Just days after Robert F Kennedy Jr managed to place his allies in key health positions within Donald Trump's next administration, signs are emerging that his "Make America Healthy Again" (MAHA) movement is beginning to fracture. Behind closed doors at Trump's Mar-a-Lago country club and at Kennedy's nearby Palm Beach residence, tensions have been brewing between two competing visions for MAHA.

Unraveling the Tensions within Kennedy's Health Movement

One Camp: Focus on Vaccine Overuse

One camp within the MAHA movement is led by Kennedy's longest-serving advisers. Anti-vaccine campaigner Del Bigtree and vaccine injury attorney Aaron Siri are central emissaries to the Trump transition team. They firmly believe that the movement should center around the fight against the overuse of vaccines. They have been closely examining the nominees for health positions, specifically their stances on vaccine safety. This group is dedicated to ensuring that vaccine issues are given the attention they deserve.

For instance, when Kennedy was chosen two weeks ago to lead the health department, he was only informed a couple of days before the official announcement about Janette Nesheiwat being picked as surgeon general. This was a rare instance where a Kennedy candidate was overlooked for a top job. Siri and Bigtree then invited Nesheiwat, who had previously described the Covid jab as "a gift from God," for an urgent meeting at Kennedy's Florida residence on Saturday. The grilling that lasted most of the day was described by one person as a "re-education camp" on vaccines. This shows the intensity with which they are pushing their agenda.

Other Advisers: Worry about Anti-Vax Obsession

Meanwhile, other Kennedy advisers have concerns. They fear that the anti-vax obsession is overshadowing the broader pledge to address the "tragic epidemic of chronic disease." This was Kennedy's vow when he dropped his own bid for the presidency and endorsed Trump.

Washington healthcare policy analyst Chris Meekins pointed out that within the wide MAHA tent, there are many different ideas about what a healthy America looks like and how much money should be allocated. If there are too many ambitions, only a few will actually get implemented. So, Kennedy needs to prioritize and not let the bureaucracy swallow his movement whole.

Appointments and Challenges Ahead

Kennedy will control a large and influential Health and Human Services department with a budget of $1.7tn and 13 divisions. So far, his hit rate on appointments has been strong. Apart from appointing Brooke Rollins as agriculture secretary, almost all of Trump's health-related nominees have become Kennedy picks. His team lobbied for various figures to take on key positions, such as TV doctor Mehmet Oz for the Centers for Medicare and Medicaid Services, Johns Hopkins surgeon Marty Makary as Food and Drug Administration commissioner, and physician and former Republican congressman Dave Weldon to run the Centers for Disease Control and Prevention. Trump announced all these appointments last week.

However, early internal friction within the MAHA movement sets the stage for a tumultuous few years of healthcare policymaking in Washington. Kennedy will face battles with Big Pharma and Big Agriculture. His first dilemma will be whether to follow through on the surprise plan by outgoing Democratic President Joe Biden to allow obesity drugs to be paid for by Medicare and Medicaid for weight loss. Kennedy has recently made controversial statements about Novo Nordisk, the Danish drugmaker behind anti-obesity drugs. And the array of ambitions within the MAHA movement, from reviewing mandatory vaccine recommendations to legalizing psychedelic drugs and making other changes, will make it an easy target for Big Pharma's lobbyists.

Washington insiders worry that Kennedy may simply seek "grand gestures" rather than making specific reforms. A pharma lobbyist pointed out that there are many safeguards in the process that make it difficult to implement big changes. Kennedy, being an outsider, may need to realize that reality often doesn't match rhetoric.