Joseph J. Amon and Carmel Williams
On February 21, 2022, the Health and Human Rights Journal Editor-in-Chief, Dr. Paul Farmer, MD PhD, died in his sleep while working in Rwanda.
In addition to his role at the Journal which he had held since 2008, Paul was Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School, chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston, and co-founder and chief strategist of Partners In Health. Paul followed Dr. Jonathan Mann as Editor and not long after taking on the role gave tribute to Mann by giving the inaugural Jonathan Mann lecture at Drexel University, the Journal’s co-publisher. The talk was introduced by Lydia Mann, Jonathan Mann’s daughter.
In her introduction, Lydia said that her father believed that to become a public health professional “implicitly places you on the side of those who believe that the world can change. Every act challenges the apparent inevitability of the world as it is and the natural history of illness, disability and death. At a profound, even instinctual, level people become health professionals to struggle against the weight of human suffering and thereby place themselves among those who intervene in the present because they believe the future can be different.”
This desire to fight against the “apparent inevitability” of the world, and of those who would deny the poor the right to health or access to medicines, was at the heart of Paul’s writing and work. He challenged global health leaders on why is it acceptable that some individuals have access to information, to prevention, and to the best care possible while others do not? Whether it was HIV, TB, or COVID—in Haiti, Rwanda, or the United States—Paul, like Jonathan Mann before him, forced people to see not just the immediate determinants of health, but also the underlying structural and political determinants that public health professionals often feel are beyond their scope of work.
For Paul, the notion that health is a human right was obvious. But it was also profound, and it had consequences for how he believed public health should be taught, how global health should be delivered, and how public health practitioners should engage individuals, communities, and policy makers. Paul’s writing over the past two years illustrates the current issues he was absorbed by, and highlights his blunt assessment of where we are failing.
On COVID-19, Paul foresaw the massive challenge it would be to vaccinate the world. At the time of his death, only 12% of the population in low-income countries around the world had received at least one dose of a vaccine. In high- and upper-middle-income countries, this figure was 79%.[1] Recognizing this, Paul advocated for a temporary intellectual property waiver of COVID-19 vaccines. Paul and co-authors said: “The longer states stall, the more people die needlessly. Covid-19 has repeatedly shown that people without access to resources such as strong health systems, health workers, medicines, and vaccines will preferentially fall ill and die. For too long, this cycle has been “other people’s” problem. It is not. It is our problem.”[2]
Paul also focused his attention on the patterns of racial disparities of COVID-19 in the United States. To address the structural racism causing these disparities, Paul and his co-authors advocated for racial-justice interventions and reparations for Black Americans that could decrease COVID-19 and other public health risks.[3] He wrote about the need to address the risk of COVID-19 in jails and prisons in the United States through vaccination and decarceration: “On the grounds of scientific evidence and our ethical responsibility to protect the vulnerable and the public at large, we can use our influence to demand” these changes.[4] He wrote too of the need to protect health workers, globally, from COVID infection.[5]
Beyond the issue of COVID-19, Paul championed other health issues that he saw as not getting enough attention among public health donors and practitioners, including expanding the capacity of the global health workforce and looking at the long-term impact of Ebola in West Africa, and the myriad health consequences of poverty in Haiti.[6] He wrote of the millions of people globally who suffer, needlessly, from lack of access to palliative care.[7] He also recognized what he referred to as “the moral case for global mental health delivery”, and the structural violence that is often committed on people with mental illness, occurring at the intersection of deprivation, exclusion, and discrimination.[8]
Focusing too much on specific health issues though misses the important holistic view that Paul brought to public health. Paul was skeptical of what he described as “narrowly defined technological fixes”, and the ways in which these “fixes” could individually be seen as effective and affordable but could be competed against one another or delivered in silos, ultimately failing to deliver the comprehensive public health systems that communities need.
Under Paul’s editorship, the Journal flourished, reflecting his wide interests and underlying belief in the importance of strong health systems. His influence expanded the readership beyond academic circles to practitioners and activists, working in both the Global North and South. He insisted the Journal must be open access to both readers and contributors so that lack of financial resources could never stop good research being published.
His leadership will be missed but his legacy will continue. For years to come his articles and books will remain prescribed reading in university courses and they will continue to inspire students and global health practitioners and leaders, and help guide those who hold government to account for their human rights duties. In addition to remembering his hard work and dedication, his sense of humility, humor, and optimism must be recalled, and emulated among those working in health and human rights. Along with his innumerable colleagues, friends, and admirers around the world, in our sadness and shock at Paul’s sudden death, we will strive to keep alive his belief that the future can be different.
Joseph J. Amon is senior editor at Health and Human Rights Journal
Carmel Williams is executive editor at Health and Human Rights Journal
References
[1] J. Holder, Tracking Coronavirus Vaccinations Around the World, “New York Times” Feb 23 2022, available at: https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html
[2] P. Erfani, A. Binagwaho, M. J. Jalloh, M. Yunus, P. Farmer, et al. “Intellectual property waiver for covid-19 vaccines will advance global health equity,” BMJ 2021; 374 :n1837 doi:10.1136/bmj.n1837
[3] E. T. Richardson, M. M. Malik, W. A. Darity, et al. “Reparations for Black American descendants of persons enslaved in the US and their potential impact on SARS-CoV-2 transmission,” Social Science & Medicine 276 (2021): 113741.
[4] B. A. Barsky, P. Farmer, and S. Keshavjee. “Vaccination plus decarceration—stopping COVID-19 in jails and prisons,” New England Journal of Medicine 384/17 (2021) pp. 1583-1585.
[5] Y. Zhao, C. Cui, K. Zhang, et al. “COVID19: a systematic approach to early identification and healthcare worker protection.” Frontiers in Public Health 8 (2020) p. 205. Doi: 10.3389/fpubh.2020.00205
[6] D. E. Berry, J. C. Bavinger, A. Fernandes, et al. “Posterior Segment Ophthalmic Manifestations in Ebola Survivors, Sierra Leone.” Ophthalmology 128/9 (2021) pp. 1371-1373; C. Millien, A. Manzi, A. M. Katz, et al. “Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study,” International Journal for Equity in Health 20/1 (2021) pp. 1-17.
[7] W. E. Rosa, A. Parekh de Campos, N. C. Abedini, et al. “Optimizing the global nursing workforce to ensure universal palliative care access and alleviate serious health-related suffering worldwide,” Journal of Pain and Symptom Management 63/2 (2022), pp e224-e236.
[8] V. Patel and P. E. Farmer. “The moral case for global mental health delivery,” Lancet 395/10218 (2020), pp. 108-109.