The Make America Healthy Again (MAHA) Commission has released its list of 128 recommendations and actions for health, agriculture and education departments and other federal departments it said will improve the health of U.S. children.
The strategy document (PDF), a near-final draft of which was leaked last month, includes calls to reorganize some health and research agencies, launch new studies into chronic disease, increase the availability of nutritional information, promote fitness and foster private sector collaboration while deregulating certain areas of food production and treatment approvals.
Certain policies previously resisted by industry groups, like restrictions on pesticides, were absent from the recommendations, as was any mention of firearm violence.
Included in the report—and highlighted by government agency heads in a Tuesday press con,ference—were several of Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s more controversial policy priorities, including increased scrutiny of childhood vaccine safety, conflicts of interest in federal health research and advisory groups, public water fluoridation and prescription therapeutics for mental health conditions.
“A lot of these 128 recommendations are things I have been dreaming about my whole life,” RFK Jr. said during the press event.
In statements, associations representing the pharmaceutical industry and infectious disease specialists said they welcome the administration's tighter focus on chronic disease, but denounced items from the report and statements from MAHA Commission members suggesting rollbacks of tools like vaccines due to widely debunked autism concerns.
Cross-agency work on the strategy document was directed by President Donald Trump in a February order and led by RFK Jr., who has broadly campaigned on addressing the country’s “existential crisis” of high chronic disease burden.
In May, the secretary and other members of the MAHA Commission released an initial 72-page report outlining their initial findings on the causes of Americans’ disease burdens. That document, which was found to have misrepresented or outright fabricated multiple academic studies, landed on four key targets for government focus: poor diet, environmental chemical exposure, physical activity/stress and “overmedicalization.”
Those top-line factors were again cited in the strategy document released Tuesday, along with the 128 recommended executive actions for the president and his departments to pursue.
“This report is the result of a thorough and robust policy process that relied heavily on the input and expertise of families, farmers, doctors, industry leaders and innovators,” Vince Haley, director of the domestic policy council and a member of the MAHA Commission, said Tuesday. “Our commission team met over 120 groups at the White House, engaged MAHA Moms directly and received countless recommendations from industry and advocates that were thoughtfully considered.”
The report itself doesn’t outline costs, timelines or other specifics on how the recommendations will be implemented.
Still, RFK Jr. noted that many of the goals are already in progress or will be reached by the end of this year, and pointed to industry commitments on removing food dyes from products, updates to dietary guidelines, new Medicaid quality metrics focused on fitness indicators, the removal of soda and candy from some state’s Supplemental Nutrition Assistance Programs and “acknowledging and addressing vaccine injuries.”
Among the most noteworthy recommendations for the healthcare and broader life sciences industries are:
- Full implementation of hospital and insurer price transparency
- Creation of a “mental health diagnosis and prescription working group” to review prescription patterns, potential harms and “over-prescription trends,” which will include new research and updated drug labels
- Collaboration with states on prior authorization requirements and prescribing safeguards “to address the overuse of medications in school-age children—particularly for conditions such as ADHD”
- New quality metrics centered on health outcomes as well as Medicaid managed care quality metrics “that promote measurable health improvements through nutrition coaching and other fitness indicators”
- A new “vaccine framework” that focuses on vaccine injuries, transparency, “correcting conflicts of interest and misaligned incentives” and “ensuring scientific and medical freedom”
- A National Institutes of Health (NIH) chronic disease research initiative that takes a whole-person-health approach to prevention
- The creation of a real-world data platform at NIH linking data sources such as insurance claims, EHRs and wearables data
- Leveraging the NIH’s longitudinal birth cohort data for chronic disease research and prevention
- Expanded use of New Approach Methodologies (NAMs) at the NIH, the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA)
- Promoting direct primary care model use with health savings accounts, as well as enrollment for those on high-deductible health plans
- Increased enforcement and oversight of direct-to-consumer pharmaceutical advertising—which was also cemented in a memorandum signed by President Donald Trump
- Leveraging HHS funding toward community health programs and partnerships
- Requirements that HHS advisory committee members recuse themselves for financial conflicts of interest
- New research into “the root causes of autism,” results from which HHS leaders previously said could come this year (with recent reports suggesting Tylenol use during pregnancy will be named as a potential cause)
- Public databases on the payments received by health researchers, "similar" to [the Centers for Medicare and Medicaid Services’] Open Payments system for physicians
- The creation of the Administration for a Healthy America, which would take several responsibilities around chronic health from the Centers for Disease Control and Prevention (CDC)
- The launch of a new Office of Research Innovation, Validation and Application at the NIH, which will focus on shifting away from animal testing in favor of advanced techniques such as organoids, computational models and real-world health data analysis
- The development of a new Office of Research Innovations, Planning and Analysis at the NIH, focused on disease-specific portfolio analysis and research prioritization
- Review participation in any projects funded by food or pharmaceutical companies through the CDC Foundation, Foundation for the NIH or the Reagan-Udall Foundation
- Policies at the NIH limiting open access payments to scientific journals
- Promoting nutrition in medical school curriculum
- Supporting new medical education program accreditors, “including those with a focus on treating the root causes of chronic disease”
- Various educational programs on topics like screen time, pediatric mental health, fitness, pesticide review processes and “the appropriate levels of fluoride”
Agency leaders under RFK Jr. who served on the MAHA Commission affirmed their teams will be prioritizing the recommendations. They echoed the secretary’s talking points on the need to tackle chronic illness and said the appetite to directly address the “root causes” of disease is shared by the public.
“There are real scientific issues that need to be addressed,” Jay Bhattacharya, M.D., director of the NIH, said. “Why are autism rates going up so quickly? What can we do about it? What is the answer for Type 1 diabetes for kids? What are the long-term effects of the rising use of antidepressants in children? The problem of ADHD—we could go on and on and on. What we have is a picture of real questions that need to be answered with excellent science.”
“We’ve done a terrible thing to doctors in this country,” added Marty Makary, M.D., commissioner of the FDA. “The healthcare system has put them on a hamster wheel where we are treating, prescribing, operating—I was on this wheel—and then we code and we’re billed and we’re measured by our throughput. … The medical community is thirsty to talk about the root causes that we don’t talk about because historically it has not been a part of the NIH agenda, until now.”
PhRMA, which represents drugmakers, released a statement that was supportive of the MAHA Commission's goals but warned against "misleading" claims of overmedicalization and reiterated "decades of studies involving more than a million children" showing no link between vaccines and autism.
“It’s concerning, however, that the report casts doubt on the very things that have helped protect and improve health for generations," PhRMA President and CEO Stephen Ubl said. "Americans should have access to every option at their disposal to safeguard the well-being of children—including medicines and vaccines that prevent and treat disease. Undermining these advances risks reversing decades of progress."
Infectious Diseases Society of America President Tina Tan, M.D., similarly warned against policy changes that don't align with longstanding vaccine research.
“Any federally funded research into the cause of autism must be based on credible science and not reach premature, inaccurate or preordained non-scientifically based conclusions," she said. "Decades of scientifically sound research have proven that vaccines do not cause autism and are not associated in any way with autism. Decisions about vaccine policies should be made by objective experts in vaccines.”
The recommendations come as pushback mounts against RFK Jr.’s sweeping policy changes and broad upheaval at the CDC. More medical associations have outright denounced recent changes to CDC vaccine guidance and published their own recommendations, and cracks in the secretary’s support among prominent lawmakers came to the surface during a fiery hearing last week.
Jim O’Neill, deputy secretary of HHS and the acting director of the CDC following the prior director’s removal, said the report’s priorities are part of the government’s work to restore trust in the public health agency.
“Tools that are meant to fight disease, such as vaccines, antibiotics and therapeutics, can save lives, but can also trigger adverse events in some patients,” he said Tuesday. “And that truth must no longer be denied or distorted. We’re bringing transparency and research to this critical connection.”
During a Q&A at Tuesday’s event, reporters questioned the report’s notable absence of gun violence and concrete pesticide restrictions.
On firearms, the leading cause of death for children under 18 and often referred to by healthcare groups and leaders as a public health crisis, RFK Jr. responded that gun ownership has been prolific through America’s history and recalled the prominence of school gun clubs during his childhood. Mass shootings of schools or other public places were unheard of then, he said while suggesting that the use of medications for mental health issues that began in the 1990s could be a factor.
“At NIH, we are doing studies now, we’re initiating studies to look at the relation and potential connection between overmedicating our kids and this violence, and these other possible cofounders,” he said.
On pesticides, a key issue for MAHA supporters that’s faced pushback from the agricultural industry, officials pointed to the report’s promises of new research and plans to heighten enforcement against the use of products currently illegal in the U.S.