What Does Democratic Control of Congress Mean for Global Health?

After unprecedented disruptions and changes made by the Trump administration to U.S. global health funding and programs, altering the larger global health landscape, and eventually leading to its new America First Global Health Strategy (AFGHS), what might Democratic control of Congress mean going forward?

First, and importantly, the election was not about global health or foreign aid. It was largely about what Americans are experiencing at home and their concerns about the economy and affordability, including their own health care costs, though foreign policy also registered, including opposition to the Iran war and other conflicts.

At the same time, the Trump administration’s moves to end USAID received significant public attention. And, when asked, the public does care about the health of those around the world and believes that the Trump administration’s cuts have had a negative impact on their health and on how the U.S. is viewed in the world.

So, what might a Democratic Congress do on global health?

• Oversight. Congress has broad oversight authority over the executive branch, including through hearings, investigations, legislative report language, document requests, and other actions. Since 2025, Congress has used some of this authority to provide oversight of global health, the AFGHS and its bilateral MOUs with countries, including through reporting requirements and other language in appropriations legislation, and through select hearings, although these have been limited. While there were congressional inquiries over the past two years, Democrats will likely be sharper in their questions and willing to challenge the Administration more than the President’s own party. There are also likely to be stronger calls for data and transparency, given concerns about the loss of data, and lack of information on the AFGHS MOUs and implementation plans, which has limited the ability of Congress and others to monitor the status of services and programs and, ultimately, health outcomes. There is also likely to be increased oversight of what happened to USAID and the implications of shuttering the agency for global health and development efforts.
• Appropriations. Despite the many changes made by the Trump administration to global health, the Republican controlled Congress continued to appropriate near level funding for global health programs in most cases. At the same time, the administration rescinded some of this funding and has redirected appropriated funds from their originally intended purpose. Both Republicans and Democrats have pushed back on this and more is to be expected with the Democrats in the majority, including stronger appropriations language regarding exactly how funding should be spent. If the administration were to rebuff these efforts, Congress has the ability to go to court (though it is not clear if they would on these issues).
• Authorizing & Shaping the Future. More generally, there are many questions about how to make the new AFGHS successful and what the future of the U.S. global health response should be given the changes made by the administration, but also broader changes happening in global health. These questions have been raised by both Republicans and Democrats in the current Congress and Democrats could continue to lay out a vision for the future, including:
  • How transition and sustainability of U.S. global health programs can responsibly be achieved, and what are the right early warning indicators and metrics that could be used to assess progress? What data and monitoring systems are needed?
  • What is the future role of PEPFAR, the President’s Emergency Plan for AIDS Relief, the largest component of the U.S. global health portfolio? What will be the continued focus on HIV as the U.S. seeks to integrate HIV programs into country health systems?
  • How should those who are most vulnerable and at-risk best be reached, as more responsibility for financing and service delivery is transferred to countries?
  • Where and under what circumstances might the U.S. want to continue to provide bilateral global health support, especially to countries that are most financially vulnerable and/or experience unexpected shocks or crises in the future?; and
  • How might the U.S. engage multilaterally on global health (as it has been doing even under the Trump administration through new partnerships with the Global Fund to Fight AIDS, Tuberculosis and Malaria and a resumption of funding for Gavi, The Vaccine Alliance), ) including through expanded pooled procurement to promote affordable access to health products?

These issues are part of a longer-term project, but one that Congress could increasingly weigh in on now.

What we still don’t know. Of course, there remain many unknowns and questions about the next two years, even with the shift in control of Congress. The administration has and likely still will use executive authority broadly and on global health specifically. Congress cannot simply rescind the many executive orders the administration has issued. It is also unknown how the administration might react to more oversight of these issues – President Trump could still ignore what Congress demands, double down on the current path, or seek to pursue greater cooperation in some areas. There may be changes in agency personnel that could impact global health programs, such as if Secretary of State Rubio or Secretary of HHS Kennedy step down, each of whom has authority over different aspects of global health policy. Finally, while bipartisanship has historically been the “secret sauce” of U.S. global health over multiple Congresses and administrations and even carrying through, albeit to a lesser extent, the past two years, there will be numerous changes in Congress that create some uncertainty in this regard. This includes the loss of several Republican global health champions (e.g., Senators Collins and Graham), the elevation of Democratic champions as part of the majority (e.g., Senators Murray, Shatz, and Coons and Representative Frankel), and the entrance of more than 100 new members of Congress, most of whom will be new to global health and development. Ultimately, whether bipartisanship on global health holds, or becomes more fractured, will be an important determinant of the future story.