Robert F. Kennedy Jr. could wield significant authority to directly affect how and whether Americans get vaccines nationwide, current and former federal health officials say, if he is confirmed next year to head the Department of Health and Human Services under President-elect Donald Trump.

The position would grant Kennedy authority over efforts like the Vaccines for Children program, which is estimated to have saved 1.1 million lives by immunizing children against diseases like polio and measles that are now rare thanks to the shots.

Many public health experts have decried the pick, saying Kennedy’s past claims about vaccines are disqualifying. 

“A serious candidate for this position would follow the decades of real-world evidence that shows that vaccines are safe and prevent as many as 5 million deaths each year,” Dr. Georges Benjamin, executive director of the American Public Health Association, said Monday in a statement.

Is RFK Jr. anti-vaccine?

Kennedy has insisted he is not “anti-vaccine” and promised not to try to ban the shots under the Trump administration — but he has a long record of making misleading statements about vaccines and fanning doubts about their proven benefits and safety. 

He wrote a now-retracted article in 2005 falsely claiming autism was linked to a discontinued ingredient in vaccines, and continues to say he thinks vaccines are a cause of autism, which decades of scientific research has thoroughly discredited. 

On social media, Kennedy called COVID shots “a crime against humanity” and claimed children did not need COVID vaccines. (Research estimates that COVID vaccines prevented 3.2 million deaths in the U.S. through 2022.)

The group he chaired, Children’s Health Defense, has been denounced by experts for being among the most prolific spreaders of misinformation about vaccines. 

In recent months, Kennedy has said his goal is to “provide Americans with transparency and access to all the data so they can make informed choices.” He also wants to clean house at federal health agencies, ousting “corrupt” officials he claims have clouded “their rich tradition of gold-standard, evidence-based science.”

The head of the FDA’s vaccines program says he hopes Kennedy will “keep an open mind” about what the science shows.

“Perhaps engaging in that dialogue, especially if it’s in a public venue, it may help. It may help bring some of the rest of the country along because sometimes as somebody is convinced, perhaps, maybe some of the rest of the country will be,” Dr. Peter Marks, head of the FDA’s Center for Biologics Evaluation and Research, said earlier this month. 

CDC recommendations and covering costs

One of the biggest roles that the CDC plays in vaccinations is in deciding which vaccines health insurers are required to cover. Nearly all plans are required by law to cover routine shots that are recommended by the agency’s Advisory Committee on Immunization Practices.

Updating that “schedule” of routinely recommended vaccines is usually a monthslong process for the committee, which is made up of medical experts who work to publicly analyze and vote on the benefits and risks of different shots. 

Those meetings happen at least three times every year, as the committee debates newly approved vaccines, annual updates to routine shots like influenza or COVID-19 and reevaluating the data on older immunizations.

“They incorporate epidemiology. Which groups are most affected? Are there certain subgroups that it is most effective for? Are there some groups that may not benefit very much from a certain vaccine,” said Dr. Carolyn Bridges, the CDC’s former associate director for adult immunizations. 

Bridges, who now works as a consultant on adult vaccinations, praised the “very public discussion and often very rigorous debate” among the experts selected to serve on the committee.

The CDC’s career civil servants are traditionally able to offer input into which experts are chosen for the panel, and federal law says the committee’s membership should be “fairly balanced in terms of the points of view.”

But, it will be Kennedy’s decision alone to decide who sits on the committee. Kennedy’s pick to head the CDC would also have the authority to override the panel’s votes, as was done in 2021 to roll out some COVID-19 booster shots.   

The panel’s recommendations have a wide impact beyond insurance coverage, Bridges said, influencing how doctors and local health departments talk about and offer the shots.

Kennedy and his pick to head the CDC could also affect the agency’s wide-ranging immunization work in other ways. 

For example, the agency is responsible for the Vaccines for Children program that supplies shots to pediatricians nationwide to ensure no-cost access for uninsured children. It also routinely steps in to sort out any confusion among providers over vaccine recommendations.

The CDC also runs the main national data sources tracking immunization rates, vaccine effectiveness for some common shots and ongoing monitoring of vaccine safety. 

“It’s really the integration of all of those things. There’s a lot that goes into this — the policy, the monitoring, the coordination, the communication,” Bridges said.

FDA approvals and regulations

Kennedy and whoever he picks to lead the FDA would also play a big role in both the approval of vaccines and in regulating them after they are on the market. 

Decisions on whether to approve or reject applications from vaccine makers are traditionally left up to career scientists working in the agency’s Center for Biologics Evaluation and Research. That is mostly ensured only by norms, not law. 

“It’s totally within the law for the president or the HHS secretary to overrule the entire FDA. And so, that could happen. Did it happen to me? No. But I also want to say, I think the view that there’s a sharp line between the political and scientific, we got to speak truthfully about this,” FDA Commissioner Dr. Robert Califf said Nov. 11, speaking at an event hosted by the Friends of Cancer Research. 

Califf said that “99.95% of FDA decisions about individual products” are made by civil servants with scientific expertise in the field. But the commissioner is sometimes forced to step in, like to resolve internal disagreements or appeals from outside the agency.

Kennedy and his FDA commissioner could also influence vaccines in other ways, like through guidance the agency issues to manufacturers seeking approval. 

Policy changes recommended by the agency’s staff can be stalled or rejected by political leaders. Major changes to FDA’s rules are also funneled through the White House, which has the ability to block them.

“There’s so many other aspects of this that are integrated in various ways with politics. And there’s just no way around it,” Califf said. 

Communicating risks and benefits

Beyond Kennedy’s direct authority over vaccines, another major way he and his picks to head the CDC and FDA could influence public opinion is through how they approach talking to Americans about the risks and benefits of vaccines.

The department funds a number of efforts to survey public confidence in vaccines and study ways to improve it. They also run a number of campaigns to promote recommended shots, like advertising about the annual COVID-19 and flu vaccines or helping health departments respond to backsliding immunization rates in schools.

“We don’t have to remember too far back to see what happens because of vaccination rates, when there aren’t requirements and people don’t have access,” said Bridges, citing a polio case that emerged in New York in 2022. 

Outbreaks of polio once killed thousands of Americans and left many survivors paralyzed, until the disease was virtually eliminated in the U.S. by vaccines that first rolled out in the 1950s.

The return of polio prompted an investigation by health authorities and a renewed push for vaccinations, though officials acknowledged they struggled to “meaningfully increase” immunization coverage.

“That’s just mind-boggling that we can have a polio resurgence, in a country with all of our resources. It doesn’t take all that much for diseases still circulating in other places to retake hold,” said Bridges.

Another way the communications role comes up is in navigating how to explain potential risks flagged by federal vaccine safety systems to doctors and the public.

An example last year came after the FDA and CDC officials worked to craft a bulletin disclosing early concerns that COVID-19 shots might be increasing the risk of stroke for seniors, while also explaining why the preliminary “safety signal” did not warrant stopping use of the shots.

Intense scrutiny of the issue by the U.S. and health authorities overseas eventually found “no evidence of a safety concern,” though health authorities continue to closely study the issue.

The benefits of the vaccine continue to far outweigh this theoretical risk, the CDC’s advisers concluded, especially among seniors who are at higher risk of severe illness or death from COVID.

“The current evidence does not support the existence of a safety issue. FDA and CDC will continue to evaluate data as they are available and update the public as needed,” the FDA said.