By AMANDA SEITZ, MATTHEW PERRONE and JONEL ALECCIA

WASHINGTON (AP) — Robert F. Kennedy Jr.an anti-vaccine activist and environmentalist, for years earned a loyal and fierce audience with his scathing denunciations of how the nation’s public health authorities do business.

And that has put him on a direct collision course with some of the 80,000 scientists, researchers, doctors and other officials who work for the Department of Health and Human Services, particularly with President-elect Donald Trump taps him to lead the agency.

If confirmed, Kennedy will control the world’s largest public health agency and its $1.7 trillion budget.

The agency’s reach is enormous. It provides health insurance for nearly half the country – poor, disabled and elderly Americans. It oversees research into vaccines, diseases and cures. It regulates the medicines that are in medicine cabinets and inspects the foods that end up in the cabinets.

A look at Kennedy’s comments about some of the agencies that fall within the HHS arena, and how he’s said he plans to shake them up:

Food and Drug Administration

— “The FDA’s war on public health is about to end,” he wrote on X in late October. “If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Save your records and 2. Pack your bags.”

The FDA’s 18,000 employees include career scientists, researchers and inspectors responsible for the safety and effectiveness of prescription drugs, vaccines and other medical products. The agency also has broad oversight of a variety of consumer products, including cosmetics, electronic cigarettes and most foods.

HHS has legal authority to reorganize the agency without congressional approval to maintain the safety of food, drugs, medical devices, and other products.

And Kennedy has long criticized the FDA’s work on vaccines. During the covid-19 epidemic, his non-profit group, Children’s Health Defense, petitioned the FDA to stop the use of all covid vaccines. The group has argued that the FDA is beholden to “big pharma” because it gets much of its budget from industry fees and some employees who have left the agency have gone on to work for drugmakers.

His attacks have become more widespread, with Kennedy suggesting he will purge “entire departments” at the FDA, including the agency’s Food and Nutrition Center. The program is responsible for preventing foodborne illness, promoting health and wellness, reducing diet-related chronic diseases, and ensuring that chemicals in food are safe.

Last month, Kennedy threatened on social media to fire FDA employees for “aggressively suppressing” a host of unsubstantiated products and therapies, including stem cells, raw milk, psychedelics and discredited treatments from the covid era such as ivermectin and hydroxychloroquine.

In the case of hydroxychloroquine, for example, the agency stopped its emergency use after determining that it was not effective in treating covid and increased the risk of potentially fatal cardiac events.

Consuming raw milk has long been considered risky by the FDA because it contains a host of bacteria that can make people sick and has been linked to hundreds of disease outbreaks.

If confirmed, Kennedy could essentially overturn almost any FDA decision. There have been rare cases of such decisions in previous administrations. Under both George W. Bush and Barack Obama, HHS overruled FDA approval decisions on the availability of emergency contraception.

Winding down FDA regulations or revoking approval of long-standing vaccines and drugs would likely be more challenging. The FDA has lengthy requirements for removing drugs from the market, which are based on federal laws passed by Congress. If the process is not followed, drug manufacturers can file lawsuits that would have to work their way through the courts.

Centers for Disease Control and Prevention

— “On January 20, the Trump White House will advise all US water systems to remove fluoride from public water,” Kennedy wrote on social media in November.

The CDC’s fluoride guidance is just one recommendation the agency has made as part of its mission to protect Americans from disease outbreaks and threats to public health.

The agency has a core budget of $9.2 billion and more than 13,000 employees

Days before Trump’s victory, Kennedy said he would reverse the agency’s recommendations on fluoride in drinking water, which the CDC currently recommends is 0.7 milligrams per liter of water.

The recommendations have strengthened the teeth and reduced cavities with replaces minerals lost through normal wear and tear. Spotted tooth patterns have occurred with higher levels of fluoride, prompting the US government to lower its recommendations from 1.2 milligrams per liter of water in 2015.

Local and state agencies control water supplies, with some states requiring fluoride levels by state law.

Kennedy, who has said “there is no vaccine that is safe and effective,” would be responsible for the appointments to the committee of influential panel experts who help set vaccine recommendations for doctors and the public. These include polio and measles given to infants and toddlers to protect against debilitating diseases to vaccinations given to older adults to protect against threats such as shingles and bacterial pneumonia, and shots against more exotic dangers for international travelers or laboratory workers.

National Institutes of Health

— “We must act quickly,” Kennedy was reported to have said during a visit to Scottsdale, Arizona event over the weekend. “So on January 21, 600 people will enter offices at NIH and 600 people will leave.”

The agency’s $48 billion budget funds medical research into cancer, vaccines and other diseases through competitive grants to researchers at institutions across the country. The agency also conducts its own research with thousands of scientists working at NIH labs in Bethesda, Maryland.

Among advances supported by NIH money are an opioid addiction drug, a vaccine to prevent cervical cancer, numerous new cancer drugs, and the rapid development of mRNA COVID-19 vaccines.

Previous, Kennedy has criticized the NIH for not doing enough to study the role of vaccines in autism.

Kennedy wants half of the NIH budget to go to “preventive, alternative and holistic approaches to health.” he wrote in the Wall Street Journal in September. “In the current system, researchers don’t have enough incentive to study generic drugs and root cause therapies that look at things like diet.”

Kennedy wants to prevent the NIH from funding researchers with financial conflicts of interest, citing a 2019 ProPublica investigation which found that more than 8,000 federally funded health researchers reported significant conflicts such as taking stakes in biotech companies or licensing patents to pharmaceutical manufacturers.

Centers for Medicare and Medicaid Services

— “If a doctor’s patient has diabetes or obesity, the doctor should be able to say, I’m going to recommend gym memberships, and I’m going to recommend, good food, and Medicaid should be able to fund those things. the same as they would Ozempic,” Kennedy said during a town hall on Sept. 30 in Philadelphia.

Kennedy has not focused as much on the agency that spends more than $1.5 trillion annually to provide health care coverage for more than half the country through Medicaid, Medicare or the Affordable Care Act.

Even as Trump and other Republicans have threatened some of that coverage, Kennedy has remained mum.

Instead, he has been an outspoken opponent of Medicare or Medicaid covering expensive drugs developed to treat diabetes, such as Ozempic, now also sold for weight loss as Wegovy. These drugs are not widespread covered by both programsbut there is some bipartisan support in Congress to change that.