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KFF Health News Dec 17 2024

Many of President-elect Donald Trump's candidates for federal health agencies have promoted policies and goals that put them at odds with one another or with Trump's choice to run the Department of Health and Human Services, Robert F. Kennedy Jr., setting the stage for internal friction over public health initiatives.

The picks hold different views on matters such as limits on abortion, the safety of childhood vaccines, the covid-19 response, and the use of weight-loss medications. The divide pits Trump picks who adhere to more traditional and orthodox science, such as the long-held, scientifically supported findings that vaccines are safe, against often unsubstantiated views advanced by Kennedy and other selections who have claimed vaccines are linked with autism.

The Trump transition team and the designated nominees mentioned in this article did not respond to requests for comment.

It's a potential "team of opponents" at the government's health agencies, said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian policy organization.

Kennedy, he said, is known for rejecting opposing views when confronted with science.

"The heads of the FDA and NIH will be spending all their time explaining to their boss what a confidence interval is," Cannon said, referring to a statistical term used in medical studies.

Those whose views prevail will have significant power in shaping policy, from who is appointed to sit on federal vaccine advisory committees to federal authorization for covid vaccines to restrictions on abortion medications. If confirmed as HHS secretary, Kennedy is expected to set much of the agenda.

"If President Trump's nomination of RFK Jr. to be secretary is confirmed, if you don't subscribe to his views, it will be very hard to rise in that department," said Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security. "They will need to suppress their views to fit with RFK Jr's. In this administration, and any administration, independent public disagreement isn't welcome."

Kennedy is chair of Children's Health Defense, an anti-vaccine nonprofit. He has vowed to curb the country's appetite for ultra-processed food and its incidence of chronic disease. He helped select Trump's choices to lead the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. If confirmed, he would lead them from the helm of HHS, with its more than $1.7 trillion budget.

Clashes are likely. Kennedy has supported access to abortion until a fetus is viable. That puts him at odds with Dave Weldon, the former Florida congressman whom Trump has chosen to run the CDC. Weldon, a physician, is an abortion opponent who wrote one of the major laws allowing health professionals to opt out of participating in the procedure.

Weldon would head an agency that's been in the crosshairs of conservatives since the covid pandemic began. He has touted his "100% pro-life voting record" on his campaign website. (He unsuccessfully ran earlier this year for a seat in Florida's House of Representatives.)

Trump has said he would leave decisions about abortion to the states, but the CDC under Weldon could, for example, fund studies on abortion risks. The agency could require states to provide information about abortions performed within their borders to the federal government or risk the loss of federal funds.

Weldon, like Kennedy, has questioned the safety of vaccines and has said he believes they can cause autism. That's at odds with the views of Marty Makary, a Johns Hopkins surgeon whom Trump plans to nominate for FDA commissioner. The British American said on the "Brian Kilmeade Show" on Fox News Radio that vaccines "save lives," although he added that it's good to question the U.S. vaccine schedule for children.

The American Academy of Pediatricians encourages parents and their children's doctors to stick to the recommended schedule of childhood vaccines. "Nonstandard schedules that spread out vaccines or start when a child is older put entire communities at risk of serious illnesses, including infants and young children," the group says in guidance for its members.

Jay Bhattacharya, a doctor and economist who is Trump's selection to lead NIH, has also supported vaccines.

Kennedy has said on NPR that federal authorities under his leadership wouldn't "take vaccines away from anybody." But the FDA oversees approval of vaccines, and, under his leadership, the agency could put vaccine skeptics on advisory panels or could make changes to a program that largely protects vaccine makers from consumer injury lawsuits.

"I do believe that autism does come from vaccines," Kennedy said in 2023 on Fox News. Many scientific studies have discredited the claim that vaccines cause autism. Related StoriesAI-generated handoff notes: Study assesses safety and accuracy in emergency medicineStudy: Brain volume changes correlate with social behavior differences in psychiatric conditionsResearch uncovers dietary patterns influencing Mediterranean Diet adherence

Ashish Jha, a doctor who served as the White House covid response coordinator from 2022 to 2023, noted that Bhattacharya and Makary have had long and distinguished careers in medicine and research and would bring decades of experience to these top jobs. But, he said, it "is going to be a lot more difficult than they think" to stand up for their views in the new administration.

It's hard "to do things that displease your boss, and if [Kennedy] gets confirmed, he will be their boss," Jha said. "They have their work cut out for them if they're going to stand up for their opinions on science. If they don't, it will just demoralize the staff."

Most of Trump's picks share the view that federal health agencies bungled the pandemic response, a stance that resonated with many of the president-elect's voters and supporters — even though Trump led that response until Joe Biden took office in 2021.

Kennedy said in a 2021 Louisiana House oversight meeting that the covid vaccine was the "deadliest" ever made. He has cited no evidence to back the claim.

Federal health officials say the vaccines have saved millions of lives around the globe and offer important protection against covid. Protection lasts even though their effectiveness wanes over time.

The vaccines' effectiveness against infection stood at 52% after four weeks, according to a May study in The New England Journal of Medicine, and their effectiveness against hospitalization was about 67% after four weeks. The vaccines were produced through Operation Warp Speed, a public-private partnership Trump launched in his first term to fast-track the shots as well as other treatments.

Makary criticized covid vaccine guidance that called for giving young children the shots. He argued that, for many people, natural immunity from infections could substitute for the vaccine. Bhattacharya opposed measures used to curb the spread of covid in 2020 and advised that everyone except the most vulnerable go about their lives as usual. The World Health Organization warned that such an approach would overwhelm hospitals.

Mehmet Oz, Trump's choice to head the Centers for Medicare & Medicaid Services, an agency within HHS, has said the vaccines were oversold. He promoted the use of the anti-malaria drug hydroxychloroquine as a treatment. The FDA in 2020 revoked emergency authorization of hydroxychloroquine for covid, saying that it was unlikely to be effective against the virus and that the risk of dangerous side effects was too high.

Janette Nesheiwat, meanwhile, a former Fox News contributor and Trump's pick for surgeon general, has taken a different stance. The doctor described covid vaccines as a gift from God in a Fox News opinion piece.

Kennedy's qualms about vaccines are likely to be a central issue early in the administration. He has said he wants federal health agencies to shift their focus from preparing for and combating infectious disease to addressing chronic disease.

The shifting focus and questioning of vaccines concern some public health leaders amid the spread of the H5N1 bird flu virus among dairy cattle. There have been 60 human infections reported in the U.S. this year, all but two of them linked to exposure to cattle or poultry.

"Early on, they're going to have to have a discussion about vaccinating people and animals" against bird flu, said Georges C. Benjamin, executive director of the American Public Health Association. "We all bring opinions to the table. A department's cohesive policy is driven by the secretary."

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism. Source:

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Politics

Welfare concessions ‘common sense’, says PM – as he defends U-turn

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Welfare concessions 'common sense', says PM - as he defends U-turn

Sir Keir Starmer said changes to his welfare bill “strike the right balance” after making concessions to his backbench MPs.

The prime minister described the U-turn as “common sense” and said it means “we can now get on with the job”.

Politics Live: Starmer defends U-turn

Sir Keir faced a significant rebellion over plans to cut sickness and disability benefits as part of a package he said would shave £5bn off the welfare bill and get more people into work.

Speaking to reporters on Friday, he stood by his position that the welfare system needs reform as “it doesn’t work, and it traps people”.

He added: “We need to get it right. That’s why we’ve been talking to colleagues and having a constructive discussion.

“We’ve now arrived at a package that delivers on the principles with some adjustments, and that’s the right reform, and I’m really pleased now that we’re able to take this forward.

“For me, getting that package adjusted in that way is the right thing to do, it means it’s the right balance, it’s common sense that we can now get on with it.”

The concessions include exempting existing Personal Independence Payment claimants (PIP) from the stricter new criteria, while the universal credit health top-up will only be cut and frozen for new applications.

Analysis: Welfare bill U-turn a humiliating blow for Starmer

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“No leadership” in Labour says MP

More money will also be front-loaded into helping people find jobs, though it is not clear how much beyond the £1bn already announced.

The changes came after 127 Labour MPs signed an amendment calling for the cuts to be delayed and consulted on with disabled people.

Rebels feared the reforms wouldn’t actually help people find work while pushing thousands of disabled people and children into poverty, as per the government’s own impact assessment.

The discontent threatened to derail the Universal Credit and Personal Independence Payment Bill when it comes before the Commons for a vote on Tuesday, on the week that marks a year of Starmer in government.

Asked what he would do about a “hole” in the public finances that the changes are said to leave, Sir Keir said the funding will be set out in the autumn budget “in the usual way”.

The concessions on PIP alone will protect an estimated 370,000 people currently receiving the allowance who were set to lose out following reassessment.

Economists at the Institute for Fiscal Studies and the Resolution Foundation have both suggested that the changes could reduce savings intended in the original package by up to £3bn.

Chancellor Rachel Reeves is also under pressure to find money to pay for the U-turn on cuts to winter fuel, which followed a drubbing at the local elections in May.

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‘This week is going to haunt the prime minister,’ says Sky’s Ali Fortescue .

Asked about the series of U-turns, Work and Pensions Secretary Liz Kendall earlier said: “Sometimes there’s strength in listening.

“I really believe that to be the case, that you end up in the right position when you talk to all of those with knowledge and experience and actually, if you want decisions to be the right ones and to last for generations to come, I believe that’s how you make the right changes.”

However, she would not guarantee the bill will pass next week.

Some 83 Labour MPs would need to rebel for the government to be defeated.

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Govt makes offer to rebels on welfare reforms

Last night Dame Meg Hillier, one of the leading rebel voices, hailed the concessions as “massive changes” to protect vulnerable people and involve disabled people in the design of future reforms.

However, not all the rebels have been satisfied with the changes, with several suggesting they would create a “two-tier system”. Sky News is aware of at least 20 MPs who currently intend to still vote against. Many others are undecided.

The concessions came after Downing Street publicly stuck to its guns while engaging in a frantic ring-around to get rebels onside, which further angered MPs.

Many have called for a reset in relations with Downing Street, as the fallout from the rebellion threatens to cause lasting damage.

Conservative leader Kemi Badenoch criticised the U-turn, saying the government’s failure to make “minor savings” on welfare showed they were unable to deal with major issues.

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US Supreme Court curbs injunctions that blocked Donald Trump’s birthright citizenship plan

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US Supreme Court curbs injunctions that blocked Donald Trump's birthright citizenship plan

Donald Trump’s administration will be allowed to take steps to implement its proposal to end automatic birthright citizenship in the US following a decision by the Supreme Court.

Under the current rules, nearly anyone born on US territory has automatic citizenship rights – commonly known as “birthright citizenship”.

But in January, on his first day back in the White House, Trump signed an executive order aimed at ending that right.

A series of lawsuits followed, with district courts issuing nationwide injunctions aiming to block the order from taking effect.

The Supreme Court on Friday voted 6-3 to allow the Trump administration to narrow the scope of nationwide injunctions imposed by judges so that they apply only to states, groups and individuals that sued.

This means the birthright citizenship proposal can likely move forward at least in part in the states that challenged it, as well as those that did not.

Protests in support of birthright citizenship in Washington DC in May. Pic: AP
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Campaigners argue that restricting automatic birthright citizenship is an erosion of people’s constitutional rights. Pic: AP

People demonstrating outside the Supreme Court in May against plans to restrict automatic birthright citizenship. Pic: Reuters
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People demonstrated outside the Supreme Court in May. Pic: Reuters

The US president responded with a post on Truth Social by welcoming the ruling as a “giant win”.

At a news conference at the White House, he said: “In recent months, we’ve seen a handful of radical left judges effectively try to overrule the rightful powers of the president… to dictate the law for the entire nation… this was a colossal abuse of power.”

He went on to suggest the current birthright was being abused and had originally been designed for a different era, to give the descendants of slaves the right to citizenship.

“It wasn’t meant for people trying to scam the system and come into the country on a vacation. It was meant for the babies of slaves. Hundreds of thousands of people are pouring into our country under birthright citizenship,” he said.

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In a wide-ranging news conference, he also said he would consider bombing Iran again if they continued their nuclear programme and expects the country to open itself to international inspections.

He also said he was preparing fresh trade tariffs for several countries and had secured mineral rights in the Democratic Republic of Congo, which is signing a peace deal with Rwanda at the White House to end years of fighting.

Friday’s Supreme Court decision was focused on cases filed in Maryland, Massachusetts and Washington state.

The policy remains blocked for now in one additional state, New Hampshire, as a result of a separate lawsuit that is not before the Supreme Court.

Mr Trump’s plan has the backing of 21 other states.

People demonstrate in front of the Supreme Court in Washington regarding birthright citizenship
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Pic: picture-alliance/dpa/AP

Friday’s ruling was decided on a 6-3 vote following a divide on ideological lines, with conservatives in the majority and liberals in dissent.

Mr Trump previously helped shape the makeup of the court with the appointment of three judges, ensuring a 6-3 conservative majority, though past rulings have still not always gone in his favour.

It has long been widely accepted, including by legal scholars on the left and right in the US, that the Constitution’s 14th Amendment confers automatic citizenship to almost anyone born in the United States.

Mr Trump wants that restricted to only those with at least one parent who is a US citizen or permanent resident.

Friday’s ruling does not examine the legal merits of the policy, but only whether judges had the authority to put it on hold across the entire country.

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As a result of the ruling, the proposal can potentially move forward nationwide, although individuals could still file their own lawsuits at the state level.

Those currently challenging the policy could also still reinstate injunctions which are less broad in scope.

The US president and his allies have been harshly critical of judges who have blocked aspects of his agenda, although it is not a new phenomenon for courts to impose nationwide injunctions.

His administration has battled against judges who have issued nationwide injunctions in response to a bold and aggressive use of executive power to implement a controversial agenda, including ramping up deportations, downsizing federal agencies, targeting law firms and universities and firing thousands of federal employees.

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US

Man kicks customs dog at Washington Dulles International Airport, say authorities

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Man kicks customs dog at Washington Dulles International Airport, say authorities

An Egyptian man has admitted federal charges after kicking a customs dog at a US airport, authorities say.

Hamad Ramadan Bayoumy Aly Marie, 70, pleaded guilty to “harming animals used in law enforcement” during an appearance in the US District Court of eastern Virginia on Wednesday.

Five-year-old male beagle Freddie allegedly detected more than 100lbs (45kg) of undeclared agricultural products in Marie’s luggage after he arrived at Washington Dulles International Airport from Cairo, Egypt, on Tuesday.

When Freddie’s handler started questioning the passenger, he kicked the 25lb (11kg) animal so hard that it was lifted off the ground, according to US Customs and Border Protection.

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CCTV captured the moment Freddie was kicked. Pic: US Homeland Security

A veterinarian determined that Freddie suffered contusions to his right rib area as a result of being kicked.

Marie was placed in handcuffs by US Customs and Border Protection (CBP) officers, who found 55lbs (24.9kg) of beef meat, 44lbs (20kg) of rice, 15lbs (6.8kg) of eggplant, cucumbers and bellpeppers, 2lbs (0.9kg) of corn seeds, and 1lb (0.5kg) of herbs in his luggage, according to authorities.

All agricultural products were seized as they are prohibited, to prevent the introduction of harmful plant pests and foreign animal diseases from entering the country.

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“Being caught deliberately smuggling well over 100lbs of undeclared and prohibited agricultural products does not give one permission to violently assault a defenceless Customs and Border Protection beagle,” said Christine Waugh, the CBP’s director for the area port of Washington DC.

“We rely heavily on our K9 partners and Freddie was just doing his job.

“Any malicious attack on one of us is an attack on all of us, and CBP will continue to work with our investigating and prosecuting partners to deal swift and severe justice to perpetrators.”

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Marie was credited with time served after being taken into custody on Tuesday and was ordered to pay the veterinarian’s fee of $840 (£612) for Freddie’s treatment, a court filing shows.

He was also told to immediately report to CBP for removal from the US, and he left the country on a flight to Egypt at 12.30pm local time on Thursday.

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