Fri Feb 14

In Robert F. Kennedy Jr, the US has put a conspiracy theorist in charge of public health

Written by: Hassan Vally, Associate Professor, Epidemiology, Deakin University

Overnight, Robert F. Kennedy Jr was confirmed ^[1] as the secretary of the US Health and Human Services Department. Put simply, this makes him the most influential figure in overseeing the health and wellbeing of more than 330 million Americans.

As health secretary, Kennedy will be involved in overseeing federal health agencies ^[2] that regulate medical research, disease prevention, drug approvals and health-care programs.

This includes oversight of the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration and the National Institutes of Health, which are among the most crucial public health agencies in the country.

Reports suggest he’ll oversee a budget in the order of US$1.8 trillion ^[3] (A$2.8 trillion) annually.

In the era of Trump 2.0, there’s little that shocks me anymore. But Kennedy would have to be the most unqualified person ever to hold this crucial role of protecting the health of the American people.

A history of discounting science

The absolute minimum requirement for someone occupying such as role should be an understanding of science and respect for scientific evidence and expertise. Yet, Kennedy fails spectacularly in this regard.

Here are just some of the false claims he has made over the years:

None of these positions has even the smallest amount of scientific support.

It’s hard to predict what Kennedy will do as health secretary, especially given his confirmation hearings ^[4] looked to be an exercise in being vague, evasive and denying or downplaying his prior controversial statements to secure support.

But there are three areas where his views are fairly clear and his appointment could be expected to have a significant impact. These are water fluoridation, infectious diseases research and vaccines.

Fluoridation of water

Kennedy has been a long-term opponent of water fluoridation, despite its proven benefits in preventing tooth decay ^[5]. He has consistently questioned its safety and claimed it’s linked to a range of illnesses ^[6] such as arthritis, bone cancer, IQ loss and neurodevelopmental disorders.

While a recent review suggested a link between water fluoridation and lower IQ in children ^[7], the levels of fluoride in the water in countries included in this review were generally several times higher ^[8] than the levels in public water fluoridation programs in countries such as the US and Australia. There were also other limitations that make interpreting these findings challenging.

The CDC has identified community water fluoridation as as one of the ten great public health achievements of the 20th century ^[9]. And it continues to benefit dental health today, without any convincing evidence of possible harms.

Nonetheless, it seems likely that in keeping with his longstanding views one of Kennedy’s first priorities will be to try to halt water fluoridation in the US.

Infectious diseases

Alongside his confirmation as health secretary, US President Donald Trump signed an executive order ^[10] establishing “The President’s Commission to Make America Healthy Again”, with Kennedy as the chair.

The Make America Healthy Again ^[11] movement (MAHA) is an initiative driven by Kennedy focusing on improving nutrition, increasing transparency in medical practices and reducing the corporate influence in health.

Though premised primarily on combating chronic diseases, the movement also embraces scepticism of established medical practices, unproven alternative therapies and a general mistrust of institutions.

What’s more, Kennedy’s focus on chronic diseases seems to be coming at the expense of continued work on infectious diseases.

He has proposed directing the National Institutes of Health to pause infectious disease research ^[12] for eight years to prioritise research into chronic diseases and alternative treatments.

As health secretary, Kennedy has the power to shift research priorities. If he were to effectively halt infectious diseases research – in the wake of COVID and with a looming threat ^[13] of future pandemics – this would be catastrophic for the US and global health.

Vaccine scepticism

Related to infectious diseases, there’s little doubt the area in which Kennedy has done the most damage relates to vaccines.

He has dedicated a large part of his life to undermining public confidence ^[14] in vaccines. This is despite overwhelming scientific evidence demonstrating their safety and effectiveness, and the millions of lives ^[15] they’ve saved.

Although he has subsequently denied it, Kennedy is on record ^[16] as falsely stating there is no such thing as a safe and effective vaccine. Notably, he has continued to push the debunked claim ^[17] that the measles, mumps and rubella (MMR) vaccine is linked to autism, despite the single study finding this having been widely discredited.

Kennedy’s frequent assertion that he’s not anti-vaccine, but “pro-safety ^[18]”, is also deeply disingenuous. Being “pro-safety” is a deliberately vague notion designed to appear reasonable while at the same time undermining the scientific evidence.

The impact of Kennedy’s appointment as health secretary on vaccine confidence will not just be limited to the US. Vaccine hesitancy has been recognised as one of the greatest threats to public health ^[19]. Having a vaccine sceptic leading the US health agencies has the potential to harm vaccine uptake worldwide.

As we’ve seen during the COVID pandemic, producing a vaccine is only half the battle. Convincing people to take it is just as important. There’s no doubt Kennedy’s influence on public health messaging could further erode vaccine confidence at a time when vaccine messaging must be clear.

It’s bad news for the US and the world

One of the reasons Kennedy poses such a threat to public health in the US and globally is his lack of trust in science. He believes a narrative can be crafted by picking and choosing any study that fits with his world view, regardless of its quality.

In addition, he personifies the bad-faith tactics of conspiracy theorists globally, “selling” the flawed premise that any assertion is valid until others prove it false.

What the world needs now is a safe pair of hands leading public health in the US. Someone who is guided by evidence – not someone who promotes anti-science propaganda and conspiracy theories.