Just days after Robert F Kennedy Jr succeeded in putting his allies into the top health jobs in Donald Trump’s next administration, there are signs his “Make America Healthy Again” movement is starting to splinter.
Behind closed doors at Trump’s Mar-a-Lago country club and at Kennedy’s nearby Palm Beach residence in recent days, tensions have emerged between two competing MAHA visions, according to multiple people close to the movement and the president-elect’s transition team.
One camp consists of Kennedy’s longest-serving advisers — anti-vaccine campaigner and TV producer Del Bigtree and vaccine injury attorney Aaron Siri, who are central emissaries to the Trump transition team. They believe the movement should focus on the fight against overuse of vaccines — and have been probing nominees for health positions on their stance on vaccine safety, according to three people.
Kennedy, who Trump picked two weeks ago to run his health department, was only informed by the president-elect of his choice of Janette Nesheiwat as surgeon general a couple days before the official announcement — a rare instance in which a Kennedy candidate was overlooked for a top job.
Siri and Bigtree invited Nesheiwat, who previously described the Covid jab as “a gift from God”, for an urgent meeting at Kennedy’s Florida residence on Saturday, three people said. The grilling, which stretched on for most of the day, was described by one person as a “re-education camp” on vaccines.
Other Kennedy advisers, meanwhile, fear that the anti-vax obsession is undermining the wider pledge to address the “tragic epidemic of chronic disease” — his vow when he dropped his own bid for the presidency and endorsed Trump.
“There are lots of different ideas about what a healthy America looks like within the very wide MAHA tent — and how much money needs to be spent on them,” said Chris Meekins, Washington healthcare policy analyst at investment bank Raymond James. “If there’s 100 things RFK wants, only two or three will ever get done, so he has to decide what his priorities are, or the bureaucracy will swallow his movement whole.”
The frictions within Kennedy’s MAHA movement point to some of the squabbling in Mar-a-Lago as Trump races to fill his cabinet positions weeks ahead of his return to Washington on a pledge to enact a radical agenda including slashing taxes and deporting immigrants.
Kennedy, a scion of the storied Democratic family, has been among Trump’s most controversial picks given his goal of dismantling America’s health and pharmaceutical industries and bureaucracies — an ambition that could be a problem for some of the US senators that will need to approve his nomination.
The early internal friction within the MAHA movement sets the stage for a tumultuous few years of healthcare policymaking in Washington, where Kennedy will face battles with Big Pharma and Big Agriculture.
His team was aiming to unveil a presidential task force on chronic disease within a week of Trump returning to the White House in January, people familiar with the plan said.
Representatives for Kennedy and Trump’s transition team did not respond to requests for comment. Bigtree, Siri and Nesheiwat could also not be reached for comment.
Atop the Health and Human Services department, Kennedy will control a sprawling organisation with a budget of $1.7tn and 13 divisions, but the heads of individual agencies exert significant influence.
Kennedy’s hit rate on the appointments so far has been strong. Aside from the appointment of Brooke Rollins, head of the right-wing America First Policy Institute think-tank, as agriculture secretary, almost all of Trump’s health-related nominees have ended up as Kennedy picks.
His team lobbied for TV doctor Mehmet Oz to be given control of the Centers for Medicare and Medicaid Services, for Johns Hopkins surgeon Marty Makary to be named Food and Drug Administration commissioner, and for physician and former Republican congressman Dave Weldon to run the Centers for Disease Control and Prevention. Trump announced all their appointments last week.
Earlier this week, two other Kennedy allies — Stanford University professor Jay Bhattacharya and former George W Bush administration official Jim O’Neill, both of whom were once close to Silicon Valley billionaire Peter Thiel — were given roles as director of the National Institutes of Health and as Kennedy’s deputy. Weldon has previously broadcast conspiracy theories connecting vaccines with autism, while Makary and Bhattacharya questioned the logic of widescale vaccine rollouts and jab mandates during the Covid-19 pandemic.
The appointments suggest Trump was serious about his pledge to let Kennedy “go wild” on health and food reform.
Kennedy’s first dilemma will be whether to follow through on the surprise plan announced by outgoing Democratic President Joe Biden to allow obesity drugs to be paid for by Medicare and Medicaid to treat weight loss on its own.
Biden’s calculation was “hey, we lost so . . . let’s dump this on the Trump administration and make this their problem — it’s very clever,” said David Bowen, the former health policy director of the Senate health committee, on a Guggenheim Securities call this week.
Kennedy recently told Fox News that Novo Nordisk, the Danish drugmaker behind the top-selling anti-obesity drugs Ozempic and Wegovy, was “counting on selling it to Americans because we’re so stupid and so addicted to drugs”.
But Oz and Makary have both previously praised the new class of weight loss treatments.
The array of ambitions in the MAHA movement — everything from reviewing mandatory vaccine recommendations and legalising psychedelic drugs to banning seed oils from foods and removing fluoride from drinking water — will make it an easy mark for Big Pharma’s lobbyists, said Washington insiders.
Bowen questioned whether Kennedy would actually make specific reforms, such as to the National Vaccine Injury Compensation Program, or simply seek “grand gestures”. Big Pharma would be happier with “sweeping statements rather than taking discrete, concrete actions”, he said.
“There are endless safeguards or tripwires, depending on how you see it, built into the process to stop big changes from getting done,” said one Washington-based pharma lobbyist. “One thing about RFK is he’s not this big DC insider and so he will come to realise that reality never matches rhetoric.”