The Democratic control of Congress may have significant implications for global health, following the Trump administration’s changes to U.S. global health funding and programs. The administration’s moves, including the introduction of the America First Global Health Strategy, have changed the global health situation.
The election that led to Democratic control of Congress was largely focused on domestic issues, including the economy and healthcare costs. However, the Trump administration’s attempts to end USAID received significant public attention, and the public has expressed concern about the impact of these changes on global health.
Congressional Oversight and Action
Congress has broad oversight authority over the executive branch, which it can use to provide scrutiny of global health programs and policies. Democrats are likely to be more aggressive in their oversight, with sharper questions and a greater willingness to challenge the administration.
There will be stronger calls for data and transparency, particularly regarding the America First Global Health Strategy and its implementation plans. Congress may also increase its oversight of what happened to USAID and the implications of shutting down the agency for global health and development efforts.
In terms of appropriations, the Republican-controlled Congress had continued to provide near-level funding for global health programs, despite the administration’s attempts to rescind or redirect funding. With Democrats in control, there may be stronger language in appropriations bills regarding how funding should be spent.
Shaping the Future of Global Health
There are many issues surrounding the future of U.S. global health programs, including how to achieve transition and sustainability, and what metrics should be used to assess progress. Democrats may continue to lay out a vision for the future, including the role of PEPFAR, the President’s Emergency Plan for AIDS Relief.
Other issues that may be addressed include how to reach vulnerable and at-risk populations, and where the U.S. should continue to provide bilateral global health support.
As the administration has used executive authority broadly, Congress cannot simply rescind the many executive orders that have been issued. The administration’s reaction to increased oversight is also unknown, and there may be changes in agency personnel that impact global health programs, such as the potential departure of Secretary of State Rubio or Secretary of HHS Kennedy.
The loss of Republican global health champions, such as Senators Collins and Graham, and the elevation of Democratic champions, may create some uncertainty about the future of bipartisanship on global health. The entrance of over 100 new members of Congress, most of whom are new to global health and development, may also impact the future of global health policy.
The Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, The Vaccine Alliance are examples of organizations that the U.S. has engaged with on global health issues. The future of these partnerships and others like them may be shaped by the Democratic control of Congress and the administration’s response to increased oversight.
According to local reports, the administration’s use of executive authority and the potential changes in agency personnel may impact the implementation of global health programs, including those related to PEPFAR and the America First Global Health Strategy. The report notes that the administration has used executive orders to make significant changes to global health policies, and it is unclear how Congress will respond to these changes.
Future of Global Health Programs
The future role of PEPFAR will be an important issue for Congress to consider. Democrats may seek to integrate HIV programs into country health systems and ensure continued focus on HIV as a key component of U.S. global health efforts.
