Chronic Disease, COVID Vaccines Get Nods at Trump’s Inaugural Address

President Trump’s inaugural address to the nation on Monday contained few references to healthcare, but the health topics he did mention — chronic disease, COVID vaccine mandates — echoed some of his campaign themes and previous remarks.

Trump also criticized the U.S. public health system during his address. “We have a public health system that does not deliver in times of disaster, yet more money is spent on it than any country, anywhere in the world,” he said.

Ending Chronic Disease

“Together we will end the chronic disease epidemic and keep our children safe, healthy, and disease free,” he said. That statement hearkened back to when Trump nominated Robert F. Kennedy Jr. as HHS secretary, saying at the time that Kennedy would “end the chronic disease epidemic” and “Make America Great and Healthy Again!”

Regarding Trump’s mention of keeping children disease-free, “other than this is impossible, it may be a veiled nod toward some public health initiative that rhetorically (not scientifically) reduces the need for vaccinations,” Joe Antos, PhD, senior fellow emeritus at the American Enterprise Institute, said in an email. “Rhetoric, not actual policy, which is what we get in these kinds of speeches.”

Wendell Primus, PhD, visiting fellow at the Brookings Schaeffer Initiative on Health Policy, wondered about Trump’s remark regarding eliminating chronic disease. “He gave no indication that I saw of how he would accomplish that,” Primus said in a phone interview. “If we could snap our fingers and get rid of chronic disease, it would be a wonderful thing, obviously. But that’s very hard to do.”

And if the Trump administration is trying to get rid of chronic disease, then some of the other policies Republicans are talking about pursuing — such as cutting Medicaid, permitting states to implement Medicaid work requirements, and allowing premium subsidies for Affordable Care Act health insurance plans to expire — could hurt that goal if they result in more people becoming uninsured, said Primus, who was previously a health policy adviser to former House speaker Nancy Pelosi (D-Calif.).

Chris Pope, PhD, a senior fellow at the Manhattan Institute, a conservative think tank, said in a phone interview that Trump’s goal of ending chronic disease “is actually not that different to Biden’s ‘Cancer Moonshot’ goal … It is a strange kind of parallel with Biden … in the sense that who could be against that, or for chronic disease?”

He noted that even though Trump didn’t play up healthcare or Medicare reform in his campaign, the bulk of Medicare spending is on chronic disease, “so maybe rethinking Medicare in terms of chronic disease actually would make sense. And maybe that’s a way to kind of get into the business of Medicare reform without putting it up top.”

Vaccine Mandates

During his address, Trump said he would reinstate servicemembers who were “unjustly expelled from our military” due to COVID vaccine mandates, and with full back pay.

This idea is probably “something he can do without Congress since the people he’s referring to were separated from service” through an administrative process, according to Antos. However, he added, it’s unclear how many of those servicemembers would want to come back. “Many have probably moved on with their lives, found work in the civilian sector, and clearly have a different view about military service than they had when they first enlisted. The lack of respect for service has been drilled into them personally — do they want to put in another few years risking getting fired by the next [Democratic] administration?”

Opposing vaccination mandates is “not a good policy,” Primus said. “Those vaccines worked — almost all the public health experts that I know of [say] they did a lot of good. They saved a lot of lives.” He noted that Kennedy petitioned the FDA in 2021 to revoke authorization of all COVID vaccines.

Jeffrey Singer, MD, a senior fellow at the Cato Institute, a libertarian think tank, had a different opinion. “I don’t think it was right to mandate the vaccines in the first place,” he said.

“When we learned … within a matter of months that the vaccines didn’t prevent the spread and didn’t prevent you from getting it, but did reduce the severity, then there was really no argument you could make to force somebody to get something inserted into their bodies that they didn’t want. That’s an assault on autonomy,” said Singer, who is also founder of Valley Surgical Clinics in Arizona.

Andrea Ducas, vice president of health policy at the left-leaning Center for American Progress, said she found the president’s positions on chronic disease and vaccine mandates contradictory. “[To] stand up and say, ‘I want to end chronic disease. I want to keep kids disease-free, but I want to punish the government for trying to make sure that people get vaccinated against a novel virus that’s killed thousands of people'” seems at cross-purposes, she said.

Wanting to sow distrust in the polio vaccine, the measles mumps and rubella vaccine, and fluoride “is sort of indicative of what I think this incoming administration really believes, which is that the health of the public is not actually a priority,” said Ducas.

Overall, the speech had relatively few mentions of healthcare, which was likely for strategic reasons, observers said. “[President Trump] is correct: health policy isn’t a winner for him,” said Antos.

“Healthcare payment policy has fallen way down the list of priorities,” said Pope. “I think this is going to be one of those administrations where going in, the intent is to not really do too much healthcare policy.” However, he added, if there were to be a big fiscal crisis, healthcare may emerge as an issue because it is a major cause of fiscal challenges. “Healthcare payment policy can quickly raise up in the political agenda, even if people wouldn’t want it to … You can’t really pass a budget without doing healthcare payment reform of some sort.”

Gender Issues in the Spotlight

Trump also addressed policies on gender identity in his speech. “It will henceforth be the official policy of U.S. government that there are only two genders, male and female,” said Trump, whose presidential campaign heavily criticized the Biden administration’s stance on gender identity issues.

Continuing with the military theme, Trump added, “I will sign an order to stop our warriors from being subjected to radical political theories and social experiments while on duty. It’s going to end immediately.” Presumably, the president was referring to the Defense Department’s diversity, equity, and inclusion policies, although he didn’t say so specifically.

Singer said he favored having the government generally take a hands-off approach to gender issues. “I don’t think there’s anything constructive to be gained by wading into the culture war,” he said. “The government should just stay out of it and let people work things out among themselves.”