The November 3, 2026, midterm elections have fundamentally altered the balance of power in Washington, DC. Democrats have secured control of both the US House of Representatives and Senate, although the final composition of Congress remains subject to outstanding counts and certification.
The incoming Congress will inherit a public health landscape marked by disputes over scientific independence, changes to vaccination policy, threats to federal health infrastructure, and significant uncertainty surrounding health financing. The question is no longer simply how Congress should respond to these developments, but how it can exercise its constitutional powers to investigate, correct, and prevent institutional failures.
In Chapter 21 of my new book “Aftershocks: Trump 2.0, Public Health, and Our Better Angels,” I propose Horizons 2028 as a framework for this work. Its central principles are scientific independence, institutional accountability, transparent data, a protected health workforce, meaningful community governance, health equity, and stronger local and global public health systems.
The following 10-point agenda translates those principles into congressional actions. It distinguishes measures Congress can undertake independently – such as oversight, subpoenas, investigations, and appropriations restrictions – from legislation that would require presidential approval or sufficient votes to override a veto.
1. Investigate HHS Secretary Robert F. Kennedy Jr. and pursue impeachment if warranted by the evidence.
Congress should initiate a comprehensive investigation into Secretary Kennedy’s stewardship of the Department of Health and Human Services (HHS), including decisions affecting vaccine policy, scientific advisory committees, biomedical research, agency staffing, and public health communications. The investigation should determine whether actions taken under his leadership violated federal law, abused executive authority, obstructed congressional oversight, or otherwise constituted impeachable misconduct.
The House should establish a formal evidentiary record through sworn testimony, subpoenas, and independent assessments of the public health consequences of decisions made under Kennedy’s leadership. Where the evidence supports constitutional grounds, the House should consider articles of impeachment, recognizing that removal would require conviction by a two-thirds majority in the Senate.
Congressional Action: Initiate oversight and impeachment inquiries, compel the production of relevant records, protect whistleblowers, and refer substantiated findings to the House Judiciary Committee.
2. Establish a Congressional Commission on Public Health Harms, 2025–2026.
Congress should create an independent, bipartisan commission to document and quantify the public health consequences of federal policy decisions during the first two years of the Trump administration. The commission should investigate disruptions to HIV prevention and treatment, vaccination programs, Medicaid, maternal and reproductive health services, mental health and substance use disorder treatment, biomedical research, and emergency preparedness.
The commission should distinguish between documented adverse outcomes and projected future harms, using epidemiological evidence, financial records, clinical service data, and testimony from affected communities. Its mandate should extend beyond identifying administrative failures to determining whether decisions contributed to preventable illness, deaths, service interruptions, or widening health inequities.
Congressional Action: Establish a commission with subpoena authority, independent scientific expertise, public reporting requirements, and an initial findings deadline of 180 days, followed by recommendations for corrective legislation and administrative accountability.
3. Restore Scientific Independence and Protect Federal Health Institutions from Political Interference.
Congress should advance comprehensive scientific integrity legislation to protect the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Food and Drug Administration (FDA), and other federal health agencies from improper political interference. Scientific recommendations, regulatory assessments, research priorities, and public health communications must be guided by transparent evidence and established professional standards rather than ideological considerations.
Reforms should include independent scientific review procedures, transparent criteria for advisory committee appointments and removals, whistleblower protections, and safeguards against the suppression or alteration of scientific findings. Congress should also examine whether recent institutional reorganizations have compromised essential public health functions and require corrective action where necessary.
Congressional Action: Enact a Public Health Scientific Integrity Act, establish enforceable standards for scientific advisory bodies, strengthen inspector general oversight, and require congressional review of major changes affecting scientific governance.
4. Rebuild Vaccination Confidence and Restore the Nation’s Prevention Infrastructure.
Congress should review changes to federal immunization policies and restore confidence in evidence-based vaccination programs through independent scientific assessment, transparent recommendations, and reliable public communications. The objective should be to ensure that vaccine recommendations reflect the best available evidence and that communities retain dependable access to recommended immunizations.
The effort must extend beyond vaccines to the broader prevention infrastructure, including HIV pre-exposure prophylaxis (PrEP), sexually transmitted infection (STI) prevention, tuberculosis (TB) and viral hepatitis programs, harm reduction, overdose prevention, and community-based health education. Prevention cannot function effectively when funding, scientific guidance, or service delivery becomes unpredictable.
Congressional Action: Protect dedicated prevention appropriations, establish transparent standards for federal immunization recommendations, restore disrupted prevention services, and require annual reporting on prevention access, coverage, and population health outcomes.
5. Protect Medicaid and Reverse Policies That Threaten Access to Essential Health Care.
Congress should examine and seek to amend provisions enacted during the Trump administration that could increase the number of uninsured Americans or create avoidable barriers to care. Particular attention should be directed toward Medicaid work requirements, more frequent eligibility redeterminations, reduced retroactive coverage, and administrative procedures that may cause eligible individuals to lose health insurance.
These policies warrant scrutiny for their potential consequences for people living with HIV, individuals with disabilities, people managing chronic diseases, low-income families, and communities already experiencing disproportionate barriers to care. Congressional action should distinguish legitimate program integrity measures from administrative requirements that produce coverage losses without demonstrable improvements in health outcomes.
Congressional Action: Introduce legislation to modify harmful Medicaid provisions, strengthen coverage-continuity protections, preserve exemptions for medically vulnerable populations, and require independent assessments of coverage losses and associated health consequences.
6. Protect the Federal HIV Response and Ensure Continuity of Lifesaving Services.
Congress should safeguard the domestic and international HIV response from funding instability, institutional fragmentation, and disruptions to essential prevention, treatment, and care services. This includes protecting the Ryan White HIV/AIDS Program, CDC HIV prevention activities, Ending the HIV Epidemic initiatives, and the US President’s Emergency Plan for AIDS Relief (PEPFAR).
The objective should not be to preserve HIV exceptionalism or existing institutional arrangements indefinitely, but to protect the hard-won gains achieved over four decades while modernizing HIV services through integrated, person-centered care. Such an approach should maintain specialized HIV expertise and dedicated resources while strengthening connections to primary care, cardiometabolic health, mental health, substance use treatment, and other services across the life course.
Congressional Action: Protect HIV-specific appropriations, require assessments before major program consolidations or funding transfers, establish continuity-of-care safeguards, and strengthen accountability for HIV prevention, treatment retention, viral suppression, and health-related quality of life.
7. Rebuild the Federal Public Health Workforce and Restore Essential Institutional Capacity.
Congress should conduct a comprehensive assessment of the consequences of federal workforce reductions, agency reorganizations, and the loss of scientific and technical expertise across HHS and its operating divisions. Public health capacity depends on experienced epidemiologists, laboratory scientists, clinicians, researchers, data specialists, emergency preparedness professionals, and community health workers whose expertise cannot be rapidly replaced.
A workforce restoration strategy should prioritize functions essential to disease surveillance, outbreak response, biomedical research, clinical guidance, and the administration of federal health programs. It should also address employee protections, institutional knowledge retention, and the ability of federal agencies to recruit and retain qualified professionals.
Congressional Action: Commission independent workforce and institutional capacity audits, fund targeted restoration of critical positions, strengthen protections against improper political retaliation, and require congressional oversight of reorganizations that could compromise essential public health functions.
8. Establish a Public Health Data Integrity and Transparency Act.
Congress should establish enforceable protections for the integrity, completeness, and public accessibility of federal health data. Public health surveillance and reporting must be insulated from improper political interference, including the suppression of findings, unexplained delays in publication, manipulation of indicators, or elimination of data categories necessary to identify disparities.
Federal agencies should be required to document changes to surveillance methodologies, preserve appropriate disaggregation of data, and ensure that public health professionals can report scientifically valid findings without fear of retaliation. Particular attention should be directed toward HIV surveillance, vaccine-preventable diseases, maternal mortality, chronic disease burdens, and emerging infectious disease threats.
Congressional Action: Enact statutory standards for public health data integrity, mandate transparent reporting and independent audits, strengthen whistleblower protections, and establish accountability mechanisms for intentional suppression or manipulation of information with foreseeable public health consequences.
9. Make Health Equity, Community Participation, and Local Public Health Capacity Enforceable Priorities.
Congress should recognize that meaningful community participation is essential public health infrastructure rather than an optional feature of program design. Federal health programs should be required to engage affected communities in governance, priority setting, implementation, and evaluation, particularly where decisions affect populations experiencing disproportionate disease burdens or barriers to care.
Congress should also strengthen state and local public health capacity, including community-based organizations, rural health systems, and municipal health departments. Federal investment should support integrated approaches to communicable and noncommunicable diseases, housing instability, food insecurity, environmental exposures, and the health impacts of climate change.
Congressional Action: Establish community governance requirements for federally funded programs, protect funding for local public health infrastructure, incorporate measurable equity and service-continuity indicators into federal grants, and require transparent reporting on community participation and population health outcomes.
10. Restore Global Health Leadership and Demand Accountability for the Dismantling of USAID.
Congress should investigate the dismantling of the US Agency for International Development (USAID), including the termination of lifesaving programs, loss of institutional expertise, and resulting disruptions to HIV, TB, malaria, maternal and child health, and other essential health services. The investigation should document preventable illness and deaths attributable to these decisions and determine whether executive actions violated congressional appropriations or other applicable laws.
Particular scrutiny should be directed toward the suspension of US foreign assistance to South Africa and the administration’s restructuring of global health cooperation through bilateral health agreements. Congress should assess whether these actions were driven by legitimate public health priorities or political considerations, whether they undermined national ownership and multilateral cooperation, and whether adequate safeguards were established to protect continuity of care. Congress should also reaffirm US engagement with WHO, UNAIDS, the Global Fund, and other international health institutions while strengthening accountability for foreign assistance decisions.
Congressional Action: Investigate USAID’s dismantling and foreign assistance suspensions, mandate independent health impact assessments, require congressional review and transparency of bilateral health agreements, examine potential violations of appropriations law, and establish safeguards against politically motivated disruptions to essential global health programs.
As I write in “Aftershocks,” our advocacy push as a public health community should extend beyond restoration to the imperative of public health renewal. The first two years of the second Trump administration have raised fundamental questions about the independence of science, the integrity of federal health institutions, the reliability of essential services, and the responsibilities of government to protect population health.
Congressional oversight should establish which actions caused demonstrable harm, which created foreseeable risks, and which reflected deeper institutional vulnerabilities that predated the current administration. Of course, as I do in “Aftershocks,” we must also recognize that the nation’s public health architecture was imperfect long before January 20, 2025. Persistent inequities, fragmented service delivery, inadequate investment in prevention, and the exclusion of affected communities from meaningful decision-making were already undermining its effectiveness.
The challenge is therefore to address preventable harm while building institutions capable of withstanding future political, economic, and public health shocks. The measure of the 120th Congress will not be the number of investigations it launches or the legislation it introduces, but whether its actions produce greater accountability, more reliable access to care, stronger scientific institutions, and measurable improvements in population health.
Horizons 2028 calls for a public health system in which science is protected, communities share power, health equity is embedded in governance, and political authority is accompanied by enforceable responsibility. That is the standard against which the incoming Congress’s actions should be judged.
Dr. José M. Zuniga
Leave a Reply