I think about him in moments when the scale of suffering in the world feels overwhelming, when the distance between what we know how to do and what we are willing to do feels painfully wide. I think about him when public choices widen that distance—when lifesaving programs are scaled back, research slowed, or partnerships abandoned. When the current administration decimated funding for USAID, research projected that, if those cuts remained in place, more than 14 million preventable deaths could occur by 2030. We know that hundreds of thousands of people, per estimates, have already died due to the lack of funding, roughly two thirds of them children. Such outcomes reflect decisions, not inevitabilities. When research halts, clinical trials slow, or scientists are pushed out of their work, it puts real people at risk by delaying the cures for which they’re waiting. The same is true when new policy weakens vaccination programs despite clear evidence that vaccines save millions of lives every year. Dismantling these systems not only threatens health, but also undermines trust, often for reasons that have more to do with self-interest than science, with seeming imperviousness to the real costs in human lives lost.

However, and perhaps more instructively, I think about him in moments of hope, such as the graduation of the first medical-degree class last month at the University of Global Health Equity, an institution he helped found—a reminder that investments in health systems are not abstractions but lifelines, for individuals, communities, and countries. I think of him when I see people choosing solidarity over individual maximization, the work over performative presence, and persistence over despair. This is clear every day in the continued work of Partners in Health (PIH), the international public health nonprofit he cofounded. In Sierra Leone, for example, PIH and thousands of supporters helped hasten one of the fastest declines in maternal mortality and this month opened the Paul E. Farmer Maternal Center of Excellence, a large, cutting-edge facility with the country’s first neonatal intensive care. I think about him in quieter moments too, when I find myself returning to the principles Paul taught so many of us to live by: accompaniment over distance, partnership over hierarchy, and never to accept the status quo as inevitable. And I think about him when I look at my children and send prayers into the night that they forge lives of purpose and find friends to help make them meaningful.

I first encountered Paul through his ideas. As a junior at Stanford, I read Infections and Inequalities and felt, with the confidence—and audacity—of a college student, that he had gotten so much right and just a few things wrong. To my great mortification and slight bemusement, I wrote him a long email full of thoughts, questions, and critiques. To my great surprise, he wrote back. That exchange became a correspondence, and eventually a friendship, that shaped how I think about health, justice, and responsibility. It is an enduring family joke that while my father and Paul might have worked together on infectious diseases and post-disaster recovery, everywhere from Haiti to Rwanda, and traveled thousands, if not millions, of miles together, my mother and I both admired and knew of Paul first.

What struck me then, and continued to strike me over the years, was how seriously Paul took ideas, precisely because he understood that ideas shape systems and power, and systems and power shape lives. They shape what is understood to be possible, what is thought too radical, what is urgent and what is not. Paul also was equally clear that ideas were never enough on their own and that the ones that deserved to be taken most seriously originated from the people whose lives would be most impacted by their adoption or rejection. For Paul, the work was always about closing the gap between moral clarity and material reality, between what we claim to value and what we actually build, between what we assert we will defend and where we actually mount a defense.