. “I agree that chronic diseases are a big issue but unfortunately, we have multiple concurrent big issues,” Dr Karan argued. Mr Trump is no stranger to pandemics; he was in office and seeking re-election when Covid-19 swept the world in 2020. The US had one of the highest recorded Covid death tolls in the world, and a higher death rate than countries of comparable size and wealth, making the pandemic the deadliest mass casualty event and health crisis in the country's history. Under Mr Trump's leadership and before Covid's spread, millions of dollars were stripped from a USAID early warning programme for potential pandemics, the global health security unit of the National Security Council was disbanded and US disease-fighting funds were reduced. Later, with the rise of Covid, Mr Trump cut ties with the WHO , taking away vital US financial contributions. But his administration was responsible for the launch of Operation Warp Speed , which saw the development of the Covid-19 vaccines that saved millions of lives. For his new presidency beginning in January, Mr Trump has voiced plans to end President Joe Biden's pandemic preparedness units and severing ties with the WHO again.

What does Robert F Kennedy Jr's nomination to Trump's cabinet mean for US pandemic plans?

Vaccine sceptic's nomination amid rising health threats is considered a cause for concern by some