Over the past year, Jim O’Neill has become one of the most powerful people in public health. As the US deputy health secretary, he holds two roles at the top of the country’s federal health and science agencies. He oversees a department with a budget of over a trillion dollars. And he signed the decision memorandum on the US’s deeply controversial new vaccine schedule. He’s also a longevity enthusiast. In an exclusive interview with MIT Technology Review earlier this month, O’Neill described his plans to increase human healthspan through longevity-focused research supported by ARPA-H, a federal agency dedicated to biomedical breakthroughs. At the same time, he defended reducing the number of broadly recommended childhood vaccines, a move that has been widely criticized by experts in medicine and public health. In MIT Technology Review’s profile of O’Neill last year, people working in health policy and consumer advocacy said they found his libertarian views on drug regulation “worrisome” and “antithetical to basic public health.” He was later named acting director of the Centers for Disease Control and Prevention, putting him in charge of the nation’s public health agency. But fellow longevity enthusiasts said they hope O’Neill will bring attention and funding to their cause: the search for treatments that might slow, prevent, or even reverse human aging. Here are some takeaways from the interview. Vaccine recommendations could change further Last month, the US cut the number of vaccines recommended for children. The CDC no longer recommends vaccinations against flu, rotavirus, hepatitis A, or meningococcal disease for all children. The move was widely panned by medical groups and public health experts. Many worry it will become more difficult for children to access those vaccines. The majority of states have rejected the recommendations. In the confirmation hearing for his role as deputy secretary of health and human services, which took place in May last year, O’Neill said he supported the CDC’s vaccine schedule. MIT Technology Review asked him if that was the case and, if so, what made him change his mind. “Researching and examining and reviewing safety data and efficacy data about vaccines is one of CDC’s obligations,” he said. “CDC gives important advice about vaccines and should always be open to new data and new ways of looking at data.” At the beginning of December, O’Neill said, President Donald Trump “asked me to look at what other countries were doing in terms of their vaccine schedules.” He said he spoke to health ministries of other countries and consulted with scientists at the CDC and FDA. “It was suggested to me by lots of the operating divisions that the US focus its recommendations on consensus vaccines of other developed nations—in other words, the most important vaccines that are most often part of the core recommendations of other countries,” he said. “As a result of that, we did an update to the vaccine schedule to focus on a set of vaccines that are most important for all children.” But some experts in public health have said that countries like Denmark and Japan, whose vaccine schedules the new US one was supposedly modeled on, are not really comparable to the US. When asked about these criticisms, O’Neill replied, “A lot of parents feel that … more than 70 vaccine doses given to young children sounds like a really high number, and some of them ask which ones are the most important. I think we helped answer that question in a way that didn’t remove anyone’s access.” A few weeks after the vaccine recommendations were changed, Kirk Milhoan, who leads the CDC’s Advisory Committee on Immunization Practices, said that vaccinations for measles and polio—which are currently required for entry to public schools—should be optional. (Mehmet Oz, the Center for Medicare and Medicaid Services director, has more recently urged people to “take the [measles] vaccine.”) “CDC still recommends that all children are vaccinated against diphtheria, tetanus, whooping cough, Haemophilus influenzae type b (Hib), Pneumococcal conjugate, polio, measles, mumps, rubella, and human papillomavirus (HPV), for which there is international consensus, as well as varicella (chickenpox),” he said when asked for his thoughts on this comment. He also said that current vaccine guidelines are “still subject to new data coming in, new ways of thinking about things.” “CDC, FDA, and NIH are initiating new studies of the safety of immunizations,” he added. “We will continue to ask the Advisory Committee on Immunization Practices to review evidence and make updated recommendations with rigorous science and transparency.” More support for longevity—but not all science O’Neill said he wants longevity to become a priority for US health agencies. His ultimate goal, he said, is to “make the damage of aging something that’s under medical control.” It’s “the same way of thinking” as the broader Make America Healthy Again approach, he said: “‘Again’ implies restoration of health, which is what longevity research and therapy is all about.” O’Neill said his interest in longevity was ignited by his friend Peter Thiel, the billionaire tech entrepreneur, around 2008 to 2009. It was right around the time O’Neill was finishing up a previous role in HHS, under the Bush administration. O’Neill said Thiel told him he “should really start looking into longevity and the idea that aging damage could be reversible.” “I just got more and more excited about that idea,” he said. When asked if he’s heard of Vitalism, a philosophical movement for “hardcore” longevity enthusiasts who, broadly, believe that death is wrong, O’Neill replied: “Yes.” The Vitalist declaration lists five core statements, including “Death is humanity’s core problem,” “Obviating aging is scientifically plausible,” and “I will carry the message against aging and death.” O’Neill said he agrees with all of them. “I suppose I am [a Vitalist],” he said with a smile, although he’s not a paying member of the foundation behind it. As deputy secretary of the Department of Health and Human Services, O’Neill assumes a level of responsibility for huge and influential science and health agencies, including the National Institutes of