[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. Res. 358 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. RES. 358
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
July 31, 2025
Mr. Markey (for himself and Ms. Warren) 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 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 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;
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--
G (A) 680,000 deaths from HIV/AIDS;
G (B) 1,500,000 deaths from tuberculosis;
G (C) 627,000 deaths from malaria;
G (D) 295,000 deaths of mothers during and following pregnancy and
childbirth;
G (E) 9,560,000 deaths among children under the age of 15; and
G (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--
G (A) 92 years for the tuberculosis death rate;
G (B) 109 years for the maternal mortality rate; and
G (C) 88 years for the under-15 child mortality rate; and
(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
$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--
G (A) fragmentation of care delivery;
G (B) poor donor coordination across partners; and
G (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--
G (A) the public health system;
G (B) health care access;
G (C) health equity; and
G (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 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, 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
Resolved, That it is the sense of the Senate that--
(1) the Federal Government should adopt a new, 21st century
global health solidarity strategy to end medically unnecessary
deaths and respond to the full burden of disease in poor
countries by--
(A) supporting developing countries to meet the
material needs of their health systems by localizing
investments in support of national public-sector and
local priorities, referred to as ``accompaniment'' by
Dr. Paul Farmer, and delivered through what Dr. Paul
Farmer called the ``Five S's'', which refers to--
(i) staff, meaning the human resources
necessary for high-quality service delivery,
including clinical staff, transportation teams,
and community health workers, especially by--
(I) supporting long-term training
and education systems, including
medical schools and teaching hospitals
to train the health workforce and
improve the quality of care across
diseases; and
(II) supporting professionalized
community health worker programs
whereby community health workers are
recruited, adequately compensated,
comprehensively trained, supported for
long-term retention, positioned as
bridges to care, and tasked with
undertaking community work with
appropriate patient ratios and a
manageable scope of work;
(ii) space, meaning the infrastructure
needed for service delivery at primary,
secondary, and tertiary levels to deliver safe
and high-quality care to meet all health care
needs;
(iii) stuff, meaning the tools and
resources necessary for high-quality care
provision, including medical supplies,
technologies, and equipment;
(iv) systems, meaning the leadership and
governance, health information systems, supply
chain systems, logistics, laboratory capacity,
and referral pathways required to meet the
health needs of the population; and
(v) social support, meaning the resources
needed, beyond the direct delivery of health
care, to ensure effective care; and
(B) financing the discovery and development of new,
urgently needed health technologies, such as
diagnostics, treatments, and vaccines, particularly for
neglected diseases of poverty, and ensuring their
availability as global public goods;
(2) the objectives of adopting a 21st century global health
solidarity strategy to end medically unnecessary deaths and
responding to the full burden of disease in poor countries will
require--
(A) increasing annual global health spending to
$125,000,000,000, sufficient--
(i) for the first time, to meet the United
Nations development assistance target of
spending the equivalent of 0.7 percent gross
national income on development assistance,
which 6 other countries have previously met;
and
(ii) to close over 100 percent of the
essential universal health coverage financing
gap for low-income countries, and 30 percent of
the overall financing gap for low- and lower-
middle income countries;
(B) optimizing global health delivery spending by--
(i) introducing a new form of coordinated,
multilateral fiscal cooperation for global
public investment that--
(I) ensures increased and ongoing
global public funding of common goods
for health; and
(II) exhibits shared governance
with global South governments and
meaningful participation of civil
society, which is also essential for
addressing intersectional crises of
social inequalities including the
climate crisis; and
(ii) ensuring funding directly supports
national health plans, public institutions,
local priorities, and donor coordination,
practices aligned with what Dr. Paul Farmer
called ``accompaniment'';
(C) focusing on health service delivery for
vulnerable populations, such as--
(i) people living in poverty;
(ii) women; and
(iii) children; and
(D) optimizing research and development spending
for neglected diseases of poverty by ensuring the
knowledge and technology produced by these efforts
remains accessible to all as global public goods;
(3) the Federal Government should pass and enforce laws and
use its diplomatic influence to stop ongoing economic harms to
developing countries that deplete impoverished countries of the
resources required to provide health and social services for
their populations by--
(A) supporting debt cancellation initiatives for
low- and middle-income countries, particularly
countries in need of debt cancellation, across
bilateral, multilateral, and private creditors;
(B) democratizing institutions of global
governance, such as the International Monetary Fund,
the World Bank, and the World Trade Organization, to
ensure fair and equal representation among member
countries so that low- and middle-income countries can
have greater decisionmaking power in the creation of
policies that affect them;
(C) supporting a United Nations Convention on Tax
and other measures to dramatically reduce tax
avoidance, tax evasion, and other forms of harmful
licit and illicit financial flows from developing
countries through fundamental reform of international
tax cooperation;
(D) supporting global labor rights and living
wages, such as a global minimum wage set at local
living-income thresholds; and
(E) adopting new indicators of progress that
measure social and ecological health and abandon gross
domestic product as a measure of progress; and
(4) it is the duty of the Federal Government to issue
reparations, containing multiple elements, including apology,
award, and guarantees of non-repetition of harms, for--
(A) the institution of slavery, the subsequent
racial and economic discrimination against African
Americans that resulted from the institution of
slavery, and the impact of these forces on living
African Americans, following the establishment of a
commission substantively similar to the commission
established under the Commission to Study Reparation
Proposals for African Americans Act, H.R. 40, as
introduced on January 4, 2021;
(B) the harms of colonialism and subsequent forms
of imperialism, which have undermined sovereignty,
democracy, self-determination, social and economic
rights, and human and ecological well-being in both the
colonial and post-colonial eras; and
(C) the disproportionate responsibility of the
Federal Government for climate breakdown, the burden of
which unjustly and overwhelmingly falls on the global
South.
<all>