Each of Donald Trump’s most challenging cabinet picks has been a calculated punch in the mouth to pundits, elites and bureaucrats in government agencies in Washington.

But his decision to leave Robert F. Kennedy Jr.a vaccine skeptic and conspiracy theorist, “going crazy” on health and drugs as secretary of health and human services is his most shocking attempt at anti-establishment demolition.

The president-elect’s previous selections for director of national intelligence, attorney general and secretary of defense could change the country and the world in the long run. But their effect would be remote for most Americans.

Whether Kennedy will get a chance as the nation’s top health official to push past claims that vaccines are not safe and effective or to act on his desire to fire 600 people at the National Institutes of Health, which oversees many aspects of health research, including vaccines, he could have a more immediate impact on the lives of millions of Americans. If, for example, his advice or ideas led to a decrease in vaccine penetration in the US population, a significant number of lives could be at risk.

Kennedy has some views that top doctors welcome, including his calls for processed foods to be removed from school lunches and his warnings that the food industry is marketing products that are fueling a chronic disease crisis. But the president-elect’s decision to put RFK Jr. in charge of the health of 350 million Americans, despite his positions on vaccines that contradict the science-based research of most scientists and medical experts, is likely to ignite a new debate about the potential real-world implications of Trump’s second term, which begins in January.

Part of Trump’s MAGA dream team can best be explained by a former president trashing the agencies and institutions he believes thwarted his first term. But Kennedy’s rise and seemingly long political leash go far beyond Trump’s quest for revenge. It could impact the drugs Americans use, the drug treatments and therapies that are approved, the inoculations used to protect the nation’s school children from diseases such as measles and the food everyone eats.

The Secretary of the US Department of Health and Human Services has a massive platform and enormous power to influence the information Americans have and the choices they make. If Kennedy is confirmed and another pathogen emerges to cause a pandemic in the next four years, he will be in charge of fighting it.

“People Like You Bobby”

Kennedy was spotted at Trump’s Mar-a-Lago resort in Florida in black tie on Thursday night, hours after the announcement sent shockwaves through the medical community.

The president-elect praised his selection during a speech. “I guess if you like health and you like people living a long time, that’s the most important position,” Trump said. “I just watched the news. People like you, Bobby. We want you to come up with things and ideas and what you’ve been talking about for a long time.”

Kennedy’s selection came after the president-elect tapped controversial congressman Matt Gaetz as attorney general, dealing a blow to the legal establishment that tried to hold him accountable for his attempt to steal the 2020 election. The generals Trump believes they blocked him during his first term could end up working for Fox News star Pete Hegseth, who believes there is a “woke” war against American warriors and is on track to be secretary of defense. And Trump has shown his anger at the “deep state” of intelligence by naming Tulsi Gabbard, who has met Syrian dictator Bashar al-Assad and is a favorite of Russian propaganda TV, as America’s top spy.

This election caused an uproar in Washington.

But they are seen very differently from millions of Trump voters who believe the capital institution is rotten and has failed them. And they are symptomatic of a president-elect who returns to power with very few constraints and shows he intends to be aggressive in a term he said on the campaign trail would be devoted to revenge against his opponents.

Trump believes he has a mandate for his unorthodox choices

So far, Republicans have responded to criticism of Trump’s approach in Washington with a simple argument: He has a mandate.

For example, CNN’s Jake Tapper asked Indiana Senator-elect Jim Banks if he was concerned about Kennedy’s false claims that vaccines can cause autism. “Look, Jake, in the election, Donald Trump won the popular vote,” Banks said. “And one of the things he promised during the campaign is to have a serious, thoughtful conversation about vaccines, especially after the pandemic.”

It’s true that Trump made no secret on the campaign trail of his intention to hand Kennedy significant power to overhaul health care facilities. And the whole subtext of his campaign was a vow to blow up the Washington consensus.

The president-elect has long resented the scientific class and experts in the US government, particularly dating back to their advice during the Covid-19 pandemic — an emergency that Trump has repeatedly downplayed — that went into conflict with his desire to open the economy again during his re-election. year. Other Americans have chafed at wearing masks, and many conservative states have opposed the federal government’s advice on the pandemic on matters such as school closures and lockdowns.

But despite Trump’s victory this year, in which he won all seven battleground states, the US remains essentially a 50-50 nation, and it’s debatable whether the president-elect really has the mandate to destroy generations of political orthodoxy and institutional – especially in fields. such as health.

“An extraordinarily bad choice”

Kennedy has some views that would find favor with the medical establishment, particularly regarding his efforts to address unhealthy US diets that cause chronic and non-communicable diseases that are largely preventable. He said he would “immediately” begin studying the safety and effectiveness of the vaccines, but promised he would not “take the vaccines from anyone.” He also pledged to formally recommend that states and municipalities eliminate fluoride from public water.

Kennedy also says he wants to return a gold standard of science to a health sector he believes is being misrepresented by big pharmaceutical companies. But his long record of misinformation and selective use of vaccine data directly conflicts with the consensus among scientists and medical experts.

“I think this is an extraordinarily poor choice,” Dr. Ashish Jha, former Biden administration Covid-19 coordinator and dean of Brown University’s School of Public Health, told CNN’s Wolf Blitzer. Previous HHS secretaries in Republican and Democratic administrations have allowed scientists from agencies under their watch to make decisions, Jha said. “RFK Jr. has given us every signal that he doesn’t intend to do that, he doesn’t intend to rely on rigorous evidence and analysis to make decisions, but to use his own ideas.”

Another health expert and former acting director of the US Centers for Disease Control and Prevention condemned the choice. “Honestly, I find it scary,” said Dr. Richard Besser. Besser, who practiced pediatrics, warned that Kennedy’s views on childhood vaccines were dangerous, telling CNN’s Kaitlan Collins, “He has done so much to undermine people’s confidence in this incredible intervention.”

Kennedy’s selection was made public the same day the World Health Organization and the CDC — an agency that would be under RFK Jr.’s control — said worldwide measles cases had risen more than 20 percent to about 10 .3 million last year. The highly contagious disease can be prevented with two doses of the measles vaccine that most Americans receive as children.

In the US, a decline in vaccination rates among kindergarten children has coincided with a time when some conservative politicians, in particular, have fueled vaccine skepticism in the wake of the Covid-19 pandemic. As of November, 266 measles cases have been reported this year, with 16 outbreaks.

CDC Director Dr. Mandy Cohen told CNN’s Meg Tirrell on Wednesday that childhood vaccines are the way to make the country as healthy as possible. “I think we have a very short memory of what it’s like to hold a child who has been paralyzed by polio or to comfort a mother who has lost a child to measles,” Cohen said at the Future of Health Summit in Milken Institute.

Kennedy has denied being a vaccine skeptic. But on Lex Fridman’s podcast last year, he said “there’s no vaccine that’s, you know, safe and effective,” and in December 2023, he told CNN’s Kasie Hunt that he “would be against mandates.” for children in public schools.

Another election adds to the mounting pressure on Senate Republicans

The Trump cabinet’s most controversial pick has escalated one of the first dramas of Trump’s second term — the question of whether all of them will be confirmed by the Senate.

Serious doubt was already swirling around Gaetz, who was himself being investigated by the FBI and the subject of a House Ethics Committee investigation before he officially resigned from the House of Representatives on Wednesday. And Kennedy’s entry into the mix will present another challenge for Republican senators who have little evidence of taking on the president-elect.

It would take a handful of Republican lawmakers to defect to jeopardize Trump’s confirmation — and his grip on the GOP has never been stronger after he pulled off the biggest comeback in US political history and reclaimed the House White.

The president-elect, ahead of the selection of some of his most controversial Cabinet picks, has warned Republicans that he will push for recess appointments if they are blocked in a way that would bypass the Senate’s advisory and consent function according to the Constitution.

Like other nominees, RFK Jr.’s hopes may hinge on the attitude of several more moderate senators in the GOP coalition. They could be swayed by members who plan to retire midterm and be less beholden to Trump, or by the new influx of just-elected senators who won’t have to run for re-election until two years after their term ends or.

And then there’s the vote that belongs to Senate Republican leader Mitch McConnell, a polio survivor.

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