Public health policy became a defining — and controversial — issue for Donald Trump when the Covid-19 pandemic struck the last time he was in the White House.

Now, as he prepares for his second turn as president, he’s pledged to slash rates of chronic disease with his “Make America Healthy Again” plan, setting up figures like anti-vaccine advocate Robert F. Kennedy, Jr.. to overhaul federal health programs and institutions. The plan’s sweeping proposals could have implications for everything from the Food and Drug Administration to academic research institutions and even grocery store shelves.

STAT asked experts in heart disease, health equity, epidemiology, and more about their thoughts on how the new administration may affect the future of health and scientific research. Their responses have been edited for length and clarity.

On the future of public health and chronic illness

Clyde Yancy, chief of cardiology, Northwestern Medicine; former president of American Heart Association

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We are benefitted by a hard-wired health care and science infrastructure — difficult to deconstruct — and it is functioning reasonably well. The best aspects of the Affordable Health Care Act are now too deeply embedded in American society; e.g., coverage to age 26 and Medicaid expansion. AND, Medicare is sacrosanct. Leave it be.

Politics as we know it today is reactive and short circuit, not proactive and long-term. Most folks like living, yet heart disease remains the greatest risk; the inherent momentum in our continued discovery, diagnosis, and treatment of heart disease is immutable and will likely continue. Over the past 12 years, we’ve had three fundamentally different White House administrations yet cardiovascular health and health care remained undeterred.

Dariush Mozaffarian, director, Tufts Food is Medicine Institute; cardiologist and professor at Tufts Friedman School of Nutrition Science and Policy

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With the interest of the [Make America Healthy Again] movement around food, it will be important to see if this fight will be taken up by President Trump and Congress. We face a national nutrition crisis — for me the top challenge, and opportunity, for the country. We already invest hundreds of billions of dollars in Medicare, Medicaid, federal nutrition programs, farm subsidies, and NIH research.

Meanwhile, the ‘F’ has been largely missing from FDA. I hope we can incorporate Food Is Medicine into standard clinical care, ensure nutrition security in USDA’s food and subsidy programs, prioritize nutrition science at NIH, and arm the FDA with resources and authority to remove harmful preservatives and chemicals from our food.

Ziyad Al-Aly, senior clinical epidemiologist at Washington University

This is an opportunity to reform the agencies that failed the American people from the NIH to CDC to FDA and others within HHS and beyond. From the massive obesity epidemic, to rampant drug overdose, to lagging life expectancy, these agencies proved to be inefficient, laden/shackled with bureaucracy and delivered very little to the American people. This is an opportunity for course correction. We must work together to improve the health and well-being of all Americans.

Georges Benjamin, executive director of the American Public Health Association

Everybody’s just in shock right now. Everybody’s trying to figure out, quite frankly, where do we go from here.

There’s great concern about what Trump version two is going to look like, or whether or not this is going to be Groundhog Day.

Let’s start with personnel. Who is he going to pick? [We’re] honestly hoping that he’ll pick people to go into the administration that are trained, skilled and competent … I’ve seen lists of some people that they might get, and there’s certainly some pretty good people out there, [but] RFK Jr. and [Joseph] Ladapo down in Florida are not on my list of people that I would pick.”

Lisa McCorkell, co-founder, Patient-Led Research Collaborative

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Over 20 million American adults and children have long Covid; millions more have other infection-associated chronic conditions and have been suffering for decades. I have deep concern that existing health care access, safety net access, and research funding issues will be made even worse, resulting in severe consequences to Americans’ lives, and that more and more people will join our community if Covid continues to spread unchecked.

The Trump administration must prioritize ensuring that people can access quality health care, that a safety net is in place and is robust for those who need it, that people have the right and ability to protect themselves from viruses, and that there is significant research funding for long Covid and other infection-associated chronic conditions to get us to treatments and cures. These issues do not just impact one party — we’ve seen bipartisan support in Congress, and we’ll need additional leaders to step up to address this crisis across government.

On the future of health equity

Daniel E. Dawes, founding dean, School of Global Health at Meharry Medical College and author of the “The Political Determinants of Health”

The movement to advance health equity for all in our nation does not stop based on an election.

I applaud the fact that so many people were engaged in our elections because voting is a critical political determinant of health. Now that we have the attention of the nation, there is fertile ground to find common ground on health equity, to eliminate the barriers that have prevented people from achieving their best health. The United States today ranks 60th in the world for life expectancy having fallen from 34th in 2016, and is expected to continue sliding further down.

I hope the new administration will seize this moment of opportunity to build bridges across social, political, economic, and geographic lines because the want for health is a common issue across these lines.

The past few years have shown us that what we as a country prioritize with respect to health policy and health equity, sets the agenda for the rest of the world. Everyone is looking to our country to lead, and this election has given us the perfect opportunity to re-establish ourselves as the undisputed health equity champions.

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I am concerned these efforts could take a back seat because the National Academy of Medicine recently issued the Ending Unequal Treatment report showing that over the last 20 years we have made little progress on eliminating health disparities because it was not prioritized to the degree it needed and investments were inconsistent and scarce.

On the future of scientific research

Carrie Wolinetz, chair of Health Bioscience Innovations Practice at Lewis-Burke; former senior advisor at the National Institutes of Health

One interesting thing to watch is how the second term Trump Administration thinks about ARPA-H — although it’s now seen as a signature initiative of the Biden Administration, which successfully established it, it was an idea that was of interest to President Trump during his first term, as he was close to Bob Wright, a major advocate of the agency (although it was called HARPA at that time). It was particularly raised in the context of research on the connection between mental illness and gun violence, and it’ll be interesting to see if that becomes a push for the agency during a second term.

Holden Thorp, editor-in-chief of the Science family of journals

It sends a sobering reminder that the scientific establishment and higher education and knowledge creation in general has not captured the imagination of a lot of the coalition that Trump has built.

A lot of that coalition is losing trust in institutions, and science and higher education and academic medicine and the medical establishment, these are all institutions that need to be more proactive about getting people’s trust back.

I think we have to figure out new ways to get scientific information into the public where it can be disseminated in strategic ways … I don’t think one-on-one debates where people are arguing with each other and it becomes a contest over who has the best debating style rather than who has the best evidence are doing much for anyone.

We have to do a better job of explaining how science works and acting with the values that we all embrace, in terms of self-correction and in terms of standing up for science when it’s correct.

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Jennifer Jones, director of Center for Science and Democracy at the Union of Concerned Scientists

President-elect Trump, and his Project 2025, have promised an all-out war on science and scientists. He and his anti-science crusaders are already working with corporate polluters to intimidate scientists and sideline science — endangering communities, people, and the planet. The reason for this radical and dangerous agenda is simple. Scientists do the work that stands in the way of self-serving officials and corporate polluters who put power and profits over people.

The last Trump presidency saw 207 attacks on science, including censorship, falsified records, political interference, and intimidation of scientists.

We expect the coming Trump administration to continue those attacks and do everything it can to silence science and scientists who threaten its goals and those of its corporate allies. We will work to advance federal legislation that permanently establishes scientific integrity principles and practices across the federal government, prevents excessive and undue influence of corporate special interests, and undoes the damage caused by recent Supreme Court decisions that undermine the ability of federal agencies to implement equitable science-based policies.