In 2025,President-elect Donald Trump nominated O'Neill to serve as U.S. Deputy Secretary of Health and Human Services. He was confirmed along party lines by a 52–43 vote,and assumed office on June 9,2025. Later that year,O'Neill was concurrently appointed as Acting Director of the Centers for Disease Control and Prevention.
Early life and education
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From December 2002 to August 2005, O’Neill served as Director of the Speech and Editorial Division of the U.S. Department of Health and Human Services (HHS),[4] where he wrote or edited all speeches given by the HHS Secretary. He was also a member of the United States Delegation to the World Health Assembly.[citation needed]
He was Associate Deputy Secretary and Senior Advisor to the Deputy Secretary of HHS from August 2005 to November 2007,[4] where he was involved in policy formulation for various HHS components.
After working at HHS, O'Neill was managing director of Clarium Capital, a hedge fund led by Peter Thiel, during 2008–2012.[4][6][7] During this time he was also CEO of the Thiel Foundation from 2009 to 2012 and was managing director from 2008 to 2012 at Thiel Capital. O'Neill is a co-founder of the Thiel Fellowship, founded in 2010,[3] which gives 24 students a year $100,000 to drop out of school and pursue entrepreneurial interests,[8] and Breakout Labs, a venture capital firm affiliated with the Thiel Foundation founded in 2011,[3] which provides funding to food science and biotech firms.[6][9]
He was appointed CEO of the SENS Research Foundation in October 2019, having previously been a board member during 2010–2011.[9][12] He remained in that position until July 2021.[13]
He was also a board member of the Seasteading Institute, until shortly before 2017.[14] In March 2023, he joined the board of ADvantage Therapeutics Inc.[15]
Second Trump administration (2025–present)
O'Neill was considered a candidate for FDA Commissioner and was reportedly favored by Donald Trump's transition team in 2016,[16][17] but was not nominated for that position.
In November 2024, President-elect Trump said he intended to nominate O'Neill to serve as Deputy Secretary of Health and Human Services under Robert F. Kennedy Jr., both of whom would need confirmation by the U.S. Senate.[18] He was confirmed on June 5, 2025, in a 52–43 vote,[19] and assumed office on June 9.[18]
In a 2009 talk, he called for freer markets for a wide range of health-care goods and services. "Basically, because there’s not a free market in health care, people are suffering very significant health consequences that in a free market they would not suffer," he said, asserting that a free market in health care "would drive prices much lower and allow innovation in cheaper delivery of care, both in terms of drugs and devices and better forms of delivery."[3]
While at HHS during the George W. Bush administration, O'Neill opposed FDA regulation of some companies that use mathematical algorithms to perform complex laboratory-developed tests. "In order to regulate in this space, FDA had to argue that an algorithm, a series of numbers that match up to things, is a medical device," he said. "I found that really astonishing – astonishing that someone could say it with a straight face, and astonishing that someone could claim the ability to shut down companies that were never touching a patient but only accurately matching algorithms."[3]
O'Neill said in a 2014 speech, "We should reform FDA so there is approving drugs after their sponsors have demonstrated safety – and let people start using them, at their own risk, but not much risk of safety....Let’s prove efficacy after they’ve been legalized."[3]
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