On a Friday night, a series of announcements revealed President-elect Donald Trump's selections for the United States' top health leadership positions. The choices include a New York family physician and Fox News medical contributor for Surgeon General, a Florida physician and former congressman for the CDC director, and a surgeon and researcher at Johns Hopkins for the FDA commissioner. Public health experts, former officials, and researchers, including ten who spoke with us, have begun to weigh in with praise, critiques, and questions about Trump's picks: Dr. Janette Nesheiwat for US Surgeon General, Dr. David Weldon for CDC Director, and Dr. Marty Makary for FDA Commissioner. Each nominee will face a Senate confirmation hearing.

Reasonable Choices and Federal Health Department Challenges

Several health experts consider Makary and Nesheiwat as reasonable choices who may be tested under a federal health department led by Robert F. Kennedy Jr., a well-known anti-vaccine conspiracy theorist, at the US Department of Health and Human Services. Concerns have also been raised about Weldon, Trump's pick to lead the CDC, who has a history of introducing legislation that would shift vaccine safety oversight away from the CDC and has repeatedly questioned the safety of vaccines that have been studied.

Keeping Politics Out of Science: A Key Challenge

A key challenge for all of Trump's new public health leaders, according to experts, will be to keep politics out of science. We reached out to Nesheiwat and Makary for comment but did not receive a response. Weldon could not be reached. In response to questions, Katie Miller, a spokesperson for the Trump transition, stated, "Mr. Kennedy is the right choice to lead HHS and put Americans back in charge of their health care, not corporations."

Handling Conflicts Between Science and Health Secretary's Desires

Dr. Ashish Jha, dean of Brown University’s School of Public Health and former White House Covid-19 response coordinator under President Joe Biden, said that one important question for senators to push each candidate on will be how they would handle a situation where recommendations from scientists at the CDC or the FDA conflict with what the health secretary wants. "It’s reasonable to disagree with people on health policy," Jha said. "There are people out there who are smart, who are well-trained, who believe in modern medicine, who come out differently than I do because they read data differently than I do. That is a very normal part of scientific discourse."

Makary and Nesheiwat as Open-Minded Physicians

Several experts who spoke with us generally described Makary and Nesheiwat as open-minded physicians who respect the scientific process, even if they disagree with some of their policies. Some said that could put them at odds with Kennedy, whom Trump has chosen for the nation's top health post as HHS secretary. "It’s very hard to defy your boss," Jha said. "There’s going to be an immense pressure on the CDC director, on the FDA commissioner, on all of these people. It’ll be very difficult for them to just make the decisions that are right for the health of the American people and not get swayed by someone who doesn’t understand evidence and data but has strongly held views."

Weldon's Partisan Past and Vaccine Concerns

Weldon's nomination for CDC director has garnered more hesitancy among experts due to his partisan past with vaccines. "While Drs. Makary and Nesheiwat seemingly lack experience in managing large organizations like the FDA and [the US Public Health Service], I believe they are competent physicians who will prioritize science-based decision-making," Dr. Jerome Adams, who served as surgeon general in the first Trump administration, said in an email. "However, beyond his own lack of experience with large organizations (and the CDC is a behemoth), I have concerns about Dr. Weldon’s past statements on vaccines and believe he should be closely scrutinized on this issue during confirmation. The CDC plays a critical role in global health, and it would be disastrous if its leader were to promote unfounded theories and exacerbate vaccine hesitancy."

Vaccination: A Bellwether of Leadership Approach

Vaccination is far from the only issue on which federal health leaders guide policy, but experts say that it is one of the most important right now and could be a bellwether of each leader's approach. The Covid-19 pandemic brought vaccines to the forefront of public health awareness and created opportunities for increased scrutiny but also dangerous skepticism and conspiracies that have had deadly consequences, said Dr. Peter Hotez, an infectious disease expert and director of vaccine development at Texas Children’s Hospital. "It’s so dangerous for the country, and now it’s deadly," Hotez said. "That’s going to continue to be one of our big challenges in uncoupling the anti-science from politics."

Assessing Scientific Data on Vaccines: A Litmus Test

The way a public health leader assesses scientific data on vaccines is an "important litmus test," said Dr. Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health. "It shows how someone makes decisions about complex, high-stakes issues and what level of evidence and rigor someone insists upon when making those decisions," she said. "When you see someone who says there is no safe and effective vaccine, and that statement is so at odds with all of the evidence we have, that really makes you question the judgment and character of the person who is making that statement. In my view, that is disqualifying for any serious governmental position."

Weldon's Efforts in Congress: A Cause for Concern

Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said Weldon's efforts in Congress worry him. "I think it’s very concerning that [the] potential next chief of the CDC is someone who has been a purveyor of vaccine misinformation, particularly relating to the preservative [thimerosal]," Adalja wrote in an email, referring to the disproven belief that the preservative is linked to autism. "It requires a high degree of an evasion, especially in a physician, to accept fallacious ideas that lead people to diminish their acceptance of what is probably one of humankind's greatest technological developments."

Weldon's Lack of Public Health Experience

"Who?" Is the most common reaction Dr. Brian Castrucci said he's heard in response to Weldon's nomination to lead the CDC. "To the best of anyone’s knowledge, [Weldon has] not had much interaction or experience working in a health department. It doesn’t seem that he has much experience working in the field of public health," said Castrucci, an epidemiologist who is president and CEO of the de Beaumont Foundation, a nonprofit focused on strengthening the US public health system. "I think, unfortunately, given who may have been the nominee, there’s almost a sigh of relief, and somehow, not knowing who this person is is acceptable over some of the folks that it could have been. That’s not good enough for me," Castrucci said.

Weldon's Past Legislation and Its Implications

Weldon served 14 years in Congress, representing a Florida district near Tampa from 1995 to 2009. In 2007, Weldon introduced the Vaccine Safety and Public Confidence Assurance Act, which aimed to create an "Agency for Vaccine Safety Evaluation" within HHS, independent of the CDC. "The Centers for Disease Control and Prevention is responsible for promoting both high immunization rates and vaccine safety, duties perceived by some to constitute a conflict of interest," the legislation noted.

The Dangers of Fixed Beliefs in Science-Based Agencies

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, recalled a run-in with Weldon during his time on the CDC’s Advisory Committee for Immunization Practices. He said Weldon "believed strongly that [the measles, mumps, and rubella vaccine] was the cause of autism. And he believed … that if you separate that vaccine into its three component parts, that you can avoid autism, which, of course, is absurd, because already studies had shown that you were at no greater risk of autism if you’d gotten that vaccine or you hadn’t." But Weldon’s position at the time on the House Appropriations Committee, on which the CDC depended for government funding, "essentially forced a vote" on whether to give the vaccine as three instead of one, Offit recalled. "These are science-based agencies. They depend on good science to move forward. And when you have someone who has a series of fixed beliefs that they hold with the strength of religious convictions, that’s dangerous."

The Potential Dismantling of Vaccine Administration

If Kennedy and Weldon are confirmed, Offit said, "I think that there is every reason to believe that there will be a dismantling of the way that we perceive and administer vaccines in this country, and that that will cause a decrease in vaccine rates, and the first disease to come back is measles. And I think that we will make measles great again, and thousands of cases will result in some children dying from a disease that’s preventable."

The Confirmation Hearing: A Crucial Moment for Weldon

Hotez says that Weldon’s name hasn’t been on his radar for more than a decade and a half, and it will be important to hear at the confirmation hearing