By AMANDA SEITZ, MATTHEW PERRONE and JONEL ALECCIA

WASHINGTON (AP) — Robert F. Kennedy Jr.an anti-vaccine activist and environmentalist, has for years earned a loyal and fierce following through his scathing condemnations of the way the nation’s public health agencies do business.

And that has put him on a direct collision course with some of the 80,000 scientists, researchers, doctors and other officials who work for the Department of Health and Human Services, particularly with President-elect Donald Trump. tapping him to run the agency.

If confirmed, Kennedy will control the world’s largest public health agency and its $1.7 trillion budget.

The agency’s action is massive. It provides health insurance for nearly half the country – poor, disabled and elderly Americans. It oversees research into vaccines, diseases and cures. Regulates medications in medicine cabinets and inspects food entering cabinets.

A look at Kennedy’s comments about some of the agencies that fall within the HHS arena and how he said he plans to shake them up:

Food and Drug Administration

— “The FDA’s war on public health is about to end,” he wrote on X in late October. “If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Keep your records and 2. Pack your bags.”

The FDA’s 18,000 employees include career scientists, researchers, and inspectors responsible for the safety and effectiveness of prescription drugs, vaccines, and other medical products. The agency also has broad oversight of a range of consumer goods, including cosmetics, e-cigarettes and most foods.

HHS has the statutory authority to reorganize the agency without congressional approval to maintain the safety of food, drugs, medical devices, and other products.

And Kennedy has long railed against the FDA’s work on vaccines. During the COVID-19 epidemic, his nonprofit group, Children’s Health Defense, petitioned the FDA to halt the use of all COVID vaccines. The group argued that the FDA is beholden to “big pharma” because it receives much of its budget from industry taxes and some employees who have left the agency have gone on to work for drugmakers.

His attacks grew more forceful, with Kennedy suggesting he would free “entire departments” at the FDA, including the agency’s food and nutrition center. The program is responsible for preventing foodborne illness, promoting health and wellness, reducing diet-related chronic diseases, and ensuring the safety of chemicals in food.

Last month, Kennedy threatened on social media to fire FDA employees for “aggressively suppressing” a range of unsubstantiated products and therapies, including stem cells, raw milk, psychedelic and discredited treatments from the COVID era such as ivermectin and hydroxychloroquine.

In the case of hydroxychloroquine, for example, the agency halted its emergency use after determining that it was ineffective in treating COVID and increased the risk of potentially fatal cardiac events.

Drinking raw milk has long been considered risky by the FDA because it contains a number of bacteria that can make people sick and has been linked to hundreds of disease outbreaks.

If confirmed, Kennedy could in principle overturn almost any FDA decision. There have been rare cases of such decisions in previous administrations. Under both George W. Bush and Barack Obama, HHS overturned FDA approval decisions regarding the availability of emergency contraceptives.

Overturning FDA regulations or revoking approval of vaccines and long-acting drugs would likely be more difficult. The FDA has lengthy requirements for removing drugs from the market, which are based on federal laws passed by Congress. If the process is not followed, drug manufacturers could file lawsuits that would have to go through the courts.

Centers for Disease Control and Prevention

— “On January 20, the Trump White House will advise all US water systems to remove fluoride from public water,” Kennedy wrote on social media in November.

The CDC’s fluoride guidelines are just one recommendation the agency has made as part of its mission to protect Americans from disease outbreaks and public health threats.

The agency has a base budget of $9.2 billion and more than 13,000 employees

Days before Trump’s victory, Kennedy said he would reverse the agency’s guidelines for fluoride in drinking water, which the CDC currently recommends at 0.7 milligrams per liter of water.

Recommendations strengthened teeth and reduced cavities by replacing minerals lost during normal wear and tear. Patterns of stained teeth emerged with higher levels of fluoride, prompting the US government to lower its recommendations from 1.2 milligrams per liter of water in 2015.

State and local governments control the water supply, with some states mandating fluoride levels by state law.

Kennedy, who said “there is no such thing as a safe and effective vaccine,” would be in charge of appointments to the panel of influential experts who help set vaccine recommendations for doctors and the general public. These include polio and measles given to infants and young children to protect against debilitating diseases, to inoculations given to older adults to protect against threats such as shingles and bacterial pneumonia, as well as vaccines against more exotic dangers for international travelers or laboratory workers .

National Institutes of Health

— “We have to act quickly,” Kennedy reportedly said during a visit to Scottsdale, Arizona event on the weekend. “So on January 21st, 600 people will walk into offices at NIH and 600 people will walk out.”

The agency’s $48 billion budget funds medical research into cancers, vaccines and other diseases through competitive grants awarded to researchers at institutions across the country. The agency also conducts its own research with thousands of scientists working at NIH laboratories in Bethesda, Maryland.

Advances supported by NIH money include a drug for opioid addiction, a vaccine to prevent cervical cancer, many new cancer drugs, and the rapid development of COVID-19 mRNA vaccines.

In the past, Kennedy criticized the NIH because he didn’t do enough to study the role of vaccines in autism.

Kennedy wants half of the NIH budget to go toward “preventive, alternative, and holistic approaches to health.” he wrote in the Wall Street Journal in September. “In the current system, researchers don’t have enough incentive to study generic drugs and originator therapies that look at things like diet.”

Kennedy wants to prevent the NIH from funding researchers with financial conflicts of interest, citing a 2019 ProPublica investigation which found that more than 8,000 federally funded health researchers reported significant conflicts, such as taking stakes in biotech companies or licensing patents to drugmakers.

Centers for Medicare and Medicaid Services

— “If a doctor’s patient has diabetes or obesity, the doctor should be able to say, I’m going to recommend a gym membership and I’m going to recommend, good food and Medicaid should be able to fund those things. as with Ozempic,” Kennedy said during a Sept. 30 town hall in Philadelphia.

Kennedy didn’t focus as much on the agency that spends more than $1.5 trillion annually to provide health coverage for more than half the country through Medicaid, Medicare or the Affordable Care Act.

Even as Trump and other Republicans threatened some of that cover, Kennedy remained mum.

Instead, he was an outspoken opponent of Medicare or Medicaid covering expensive drugs that were developed to treat diabetes, such as Ozempic, now also sold for weight loss under the name Wegovy. These drugs are not widespread covered by any of the programsbut there is bipartisan support in Congress to change that.