By Josh Nathan-Kazis

As the Senate committee hearings over Robert F. Kennedy Jr.'s nomination to serve as secretary of Health and Human Services kick off Wednesday, opposition to his bid is mounting.

Kennedy, the son of a murdered Democratic U.S. attorney general, is an awkward fit both within the Republican coalition, and the federal health bureaucracy he intends to lead. While all of President Donald Trump's formal nominees have made it through the Senate confirmation process thus far, the prospects for Kennedy's approval are far from certain.

Kennedy, a harsh and persistent critic of childhood vaccination, led the nation's top antivaccine organization for years. He also has a mixed record on abortion, a major concern for some Republican lawmakers.

"There's just a lot of different groups that he's offended, or that have concerns about his views," says Chris Meekins, a healthcare policy analyst at Raymond James.

Three Republicans defected to oppose the confirmation of Defense Secretary Pete Hegseth over the weekend, requiring Vice President JD Vance to step in with a tiebreaking vote. The question is whether Kennedy will fare as well, or whether at least four Republican senators, driven by public-health concerns or socially conservative ideological commitments, will choose to stand against him.

Kennedy has met with dozens of senators since his nomination was announced in November. Now it all comes down to a series of hearings that begins Wednesday with a meeting of the Senate Finance Committee, and ends Thursday in the Senate Committee on Health, Education, Labor, and Pensions.

After that, the finance committee will vote on his candidacy, setting up a vote in the full Senate. Neither the committee vote nor the final Senate vote is yet scheduled.

"I think that the confirmation hearings are arguably the most consequential confirmation hearings for an HHS secretary or nominee that we've seen in at least a generation," says Meekins. "I truly believe his performance at this confirmation hearing could be the determining factor of whether he's confirmed or not."

Kennedy has moderated how he discusses his more controversial views since his nomination, insisting that he isn't antivaccine, and that he supports "transparency." But as the Washington Post reported on Monday, he has a long history of broadly criticizing vaccines, and of alleging a discredited link between autism and childhood vaccination.

Kennedy is likely to present the most moderate possible version of himself at this week's hearings. In a note on Tuesday, Jefferies analyst Michael Yee predicted an "RFK rally" in healthcare stocks, writing he expects Kennedy to present a more moderate face on vaccine policy under pressure from Trump allies.

The days leading up to Wednesday's hearing have seen renewed attacks on Kennedy and his fitness to hold the job leading the Department of Health and Human Services. The department is responsible for a quarter of the federal government's annual spending and includes some of the most consequential federal agencies.

In a letter released on Tuesday, Caroline Kennedy, the daughter of former president John F. Kennedy and first cousin of Robert F. Kennedy Jr., wrote that her cousin was "a predator" who led his younger brothers and cousins "down the path of drug addiction."

On Monday, The Wall Street Journal editorial board argued against Kennedy's confirmation, writing that "Senators would be wise to believe RFK Jr.'s career of spreading falsehoods rather than his confirmation conversions."

Notably absent from the debate has been the pharmaceutical industry, which stands to lose the most if Kennedy were to be confirmed, and to drastically change the U.S. approach to vaccines. Barron's asked virtually all the big pharma companies on Monday whether they supported or opposed Kennedy's confirmation. None provided a direct answer.

Sanofi, one of the major flu vaccine manufacturers, said it works "with regulators and lawmakers in the U.S. and around the world." AstraZeneca, which also sells flu shots, didn't comment. Neither Merck nor Pfizer, both of which sell blockbuster vaccines, responded to a request for comment. PhRMA, the industry trade group, referred to a November statement it issued when Trump selected Kennedy, which neither supported nor opposed him.

The radio silence is in line with the drug industry's broad approach to the Trump administration. It has steered clear of any criticism while trying to make progress on long-term industry priorities like pushing back against the pharmacy-benefit managers, whom drugmakers blame for high U.S. drug prices. At an investor conference earlier this month, Pfizer CEO Albert Bourla said he had spoken with Kennedy.

"My philosophy is that we should try to engage not only on the things we disagree, but to find opportunities on things we can agree," Bourla said at the time. "On vaccines, if he does some of the things that he has spoken about in the past, I think he will find in front of him not us, but the entire medical community, the entire scientific community."

Meekins said that the industry might be keeping quiet now out of a worry that making their opposition to Kennedy known might backfire. "When you're an organization that is as unpopular with the public as the pharmaceutical industry has been in recent years...there actually could be backlash if the pharmaceutical industry had come out full-throated against him," he said.

Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com

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January 28, 2025 17:50 ET (22:50 GMT)

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