Surgeon general nominee Nicole Saphier, seeking to be confirmed as the nation’s top health educator and spokesperson, on Wednesday declined to fully distance herself from the Trump administration’s changes to the childhood vaccine schedule when pressed by a prominent Republican.

During a hearing of the Senate Health, Education, Labor and Pensions Committee, outgoing Chairman Bill Cassidy, R-La., attempted to get Saphier on the record that the measles, mumps and rubella vaccine does not cause autism and that a universal recommendation for a hepatitis B vaccine at birth should remain in place.

Saphier would not openly refute the stances of Health and Human Services Secretary Robert F. Kennedy Jr. or President Donald Trump, both of whom have suggested a link between autism and the MMR vaccine.

The discussion occurred at the outset of a hearing to consider Saphier’s nomination. Also appearing were Chris Klomp, who’s nominated to be deputy HHS secretary, and Timothy Westlake, up for assistant HHS secretary for Mental Health and Substance Use.

Saphier attracted the heaviest questioning from senators, many of whom grilled her on whether she would knowingly spread misinformation if Kennedy asked her to do so.

“Well, humbly, I don’t know what causes autism, but I have not seen repeatable evidence that will suggest it causes autism,” Saphier said when Cassidy asked her if she believed that the MMR vaccine is a cause.

Cassidy interrupted Saphier to say her answer gave “too much wiggle room” and asked her to be more specific because nominees can “use wiggle room to do things that are quite contrary.”

Saphier told him that she did not believe the vaccines to be lethal, as Trump once suggested, and would recommend the shots, but she appreciated that some parents are skeptical of the vaccine and the Trump administration is trying to appeal to these people.

“I’m not sure that you reach people who are vaccine-hesitant by feeding into their own truths,” Cassidy responded. “The way to dispel confusion is not to sell more confusion.”

As for the hepatitis B vaccine, the Centers for Disease Control and Prevention’s vaccine panel in December voted to drop the universal recommendation that babies receive it at birth after Kennedy cast doubt on the validity of the shot. Cassidy, a longtime liver doctor who treated hepatitis, is a strong proponent.

A judge temporarily blocked the panel’s recommendations in March, including the change to the hepatitis B vaccine.

“I support universal hepatitis B vaccination,” Saphier told Cassidy. But she would not go as far as saying that Kennedy should keep the recommendation in place, much to Cassidy’s chagrin.

Vaping

When Sen. Susan Collins, R-Maine, asked Saphier about flavored vaping, the nominee again had to contend with the Trump administration versus conventional medical wisdom.

“As a physician, I don’t want anyone smoking anything. The lungs are very sensitive and they don’t regenerate,” Saphier said. She added that “if flavor [vapes] can entice an adult to quit smoking cigarettes, then maybe it’s something to be considered.”

In May, the Food and Drug Administration authorized four new fruit- and menthol-flavored vapes. Former FDA Commissioner Marty Makary deeply disagreed with the decision and resigned from his post soon after it was made. Rich Danker, a top HHS spokesperson, also resigned in protest of the vaping decision.

Sen. Tim Kaine, D-Va., said he was very disappointed in the administration’s shuttering of the CDC’s smoking cessation office. Sen. Lisa Murkowski, R-Alaska, added that Saphier’s past work as a social media influencer could help make her an effective anti-smoking spokesperson for the nation.

“I am as anti-smoking, anti-tobacco as you could imagine anyone to be,” Saphier responded.

Measles

Saphier’s appearance resembled Klomp’s at the Senate Finance Committee on Tuesday, where he toed the line between portraying himself as a trustworthy, policy-focused nominee while declining to fully distance himself from Kennedy’s vaccine policies.

In questioning Klomp on Wednesday, Cassidy pointed to four measles deaths in Pennsylvania. The CDC has yet to update its website to reflect these deaths, as Kennedy and Pennsylvania officials have feuded over whether they were a result of measles or other causes.

Cassidy said there’s a perception that the agency is “trying to dance around the sensitivities of [Kennedy] as opposed to being straightforward with the American people.”

Klomp said if confirmed, HHS would “address the operational shortcomings and create a clear definition of measles-related death.”