A key figure in Donald Trump’s election campaign and a likely figure in his incoming administration is Robert F. Kennedy Jr, or RFK Jr for short. After abandoning his own tilt at president, the prominent anti-vaxxer endorsed and campaigned for Trump, helping propel him to victory.

Kennedy promoted the banner “Make America Healthy Again” during the campaign. Now Trump has made clear Kennedy will play a significant role in health.

He has been promised a “big role” in guiding health policy, and Trump has said he would enable Kennedy to “go wild” on health, food and medicines.

So, who is Kennedy and what could his vision of a healthy America mean for public health in the US and globally?

Who is RFK Jr?

RFK Jr was born into a famous American political dynasty. He is the son of Robert F. Kennedy, who served as US attorney general under his brother John F. Kennedy, who was president. Robert F. Kennedy was then a senator before he was assassinated during his own run for the presidency in 1968.

His son, RFK Jr, was a prominent and effective environmental lawyer and activist, helping to pursue litigation against corporations, including Montsanto and DuPont.

For the past 20 years, however, he has been better known for his embrace of various conspiracy theories and as a key source of vaccine misinformation spreading on social media.

Kennedy has recently said he is “not going to take anyone’s vaccines away”. However, he continues to make false claims about COVID vaccines, and to promote false facts about vaccines and autism when there is scientific consensus there is no causal link.

What role will he have?

Although Trump has publicly committed to Kennedy having a major role, it is unclear what that will be.

Based on a video obtained by Politico, Kennedy said he was promised control of federal public health agencies, including the Department of Health and Human Services and its sub-agencies, as well as the Centers for Disease Control and Prevention, Food and Drug Administration and National Institutes of Health.

Such broad authority would be unprecedented. Appointments to major agencies and cabinet positions in the US government require approval by Congress. Kennedy’s lack of experience in health care or public health, and his absence of scientific training and credentials, will make such an approval uncertain. His unscientific allegations would resurface and there would be an almost certain media circus.

Even if Kennedy was in a position of authority, many changes to these federal agencies would require Congressional oversight. For instance, any changes to how drugs are approved would be challenging to implement in the short term.

This is not to underestimate the damage Kennedy could do. In the past, Trump circumvented Congressional approval for various posts by appointing “acting officials”. So even without any official post, Kennedy’s potential influence in the Trump administration is alarming.

More misinformation

It is no surprise Trump has embraced Kennedy as the “health czar” of his second presidency. They have both spread COVID misinformation and promoted unproven treatments, particularly early in the pandemic. These include promoting hydrocholoroquine (when there is strong evidence of its toxic effects to the heart).

Kennedy leverages the language of science to give a veneer of credibility. He promises to return health agencies “to their rich tradition of gold-standard, evidence-based science” and to “clean up” agencies he accuses of being corrupt. He may well roll back regulatory controls that protect the health of Americans from unproven treatments.

If Kennedy is to be the health czar of the Trump presidency, his platform to recruit Americans to his anti-science agenda would be considerably enhanced. The result? The very real threat of worsening the public’s health.

Outbreaks of vaccine-preventable infections, such as measles, will rise.

Many Americans also grew up with fluoridated water and have not witnessed the impacts of widespread dental caries (tooth decay). So, Kennedy may be well placed to convince enough of the American people that fluoridated water is dangerous, and that fluoride should be an individual’s choice.

Governments and public health officials may face an uphill battle to maintain fluoride in the community water supply, rolling back one of the greatest public health achievements of the past century.

If Kennedy’s anti-science claims gain traction, his legacy will be the opposite of the banner “Make America Healthy Again”. The health of the American population will deteriorate with far-reaching impacts for decades to come.

There are global implications, too

The potential harms of elevating someone like Kennedy to positions of authority and influence will not just affect Americans.

For instance, after Kennedy and his anti-vaccine organisation visited Samoa in 2019, the deaths of two children were falsely attributed to the measles vaccination. Vaccination rates in Samoa plummeted to 31% (half the previous rate) and a subsequent measles outbreak killed 83 people.

Kennedy questioned if the deaths were related to a “defective vaccine” and denied he had any hand in spreading misinformation.

One of the outstanding achievements of the previous Trump presidency was Operation Warp Speed, which enabled the development, testing and mass production of COVID vaccines at unprecedented speed, saving many millions of lives around the world.

Should another pandemic occur over the next four years, with Kennedy in the White House, the US is unlikely to provide similar leadership.

Kennedy has been deeply critical of COVID vaccine development, including in his best-selling 2021 book, The Real Anthony Fauci, about the former head of the National Institute of Allergy and Infectious Diseases.

Kennedy said COVID vaccines were not sufficiently tested and continued to advocate for disproven COVID treatments, specifically hydroxychloroquine and ivermectin.

In a podcast earlier this year, Fauci recalled a presentation Kennedy gave him about vaccinations. For 40 minutes Kennedy “showed slide after slide after slide that […] made no sense at all”.

Later, Fauci spoke with Kennedy saying:

Bobby, I believe you care about children and you care that you don’t want to hurt them. But you got to realise that from a scientific standpoint, what you’re saying does make no sense.

Unfortunately, in the distorted reality of a Trump administration with Kennedy at his side, truth and science may no longer matter. And the health of the world will suffer.