Tomorrow is Election Day. If you haven’t already, please vote.
With so many races predicted to be close, your vote matters more than ever.
Over the last 20 months, the Trump Administration has proven hostile to policies and programs generally favored by the public health, medicine, bioscience, and scientific research (here) communities. Unlike many past battles on similar issues, Congress has been largely ineffective in countering the onslaught of program cuts and adverse policies emanating from the President.
This need not continue forever–or even wait until the end of Trump’s term in January 2029. With 435 House seats and 35 Senate seats on the ballot, this difficult dynamic could start to change when the new Congress is sworn in on January 3, 2027.
My underlying assumption is that broad turnout for Democratic candidates is the only hope to slow down President Trump and HHS Secretary Kennedy’s assault on public health and specifically vaccines. (Note: this assumption is specific to public health at FDA and CDC and not necessarily applicable to other parts of FDA’s jurisdiction or to NIH).
This assumption requires a global analysis of Democratic prospects and does not account for Republicans who might vote against President Trump on public health issues if elected/re-elected to Congress. To date, the Republican track record on this dynamic has been thoroughly uninspiring.
Here are some tips for understanding the election results and the likelihood that more favorable public health policies are possible in 2027 and thereafter.
Election Day: The Start of What Could Become a Long Process
Overall, Democrats are expected to have an excellent night. However, in this political atmosphere and with the possibility of genuinely tight races, outcomes may be preliminary until every vote is counted, then recounted, and then litigated and appealed. There is also a non-zero possibility that the Administration might use extra-judicial means to contest seats lost by Republicans (although this interview is reassuring here).
As a result, it could be several weeks (or longer) before winners are considered final, official, and certified. Election analysts will likely call nearly all of those races much sooner. The definitive source for those calls is the Associated Press (AP), which other outlets widely cite even if they have their own election analysts.
Voter Sentiment Apparent from Initial Vote Counts
Despite likely delays, the general tenor of voter sentiment matters deeply for the public health community trying to get help from Congress to rebuff Trump/Kennedy policies. This will likely be known by late evening on Election Day.
I see four possible outcomes, which are summarized below with the outcomes likely to be associated with them:
| Outcome | Tone | House Range | Senate Range (D + Ind.) |
Comment |
| Blue Tsunami (possible) | R & independents stay home or vote D. Seen as repudiation of Trump policies. | 250 D / 185 R | 54-57 D | D majority large and broad to confront all Trump policies. Not enough to override a veto. |
| Blue Wave (most likely) | A really good night for D’s with broad R losses in red states. Unambiguous message. | 235 D / 200 R | 52-54 D | Dem margins sufficient to deal directly with Trump and not beholden to R’s. |
| Red Undertow (very possible) | Some R losses in red states. Ambiguous message | 225 D / 210 R | 49-51 D | House turns Democratic; the Senate is narrowly divided |
| Red Status Quo (unlikely) | Polls widely undercount R’s. No change in policies. | 220 R / 215 D (R retains House) |
48 or fewer D | Trump + Congress continue to advance Trump policies |
It Still Matters Who Wins
Ultimately, what matters is who is seated in the new Congress on January 3, 2027.
We won’t have a full sense of that unless there is a blue wave bordering on a tsunami on election day OR Republicans clearly hang on (e.g., if early returns show substantial undercounting of Republicans in polling). More likely it will be a blue wave or a red undertow… and enough races will be in doubt for a while or will be litigated.
There are six open-seat Senate elections and at least six more races where the incumbent’s re-election is uncertain (“tilt Republican, toss-up, or tilt Democratic” and within or near the polling margin of error). Because polling is an inexact science, literally anything could happen. However, it is reasonable to expect polling to be generally, though not precisely, accurate.
My plan is to run a follow-up column soon that will be more granular about who is or may be elected and whether it signals a possible change in Congress’s response to the Administration’s hostility towards public health.
