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HHS Secretary Robert F. Kennedy Jr.'s impact on Americans' health

DAVE DAVIES, HOST:

This is FRESH AIR. I'm Dave Davies. Is Robert F. Kennedy Jr., the U.S. secretary of health and human services, endangering Americans' health? That's the gist of a letter signed by nine former directors of the Centers for Disease Control and Prevention, published Monday in The New York Times. Since Kennedy was sworn in last February, the nation's public health infrastructure has been rocked by a series of events culminating with the abrupt firing of CDC Director Susan Monarez last week.

The CDC and other health agencies have been decimated by thousands of staff layoffs. In August, a gunman reportedly angry about COVID vaccines fired hundreds of rounds at the CDC headquarters, killing a policeman. Kennedy has announced new, more restrictive recommendations on who should receive COVID vaccine boosters, eliminating healthy pregnant women, among others. He canceled $500 million in mRNA vaccine research contracts. He fired all 17 members of a prestigious CDC advisory committee on immunization, replacing them with eight appointees, some with histories as vaccine skeptics. And when the CDC director was fired last week, four senior officials of the agency abruptly resigned. Meanwhile, Kennedy is pursuing another agenda, tagged Make America Healthy Again, or MAHA, to reduce the presence of food additives and ultra-processed food in our diets.

To understand these events and how they'll affect us, we've invited Sheryl Gay Stolberg to join us. She covers health policy for The New York Times. Before joining The Times in 1997, she was at the Los Angeles Times, where she shared in two Pulitzer Prizes for coverage of racial unrest and a devastating earthquake. We recorded our conversation yesterday.

Well, Sheryl Gay Stolberg, welcome to FRESH AIR.

SHERYL GAY STOLBERG: Well, thank you for having me.

DAVIES: You know, there was this letter that was issued Monday by nine former directors of the Centers for Disease Control and Prevention who served under Republican and Democratic presidents, a really scathing critique of many of the steps Senator Kennedy has taken as health and human services secretary. What's your sense of what the impact of that might be?

STOLBERG: That was really a stunning letter from CDC directors going all the way back to the Jimmy Carter administration and the Reagan administration. And I think it will have a very powerful impact. I think that we are at an inflection point right now. We will see how Congress addresses these issues. President Trump himself has spoken on Truth Social, his social media platform, about the chaos that's happening at CDC. I think that this letter will really add to the public debate over Kennedy's leadership.

DAVIES: I want to talk about Kennedy himself and his life and formative influences. You wrote a profile with two colleagues earlier this year. We generally think of him, probably, as a vaccine skeptic who has exhibited some quirky behavior at times. Let's talk a little bit more about him. He was 9 years old when his uncle, President Kennedy, was assassinated, 14 when his father was killed. He was in a wealthy family and went to private schools, then Harvard. What was he like as a young man?

STOLBERG: Kennedy has a fascinating background. He comes from this storied Democratic clan - a clan that was filled with success, but also tragedy. And he was hit very hard by the deaths of his uncle and his father. And after his father died - he was 14 - he descended into heroin addiction. Kennedy loved animals, and his family sent him off to this boarding school where he was able to keep his pet hawk. Some of his behavior was really quite troubling, frankly. One of his classmates told me that at night, when it was time to clear the tables, one night, Kennedy held his lighter under the table and heated up all the utensils so that when this other boy went to clear the utensils, he would get burned. Kennedy's cousin Caroline spoke of how he would pluck the wings off pigeons to feed to his hawks. I mean, this is, you know, kind of odd behavior.

Kennedy did go on to Harvard, as you mentioned. In 1983, though, he was on a plane to Rapid City, South Dakota, and he was arrested and stopped because he was carrying heroin in his bags. And that set him off on a path of sobriety. And eventually, he channeled his interest in nature into a career in environmental law. And he was quite a prominent environmental lawyer who really accomplished quite a bit of good.

DAVIES: His environmental work eventually led him into the antivaccine movement, through parents who came to him and said, you should be looking at, you know, how mercury is used in preservatives in some vaccines. He became quite active in this - formed a nonprofit, the Children's Health Defense. I mean, he did this over many years. But in - generally speaking, what did he advocate for, and how credible was it?

STOLBERG: Kennedy came to believe that thimerosal, a mercury-containing preservative in vaccines, was causing autism. We need to scroll back a little bit to 1998 when Andrew Wakefield, a British doctor, published a report in The Lancet, a very respected medical journal, suggesting that the measles, mumps, rubella and - vaccine was linked to autism. Wakefield's report was ultimately discredited, but it was not retracted for more than a decade.

During this time, the CDC and the FDA also became concerned about - not about autism, but about thimerosal, this mercury-containing preservative. And it's very important to note that the measles, mumps and rubella vaccine never contained this preservative. But nonetheless, the preservative was removed from most childhood vaccines by 2000. Yet somehow, the notion that this mercury preservative was linked to autism took hold within the antivaccine community, and Kennedy seized on this notion. He had been working as a lawyer to get mercury out of waterways, and parents would come to him and say, you've got to look at mercury in vaccines. In 2005, he wrote an article in Rolling Stone called "Deadly Immunity," making the case that this preservative caused autism. That article, too, was retracted, but it set him off on this path of advocating that vaccines are dangerous.

DAVIES: And you write that the pandemic was - what? - an accelerant for his activism and his public profile. How did that affect his career?

STOLBERG: The pandemic drew the nation's attention toward vaccines. And suddenly Kennedy, who had really already been the de facto leader of this movement - he would call it a vaccine safety movement; others would call it an antivaccine movement - was suddenly thrust to the fore. President Biden's decision to mandate coronavirus vaccination for federal employees and for large businesses didn't help. It gave the activists a platform to talk about individual liberty and no mandates, and nobody can force us what to do. And Kennedy started leading these rallies, these Defeat the Mandates rallies.

DAVIES: Right. And you write that his rhetoric became darker in some ways, right? More extreme?

STOLBERG: Yes, absolutely darker. At one point, he invoked the Holocaust. He said, even in Hitler's Germany, you could hide, like Anne Frank, suggesting that these vaccine mandates were akin to, you know, Nazi rule. And he certainly has a dark view of the pharmaceutical industry, which he views as corrupt. He views federal regulators like the CDC and the FDA as in partnership with this corrupt industry, and he began to paint a very, very dark picture of the nation's public health establishment.

DAVIES: He eventually decided to run for president, launched a campaign in 2023 for the 2024 Democratic nomination, you know, calling himself a Kennedy Democrat, invoking the family name. How did he end up in the Donald Trump camp?

STOLBERG: Well, it was a circuitous route, but he started as a Democrat. He clearly was not going to win the Democratic nomination over Joe Biden. He became an independent candidate. But still, too, running as an independent in the United States has its challenges. And, you know, by mid-2024, it became clear to him that he wasn't going to win. He put out feelers to the Kamala Harris campaign. She was by that time the nominee, having replaced Biden who had stepped aside, and he didn't really get much traction with them at all.

One of his advisers, a man by the name of Calley Means, began to think that maybe Kennedy's path was by partnering with Donald Trump. And when Trump was the victim of an assassination attempt in Butler, Pennsylvania, Means persuaded Kennedy to call Trump just on a personal note to say, look, I come from a family that has experienced assassination. I know the toll that this takes on a family. And Kennedy did that. He and Trump spoke just literally hours after Trump was released from the hospital, and this began a series of conversations between the two of them, about six weeks. And by the fall of 2024, Kennedy had merged his campaign with Trump's, feeling that through Trump, he could achieve his goals of, as he eventually came to call it, making America healthy again.

DAVIES: And I'm sure for Trump, there was some appeal in Kennedy's supporters, many of whom embrace conspiracy theories. Did he have any particular admiration for the Kennedy family or the Kennedy name?

STOLBERG: Absolutely.

DAVIES: Yeah.

STOLBERG: Well, a couple of things. First of all, it's important to note that Trump, too, had embraced the idea that vaccines cause autism and had been speaking about it at least since 2007. But separately, Trump was very enamored of the Kennedy name. It brings a certain glamour and cachet. More important, Kennedy was polling at about 2 or 3%, and in a really tight race, that's an important percentage. And Kennedy had a base of supporters that was distinct from Trump's. Kennedy's supporters were not MAGA. They were MAHA. And Trump knew that and knew that Kennedy could perhaps swing the election in Trump's favor. And as we know, Trump said he was going to, quote, "let Bobby go wild on health." And when Trump won the election, that's what happened.

DAVIES: We're going to take a break here. Let me reintroduce you. We are speaking with Sheryl Gay Stolberg. She covers national health policy for The New York Times. We'll continue our conversation in just a moment. This is FRESH AIR.

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DAVIES: This is FRESH AIR, and we're speaking with Sheryl Gay Stolberg. She covers national health policy for The New York Times. We're talking about some of the events that have engulfed the nation's public health agencies since Secretary of Health and Human Services Robert F. Kennedy was sworn in last February.

So let's talk about Robert F. Kennedy as Health and Human Services secretary. You know, one thing that happened early was there were thousands of layoffs at the Centers for Disease Control and Prevention, the National Institutes of Health, other health agencies. This - some of this, I guess, was driven by DOGE, the Elon Musk-led government efficiency drive. But Kennedy really embraced this, didn't he?

STOLBERG: Kennedy embraced it, and not only that. Kennedy advanced it. When he was confirmed, he promptly announced that he was going to lay off another 10,000 employees. You know, there's been a lot of lawsuits back and forth. People are - many are on administrative leave or continue to be paid, even though they weren't allowed to come to work. But yes, there has been a mass exodus of federal health employees. And let's not forget, also a lot of grant money was rescinded, cut off. This doesn't affect the CDC so much as it affects the National Institutes of Health, but the CDC did lose grant money for research that it funds.

DAVIES: All of this, of course, had an effect on staff morale. And then in August, there was this dreadful incident when a man reportedly angry about COVID vaccines shot hundreds of bullets at the CDC headquarters, killed a police officer, took his own life. This was obviously traumatic for an already demoralized workforce. What did you hear from CDC and other agency workers about the way Robert Kennedy Jr. responded to that event?

STOLBERG: Before we get into the shooting, important to note also that in addition to the layoffs, Kennedy has moved to dismantle the CDC as we know it. The CDC does not just deal in infectious disease. It has a chronic disease division. It deals in injury prevention, et cetera. And one of Kennedy's big moves was to say he was going to scale the CDC back to its original mission of infectious disease, and all of these other causes of disease or injury or death were going to be addressed by this new agency, the Administration for a Healthy America, or AHA.

So going into this shooting, we had a terribly demoralized CDC, layoffs, people fearing that, you know, their lives would be upended with this restructuring. And then you had this guy shooting a barrage of bullets on a Friday evening, early evening, when people were still at work. Not only was it terrifying, it reinforced the idea that misinformation was driving hatred, pure hatred and violence toward America's public health workforce. This man, who was firing his gun, was upset about COVID vaccines, and I think that people inside the agency and former agency leaders felt that this was, like, the perfect storm. This was sort of everything coming home to roost, from Kennedy spouting this - these ideas about vaccines that were unfounded, to anger that lingered from the coronavirus pandemic, to gun violence, which is something that the CDC actually had a program to prevent, all merging in this one horrible event that led to the tragic death of a police officer and just shattered the morale of the agency's workforce.

DAVIES: So when this horrible attack happened, did the staff feel supported by Robert Kennedy Jr...

STOLBERG: No.

DAVIES: ...Or the president?

STOLBERG: No. In a word, no. First of all, President Trump has never said anything about it. Kennedy made some kind of anodyne remarks about it, but people were angry. People felt that his rhetoric had contributed to the climate that caused this shooting.

DAVIES: So let's talk about Kennedy and autism as secretary of Health and Human Services. In May, when he was - after he was confirmed as secretary, he announced plans for a massive new database, a real-world platform, I think, was the expression, to study the root causes of autism. Why was this controversial?

STOLBERG: Well, it was controversial because of the person that Kennedy picked to lead this effort. He picked a man named David Geier, who had been accused of practicing medicine without a license in Maryland, along with his own father, who was a doctor and who lost his medical license. And Geier has a very particular point of view. Geier is the author of numerous articles asserting that there is a link between vaccines and autism, and examinations of his research, including one recently published by my own newspaper, have shown that it is deeply flawed. So Kennedy installed a guy who has a predetermined view about vaccines and autism to investigate whether vaccines are linked to autism.

DAVIES: You know, we recently saw the worst measles outbreak in decades in West Texas. What did he have to say about that?

STOLBERG: Kennedy was very careful when the measles outbreak occurred in Texas. He did say that the measles vaccine was the only known way to prevent the spread of measles. But he quickly followed that up by saying, of course, vaccination is a personal choice. Now, what every public health expert will tell you is that vaccines, vaccination is a communitarian endeavor, that we get vaccinated not only to protect ourselves, but to protect others around us. And if you break that notion, that communitarian notion, and say getting vaccinated is a personal choice, then you destroy the benefit of mass vaccination.

DAVIES: So Kennedy said that the best way to prevent infection of measles is the vaccine, right? He said that. What has he said about, you know, how much harm might come from vaccines or whether he - and I know his kids were vaccinated, but he expressed some hesitation about whether he would have done that again, right?

STOLBERG: Well, he always says, all my kids are vaccinated. Well, his kids were vaccinated before he started questioning vaccines. He has refused to say whether he would recommend to new parents that they vaccinate their children. He made a comment that his critics found, in some ways, comical. He said people should do their own research. Now, during the pandemic, do your own research became kind of a meme. You know, you would go around liberal neighborhoods and see, you know, on Halloween, tombstones that said, I did my own research. But, you know, Kennedy is the first health secretary, certainly that I know of and probably ever, who has refused to endorse vaccination, who has made the case that it's up to you and your doctor.

DAVIES: At a recent Cabinet meeting, President Trump turned to Kennedy and said, you know, autism is growing dramatically in the United States. What are you doing on that? And he promised some results. What did - right? - what did he say?

STOLBERG: He said, yes, Mr. President, we're commissioned in study on the root causes of autism, and we'll have a report for you in September.

DAVIES: And kind of indicated - well, I guess he didn't indicate (laughter).

STOLBERG: He didn't indicate, but many people who have watched him for a long time and who have watched David Geier believe strongly that this report will somehow point the finger at vaccines. I think that is the big question coming up.

DAVIES: Let's take a break here. Let me reintroduce you. We are speaking with Sheryl Gay Stolberg. She covers national health policy for The New York Times. We recorded our conversation yesterday. We'll hear more after this short break. I'm Dave Davies, and this is FRESH AIR.

(SOUNDBITE OF BRAD MEHLDAU'S "AFTER BACH: FLUX")

DAVIES: This is FRESH AIR. I'm Dave Davies. We're listening to my interview with Sheryl Gay Stolberg, who covers national health policy for The New York Times. She's been covering the chaotic events that have engulfed the nation's public health agencies since Secretary of Health and Human Services Robert F. Kennedy Jr. was sworn in last February. Kennedy has announced new, more restrictive guidelines for COVID booster shots, canceled a half billion dollars in vaccine research grants, dismissed all 17 members of a prestigious immunization advisory panel and orchestrated the firing of CDC director Susan Monarez. We recorded our conversation yesterday.

I want to talk about these new guidelines for who can get COVID vaccines this fall. You know, reading all this, the process for deciding policy on this is - you know, it's a little complicated, a little confusing. I want to understand if I have this right. Normally, there would be a recommendation from this immunization advisory committee within the CDC, the Centers for Disease Control, that would carefully review all the vaccines and tests and studies which had been of vaccines that had been approved by the FDA. And that advisory committee would recommend which vaccines would be advisable for specific groups of patients by age, you know, childbearing status, medical conditions, etc. Then those recommendations would be approved by the director, and then all of us and our pharmacists and doctors and insurance companies would know the rules of the road. Is that typically the way this is supposed to work?

STOLBERG: Yes. That is the way it's supposed to work.

DAVIES: Right. So it was different under Robert F. Kennedy. What happened?

STOLBERG: What happened is he made the decision himself, sort of bypassing this advisory process. And medical associations are up in arms over this. In fact, several of them are suing, saying that his decision to limit access to vaccines is harmful to the public and was unscientific.

DAVIES: Yeah. I think one of these was announced in a tweet, where he stood with the head of the Food and Drug Administration and, I guess, the National Institutes of Health.

STOLBERG: Well, he forecast that he would do this. I mean, he announced it in - as far back in May, in a video posted on social media, saying that the CDC would stop recommending COVID vaccines for healthy children and for pregnant women. So he kind of let people know in advance what he was going to do.

DAVIES: People that you talked to within the agency, did they wonder, well, what was this based on? What was the science? Where were the studies? You know, what happened internally?

STOLBERG: Well, you know, Kennedy had fired this entire committee of vaccine advisers, all 17 members, and had installed eight replacements, some of whom were vaccine skeptics. So I think people inside the agency felt that their whole structure for examining the usefulness of vaccines had really fallen apart, and there were no more checks and balances. There was just a secretary making pronouncements.

DAVIES: Right. But on this critical question of who should be recommended to take the vaccines this fall, the - you know, the boosters, they didn't act, did they?

STOLBERG: That's correct. They did not act on this critical decision. There was no recommendation out of the ACIP, the Advisory Committee on Immunization Practices, for COVID-19 vaccines. Kennedy simply made the announcement himself without guidance from the expert panel that he himself appointed.

DAVIES: So we are now in a posture where this advisory committee has not acted on this critical question of who should get COVID vaccines this fall, boosters. But the Secretary of Human Services had said that it should not be given to people below the age of 65 unless there's a preexisting medical condition, should not be given to healthy pregnant women. How does this affect consumers' ability to get these vaccines, given that - I mean, can they assume that pharmacies will provide them, that insurers will cover them?

STOLBERG: No. This is going to have a profound effect on how consumers will get vaccines. There are questions about whether insurers will cover them. There are questions about, how will people in those states where pharmacies aren't providing them get the vaccines from their doctors, or will they be able to get vaccines from their doctors? Are doctors' offices going to start ordering COVID vaccines? You know, we don't know, and, you know, we're heading into the fall season, which is the season that most people would, if they wanted a COVID booster - and granted the percentage of Americans that had been taking COVID boosters was way down to roughly a quarter of Americans. But we are heading into this fall season where people would get their vaccines for flu and for COVID, if they wanted them, and now do not know if they will have access to the COVID vaccines.

DAVIES: Secretary Kennedy has said he wants more studies of the coronavirus vaccines, placebo-controlled trials for the boosters. What are the implications of his demand for these studies?

STOLBERG: You might as well not have boosters. If you're going to conduct a placebo-controlled trial, it would have to happen while the virus was circulating. So presumably, you'd have half the people in that experiment getting the vaccine, but half would be unable to get it, and it would, effectively, delay availability of the vaccine. It would delay approval of the vaccine because you wouldn't approve the vaccine until the trial had been conducted and the data was examined and the FDA considered it. And by that time, you might be past the COVID season.

DAVIES: Right, because it just takes longer.

STOLBERG: It just take - it would just take too long.

DAVIES: We're speaking with Sheryl Gay Stolberg. She covers national health policy for The New York Times. We'll continue our conversation after this short break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

DAVIES: This is FRESH AIR, and we're speaking with Sheryl Gay Stolberg. She covers national health policy for The New York Times. We're talking about some of the events that have engulfed the nation's public health agencies since Secretary of Health and Human Services Robert F. Kennedy was sworn in last February.

Last week, we saw the dismissal of the director of the Centers for Disease Control and Prevention, Susan Monarez. Do you know what led to this exactly? Is that clear?

STOLBERG: It is clear. Kennedy summoned Susan Monarez to his office in Washington on a Monday and said that he wanted her to fire the top leadership of the CDC, and also to commit to accepting any future recommendations of the Advisory Committee on Immunization Practices. And she said no. It's the responsibility of the CDC director to take recommendations from that committee, consider them and then decide whether they will accept or reject them. And Kennedy wanted a commitment for a blanket approval, and Dr. Monarez said no. And he said, if you don't agree, you'll be fired.

DAVIES: Right. And then she apparently called Senator Bill Cassidy, the Republican from Louisiana who chairs the Senate Health Committee, who's a big supporter of vaccines and has a history of concern about this issue. The fact that she called Senator Cassidy - how did that play within the administration?

STOLBERG: Let's just say, not well. So she called Senator Cassidy. Senator Cassidy called Kennedy. And the next day, on a Tuesday, Susan Monarez was summoned back to Kennedy's office. And he told her at this point that, you know, he was not pleased with this. He and another person in the room accused her of being a leaker. They said she could be fired - this is according to someone, one of my sources, who was very close to the events - said she could be fired just for leaking and again reiterated that she needed to accept the recommendations of the advisory committee, fire the top CDC leadership, or she herself was going to be fired.

DAVIES: So as it turned out, I mean, the secretary himself could not fire her, because she was a presidential appointee approved by the Senate. Eventually, the White House endorsed the firing. Is that resolved? I mean, her lawyer was disputing the firing for a while. It appears she has indeed been fired.

STOLBERG: For all intents and purposes, she has been fired. President Trump never publicly announced that he was firing her. The White House announced that she had been fired. Her lawyers said that it was up to the president to fire her personally and that if he didn't fire her, she considered herself still on the job. Well, she lost her access to her email and to the CDC systems, and Kennedy and President Trump installed an acting CDC director. So for all intents and purposes, she is no longer the CDC director.

DAVIES: Meanwhile, there is a new director of the CDC, Jim O'Neill.

STOLBERG: An acting director, yes.

DAVIES: Acting director, yeah. What is his experience and qualifications?

STOLBERG: So Jim O'Neill had worked in the Bush administration at HHS, ultimately rising to the position of, I think, a deputy secretary. He oversaw FDA and NIH. His portfolio also included the Office of Science and Public Health. But really, he's a biotech guy. He went off after that and became a biotech industry investor. He does not appear to have any background in public health at all. I think that's very worrisome for people who work at CDC and who have worked at CDC.

DAVIES: We should talk a bit about the other thing that Kennedy is really interested in. And that is his Make America Healthy Again initiative, MAHA. And a lot of this involves additives to food and ultra-processed food. He's used a pressure campaign to try to get food manufacturers to stop using synthetic food dyes - kind of a jawboning thing, not through regulation. How has that gone?

STOLBERG: Well, as far as the jawboning, it's actually gone pretty well for Kennedy. A number of big food manufacturers have said they will no longer be using synthetic food dyes. But jawboning only gets you so far. And as I have written, the biggest user of artificial food dyes in the food industry, which is the candy makers, have no intention of dropping artificial dyes from their products unless they are forced to by regulation or law or some other government action that Kennedy and Trump have so far seemed unwilling to take.

DAVIES: You know, there is this issue that if you really go after ultra-processed foods, you're going to anger some very powerful interests - you know, agricultural interests, you know, food processors, chemical manufacturers.

STOLBERG: The sugar industry.

DAVIES: Yeah. So how is that working, with, you know, a Republican president who has a lot of support in those constituencies?

STOLBERG: Right. Well, this is the same question. The question is, will Kennedy and Trump put their money where their mouth is? Will they use the levers of government to make changes in how food is produced in this country, grocery store food is produced in this country? And that is going to mean taking on big industries like the agricultural industry, which have traditionally supported Republicans. And so far, they haven't been willing to do it.

DAVIES: You know, you've written that David Kessler, who's the former head of the Food and Drug Administration and was an adviser in the Biden administration, has kind of, in - joined this fight, in a way. He wants the Food and Drug Administration to declare that the core ingredients of processed foods are no longer generally recognized as safe. And he's filed what's called a citizens' petition, which the FDA has to respond to. He disagrees with Secretary Kennedy on a lot of things, but on this, he's in all the way. What might come of this?

STOLBERG: Well, I think Kessler is really throwing down the gauntlet here. He is both giving Kennedy and the Trump administration a path to regulate ultra-processed foods, but he's also challenging them to do it, to take him up on it, by declaring these ingredients no longer generally recognized as safe. This would be a huge, huge change. And if the FDA were to do such a thing, it would very much anger the corn growers - you know, the makers of, you know, high-fructose corn syrup, et cetera. It would anger the agriculture industry broadly. The FDA has six months to respond to Kessler's petition, and we'll see what steps, if any, it takes. I would be surprised if they granted this petition outright. Perhaps they would start down some path of investigating or granting part of it or carving off a piece of it in some way. But we're going to have to wait to see what they do.

DAVIES: I guess one model is, you know, the fight against the tobacco companies. I mean, there were a lot of steps that didn't go very far, but they generated, you know, public attention and gathered new allies that eventually made a big difference.

STOLBERG: Yes, that's right. And, you know, Kessler was the FDA director who famously went after the tobacco industry in 1994, more than 30 years ago. So these things do take time, but he did use the model of the citizens' petition, which had been employed during the tobacco wars. And that citizens' petition way back when gave Kessler an opportunity to declare that the FDA was going to regulate nicotine as a drug. It never went through. It was struck down by the Supreme Court. But ultimately, it triggered a lot of other changes.

DAVIES: You mentioned Calley Means as having influenced Secretary Kennedy to join the Trump campaign. Can you tell us a bit about his sister, Casey Means, who was Trump's pick as surgeon general?

STOLBERG: Yes. Calley and Casey Means together are very powerful wellness influencers. They wrote a very popular book after their mother died, and it was sort of a prescription for healthy living. And this book brought them into the orbit of Kennedy, and Calley became a very close adviser to Kennedy. He was installed in the White House as a special government employee. And Casey Means, who is a medical doctor, has been nominated to be Trump's surgeon general. Casey was a controversial pick as surgeon general because she's not currently a practicing physician. She left her residency in order to practice so-called functional medicine, which is really wellness. Laura Loomer, the right-wing provocateur, had picked out some blog posts that Casey wrote in which she talked about magic mushrooms and other alternative medical treatments. And she's not a conventional physician.

DAVIES: Would she be an ally of Secretary Kennedy and his priorities?

STOLBERG: Oh, absolutely.

DAVIES: Yeah.

STOLBERG: Absolutely. I mean, it was Kennedy's doing that prompted Trump to nominate her as surgeon general. She was effectively Kennedy's pick.

DAVIES: You know, it's fall, and kids are going back to school. And for some, that means requirements to get their kids vaccinated. Are parents questioning what vaccines they should get?

STOLBERG: Well, vaccination rates have been going down. Certainly, since the COVID vaccine, more and more parents are seeking exemptions from school vaccine requirements. And there's a lot of concern among public health officials that if vaccination rates drop too low, we will see a return of infectious diseases, that the first disease to come back will be measles because it is the most contagious of the childhood diseases. And in fact, we have already seen that with the measles outbreak in Texas.

DAVIES: What's the state of the law on vaccine requirements? Can a school district insist upon it and not admit the student if their parents refuse?

STOLBERG: Vaccine requirements are the province of the states. The state of the law is actually more than a century old. In 1905, the Supreme Court issued a ruling, Jacobson v. Massachusetts, that said that states have a right to require vaccination in order to protect the health of the community. That ruling remains intact. Some public law experts think that it may be not long for this world. But nonetheless, states do have the right to require vaccination. Nearly every state offers some kind of exemption, be it a philosophical exemption or a religious exemption. Some are looser than others.

DAVIES: Well, Sheryl Gay Stolberg, thank you so much for speaking with us.

STOLBERG: Thank you for having me.

DAVIES: Sheryl Gay Stolberg covers health policy at The New York Times. We recorded our conversation yesterday. Coming up, John Powers reviews a new Prime Video thriller series set in South Korea. This is FRESH AIR.

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Dave Davies is a guest host for NPR's Fresh Air with Terry Gross.