The change in control of Congress has major implications for health policy. Food regulation, gambling, pharmaceutical pricing, vaccines and America’s relationship with the World Health Organization will all receive renewed attention. For the Center for Global Health Accountability and the International Health Reform Panel, the implications are mixed.
My expectation is that the incoming majority will scrutinize commercial influence more aggressively while defending established public-health institutions more vigorously. There are opportunities in both. Companies should answer for harmful conduct, and effective health services deserve support. But neither hostility to industry nor loyalty to institutions provides a reliable guide to better health.
The question running through our work is whether policies deliver benefits proportionate to their costs. That applies to a vaping restriction, a gambling safeguard, a vaccine recommendation or a multibillion-dollar pandemic initiative. The election changes who asks the questions in Washington. It does not change the standards by which the answers should be judged.
Where congressional power will matter
Much depends on committee assignments and leadership elections. The current senior Democrats—Bernie Sanders on Senate Health, Education, Labor and Pensions, Ron Wyden on Senate Finance, and Frank Pallone on House Energy and Commerce—provide an indication of the direction if they assume the corresponding chairmanships. The House committee’s health jurisdiction explicitly includes FDA regulation of food, drugs and tobacco.
Committee leadership determines which investigations begin, who gives evidence and whether hearings examine regulatory failures or defend existing approaches. New members can contribute medical expertise and political energy, but a chairman controlling the agenda generally matters more immediately than an individual freshman.
Foreign affairs committees will influence debate over WHO and international health cooperation. Appropriators will negotiate funding and conditions attached to it. Agriculture committees, less obviously, are central to prediction markets because of their oversight of the Commodity Futures Trading Commission.
These powers have limits. Congress cannot reverse every executive decision through a hearing or a press release. Legislation normally requires presidential approval or sufficient votes to override a veto. Agency decisions remain subject to statutory procedures and judicial review. Nevertheless, oversight can expose information, increase the political cost of a policy and influence how officials exercise their discretion.
I therefore expect the earliest changes to appear through hearings, document demands and budget negotiations, followed by attempts to turn that pressure into legislation.
Commercial determinants and scrutiny of business
The commercial determinants of health framework examines how business practices influence health. Its underlying concerns—marketing, product design, lobbying and conflicts of interest—are likely to gain prominence, whether or not lawmakers use the terminology.
There is already a concrete agenda. Sanders’s Childhood Diabetes Reduction Act proposes warning labels, restrictions on advertising to children, further research into ultra-processed foods and public education. His office reported that the measure advanced through committee with bipartisan support in July.
Food policy is consequently one area where Democratic priorities could overlap with the administration’s MAHA agenda. Agreement that diet-related disease requires attention, however, does not establish that a particular label, advertising restriction or product classification will improve it.
CGHA’s contribution should be to distinguish criticism of specific conduct from a presumption that commercial activity is inherently suspect. Misleading claims, concealed evidence and manipulative marketing deserve scrutiny. So do regulations that protect established businesses, discourage useful innovation or impose costs without demonstrable benefits.
GLP-1 medicines illustrate the need for that distinction. Their manufacturers’ commercial interests do not settle the clinical questions. Neither do adverse effects considered in isolation. The relevant assessment includes benefits, harms, patient selection, affordability and the consequences of restricting access.
The same discipline should apply across nicotine, alcohol, food and pharmaceuticals. A business may sell products with very different risk profiles. Policy should recognize those differences.
Nicotine prospects and openings
The congressional outlook for tobacco harm reduction is probably less favorable. Several incoming and returning Democrats have supported flavor restrictions, higher nicotine taxes or tighter market controls.
Incoming California representative Richard Pan, a pediatrician and former state senator, jointly authored the state’s flavor-ban legislation. His stated rationale concentrated on preventing youth nicotine addiction. Returning physician Herb Conaway’s campaign explicitly celebrates his role in eliminating flavors from tobacco products in New Jersey. Kelly Morrison participated in a Minnesota initiative combining flavor restrictions, tax increases and cessation support.
Other records are more nuanced. Michigan’s incoming senator Abdul El-Sayed has acknowledged that smoking is substantially worse than vaping and discussed evidence of lower lung and cardiovascular risks. He has also strongly criticized JUUL’s marketing and youth addiction. His published discussion demonstrates an understanding of relative risk, although it does not establish where he stands on adult access, flavors or taxation.
Our initial review found no clear THR position from incoming South Carolina senator Annie Andrews, a pediatrician, or New Jersey representative Adam Hamawy, a surgeon. Their medical qualifications warrant engagement, rather than assumptions about their views.
Taxation deserves particular attention. Sherrod Brown, projected to return to the Senate after defeating Jon Husted in Ohio’s special election following his own 2024 defeat, previously supported legislation introducing federal e-cigarette taxation and harmonizing taxes across tobacco products. Reducing the price advantage of lower-risk substitutes could weaken smokers’ incentive to switch.
Expect more scrutiny of FDA authorizations, flavored products and industry influence. Wyden has already investigated the administration’s dealings with tobacco companies. Legitimate questions about regulatory integrity must nevertheless be distinguished from the scientific merits of the products concerned.
CGHA should keep asking what happens to smoking, lawful switching and illicit purchases. FDA itself recognizes that noncombustible products generally carry lower risks than cigarettes. Congressional policy should reflect that distinction.
Gambling and prediction markets
Gambling oversight is likely to intensify. Blumenthal, Tonko and Foushee have already demanded information from sportsbooks and prediction markets about VIP programs, customer losses and the use of AI. Their October letters specifically questioned incentives offered to vulnerable gamblers.
That overlaps with CGHA’s work on chasing losses and the treatment of high-spending customers. Research into whether operators recognize harmful behavior—and what they do after recognizing it—could find a receptive audience.
The policy challenge is to identify safeguards that work. Cooling-off periods, clearer account information and interventions prompted by escalating losses should be evaluated against outcomes. Broad restrictions should face the same evidentiary test.
AI particularly requires discrimination. A system encouraging someone to continue betting after substantial losses raises different questions from a tool helping that person recognize a harmful pattern and stop. Congress should examine incentives and behavior rather than treating the technology itself as the problem.
Prediction markets face a separate institutional battle. Senate Democrats, including Agriculture Committee ranking member Amy Klobuchar, have called for stronger CFTC oversight. The House Agriculture Committee has already held a hearing on customer protection and market integrity in sports-event contracts.
Expect greater attention to insider trading, manipulation and the relationship between federal market regulation and state gambling law. CGHA should defend consistent principles: consumer protection, transparent rules and access based on risk rather than political favoritism toward particular operators.
WHO membership and congressional influence
The congressional election does not itself restore American WHO membership. The administration states that the United States formally withdrew in January 2026.
It would nevertheless be mistaken to conclude that Congress has no role. Congressional Research Service analysis identifies legislative, funding and oversight options concerning WHO participation and withdrawal. Their practical effect would depend on the legislation enacted, executive cooperation and any legal disputes.
Democratic senators have already demanded answers about surveillance, outbreak coordination, smallpox arrangements and financial obligations following withdrawal. Their March letter provides a likely template for future oversight.
I expect pressure to restore engagement and challenge the adequacy of replacement arrangements. That could produce useful scrutiny. The administration should demonstrate that its alternative partnerships perform necessary functions.
WHO should face equally demanding questions. Membership, funding and participation are inputs. Effective cooperation, accountable decisions and improved health are the outcomes. IHRP’s case should be that international cooperation requires institutional reform and measurable performance, regardless of America’s membership status.
Pandemic agreements and health spending
Congress cannot determine what WHO member states agree in Geneva. The current PABS negotiations run through November 13, with their outcome intended for consideration at the May 2027 World Health Assembly.
American lawmakers can scrutinize implications for research, manufacturers, public funding and any proposed future American participation. Greater Democratic receptiveness to multilateral initiatives may make it harder to secure attention for arguments about institutional overreach. It also makes a carefully evidenced case about opportunity costs more valuable.
Preparedness spending should be assessed alongside established burdens: tuberculosis, malaria, HIV, maternal mortality and poorly functioning health systems. Calling expenditure “preparedness” does not establish its priority over these needs.
There is potential common ground. Democratic lawmakers have pressed for the release of appropriated funds supporting HIV, tuberculosis, malaria, maternal and child health, and nutrition. Protecting effective services is compatible with questioning expensive pandemic initiatives.
For IHRP, the strongest argument is about allocation: which investments produce the greatest health gains, who makes those decisions and how are they held accountable? Biosafety and pathogen-sharing arrangements also require scrutiny of operational risks, responsibilities and enforceable safeguards.
Vaccines and FDA performance
Expect aggressive oversight of Kennedy, CDC and changes to vaccine policy. Sanders has already published material challenging political intervention in vaccine decisions.
CGHA’s position should remain specific. Effective vaccines deserve support; recommendations should reflect the evidence for particular populations and outcomes. Access, safety monitoring, communication and mandates raise related but distinct questions.
There is a risk that opposition to Kennedy turns into blanket defense of every previous institutional decision. There is also a risk that justified criticism of institutional failures becomes blanket rejection of useful interventions. Neither helps restore trust.
The same applies to FDA performance. Congressional scrutiny should examine delayed access as well as premature approval, manufacturing quality as well as initial applications, and whether regulators respond promptly when postmarket evidence changes the balance of benefit and harm.
Accountability must include advocacy
Greater scrutiny of corporate conflicts should also prompt examination of advocacy organizations, research funding and litigation incentives. Financial interests do not disappear when an organization describes itself as nonprofit or public-interest.
CGHA’s work on lawfare should ask whether particular campaigns follow the evidence, how funding relationships are disclosed and whether litigation incentives influence public-health priorities. Those are questions to investigate, not conclusions to presume.
The incoming majority may be less receptive to criticism of organizations aligned with its agenda. That makes consistent methods especially important. The same disclosure and evidentiary standards should apply to companies, foundations, NGOs, researchers and public agencies.
The most plausible near-term outcome is intensified oversight and contested budgets, with legislative breakthroughs in selected areas. CGHA and IHRP should engage wherever lawmakers are willing to examine outcomes honestly—and challenge them wherever institutional loyalties or hostility to industry replace that examination.
