Editor’s note: AJN news director Karen Roush, PhD, RN, FNP, will be providing regular updates on AJN Off the Charts about the details and implications of rapid and potentially momentous changes being made by the Trump administration to the public health system in the United States.

It’s been a tumultuous seven weeks since President Trump’s inauguration. Changes in leadership and priorities have swept across every federal department, bringing uncertainty and disruption. Trump signed more than 70 executive orders (EOs) in his first month in office, including orders to erase diversity, equity, and inclusion efforts from federal agencies and the military (EO 14151); limit the rights of transgender people and declare that only two “sexes,” biological males and females, would be recognized by the federal government (EO 14168); end birthright citizenship (EO 14160); and further limit access to abortion (EO 14182). Elon Musk’s Department of Government Efficiency, known as DOGE, has fired tens of thousands of federal employees, dismantled entire agencies, including USAID, and pulled grant funding from universities, nongovernmental organizations, and the National Institutes of Health (NIH).

The appointment of Robert F. Kennedy, Jr. to head HHS.

Many of the administration’s actions in the health care sector have raised alarm among health care experts and clinicians, particularly those in public health. This includes the appointment of Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services (HHS).

Once widely respected for his environmental activism as an environmental lawyer, Kennedy is now known more for his anti-vaccination activism, in which he has promoted debunked claims about vaccine risks and insisted that the very federal agencies he now controls were corrupt and conspiring with pharmaceutical companies to hide the risks of vaccines. He is the founder of the Children’s Defense Fund, an organization whose advocacy is based on a belief that childhood vaccines are responsible for the increase in many childhood chronic health problems—including developmental delays, autoimmune diseases, asthma, and autism—and cause serious vaccine injuries, such as allergic reactions, seizures, and death, far more frequently than the vaccine monitoring body reports.

In his confirmation hearing, Kennedy distanced himself from his anti-vax history, stating, “I believe that vaccines play a critical role in health care.” However, his response to the ongoing measles outbreak in Texas has not allayed concerns. In the first cabinet meeting at the White House, when asked about the outbreak, he stated that 20 people had been hospitalized, “mainly for quarantine.” According to a Reuters’s report, Texas hospital officials rebutted that claim, stating that “all children who had been admitted were unvaccinated and had serious respiratory problems, including some requiring intensive care, and they do not keep patients solely for quarantine.”

In his NIH press release on the Texas measles outbreak, Kennedy stated he had directed the Centers for Disease Control and Prevention (CDC) and the Administration for Strategic Preparedness and Response (ASPR) to provide comprehensive support to Texas authorities, including providing vaccines and therapeutics as needed. He noted the importance of vaccines in protecting individuals and contributing to community immunity, but did not go so far as to encourage people to get vaccinated, stating that vaccination remains a personal choice.

Some health experts have voiced concern about the assertion in the press release that “good nutrition remains a best defense against most chronic and infectious illnesses.” While there is evidence that vitamin A may reduce the risk of mortality and pneumonia when given to children with measles when there is a vitamin A deficiency, it’s important to be clear that neither it or other vitamins prevent the disease. His comments in a March 4 Fox News interview that NIH staff sent to the area were seeing good results with the use of budesonide, erythromycin, and cod liver oil have further alarmed public health experts, as there is no evidence for using cod liver oil to treat measles.

A growing measles outbreak.

Meanwhile, the outbreak continues to grow. As of March 6, there had been 169 cases and 22 patients hospitalized. One child died in late February, the first measles death in a decade, and this week a second death was reported when an unvaccinated New Mexico man who had recently died was discovered to have measles.

In his opening remarks to HHS staff, Kennedy stated that his main mission is to “reverse the chronic disease epidemic in America.” Everyone in health care agrees that this is a crucial goal. Chronic diseases in Americans have risen steadily over the last two decades along with the number of people with multiple chronic diseases. This first test of how committed he is to ensuring that evidence-based, scientific principles prevail leave many health care experts and clinicians wary. They will be watching carefully as his vision of health prevention and promotion unfolds more broadly in the coming months.