Policy Brief for the National Security Council
Executive Summary
The 2025 National Security Strategy calls for “a more suitable Coast Guard and Navy presence to control sea lanes, to thwart illegal and unwanted migration, to reduce human and drug trafficking, and to control key transit routes in a crisis” (The White House, 2025, p. 16). In addition to the aforementioned need for U.S. Navy presence in the Western hemisphere, China’s Navy strives to dominate the South China Sea, where one-third of global shipping passes annually. Funaiole and Hart (2025) highlight that the PLA Navy currently has far more ships than the U.S. Navy and is projected to continue increasing in size. Shambaugh (2025) further cautions how, “[t]he multifaceted challenges that China presents to the United States (and to the world) today are so urgent and complicated that most analysts are now debating how – not whether – to push back against China” (p. 24). Amidst the growing need for a strong U.S. Navy presence across the globe, the 50-year old USNS Mercy is currently undergoing a $90 million overhaul which began March 20, 2026 (Graves, 2026).
While naval medical capabilities are not specifically referenced in the 2025 National Security Strategy, one can infer that it is appropriate, and even essential, to replace the USNS Comfort and USNS Mercy to best meet U.S. national interests in the 21st century. This military medicine initiative clearly falls in line with the Trump administration’s overall goal of fielding “the world’s most powerful, lethal, and technologically advanced military” (The White House, 2025, p. 3). With the ever-increasing U.S. naval operational tempo, rather than continuing to nurse these two aged hospital ships to health for the foreseeable future, this policy brief proposes three alternative courses of action the National Security Council should consider to best ensure navy medicine is capable of meeting the humanitarian and combat needs of the United States as outlined in the 2025 National Security Strategy. In essence, now is the ideal time to build two new state-of-the-art hospital ships.
Background and Context
The USNS Mercy and USNS Comfort are 1,000 bed “floating level-I trauma centers” with a long history of compassionate service, each having cared for thousands of patients across the globe (Sechriest and Lhowe, 2008, p. 849). According to Provencher and Douglas (2011), their “primary mission centers on providing an afloat, mobile, acute surgical and medical facility to the U.S. military in support of expeditionary warfare. [Their] secondary mission is to provide full hospital services to support U.S. disaster relief and humanitarian operations worldwide” (p. 38). The USNS Comfort is homeported in Norfolk, Virginia, and primarily operates in the Atlantic Ocean, while the USNS Mercy is homeported in San Diego, California, and primarily operates in the Pacific Ocean.
According to the U.S. Navy’s Military Sealift Command (2025), the current USNS Mercy is the third U.S. Navy ship to bear the name and was initially built as an oil tanker in 1976. In 1984, it was acquired by the U.S. Navy, converted to a hospital ship, renamed Mercy, and launched in 1985. The USNS Mercy is assigned to the Pacific Ocean, although it was called upon to support Operation Desert Shield. During its 40 years of military service, the USNS Mercy has responded to multiple typhoons and other natural disasters throughout the Pacific, and most recently supported the COVID-19 response in Los Angeles, California, in March of 2020.
The U.S. Navy’s Military Sealift Command (2025) additionally discusses how the USNS Comfort has a similar story to that of the USNS Mercy. It was also originally launched in 1976 as an oil tanker and later converted to a hospital ship in 1987, making both the USNS Mercy and USNS Comfort 50 years old. The mission and capabilities are identical, as the Comfort also provides mobile and acute surgical medical facilities when needed, albeit primarily in the Atlantic Ocean. Similar to the Mercy, onboard medical capabilities include 80 intensive care beds, 15 patient wards, 11 operating rooms, a 5,000-unit blood bank capacity, a radiology suite, and so much more. “Fully staffed, there are 1,214 military personnel and 63 civilian mariners” (Worlton et al, 2020, p.1). Notable recent USNS Comfort missions include Operation Noble Eagle, where it docked in Manhattan immediately following the 9/11 terror attacks in New York City, Hurricanes Katrina and Rita in New Orleans, Louisiana, Operation Iraqi Freedom, and Operations Desert Shield and Desert Storm. Finally, while the USNS Mercy was docked in Los Angeles, California, in support of COVID-19, the USNS Comfort was docked in New York City during the pandemic.
Policy Option 1 – Replace the USNS Comfort and USNS Mercy
The recommendation to replace the dated USNS Comfort and USNS Mercy is in harmony with the spirit of the November 2025 National Security Strategy. “We want to recruit, train, equip, and field the world’s most powerful, lethal, and technologically advanced military to protect our interests, deter wars, and – if necessary – win them quickly and decisively, with the lowest possible casualties of our forces” (The White House, 2025, p. 3). The 2025 National Security Strategy goes on to highlight that “there is, rightly, much focus on Taiwan” (p. 23), and as the Trump administration reconsiders U.S. military presence in the Western Hemisphere, “a more suitable Coast Guard and Navy presence” is needed (p. 16). As the U.S. Navy rapidly modernizes and builds needed capabilities to prepare for possible future conflicts, their hospital ships cannot be left out of the discussion. In regards to foreign policy, President Trump’s principle of “peace through strength – strength is the best deterrent” inevitably includes military medicine, specifically the U.S. Navy’s two hospital ships, as a critical part of this strategy (p. 8).
This initiative is likely to be well received by both parties, as both Republicans and Democrats serve in the military, and both have family members and friends who serve. This bipartisan effort will go a long way to healing the toxic divide currently found in the United States, allowing President Trump to build upon his legacy of being a peacemaker. “[O]ver the course of just eight months, we settled eight raging conflicts – including between Cambodia and Thailand, Kosovo and Serbia, the DRC and Rwanda, Pakistan and India, Israel and Iran, Egypt and Ethiopia, Armenia and Azerbaijan, and ending the war in Gaza with all living hostages returned to their families” (The White House, 2025, p. i). Resolving political conflict within the U.S. would be a wonderful addition to this list and further strengthen President Trump’s resolve to put America First.
Policy Option 2 – Update/Revise the November 2025 National Security Strategy
The Trump administration can consider revising the 2025 National Security Strategy to focus on fewer regions of the world which would minimize, or at least delay, the need to replace the U.S. Navy hospital ships. In four separate instances, the 2025 National Security Strategy calls for action to stop drug trafficking (The White House, 2025). To this end, the Trump administration labeled drug cartels as terrorist organizations and began a U.S. naval buildup in the southern Caribbean in August 2025. Several news reports, to include an article written by Watson (2025), indicated that the U.S. military had carried out three deadly strikes in September 2025, specifically targeting boats carrying drugs from Venezuela. Detsch and Bazail-Eimil (2025) reported how Secretary Rubio took the opportunity to tell reporters that the Trump administration would “wage combat” against drug cartels threatening the United States. Hubenko (2025) noted that Secretary Rubio vowed to continue military strikes against drug cartels, and during a recent meeting with Mexican President Claudia Sheinbaum he stated “What will stop them [drug cartels] is when you blow them up, when you get rid of them.” This war on drugs, of course, is in addition to the concerns with Taiwan and China, as cited in the 2025 National Security Strategy. Furthermore, Trotta (2026) reports how more than a dozen U.S. presidents have opposed Cuba’s Communist government and criticized its human rights record. As the U.S. is at war with Iran, President Trump has also drawn attention to Cuba, hinting at the possibility of the United States taking action against them. With the United States focusing on these and so many other priorities, it is possible that the U.S. Navy will eventually be stretched too thin to effectively carry out all of these military operations simultaneously around the world.
Policy Option 3 – Reinvigorate Diplomatic Efforts
McCormick (2024) reminds us that the Department of State is the oldest Cabinet post in the United States and it engages directly in diplomatic relations with nearly every country across the globe. Walt (2018) highlights that there is good reason why the U.S. founding fathers intentionally created a Cabinet specifically dedicated to diplomacy. George Washington warned against the U.S. becoming too entangled with other nations. This message was essentially repeated by Dwight D. Eisenhauer who emphasized the need for America to not invest too much into military options and capabilities, but rather focus on diplomacy to solve problems so that much of the money spent on war efforts could be redirected to other purposes. Both of these generals had made their thoughts known after winning the Revolutionary War and World War II, so they were intimately familiar with combat. As experts in war, however, they urged America to use nonmilitary options when possible.
Risks and Trade-offs
The current plan for the USNS Comfort and USNS Mercy is to continue investing in upgrades to keep these ships operational for years to come, but antiquated military equipment is simply not ideal for 21st century challenges. Acquiring new hospital ships will be expensive, so risk occurs as other U.S. initiatives become a lesser priority. However, replacing these hospital ships will ensure that the U.S. warfighters will get the world-class medical attention they deserve. Additionally, these platforms keep surgical skills current, facilitate world-class medical research, and offer “the unique capability to provide humanitarian surgical assistance” (Fluke et al, 2018, p. 1307).
Final Recommendation
Of the three recommendations proposed in this policy brief, I recommend replacing the two U.S. Navy hospital ships. Considering the long history of proven success in multiple operations across the globe, coupled with the current and immediate need for critical maritime operations, it is paramount that the USNS Comfort and USNS Mercy legacy continue to keep pace with today’s scientific and technological advancements. With the Trump administration’s focus on improving U.S. Naval capabilities, simply put, it would be a lost opportunity for the National Security Council to overlook the Comfort and the Mercy during this time of military seafaring modernization and growth. This initiative is clearly aligned with the goals outlined in the November 2025 National Security Strategy of the United States of America. “Deterring a conflict over Taiwan, ideally by preserving military overmatch, is a priority” (The White House, 2025, p. 23). A key component to military capability is military medicine. Even in a hypothetical peaceful world, without terrorism and wars, these hospital ships are a good investment for the American people. With President Trump’s desire to increase the U.S. Navy and U.S. Coastguard presence across the globe, now is an opportune moment to acquire two new U.S. Navy hospital ships.
Note: AI was not used for this assignment
References
Detsch, J. & Bazail-Eimil, E. (2025). US, in escalation, conducts strike on drug vessel near Venezuela. Politico. https://www.politico.com/news/2025/09/02/navy-strike-drug-vessel-venezuela-00540325
Fluke, L. M., Restrepo, R. D., Pryor, H. I., Duncan, J. E., & Mann, K. E. (2018). The surgical experience aboard USNS COMFORT (T-AH-20) during operation continuing promise 2015. The American Surgeon, 84(8), 1307-1311. https://doi.org/10.1177/000313481808400842
Funaiole, M. P. & Hart, B. (2025, September 2). China’s military in 10 charts. Center for Strategic & International Studies. https://www.csis.org/analysis/chinas-military-10-charts
Graves, M. W. (2026, March 25). 900-foot floating hospital arrives in Portland for $90 million overhaul. The Oregonian/OregonLive. https://www.oregonlive.com/pacific-northwest-news/2026/03/900-foot-floating-hospital-arrives-in-portland-for-90-million-overhaul.html
Hubenko, D. (2025). US says attacks on suspected drug boats will happen again. DW. https://www.dw.com/en/us-says-attacks-on-suspected-drug-boats-will-happen-again/a-73872107
McCormick, J. M. (2024). American foreign policy and process. Cambridge University Press.
Provencher, M. T., & Douglas, T. D. (2011). Humanitarian assistance and disaster relief aboard the USNS Mercy (TAH-19). Journal of Surgical Orthopaedic Advances, 20(1), 38. https://www.wheelessonline.com/userfiles/20-1-7.pdf
Sechriest, V. F. & Lhowe, D. W. (2008). Orthopaedic care aboard the USNS mercy during operation unified assistance after the 2004 Asian tsunami: A case series. The Journal of Bone & Joint Surgery, 90(4) 849-861. https://doi.org/10.2106/JBJS.G.00821
Shambaugh, D. (2025). Breaking the engagement: How China won & lost America. Oxford University Press.
The U.S. Navy’s Military Sealift Command. (2025). USNS Comfort. https://www.msc.usff.navy.mil/Ships/Comfort/
The U.S. Navy’s Military Sealift Command. (2025). USNS Mercy. https://www.msc.usff.navy.mil/Ships/Mercy/
Walt, S. M. (2018). The hell of good intentions: America’s foreign policy elite and the decline of the U.S. primacy. Macmillan Publishing.
The White House. (2025). National security strategy of the United States of America. https://www.whitehouse.gov/wp-content/uploads/2025/12/2025-National-Security-Strategy.pdf
Trotta, D. (2026). Trump says he can do ‘anything I want’ with Cuba. Reuters. https://www.reuters.com/world/americas/trump-says-he-thinks-he-will-have-honor-taking-cuba-2026-03-16/
Watson, E. (2025). Trump administration tells Congress the U.S. is in “armed conflict” with drug cartels after Venezuela boat strikes. CBS News. https://www.cbsnews.com/news/trump-tells-congress-armed-conflict-drug-cartels-venezuela-boat-strikes/
Worlton, T., Uber, I., Bronaugh, S., Liedtke, E., Dougherty, J., Pinkos, K., Weimerskirch, B. (2020). USNS Comfort (T-AH 20) surgical services response to the COVID-19 pandemic in New York City. Annals of Surgery, 1-3. https://doi.org/10.1097/SLA.0000000000004320
