The White House’s overhaul of leadership at the Department of Health and Human Services is extending to Sec. Robert F. Kennedy Jr’s top aide and principal deputy chief of staff, Stefanie Spear, who is being forced into a diminished role after White House frustration with her performance, according to two White House officials and another person familiar with the matter.
People within the administration believed Spear, who also serves as senior counselor to Kennedy, has struggled to work well with others, one of the White House officials told MS NOW.
It is unclear how exactly Spear’s new responsibilities will manifest — whether, for instance, her title of principal deputy chief of staff will change. But all three sources described what’s happening as a demotion.
The changes for Spear are part of a recent overhaul among senior leadership at HHS, which included the departure of Jim O’Neill, the deputy secretary and acting director of the Centers for Disease Control and Prevention, and the elevation of top Centers for Medicare and Medicaid Services official Chris Klomp to HHS chief counselor, where he will take charge of the department’s day-to-day operations.
The White House drove the sweeping changes to shore up department leadership and improve its operations ahead of the 2026 midterm elections, when health officials and “Make America Healthy Again” advocates hope to deliver results for Republicans, according to three people with knowledge of the White House’s thinking.
Spear’s shifting responsibilities have not been previously reported.
A White House spokesman on Tuesday night refuted the notion that Spear’s roles were changing.
“This is absolute fake news. Nothing is changing with Stefanie Spear, who will maintain her title of Senior Counselor, remain a close advisor to Secretary Kennedy — as she has been for years — and continue serving as a key HHS official in the Trump administration,” Kush Desai, the spokesman, said in a statement.
Desai said he did not know whether Spear would keep the title of principal deputy chief of staff.
Spear did not respond to a request for an interview.
Spear, one of Kennedy’s most trusted and loyal aides, has worked with him for years, first collaborating on environmental causes before joining Kennedy’s anti-vaccine advocacy group and serving as press secretary for his 2024 presidential campaign.
But she has drawn criticism from Trump allies since before Kennedy was confirmed as secretary. The Wall Street Journal reported in January 2025 that Trump’s transition team sidelined her over concerns that, while interviewing prospective HHS candidates, she would raise questions about their vaccine beliefs even if they were interviewing for posts that had little to do with the topic. They cited people familiar with the interviews.
She was also passed over for the role of chief of staff at HHS and drew the ire of conservative commentator Laura Loomer, who called Spear disloyal to Trump, and accused her of using her position at HHS to lay the foundation for Kennedy to run for president again in 2028. Kennedy has ruled out a run in a post on X.
Will McDuffie is a reporter for MS NOW.
Jake Traylor is a White House correspondent for MS NOW.