RFK Jr. Is One Vote Away from Becoming HHS Secretary

The Senate Finance committee today recommended Robert F. Kennedy Jr. to be the next secretary of the Department of Health and Human Services (HHS). The result was uncertain until the end, but Kennedy eventually prevailed in a 14-13 party-line vote.

Kennedy will face a full Senate vote in the near future. 

As HHS leader, Kennedy would oversee the Food and Drug Administration (FDA), the agency that regulates vapes and other consumer nicotine products through its Center for Tobacco Products. 

The HHS also controls the Centers for Disease Control and Prevention (CDC), the National Institutes for Health (NIH), and the Centers for Medicare and Medicaid Services (CMS). At HHS, Kennedy would manage an annual budget of over $1 trillion. 

President Donald Trump has nominated Dr. Martin Makary to lead the FDA. A pancreatic surgeon at Johns Hopkins Hospital, Makary’s views on vaping and nicotine are unknown. Trump’s FDA, CDC, and NIH nominees have not yet faced Senate confirmation hearings. 

The controversial nominee still faces an uncertain Senate vote

Since Trump announced in November he would nominate Kennedy to lead the HHS, Kennedy’s belief that vaccines are tied to rising autism rates has been in the spotlight, along with numerous statements Kennedy has made supporting offbeat theories about health issues being caused by wi-fi, antidepressants, and fluoride in water, among other things.

Kennedy, 70, was born into Democratic Party royalty as the son of former senator and Attorney General Robert F. Kennedy, and the nephew of President John F. Kennedy. His HHS nomination is opposed by many of the Kennedy clan, including his cousin Caroline, President Kennedy’s daughter and the former ambassador to Japan.

A longtime environmental activist and lawyer, RFK Jr. ran for President in 2024 as a Democrat and then as an independent. He eventually dropped out of the race and agreed to endorse Trump in exchange for a promise he would have influence on health, food and agricultural policy in a new Trump administration. Trump said he would let Kennedy “go wild” on health policy.

During his confirmation hearings in the Senate Finance and Health, Education, Labor and Pensions (HELP) committees, Kennedy fended off tough questioning about his long history of anti-vaccine activism and his support for abortion rights.

Republican Senator Bill Cassidy—a physician and chairman of the HELP committee—sparred with Kennedy over vaccine evidence, and Kennedy quoted a study funded by an anti-vaccine group to support his position. Cassidy expressed severe doubts about the nominee, noting he feared Kennedy would undermine faith in vaccines.

In the end, Cassidy voted in the Finance committee to recommend Kennedy. However, with a Republican Senate majority of 53-47, Kennedy will probably need at least 50 Republican votes to be confirmed (a 50-50 tie would be broken by Vice President JD Vance, serving as President of the Senate). Several GOP senators remain on the fence about supporting the controversial nominee.

Kennedy uses nicotine pouches, but his stance on vaping remains unknown

Kennedy’s beliefs and plans regarding nicotine product policies are unknown. As far as we can tell, he has made no public statements on the topic, and no related questions were asked at his confirmation hearings.

In responses to written questions posed by the Senate Finance committee, the nominee was non-committal, offering only generic answers intended to avoid any possible controversy:

• Question: Currently, there is no federal excise tax nor manufacturer user fee on e-cigarettes. Should there be one?

       Response: Congress sets federal tax policy and the Internal Revenue Service is responsible for 

       collecting taxes. If confirmed, I look forward to learning more from the FDA on their work as it 

       relates to e-cigarettes.

• Question: Do you believe that flavored nicotine products, especially flavored e-cigarettes, attract children to use these products?

       Response: If confirmed, I look forward to learning more from the FDA on this issue.

• Question: Should flavored e-cigarettes continue to be available for sale in the U.S.?

       Response: If confirmed, I look forward to learning more from the FDA on this issue.

• Question: How will you ensure that the FDA will continue to use the best scientific evidence to keep addictive and deadly products off the market?

       Response: If confirmed, I look forward to ensuring scientific integrity at all HHS sub-agencies.

However, Kennedy caused quite a kerfuffle when he was caught on camera using nicotine pouches during a hearing. 

Most observers identified the product Kennedy was using as pouch market-leader ZYN, which recently became the first nicotine pouch brand to be granted FDA marketing authorization. But the eagle-eyed staff at ALP—a new pouch manufacturer owned by conservative TV personality Tucker Carlson—bragged that the Trump nominee was using ALP pouches.

Kennedy hasn’t spoken publicly about his nicotine use, but the tempest created by his almost invisible pouch consumption was impressive. Social media buzzed with talk about his penchant for pouches, and the topic even made it into newspaper stories. 

In a florid New York Post op-ed, radiologist and well-known TV doctor Nicole Saphier berated Kennedy for “platforming” nicotine pouches at the hearings. Pouches, she said, are “a new form of addiction, wrapped in contemporary packaging and pushed by savvy youth-targeted media campaigns.”

Other observers suggested that Kennedy could be using the nicotine product as an off-label treatment for spasmodic dysphonia, the neurological condition he suffers from that causes involuntary spasms in the larynx muscles. There is some preliminary evidence that nicotine could reduce the symptoms of the condition, which causes Kennedy’s voice to sound strangled and halting.

Yet others thought the nominee was using nicotine to stay alert during the grueling questioning. Very few commenters seemed to consider that Kennedy might simply like nicotine.

In any case, without questions from the Senate panelists—probably because they, like me, didn’t notice the nominee’s stealthy pouch use—we don’t know why RFK Jr. uses nicotine, and we definitely don’t know what his policy positions on nicotine and vaping would be.

President Trump promised before the election that he would “save flavored vaping” if elected, but that promise, if acted upon, could take many forms.

If Kennedy is confirmed by the full Senate, we hope he will lead a health team that treats non-combusted nicotine as a legal product to be regulated fairly by the FDA, without favor shown to large campaign contributors like R.J. Reynolds.