US Health Secretary Robert F. Kennedy Jr. is at war with the nation’s public health establishment. He’s overseen mass layoffs at the Centers for Disease Control and Prevention; canceled $500 million in federal funding for mRNA vaccine development; and promised to end the bias against “alternative medicine.”
The country’s leading scientists and physicians have started pushing back against the Trump administration’s agenda, with some physician groups releasing their own Covid vaccine recommendations after Kennedy unilaterally changed the federal guidance this summer. Doctors say they’re looking to protect the most vulnerable as the government turns against the long-standing public health consensus.
“I think we all actually have a duty to try to improve the country no matter who’s in power,” said Ezekiel Emanuel, an oncologist and a medical ethicist who works at the University of Pennsylvania.
Emanuel was a senior health care adviser in the Obama administration and informally counseled President Donald Trump’s first administration on prescription drug prices and the early Covid-19 response. He said public health does need to be bipartisan — but Kennedy’s agenda risks further dividing Americans. The health crises facing Americans are real, and we need real solutions — but Kennedy is not proposing them.
Below is an excerpt of Emanuel’s conversation with Today, Explained host Sean Rameswaram, edited for length and clarity. Listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.
When you heard that Robert F. Kennedy Jr. would be in charge of the US health department, what were your thoughts?
I do not think he’s qualified in any shape or form. He has been against vaccines, and that is very bad. Vaccines are probably the single biggest benefit to people in the 20th century in terms of total lives saved from 1974 to today. Those are huge achievements, and now, we’re trying to roll them back.
The thing about Kennedy that I actually supported is his emphasis on nutrition, his emphasis on chronic diseases, and trying to address them. The problem is, so far, the big success we’ve gotten is removing dyes. That’s not going to really save any lives.
We need to address the whole food chain and nutrition subsidies that we have in this country — whether it’s SNAP [food stamps] or the food subsidies to corn, soybeans, and wheat that help us get more cheap ultra-processed foods in the food system — and those haven’t been addressed. If you really want to address chronic disease in America, that is a critical step.
And yet, I don’t see him really leaning into it. Yes, it’s a challenge, but it’s really important.
Last week, at a Senate hearing, Kennedy defended his shakeup at the CDC by saying, “We are the sickest country in the world. That’s why we have to fire people at the CDC. They did not do their job. This was their job to keep us healthy.” Are we the sickest country in the world?
Well, I wouldn’t say the sickest country in the world. But, in terms of high income countries, we aren’t doing that well. We’ve fallen off the growth curve, as they say, in terms of the increase in life expectancy and the decrease in the number of disability-adjusted life years. Our health span is actually getting shorter, and that’s been happening since roughly 1980.There are lots of hypotheses about that; I’ll give you two that I think are really important. Richard Nixon’s Secretary of Agriculture Earl Butz really leaned into the production of industrial commodity crops — with heavy subsidies for corn, soybean, rice, wheat — that made the components of ultra-processed foods cheap. It really promoted big industrial farms. He often said, “Get big or get out of farming.” So, that was one element. The other element was Ronald Reagan taking over and the resulting cutbacks in the social safety net: housing, food stamps, and other programs.
That combination — spending more to get cheaper components for ultra-processed foods and reducing the social safety net — are probably two of the biggest components of the obesity epidemic we’ve had, which has really fueled chronic diseases. You see this in the increase in diabetes, the increase in lots of illnesses. I think if we really want to get a health care system, we have to focus on those two elements.
Do you think there are areas for improvement at the CDC?
Yes, I do think we can improve the CDC. But, let’s be honest: If you’re going to improve the CDC, the first place to start is not cutting its workforce, cutting its budget by billions of dollars. We’re eliminating programs like the National Center for Chronic Disease Prevention and Health Promotion, the National Center for Environmental Health, our ability to forecast and monitor adverse health outcomes, the Public Health Preparedness and Response Center, the Global Health Center. The idea that we need to cut in order to actually improve, I think, is false.
What do you think the effects are thus far of RFK’s actions at the CDC and in public health more broadly?
Here’s the thing about public health: You invest today for the benefits tomorrow. So, it will take a while to actually see the effects. But we’re already seeing real harms in several ways. The first way is clearly the measles outbreak in Texas — two kids dead, lots of hospitalizations. It’s not just Texas now; it’s spread across parts of the country. You’re getting increasing vaccine skepticism in parents who are uncertain, who don’t study the issue, who just are trying to go about their lives and can’t really study these various issues.
When you get fewer and fewer people vaccinated, you are going to get disease outbreaks — whether today, tomorrow, or in a long time, we can’t exactly predict.
I also think if chronic disease is our big problem, which RFK Jr. clearly agrees with, cutting back on our chronic disease programs, our prevention programs, our response programs, our health promotion programs — that’s not a good idea. Maybe we need to do them differently, but cutting is certainly not in the cards for all those chronic diseases. If you want to control health care costs, you’ve got to address chronic disease better. Cutting back the CDC’s role is not better.
My colleague, Dylan Scott, reported on RFK Jr. and the Trump administration burying a study about alcohol’s links to cancer, and there’s no clear explanation for why they’d not want this information to be in the hands of the public. Where do you think people, everyday Americans, should be turning to for health information if they feel like they can’t trust the government anymore?
The problem with undermining the CDC is you undermine the single source of information where the goal is public health. Now, it’s going to put more burden on people to get their information from a variety of sources. On vaccines, maybe my good friend Michael Osterholm’s Vaccine Integrity Project, if you want to look it up online. In other areas like alcohol, you’ll have to look at the old Surgeon General’s report and try to get a copy of that. That reported on alcohol’s problems, especially related to cancer, but not exclusively. Alcohol is a global issue, so there are a lot of global resources available, whether England or Australia or the Cochrane Collaborative.
But that requires a lot more effort, and that’s one of the problems. Everyone’s short on time. Spending a lot of time running around and looking for individual programs rather than being able to go to one site and readily access an objective answer is a major, major problem.
I think that is part of the plan for this administration: make it very difficult to get this kind of information.
