Robert F. Kennedy Jr.’s potential role leading the Department of Health and Human Services would not give him carte blanche over fluoride in drinking water — although he could still influence the debate in other ways, legal experts say.
Kennedy, President-elect Donald Trump’s pick to head HHS, professed this month that Trump would sign an executive order in January advising all water utilities to remove fluoride from drinking water supplies.
But while Trump later expressed tentative support for the idea, the main agency with the ability to mandate changes on water fluoridation is EPA — not the one Kennedy was chosen to lead.
“The HHS makes recommendations about fluoride, but that’s all,” said Mark Duvall, principal at the environmental law firm Beveridge & Diamond PC. “As secretary of HHS … [Kennedy] would have no ability to direct people to take particular actions other than in an advisory manner.”
A representative for Kennedy did not respond to a request for comment. His nomination is currently facing pushback from many public health experts due to his opposition to vaccines and support for certain debunked health claims.
Many water utilities have for years added fluoride to public water supplies to help prevent tooth decay. The practice is widely supported by dentists, who say it is a cost-effective way to promote oral health, particularly for individuals without reliable access to dental care.
Yet fluoride is also a neurotoxin that could be dangerous to human health at high levels. This year, a California district judge ruled that HHS’ optimal level of fluoride in drinking water “poses an unreasonable risk of reduced IQ in children.” Unless EPA appeals the ruling, it must initiate a rulemaking to further evaluate the risk.
If Kennedy is confirmed to lead HHS, he could push the Centers for Disease Control and Prevention to change its recommended level for fluoride — which is currently 0.7 milligrams per liter — to something much lower, or to zero, said Alan Roberson, executive director of the Association of State Drinking Water Administrators.
“[EPA] can do a requirement for a low maximum contaminant level. The CDC can make a recommendation to stop the addition of it or say that the level should be zero,” Roberson said. “It’s a pretty big difference.”
Still, fluoridation of water is ultimately decided at the state and local level, and fluoride is naturally occurring in some water systems, Roberson said. The most likely path to removing the substance from water, he added, is through EPA. A nationwide push to get rid of fluoride through EPA policies would probably take more than four years and face pushback from dentists, he said.
Advocates for ending water fluoridation nonetheless say that CDC — and Kennedy’s elevated public profile — can influence how cities and towns approach the issue.
The city of Winter Haven, Florida, for example, voted last week to stop adding fluoride to its water supply starting next year. One city official cited Kennedy’s comments on the topic when discussing his reasons for voting to end fluoridation in the community, according to local reports.
“If the Centers for Disease Control comes out with a new, revised recommendation that communities should not be fluoridating their water, then presumably a lot of communities across this country are going to quickly abandon the practice, as they should,” said Michael Connett, an attorney who represented petitioners in the recent court ruling on fluoride.
Under the Safe Drinking Water Act, EPA currently requires water systems to limit fluoride levels to no more than 4 milligrams per liter, said Betsy Southerland, a retired EPA official who worked in the Office of Water. EPA also recommends the level at which water utilities should add fluoride, if they choose to do so, Southerland said.
The recent ruling from the U.S. District Court for the Northern District of California now forces EPA to revisit the issue.
According to Duvall, EPA could refer the issue to the Office of Drinking Water, setting the stage for potential changes to the maximum contaminant levels that EPA currently uses. But even that process would take at least a couple of years, Duvall said.
For now, the main impact of Kennedy’s potential appointment to HHS on fluoridation has more to do with the public’s perception of the issue, according to drinking water experts. EPA, for its part, has not yet responded to the district court ruling and says it is still evaluating the decision.
“At this point, for most utilities, it’s about how do they communicate with members of the public when they ask [about this], because it’s very much part of the current news cycle,” said Steve Via, director of federal relations at the American Water Works Association.
Karoline Leavitt, a spokesperson for the Trump transition team, declined to offer specifics on Trump’s position on fluoridation.
“The American people re-elected President Trump by resounding margins because they trust his [judgment] and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.,” Leavitt said in an emailed statement.
Reporter Ellie Borst contributed.
