In the Next Pandemic, We Need Better than RFK Jr.

Robert F. Kennedy, Jr. (RFK Jr.), Donald Trump’s nominee to head the US Department of Health and Human Services (HHS), is a terrible choice for many reasons. His unfitness to lead the agency’s response to a pandemic should be high on the list of reasons for Senators to vote against his confirmation. The first reported US human death from the H5N1 “bird flu” virus, announced on January 6, reminds us that this appointment is a life-and-death decision.

There’s still no indication that bird flu is spreading between humans, but analysis of the virus that killed the person in Louisiana shows the potential for harmful mutations. If the virus mutates in a way that enables easy human-to-human transmission, a pandemic is highly likely. Responding effectively to a pandemic requires basing decisions on the best available evidence and advice, and RFK Jr.’s record suggests he’d do the opposite.

Leaders responding to a pandemic need to know how the virus spreads, both in terms of transmission (is it spread by large or small droplets in the air, via contaminated surfaces, etc.?) and the spread through populations (e.g., how many people is one infected person likely to spread the virus to in various settings, and where are the current hot spots?). They need to know what kinds of symptoms are common and what kind of care can prevent death and disability. They need to know how effective various countermeasures — like wearing masks or other protective gear, washing hands, improving ventilation, and limiting large gatherings — are at limiting the virus’s spread. They need to know whether any existing vaccines or drugs can prevent transmission or reduce symptom severity, and if no existing product is known to work well, they should support the testing of existing products and development of new ones. We don’t expect the head of HHS to come into the job with this expertise, but we expect them to listen to people who do. RFK Jr. has a high profile and could presumably have discussed infectious disease science with a long list of experts over the past decades. Instead, he has promoted his own unsubstantiated and debunked views.

Pandemics involve making tough decisions, like who should receive limited supplies of vaccines and what kinds of costs are worth paying to limit transmission. People acting in good faith can come to different decisions about implementing countermeasures — for instance, they might have different answers to how much loss of learning and strain on parents is acceptable to achieve the transmission reduction that comes from closing schools for different amounts of time. But they should make these decisions after familiarizing themselves with the best available data and hearing from experts — something RFK Jr. has failed repeatedly to do.

Much of the well-deserved opposition to RFK Jr.’s nomination focuses on his highly inaccurate and dangerous assertion that no vaccine is safe and effective, his spreading the debunked claim that vaccines cause autism, and the fact that the lawyer working with him on filling HHS positions has petitioned the government to revokes its approval of the polio vaccine. (And he’s not the only anti-vaccine nominee, either.) Guided by beliefs not based on high-quality evidence, RFK Jr. could take several actions that would result in vaccine-preventable disease rates rising across the US — and potentially bring us back to an era when children dying before the age of five was a heartbreaking but common occurrence.

In addition to harming overall population health, unwarranted hostility to vaccines can stymie pandemic response. US government leaders made many mistakes in their responses to COVID-19 (and they’re still not doing enough to publicize rising infection rates and recommend basic precautions like masking and ventilation), but one thing they did well was to support the rapid development, testing, authorization, and administration of vaccines. A Commonwealth Fund study estimated that two years of COVID-19 vaccines prevented more than three million deaths. Imagine that the next pandemic kills three million more people because Donald Trump and the Senate majority made a poor choice for HHS secretary.

When it comes to the other aspects of pandemic response, can we expect RFK Jr. to listen to the many government scientists who can provide high-quality evidence on disease transmission, symptoms, and countermeasures? I’m not optimistic here, either. Vaccines might be the best-known area where RFK Jr. spreads misinformation, but they’re not the only one; he has also blamed school shootings on antidepressants, suggested AIDS might not be caused by HIV, and promoted raw milk (at a time when pasteurization is crucial for killing the H5N1 virus). It appears that RFK Jr. either doesn’t know how to tell the difference between information of high and low quality or doesn’t care to.

Plus, if RFK Jr. fulfills his plans to get rid of “entire departments” at the Food and Drug Administration (FDA) and replace hundreds of current National Institutes of Health (NIH) employees while instituting an eight-year pause on infectious disease research, there might be far fewer scientists to provide advice on halting the spread of infectious diseases. When facing a public health emergency, the HHS Secretary must work productively with leaders of the various agencies within HHS (including FDA, NIH, and CDC), and that will be much harder if the Secretary doesn’t value the important work these agencies’ scientists perform.

RFK Jr. began meeting with Senators in mid-December. Some might convince themselves that he will live up to his claim that he won’t “take vaccines away from anybody.” But we shouldn’t gamble the lives of millions on a hope that someone who has ignored high-quality science and spread misinformation for years will suddenly start listening to experts when the next pandemic arrives. If you have Senators, let them know public health is too important to be left to nominees like RFK Jr. who haven’t shown the necessary respect for science.

About the author

Liz Borkowski is the managing director of the Jacobs Institute of Women’s Health at the Milken Institute School of Public Health at George Washington University. She is the managing editor of Women’s Health Issues, the peer-reviewed journal of the Jacobs Institute, and a member of the GW Center of Excellence in Maternal and Child Health. She has an MPH in health policy from George Washington University.

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