A longtime leader of the anti-vaccine movement. A highly credentialed surgeon. A seven-term member of Congress. A Fox News contributor with her own line of vitamins.

President-elect Donald Trump’s eclectic roster of figures to lead federal health agencies is almost complete — and with it, his vision for a sweeping overhaul is coming into focus.

Trump’s choices have varying backgrounds and public health views. But they have all pushed back against COVID policies or supported ideas that are outside the medical mainstream, including an opposition to vaccines. Together, they are a clear repudiation of business as usual.

“What they’re saying when they make these appointments is that we don’t trust the people who are there,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an adviser to the Food and Drug Administration.

Some doctors and scientists are bracing themselves for the gutting of public health agencies, a loss of scientific expertise and the injection of politics into realms once reserved for academics. The result, they fear, could be worse health outcomes, more preventable deaths and a reduced ability to respond to looming health threats, like the next pandemic. “I’m very, very worried about the way that this all plays out,” Offit said.

But other experts who expressed concerns about anti-vaccine views at the helms of the nation’s health agencies said that some elements of the picks’ unorthodox approaches were welcomed.

After a pandemic that closed schools across the country and killed more than 1 million Americans, many people have lost faith in science and medicine, surveys show. And even some prominent public health experts were critical of the agencies’ COVID missteps and muddled messaging on masks and testing.

“We are playing with fire with the shake-ups and choices, but at this point change is needed,” said Dr. Michael Mina, an epidemiologist and former Harvard professor. He said the agencies were often too slow and bureaucratic, and their leaders too unwilling to engage with the public’s concerns. “At least there’s a better chance of positive change compared to complacency and more of the same,” he said.

One thing seems certain: It will not be more of the same.

In the final months of Trump’s campaign, he brought Robert F. Kennedy Jr. aboard with the message that a total remake of the nation’s public health system was the only way, as Kennedy’s own presidential campaign slogan put it, to “Make America Healthy Again.”

Less than two weeks after the election, Kennedy was tapped to lead the Health and Human Services Department, a sprawling federal agency that includes the Centers for Disease Control and Prevention, the FDA and the National Institutes of Health, and also oversees Medicare and Medicaid.

Kennedy, an environmental lawyer, has a long track record of spreading falsehoods about vaccines and using his nonprofit, Children’s Health Defense, to promote a database of misleading interpretations of research data.

He once asserted publicly that “there’s no vaccine that is, you know, safe and effective.”

He was Trump’s first public health pick, and experts said he remains his most dangerous one.

Kennedy “is just in a category by himself,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, Rhode Island. “RFK Jr. just willfully disregards existing evidence, relies on talking points that have been consistently debunked.”

If confirmed by the Senate, Kennedy would oversee the agencies that regulate vaccines and set national vaccine policy — and the heads of those agencies would report to him. “He will have enormous influence,” said Dr. Ashish Jha, dean of the Brown University School of Public Health, who oversaw the Biden administration’s response to the coronavirus pandemic.

Dr. David Weldon, Trump’s pick to lead the CDC, has also promoted anti-vaccine views. An internist by training, Weldon served seven terms in Congress, representing Florida’s 15th District, near Tampa, before returning to his medical practice.

While in Congress, Weldon was known for pushing the false notion that thimerosal, a preservative compound in some vaccines, had caused an explosion of autism cases.

“The notion that this man who held a series of false beliefs about science and medicine could rise to the position where he would head the CDC is in some sense frightening,” Offit said.

Weldon also introduced a “vaccine safety bill” in 2007 that aimed to relocate most vaccine safety research from the CDC to a separate agency within the Health and Human Services Department. The bill did not advance out of committee. The question is whether Weldon will bring similar aspirations with him back to Washington, persuading Congress to narrow the reach of his own agency.

Some of the most extreme anti-vaccine policies, such as an outright ban on certain shots, would be difficult, if not impossible, to put in place, experts said. And pharmaceutical companies are poised to push back — hard — on any policies that would threaten their vaccine business.

Trump’s choice for FDA commissioner, Dr. Martin Makary — a pancreatic surgeon at the Johns Hopkins School of Medicine in Baltimore — has been broadly supportive of childhood vaccines. But he has questioned the benefits of certain shots, including the hepatitis B vaccine for newborns and a third COVID booster shot for healthy children. “I think there are questions that we can ask that have been taboo to ask,” he told The Wall Street Journal.

If confirmed, he would direct the agency that approves new flu and COVID vaccines each year and monitors reports about vaccine side effects.

Makary has become known — in opinion articles and on podcasts and spots on Fox News — for critiquing vaccine mandates and many other parts of U.S. COVID policies, and for arguing that doctors have underestimated natural immunity.

Nuzzo, who was once a colleague of Makary’s at Johns Hopkins, said that while she disagreed with some of his views, she believed that he was qualified for the position.

“I believe Marty is a man of science,” she said. “I think he will look at the scientific evidence carefully and interpret it using the training and skills that he has.”

But how much Makary would be able to separate himself from Kennedy remains an open question. “How does he withstand the pressure of an HHS secretary who fundamentally doesn’t believe in modern medicine?” Jha asked.

Trump’s pick for surgeon general is Dr. Janette Nesheiwat, a medical director of CityMD, a chain of urgent care centers. Nesheiwat, who is also a Fox News contributor, provided on-the-ground medical treatment after Hurricane Katrina and a 2011 tornado that struck Joplin, Missouri, according to a statement from Trump.

She was generally supportive of the COVID vaccines, calling them “a gift from God” in a 2021 opinion article for Fox News. But she has opposed COVID vaccine mandates and argued against the dismissal of soldiers who refused to be vaccinated.

Her upcoming book, “Beyond the Stethoscope: Miracles in Medicine,” shows the “transformative power of prayer,” according to a description on the publisher’s website. She also sells her own line of dietary supplements.

Nesheiwat’s sister Julia Nesheiwat was homeland security adviser in the first Trump administration and is married to Rep. Michael Waltz, R-Fla., Trump’s pick for national security adviser.

Surgeons general have historically had little power, but have tended to use their position to draw attention to their public health priorities. President Joe Biden’s surgeon general, Dr. Vivek Murthy, has lately warned about the dangers of social media.

“I feel pretty good about the appointment of the surgeon general,” said Dr. Peter Hotez, a vaccine expert at the Baylor School of Medicine in Houston. “I’ve spoken to her many times and texted her during the pandemic. She’s open-minded, thoughtful and is evidence-based.”

Although high-level staffing picks set the tone, what happens to the nation’s public health system will also depend on Trump administration decisions that are still to come.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said that he would be keeping a close eye on lower-level appointees — those who carry out the day-to-day work of these agencies. He is also especially concerned about the possibility that the administration will move to fire the federal scientists working as civil servants.

“Everything that we have so far points to some radical changes that are about to occur,” Osterholm said.

This article originally appeared in The New York Times.

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