HHS is in chaos and his MAHA movement looks like a spent force.
First, Commissioner Dr. Martin Makary resigned. He was replaced by
Kyle Diamantis, a crony of Donald Trump Jr. who has no medical qualifications.
Makary was soon followed to the exit by administrator Dr. Tracy Beth Hoeg, an
anti-vax crank aligned with
the rolling public health disaster that is Health and Human Services Secretary
Robert F. Kennedy Jr.
The turmoil at the FDA is a sign of the administration’s
deeply unserious and incoherent approach to public health. That is not,
obviously, something to celebrate.
Trump’s catastrophically inadequate response to covid helped
kill 1.2 million people in the US. In his second term he seems determined to
ensure that the US is even more unprepared to face any and every public health
crisis than it was in 2020.
At the same time, the instability at US public health
agencies underlines the precarity of the Make America Healthy Again (MAHA)
movement, with all its snake-oil, fatphobia, and eugenic woo woo. MAHA never
had a solid constituency on the right, and its support appears to have eroded
further the longer the nation has stared into Kennedy’s beady, fanatic eyes.
The fall of Makary
The immediate cause of Makary’s departure was his opposition to
fruit-flavored vapes, which he believed would encourage children to become
addicted.
MAHA’s emphasis on natural lifestyles is an uncomfortable
fit with vaping, to say the least, and Kennedy’s senior spokesperson Richard
Danker also resigned last
week over the issue. Trump, though, appears to have been swayed by industry
lobbying — an example of corporate cronyism overruling ideology.
In addition to irritating the right’s corporate wing, Makary
also enraged anti-abortion advocates by refusing to aggressively target and
regulate the abortion drug mifepristone. Mifepristone is “safe, effective, and
widely used” per the Guttmacher
Institute. But abortion opponents want it banned whatever the research;
Sen. Josh Hawley was enraged that
Makary “froze out pro-life leaders” when they wanted to meddle in scientific
decisions.
Actions like this earned Makary some praise from Democrats.
Sen. Dick Durbin, for example, said that
he hoped Makary would “inspire others” to say no to Trump on issues of
conscience.
The problem, though, is that Makary’s conscience is a MAHA
conscience, which means that it is profoundly broken. He, Hoeg, and Dr. Vinay
Prasad — the FDA vaccine chief removed in March — pushed junk
science anti-vax claims that 10 children died from the covid vaccine.
Epidemiologist Elizabeth Jacobs said that
Prasad, Makary, and Hoeg were guilty of “lying to the American people.”
Makary also abandoned the FDA’s independent expert review by
creating ad hoc panels staffed with
cranks who shared Kennedy’s antipathy to antidepressants and fluoride — or with
industry advocates pushing therapies for treatments like estrogen-based
medications for menopause. Genevieve Kanter, a health policy expert at
USC, told the
AP that the panels “seem designed … to put a stamp of approval on predetermined
opinions.”
Whether dealing with vapes, abortion drugs, antidepressants,
or vaccines, Makary followed the MAHA playbook — which is to say, he consulted
his own prejudiced intuitions and then tried to find evidence that coincided
with his views. While this can sometimes look sort of principled, as in his
resistance to endorsing vaping, in the long run it undermines scientific
process and public health, not least by kneecapping trust in government
officials and recommendations.
The lack of respect for procedure and science is part and
parcel of the Trump administration’s gutting of public health capacity.
Kennedy fired some
3,500 FDA workers last year, belatedly realized that in fact the FDA is a vital
agency and can’t run without employees. He’s now trying to hire 3,200
replacements, but without much luck, because who on earth would want to work
for RFK Jr.?
Unsurprisingly, experts worry that the weakened, rudderless
FDA — and similar cuts at the Department of Agriculture and the Centers for
Disease Control — have made US
food supplies significantly less safe.
Makary and Hoeg were not ejected because of their anti-vax
and anti-science garbage, but that garbage didn’t save them either. On the
contrary, Republicans inside and outside the Trump administration have become
increasingly nervous about the anti-vax MAHA agenda and its relationship to
their coalition.
It’s worth remembering that Kennedy was a lifelong Democrat
until he realized the party was never going to give him the opportunities he
craved to gut child
vaccine schedules or spread lies
about and insult autistic people. His endorsement of Trump was opportunistic,
as was Trump’s appointment of him.
Covid turned a rabid portion of the right against the public
health establishment, and Kennedy seemed like a good way to channel that
energy. But he doesn’t have deep relationships with other portions of the
conservative movement. And as Trump’s approval plunges, Kennedy is beginning to
look like he might be more of a hindrance than a help.
Despite MAHA’s best efforts, vaccines remain popular. A
December poll by Trump pollster Tony Fabrizio found “strong
bipartisan support for routine childhood vaccines in the nation’s most
competitive House districts;” 86 percent of voters believe vaccines save lives.
In a February poll,
54 percent of US adults said that Kennedy’s vaccine schedule changes would harm
children’s health; only 26 percent said it would be a positive change.
Kennedy’s anti-vax cronyism has also caused major headaches
for Trump with the Senate. Republican senators, including physician and
childhood vaccine advocate Bill
Cassidy, disgracefully confirmed Kennedy to placate Trump. But since then,
they’ve been quietly but consistently pushing back on Kennedy-aligned
appointees.
Lisa Murkowski, Susan Collins, and Cassidy were involved in
killing the nomination of Kennedy stooge David Weldon to head the CDC in March
2025. Instead, they confirmed Susan Monarez — who Kennedy fired when
she wouldn’t go ahead with his attack on childhood vaccinations.
The acting director who replaced Monarez, Jim O’Neill, was more compliant. But a judge blocked Kennedy’s changes to the vaccine schedule, and O’Neill has been replaced by Jay Bhattacharya — another Kennedy ally and covid denialist, who is stretched thin because he’s also the head of NIH.
In an effort to end the revolving door chaos, Trump has finally nominated another director, Dr. Erica Schwartz, a supporter of vaccines who is trusted by the public health community. Kennedy has said publicly he was not consulted about her appointment. That probably means the White House wants the Senate to know Kennedy wasn’t involved, because nominees associated with him are DOA.Last month, Trump was again forced to withdraw a
Kennedy-aligned nominee. This time the failed apparatchik was Casey Means, a
wellness influencer who has no medical license and whose brother is a top
Kennedy aide.
Means did not impress during her confirmation hearing, and
Trump pulled her
in favor of Nicole Saphier, a Fox News contributor who has more conventional
experience and views, though she’s also pushed false claims about children’s
deaths from MMR vaccines.
It’s not clear whether Saphier will be confirmed. Cassidy
just lost his
Senate primary, and without reelection worries, he may become a more spineful
opponent of Kennedy’s homicidal nonsense.
In theory, Republicans don’t want to lose MAHA voters. So
they are trying to downplay the anti-vax messaging and instead talk about
lowering drug pieces (they actually are
up under Trump) and regulating food (gutting the FDA was not a good
way to ensure food safety).
In practice, Trump regularly chooses industry over MAHA,
whether that means approving fruit-flavored vapes or trying to increase production
of weedkiller linked to cancer.
Kennedy rarely pushes back, because his first and really only commitment is to
deeply unpopular attacks on vaccines. Polling shows MAHA
voters themselves are motivated more by healthcare costs than by vaccines or
other MAHA hobby horses. That’s bad news for Republicans, since Trump has
record-high disapproval on
healthcare issues.
The MAHA-GOP marriage of convenience looks increasingly
inconvenient. Trump may
or may not be considering whether to push Kennedy out after the
midterms. But he is certainly taking steps to marginalize him and his anti-vax
agenda.
Trump’s brave fight for cancer-causing weed killer and
fruit-flavored vapes is hardly something to admire. Still, the exit of Makary,
Hoeg, Prasad, and other MAHA ghouls is a good thing. Trump is the main force
for evil in his own administration. But Robert F. Kennedy Jr. is also a
singularly malevolent presence in American public life. His humiliation, and
the complete humiliation of his ugly, dangerous movement, is necessary, and
cannot happen soon enough.
