A resolution honoring the life of Dr. Paul Farmer by recognizing the duty of the Federal Government to adopt a 21st century global health solidarity strategy and take actions to address past and ongoing harms that undermine the health and well-being of people around the world.

III 118TH CONGRESS 1ST SESSION S. RES. 95 Honoring the life of Dr. Paul Farmer by recognizing the duty of the Federal Government to adopt a 21st century global health solidarity strategy and take actions to address past and ongoing harms that undermine the health and well-being of people around the world. IN THE SENATE OF THE UNITED STATES MARCH 7, 2023 Mr. BROWN (for himself, Ms. WARREN, and Mr. MARKEY) submitted the fol- lowing resolution; which was referred to the Committee on Foreign Rela- tions RESOLUTION Honoring the life of Dr. Paul Farmer by recognizing the duty of the Federal Government to adopt a 21st century global health solidarity strategy and take actions to ad- dress past and ongoing harms that undermine the health and well-being of people around the world. Whereas Dr. Paul Farmer, who pioneered novel community- based strategies for the delivery of high-quality health care in impoverished settings, inspired a paradigmatic shift in global health, including inspiring robust United States leadership to address the global HIV/AIDS epi- demic in the early 2000s through the United States President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria; VerDate Sep 11 2014 23:03 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6300 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 2 •SRES 95 IS Whereas, in spite of progress made in global health, weak health systems continue to cause millions of people, pri- marily the global poor, to die tragic and unnecessary deaths, including— (1) annually, approximately— (A) 680,000 deaths from HIV/AIDS; (B) 1,500,000 deaths from tuberculosis; (C) 627,000 deaths from malaria; (D) 295,000 deaths of mothers during and fol- lowing pregnancy and childbirth; (E) 9,560,000 deaths among children under the age of 15; and (F) 560,000 deaths of children and young adults, living among the poorest billion people in the world, from non-communicable diseases and injuries; and (2) a SARS–CoV–2 case-fatality rate of up to 300 percent greater in low-income countries than in high-in- come countries during the first 2 years of the COVID– 19 pandemic; Whereas progress against unnecessary deaths in impoverished countries is being made, but progress is occurring so slowly that— (1) based on rates of decline from 2013 to 2022, it will take approximately a century for core mortality sta- tistics in low-income countries to converge with those of high-income countries, including— (A) 92 years for the tuberculosis death rate; (B) 109 years for the maternal mortality rate; and (C) 88 years for the under-15 child mortality rate; and VerDate Sep 11 2014 23:03 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6300 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 3 •SRES 95 IS (2) the death rate in low- and middle-income coun- tries from non-communicable diseases and injuries, which make up 40 to 60 percent of the disease burden of those countries, will never converge with that of high-income countries based on rates of reduction from 2013 to 2022; Whereas weak health systems that fail to prevent unnecessary deaths also lack the staff, health facility infrastructure, and medical technologies required for effective care deliv- ery and disease containment, placing all countries at in- creased risk of pandemic disease; Whereas essential medical technologies, such as diagnostics, treatments, and vaccines for diseases that affect the glob- al poor, are frequently unavailable or inaccessible to health systems in developing countries, because— (1) investing in research and development of tech- nologies for diseases that disproportionately affect the global poor is often unprofitable for pharmaceutical cor- porations; (2) costly intellectual property licensing fees from originator companies to generic manufacturers frequently leave the global poor unable to purchase or access med- ical technologies; and (3) originator technology companies often refuse to share or license intellectual property to generic manufac- turers, which results in limited supply and high prices, as was the case with the COVID–19 vaccine; Whereas, according to the Lancet Commission on Investing in Health, preventing most avertable deaths and confer- ring ‘‘essential universal health coverage’’ in low- and lower-middle income countries requires an increase in an- nual health systems resources in those countries of VerDate Sep 11 2014 23:03 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6300 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 4 •SRES 95 IS $75,000,000,000 and $293,000,000,000 (in United States dollars as of 2016), respectively; Whereas, historically, the United States and other global North-supported global health programs have inadvert- ently entrenched standards of care in low-income coun- tries that would be unacceptable in rich countries by funding only health services narrowly defined as ‘‘sus- tainable’’, ‘‘cost-effective’’, or ‘‘appropriate’’ in poor set- tings; Whereas the effectiveness and efficiency of current United States overseas development assistance for health is often undermined by— (1) misalignment with the national health plans of the host country; (2) bypassing delivery systems with parallel inputs, leading to— (A) fragmentation of care delivery; (B) poor donor coordination across partners; and (C) weak health systems; (3) favoring technical assistance from consultants from high-income countries, especially the United States, over funding health service delivery in beneficiary coun- tries; and (4) promoting privatization of health services, which weakens— (A) the public health system; (B) health care access; (C) health equity; and (D) financial risk protection; Whereas 98 percent of the annual $1,500,000,000,000 in health spending in aid-eligible low- and middle-income VerDate Sep 11 2014 23:03 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6300 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 5 •SRES 95 IS countries is mobilized domestically by the countries them- selves, and only 2 percent of this spending comes from overseas development assistance for health; Whereas many of the poorest developing countries lack the tax capacity to mobilize the necessary resources to close the universal health coverage financing gap, meaning un- necessary deaths will continue in the poorest developing countries for the foreseeable future without external donor financing or dramatic increases in domestic tax ca- pacity; Whereas the inability of many of the poorest developing coun- tries to fully close the financing gap for universal health coverage and the provision of numerous other public goods and services is in part due to the intimate eco- nomic links between those countries and high-income countries, including the United States, which have been marked throughout history by acts of violence and coer- cion; Whereas these harms have entrenched a global economic ar- chitecture of upward wealth redistribution that has re- sulted in— (1) depressed wages of workers and artificially low prices of natural resources in developing countries, amounting to an appropriation of tens of billions of tons of raw materials and hundreds of billions of hours of human labor through unequal exchange; (2) 3,500,000,000 people living under the poverty line of $5.50 from 1993 to 2023, even as global gross do- mestic product has more than tripled in size during this time; (3) more financial resources flowing out of devel- oping countries than into developing countries each year, VerDate Sep 11 2014 23:03 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6300 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 6 •SRES 95 IS estimated by Global Financial Integrity to total a net negative of $2,000,000,000,000 annually in 2012; and (4) developing countries bearing nearly all deaths and the vast majority of economic losses attributable to climate change, despite rich countries bearing 92 percent of the responsibility for climate change; Whereas leadership from the United States to close the fi- nancing gaps for essential universal health coverage in low- and lower-middle income countries could precipitate increased global health financing from other donor part- ners, as evidenced by United States leadership that ad- dressed the HIV/AIDS epidemic in the early 2000s, which spurred a 100-percent increase in global overseas development assistance among all donor partners from 2000 to 2006; Whereas official United States development assistance to lower-middle income countries is not a supplement for United States action to stop ongoing structural violence and economic injustices preventing countries from financ- ing and delivering universal health care and other social services for their populations; and Whereas it is the view of the Senate that creating a decent, humane world without tragic, unnecessary deaths re- quires both a modest but meaningful increase in global health aid funding and a meaningful effort to stop the economic abuse of low- and middle-income countries: Now, therefore, be it Resolved, That it is the sense of the Senate that— 1 (1) the Federal Government should adopt a 2 new, 21st century global health solidarity strategy to 3 VerDate Sep 11 2014 23:48 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 7 •SRES 95 IS end medically unnecessary deaths and respond to the 1 full burden of disease in poor countries by— 2 (A) supporting developing countries to 3 meet the material needs of their health systems 4 by localizing investments in support of national 5 public-sector and local priorities, referred to as 6 ‘‘accompaniment’’ by Dr. Paul Farmer, and de- 7 livered through what Dr. Paul Farmer called 8 the ‘‘Five S’s’’, which refers to— 9 (i) staff, meaning the human re- 10 sources necessary for high-quality service 11 delivery, including clinical staff, transpor- 12 tation teams, and community health work- 13 ers, especially by— 14 (I) supporting long-term training 15 and education systems, including med- 16 ical schools and teaching hospitals to 17 train the health workforce and im- 18 prove the quality of care across dis- 19 eases; and 20 (II) supporting professionalized 21 community health worker programs 22 whereby community health workers 23 are recruited, adequately com- 24 pensated, comprehensively trained, 25 VerDate Sep 11 2014 23:48 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 8 •SRES 95 IS supported for long-term retention, po- 1 sitioned as bridges to care, and tasked 2 with undertaking community work 3 with appropriate patient ratios and a 4 manageable scope of work; 5 (ii) space, meaning the infrastructure 6 needed for service delivery at primary, sec- 7 ondary, and tertiary levels to deliver safe 8 and high-quality care to meet all health 9 care needs; 10 (iii) stuff, meaning the tools and re- 11 sources necessary for high-quality care pro- 12 vision, including medical supplies, tech- 13 nologies, and equipment; 14 (iv) systems, meaning the leadership 15 and governance, health information sys- 16 tems, supply chain systems, logistics, lab- 17 oratory capacity, and referral pathways re- 18 quired to meet the health needs of the pop- 19 ulation; and 20 (v) social support, meaning the re- 21 sources needed, beyond the direct delivery 22 of health care, to ensure effective care; and 23 (B) financing the discovery and develop- 24 ment of new, urgently needed health tech- 25 VerDate Sep 11 2014 23:03 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 9 •SRES 95 IS nologies, such as diagnostics, treatments, and 1 vaccines, particularly for neglected diseases of 2 poverty, and ensuring their availability as global 3 public goods; 4 (2) the objectives of adopting a 21st century 5 global health solidarity strategy to end medically un- 6 necessary deaths and responding to the full burden 7 of disease in poor countries will require— 8 (A) increasing annual global health spend- 9 ing to $125,000,000,000, sufficient— 10 (i) for the first time, to meet the 11 United Nations development assistance 12 target of spending the equivalent of 0.7 13 percent gross national income on develop- 14 ment assistance, which 6 other countries 15 have previously met; and 16 (ii) to close over 100 percent of the 17 essential universal health coverage financ- 18 ing gap for low-income countries, and 30 19 percent of the overall financing gap for 20 low- and lower-middle income countries; 21 (B) optimizing global health delivery 22 spending by— 23 VerDate Sep 11 2014 23:03 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 10 •SRES 95 IS (i) introducing a new form of coordi- 1 nated, multilateral fiscal cooperation for 2 global public investment that— 3 (I) ensures increased and ongo- 4 ing global public funding of common 5 goods for health; and 6 (II) exhibits shared governance 7 with global South governments and 8 meaningful participation of civil soci- 9 ety, which is also essential for ad- 10 dressing intersectional crises of social 11 inequalities including the climate cri- 12 sis; and 13 (ii) ensuring funding directly supports 14 national health plans, public institutions, 15 local priorities, and donor coordination, 16 practices aligned with what Dr. Paul 17 Farmer called ‘‘accompaniment’’; 18 (C) focusing on health service delivery for 19 vulnerable populations, such as— 20 (i) people living in poverty; 21 (ii) women; and 22 (iii) children; and 23 (D) optimizing research and development 24 spending for neglected diseases of poverty by 25 VerDate Sep 11 2014 23:03 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\SR95.IS SR95 kjohnson on DSK79L0C42PROD with BILLS 11 •SRES 95 IS ensuring the knowledge and technology pro- 1 duced by these efforts remains accessible to all 2 as global public goods; 3 (3) the Federal Government should pass and 4 enforce laws and use its diplomatic influence to stop 5 ongoing economic harms to developing countries that 6 deplete impoverished countries of the resources re- 7 quired to provide health and social services for their 8 populations by— 9 (A) supporting debt cancellation initiatives 10 for low- and middle-income countries, particu- 11 larly countries in need of debt cancellation, 12 across bilateral, multilateral, and private credi- 13 tors; 14 (B) democratizing institutions of global 15 governance, such as the Int [Text truncated for display. 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