海角大神

RFK Jr. faces a trust gap. So do the health agencies he鈥檚 aiming to change.

Amid unprecedented upheaval at the Centers for Disease Control and Prevention 鈥� including the termination last week of the agency鈥檚 new director, the mass firing of a vaccine advisory panel, and the resignations of top officials 鈥� critics and supporters agree on one thing: Politics should be kept out of public health.

But 鈥減olitics鈥� is very much in the eye of the beholder.

During a contentious appearance before the Senate Finance Committee on Thursday, Robert F. Kennedy Jr., the secretary of Health and Human Services, said the United States needs 鈥渦nbiased, politics-free, transparent, evidence-based science.鈥� Staff shake-ups at the CDC were 鈥渁bsolutely necessary,鈥� he said, and within his mission to 鈥渆liminate the politics from science.鈥�

His opponents, on the other hand, say politicizing public health is precisely what Mr. Kennedy has been doing in his nearly seven months on the job.

鈥淧ublic health shouldn鈥檛 be partisan,鈥� wrote Susan Monarez, who was fired as CDC director after 29 days, . She says her ouster came for refusing to preapprove the recommendations of the new vaccine advisory panel that includes allies of Mr. Kennedy.

Democrats on the committee were even blunter toward Mr. Kennedy. 鈥淵ou鈥檙e a charlatan,鈥� charged Sen. Maria Cantwell of Washington.

The angry exchanges on Capitol Hill underscored a deep loss of public trust in the wake of the COVID-19 pandemic,聽including over mandated vaccines 鈥� a distrust that is now聽playing out now in the extraordinary churn at the CDC. Mr. Kennedy and his supporters say the government has been captured by a profit-driven pharmaceutical industry that fails to serve the public interest. The secretary鈥檚 critics say he is destroying a premier agency that has safeguarded the nation鈥檚 health for decades, based on junk science and an ideological agenda. As President Donald Trump continues to dismantle and disrupt different areas of government 鈥� rooting out what he calls corrupt and partisan bureaucrats 鈥� the fight over the direction of public health, including things like vaccine recommendations, might be the most fraught of all.

Even some of Mr. Trump鈥檚 GOP allies are expressing unease with the disruption Mr. Kennedy is bringing.

鈥淚鈥檝e grown deeply concerned,鈥� said Wyoming Sen. John Barrasso, the chamber鈥檚 No. 2 Republican and a former orthopedic surgeon, during Thursday鈥檚 hearing. 鈥淎mericans don鈥檛 know who to rely on.鈥� He added: 鈥淚f we鈥檙e going to make America healthy again, we can鈥檛 allow public health to be undermined.鈥�

Despite all the calls for a politics-free health policy, some experts say it鈥檚 not actually possible to completely separate the two. While the scientific process can and should be nonpartisan and evidence-based 鈥� and rigorous research should stand on its own 鈥� public health policy is always going to be shaped by the values and beliefs of those in power.

鈥淪cience can never be completely divorced from politics,鈥� says John Holdren, who served as Barack Obama鈥檚 science adviser for all eight years of his presidency. It鈥檚 politics that often decides what scientific research gets funded in the first place, he notes, and that research is what drives policymaking.

鈥淲e need a healthy relationship between science and policy, a healthy interaction of science and policy,鈥� says Dr. Holdren.聽

In the early days of the pandemic, some officials found ways to agree on the science while 鈥渄ebating the values,鈥� says Lawrence Gostin, a professor of global health law at Georgetown University鈥檚 O鈥橬eill Institute and director of the World Health Organization Collaborating Center for National and Global Health Law.

Alex Azar, who was HHS secretary during Mr. Trump鈥檚 first term and oversaw Operation Warp Speed, which expedited the development of vaccines to combat the coronavirus, maintained that the vaccines while opposing mandates or vaccine passports. Though Professor Gostin says he frequently disagreed with Mr. Azar, he never doubted that the former secretary trusted the rigors of scientific research.

鈥淭here is no question that science is neutral and it seeks to discover knowledge using a systematic approach,鈥� says Professor Gostin. 鈥淎nd it鈥檚 also true that when we implement science through policy, we need to weigh our values and there are major tradeoffs. What鈥檚 more important to our society? Education or control of infectious disease? Freedom or economics?鈥�

A tide of controversies

Critics say Mr. Kennedy will have no competing values to weigh, given his dismissal of officials who disagree with his own worldview.

In June, Mr. Kennedy fired all 17 members of the CDC鈥檚 Advisory Committee on Immunization Practices, known as ACIP 鈥� despite promising Republican Sen. Bill Cassidy of Louisiana, a physician, during his confirmation hearing that he would not do so. Mr. Kennedy appointed seven new members and earlier this week suggested seven new appointments, despite the fact that the vetting process for committee members typically . Several of these new and current appointees, like Mr. Kennedy, have questioned the safety and efficacy of at least some vaccines.

Ms. Monarez has said she was fired less than one month after her Senate confirmation because she refused to 鈥溾�� recommendations by the new ACIP, a panel 鈥渘ewly filled with people who have publicly expressed antivaccine rhetoric,鈥� ahead of the committee鈥檚 September meeting. In his testimony on Thursday, in front of many senators who had just recently voted to confirm Ms. Monarez, Mr. Kennedy denied this.

After Ms. Monarez鈥檚 firing, which required a signoff by the White House, four senior CDC officials 鈥� including the chief science and medical officer and the director of the National Center for Immunization and Respiratory Diseases 鈥� resigned. And in response to the firing, nine former CDC directors and acting directors, who served under both Republican and Democratic presidents, penned a New York Times op-ed saying Mr. Kennedy鈥檚 actions at HHS should 鈥�.鈥�

His office disagrees.

鈥淪ecretary Kennedy has been clear: The CDC has been broken for a long time. Restoring it as the world鈥檚 most trusted guardian of public health will take sustained reform and more personnel changes,鈥� said HHS Communications Director Andrew Nixon in a statement to the Monitor.

A pivot toward prevention?

Mr. Kennedy isn鈥檛 just attempting to bring more scrutiny to the safety and efficacy of certain vaccines. He says he hopes to shift the nation from managing chronic conditions in a 鈥渟ick-care system鈥� to greater prevention in a 鈥渉ealth-care system.鈥� In his remarks on Thursday, he said that more than three-quarters of Americans have been diagnosed with some form of chronic disease 鈥� an indictment of the public health establishment, he said.

In the years since COVID-19 upended the country in 2020, Americans of both parties have questioned the CDC鈥檚 guidance during the unprecedented pandemic, reweighing the costs and benefits of stay-at-home orders. Public health officials have defended their recommendations as following science as it develops, but Republicans and Democrats alike continue to have low levels of trust in agencies including the CDC.

About 54% of Americans have only "little" or no confidence that the FDA and CDC can ensure the safety and effectiveness of prescription drugs, . The results were similar for vaccines. And only 33% had more than a little confidence in the ability of those agencies to act independently from outside interests.

For his part, Mr. Kennedy called the CDC the 鈥渕ost corrupt鈥� agency in HHS and maybe the government during Thursday鈥檚 hearing.

The ire directed toward the CDC has proved dangerous. Last month, a man, claiming that the COVID-19 vaccine made him depressed, fired 180 shots at the agency鈥檚 headquarters in Atlanta. One police officer was killed.

Mr. Kennedy, a longtime critic of vaccine policies and practices, has suggested the coronavirus vaccines hurt more Americans than the disease itself. That claim has not been substantiated, with studies suggesting that the vaccines . But the COVID-19 vaccines, which were federally mandated for military and health care workers, also caused rare but serious side effects.聽The president himself questioned the vaccines鈥� effectiveness , despite his oversight of their development during his first administration. Last week, the Food and Drug Administration, which is also under Mr. Kennedy鈥檚 purview, authorized COVID-19 vaccines for people over 65 while . Other news outlets have reported that Mr. Kennedy hopes to pull the Pfizer and Moderna vaccines .

While Mr. Kennedy鈥檚 vaccine-skeptic supporters were part of Mr. Trump鈥檚 winning coalition last November, they might be a small sliver of the electorate. A poll from the Harvard T.H. Chan School of Public Health this year found that agree that parents should be required to have their school-aged children vaccinated. And a majority of parents, across party lines, believed vaccines were safe: 97% of Democrats, 88% of Republicans, and 84% of the self-proclaimed 鈥淢ake America Great Again鈥� supporters agreed. A published this week found that almost three-fourths of Americans say government health agencies should make vaccines more available, while a plurality says Mr. Kennedy鈥檚 policies are making them less available. The same poll found Mr. Kennedy鈥檚 job disapproval rating at 55%.

States going their own ways

Amid the federal churn, states are charting their own approaches. Florida鈥檚 surgeon general on Wednesday announced plans for his state to become the first to . That same day, California, Oregon, and Washington announced they were forming the West Coast Health Alliance, which will provide residents with . Hawaii has since joined the alliance.

But public health experts say a state-by-state approach can be ineffective for public health crises that require a unified response, on top of the fact that states often rely on the CDC for support. After the measles outbreak in Texas earlier this year, for example, state officials say they reached out to the CDC for help .

Some public health observers say they worry about the departure of experienced experts from the federal government, but also the future of young scientists who could be deterred from a job that is so vilified.

鈥淚 don鈥檛 know how [the CDC] is going to recover in the foreseeable future. The experience, knowledge, and deep commitment that scientists and leaders had is gone and I don鈥檛 think they鈥檙e coming back,鈥� says Professor Gostin, who was recently fired himself from a National Institutes of Health advisory board.