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Robert F. Kennedy Jr.s nomination to be Donald Trumps health secretary has been dogged by his long record of anti-vaccine and anti-science statements. Even as Republicans embrace him as an iconoclast, Democrats and other critics have lambasted Kennedy as a know-nothing without the scientific or bureaucratic experience to do the job effectively.But in painting Kennedy as a clown, those criticisms miss something important. Kennedy has not only gained a public following for his outlandish claims, he has also made a lot of money broadcasting them. And he could stand to make more from his anti-vaccine crusade as Americas top health official the kind of brazen self-dealing thats become all but normalized in Trumps America.As the New York Times reported last week, Kennedy has referred potential plaintiffs people who say they have been injured by vaccines to the law firm Wisner Baum, which is suing Merck over alleged harm related to the HPV vaccine. (He has also been involved in other cases for the firm.) Wisner Baum pays Kennedy for these referrals, in the vaccine case and other cases: Hes earned more than $2.5 million over the past two years, the Times reported. When the lawsuit concludes, if the vaccine manufacturer loses, Kennedy will get a financial reward.At the Senate Finance Committees hearing Wednesday on Kennedys nomination, Kennedy refused to say that he would end the relationship with Wisner Baum during a line of questioning by Sen. Elizabeth Warren (D-MA). After affirming Kennedy would not accept drug company money as health secretary, Warren asked if Kennedy would likewise commit not to take money from lawsuits against drug companies, under his arrangement with Wisner Baum.Youre making me sound like a shill, Kennedy replied, before deflecting Warrens question with an excuse he repeated more than once: Youre asking me to not sue drug companies.Warren then ran through the various ways Kennedy could influence the outcome of those lawsuits while serving as secretary of the US Department of Health and Human Services. He could publish anti-vaccine conspiracy theories, she said, this time on US government letterhead. He could appoint anti-vaccine scientists to federal vaccine panels and remove vaccines from the federally recommended schedule of childhood vaccines. He could even give FDA data, Warren said, to the law firm that sues the drug companies and compensates him for their wins.Given another opportunity by Warren, Kennedy again declined to commit to removing his financial stake from the anti-vaccine litigation. Instead, a few minutes later, he claimed that he had been unfairly maligned as a conspiracy theorist because he opposed powerful corporate interests the same kind of misdirection that has fueled his ascent toward the top of US health policy, while providing cover for his actual conflicts of interest. No one should be fooled here, Warren said. As secretary of HHS, Robert Kennedy will have the power to undercut vaccines and vaccine manufacturing across our country ... Kennedy can kill off access to vaccines and make millions. Kids might die, but Kennedy can keep cashing in. Despite all this, the Senate appears on track to approve his nomination, at least so far. Kennedy will testify at the Senate health committee on Thursday.The second Trump term is shaping up to be even less constrained by the old norms of good governance, which prize the avoidance of any perception that a public official could profit from their role. In that respect, Kennedy is much like Trump himself: His risible public statements, designed to draw a spectacle, can distract from any old-fashioned corruption happening behind the scenes.RFK Jr. vs. the vaccinesOver the last 30 years, vaccines have saved the lives of more than 1.1 million children in the US alone. Over the same period, theyve also saved Americans $540 billion in direct health care costs and trillions in social costs by preventing illnesses like polio and measles. Kennedy has spent decades spreading anti-vaccination pseudoscience, and the organization he leads, Childrens Health Defense, has been one of the foremost anti-vaccine advocacy groups in the US and abroad. As part of his disclosures as a Cabinet nominee, Kennedy reported millions of dollars in income from book deals and speaking engagements that have resulted from his public profile, on top of his income from Wisner Baum.There have been serious health consequences from Kennedys anti-vaccine campaign as well. His support of an anti-vaccine group in American Samoa helped fuel a wave of vaccine hesitancy in the island nation; a 2019 measles epidemic killed 83 people there, most of them children. During Wednesdays hearing, when criticized about his involvement by Sen. Ron Wyden (D-OR), Kennedy insisted he played no role in the outbreak and even alleged that many of the people had not actually died from measles. (The deaths were reported by the WHO as related to measles, and measles continues to kill 100,000 people globally every year.) He also refused to answer a question from Wyden about whether measles was a deadly disease. Kennedy has espoused other conspiracy-laden ideas about health: He says fluoride is industrial waste linked to a range of diseases, and suggested it should be removed from all US water systems. He has speculated that gender dysphoria may result from herbicide exposure and implied mass shootings are linked to antidepressants. These views have angered scientists, but they also helped fuel the burgeoning Make America Healthy Again movement. There is now an ecosystem of influencers and companies trying to make money by pitching themselves, like Kennedy, as alternatives to the conventional pharmaceutical and wellness industries.In one of the hearings more remarkable moments, Sen. Michael Bennet (D-CO) asked Kennedy about his baseless beliefs in a series of rapid-fire questions. Bennet pressed Kennedy about his past claims that Lyme disease was highly likely to have been engineered by the military. I probably did say that, Kennedy allowed.Despite Kennedys long history of anti-vaccine rhetoric, he said before the election and again at the hearing that he wasnt planning to take anyones vaccines away. I support the polio vaccine. I support the measles vaccine, he said in his exchange with Warren. This is despite his long record of public statements disparaging vaccines, including casting doubt on the necessity of the measles shot, suggesting the disease could be cured by chicken soup instead.However, a co-chair of Trumps transition team had said just a week earlier that Kennedy hoped to access federal health data with the goal of proving vaccines are unsafe and pulling them from the US market.And if, under Kennedy, the federal government starts to say vaccines are unsafe, that could provide the basis for more vaccine lawsuits and potentially more income for Kennedy. His refusal to say hed withdraw from that conflict of interest is telling, and heightens those fears: Warren gave him an easy out to commit to good government principles. He refused to take it.In addition to the possibilities Warren floated, there are various ways Kennedy could sow doubts about vaccine safety: He could resuscitate HHSs National Vaccine Program Office, which monitored vaccine safety with particular rigor but was shuttered during the first Trump presidency.As health secretary, he would also oversee the Centers for Disease Control and Prevention (CDC), which is housed under HHS. That agency has two important roles in promoting vaccines in the US: It convenes an Advisory Committee on Immunization Practices to provide expert recommendations on who should get which vaccines and at which age, and it administers the Vaccines for Children program, which provides free vaccines for millions of children in low-income families. The advisory committee is not mandated by federal law it is convened only because the CDC has historically wanted it to be. A vaccine skeptic appointed to run the CDC could either staff the committee with anti-vaccination activists or dissolve it entirely, further eroding the publics faith in vaccines and potentially providing more fuel to anti-vaccine litigation.Having a president and HHS secretary so openly hostile to the US public health establishment is unprecedented. Already, as vaccination rates nationwide slip, the US is seeing more outbreaks of measles and other diseases that had previously been stamped out by vaccines. Normally, we would expect the nations top health care official to marshal any resources necessary to prevent such outbreaks. But Kennedy has a financial as well as an ideological stake in denying vaccines effectiveness and safety. 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