A longtime leader of the anti-vaccine movement. A highly credentialed surgeon. A seven-term Florida congressman. A Fox News contributor with her own line of vitamins.

US President-elect Donald J. Trump’s eclectic roster of figures to lead federal health agencies is almost complete — and with it, his vision for a sweeping overhaul is coming into focus.

Trump’s choices have varying backgrounds and public health views. But they have all pushed back against Covid policies or supported ideas that are outside the medical mainstream, including an opposition to vaccines. Together, they are a clear repudiation of business as usual.

“What they’re saying when they make these appointments is that we don’t trust the people who are there,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an adviser to the Food and Drug Administration.

Some doctors and scientists are bracing themselves for the gutting of public health agencies, a loss of scientific expertise and the injection of politics into realms once reserved for academics. The result, they fear, could be worse health outcomes, more preventable deaths and a reduced ability to respond to looming health threats, like the next pandemic.

In the final months of Trump’s campaign, he brought Robert F. Kennedy Jr. aboard with the message that a total remake of the nation’s public health system was the only way, as Kennedy’s own presidential campaign slogan put it, to “Make America Healthy Again”.

Less than two weeks after the election, Kennedy was tapped to lead the health and human services department, a sprawling federal agency that includes the Centers for Disease Control and Prevention, the FDA and the National Institutes of Health, and also oversees Medicare and Medicaid.

Kennedy, an environmental lawyer, has a long track record of spreading falsehoods about vaccines and using his nonprofit, Children’s Health Defense, to promote a database of misleading interpretations of research data. He once asserted publicly that “there’s no vaccine that is, you know, safe and effective”.

Dr. David Weldon, Trump’s pick to lead the CDC, has also promoted anti-vaccine views. An internist by training, Dr. Weldon served seven terms in Congress, representing a district on Florida’s central east coast, before returning to his medical practice.

While in Congress, Dr. Weldon was known for pushing the false notion that thimerosal, a preservative compound in some vaccines, had caused an explosion of autism cases.

Trump’s choice for FDA commissioner, Dr. Martin Makary — a pancreatic surgeon at the Johns Hopkins School of Medicine — has been broadly supportive of childhood vaccines. But he has questioned the benefits of certain shots, including the hepatitis B vaccine for newborns and a third Covid booster shot for healthy children. “I think there are questions that we can ask that have been taboo to ask,” he told The Wall Street Journal.

Trump’s pick for surgeon general is Dr. Janette Nesheiwat, a medical director of CityMD, a chain of urgent care centres. Dr. Nesheiwat, who is also a Fox News contributor, provided on-the-ground medical treatment after Hurricane Katrina and a 2011 tornado that struck Joplin, Mo., according to a statement from Trump.

She was generally supportive of the Covid vaccines, calling them “a gift from God” in a 2021 opinion article for Fox News. But she has opposed Covid vaccine mandates and argued against the dismissal of soldiers who refused to be vaccinated.

Although high-level staffing picks set the tone, what happens to the nation’s public health system will also depend on Trump administration decisions that are still to come.

New York Times News Service