Each of Donald Trump’s most provocative Cabinet picks has been a calculated punch in the mouth to experts, elites and bureaucrats in Washington’s government agencies.

But his decision to let Robert F. Kennedy Jr., a vaccine skeptic and conspiracy theorist, “go wild” on health and medicines as health and human services secretary is his most shocking attempt yet at an anti-establishment tear-down.

The president-elect’s previous selections for director of national intelligence, attorney general and defense secretary could change the country and the world in the long term. Their effect, however, would be distant for most Americans.

If Kennedy gets an opportunity as the country’s top health official to promote his past claims that vaccines are not safe and effective or to act on his desire to fire 600 people at the National Institutes of Health, which oversees many facets of health research, including vaccines, he could have a more immediate impact on the lives of millions of Americans. If for instance his advice or ideas led to a lowering of the penetration of vaccines in the US population, a significant number of lives could be at risk.

Kennedy has some views that top physicians welcome, including his calls for processed foods to be removed from school lunches and his warnings that the food industry is marketing products that increase a chronic disease crisis. But the president-elect’s decision to put RFK Jr. in charge of the health of 350 million Americans, despite his stances on vaccines that contradict the science-based research of most scientists and medical experts, is likely to ignite a new debate about the potential real-world implications of the second Trump term that will begin in January.

Some of Trump’s MAGA dream team can be best explained by a former president grinding an ax against agencies and institutions that he believes thwarted his first term. But Kennedy’s ascendency and apparently long political leash goes far beyond a Trumpian retribution quest. It could impact the medicines Americans use, the treatments and drug therapies that are approved, the inoculations used to protect the country’s school kids from diseases like measles and the food that everyone eats.

The US Department of Health and Human Services secretary has a massive platform and huge power to influence the information that Americans have and the choices they make. If Kennedy is confirmed and another pathogen emerges and causes a pandemic in the next four years, he will be in charge of fighting it.

‘People like you, Bobby’

Kennedy was seen at Trump’s Mar-a-Lago resort in Florida in black tie on Thursday night, hours after an announcement that sent despair and concern coursing through the medical community.

The president-elect lauded his selection during a speech. “I guess if you like health and you like people who live a long time, it is the most important position,” Trump said. “I just looked at the news reports. People like you, Bobby. We want you to come up with things and ideas and what you have been talking about for a long time.”

Kennedy’s selection came after the president-elect picked controversial congressman Matt Gaetz to be attorney general, aiming a blow at the legal institutions that tried to hold him to account for his attempt to steal the 2020 election. Generals who Trump thinks blocked him during his first term may end up working for Fox News star Pete Hegseth, who thinks there is a “woke” war against American warriors and is in line to be defense secretary. And Trump took out his fury against the intelligence “deep state” by naming Tulsi Gabbard, who met Syrian dictator Bashar al-Assad and is a favorite of Russian propaganda TV, as America’s top spy.

These picks have caused uproar in Washington.

But they are seen very differently by millions of Trump voters who think the capital’s establishment is rotten and has let them down. And they are symptomatic of a president-elect who is returning to power with very few constraints and is showing he plans to behave aggressively in a term he said on the campaign trail would be devoted to retribution against his opponents.

So far, Republicans have responded to critics of Trump’s burn-Washington-down approach with a simple argument: He has a mandate.

For instance, CNN’s Jake Tapper asked Indiana Sen.-elect Jim Banks whether he was concerned about Kennedy’s false claims that vaccines can cause autism. “Look Jake, in the election, Donald Trump won the popular vote,” Banks said. “And one of the things he promised on the campaign trail is to have a serious and thoughtful conversations about vaccines, especially after the pandemic.”

It’s true that Trump made no secret on the campaign trail of his intention to hand significant power to Kennedy to overhaul health institutions. And the entire subtext of his campaign was a vow to blow up the Washington consensus.

The president-elect has long resented the science and expert class in the US government, especially dating from their advice during the Covid-19 pandemic — an emergency that Trump repeatedly downplayed — that conflicted with his desire to get the economy open again in his reelection year. Other Americans chafed at mask wearing and many conservative states resisted federal government advice on the pandemic on matters like school closures and lockdowns.

But despite Trump’s victory this year, in which he won all seven battleground states, the US basically remains a 50-50 nation, and it’s debatable whether the president-elect truly has a mandate to destroy generations of policy and institutional orthodoxy — especially in areas like health.

‘An extraordinarily bad choice’

Kennedy does have some views that would find favor in the medical establishment, especially concerning his efforts to address unhealthy diets in the US that cause chronic and noncommunicable diseases that could mostly be prevented. He has said he’d “immediately” begin studying vaccine safety and efficacy but promised not to “take vaccines away from anybody.” He also committed to formally recommending states and municipalities remove fluoride from public water.

Kennedy also says he wants to return a gold standard of science to a health sector he believes is skewed by massive pharmaceutical companies. But his long record of misinformation and selective use of data on vaccines is directly in conflict with the consensus among scientists and medical experts.

“I think this is an extraordinarily bad choice,” Dr. Ashish Jha, a former Biden administration Covid-19 coordinator and the dean of Brown University’s School of Public Health, told CNN’s Wolf Blitzer. Previous HHS secretaries in both Republican and Democratic administrations have allowed scientists in agencies under their oversight to make determinations, Jha said. “RFK Jr. has given us all the signals that he does not plan to do that, he does not plan to lean on evidence and rigorous analysis to make decisions but instead to use his own ideas.”

Another health expert and former US Centers for Disease Control and Prevention acting director condemned the pick. “Frankly, I find it chilling,” said Dr. Richard Besser. Besser, who practiced pediatrics, warned that Kennedy’s views on child vaccines were dangerous, telling CNN’s Kaitlan Collins: “He has done so much to undermine the confidence that people have in that incredible intervention.”

Kennedy’s selection was made public on the same day that the World Health Organization and the CDC — an agency that would be under RFK Jr.’s purview — said global measles cases surged by more than 20% to an estimated 10.3 million last year. The highly contagious disease is preventable with two doses of the measles vaccine that most Americans get as kids.

In the US, a dip in vaccination rates among kindergartners has coincided with a period in which some conservative politicians in particular have fueled skepticism about vaccines following the Covid-19 pandemic. As of November, 266 measles cases have been reported this year with 16 outbreaks.

CDC Director Dr. Mandy Cohen told CNN’s Meg Tirrell on Wednesday that childhood vaccines were the way to make the country as healthy as possible. “I think we have a very short memory of what it is like to hold a child who has been paralyzed with polio or to comfort a mom who’s lost her kid from measles,” Cohen said at the Milken Institute’s Future of Health Summit.

Kennedy has denied he is a vaccine skeptic. But on Lex Fridman’s podcast last year, he said that “there is no vaccine that is, you know, safe and effective,” and in December 2023, he told CNN’s Kasie Hunt he “would be against mandates” for children in public schools.

Another pick adds to growing pressure on Senate Republicans

The latest controversial Trump Cabinet pick escalated one of the first dramas of the Trump second term — the question of whether all of them will get confirmed by the Senate.

Serious doubt was already swirling around Gaetz, who was himself under investigation by the FBI and was the subject of a House Ethics Committee probe before he officially resigned from the House of Representatives on Wednesday. And Kennedy’s entry into the mix will present another challenge for Republican senators who don’t have much of a record of standing up to the president-elect.

It would take a handful of Republican lawmakers to defect in order to imperil the confirmation of a Trump pick – and his control of the GOP has never been stronger after he mounted the greatest comeback in US political history and reclaimed the White House.

The president-elect, prior to the selection of some of his most controversial picks for Cabinet posts warned Republicans that he would press for recess appointments if they are blocked, in a way that would bypass the Senate’s advice and consent function under the Constitution.

Like other nominees, RFK Jr.’s hopes could depend on the attitude of several more moderate senators in the GOP coalition. They might be influenced by members who plan to retire at the midterms, and may be less beholden to Trump, or the new influx of senators just elected who won’t have to run for reelection until two years after his term ends.

And then there is the vote that belongs to outgoing Senate Republican leader Mitch McConnell — a polio survivor.