So - it's RFK Jr.

Trump wants a vaccine skeptic to run the nation's health department. We're in uncharted waters.

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Two weeks ago, the co-chair of Donald Trump’s transition team went on national TV and pledged: Robert F. Kennedy Jr. wasn’t going to run the nation’s Health and Human Services department.

“He's not getting a job for HHS,” said Howard Lutnick, as CNN’s Kaitlan Collins pressed him. “He's not going to be the Secretary, no.”

Robert F. Kennedy Jr. got the job for HHS. He could soon be the Secretary of a nearly $2 trillion federal department that oversees everything from the Affordable Care Act to zoonotic diseases — if the Senate votes to confirm him, or if Trump finds a work-around.

My colleagues and I have been covering Kennedy’s rapid rise in TrumpWorld, as he went from a potential election spoiler three months ago to a key ally promised a big role overseeing food and health safety.

We’ve written about Kennedy’s “Make America Healthy Again” plan, his set of promises to tackle causes of chronic disease and childhood illness. And we’ve drilled down on some of his individual goals — Kennedy’s longtime criticism of vaccines and demands for more data, his newer opposition to fluoride in drinking water, and his push to change the nation’s food.

There’s now much, much more to write about Kennedy’s record, allies and agenda — and you’ll find that at The Washington Post in the days and weeks ahead.

In the meantime, I wanted to share a few thoughts that occurred to me as we were frantically writing and reporting on Thursday.

The big question: Will this nomination survive?

Kennedy needs 50 votes to be confirmed. It’s hard to see any Senate Democrats backing him, simply because of his vaccine views alone.

“Donald Trump’s selection of a notorious anti-vaxxer to lead HHS could not be more dangerous—this is cause for deep concern for every American.,” Sen. Patty Murray, a key Democratic leader, said in a statement. (Kennedy has repeatedly insisted that he is not against vaccines; he just has questions about them. But he keeps raising the same, debunked claims.)

So that likely means Kennedy can only lose three GOP votes. And it’s not hard to imagine who might oppose him. There are the few moderates — Sens. Lisa Murkowski and Susan Collins among them — who have broken with the pack before. There are a bunch of Republican senators who have ties to the pharma industry, which doesn’t want to see Kennedy leading HHS for a variety of reasons.¹

One person I was texting with on Thursday night even floated the idea of Sen. Mitch McConnell — having given up his Senate leadership position and unlikely to run again — voting against Kennedy as a late-career stand. (It’s true that McConnell, a polio survivor, has touted the benefits of the same vaccines that Kennedy has frequently questioned. He’s also sided with Trump, uh, more than a few times.)

One senator I’m particularly curious about is Sen. Bill Cassidy, a GOP physician who’s going to lead the Senate’s health committee next year.

He’s broken with the party before — he voted to impeach Trump — but is also up for reelection in 2026 so may feel pressure to support Trump’s cabinet picks.

Cassidy’s initial statement was noncommittal on Kennedy but praised his views on chronic disease; you can read Cassidy’s tweet and judge for yourself on whether this is teeing up support for Kennedy or skepticism about his conservative bona fides.

If there’s no path on the nomination, does Trump try to use a recess appointment?

The president-elect has put pressure on the Senate to allow him to avoid confirmation hearings for his Cabinet nominees, and simply install them in office for a limited time.

That might suit Kennedy — a guy who’s acknowledged that he’s got more than a few personal entanglements. Trump advisers had also predicted for weeks he might not want to go through a brutal Senate confirmation fight.

“I told my wife the other day, I said, ‘I got so many skeletons in my closet that if they could vote, I could be king of the world,’” Kennedy said at his presidential announcement last year.

There really are Democrats and independents who hear Kennedy’s message, particularly on food and disease, and are jazzed by it.

Colorado Gov. Jared Polis initially posted a tweet saying he was "excited" that Trump had chosen Kennedy, particularly because he’d declared war on Big Pharma and Big Food. (The Democratic governor and his team then walked back the enthusiastic support.)

Polis isn’t alone. I’ve heard from left-leaning voters who said that Kennedy’s pledge to tackle drivers of disease and unhealthy diets has resonated with them.

If Kennedy gets into HHS, and tries to make the big changes he's promised, does he get eaten by the bureaucracy?

Kennedy has never held a senior federal job. Now he’s been tapped to lead a sprawling, nearly $2 trillion agency with responsibility for regulating food and drugs … for responding to hurricanes and disease outbreaks … for taking custody of unaccompanied migrant kids on the border … the list goes on and on.

Even in relatively slow times, there is always some crisis consuming some part of the health department. That’s why advisers in both parties have said that the secret to running HHS is having executive experience — just look at the parade of past secretaries who have been governors, university presidents or both — and deputies who know how to navigate the agency.

It’s not clear yet what the rest of Kennedy’s team will look like, let alone how he’d balance the far-reaching goals of Make America Healthy Again with the daily demands of running an 80,000-person department.

There’s a long list of would-be reformers who came to Washington … and left with their agenda largely defeated by Washington.

Even if Kennedy can't accomplish his agenda, do many federal officials simply leave out of fear and frustration?

Kennedy says he wants many career officials at the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health to go.

His contention: they’ve been influenced by the industries they’re supposed to regulate, and they’re not doing their jobs. (The federal officials, of course, insist that Kennedy has it wrong, and they share the same goals of trying to make Americans healthier.) Trump also has promised to target career officials’ civil-service protections.

Installing Kennedy at the head of the department will drive some of those officials out the door willingly. Those departures might not immediately resonate with the average American. But…

If Kennedy is health secretary, and there's another major disease outbreak, what happens?

No, really — what happens?

Trump's last HHS secretary, Alex Azar, helped launch Operation Warp Speed to fight covid. That effort, and other parts of the pandemic response, involved career civil servants, many working nonstop in the early days as the virus menaced Americans.

Kennedy, meanwhile, once tweeted that "COVID shots are a crime against humanity."

So, again: what happens?

1. Kennedy could potentially undermine public confidence in the vaccines that drug companies make. He could also take small steps that complicate drug approvals, or pursue big swings to fight the industry’s power. All told, the pharma industry is pretty worried.