What Donald Trump’s Win Could Mean for Vaccines

President-elect Donald Trump’s victory over Vice President Kamala Harris means U.S. health policy may soon be shaped, at least in part, by one of the country’s most notorious vaccine skeptics: Robert F. Kennedy Jr.

At this point, no one knows exactly what Trump’s second term will mean for vaccine policy or health policy more broadly. But Kennedy, who is infamous for peddling debunked views of vaccines and science, is poised to play a major role in defining Trump’s health legacy. “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines,” Trump said of Kennedy at an October campaign rally in New York City. [time-brightcove not-tgx=”true”]

Though it’s unclear whether Kennedy would serve in an official role within the Trump Administration, he is reportedly involved in discussions about who should head federal health agencies, including the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). Florida Surgeon General Dr. Joseph Ladapo, who during the pandemic discouraged healthy children from getting COVID-19 vaccines, is reportedly in consideration to run the U.S. Department of Health and Human Services, further stoking fears about an anti-vaccine agenda under Trump.

“I see an America whose health will suffer greatly in the next four years,” says Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law. “And I see an American whose trust in science and public health will be severely damaged in the next four years.”

Trump’s first administration oversaw Operation Warp Speed, the cross-governmental effort that led to the historically fast creation and distribution of COVID-19 vaccines. But Kennedy’s influence has some experts worried that, the second time around, Trump’s administration may attempt to discourage people from receiving vaccines or even curtail access to them. Kennedy has said that he is not against vaccination, but he has for years spread misinformation about immunizations, questioning their well-proven safety and efficacy and promoting the debunked claim that they are linked to autism.

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Howard Lutnick, co-chair of Trump’s transition team, told CNN in October that Kennedy wants additional data on vaccines, despite the fact that troves of information about vaccine safety and efficacy are already widely available. “He says, ‘If you give me the data, all I want is the data and I’ll take on the data and show that it’s not safe. And then if you pull the product liability, the companies will yank these vaccines right off of the market.’ So that’s his point,” Lutnick told CNN.

Kennedy, however, said in post-election interviews that he and the Trump Administration do not plan to take vaccines off the market, despite widespread speculation to that effect. “I’m not going to take away anybody’s vaccines. I’ve never been anti-vaccine. If vaccines are working for somebody, I’m not going to take them away,” he told NBC on Nov. 6. “People ought to have [a] choice, and that choice ought to be informed by the best information.” (In the same interview, Kennedy cast doubt on the efficacy of COVID-19 vaccines, which are credited with saving millions of lives.)

Even if the Trump Administration did attack vaccine access, it’s not clear how much they could actually do, Gostin says. The federal government has a hand in aspects of vaccine distribution, including funding the Vaccines for Children program, which provides free shots to kids whose parents could otherwise not afford them. But ultimately, states craft their own policies around vaccination, including which shots are required for children entering school. At least under current standards of governance, the president “would have no power to force the states to do anything,” Gostin says.

That’s not to say anti-vaccine sentiment in the White House would have no effect, says Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia who has served on CDC and FDA vaccine advisory committees. One aim of Project 2025—a conservative policy plan from which Trump tried to distance himself during his campaign, but which many political experts view as a blueprint for his second term—is restructuring the CDC such that it can no longer provide recommendations about vaccinations. Many states lean on CDC guidance to create their local mandates, Offit says, and the agency’s recommendations also inform insurance coverage.

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If states ease vaccine requirements—or if people emboldened by a vaccine-hesitant White House seek exemptions from those requirements, a trend that’s already on the rise—the U.S. may see a resurgence of vaccine-preventable illnesses such as measles, chickenpox, and mumps. “Viruses don’t recognize state lines,” Offit says. “We don’t see ourselves as part of a whole. But we are, especially when it comes to contagious diseases.”

What will happen within the FDA, which approves vaccines and drugs, is another question mark. The Trump Administration could nominate an FDA commissioner who, if confirmed by the Senate, could theoretically try to revoke approvals for vaccines. But, Gostin says, such a move would likely be challenged in court. “If the FDA were to have a record of approving a vaccine for many decades and then all of a sudden withdrew that approval, the courts would demand scientific justification for it,” he says.

Even with a conservative-majority U.S. Supreme Court in place, Gostin says he’s confident the judiciary wouldn’t overlook decades of solid safety and efficacy data on vaccines.

In June, the Supreme Court ruled that anti-abortion activists seeking to overturn the FDA’s long-standing approval of mifepristone, one of two drugs used to complete a medication abortion, had no legal basis to do so. Their decision signals some willingness to respect the FDA’s scientific review process, since ruling in favor of the anti-abortion groups could have set a precedent that made it easier for other groups to challenge the agency’s decisions.

It’s too soon to say what legal or legislative curveballs a second Trump term will bring. But Gostin says he’s confident legal guardrails will hold, even though they can’t stop the influence of anti-vaccine sentiment entirely.

The best thing concerned people can do now, Gostin says, is “get yourself and your children up to date on all their vaccinations. Be very active in your local school boards, and fight for vaccination and public health.”