For years, Robert F. Kennedy Jr., has leveraged his famous name, his celebrity connections and his nonprofit, Children’s Health Defense, to spread misinformation about vaccines and call their safety and efficacy into question. Soon, he might have the power to go much further.

If Kennedy is confirmed by the Senate to be secretary of health and human services, he would be in charge of the nation’s preeminent public health and scientific agencies, including those responsible for regulating vaccines and setting national vaccine policy.

Legal and public health experts agree he would not have the authority to take some of the most severe actions, such as unilaterally banning vaccines, which Kennedy has said he has no intention of doing.

“I’m not going to take anyone’s vaccines away from them,” he wrote on social media last month. “I just want to be sure every American knows the safety profile, the risk profile, and the efficacy of each vaccine.”

But Kennedy, who has said that he wants federal researchers to pull back from studying infectious diseases, could exert his influence in many other ways. His actions could reduce vaccination rates, delay the development of new vaccines and undermine public confidence in a critical public health tool.

In the last three decades alone, childhood vaccines have prevented more than 500 million cases of disease, 32 million hospitalizations and more than 1 million deaths in the United States, according to a recent report from the Centers for Disease Control and Prevention. But vaccination rates have been falling in recently years, and Kennedy could accelerate the trend, public health experts said.

“A lot of damage is possible,” said Dr. Tom Frieden, a former director of the CDC who now leads Resolve to Save Lives, a public health nonprofit. “The secretary of health has a life-or-death responsibility. And if unscientific statements and decisions are made, if agencies are damaged, if public confidence is undermined, then you can get spread of disease.”

Here are five things Kennedy could do.

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He Could Revise the Government’s Vaccine Recommendations.

As the federal health secretary, Kennedy would oversee the CDC, the agency that issues guidance on which immunizations Americans should get and when.

Health insurers look to those recommendations to determine what vaccines to cover and state health departments use them to inform their own vaccine policies.

Kennedy would have final say over which experts sit on the external committee that advises the CDC on vaccines, and he would be the boss of the CDC director, who decides whether to adopt that guidance. “That’s, in my mind, a recipe for a disaster,” said Lawrence O. Gostin, an expert in public health law at Georgetown University.

A CDC director or advisory committee that is hesitant toward vaccines could usher in changes in the childhood vaccine schedule, such as removing vaccines from the list of recommended immunizations or changing the ages at which they are advised.

“If the question is purely, could the HHS secretary unilaterally remove vaccines from a schedule or alter the schedule, I think the answer to that would ultimately be no,” said Dr. Michael Mina, an epidemiologist and former professor at Harvard University. “But with a little bit of planning, through like-minded appointments and top-down pressure, the answer to that starts to move the needle toward yes.”

One thing he could not do is abolish vaccine mandates, such as requirements that children receive certain immunizations before attending school. Those are set by state and local governments. The federal health secretary does not have the authority to override them.

But some public health experts fear that some state health authorities, particularly in Republican-led states, could follow a CDC that is skeptical of vaccines. One result might be lower vaccination rates — and worse public health outcomes — in red states than in blue ones, Gostin said, similar to the pattern that played out with the COVID-19 vaccines.

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He Could Slow Vaccine Development and Approval.

Kennedy would also be in charge of the Food and Drug Administration, the agency responsible for approving new vaccines.

He has repeatedly criticized the agency, which fast-tracked the authorization of the COVID-19 vaccines, as well as the shots themselves. As health secretary, he would not be able to remove them or any other already authorized vaccines from the market without strong scientific evidence, Gostin said. If he tried, vaccine manufacturers could sue over such a decision and courts would most likely rule in their favor, he said.

But he could bring people who share his views into the FDA. Together, they could make the process for approving new vaccines more onerous and lengthy, including requiring more data.

“He could say, ‘I don’t think this has been studied in the right way,’” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an adviser to the FDA.

He could also stop or slow vaccine development research conducted at or funded by the National Institutes of Health, the federal government’s top medical research agency, which would also fall under his purview. He has been clear about his plans to empty some divisions that focus on advancing vaccine research and development. He has said he would fight the next pandemic instead by “building people’s immune systems.”

“I’m going to say to NIH scientists, ‘God bless you all,’” Kennedy said as a presidential candidate in November 2023. “‘Thank you for public service.’ We’re going to give infectious disease a break for about eight years.”

Infectious diseases are still looming, however. And a slowdown in vaccine research, development or approval could have particularly dire consequences in the event of another public health emergency like COVID-19.

Bird flu, for instance, continues to infect American farmworkers, and experts have worried that the virus could evolve to spread more easily among humans. If that happened, “we would be in a new pandemic,” said Jennifer Nuzzo, the director of the Pandemic Center at Brown University. “And that pandemic would move very quickly. Any attempt to not act with urgency would be deadly.”

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He Could Emphasize Vaccine Side Effects.

Decades of scientific study confirm that the benefits of vaccines far outweigh the risks, but like all medications, they carry the possibility of side effects, including some rare but serious ones. Kennedy — who has said he wants more public visibility into safety data — is poised to draw outsize attention to adverse outcomes.

His nonprofit promotes a database of research that includes hundreds of misleading interpretations of vaccine data. In September, the group released “Vaxxed 3: Authorized to Kill,” a film claiming that COVID vaccines led to “tragic outcomes of either death or serious injury.”

Under Kennedy, federal agencies like the FDA could highlight potential side effects by requiring vaccine-makers to list even very rare ones on the packaging label.

Kennedy could also draw attention to unverified reports of adverse events collected by federal agencies. “What I would worry about is an abuse of the data,” said Dr. Peter Lurie, the president of the Center for Science in the Public Interest and a former associate commissioner at the FDA.

Kennedy could also push federal agencies to conduct more research into vaccine safety. That would not be a bad thing in itself, said Dr. Ofer Levy, director of the precision vaccines program at Boston Children’s Hospital and an adviser to the FDA. “There is more research that can be done, particularly on some of the newer vaccines,” he said.

But, the research must be scientifically rigorous, he added, and build upon decades of scientific evidence related to vaccine safety. “If you signal this to the public as, ‘Well, we have to start from scratch, all of these vaccines are suspect,’ I would disagree with that approach,” Levy said. “Because many of these vaccines have been very, very well studied, and they’re a huge win for kids.”

He Could Weaken Legal Protections for Vaccine-Makers.

Under a long-standing federal law, people who experience serious side effects after receiving certain routine vaccinations are limited in their ability to sue drug companies. Instead, they can seek compensation through a government-run program. The law is intended to encourage drug companies to invest in vaccine development.

Kennedy could not make major changes to the law without congressional approval, but he could remove specific vaccines from the program. Whether he could take every vaccine off the list is “difficult to say, because it’s uncharted waters, legally speaking,” said Ana Santos Rutschman, an expert on health law and policy at Villanova University.

If vaccines are removed from the program, some companies may decide to stop making them. “And that’s going to have two effects: driving vaccine costs up and reducing availability for those who want the vaccines,” said Dorit Reiss, an expert on vaccine policy and law at the University of California College of the Law, San Francisco.

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He Could Speak out Against Vaccines.

Many experts say they worry most about Kennedy’s bully pulpit. If confirmed, Kennedy would have a new platform for spreading misinformation about vaccines and amplifying fears about their safety.

“It’s very hard to claw back outrageous ideas when social media algorithms propel them forward,” Nuzzo said.

Vaccine hesitancy grew during Trump’s first term as president and persisted after he left office.

Vaccine experts have said Kennedy is particularly skilled at taking good, peer-reviewed science and skewing the findings.

Mina said he expected Kennedy to “to do exactly what he’s been doing for years: fudging the way that data is meant to be interpreted, using very manipulative tactics to drive a message that makes vaccines look dangerous. He is a master at it — truly a master.”

During a measles outbreak in Samoa in 2019, Kennedy stoked the skepticism driving the spread. He wrote to the nation’s prime minister on the Children’s Health Defense letterhead, suggesting that the failure of vaccines given to pregnant women and children was the true culprit. More than 50 children died in the outbreak.

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This article originally appeared in The New York Times.

By Emily Anthes and Emily Baumgaertner/Hiroko Masuike
c. 2024 The New York Times Company