How worried should we be about RFK Jr as health secretary? Ask Florida

Donald Trump’s promise to upend public health policy across the US by installing Robert F Kennedy Jr as health secretary is resonating in Florida, where experts say the nation can learn from its own experience of a vaccine-denying state surgeon with unorthodox scientific views.

Like Kennedy’s relationship with the incoming president, Dr Joseph Ladapo was championed by, and is closely aligned to, a powerful rightwing political leader – Ron DeSantis, Florida’s Republican governor.

Since Ladapo’s February 2022 swearing-in, he has been at the heart of several controversies. Some have included advising parents to send unvaccinated children to school during a measles outbreak, personally manipulating a study to try to show Covid-19 vaccines pose a greater health risk than they do and urging municipalities to remove fluoride from drinking water despite proven dental health benefits.

His fringe opinions, and public guidance often in direct contravention of that from the federal Centers for Disease Control and Prevention (CDC), are parallel to those of Kennedy, an equally polarizing figure who has peddled numerous conspiracy theories including the discredited link between vaccines and autism, promoted raw milk and denigrated the pharmaceutical industry.

Florida’s experience could soon become that of the wider US, experts fear, if Kennedy is confirmed by the Senate and allowed to convert some of his more extreme beliefs into federal public health policy.

“During the pandemic, this wave of anti-expert, anti-public health sentiment blossomed, with the flames fueled by politics, and the pandemic response became very politicized in a way that no pandemic response has ever happened before. That certainly hit a resonant chord with many people in this country,” said Dr Scott Rivkees, Ladapo’s predecessor as Florida’s surgeon general who was sidelined then replaced by DeSantis for his pro-mask, pro-vaccine stance that clashed with the governor’s.

“In terms of the views that my successor Dr Ladapo and RFK Jr express, there is a sentiment in the US that believes what they’re saying, and believes there should be more personal freedom and less of a role for the government in telling people what they should do to protect themselves and others.

“This has made things challenging in the healthcare sector and in public health, as many of the guardrails that keep individuals safe and healthy, and protect communities, are now being threatened and challenged.”

The day after November’s election, DeSantis, whose failed presidential campaign blueprint was essentially “Make America Florida”, was promoting Ladapo for the role of health secretary. The president-elect ultimately went with Kennedy, but Washington Post reporting that Ladapo was on the shortlist suggests that Trump had watched and admired his maverick tenure as Florida’s surgeon general, and seeks to replicate it nationwide.

Rivkees said the approach was concerning, but he remained optimistic.

“Some of the new messaging – anti-vaccination, anti-healthcare and education, things like that – will eventually take their toll in terms of public protection, but there is a lot of momentum behind what has been in place for public health that should allow us to be able to weather the current storm,” he said.

“We have hundreds of thousands of practitioners in the US who still promote vaccination and healthy lifestyles, who meet with families every day and talk about what they need to do to protect themselves.

Robert F Kennedy Jr takes a selfie with guests at Donald Trump’s Mar-a-Lago resort in Florida on 14 November 2024. Photograph: Joe Raedle/Getty Images

“They may not be as overt in terms of public health vaccination campaigns, for example, but will continue to make sure individuals get vaccinated in a more quiet way that won’t necessarily raise political hackles.”

Statistics from Florida, however, show it might be an uphill battle if Ladapo’s anti-vaccine messaging is amplified nationally, which it looks certain to be. Another Florida doctor who has questioned the safety of vaccines, David Weldon, has been nominated by Trump to lead the CDC.

Weldon shares many of the views of Ladapo, who altered a study to make the Covid vaccine look more harmful to young men and has made frequent false assertions about vaccinations generally, including that mRNA Covid boosters alter human DNA and can potentially cause cancer.

Vaccination rates for kindergartners in Florida, already in decline since 2016, dropped precipitously following Ladapo’s nomination in 2021, from 93.3% to 88.1% last year, according to the the CDC. The vaccination rates at a Broward county elementary school that saw a February 2024 outbreak of measles was 89.31%, officials said.

“We’re going to start seeing localized outbreaks of vaccine-preventable diseases and public health is going to have to shift to be able to deal with these outbreaks that we have not seen before,” Rivkees said.

Not all experts see a worst-case scenario in a federal health department with similar values and attitudes to Ladapo’s state agency. Jay Wolfson, distinguished professor of public health, medicine and pharmacy at the University of South Florida’s Morsani college of medicine, said the US constitutional system leaves most healthcare policy decisions to the states anyway, and some of Kennedy’s “challenging” positions would carry little weight.

“The supreme court justice Louis Brandeis said, ‘It is one of the happy incidents of the federal system that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country,’” Wolfson said.

“Things that Florida has done may or may not be of value to other states and the rest of the country, and we have a lot to learn from that. And while some of Mr Kennedy’s ideas about fluoridation and about vaccination are certainly challenging, he has in mind some very interesting, positive public health things, about food additives, chronic diseases like diabetes, heart disease, hypertension and obesity, and the need to address those as epidemics.

Wolfson emphasized that DeSantis “relied extensively on Dr Ladapo, and some of us have expressed concerns about some of his science”.

“But at the national level, Kennedy is not going to be the singular force,” he said.

“Trump will hear what Mr Kennedy has to say but I think he’ll balance it against the people who will bring good science, good medicine and good policy to [the National Institutes of Health], and smooth the rough edges, a bit, of Kennedy’s policy views.”