President Trump signed an executive order Monday morning that he said Sunday would cut prescription drug and pharmaceutical prices "almost immediately, by 30% to 80%."

Why it matters: Drug prices are considerably higher for U.S. patients than in other countries, and Trump and his predecessor President Biden have pushed for lower costs.

Driving the news: Trump's executive order directed Health and Human Services Secretary Robert F. Kennedy Jr. to facilitate direct-to-consumer purchasing programs for manufacturers to sell pharmaceutical products to U.S. patients at "the most-favored-nation price."

• It further ordered officials to communicate price targets to drug companies.
• Should drug manufacturers not offer U.S. consumers the "most-favored-nation lowest price," his order pledged, the administration will take "additional aggressive action."
• "Americans will no longer be forced to pay almost three times more for the exact same medicines, often made in the exact same factories," Trump's order reads. "As the largest purchaser of pharmaceuticals, Americans should get the best deal."

Context: Trump said on Truth Social Sunday, "Our Country will finally be treated fairly, and our citizens Healthcare Costs will be reduced by numbers never even thought of before," said Trump.

• "On top of everything else, the United States will save TRILLIONS OF DOLLARS."

Flashback: Trump proposed the "most-favored nation" plan for Medicare in his first term, but it was halted by a federal court after drugmakers sued.

How it works: The idea of MFN is to tie U.S. drug prices to the generally lower prices paid abroad, typically in government-run health systems.

• It runs counter to free-market orthodoxy but could be hard for Republican lawmakers to refuse with Trump applying pressure.

State of play: The White House earlier this month pressed Congress to add the MFN idea to ongoing Medicaid negotiations, complicating efforts to craft a reconciliation package and raising alarm in the pharmaceutical industry.

• The trade group PhRMA says MFN is a form of government price-setting that could have spillover effects to multiple federal health programs.
• Trump in April signed a separate executive order addressing drug costs that also revived a number of ideas from his first term, including encouraging state plans to import drugs and providing discounted insulin through federally qualified health centers.
• Trump at that time endorsed a pharmaceutical industry-backed change to Medicare drug price negotiations.

What they're saying: "This Foreign First Pricing scheme is a bad deal for American patients," Stephen Ubl, president and CEO of the trade group PhRMA, said in an emailed statement Sunday evening.

• "Importing foreign prices will cut billions of dollars from Medicare with no guarantee that it helps patients or improves their access to medicines," Ubl added.
• "It jeopardizes the hundreds of billions our member companies are planning to invest in America, making us more reliant on China for innovative medicines."

Between the lines: The president has a long history in his first term of talking bigger on drug pricing than what his policies would actually do," wrote Raymond James analyst Chris Meekins, adding that the more grandiose Trump's executive actions, the more likely they'll be successfully challenged in court.

Go deeper: Out-of-pocket drug spending hit $98B in 2024: report

Editor's note: This article has been updated with new details throughout.

The Food and Drug Administration on Thursday said it would begin phasing out animal testing requirements for antibody therapies and other drugs and move toward AI-based models and other tools it deems "human-relevant."

Why it matters: The agency is trying to reaffirm its role as a leader in modern regulatory science amid DOGE-directed cuts that have rattled drug developers and investors and stoked concerns about timely product reviews.

Driving the news: The FDA said it would launch a pilot program over the next year allowing select developers of monoclonal antibodies to use a primarily non-animal-based testing strategy.

• Commissioner Marty Makary in a statement said the shift would improve drug safety, lower research and development costs and address ethical concerns about animal experimentation.
• "This initiative marks a paradigm shift in drug evaluation and holds promise to accelerate cures and meaningful treatments for Americans while reducing animal use," Makary said.

Zoom in: FDA said its roadmap envisions using computer modeling and AI to predict a drug's behavior and possible side effects, through software simulations of how a monoclonal antibody distributes through the human body.

• It also will promote the use of lab-grown human "organoids" and "organ-on-a-chip" technology that mimic the liver, heart, and immune organs to test drug safety and reveal possible toxic effects that can go undetected in animals.
• Officials said companies that submit strong safety data from non-animal tests may receive streamlined product reviews. And the FDA will begin using safety data from other countries with comparable regulatory standards to help determine a drug's efficacy.

What they're saying: "The initiative combines deregulatory themes and cutting-edge technology — all in service of the broadly popular goal of reducing animal testing," TD Cowen analyst Rick Weissenstein wrote in a note.

• PETA said the new policies were "a significant step" towards replacing the use of animals, including vaccine and other testing on monkeys at federally-funded primate centers.
• Some health tech stocks rose on the news, including Certara Inc., a maker of biosimulation software. Animal testing firms Inotiv and Charles River Laboratories fell in after-hours trading.
• PhRMA, the drug industry trade group, didn't immediately respond to a request for comment.

Five years after the COVID pandemic began, its legacy is as much political as epidemiological, according to a comprehensive new Axios-Ipsos poll, with Americans' views of what happened cleaved by partisanship and media preferences.

The big picture: 39% say they know someone who died. Everybody wants to leave the era behind. Yet two-thirds of Americans don't believe the nation is adequately prepared to deal with another pandemic or widespread health crisis, according to the Axios-Ipsos American Health Index.

• Trust in public health institutions and leaders divided, declined and never fully recovered.
• Today, just 31% of Americans (67% of Republicans, 7% of Democrats, 22% of independents) say they trust President Trump for information about health topics. Trust in Health and Human Services Secretary Robert F. Kennedy Jr. is equally low.
• Dr. Anthony Fauci, the prominent former director of the National Institute of Allergy and Infectious Diseases who became a political target during the pandemic, today is trusted by nearly three-fourths of Democrats and half of independents but only about 1 in 10 Republicans.
• Since the election, Republicans have driven some uptick of support for federal health agencies and public health measures.

Why it matters: "We definitely see how the politicization of the COVID epidemic is still echoing through society," said Ipsos pollster and senior vice president Chris Jackson.

• The difference primarily is in the attitudes of Republicans, Jackson said of societal shifts reflected in the data. These patterns, he said, may seep over into emerging public health challenges, including a resurgence of measles.
• "You can see the seeds of the same phenomenon we saw in 2020 and 2021," Jackson said. "If these institutions get caught in the political crosshairs, their reputations suffer."

By the numbers: Nearly two-thirds believe shutdowns in early 2020 were necessary to save lives. But 56% say they caused unnecessary damage to the economy. Now consider this:

• Just 24% of those who identified their primary source of media as a conservative outlet, including Fox News, said the shutdowns were necessary, compared with 81% whose primary source of media was broadcast TV news, and 88% whose primary source was national newspapers, CNN or MSNBC.
• 90% of those who gravitated to conservative media said the shutdowns caused unnecessary economic damage, while only 52% of broadcast watchers and 23% of those who turned to national newspapers, CNN or MSNBC agreed.

Majorities of Americans still trust the Centers for Disease Control and Prevention (62% overall, 42% Republicans, 86% Democrats) and the National Institutes of Health (57% overall, 40% Republicans, 77% Democrats) — and say the government should keep funding COVID monitoring and prevention measures.

• But more than half (53%) believe public health officials lied to the public about how effective vaccines and masks were at preventing the virus' spread, with Republicans far outnumbering Democrats and independents.

Between the lines: 84% say they believe COVID has changed Americans' lives forever.

• Yet when it comes to their own experience, 7 in 10 said the virus had no lasting impact on their physical or mental health, work/life balance, professional success, ability to pay bills or their family's ability to thrive.
• About one-third said the pandemic experience made them rethink their politics and caused them to get more politically engaged.
• Women, people under 30 and self-described Democrats tended to fare worse in terms of mental health and their finances.

State of play: A minority of Americans who tend to be older and Democratic-leaning stay current on boosters and track the spread not only of COVID but other infectious diseases.

• But for most people, the perception began to shift in the second half of 2022, about a year after the deadly Delta wave, as people began venturing out and returning to their pre-COVID routines.
• Concern about COVID fell about 20 percentage points over 2022 and vaccine uptake began to plummet early in 2023. By the spring of 2023, diners were again packing bars and restaurants, gym memberships were hot again and tours by Taylor Swift and Beyoncé were filling stadiums.
• Now, just 17% of adults report receiving a COVID booster in the last three months, and fewer members of the public see COVID as a threat than the risk of unsafe chemicals or additives in food.
• More than 4 in 10 believe the only people dying from the virus are already sick or unhealthy.

But the COVID experience, and the politicization of science that characterized the past five years, still is influencing opinion.

• Trust in the government is down, and most Americans say it doesn't make the health and well-being of the public a priority.
• About a third of the population thinks getting a COVID booster poses a large or moderate risk to their well-being — about the same on the threat scale as air and water pollution.
• And we're divided on whether health care workers should be required to be vaccinated against COVID, with 47% supporting the idea and 42% opposed.

Roughly the same number think the government should be focused on healthy foods, lifestyles and disease prevention (41%) as on research to develop drugs and treatments for disease (38%).

• But more than 7 in 10 oppose ending vaccine requirements for children to attend public schools. And 55% are against preventing the CDC from showing ads encouraging people to get certain vaccines.

Methodology: This Axios/Ipsos Poll was conducted Feb. 28-March 3, 2025, by Ipsos' KnowledgePanel®. This poll is based on a nationally representative probability sample of 1,066 general population adults age 18 or older.

• The margin of sampling error is ±3.2 percentage points at the 95% confidence level, for results based on the entire sample of adults.

In nearly three weeks as Health and Human Services secretary, Robert F. Kennedy Jr. certainly hasn't allayed concerns that he'll bring his vaccine criticism — most if not all of it unfounded — into his role as the nation's top health care official.

Why it matters: Several of Kennedy's vaccine-related actions have stoked fears that the anti-vaccine movement has gained a powerful foothold within the federal government in the midst of a worsening measles outbreak in Texas, one of the worst flu seasons in more than a decade and a circulating bird flu virus that has pandemic potential.

Driving the news: Kennedy drew attention last week during a Cabinet meeting, when he described measles outbreaks as "not unusual" after one now hitting west Texas and New Mexico resulted in the first U.S. death from the virus since 2015 and almost half of the cases seen last year.

• He then wrote in a Fox News op-ed over the weekend that vaccines protect individuals and communities from the disease but also that "all parents should consult with their healthcare providers to understand their options to get the MMR vaccine," and that "[t]he decision to vaccinate is a personal one."

The lukewarm support for measles vaccines came after a tumultuous few weeks in vaccine policy, including the Food and Drug Administration's cancellation of a March 13 meeting of a federal advisory panel to discuss the composition of next season's flu shot.

• Earlier this month, a Centers of Disease Control and Prevention advisory panel on vaccines was told that a February meeting on updating vaccination guidelines had been postponed indefinitely.
• The administration is also reviewing whether to pull $590 million in funding that Moderna received in the final days of the Biden administration to develop an mRNA vaccine for bird flu, reportedly as part of a bigger examination of spending on mRNA-based shots.
• "In isolation each of these actions have their own tolerable explanation, but taken collectively they raise the specter that RFK's trial-lawyer antipathy to any and all vaccinations continues to reign supreme," a person who worked on Kennedy's confirmation told Axios.

The big picture: Everything could still turn out fine, and the U.S. may resume business as usual when it comes to vaccines after a bumpy transition period. But it's hard to ignore the series of unusual vaccine-related decisions made over the last couple of weeks against the backdrop of Kennedy's decades of anti-vaccine activism prior to his government role.

• Kennedy said during his confirmation hearing that he wouldn't take away people's vaccines, but didn't disavow past anti-vaccine statements.
• The Trump administration clearly relishes disruptions to the status quo. It's plausible that these past few weeks are just the beginning of a brand-new, less transparent approach to vaccine policy under Kennedy's leadership — an approach that deeply alarms scientists and public health experts.

Kennedy's actions so far are "significant things, and I think it's just the tip of the iceberg," said Richard Hughes, a professor of vaccine law at George Washington University and a partner at Epstein, Becker & Green.

• "This is a man who was one of the most pivotal leaders in the anti-vaccine movement," he added. "It's not like he woke up one day and said, 'You know what, I feel different about vaccines.'"

The other side: "RFK has a mandate, under the MAHA movement, to allow for all of science to be critiqued and challenged," said David Mansdoerfer, a former senior HHS official in the first Trump administration.

• "These actions don't represent the rise of an anti-vaccine movement, they instead represent a return to science being able [to be] rigorously discussed in the public square," he said.

What they're saying: Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia and a member of the FDA's advisory committee, told Axios that the cancellation or postponement of meetings, combined with recent workforce reductions at health agencies, reflects "just a gradual sort of dismembering of the public health service."

• Offit said he didn't know the reasoning behind cancellation of the meeting on flu vaccine but that HHS officials said that they are going to make the decision about the vaccine internally within the FDA.
• "The irony to me is that Robert F Kennedy Jr. talks endlessly about transparency, and now you have meetings being canceled and decisions being made behind closed doors," Offit said.

Some advocacy groups were especially alarmed at the cancellation of the flu vaccine discussions, considering the severity of the current flu season and possibly delays formulating next year's shots.

• "Cancelling essential health advisory committee meetings without promptly rescheduling them is appalling," said Public Citizen Health Research Group director Robert Steinbrook.

Officials haven't said why the advisory panel's meeting on flu vaccines was canceled, but an HHS spokesperson said the FDA will "make public its recommendations to manufacturers in time for updated vaccines to be available for the 2025-2026 influenza season."

• HHS and CDC said in identical statements that the meeting on updating vaccination guidelines for infectious diseases was postponed "to accommodate public comment in advance of the meeting," adding that advisory working groups had met as scheduled.
• Addressing the review of federal funding of mRNA vaccines, an HHS spokesperson told Axios: "While it is crucial that the U.S. Department and Health and Human Services support pandemic preparedness, four years of the Biden administration's failed oversight have made it necessary to review agreements for vaccine production."

What to watch: Kennedy has considerable discretion to put his stamp on vaccine policy, drug approvals and any number of other issues.

• Some critics expect more requests for vaccine safety data and the appointment of like-minded individuals to advisory panels that could influence coverage of drugs, services and devices.
• His leadership could also result in a shift of federal health funding to chronic disease or unproven cures, and away from infectious diseases.

Tina Reed contributed to this story.

The National Institutes of Health sent shockwaves through academic research circles late Friday, saying it will dramatically cut the rate it pays for universities' administration and overhead costs to save the government more than $4 billion.

Why it matters: The reductions will particularly hit elite institutions including Harvard, Yale and Johns Hopkins and fulfill a long-sought conservative goal that was included in the Project 2025 blueprint.

• Trump proposed a similar change during his first term, but Congress didn't act. Project 2025 says the reimbursements "cross-subsidize leftist agendas" and that universities use the funds to pay for diversity, equity and inclusion efforts.

Driving the news: NIH, as of Monday, will cap the indirect cost rate on all new and current grants at 15% of the total cost. Reimbursements vary by institution and have averaged between 27% and 28%, with some receiving more than 50%.

• It noted Harvard, Yale and Johns Hopkins each received more than 60%.
• The agency said in a post on X that $9 billion of the $35 billion that it granted for research in fiscal 2023 was used for administrative overhead, as opposed to direct research.
• The reimbursements can be used to cover the cost of lab space, data processing, safety measures for human subjects and to pay support staff, per the Association of American Universities.

What they're saying: "The United States should have the best medical research in the world. It is accordingly vital to ensure that as many funds as possible go towards direct scientific research costs rather than administrative overhead," the agency said in announcing the change.

• But academic research interests predicted the cuts will slow medical breakthroughs, including treatments for cancer and chronic diseases like diabetes and heart disease.
• The reductions "represent the federal government stepping back from commitments it has made to world-leading researchers," said Mark Becker, president of the Association of Public and Land-Grant Universities. 
• "This action will slow advances for millions of patients who desperately need critical breakthroughs and imperil the U.S.'s position as the world leader in biomedical innovation," he said.

A senior Democrat in Congress, Sen. Patty Murray (D-Wash.), said the move was illegal because annual spending bills prohibit modifications to NIH's indirect costs.

• She said the move would shift costs to states that can't afford to pay the difference.

Context: President Trump's early actions on federal health agencies included temporarily freezing NIH grant reviews and rescinding job offers.

• NIH has become a frequent target of conservatives, with lawmakers proposing a major overhaul that would include new oversight of research and additional reviews of the process for awarding grants to universities.

Dozens of newly confirmed cases of avian influenza in wild birds and the first verified U.S. case of a new strain of the virus are raising concern the bird flu crisis may be entering a troubling new phase.

Why it matters: While the developments don't necessarily raise the risk of a pandemic, they could create more havoc for farmers, exacerbate egg shortages and expose more gaps in government disease surveillance.

• The outbreak is intensifying as the Trump administration maintains a pause on most external federal health agency communications, including publication of CDC's Morbidity and Mortality Weekly Report (MMWR), a venerable source of scientific reports on public health.

Driving the news: The Department of Agriculture last week confirmed 81 detections of highly pathogenic avian flu in wild birds collected across 24 states between Dec. 29 and Jan. 17.

• Wild birds can be infected and show no signs of illness, allowing them to spread the virus to new areas and potentially expose domestic poultry.
• Officials in Pennsylvania and New York have culled thousands of wild geese, as well as commercial poultry flocks, after detecting cases of flu.

What they're saying: "If you look at what's happened the last eight weeks, the number of poultry operations that have gone down — and more recently, the duck operations — is absolutely stunning," Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota told Axios.

• The virus is being spread as wild birds comingle with birds in commercial poultry operations.
• Changes in migratory patterns may be worsening the issue in northern states, which now see certain wild birds stay for the winter because water sources aren't freezing, Osterholm said.

"There is a lot of H5N1 out there. And we're going to see more cases in humans," he said.

• But "they're going to be single, isolated cases," he said.

The intrigue: A new strain of avian flu called H5N9 was recently identified on a duck farm in California that had an outbreak of the more common H5N1 flu last fall.

• The new type is a sign that two or more viruses could be infecting the same animal and swapping genetic material. Ducks make good hosts for what scientists call "reassortment" because they aren't badly sickened by many types of avian flu.
• About 119,000 birds on the farm were euthanized following the discovery.

Such mutations, in and of themselves, may not pose a greater threat to human health.

• The H5N9 strain originated in China and is itself a mix of several other strains. It isn't thought to be more of a threat to humans than the H5N1 strain that's widely circulating in U.S. poultry, cattle and wild birds.
• But its presence could become a major problem if there was a reassortment between avian flu and a seasonal human flu, Richard Webby, director of the World Health Organization's Collaborating Center for Studies on the Ecology of Influenza, told the Los Angeles Times.
• That combination could result in a virus that is more easily transmitted between people.

Catch up quick: The bird flu crisis has struck 113 flocks in the past 30 days, affecting more than 19 million birds, per USDA. It's also been confirmed in 943 dairy herds, the vast majority in California.

• The Trump administration hasn't publicly outlined steps it's taken yet to address the spread. HHS didn't respond to a request for comment.
• HHS Secretary-designate Robert F Kennedy Jr. said he intended to "devote the appropriate resources to preventing pandemics" during confirmation hearings this week, leading some Democratic senators to point to past statements he made about giving infectious disease research "a break."

Between the lines: The partial blackout on health communications has effectively blocked publication of a pair of studies on bird flu, including one on whether veterinarians who treat cattle have been unknowingly infected by the virus, KFF Health News reported.

• The other report looked at whether people carrying the virus might have infected domestic cats.
• The reports were due to appear in the MMWR, which hasn't published since January 16 and is subject to the pause ordered by acting HHS Secretary Dorothy Fink to allow the new administration to set up a process for review and prioritization.

The communications freeze has been met with outrage in some medical and science circles. "This idea that science cannot continue until there's a political lens over it is unprecedented," Anne Schuchat, a former principal deputy director at the CDC, told KFF Health News.

• There's a lot of uncertainty around whether the administration is merely pausing communication or making a wholesale change in how the agency functions, Patrick Jackson, a UVA Health infectious diseases expert, said on a call with reporters Friday.
• "Frankly, getting CDC up and running at full speed is going to be essential to keep track of avian influenza," he said.

The Supreme Court on Friday agreed to review a challenge to the Affordable Care Act's requirement that insurers cover certain recommended preventive services at no cost.

Why it matters: Eliminating the requirement could limit access to services like cancer screenings, preventive medications for heart disease, behavioral health counseling and HIV drugs known as PrEP.

• The timing of the high court review puts the legal defense of the ACA mandate in the hands of the incoming Trump administration.

Zoom in: The case takes up whether the coverage requirement, based on the recommendations of the U.S. Preventive Services Task Force, is invalid because the panel lacked authority since its members weren't Senate-confirmed.

• Two Christian-owned companies and several individuals sued the federal government on religious freedom grounds in 2020 over the requirement that their employer-sponsored insurance cover no-cost preventive medicines for HIV.
• A federal judge in Texas in 2022 ruled in favor of the plaintiffs and blocked the government from requiring insurers to provide free coverage of recommended services.
• The 5th U.S. Circuit Court of Appeals last year agreed with some of the arguments but overturned the nationwide injunction, only blocking the requirement for the companies and individuals who brought the case.

The Biden administration and the challengers each asked the Supreme Court to review that mixed ruling. The administration argued it called into question insurers' legal duty to cover task force recommendations without cost-sharing.

• Allowing employers to exclude PrEP over religious objections could open the door to objections over other covered services, including vaccines, KFF has noted.

President-elect Trump told Time magazine he will ensure the FDA will not block access to abortion pills on his watch, the first time he has made such a commitment.

Why it matters: Medication abortions account for nearly two-thirds of all abortions nationwide. Anti-abortion groups and some Trump allies see limiting access to abortion pill mifepristone as a top priority in the new term — but, for now at least, Trump does not.

What he's saying: In the interview accompanying his Person of the Year designation, Trump said he had been "against stopping" the abortion pill during his campaign and that it was "very unlikely" he would do anything to restrict access.

• However, Trump initially declined to take a firm stand, saying that while it was "100% unlikely" he would do anything to limit access, he knew people felt "really strongly both ways" and would look into the issue at a later date.
• However, pressed on whether he would ensure the FDA does not strip access, Trump finally said: "That would be my commitment."

Context: The Supreme Court in June turned away a challenge to the FDA's guidelines for accessing the commonly used abortion pill mifepristone, saying a group of doctors who oppose abortion and brought the case couldn't show they were directly injured.

• While that ruling preserved access to the pills, several conservative-led states are continuing to challenge FDA rules that expanded access to the pill.
• Anti-abortion advocates have urged the next administration to broadly interpret the 1873 Comstock Act, which banned the interstate mailing of "obscene" material like pornography, as well as abortion drugs and contraception.
• The Biden Justice Department issued a legal memo saying Comstock didn't prohibit the lawful mailing of abortion drugs, but the memo could be rescinded.

More from the interview:

• Trump open to detaining immigrants in camps
• Trump insists Elon Musk will put country before his companies
• Trump says his daughter-in-law and children could carry on political dynasty

The public trusts Anthony Fauci more than President-elect Trump and his incoming health team as a source of medical information, according to the latest Axios-Ipsos American Health Index.

• But Robert F. Kennedy Jr.'s focus on safe food and nutrition clearly resonates with many Americans, who see chemicals and unsafe additives as a bigger health risk than climate change or infectious diseases.

The big picture: Our first polling since the election shows most Americans are happy with their ability to get quality health care or foods, but there's continued dissatisfaction with out-of-pocket costs for health care.

• 84% of the public report their own emotional well-being is very or somewhat good.
• Only about a third think the government puts the public's health and well-being first, or that America is adequately prepared to deal with another pandemic.

There's lingering dissatisfaction with health industries: 59% support banning TV pharma ads and 64% want insurers to cover prescription weight-loss drugs like Ozempic and Wegovy — up 3 percentage points from when we asked the question in August.

Between the lines: Members of the incoming Trump administration won't be entering office with widespread public trust.

• 60% or more of respondents say the have at least a fair amount of trust in information from the Food and Drug Administration, Centers for Disease Control and Prevention or National Institutes of Health. And 45% report trusting information from Fauci.
• Fewer say they have the same amount of trust in information on health topics from Trump (32%), Kennedy (30%), Elon Musk (25%), Mehmet Oz (23%) or others Trump has nominated to lead federal health agencies.

"A lot of Trump's health picks aren't well-known, so they're not trusted, but even Donald Trump hasn't seen a resurgence in public views of his credibility on public health since COVID," said Ipsos pollster and senior vice president Chris Jackson.

• There are significant partisan splits, with nearly 7 in 10 Republicans saying they trust Trump, while just 7% of Democrats do.
• And as we saw during the pandemic, independents tend to side with Democrats on the trust issue: Even now, 45% of independents say they trust Fauci, though his rating has fallen since the height of COVID.

Friction point: Kennedy, Trump's pick for Health and Human Services secretary, has struck a chord with his focus on food and nutrition. Some of that is linked to concern with obesity, which continues to rank as the top overall health threat, ahead of poor mental health and opioids and fentanyl.

• But support for his other positions is low. Just over a quarter of the public (29%) supports removing fluoride from water supplies. About 1 in 5 (18%) back ending vaccine requirements for attending public schools. One quarter (24%) support firing science staff at the FDA and NIH. And 1 in 5 (19%) would reduce testing requirements before allowing new drugs or therapies to be sold to the public.
• "RFK Jr.'s focus on safe foods goes over well with the public. He's also in the majority with his hostility to the health care industry," Jackson said.
• "But as you get to some of his other views on public health — removing fluoride, ending vaccine requirements for kids, firing research and science staff at health agencies — only a small minority support any of the non-nutrition health things he's calling for," Jackson said.

The survey shows the public still sees a significant role for government in health care.

• Presented with a choice between Musk's and Kennedy's positions, 60% support increasing food safety inspections to 37% cutting federal spending by $2 trillion.
• Majorities want to see public health programs strengthened, including 72% for food safety inspections, 71% for the Veterans Health Administration, 64% for Medicare, 57% for the CDC and 54% for Medicaid.
• 73% say the Affordable Care Act should be strengthened or left as it is.

Methodology: This Axios/Ipsos Poll was conducted Dec. 6-9 by Ipsos' KnowledgePanel®. This poll is based on a nationally representative probability sample of 1,002 general population adults age 18 or older.

• The margin of sampling error is ±3.3 percentage points at the 95% confidence level, for results based on the entire sample of adults.

Robert F. Kennedy Jr. could use Health and Human Services' vast bureaucracy to put a distinct stamp on vaccine policy, drug approvals and food regulation if he's confirmed. But with so many legal requirements and bureaucratic layers baked into the process, it's hardly a foregone conclusion he will.

Why it matters: Experts say RFK Jr.'s public calls for more transparency and vows to shore up the trustworthiness of federal health agencies may translate into more requests for vaccine safety data and into appointing like-minded individuals to advisory panels that could influence coverage of drugs, services and devices.

• They also say it could result in shifting public health funding to chronic disease or environmental health and away from infectious disease, or a diversion of federal investment to study unproven health issues instead of known risks.
• And they're expecting attempts to remove job protections from career federal employees who work in policymaking roles and reduce the ranks of officials who don't align with RFK Jr.'s goals.

Between the lines: In the near term, he's likely to focus on how much influence he might exert on negotiations between the Food and Drug Administration and the health industries it regulates over user fees for companies, which fund a significant portion of the FDA's operations.

• Talks to reauthorize programs for prescription drugs, medical devices and generics are due to start next year and could provide a crucible for Trump appointees to take aim at what they describe as regulators' coziness with industries they police.
• The spotlight could fall especially hard on vaccines, based on Kennedy's criticisms of the federal pandemic response, his calls to revoke emergency use authorizations for COVID shots and his advocacy of hydroxychloroquine and ivermectin, both of which were found ineffective for treating the virus.

The general thinking is RFK Jr. could have more openings to exert his influence through the Centers for Disease Control and Prevention than the FDA, which is tightly bound by the Food, Drug and Cosmetic Act.

• He also stack outside advisory panels like the CDC's Advisory Committee on Immunization Practices, or ACIP, with fellow vaccine skeptics.
• ACIP recommendations influence whether Medicare covers a vaccine at no cost to patients. State Medicaid programs have to cover recommended adult vaccines.
• "They have the ability to change the bylaws or the charters under which those committees run, and essentially have the ability to ignore the committees or disband it entirely if they felt like they needed to," Joshua Michaud, associate director of global health and HIV policy at KFF.

Zoom in: RFK Jr., with the help of Congress, could also seek to make changes to the National Vaccine Injury Compensation Program, which dates to the 1980s and gives vaccine makers legal immunity for any injuries caused by their products, in exchange for a 75-cent tax on each dose sold.

• The program drew criticism from the right during the pandemic, when makers of COVID-19 vaccines were not required to pay the tax because the shots were designated as "countermeasures."
• "We've never had an HHS secretary who wants to blow up the nation's immunization system. So there are questions here that haven't come up before," said Sara Rosenbaum, who served on ACIP between 2009 and 2013.

Zoom out: The HHS secretary still has a great deal of authority at the FDA.

• "The Secretary's role doesn't have to be just routinely sign off on things," said Richard Besser, former acting director for the CDC from January to June 2009 and current CEO of the Robert Wood Johnson Foundation.

Flashback: In the Obama administration, HHS Secretary Kathleen Sebelius made an unprecedented decision to override an FDA decision that would have made emergency contraceptives available over the counter, Besser pointed out. (The decision was later reversed in 2013.)

• "And Mr. Kennedy as the secretary has some strong feelings about what drugs are effective and which ones are not, and what things should be used to promote health," Besser said.

Reality check: HHS's budget and legal mandates are determined by Congress and have limits. Any major regulatory changes must go through public comment periods and comprehensive legal review.

• They would also certainly be subject to lawsuits, particularly after the fall of the Chevron doctrine.

What to watch: There's a question about whether HHS could usurp school vaccine requirements using section 361 of the Public Health Service Act of 1944, which gives it the authority to "control communicable diseases."

• "The answer is not entirely straightforward and would set off legal challenges," Richard Hughes of Epstein Becker Green wrote.

Regardless, experts say some of the most significant effects of an RFK-led HHS may be how health guidance and evidence-based information, including about vaccines, are communicated.

• "If the CDC and the HHS secretary are out there saying we have doubts about the safety of this vaccine ... that might have some downstream effects at the state and local level, which is where those vaccine requirement decisions are actually made," Michaud said.