Congress should embrace strategic health diplomacy

Whether our nation’s foreign policy is grounded in America First or American exceptionalism, improving global health should be a top policy priority of the United States. The recent hantavirus outbreak and evolving Ebola crisis serve as a reminder to Congress that the well-being of Americans is tied to the well-being of people around the globe.

Two of us, as former U.S. senators, were fortunate to play leading roles in the launch of PEPFAR, the President’s Emergency Plan for AIDS Relief, in 2003. Our research at the Bipartisan Policy Center demonstrated that beyond saving 26 million lives and preventing millions of HIV infections, PEPFAR contributed to a positive opinion of the U.S., better socioeconomic indices, and reduced political instability in target countries compared with non-PEPFAR countries. We termed this effect “strategic health diplomacy” — the idea that by addressing global health, America advances its own national strategic interests.

As the U.S. responds to new disease outbreaks, it’s important to heed PEPFAR’s lessons: have clear goals and identify policies needed to achieve them; address real needs with visible effect; be sensitive to local contexts; be in it for the long term; build capacity; and be transparent and accountable.

In addition, we know that an effective response requires preparedness. Over the past year, the U.S. has retreated from its “lean forward” posture through substantial cuts to CDC and USAID global health programs and severed links to the World Health Organization. All institutions need reform, but this process should be data-driven and guided by thoughtful dialogue with subject matter experts.

While the administration is now taking active steps to respond to both hantavirus and Ebola, it’s hard not to imagine that recent funding and policy decisions have hampered our response. The epidemiological investigation into and communications to the public and health professionals about hantavirus emerging on a cruise ship occurred late. With regards to Ebola, previously supported teams, supply chains, and protocols for early detection of an outbreak had been dismantled.

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We believe that Congress could more assertively fulfill its oversight role pertaining to global health preparedness and response in three ways.

First, Congress should hold hearings to better ascertain U.S. readiness to prevent, detect, contain, and respond to global health threats, in particular infectious disease threats with pandemic potential. It’s important to elucidate the extent to which recent federal program cuts and the lack of a White House pandemic preparedness coordinator have negatively impacted the response to hantavirus and Ebola. It’s also important to determine whether an urgent supplemental funding request for Ebola to support the regional response and domestic state and local public health preparedness is required.

Second, Congress should help the administration refine its global health strategy. Released last fall, the America First Global Health Strategy recognizes the value of global health leadership, identifies inefficiencies in past programmatic efforts, and accelerates recipient country accountability through bilateral agreements. However, significant questions remain about implementation. For example, while the strategy prioritizes rapid outbreak detection and response, the current Ebola outbreak highlights the continuing challenges of identifying and containing emerging threats quickly and effectively while building community trust.

In addition, while strengthening bilateral relationships are important, these agreements should not pull the rug from underneath countries at the first instance of difficulty meeting milestones of self-sufficiency, nor should they be transactional upon meeting certain U.S. business or economic interests. Many of these countries, including those at the center of the Ebola outbreak, saw critical U.S. health and development programs significantly scaled back during the rapid restructuring of USAID in 2025 under DOGE.

Third, Congress should continue to protect global health investments through the appropriations process. The House Appropriations Committee FY 2027 National Security, Department of State and Related Programs appropriations bill released in late April totaled $8.9 billion, nearly 75% above the president’s FY 2027 budget request ($5.1 billion). However, this is still about $500 million less than FY 2026 levels agreed to by Congress.

To support implementation of the administration’s strategy, considerations should be made to increase investments in global health security through this appropriations bill and through the recently released Labor/HHS/Education appropriations bill to bolster CDC’s global health efforts.

On this point, members of Congress would do well to remind the public of how much of the federal budget actually goes to global health. According to KFF’s Health Tracking Poll, the public believes that on average the U.S. spends about 26% of its budget on foreign aid. The reality is that less than 1% is spent on foreign aid, and global health spending is only a small fraction of foreign aid.

The moral, humanitarian, health, economic, national security, and public opinion motivations to rebuild U.S. global health leadership should be clear to Congress. A safer world makes for a more prosperous nation. 

Anand Parekh, M.D., M.P.H., is chief health policy officer at the University of Michigan School of Public Health and adjunct professor in health, management, and policy and internal medicine. He served as a deputy assistant secretary of health at the U.S. Department of Health and Human Services from 2008 to 2015. Tom Daschle is the founder and CEO of DB-3, a public policy affiliate of Baker Donelson. He represented South Dakota in Congress from 1979 to 2005 and served as Senate majority leader from 2001 to 2003. Bill Frist, M.D., is a heart and lung transplant surgeon and chairman of The Global Board of The Nature Conservancy. He represented Tennessee in the U.S. Senate for 12 years and served as Senate majority leader from 2003 to 2007.

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