As the election nears, Biden administration officials are dreading three words: Chairman Rand Paul.

The Kentucky senator, who has clashed with Anthony Fauci and other health officials throughout the pandemic, is in line to lead a Senate committee should he win reelection and Republicans retake the chamber next week. (While Paul is heavily favored in his own race, control of the Senate is viewed as a toss-up by pollsters.) GOP control would give the libertarian doctor – an outspoken critic of the government’s coronavirus policies – the power to lead investigations and help set legislative priorities next year, either as chairman of the Senate’s sweeping health committee or its more targeted government oversight panel.

“If you help me win, I promise to subpoena every last document of Dr. Fauci’s unprecedented coverup,” said a Paul fundraising email sent Oct. 20, referring to Paul’s allegations that Fauci contributed to the virus’s creation by funding research in Wuhan, China – allegations Fauci has categorically denied.

An ophthalmologist by training, Paul is set to be the most senior Republican on the Health, Education, Labor and Pensions Committee, better known as HELP, which oversees the nation’s health and education agencies as part of its expansive portfolio. The possibility has rattled health-care leaders and trade groups, worried that Paul will follow through on his criticism of “Big Pharma, the medical establishment and public health officials” for their stances on COVID. Paul has argued that those groups wrongly quashed disagreements about how to fight the pandemic. In 2021, for instance, he called for more research into treatments such as ivermectin, noting that it was already in clinical trials to test its effectiveness against a number of viruses, including SARS-CoV-2. The drug was subsequently shown to be ineffective against the coronavirus.

The American Public Health Association, a trade group representing public health professionals, recently gave Paul the lowest-possible grade on its congressional report card: zero percent.

“He has not been an exemplar of prevention or wellness,” said Georges C. Benjamin, executive director of the American Public Health Association, referring to Paul’s reticence about whether he got a coronavirus vaccine and reports that he used the Senate gym while waiting for a coronavirus test result in March 2020 that showed he was infected. “That is a real problem when you’re a physician . . . you should know better.”

Experts at three other health organizations declined to go on the record with their own concerns, citing fears that criticizing Paul could backfire if he assumes the health committee’s leadership.

J. Stephen Morrison, who oversees global health policy at the Center for Strategic and International Studies, predicted that agencies such as the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration will face considerable pressure if Paul and fellow Republicans take control of Congress and launch investigations into the government’s pandemic response.

“A certain group of Republicans feel that the actions by the public health leadership defied personal liberties, were reckless, were unaccountable. And they want to exact a price for that,” Morrison said. “They’re not thinking about what needs to be changed to protect Americans.”

Senate Minority Leader Mitch McConnell, R-Ky., said earlier this year that he expects Paul to lead the health committee if Republicans take the Senate, given the pending retirement of Sen. Richard Burr, R-N.C., the only GOP member with more seniority, the Associated Press reported.

But Paul and Senate leaders could opt that he take a different chairmanship: serving as the top Republican on the Homeland Security and Governmental Affairs Committee, the chamber’s chief panel charged with conducting oversight. That role is currently filled by Sen. Rob Portman, R-Ohio, who is retiring. Sen. Ron Johnson, R-Wis., is next in seniority but has already exhausted his six-year term limit as panel chair.

Paul, whose office did not respond to interview requests, has said he will wait until after the election to make a decision about which committee to lead. But he has repeatedly indicated that pandemic-related investigations would be his top priority: A “Fire Fauci” banner is emblazoned as the “featured issue” on his campaign website and has fueled an array of his fundraising emails, stump speeches and tweets.

Fauci, 81, who is set to retire from government this year after leading the National Institute of Allergy and Infectious Diseases since 1984, told The Washington Post that he would comply with any congressional requests next year.

“I’m always open and happy to cooperate with any committee,” Fauci said, noting that he had testified before Congress hundreds of times over the past four decades but declining questions about his relationship with Paul.

Inside the administration, senior officials are less sanguine about the prospects of Chairman Paul, who has peppered the health agencies with letters demanding information about myriad aspects of their COVID guidance; sought to unwind masking requirements on public transportation; and over the summer organized a hearing – skipped by Democrats – into whether virus research sponsored by the U.S. government contributed to the pandemic.

There’s at least one critical piece of health-care legislation on the health committee’s docket next year: The panel will need to reauthorize key pandemic preparedness programs set to expire at the end of fiscal 2023, in what could be a relatively routine matter – or could become a fierce fight given Paul’s hostility to the government’s approach.

“Oh, dear God,” said one senior administration official who was not authorized to comment. Other officials added that Paul has shown little willingness to cooperate with the administration.

Beyond the coronavirus, Paul has argued for reducing government’s role in health care, opposed federal funding of abortion and criticized hormone therapy for minors – all positions that put him on the opposite side of many public health groups.

Several administration officials and congressional staff also questioned whether Paul could build consensus among his colleagues, a role that often falls to a chairman; the Kentucky Republican briefly shut down the federal government in 2018, while Donald Trump was president and the GOP controlled Congress, citing his concerns about deficit spending, and has cultivated a reputation for an independent streak, at times taking aim at fellow Kentucky senator McConnell.

But some Republicans say they are excited about the prospect of Paul as committee chairman, pointing to bipartisan deals he has worked on – such as recent legislation to end animal testing mandates for drug companies, which passed the Senate this fall and is awaiting a House vote. Those supporters argue he would unearth problems with the Biden administration’s COVID response that the Democrat-controlled Congress has overlooked for nearly two years.

“Senator Paul is one of the brightest people on Capitol Hill,” Sen. Roger Marshall, R-Kan., a frequent ally, said in a statement. “His experience as a physician and years in the Senate would make him an exceptionally qualified HELP Committee Chairman. As we continue to investigate the origins of COVID and the role Dr. Fauci played, Senator Paul is a fighter, has the courage, and will stand up to Washington insiders.”

“I’m not sure there is a single Senator who has more dogmatically pursued the truth regarding federal public health policy than Dr. Paul,” Josh Holmes, a co-host of the conservative “Ruthless” podcast and an outside adviser to McConnell, wrote in an email. “Undoubtedly, that rubs some people the wrong way but history has shown that he was onto many aspects of the failed logic used to execute our nation’s COVID policy long before it was publicly acceptable to discuss.”

The Biden administration has already begun positioning for additional Republican oversight following the election, tapping lawyer Richard Sauber, who had been serving as general counsel of the Department of Veterans Affairs, to lead a White House response team. That team also includes Ian Sams, who previously helped lead pandemic communications at the Department of Health and Human Services.

Pending next week’s election and Democrats’ own decisions, some congressional staff are also preparing for a new top Democrat on the health panel: Sen. Bernie Sanders, I-Vt. That could set up an unusual pairing of two lawmakers who have often bucked their own party – and have occasionally found common cause with each other.

Should Paul become the leader of the health committee, he would represent a significant change from the outgoing top Republican, Burr, who sought to cultivate a reputation as a dealmaker. Burr worked alongside Chair Patty Murray, D-Wash., to craft a plan to tackle future pandemics and eventually found consensus on a deal to reauthorize critical fees funding a significant portion of the FDA’s budget.

Burr also has taken a conciliatory approach toward Fauci, praising him in September for his service, even as the GOP senator demanded more accountability from the federal government.

In contrast, Paul portrays himself as at war with Fauci and Democrats – and sometimes finds himself in fights with Republicans, too. The iconoclastic senator mocked the House GOP in March 2017 for its secrecy in crafting a plan to repeal the Affordable Care Act, toting a copy machine around the Capitol building and drawing a crowd of reporters.

Paul later opposed legislation from sens. Bill Cassidy, R-La., and Lindsey O. Graham, R-S.C., to repeal and replace the ACA in the fall of 2017, helping deal a death blow to Donald Trump’s ambition of overturning Obamacare in his first year in office, even as GOP colleagues publicly petitioned him to support it. Paul had proposed his own repeal of the 2010 law, arguing to unwind many of its federal protections and replace them with measures such as health savings accounts, although his efforts failed.

More recently, Paul has staked out an increasingly skeptical posture on vaccines, fiercely opposing mandates requiring coronavirus shots and vowing in May 2021 that he wouldn’t get the shot because he’d already been infected. His office didn’t respond to a question on whether he’s received the coronavirus vaccine.

The Kentucky senator has previously come under fire for comments suggesting that he’s heard of cases where childhood vaccines have caused “mental disorders” – remarks he quickly walked back.

“I would worry about what might happen were he chair if the COVID pandemic took a nastier turn, or something else appeared,” said Arthur L. Caplan, director of the medical ethics division at NYU Grossman School of Medicine. “He’s shown himself willing to, in my opinion, bend the facts, particularly in matters like the power of passive immunity, allowing natural infection to be a substitute for vaccination.”

Democrats are poised for their own committee shake-up, regardless of the election’s outcome. Some lobbyists and Hill staff expect Murray to leave the panel to head up, or become ranking member, of the powerful Senate Appropriations Committee if she is reelected next week. An aide to the senator said she is “focused on her reelection” and legislative work during the lame duck.

That could open up the health committee post for Sanders, a self-described democratic socialist – setting up a possible pairing with Paul that congressional staff described as unpredictable and potentially explosive.

“It goes from one of the most productive committees in the Senate to one of the least productive committees of the Senate,” one Senate GOP aide said, speaking on the condition of anonymity to be candid.

In June, the two firebrands teamed up during a committee markup of legislation to reauthorize user fees that drug companies pay to the FDA. Sanders introduced a sweeping amendment to allow drug importation from Canada, the United Kingdom and other countries – a policy despised by the drug industry but favored by Paul, who has blasted America’s sky-high prescription drug prices.

“Well, I’ve always wanted to go to a Bernie rally – now I feel like I’ve been there,” Paul said after Sanders finished castigating pharmaceutical companies and introducing several amendments aimed at cracking down on the nation’s high drug prices. “I’m going to support Sanders’s first amendment on reimportation,” Paul continued.

The potential pairing could give drug importation its biggest congressional boost yet, though it would still be an uphill battle to pass in a divided Congress.

There may be some other areas where the two could set aside their differences.

“It’s probably a little mythology that they can’t work together,” said Chris Jennings, a longtime Democratic health policy consultant who worked in the White House during the Clinton and Obama years. He pointed to their work to combat the opioid scourge in their states, though conceded, “Will they disagree a lot? Of course.”

If Paul instead heads to the Senate Oversight Committee, Sen. Bill Cassidy, R-La., would probably be next in line for the health panel’s chairmanship under GOP control. The gastroenterologist is known for being energetic and a policy wonk on health-care issues. Cassidy’s office declined to comment on his interest in the top slot, if Paul declined to take it.

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