President-elect Donald Trump said Thursday that he would nominate Robert F. Kennedy Jr. to lead the Department of Health and Human Services — setting up a debate over whether Kennedy, whose vaccine skepticism and unorthodox views about medicine make public health officials deeply uneasy, can be confirmed.

Trump is stocking his administration with people whom even some Republicans find alarming, including former Rep. Matt Gaetz as attorney general and Pete Hegseth, a Fox News host, as defense secretary. In choosing Kennedy, Trump is picking someone who is at war with the very public health agencies he would oversee.

In a statement on Truth Social, his social media platform, Trump said Kennedy would restore the nation’s health agencies “to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again!”Kennedy, who has railed against the revolving door between industry and government, vowed on social media to “free the agencies from the smothering cloud of corporate capture so they can pursue their mission to make Americans once again the healthiest people on Earth.”

If he is confirmed, Kennedy would have sweeping control of a department with 80,000 employees across 13 operating divisions that run more than 100 programs. Its agencies regulate the food and medicine that Americans encounter in their daily lives, decide whether Medicare and Medicaid will pay for drugs and hospital treatments, guard against infectious disease, and conduct billions of dollars of medical research into diseases such as cancer and Alzheimer’s.

Many Democrats and public health experts were appalled by Trump’s selection. Dr. Richard E. Besser, CEO of the Robert Wood Johnson Foundation and a former acting director of the CDC, said that having Kennedy in the health secretary job “would pose incredible risks to the health of the nation,” because Kennedy’s assault on the nation’s public health apparatus was worsening the mistrust lingering after the coronavirus pandemic.

But on the campaign trail, while he was running for president and also after his campaign merged with Trump’s, Kennedy found support from people across the political spectrum who shared his suspicion of the pharmaceutical and food industries and applauded his emphasis on nutrition and removing additives from foods.

But Kennedy has spread false information about vaccines, including that they cause autism — a theory that has long been debunked. He has publicly contradicted the Centers for Disease Control and Prevention’s recommendation that communities fluoridate their water to guard against tooth decay.

He has embraced raw milk, despite the Food and Drug Administration’s warning that drinking it is risky, particularly amid a current bird flu epidemic among dairy cows. And he has promoted hydroxychloroquine, a drug whose emergency authorization as a COVID-19 treatment was revoked by the FDA after a study of 821 people found it lacked effectiveness.

In a study of verified Twitter accounts from 2021, researchers found Kennedy’s personal Twitter account was the top “superspreader” of vaccine misinformation on Twitter, responsible for 13% of all reshares of misinformation, more than three times the second most-retweeted account.

Vaccine activism

Kennedy is perhaps best known for his criticism of childhood vaccines.

Again and again, Kennedy has made his opposition to vaccines clear. In July, he said in a podcast interview that “There’s no vaccine that is safe and effective” and told FOX News that he still believes in the long-ago debunked idea that vaccines can cause autism.

In a 2021 podcast he urged people to “resist” CDC guidelines that advise when kids should receive routine vaccinations.

“I see somebody on a hiking trail carrying a little baby and I say to him, ‘Better not get them vaccinated,’” Kennedy said.

Kennedy has also aligned himself with businesses and special interests groups such as anti-vaccine chiropractors, who saw profit in slicing off a small portion of the larger health care market while spreading false or dubious health information.

An Associated Press investigation found one chiropractic group in California had donated $500,000 to Kennedy’s Children’s Health Defense, about one-sixth of the group’s fundraising that year.

Repeated scientific studies in the U.S. and abroad have found no link between vaccines and autism. Vaccines have been proven safe and effective in laboratory testing and in real world use in hundreds of millions of people over decades. The World Health Organization credits childhood vaccines with preventing as many as 5 million deaths a year.

Trump during his first term launched Operation Warp Speed, an effort to speed the production and distribution of a vaccine to combat COVID-19. The resulting vaccines were widely credited, including by Trump himself, with saving lives.

Approval uncertain

Kennedy’s stance on vaccines raises question about his ability to get confirmed, even in a GOP-controlled Senate. He also has said he would make a controversial recommendation to remove fluoride from drinking water, although fluoride levels are mandated by state and local governments. The addition of the mineral has been cited as leading to improved dental health and is considered safe at low levels.

In addition to his outside-the-mainstream views about medicine and health, he has been associated with a number of peculiar activities, including dumping a dead bear in Central Park and supposedly decapitating a whale. In interviews before Trump’s announcement, some Republican senators said Kennedy gave them pause, but none ruled out voting for him.

Incoming Senate Majority Leader John Thune would not comment on Trump’s pick of Kennedy or any other potential nominee. “I’m not going to make any judgments about any of these folks at this point,” he said.

But Republicans more closely aligned with Trump were enthusiastic. “One hundred percent,” Sen. Tommy Tuberville, R-Ala., a member of the Senate health committee, said when asked if he would vote to confirm Kennedy. Tuberville said he was a fan of Kennedy’s because of the work he had done with food and vaccines, adding, “More than anybody that I know of, he’s had an open mind.”

Plans for health department

Lately, Kennedy has shifted his language from vaccines and toward ending what he calls the “chronic disease epidemic,” a goal that public health experts say is laudable. If he puts nutrition at the top of his agenda, he might find common cause with scientists and public health officials.

“I think there’s interest amongst policymakers on food,” said Dr. Anand Parekh, chief medical officer at the Bipartisan Policy Center. Parekh said he had been “pleasantly surprised” to see Kennedy emphasizing nutrition and “veering off his usual vaccine and environmental health narrow lanes.”

Kennedy has said little about health care delivery programs, such as Medicare and Medicaid, that fall within the purview of the Department of Health and Human Services. Instead, he has taken aim at regulators and public health and research agencies: the FDA, the CDC and the National Institutes of Health.

Days before the election, in a social media post that has received 6.5 million views, Kennedy threatened to fire FDA employees who have waged a “war on public health.” He listed some of the products that he claimed the agency had subjected to “aggressive suppression,” including ivermectin, raw milk and vitamins. His message to agency officials, he said, was “1. Preserve your records, and 2. Pack your bags.”

Kennedy has also vowed to shake up the NIH, the nation’s premier biomedical research agency, by firing 600 workers, although the vast majority of its employees have civil service protections. When he was running for president, he promised to shift the focus of the NIH away from infectious diseases.

This report includes information from the Associated Press.