Donald Trump has named Johns Hopkins surgeon and professor Martin Makary as his choice for the next commissioner of the Food and Drug Administration (FDA). He has also announced his choices for the director of the Centers for Disease Control and Prevention (CDC), and the Surgeon General post.
The FDA regulates all consumer nicotine products, including vapes. The CDC and Surgeon General have no regulatory powers, but have caused considerable reputational damage to vaping in the past.
Martin Makary: a seemingly conventional FDA nominee
Little is known about Martin Makary’s positions on vaping and nicotine use, but vaping industry and consumer advocates are eager to replace Dr. Robert Califf, a staunch foe of vaping and tobacco harm reduction (THR). Califf said in a recent interview that the FDA—which many believe is dysfunctional—is currently operating at “peak performance.”
Makary doesn’t appear to have a history of actively opposing vaping and THR, but may have made some negative comments about vaping around the time of the 2019 “EVALI” lung injury outbreak.
The British-born Makary is a pancreatic surgeon at Johns Hopkins Hospital, a professor at the Johns Hopkins School of Medicine, and an instructor at the Johns Hopkins Bloomberg School of Public Health.
The Bloomberg School is named after billionaire Michael Bloomberg, who has donated large sums to Johns Hopkins, which has become a vector of Bloomberg’s anti-vaping and anti-nicotine activism. Again, there is no evidence that Makary has endorsed Bloomberg Philanthropies’ prohibitionist approach to nicotine regulation.
Makary is respected for surgical innovations, according to Reuters, and is also an author. He has written and spoken on a range of medical topics, including overtreatment in the U.S. medical system, overuse of antibiotics, and medical education reform. He was a critic of COVID-19 vaccine and mask mandates, and has acted as an adviser to conservative think tank the Paragon Health Institute.
Unlike many other Trump cabinet and agency nominees, Makary would be a fairly conventional choice, and may not face determined opposition in the Senate confirmation process. Senate Democrats will have to carefully choose which nominees to spend their time and energy opposing, and Makary would probably be low on the list.
Trump’s CDC and Surgeon General choices
While CDC directors and Surgeons General have no regulatory or legal power over vaping products, both have been influential in advancing the long moral panic over vaping. Trump’s previous appointees were no less damaging than Obama’s or Biden’s.
President Obama’s CDC director Tom Frieden—a Michael Bloomberg crony—frequently used his pulpit to denounce vaping, and current Surgeon General Vivek Murthy (when he served in the same job under Obama) issued a widely publicized 2016 report on teen vaping that cherry picked evidence to suggest that vaping was a gateway to smoking and that legislators should consider banning vape flavors.
Trump’s first-term CDC director Robert Redfield was largely silent on vaping, but allowed his agency to suggest the “EVALI” lung injury outbreak was caused by nicotine vaping, which was not true. Biden’s CDC directors have since refused to correct those mistakes.
Much of the CDC’s EVALI misinformation came from the Office on Smoking and Health (OSH)—a hotbed of anti-vaping activism. During the EVALI outbreak, most of the CDC’s speculation on vaping being a cause of the injuries was voiced by OSH spokesperson Brian King, who was later named to lead the FDA Center for Tobacco Products (CTP) by Biden FDA Commissioner Robert Califf.
Trump’s first-term Surgeon General Jerome Adams gleefully joined in FDA Commissioner Scott Gottlieb’s claims of a “youth vaping epidemic,” calling vaping a public health emergency and citing the questionable theory that nicotine “harms” adolescent brain development.
Trump’s CDC nominee Dave Weldon
Trump has chosen former Florida congressman Dave Weldon to lead the CDC. Weldon, a doctor, left the House of Representatives in 2008 after seven terms and returned to his medical practice.
Weldon has no history with vaping or nicotine issues that we could find.
While in Congress, Weldon advocated for removing vaccine safety responsibility from the CDC and giving it to a separate agency, according to the New York Times. He also claimed a preservative used in vaccines is responsible for causing autism.
Weldon will be the first CDC director nominee to face confirmation hearings in the Senate, after a recent change in the law. He is likely to face serious opposition, considering his vaccine beliefs.
Trump’s Surgeon General choice is Janette Nesheiwat
Trump will nominate Dr. Janette Nesheiwat to serve as Surgeon General. Nesheiwat is a well-known TV doctor who has opined on many medical topics on CNN and Fox News.
She has spoken on vaping multiple times. As described in an X/Twitter thread from Gregory Conley of the American Vapor Manufacturers Association (AVM), her opinions have varied, but she hasn’t outright demanded a flavor ban or other harmful restrictions. In one interview, she says her brother used vaping to quit smoking—which could be an encouraging sign.
But in another AVM X post—presumably not written by Conley—the trade group is much more critical, claiming Nesheiwat has “parroted all the most irresponsible anti-vape talking points. Gateway theory (bunk), EVALI (zero connection), NRTs more effective (false), flavor bans work (nope).”
While the Surgeon General does lead the Public Health Service Commissioned Corps, the job is otherwise an ornamental one—unless the SG does something that receives media attention. SG Luther Terry famously issued the 1964 report on smoking that began the anti-smoking and tobacco control movement, and set the bar for the dozens of SG reports that followed on various topics.
Dr. Nesheiwat could use vaping as a hot-button issue—a “health crisis”—to gain attention, as the last two SGs have. Or she could tell the truth and help millions of people who smoke. Or she could remain silent. We don’t know enough to be sure which path she’ll take.
The Trump health team so far
The Trump health team is beginning to come together. Trump has announced he will nominate Robert F. Kennedy Jr. as secretary of the Department of Health and Human Services (HHS), which oversees the FDA, CDC, the National Institutes for Health (NIH), and the Centers for Medicare and Medicaid Services (CMS).
Kennedy’s positions on vaping, nicotine and tobacco harm reduction (THR) are unknown. A recent photo showed him holding a can of ZYN nicotine pouches, but it’s not certain he uses nicotine.
Trump has also named Dr. Mehmet Oz to run CMS. Oz has actively opposed vaping on his syndicated TV show, but will be unlikely to influence the other HHS agencies on policy.
Will Trump “save vaping”?
Before the election, Trump promised he would “save vaping,” but that will require a strategic shift by the FDA and its Center for Tobacco Products (CTP). FDA Commissioner Califf appointed anti-vaping zealot Brian King to run the CTP, and the tobacco office—with Califf’s backing—has done its best to restrict access to popular vaping products.
However, the FDA is facing a Supreme Court showdown soon (oral arguments scheduled for Dec. 2) with the independent vaping industry, which could determine whether the agency will be forced to abandon its “shadow ban” of flavored and open-system (refillable) vaping products.
In the three years since the agency began making decisions about premarket tobacco application (PMTA) submissions, millions of applications have been rejected or denied, and just a handful of products have been authorized—all of them manufactured by Big Tobacco-owned companies.
If the FDA wins the Supreme Court appeal of its Fifth Circuit loss against Triton Distribution, major changes at the CTP would be unlikely without deliberate and focused attention from HHS and FDA leadership. An FDA Supreme Court victory would essentially give the agency permission to continue on its current path. Changing that path would require CTP personnel changes and stern administration oversight, which would require active involvement by the FDA commissioner.
If the high court rules against the FDA, the Trump team could more easily chart a new regulatory course for vaping products. But at this point, we don’t know what the new administration’s goals or plans are regarding tobacco and nicotine regulation, or how much energy and time they intend to devote to vaping issues, which are a small part of the FDA’s overall portfolio.