Washington — A senior aide to Health Secretary Robert F. Kennedy Jr. is embroiled in a personnel and policy clash with Kennedy and the White House over how the Food and Drug Administration should investigate vaccine side effects, two senior administration officials said on condition of anonymity.
FDA Commissioner Marty Makary remains in his role for now, but the officials say the dispute — centered on whether the agency should quickly launch additional vaccine-safety studies or first establish a new system for reviewing side effects — remains unresolved.
Roots of the dispute
Officials described tensions over Makary’s management of the FDA that have built for months. Kennedy has pushed the agency to accelerate vaccine-safety research; Makary, a former Johns Hopkins surgeon, has resisted immediate action, arguing the agency should develop a new review framework before expanding studies. That difference of approach has frustrated Kennedy, the officials said.
Kennedy has been cautious about escalating the confrontation publicly, the officials added, because he worries further pressure could create a perception of disarray inside the Department of Health and Human Services. This year, Kennedy has already removed two deputies from his office and dismissed the director of the Centers for Disease Control and Prevention.
Personnel and White House interventions
The dispute has spilled into staffing decisions. Makary has been unable to secure White House sign-off to promote policy adviser Sanjula Jain-Nagpal to deputy chief of staff; despite the lack of formal approval, Jain-Nagpal announced the move during a November 12 call with FDA stakeholders. In the FDA directory she is listed as a health informatics specialist.
Separately, friction arose after the departure of top drug regulator George Tidmarsh in early November. At one point, White House officials considered narrowing Makary’s role by installing a day-to-day operations lead while keeping him as commissioner, but that plan was abandoned after White House Chief of Staff Susie Wiles intervened, the officials said. Makary then elevated longtime oncology chief Richard Pazdur to the vacated role.
Officials said Makary, buoyed by Wiles’ backing, has increasingly routed sensitive questions to the White House rather than to HHS, complicating coordination. Makary’s uncommon aversion to email has also made internal communication more difficult as tensions rise.
Broader context
Before his appointment, Kennedy was known for opposing mainstream vaccine policy. Since becoming health secretary, he has advocated for faster, broader vaccine-safety investigations. Makary has a record of public skepticism about some pandemic-era restrictions; both men have clashed at times with political allies and critics over policy direction.
In a statement, HHS spokesman Andrew Nixon pushed back on the idea of an outright feud: 'Secretary Kennedy has full confidence in Commissioner Makary,' Nixon said, adding that the two are closely aligned.
The White House and FDA did not immediately respond to requests for comment. Lauren Gardner contributed to this report.
