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 following resolution; which was referred to the Committee on Foreign Relations 

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. 

Whereas Dr. Paul Farmer, who pioneered novel communitybased 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 epidemic 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; 


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, primarily 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 following 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-income 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 statistics 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 


kjohnson on DSK79L0C42PROD with BILLS
3 

•SRES 95 IS 

(2) the death rate in low- and middle-income countries 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 delivery and disease containment, placing all countries at increased risk of pandemic disease; 

Whereas essential medical technologies, such as diagnostics, 

treatments, and vaccines for diseases that affect the global poor, are frequently unavailable or inaccessible to 

health systems in developing countries, because— 

(1) investing in research and development of technologies for diseases that disproportionately affect the 

global poor is often unprofitable for pharmaceutical corporations; 

(2) costly intellectual property licensing fees from 

originator companies to generic manufacturers frequently 

leave the global poor unable to purchase or access medical technologies; and 

(3) originator technology companies often refuse to 

share or license intellectual property to generic manufacturers, 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 conferring ‘‘essential universal health coverage’’ in low- and 

lower-middle income countries requires an increase in annual health systems resources in those countries of 


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 inadvertently entrenched standards of care in low-income countries that would be unacceptable in rich countries by 

funding only health services narrowly defined as ‘‘sustainable’’, ‘‘cost-effective’’, or ‘‘appropriate’’ in poor settings; 

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 countries; 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 


kjohnson on DSK79L0C42PROD with BILLS
5 

•SRES 95 IS 

countries is mobilized domestically by the countries themselves, 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 unnecessary deaths will continue in the poorest developing 

countries for the foreseeable future without external 

donor financing or dramatic increases in domestic tax capacity; 

Whereas the inability of many of the poorest developing countries 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 economic links between those countries and high-income 

countries, including the United States, which have been 

marked throughout history by acts of violence and coercion; 

Whereas these harms have entrenched a global economic architecture of upward wealth redistribution that has resulted 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 domestic product has more than tripled in size during this 

time; 

(3) more financial resources flowing out of developing countries than into developing countries each year, 


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 financing gaps for essential universal health coverage in 

low- and lower-middle income countries could precipitate 

increased global health financing from other donor partners, as evidenced by United States leadership that addressed 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 financing 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 requires 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 

1 Resolved, That it is the sense of the Senate that— 

2 (1) the Federal Government should adopt a 

3 new, 21st century global health solidarity strategy to 


kjohnson on DSK79L0C42PROD with BILLS
7 

•SRES 95 IS 

1 end medically unnecessary deaths and respond to the 

2 full burden of disease in poor countries by— 

3 (A) supporting developing countries to 

4 meet the material needs of their health systems 

5 by localizing investments in support of national 

6 public-sector and local priorities, referred to as 

7 ‘‘accompaniment’’ by Dr. Paul Farmer, and de8 livered through what Dr. Paul Farmer called 

9 the ‘‘Five S’s’’, which refers to— 

10 (i) staff, meaning the human re11 sources necessary for high-quality service 

12 delivery, including clinical staff, transpor13 tation teams, and community health work14 ers, especially by— 

15 (I) supporting long-term training 

16 and education systems, including med17 ical schools and teaching hospitals to 

18 train the health workforce and im19 prove the quality of care across dis20 eases; and 

21 (II) supporting professionalized 

22 community health worker programs 

23 whereby community health workers 

24 are recruited, adequately com25 pensated, comprehensively trained, 


kjohnson on DSK79L0C42PROD with BILLS
8 

•SRES 95 IS 

1 supported for long-term retention, po2 sitioned as bridges to care, and tasked 

3 with undertaking community work 

4 with appropriate patient ratios and a 

5 manageable scope of work; 

6 (ii) space, meaning the infrastructure 

7 needed for service delivery at primary, sec8 ondary, and tertiary levels to deliver safe 

9 and high-quality care to meet all health 

10 care needs; 

11 (iii) stuff, meaning the tools and re12 sources necessary for high-quality care pro13 vision, including medical supplies, tech14 nologies, and equipment; 

15 (iv) systems, meaning the leadership 

16 and governance, health information sys17 tems, supply chain systems, logistics, lab18 oratory capacity, and referral pathways re19 quired to meet the health needs of the pop20 ulation; and 

21 (v) social support, meaning the re22 sources needed, beyond the direct delivery 

23 of health care, to ensure effective care; and 

24 (B) financing the discovery and develop25 ment of new, urgently needed health techVerDate 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 

1 nologies, such as diagnostics, treatments, and 

2 vaccines, particularly for neglected diseases of 

3 poverty, and ensuring their availability as global 

4 public goods; 

5 (2) the objectives of adopting a 21st century 

6 global health solidarity strategy to end medically un7 necessary deaths and responding to the full burden 

8 of disease in poor countries will require— 

9 (A) increasing annual global health spend10 ing to $125,000,000,000, sufficient— 

11 (i) for the first time, to meet the 

12 United Nations development assistance 

13 target of spending the equivalent of 0.7 

14 percent gross national income on develop15 ment assistance, which 6 other countries 

16 have previously met; and 

17 (ii) to close over 100 percent of the 

18 essential universal health coverage financ19 ing gap for low-income countries, and 30 

20 percent of the overall financing gap for 

21 low- and lower-middle income countries; 

22 (B) optimizing global health delivery 

23 spending by— 


kjohnson on DSK79L0C42PROD with BILLS
10 

•SRES 95 IS 

1 (i) introducing a new form of coordi2 nated, multilateral fiscal cooperation for 

3 global public investment that— 

4 (I) ensures increased and ongo5 ing global public funding of common 

6 goods for health; and 

7 (II) exhibits shared governance 

8 with global South governments and 

9 meaningful participation of civil soci10 ety, which is also essential for ad11 dressing intersectional crises of social 

12 inequalities including the climate cri13 sis; and 

14 (ii) ensuring funding directly supports 

15 national health plans, public institutions, 

16 local priorities, and donor coordination, 

17 practices aligned with what Dr. Paul 

18 Farmer called ‘‘accompaniment’’; 

19 (C) focusing on health service delivery for 

20 vulnerable populations, such as— 

21 (i) people living in poverty; 

22 (ii) women; and 

23 (iii) children; and 

24 (D) optimizing research and development 

25 spending for neglected diseases of poverty by 


kjohnson on DSK79L0C42PROD with BILLS
11 

•SRES 95 IS 

1 ensuring the knowledge and technology pro2 duced by these efforts remains accessible to all 

3 as global public goods; 

4 (3) the Federal Government should pass and 

5 enforce laws and use its diplomatic influence to stop 

6 ongoing economic harms to developing countries that 

7 deplete impoverished countries of the resources re8 quired to provide health and social services for their 

9 populations by— 

10 (A) supporting debt cancellation initiatives 

11 for low- and middle-income countries, particu12 larly countries in need of debt cancellation, 

13 across bilateral, multilateral, and private credi14 tors; 

15 (B) democratizing institutions of global 

16 governance, such as the International Monetary 

17 Fund, the World Bank, and the World Trade 

18 Organization, to ensure fair and equal represen19 tation among member countries so that low20 and middle-income countries can have greater 

21 decisionmaking power in the creation of policies 

22 that affect them; 

23 (C) supporting a United Nations Conven24 tion on Tax and other measures to dramatically 

25 reduce tax avoidance, tax evasion, and other 


kjohnson on DSK79L0C42PROD with BILLS
12 

•SRES 95 IS 

1 forms of harmful licit and illicit financial flows 

2 from developing countries through fundamental 

3 reform of international tax cooperation; 

4 (D) supporting global labor rights and liv5 ing wages, such as a global minimum wage set 

6 at local living-income thresholds; and 

7 (E) adopting new indicators of progress 

8 that measure social and ecological health and 

9 abandon gross domestic product as a measure 

10 of progress; and 

11 (4) it is the duty of the Federal Government to 

12 issue reparations, containing multiple elements, in13 cluding apology, award, and guarantees of non-rep14 etition of harms, for— 

15 (A) the institution of slavery, the subse16 quent racial and economic discrimination 

17 against African Americans that resulted from 

18 the institution of slavery, and the impact of 

19 these forces on living African Americans, fol20 lowing the establishment of a commission sub21 stantively similar to the commission established 

22 under the Commission to Study Reparation 

23 Proposals for African Americans Act, H.R. 40, 

24 as introduced on January 4, 2021; 


kjohnson on DSK79L0C42PROD with BILLS
13 

•SRES 95 IS 

1 (B) the harms of colonialism and subse2 quent forms of imperialism, which have under3 mined sovereignty, democracy, self-determina4 tion, social and economic rights, and human 

5 and ecological well-being in both the colonial 

6 and post-colonial eras; and 

7 (C) the disproportionate responsibility of 

8 the Federal Government for climate breakdown, 

9 the burden of which unjustly and overwhelm10 ingly falls on the global South. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS