RFK Jr. appears on track to become US health secretary as he wins key Republican senator's support

All Democrats on the committee opposed Kennedy, whose family name had been synonymous with their party for generations before he aligned with President Donald Trump during the 2024 presidential campaign. They sounded an alarm on Kennedy's work to sow doubt around vaccine safety and his potential to profit off lawsuits over drugmakers.

A full Senate vote has not yet been scheduled, but with Cassidy's vote no longer in doubt Kennedy's nomination is likely to succeed absent any last-minute vote switches. Kennedy has been among the more contentious of Trump's Cabinet choices, and Republicans coalescing around him showed another powerful measure of near lockstep allegiance to the president.

Cassidy had publicly detailed his personal struggle, as a doctor who has seen the lifesaving ability of vaccines, with Kennedy's confirmation. “Your past, undermining confidence in vaccines with unfounded or misleading arguments, concerns me,” Cassidy told Kennedy last week.

Yet when it came to his vote Tuesday, he advanced Kennedy with a simple “aye.”

Cassidy, who is up for reelection next year and could face a primary challenge, later described "intense conversations" with Kennedy and Vice President JD Vance that started over the weekend and continued into Tuesday morning, just before the vote. Those conversations yielded “serious commitments” from the administration, Cassidy said. His reelection campaign had “absolutely zero to do with the decision,” he told reporters.

Cassidy said in a speech later on the Senate floor that, in exchange for his support, Kennedy has promised not to make changes to existing vaccine recommendations that have been made by a federal advisory committee and has agreed not to scrub the Centers for Disease Control and Prevention of statements that clarify vaccines do not cause autism. In addition, Cassidy said Kennedy will consult with him on new hires for the agency and appear if asked quarterly before the Senate's health committee, which Cassidy chairs. A 30-day notice will be sent to the committee if Kennedy seeks to make changes federal vaccine safety monitoring programs.

“He will be the secretary,” Cassidy said. “But I believe he will also be a partner in working for this end.”

Cassidy said Kennedy's formidable following waged a maximum pressure campaign, bombarding his office with thousands of messages daily. Pediatricians reached out, too, expressing fears of rampant disease outbreaks and deaths among children if a man who has a history of denigrating inoculations is installed as the nation's health secretary, he said.

Republican Sen. Thom Tillis of North Carolina, another vulnerable vote that Kennedy worked to win over, said he was reassured last week by the health secretary nominee’s promise to let scientists at the public health agencies, including the Centers for Disease Control and the National Institutes for Health, work “independently.”

“The only way that Bobby Kennedy will get crosswise is if he does take a position against the safety of proven vaccines,” Tillis said. “That will be a problem to me.”

Republican Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and Mitch McConnell of Kentucky have also been seen as potentially unsecured votes, because they voted against Trump's defense secretary nominee and have expressed concerns about Kennedy's anti-vaccine work. Kennedy could lose support from all three of those senators and still become the health secretary.

Democrats, meanwhile, have continued to raise alarms about Kennedy's potential to financially benefit from changing vaccine guidelines or weakening federal lawsuit protections against vaccine makers.

“It seems possible that many different types of vaccine-related decisions and communications — which you would be empowered to make and influence as Secretary — could result in significant financial compensation for your family,” Democratic Sens. Elizabeth Warren of Massachusetts and Ron Wyden of Oregon wrote in a letter sent over the weekend to Kennedy.

Kennedy said he'll give his son all of the referral fees in legal cases against vaccine makers, including the fees he gets from referring clients in a case against Merck. Kennedy told the committee he's referred hundreds of clients to a law firm that's suing Merck's Gardasil, the human papillomavirus vaccine that prevents cervical cancer. He's earned $2.5 million from the deal over the past three years.

As secretary, Kennedy would be responsible for food and hospital inspections, providing health insurance for millions of Americans and researching deadly diseases.