Donald Trump’s re-election may seem like a doomsday for America’s public health institutions. The president-elect has vowed to dismantle the federal bureaucracy, and Robert F. Kennedy Jr., the likely next secretary of health, wants to go further. As part of his efforts to “make America healthy again,” President Kennedy recently pledged to dismantle the FDA and its regulations, including those governing vaccines and raw milk. However, this effort will run into a major obstacle: the “deep state.”
the phrase deep state It may evoke images of tinfoil hats. After all, Mr. Trump has spent much of the past eight years falsely claiming that Democratic bureaucrats are unfairly persecuting him. But the operations within federal health agencies are the real deep state, albeit far more benign and rational than what President Trump has talked about. And he may not be able to break it easily.
Whether you know it or not, you’ve probably seen this deep state in action. That’s why hydroxychloroquine, President Trump’s preferred coronavirus treatment, wasn’t flooding pharmacies during the early stages of the pandemic. And that’s why a coronavirus vaccine wasn’t rushed out before the 2020 presidential election. Yet both of these efforts were thwarted by civil servants. overt pressure from playing cards and officials in his administration.
Public health officials did not oppose Trump to thwart him. They did so because neither measure was scientifically certain. The vaccine was not approved before the election because FDA officials knew they needed to wait at least two months after clinical trials were completed to ensure the vaccine did not cause dangerous side effects. And the FDA banned the use of hydroxychloroquine to treat the coronavirus, citing unproven efficacy and a mixed safety record.
Health officials could have complied with President Trump’s request if they really wanted to. But generally, no matter who the president is, they do not easily abandon their empirical views on science. The FDA’s top vaccine regulator vowed: resign That could happen in 2020 if government agencies don’t bow to President Trump’s pressure to approve vaccines quickly. Two other vaccine regulators I quit after the first year Biden administration’s After the FDA announced the rollout of coronavirus boosters. After resigning, former officials publicly claimed “The data simply does not show that all healthy adults should get the booster shot,” it said, adding that public health efforts “are trying to reach unvaccinated people, no matter where they live, with the vaccine.” The focus should have been completely on “vaccinating people.”
Decisions must be evidence-based, so every decision made by federal health agencies involves many scientists, lawyers, and doctors. Arbitrary decisions based on conspiracy theories or political whims can and will be challenged in court. “It’s definitely possible for a new administration to come in and come up with new policies,” Lowell Schiller, who led the FDA policy office during part of President Trump’s first term, told me. But he added: “There are a lot of laws that need to be followed and things have to go through due process.”
Some changes that may seem relatively unimportant may require a large amount of paperwork. When the FDA wanted to rescind the standardized federal definition of frozen cherry pie (yes, the definition existed until earlier this year), the FDA would have to go through a formal process, and the FDA’s legal Authority needed to be defended. The costs and benefits of a more laissez-faire cherry pie policy. This process took over three years. Few things are more difficult than getting a drug approved or revoked. In 2020, the FDA attempted to halt development of an unproven drug aimed at preventing preterm birth. This process took nearly three years, despite plenty of evidence showing the drug was ineffective. Now imagine what would happen if RFK Jr. pressured the FDA to take a vaccine off the market because he falsely believed it caused autism.
There are some things the Trump administration could do more easily. For example, it could direct the FDA to stop enforcing Food and Drug Administration regulations on some products that President Kennedy promotes, such as raw milk and certain vitamins. The FDA often declines to pursue various products in the name of “enforcement discretion.” While stalling enforcement action may anger some within the agency, Mr. Trump could accomplish it with little red tape.
Kennedy promised mass layoffs at the FDA, presumably to install supporters who would enact his agenda. That threat should be taken seriously. The president has broad powers to block officials who undermine his policies. The Trump administration is demoted one of the federal government officials Those who opposed the approval of hydroxychloroquine.
But there are also important checks on what the president can do to reverse badmouthing public officials. Unlike many workers, federal employees can only be fired for cause or misconduct, and public servants have the right to appeal in either case. “The complex process makes it difficult to remove people,” said Donald Kettle, professor emeritus of public policy at the University of Maryland. President Trump was famous for firing people during his first term, but those who took the ax were political appointees who don’t enjoy the same protections as civil servants. In short, very few federal employees can survive on Scaramucci alone.
But major threats still loom for federal employees. In his first term, President Trump promoted an effort to reclassify federal employees, stripping them of protections, and said in his second term he would “do the following:”immediately” Pursue that action. For Mr. Trump to follow through on his threat, it would be a difficult process and likely to be challenged in court. However, if the policy is implemented, President Trump could have significant influence over fire officials.
Still, Mr. Trump is taking these actions at the risk of his own objectives. In reality, the same members of the so-called deep state that Trump and Kennedy are threatening to remove are also essential to getting the administration to do what it wants to do. A significant part of the “Make America Healthy Again” agenda will have to be carried out through this deep state. If Kennedy, a champion of psychedelics, wants the FDA to approve new psilocybin-based treatments, the drugs must be reviewed by scientists and doctors who review the safety and effectiveness of other drugs. It won’t happen. If he wants a nationwide ban on fluoride in water, it would have to go through the EPA. There is no way around this. Kennedy cannot make these decisions on his own, even if Trump appoints him unilateral kingpin of all federal health agencies.
A central tenet of the “Make America Healthy Again” agenda is to remove potentially dangerous chemicals from food. The FDA has been slow to ban certain chemical additives, but there seems to be some light recently. Earlier this year, the company launched a new initiative to reevaluate the safety of these substances. But if Kennedy guts the FDA, there may be no one to conduct its reviews.
It’s possible that the Trump administration will hold massive job fairs to fill all these positions, especially if the president-elect follows through on his promise to make it easier to hire and fire bureaucrats. However, very few people can successfully perform these highly technical jobs. I should mention that hiring in the federal government usually takes forever. (The average recruitment period in 2023 was 101 days.)
Still, President Trump’s second term will pose one of the biggest challenges facing the federal health care system. No president in modern history has been so eager to bend health institutions to his will., And he seems to be doing so with even more courage now than he did during his first go-around. Trump will probably have some success. Some people may be fired, and some important policies may be repealed. America is about to find out just how resilient the deep state really is.
