Nov 27, 2024
President-elect Trump’s team to lead the nation’s health agencies is rapidly coming together.   Trump first tapped Robert F. Kennedy Jr. to lead the Department of Health and Human Services (HHS). Then, he announced television’s Dr. Mehmet Oz was his pick to lead the Centers for Medicare and Medicaid Services.   In a string of announcements late Friday, Trump nominated former Rep. Dave Weldon (R-Fla.) to direct the Centers for Disease Control and Prevention (CDC), Marty Makary to lead the Food and Drug Administration (FDA) and Janette Nesheiwat as the next surgeon general.    Almost all have been highly critical of the agencies they would run if confirmed, and experts say the nominees represent a complete overhaul of the vision and priorities of key agencies for health care and public health.  Here are four takeaways:  Largely positive reaction from GOP Senate Republicans have been reserved about their reactions to Kennedy's nomination to lead HHS but are signaling that they are receptive, despite some misgivings about his views on abortion and the food system.   The reactions to the other controversial nominees — including Oz and Weldon — have been largely positive.   “Congratulations, Dr. Dave Weldon! I have no doubt you will bring an exceptional skillset and much-needed change to the CDC!” Sen. Rick Scott (R-Fla.) posted on X.    “Very excited to hear that Dr. Oz will be CMS Administrator in the Trump Administration. Outstanding pick,” Sen. Lindsey Graham (R-S.C.) wrote on X.   Sen. Bill Cassidy (R-La.), the likely chairman of the Senate Health, Education Labor and Pensions Committee (HELP), said he was “glad to hear” that Oz was Trump’s pick for CMS.  “It has been over a decade since a physician has been at the helm of CMS, and I look forward to discussing his priorities. This is a great opportunity to help patients and implement conservative health reforms,” Cassidy, himself a physician, said in a statement on X.  The HELP Committee has jurisdiction over HHS nominees, so any pick will need to be approved by the panel before advancing to the Senate for confirmation.  Weldon, who was among a trio of nominees announced by Trump on Friday, will be the first CDC director nominee to go through the Senate confirmation process.  “I have firmly advocated for reforming the CDC. I look forward to learning about Doctor Weldon’s vision for the CDC,” Cassidy wrote on X.  Key moderates, including Sen. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) have not weighed in on Weldon, Makary or Nesheiwat.   Collins campaigned with Oz when he was running for Senate against now-Sen. John Fetterman (D-Pa.), and last week spoke positively about having a physician run CMS.   Some Democrats speaking out, but not all When Trump announced Kennedy’s nomination, Sens. Patty Murray (D-Wash.) and Ron Wyden (D-Ore.) were some of the first of many Democrats to blast him.  “There is no telling how far a fringe conspiracy theorist like RFK Jr. could set back America in terms of public health, reproductive rights, research and innovation, and so much else,” Murray, a member of the HELP Committee, said in a statement.   Wyden, who is Senate Finance Committee chairman, said Kennedy’s “outlandish views on basic scientific facts are disturbing and should worry all parents who expect schools and other public spaces to be safe for their children.”   Murray also spoke out against Weldon’s nomination for CDC director, raising concerns about his history pushing debunked claims about vaccine safety.  “We need a leader who has real experience in public health, not someone who has spent years promoting vaccine misinformation and junk health plans,” Murray said. “To every one of my colleagues considering this nomination, I cannot drive home enough: this isn’t a game, this is not a political role without consequence, it has real power over whether Americans can get basic information and care to keep their families safe.”  But other Democrats have been largely silent.   HELP Committee chairman Bernie Sanders (I-Vt.) hasn’t spoken up about any of Trump’s health nominees.   Other HELP members like Sens. Tim Kaine (D-Va.) and Chris Murphy (D-Conn.) haven’t reacted.  Finance Committee member Sen. Elizabeth Warren (D-Mass.) said RFK Jr. “poses a danger to public health, scientific research, medicine, and health care coverage.”   But she hasn’t weighed in on any of Trump’s other picks.  Trump’s nominees aren’t likely to pick up much, if any, support among Democrats. But the lack of open antagonism so far could be a sign that senators will let Republicans fret about the more controversial picks internally, rather than vocally oppose them.    The Make America Healthy Again agenda comes into focus Trump’s picks suggest a major shakeup of the health agencies, remade to fit the vision of Kennedy, a prominent vaccine skeptic.   Kennedy has promised to free the agencies “from the smothering cloud of corporate capture” as he implements his view for Make America Healthy Again. Public health experts said Trump’s picks signal a move to prioritize chronic disease over infectious disease.   “Given the current Chronic Health Crisis in our Country, the CDC must step up and correct past errors to focus on the Prevention of Disease,” Trump said in a statement when he announced Weldon’s nomination. “The current Health of Americans is critical, and CDC will play a big role in helping to ensure Americans have the tools and resources they need to understand the underlying causes of disease, and the solutions to cure these diseases.”  During his presidential campaign as an independent, Kennedy said he wanted to “give infectious diseases a break for about eight years.”  Experts said focusing on chronic illnesses is important, but it shouldn’t be at the expense of infectious disease.   “I sincerely want this administration to be successful in making America healthy again. Chronic diseases are important- but you can’t die from cancer when you’re 50 if you die from polio when you’re 5,” Jerome Adams, who served as surgeon general during the first Trump administration, wrote on X.   “Any idea that we can take a four-year timeout from infectious diseases is naive and dangerous,” said Michael Osterholm, a University of Minnesota infectious disease expert. “Chronic diseases are a significant cause of morbidity and mortality, but you don't fix that in four years. There's no magic pill. If you can take all the right steps, it’d be a generational effort.”   Georges Benjamin, executive director of the American Public Health Association, pointed to current outbreaks of bird flu, measles, pertussis (whooping cough), and food-borne illnesses like listeria.  "Infectious diseases are not gone,” Benjamin said. “People have both chronic diseases and infectious diseases, and you can't separate the two.”    Vaccine skeptics Kennedy was Trump’s first public health pick and is the one public health experts remain the most concerned about.  But many Democrats and public health experts who raised the alarm about Kennedy are concerned Weldon will help bolster an anti-vaccine agenda. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said he worries Kennedy’s vaccine skepticism will be the driver of much of what the agencies try to accomplish on chronic illness.   “RFK Jr. and Dave Weldon are of the belief that disorders like autism and developmental delays are because of vaccines and CDC hasn't made that clear because they’re hiding the truth. Their job is to tear these agencies apart and give Americans the real data. Which is of course is all nonsense,” Offit said.   Weldon served 14 years in Congress, representing the 15th District of Florida, where he was an outspoken critic of CDC.   He also pushed a false claim that thimerosal, a preservative used in vaccines, is linked to autism.  He introduced a bill in 2007 that would remove vaccine safety research from the CDC’s purview and move the work in an independent HHS agency.  There’s concern Weldon and Kennedy could try to purge the agencies of career scientists and install loyalists.  “The thing most of us are waiting on, with real concern, is per Kennedy's comments, will there be mass firings at CDC, NIH, FDA? If in fact that happens, that would be by far the most concerning aspect of the administration,” Osterholm said.  
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