Category: Global Health Page 1 of 13

Post-COVID Public Health is in a Trust Fall

On February 20, 2023

Dr. Heidi Larson, director of the Vaccine Confidence Project, described data from a recent Pew Center study, instructing us to “HANDLE WITH CARE!” as if a jeweled Fabergé egg and not a series of sampled statistics.

The study’s title: “Americans’ Trust in Scientists, Other Groups Declines.”

“Pew Research Center conducted this study to understand how much confidence Americans have in groups and institutions in society, including scientists and medical scientists.”
Credit to: Brian Kennedy, Alec Tyson, and Cary Funk

“Once seemingly buoyed by their central role in addressing the coronavirus outbreak,” Pew Center researchers write, the public’s trust in scientists and health professionals has sunk. This phenomenon is not confined to remote corners of Twitter or the turbulent backwaters of a few Facebook community chats. No, it’s palpable in the media, in conversation, in our collective consciousness. Why is this? And why now?

Last month, The Duke Global Health Institute hosted a few health experts to answer these questions in the “Building Trust in Public Health: A Post-COVID Roadmap” panel. Jack Leslie, a visiting fellow at the Duke-Margolis Center for Health Policy, contextualized declines in public trust, citing increased populism and anti-elitism. It’s not difficult to chart the evolution of this zeitgeist. In the past three decades alone, Americans have become completely cocooned in media.

Jack Leslie joins Duke University as a Senior Visiting Fellow at the Duke Global Health Institute (DGHI) and Visiting Fellow at the Duke-Margolis Center for Health Policy

CNN’s Ted Turner (i.e. the ‘Mouth of the South’) is accredited with the genesis of the 24 hour news cycle. He notably “didn’t bargain for… [the] insomniacs,” writes journalist Lisa Napoli, nor did he bargain for its longevity, or our inability to escape it. From coverage of the Iraq War to the OJ Simpson investigation to political partisanship in Washington, and of course, to COVID-19.

The erosion of institutional faith is not unique to the government but, like an acid rain, weathers indiscriminately. It eats away at trust in churches, corporations, media institutes, universities, K-12 schools, etc. In fact last semester, I attended another Duke panel entitled “Policing the Pages,” in which increased polarization across the US contributed to concerted efforts to bar certain books (often those with LGBT and minority characters) from elementary school libraries and syllabi. A kind of censorship akin to dress codes and mandatory veggies in bagged lunches.

This sentiment, unlike COVID-19, is not novel. Leslie described a “trifecta” of events, slowly chipping away at public trust: 1) the great recession of ‘08, 2) waves of immigration in the United States and Europe, and finally, 3) the pandemic.

For decades, and with little exception, science was lauded as infallible, an authority, bridging turbulent seas of dis- and mis-information. It was well-mannered, professorial, clad in wire-rimmed glasses and bowtie. “We had pretty high trust in scientists and public health institutions prior to the pandemic… relative to other institutions which have taken a hit over the past twenty years,” Leslie acknowledged.

Of course, this no longer is the case.

Dr. Heidi Larson is a professor of anthropology, risk, and decision science London School of Hygiene and Tropical Medicine.

Dr. Heidi Larson collected this pathos in anecdotes for the Global Listening Project, an oral history of personal pandemic experiences. Many described “…a feeling of disconnect with the government. [They] would give us these directives, but people felt they had no connection with their reality, their situation.” Larson, for example, recognized patterns of isolation in schools. There was a pervasive sense that neither legislator nor scientist had stepped foot into these schools before creating policies. Bureaucratic deflection so to speak.

Larson consequently felt a shift in COVID-19 rhetoric. What once was “upholding global unity,” “encouraging communal cooperation,” and “assuring responsive governance” became, as Larson put it, “getting a jab in the arm.” The disconnect between the Joe Publics, the John Qs, and their public institutions began to feel especially cavernous as the pandemic stretched weeks, months, then years.

This begs the question, how can we rebuild trust in public health?

Dr. Rispah Walumbe is a health policy advisor at Amref Health Africa, to support the advancement of the universal health coverage (UHC) agenda.

Dr. Rispah Walumbe, a global health policy and advocacy specialist, described the “orchestration” of multisectoral partnerships during the pandemic (in Africa, specifically) that combined “state and non-state actors with public and private sector actors and, of course, those on the social, economic, and political sides.”

She found that, at the start of the pandemic, trust was enhanced. The virus was identified as a “key problem” and was, to some degree, universally threatening. A conduit of centralized communication followed. As the pandemic elongated, the discrepancy between the populations disproportionately burdened by COVID (poor and minority communities) and those not so much grew wider. Communication became less effective. Still, Walumbe advocated for the continuity of engagement between health institutions and the public in the aftermath of the pandemic. Peel back the Oz-like bureaucratic curtains and increase transparency.

Dr. Mandy Cohen served as the Secretary of the North Carolina Department of Health and Human Services as well as the Chief Operating Officer and Chief of Staff at the Centers for Medicare and Medicaid Services. She has been elected to the National Academy of Medicine and is an adjunct professor at the UNC Gillings School of Global Public Health.

Dr. Mandy Cohen, Secretary of North Carolina’s Department of Health and Human Services, agreed. In recent studies, she explained, NC ranked 2nd among the states for its general safety during the pandemic, which she attributed to the state’s prioritization of public trust. “Before we even had our first case, we were talking about how our crisis response was going to hinge on whether we could build and maintain trust with the public… we tried to be really tactical about trust, which can feel ephemeral and fleeting… and really broke it down into three buckets. The first was transparency, the second was competency, and the third was relationships.”

Rebuilding trust in public health, thus, seems less a roadmap and more a spigot. Institutions must continue to fill the buckets Cohen described.

As the pandemic ebbs, however, the ubiquity of isolation, anxiety, and turmoil cannot be understated. A recent WHO article characterized this pervasive fear as “contagious,” pathologic, a kind of virus itself.

In this political cartoon, Sisyphus pushes a stone (the Delta variant) up the hill

In an age of mass misinformation, public health officials, doctors, and scientists now stand with the Sisyphean task of restoring public trust. And the panelists concurred: it is fragile. Volatile even.

Yet, as illustrated in this article, it is not elusive. Prioritize communication. Prioritize transparency. Prioritize competency, relationships, and community engagement.

I will defer to Walumbe who put it best during the conversation: “These institutions do not operate in a vacuum. Community is pivotal in thinking through trust, it’s how we’re organized across the world… that’s something that is critical in how we approached COVID-19 challenges…” and, presumably, in how we should continue.

Thank you to the panelists, moderator Dr. Krishna Udayakumar, and Dr. Mark McClellan, Director and Robert J. Margolis, M.D., Professor of Business, Medicine and Policy at the Margolis Center for Health Policy.

Post by Alex Clifford, Class of 2024

COVID and Our Education

By Jakaiyah Franklin

On November 28, 2022

In Biology, Global Health, Lecture, Science Communication & Education

With mask mandates being overturned and numerous places going back to “normal,” COVID is becoming more of a subconscious thought. Now, this is not a true statement for the entire population, since there are people who are looking at the effects of the pandemic and the virus itself.

I attended a poster presentation for the “The Pandemic Divide” event hosted here at Duke by the Samuel Dubois Cook Center on Social Equity. To me, all the poster boards conveyed the theme of how COVID-19 had affected our lives in more ways than just our health. One connection that particularly caught my eye would be the one between American Education and COVID.

As a student who lived through COVID while attending high school, I can safely say that the pandemic has affected education. However, based on the posters I saw, it is important to know that education, too, has a strong and impactful impact on COVID-19.

Dr. Donald J. Alcendor after a great presentation

The first evidence I saw was from Donald J. Alcendor, an associate professor of microbiology and immunology at Meharry Medical College in Nashville. His poster was about the hesitancy surrounding COVID-19 vaccines. One way he and his team figured out to lessen the hesitance from the public was to improve the public’s trust. To achieve this, Alcendor and his team sent trusted messengers into the community. One of the types of messengers they provided was scientists who studied COVID-19. These scientists were able to bring factual information about the disease, how it spreads, and the best course of action to act against it. Alcendor and his research team also brought in “vaccine ambassadors” to the community and a mobile unit to help give the community vaccines. He noted that this was accomplished with support from the Bloomberg Foundation’s Greenwood Initiative, which addresses Black health issues.

With this mobile unit, Alcendor and his team were able to reach people and help those who were otherwise unable to receive help for themselves because of their lack of transportation. They provided people from all backgrounds with help and valuable information.

Alcindor said he and his team planned pop-up events based on where the community they were trying to reach congregates. With the African American community, he planned pop-up events at churches and schools. Then for the Latino community, he planned pop-events where families tend to gather, and he held events in Latin0 neighborhoods. In addition, he made sure that the information was available in Spanish at all levels, from the flyers and the surveys, to the vaccinators themselves.

All of these amenities that he and his group provided were able to educate the community about COVID-19 and improve their trust in the scientists working on the disease. Alcendor and his team were able to impact COVID-19 through education, and by going to the event, it was evident to me that he was not the only one who accomplished this.

Colin Cannonier, an associate professor of economics at Belmont University in Nashville, asked and answered the question, “does education have an impact on COVID? Specifically, does it change health and wellbeing?” To answer this question, he researched how education about COVID can affect a person. He discovered that when a person is more educated about COVID, how it is spread, and its symptoms, they are more likely to keep the pandemic in check through their behavior. He came to this conclusion because he realized that when higher educated people know more about COVID, they exhibit behaviors to remain healthy, meaning that they would follow the health protocols given by the health officials.

While this may seem like common sense that the more educated a person is, the more they make smart choices pertaining to COVID, this shows how important education is and how deadly ignorance is. Cannonier’s research gave tangible evidence to show that education is a weapon against diseases. Unfortunately, it is evident that some officials did not believe in educating the public about the virus or the virus itself, and that proved to be extremely deadly.

To fully capture the relationship between COVID and education, one must also talk about how COVID-19 affected education.

Ms. Stacey Akines and her wonderful poster

Stacey Akines, a history graduate student at Carnegie Mellon University, studied how education was changed by the pandemic.

First, she realized that COVID schooling crossed over with homeschooling. Then she uncovered that more Black people started to research and teach their children about Black history. This desire to teach youth more about their history caused an increase in the number of Black homeschoolers. In fact, the number of Black homeschoolers doubled during the fall of 2020. While to some, this change to homeschooling may have a negative impact on one’s life, it actually gives the student more opportunities to learn things.

It is no secret that there are many books being banned here in the U.S., and there are many state curriculums that are changing to erase much of Black history. Homeschooling a child gives the parent an opportunity to ensure that the education they receive is true to and tells their history

Unlike me, where during high school, education felt lackluster and limited because of COVID, some parents saw an opportunity to better their child’s education.

I hope that it is clear that the relationship between COVID and education is a complex one. Both can greatly impact each other, whether it’s for the better or for the worse. COVID thrives when we are uneducated, and it very nearly destroyed education too, but for the efforts of some dedicated educators.

Post by Jakaiyah Franklin, Class of 2025

Truman Scholar Maya Durvasula, T’18, on her Research Journey Through Duke and Beyond

By Meghna Datta

On November 14, 2022

In Global Health, Policy, Students

Maya Durvasula, T’18, and a current Ph.D. student at Stanford University, grew up in Albuquerque, New Mexico. “And it’s hard to grow up there without a very keen sense of what it looks like when policy doesn’t work for people,” she remarks.

After graduating high school with an interest in politics, she decided to take a gap year and bounced around organizations in New Mexico, working for the state legislature, political campaigns, and even a think tank. In hindsight, she says, “Having a block of time where you have time is super helpful.” One thing she learned was that she didn’t really want to do politics. “People were making policy, but debates were heavy on feelings and politics and light on facts.”

A high school mentor suggested that maybe she would get along better with economists than politicians, so once she got to Duke, she took that to heart.

As a first-year, she says, she knew she wanted to be exposed to a lot of things, and she knew she wanted to do research, but she wasn’t really sure what “research” meant for a first-year. In the beginning, she cold-emailed a lot of people and received multiple rejections.

After rejection, though, eventually something clicks, and for Durvasula, what clicked were three main research projects she undertook in her time at Duke.

The instinct is always to start with where you want to end up and then work backward, but you don’t know where you’re going to end up”
Maya Durvasula, T’18

Her first experience in a research group was a joint venture between an academic team in China and at UNC-Chapel Hill. Their group studied behavioral interventions to increase the uptake of health technologies, with a particular focus on sexual health. Usually, as a country industrializes, the rates of sexually transmitted infections will drop, but in China, rates of HIV and syphilis continued to rise as the economy grew. Durvasula and the team looked at different interventions that might make testing for HIV more attractive to patients, such as alternative testing locations, different advertisement design, and compensation.

She also did a project with Duke professor Bob Korstad in the history department and the Samuel DuBois Cook Center on Social Equity, looking at the history of housing in Durham. Finally, she worked with her primary advisor, Duke economics professor Duncan Thomas, in his joint lab with UNC’s Elizabeth Frankenberg, on projects related to household decision-making in Indonesia.

A notable part of her undergraduate time at Duke was winning the Truman Scholarship. What was most valuable to her about the Truman was the people she met. “Most people I’ve met are defined by picking something they care about and doing a lot with it,” she says. And it’s inspiring to be surrounded by people who love what they do and immerse themselves so wholly in it.

Durvasula graduated Duke with numerous experiences and accolades under her belt. But from there, how did she find her way to doing a Ph.D. at the intersection of law, technology, and economics? As she describes it, the interplay between economics and law is inextricable. Both economic incentive and legal institutions affect the rate and direction of innovation, which affects how quickly technology is developed, and ultimately what products ends up in our hands. A question at the heart of her research is wondering how to make sure the value of this technology is distributed equally across society.

So five to ten years from now, where will we see Durvasula? She sees herself remaining in academia, although at some point she wants to work in public service. “I love learning new things, and I want to take advantage of being in a space where people are always willing to teach you things.”

And in that vein, her advice to a curious Duke student is to explore everything. “The instinct is always to start with where you want to end up and then work backward, but you don’t know where you’re going to end up,” she said.

Pursue the questions that you find exciting, and let that point you in the right direction – clearly, Durvasula is proof that this process will take you places.

Post by Meghna Datta, Class of 2023

American Epidemics and the Viral Underclass

By Alex Clifford

On October 26, 2022

In Global Health, History, Lecture

March 2020. The subsequent blur of months. Of spring into summer, fall into winter, a year into another and likely into the next. Like millions of humans around the world, 2020 itself feels infected, as if wrapped up with yellow caution tape. Virus dominates the current zeitgeist; pandemic won Merriam-Webster’s 2020 word of the year; vaccine in 2021.

We are all proto-virologists, sludging through the constant slew of “viral” media: novel variants, outbreaks, booster shots, mutations (a jargon in which we’re collectively fluent).

Monkeypox on the left, COVID-19 on the right.

In the somewhat-receding wake of COVID-19, like floodwater, viral fear recently surged again when the World Health Organization began reporting monkeypox (MPX) outbreaks in Europe and North America. The stigmatization of MPX patients as “disease-spreaders” (in the media, on the internet, in conversation, etc.) suggests these individuals have a kind of authority over the virulent strands of DNA in their bodies. This belief aligns with the etymology of “virus” from the Latin “poison,” a word that functions as both noun and verb. Passive and active. Culpable.

Alan Krumeweide in *Contagion* (Claudette Barius / Warner Bros.)

I’m reminded of Jude Law’s fear-mongering character in Contagion, Alan Krumewiede, the conspiracy theorist who conjectured MEV-1, the film’s fictional virus, was “Godzilla, King Kong, Frankenstein, all in one.”

Of course, this sentiment did not bud from MPX or COVID-19 like a novel variant. No, it has existed in the United States for decades, if not longer, and it has not been dormant.

Dr. Stephen Thrasher, a scholar of the criminalization of HIV/AIDS at Northwestern University, stood in Duke’s anthropology lecture hall this month and drew parallels between the recent MPX/COVID-19 epidemics and that of HIV/AIDS in the 1980s-90s and stretching into the new millennium. He asked us to raise our hands if we personally knew someone with HIV/AIDS. A few did. If we knew someone who had died from HIV-related causes. A few less. What about COVID? The entire audience raised hands as if to signal the new era of viral infection.

Dr. Steven Thrasher is the inaugural Daniel H. Renberg Chair of social justice in reporting (with an emphasis on issues relevant to the LGBTQ community) and an assistant professor of journalism at Northwestern. His research focuses on HIV in America.

Since the start of the HIV/AIDS epidemic in 1981, more than 700,000 people have died from HIV-related illness in the United States, a disproportionate number of whom were men who had sex with men and injection drug users (with poverty exacerbating the likelihood of acquisition).

As Thrasher historicized, the stigma that encapsulated HIV/AIDS significantly delayed life-saving interventions on the local and national scale. Prejudice hindered research funding, drug distribution, and government health agency mobilization. The rising tide of the HIV/AIDS epidemic was concurrent with increased violence towards the LGBTQ community, and gay men in particular, analogous to a king tide flooding the coastline.

Thrasher exemplified this taboo through the “patient zero” misconception, which was propagated by the media during the epidemic and embedded like a splinter in pop culture’s thumb (i.e. the film Patient Zero with Matt Smith, Stanley Tucci, and Natalie Dormer).

Gaëtan Dugas was miscredited as Patient Zero of the HIV/AIDS epidemic in America
Credit: Fadoo Productions

Gaëtan Dugas, a Québécois Canadian flight attendant, was inappropriately labeled “patient zero” of the HIV/AIDS epidemic in America. As Thrasher and other researchers have debunked, Dugas was, in fact, not the first person to bring HIV to the United States. Further, Dugas was not even included in the early infection group. And Dugas was Patient O (like oh), not zero, for Out-of-State. Yet, this contextualization of the virus endures despite being disproved. Upon diagnosis, many infected individuals will experience shame.

In the 1980s and 90s, HIV/AIDS was characterized as the “gay plague,” setting ablaze a moral panic in America comparable to that of the Satanic Panic, rock ‘n’ roll, and fear of razor blades stuffed into gooey 3 Musketeers bars at Halloween (and there’s an interesting overlap in the timing of these hysterias in the collective American consciousness). And just two months ago even, many people were characterizing MPX in the same accusatory and morally dubious way.

Like with the AIDS epidemic, Thrasher said the US government failed to mobilize public health initiatives early enough to proactively stifle MPX outbreaks in spite of the disease’s well-documented diffusion across Europe and into neighboring Canada.

“We could’ve tapped the Strategic National Stockpile,” he argued. Thrasher listed multiple public health interventions that could have and should have been implemented with the first faint smoke signals of MPX in the United States (as they were in the past for meningitis and polio outbreaks).

For context, the Strategic National Stockpile (SNS) is a cache of medicines, antibiotics, and vaccines that the government started to accumulate just prior to 9/11 in 2001 and, seemingly, in an exponential manner after — almost like doomsday preppers hoarding freeze-dried beef stroganoff and cans of beans in their underground bunkers. Born from the smoking rubble and smoke of New York City following the terrorist attack, fear of biological warfare, especially the weaponization of smallpox, paralyzed the US (i.e. the Anthrax scare).

The SNS was tapped after 9/11, for 12 major hurricanes, COVID-19, and the swine flu (to name a few), but not for monkeypox.

As historically evidenced, mass vaccination and herd immunity effectively prevent the spread of viral infections, especially for slow-mutating viruses like MPX.

“We should have quickly vaccinated queer men and transmasc people,” Thrasher said, “building on a very historic anomaly which is that adults have been socialized to take vaccines en masse in a way that has not happened in many decades.” And because MPX and smallpox are closely related viruses, a rollout of the stockpile’s smallpox vaccine could have nipped the outbreak in the bud.

But, the SNS was not tapped. 100 million doses remain stockpiled. There are nearly 28,000 total monkeypox cases documented in the United States.

A large focus of Thrasher’s research is on who is affected by viruses, and how, and why. Nearing 6.6 million COVID-19 deaths worldwide, many would argue that viruses — these ancient, non-life forms — are Earth’s “great equalizers,” as acknowledged by Thrasher in multiple publications. Evolution has pushed them to infect, replicate, and spread: machine-like and non-discriminatory.

But, he added, viruses are not great equalizers. Infection is inherently unequal. Again, we must ask the question who?

Thrasher’s book *The Viral Underclass: The Human Toll When Inequality and Disease Collide* was recently long-listed for the 2023 Andrew Carnegie Medal for Excellence in nonfiction.

Viral infections disproportionately burden marginalized bodies and communities, a concept Thrasher framed as the viral underclass (coined by activist Sean Strub and reshaped by Thrasher to describe this phenomenon). Writing in his book of the same name, “… the viral underclass can help us think about how and why marginalized populations are subjected to increased harms of viral transmission, exposure, replication, and death.”

Let’s return to the MPX vaccine. The Biden administration did not tap the SNS for mass vaccination. Instead, it rolled out meager health interventions at a snail’s pace (like Sisyphus pushing his stone up the hill). Still, many at-risk individuals, in particular men who have sex with men, opted to receive a two-shot regimen to protect themselves from the virus. Considering the viral underclass, Thrasher posed the following questions:

Who is disproportionately burdened by MPX in the US? He answered, “Black and Latino men who have sex with men.”

And, who is receiving the medical interventions to protect themselves from the painful infection? He answered again, “I got one MPX vaccine shot, almost everyone in line but me and a friend were white.” He describes the discrepancy between those receiving the vaccine and those most at-risk of acquiring MPX in his Scientific American article “Monkeypox Is a Sexually Transmitted Infection, and Knowing That Can Help Protect People.”

And his years of HIV research corroborate this trend.

From the *New York Times*, Michael Johnson has been working to overturn laws criminalizing HIV in the United States.

He spoke (and wrote in The Viral Underclass) about his time reporting the Michael Johnson court case in St. Louis, Missouri. Michael Johnson, a black, gay, former college wrestler, was sentenced to 30 years in prison after failing to disclose his HIV status to his sexual partners — a criminal offense. The prosecution had sought a maximum 60.5 years, practically a life sentence.

For context, in the state of North Carolina, the maximum sentence for voluntary manslaughter is a little under five and a half years. In the courtroom, Thrasher was privy to the prosecution’s smoking gun: Johnson had previously signed a legally-binding acknowledgment of his HIV diagnosis. With the flick of a pen, nondisclosure was a criminal offense.

In his interviews, however, Thrasher found that Michael Johnson was semi-illiterate and had not been properly informed of the legal implications of the document he had signed. Nor had he been informed of the consequences of breaking the legal contract. Nor had he been counseled or given any legal advice prior to being charged.

Michael Johnson was released from prison 25 years early after his ruling was overturned. His is a body in the viral underclass.

Excerpted from Thrasher’s book *The Viral Underclass: The Human Toll When Inequality and Disease Collide*

Vito Russo speaks at the 1988 ACT UP demonstration at the Department of Health and Human Services in Washington, D.C.
Credit: Rick Gerharter/HBO Documentary Films

Concluding his lecture, Thrasher quoted AIDS activist Vito Russo’s Why We Fight speech from the 1988 ACT UP Demonstration at the Department of Health and Human Services. In reading the entire transcript, I found that Russo was aware of the viral underclass, as Thrasher theorized, despite the term not yet existing in the academic ethos. He said in his address:

“If I’m dying from anything — I’m dying from the fact that not enough rich, white, heterosexual men have gotten AIDS…. Living with AIDS in this country is like living in the twilight zone. Living with AIDS is like living through a war which is happening only for those people who happen to be in the trenches. Every time a shell explodes, you look around and you discover that you’ve lost more of your friends, but nobody else notices. It isn’t happening to them.”

Is it possible to ever resolve the viral underclass in the US? As long as systemic inequities continue to exist, no. This may seem pessimistic or even cynical, but Thrasher concluded his lecture (and his book) with reserved optimism. “Let’s get to work,” he implored.

If we can identify and actively dismantle the systems that disproportionately burden certain populations with viruses and diseases, like a spool of yarn, we can begin to unravel the viral underclass in America.

Yes, infections should be treated with accessible and affordable medicine. Yes, healthcare should be expanded. Yes, we should continue to improve the efficacy of drugs and diagnostics. But, health interventions alone do not cure communities of disease.

Thrasher found that marginalized bodies will continue to be infected, in spite of medicinal intervention, if the inequities from which the viral underclass emerge are not concurrently cured. Let’s get to work.

If interested, here’s a link to Thrasher’s website and book: http://steventhrasher.com/

Post by Alex Clifford, Class of 2024

Working with Humans and Animals to Save What’s Left

By Adeleine Geitner

On October 26, 2022

In Animals, Environment/Sustainability, Global Health, Policy

“Krithi Karanth is…” begins a long sentence if not pruned, so I will settle on the following: Dr. Karanth is the Chief Conservation Scientist and Director at the Centre for Wildlife Studies in India, an adjunct professor in the Nicholas School at Duke, and a Vogue Woman of the Year.

On Oct. 13, she visited her alma mater to catch us up on her work.

Karanth grew up in close contact with an abundance of wildlife as the daughter of tiger biologist Dr. Ullas K. Karanth in India. Her first experience in the jungle was at the ripe age of one, and she credits this “sheer joy of watching nonhumans uninterrupted” as the basis for her deep concern and care for wildlife.

She received her Ph.D from the Nicholas School after scouring historic hunting journals and interviewing Indian wildlife scientists to build a database that documents the havoc wreaked on wildlife populations in India, beginning in the mid-nineteenth century. The results are gut-wrenching, among them: an estimated 96% plunge in the lion population, 67% drop in tigers, and a 62% decline in wolves.

After thirteen years studying and researching in the U.S., Karanth returned home to India, where she felt her impact could be greater.

Today, large British hunting parties are no longer the main cause of species decline in India. Instead, man and beast find themselves stepping on each other’s toes and tails more and more as towns expand and animals like elephants and leopards lose their habitats.

At the Centre for Wildlife Studies, Karanth’s work focuses on mitigating the most prevalent problems in human-wildlife interaction: crop and property damage, livestock predation, and human injury and death.

Her tactics for doing so are expansive. At CWS, she leads several initiatives targeting different sides of the problem.

WildSeve deploys timely assistance to people, most often farmers, dealing with destructive wildlife encounters. Farmers can call a toll free number, and a member of the team will ride out to their farm to help document the incident and file a claim for government compensation, allowing farmers to complete what would otherwise be an arduous and expensive legal process. In “peak season,” between October and November when many farmers are growing a cover crop known to attract elephants, WildSeve deploys as many as thirty conflict responders per day.

Dr. Karanth presenting at the Nicholas School

The goal of these interactions is not simply response, but mitigation. WildSeve helps farmers understand what factors increase the likelihood of human-wildlife conflict (HWC) and how to avoid these encounters in the future.

Another project in the works, WildCarbon, will assist farmers in transitioning their land from agriculture to carbon-sequestering agro-forests in places where the benefits can outweigh the costs.

Karanth says that trust is key to ensuring that the advice from the team is well-received. It is often difficult to convince a farmer to change their practices. Farming technique is both a careful science and the basis of a farmer’s livelihood. The project is in its seventh year, and Karanth says it has taken time for farmers to see that their assistance works. One factor that helps build this trust is that many members of the WildSeve team are locals in the communities.

Another program, WildShaale, is designed to foster understanding and appreciation for local wildlife in schoolchildren. Karanth pointed out that many school-age children easily recognize a kangaroo despite their lack of proximity to or interaction with the Australian marsupial, but could not identify the Indian wolf native to their backyard.

For children living in communities that come in close contact with wildlife, their perception of the animals is often one of fear. Karanth said the curiosity and empathy that WildShaale nurtures is critical to creating communities that have a net positive relationship with their animal neighbors. By fostering this empathy, violence becomes a last resort when dealing with wildlife conflicts.

After Karanth’s talk, I grabbed a chai latte from Beyu Cafe and sat down in Penn Pavilion for New York Times columnist Bret Stephens’ chat on cross-partisan conversation. At the time, I didn’t see much connection between the two events, but in retrospect, it is there. Both talks touched on that attempt at harmony, respect, and civil discourse I so often find myself craving: for Karanth, it’s between animals and people; for Stephens, people and people.

As I got ready to write this article, I turned on my GE digital clock radio to keep me company. I debated switching to a podcast, but then the host mentioned elephants and — given their relevance to task — I leaned in a little closer.

WUNC was playing this week’s segment of the TED Radio Hour, which centered on finding resolutions in situations of conflict. The woman being interviewed was discussing her own solution to elephant-human conflict in Kenya: beehives.

I will leave it to the reader to find out how, but the remainder of the segment drove home my key takeaway from hearing Karanth speak: Seeking out simple, yet innovative answers to human-wildlife conflict, a life or death issue, can teach us a lot about the importance of finding solutions to interpersonal conflict.

Post by Addie Geitner, Class of 2025

Cancer Stigma, Contraceptives, Covid-19: 2022 Global Health Research Showcase

By Victoria Wilson

On October 21, 2022

In Cancer, Field Research, Global Health, Medicine, Policy, Science Communication & Education

Last Monday, Oct. 17, Duke University students who had conducted global health research had the opportunity to present their work. From North Carolina to Sub-Saharan Africa, the 2022 Global Health Research Showcase featured works that tackle some of the world’s most pressing health issues. Over 40 undergraduate, Masters, and PhD student projects examined a broad range of issues, determinants, and phenomena in countries from almost every continent. Here’s a few project highlights, in case you missed it:

Maeve Salm, pursuing her Master of Science in Global Health, went to Tanzania to study contraceptive use. Tanzania’s youth are highly impacted by teen pregnancy, and Salm wanted to understand desires for contraceptive use among adolescents affected by HIV. She learned that, much like in the U.S., stigma influences access to sexual healthcare for adolescents. This qualitative study aimed to support young people in achieving their desired health outcomes and reducing HIV transmission by examining barriers and facilitators to family planning. Findings indicate that youth agency in reproductive health is of utmost importance.

*Maeve Salm presenting her poster at the 2022 Global Health Research Symposium.*

Wondering about the Covid-19 response in other countries? Master of Science in Global Health Candidate Stephanie Stan explored the barriers and enablers to the pandemic response in Peru. Per capita, Peru experienced the highest mortality rate form the disease compared to any other country. Due to several challenging factors, they were slow to receive COVID-19 vaccines. However, they implemented highly successful vaccination campaigns once vaccines were obtained. What can be learned from Peru’s pandemic response? Prolonged and proactive collaborations between sectors (healthcare, academics, and government) enable swift public health responses in a crisis. It’s important to have elected officials who are empowered to make decisions promoting science.

“Definitely meeting all the incredible people that I interviewed and learning about their work and involvement in Peru’s pandemic response. Learning about what happens moving forward from their point of view.”
Stephanie Stan, when asked about her global health research experience

Winning the first-place Graduate Student Research Award, Judith Mwobobia’s project examined the stigma of cancer in sub-Saharan Africa. Stigma is a huge barrier to receiving treatment, which is a problem considering that 70% of global cancer deaths originate from Africa. Perceptions of financial stress, misconceptions about cancer, and fear of death were common attitudes driving cancer stigma. Proposed interventions included education and policy recommendations for low-resourced communities. Mwobobia is pursuing her Master of Science in Global Health. Clearly a supportive group, her classmates erupted in cheers when the award was announced.

By Victoria Wilson, Class of 2023

Is it Time to Decolonize Global Health Data?

By Alex Clifford

On October 14, 2022

In Global Health, Responsible Conduct

In the digital age, we are well-acquainted with “data,” a crouton-esque word tossed into conversations, ingrained in the morning rush like half-caf cappuccinos and spreadsheets. Conceptually, data feels benign, necessary, and totally absorbed into the zeitgeist of the 21st century (alongside Survivor, smartphones, and Bitcoin). Data conjures up the census; white-coat scientists and their clinical trials; suits and ties; NGO board meetings; pearled strings of binary code; bar graphs, pie charts, scatter plots, pictographs, endless excel rows and columns, and more rows and more columns.

However, within the conversation of global health, researchers and laymen alike would more often than not describe data collection, use, and sharing as critical for resource mobilization, disease monitoring, surveillance prevention, treatment, etc. (Look at measles eradication! Polio! Malaria! Line graphs A, B, and C!)

Thanks to the internet, extracting health data is also faster, easier, and more widespread than ever . We have grown increasingly concerned, and rightfully so, about data ownership and data sovereignty.

Who is privy to data? Who can possess it? Can you possess it? As you can see, the conversation quickly becomes convoluted, philosophical even.

Dr. Wendy Prudhomme O’Meara is an associate professor at Duke University Medical School in the Division of Infectious Diseases, visiting professor at Moi University, and the Co-Field Director of Research for AMPATH. Her research focuses on malaria.

Dr. Wendy Prudhomme O’Meara, moderator of the Data as a Commodity seminar on Sept. 29 and associate professor at Duke University Medical School in the Division of Infectious Diseases, discussed bioethical complexities of data creation and ownership within global health partnerships.

“We can see that activities—where data is being collected in one place, removed from the context, and value being extracted from it for personal or financial benefit — has very strong parallels to the kind of resource extraction and exploitation that characterized colonization,” she said in her introductory remarks.

Data, like other raw materials (i.e. coffee, sugar, tobacco, etc.), can be extracted, often disproportionately, from lower-middle income countries (LMICs) at the expense of the local populations. This reinforces unequal power dynamics and harkens to the tenets of colonialism and imperialism.

This observation is exemplified by panelist Thiago Hernandes Rocha’s research which focuses on public policy evaluation and data mining. He acknowledges that global health research, in general, should prioritize the health improvements of the studied community rather than publications or grant funding. This may seem somewhat obvious to you; however, though academic competition often fosters nuances in the field, it also contributes to the commercialization of global health. Don’t be shy, everyone point your finger at Big Pharma!

Though Dr. Rocha’s data mining technique refers to “pattern-searching” and analysis of dense data sets, I find “mining” to be an apt analogy for the exploitative potential of data extraction and research partnerships between higher income countries and LMICs.

Dr. Thiago Hernandes Rocha joins the discussion via Zoom. He is an advisor on health data analysis for the Pan American Health Organization.

Consider the British diamond industry in Cape Colony, South Africa, and the parallels between past colonial mineral extraction and current global health data extraction. Imagine taking a pickaxe to the earth.

Now consider the environmental ramifications of mining, and who they disproportionately affect. Consider the lingering social and economic inequalities. Of course, data is not a mine of diamonds (as your Hay Day farm might suggest) nor is it ivory or rubber or timber. It’s less tangible (you can’t necessarily hold it or physically possess it) and, therefore, its extraction also feels less tangible, even though this process can have very concrete consequences.

Data as a power dynamic is a rather recent characterization in academic discourse. Researchers and companies alike have pushed the “open data” movement to increase data availability to all people for all uses. You can see how, in a utopian society, this would be fantastic. Think of the transparency! I’m sure you can also see how, in our non-utopian society, this can be exploited.

Dr. Bethany Hedt-Gauthier, a Harvard University biostatistician and seminar speaker, described herself as “pro ‘open data’ … in a world without power dynamics” — an amendment critical to understanding research as a commodity itself.

She justified her stance by referencing the systematic review of authorship in collaborative health research in Africa that she conducted in collaboration with others in the field. They found that even when sub-Saharan African populations were the main sites of study, when partnered with high-income, elite institutions (like Duke or Harvard), the African authors were significantly less likely to be first or senior authors despite the comparable number of academics on both sides of the partnership. To what can we attribute this discrepancy?

Dr. Bethany Hedt-Gauthier is a biostatistician in health systems research that focuses on the optimization of care and health outcomes in sub-Saharan Africa.

Dr. Hedt-Gauthier describes forms of capital that contribute to this issue, from cultural capital (i.e. credentials) to symbolic capital (i.e. legitimacy) to financial capital; however, she poses colonialism (and its continuity in socioeconomic and political power dynamics today) as the root of this incongruity from which the aforementioned forms of capital bud and flower like poisonous oleander. In recent years, institutions, including Duke, have increased efforts to “decolonize” global health to achieve greater equity, equal participation, and better health outcomes overall.

Dr. Hedt-Gauthier briefly chronicled some of her own research in Rwanda at the start of the COVID-19 pandemic. Within her research partnerships, she recollected slowing down, thoughtfully engaging in two-way dialogue, and posing questions like the following: “Who is involved [in the partnership]?” “Are all parties equally represented in paper authorship?” “If not, how can we share resources to ensure this?” “How can we assure that the people involved in the generation of data are also involved in the interpretation of its results?” “Who has access to data?” “What does co-authorship look like?”

Investing time and energy into multi-country databases, funding collaborative research infrastructures, removing barriers within academia, and training researchers are just some of the methods proposed by the speakers to facilitate equitable partnerships, data sharing and use, and continued global health decolonization.

Dr. Osondu Ogbuoji is an Assistant Research Professor at Duke Global Health Institute (DGHI) and Deputy Director at the Center for Policy Impact in Global Health at DGHI.

Dr. Osondu Ogbuoji, the final panelist, puts it best: “… We should ensure that the people in the room having the discussion about what values the data has should be as diverse as possible and ideally should have all the stakeholders. In our own research, sometimes we think we have an idea of what data to collect, but then we talk to the country partners and they have a totally different idea.”

Though the question of data ownership may feel lofty or intangible, though data legality is confusing, though you may feel yourself adrift in the debate of commodity and capital, the speakers have thrown you a buoy, grab on, and understand that generally:

It is necessary to engage with “data” in a communicative and critical manner; it is necessary to build research partnerships that are synergistic and reciprocal; and, finally, it is necessary to approach global health via these partnerships to advance the field towards greater equity.

Post by Alex Clifford, Class of 2024

Watch the recorded seminar here: https://www.youtube.com/watch?v=wRmFzif8a1c

Meet New Blogger Jakaiyah, an infectious disease enthusiast

By Jakaiyah Franklin

On September 16, 2022

In Animals, Biology, Field Research, Global Health, Immunology, Students

Hello, my name is Jakaiyah Franklin, and I am a sophomore here at Duke University. In terms of my major, I am undecided, but I do know my passion lies in biology, science communication, and environmental science.

Outside of classes, I am the treasurer for the Duke Chapter of the NAACP and LLC leader for the Stem Pathways for Inclusion, Readiness, and Excellence (SPIRE) program. Last year I was the stage manager for two Hoof n Horn productions.

This is the Rocky Horror Picture Show company after finishing our last show.

This year, I will start a research position along with this research blogging position.

In a more personal sense, I am the youngest of three and a proud aunt. Right now, I say I am from Texas, even though I have lived in Georgia, South Carolina, Germany, and presently North Carolina. If someone ever asked me, I would say that Germany holds my most memorable memories; however, I have grown into a better version of myself in each place I have lived. Other than school, I like to read and watch House of the Dragon and the earlier seasons of The Game of Thrones. I prefer to study outside or in a place where natural light is abundant. I also love learning new things pertaining to science, specifically infectious diseases.

My view of Muhuru Bay, Kenya, where I spent the summer after my first year at Duke. That’s Lake Victoria in the distance.

I find diseases fascinating, and I believe they are our natural predators. I want to be able to not only understand them, but also, I want to help prevent them. If one were to have a favorite type of disease to study, mine would be zoonotic diseases. They are interesting because the act of a virus being able to jump from a host like a rat to a human is captivating to me.

After graduating from Duke, I want to earn a master’s in public health or a Ph.D. in epidemiology, virology, or infectious disease to feed my curiosity about diseases. However, before I can even decide what Ph.D. or master’s I want to earn, my current goal is to decide on my major.

I do like to think ahead, so, for my very distant career, I know I want to be able to see infectious diseases in both the lab and in the places where they are infecting populations. I want my research to be digestible for the general population because, as seen with both COVID and Monkeypox, science can be easily misinterpreted if not delivered appropriately. I want to prevent this occurrence from happening to me by learning more about science communication and actively improving my communication skills.

I hope this blogging position will expose me to infectious disease research or general public health research. With this new understanding of the research, I hope this position will also educate me on how to inform others so that they can enjoy and understand the science.

Post by Jakaiyah Franklin, Class of 2025

Expanding the SCOPE of Medical Education

By Olivia Ares

On September 15, 2022

In Anthropology, Art, Biology, Global Health, Medicine, Students, Visualization

It may be hard to put your finger on it, but Duke often allows students to connect their classes to something more personal.

The university’s emphasis on interdisciplinary education is a major initiative that colors students’ academic experiences. While there are many examples of these connections between people, classes, fields, and departments, few so tangibly represent those connections like The SCOPES Project, which connects arts and humanities to medical education at Duke.

*Beneath the Surface* by Mihir Patel, 2022. Image Courtesy of SCOPES.

Art and medicine can exist in entirely different worlds. They can appeal to different people and tell different stories. But why be simple when you can be, well… stunning? They can be integrated to form something powerful, and that’s precisely what SCOPES leadership members Isa DeLaura, Raluca Gosman, Mason Seely, David Stevens, and Lindsay Olson aimed to do.

“It is encouraging as an upperclassman who previously participated in this program to see rising students continue the tradition of incorporating the humanities into medical practice,” Mason Seeley says. The generational aspect of the project seems to contribute to its personality; participants bring their own perspectives to their work only to walk away with dozens more.

“Having a creative outlet has helped me process interactions with patients and the difficulties of the profession, and celebrate happy moments as well,” says Isa DeLaura.

“The goal is to give artists creative freedom to explore their relationships with their patients with whatever medium and in whatever style works best for them. As such, every year the feel is entirely based on the decisions of the artists.”
Isa DeLaura, MS3+

David Stevens insists that the artists “resist… forces of depersonalization in compelling and beautiful ways.”

The project is inspired and supported by yet another interdisciplinary Duke initiative called APPLE (Appreciating Patient Perspectives through Longitudinal Encounters), which connects medical students with patients living with chronic illnesses. The artists/medical students/empaths-in-training then attended multiple creative workshops and developed art pieces to reflect their patients’ personal experiences. But this year’s 6th annual SCOPES exhibition looks a bit different from past years’ (which are conveniently available online for your viewing pleasure).

Having attended many an art opening myself, I am unashamed to say that much of my enjoyment comes from the cheeseplates (and the excitement in the air, but that’s besides the point). Some exhibitions opt for a traditional charcuterie, some marked Kirkland Signature and others displayed on a handmade butcherblock. The point of fingerfoods is to encourage the attendees to stand up, walk around, and interact with the masses. But it also encourages attendees to “just stop by,” making the affair all the less intimate.

Following limitations on group gatherings Duke enforced during COVID, the SCOPES team decided to apply their newfangled interdisciplinary/revolutionary/innovative thinking to the art opening itself: They held a banquet.

“I loved the way this turned out,” says DeLaura. “It was very personal and made for great discussion and comradery.”

*Fences, Rivers, Walls* by Taylor Yoder, 2022. Image Courtesy of SCOPES.

“SCOPES has provided an opportunity to reflect on my experiences as a first-year medical student while also exploring new ways to combine various art forms to create my vision,” says Taylor Yoder, who created Fences, Rivers, Walls, pictured above. “I hope to continue shooting film throughout my medical education and career.”

I was particularly (although wrongfully) surprised about the variety in the exhibit. While the artists attended the same workshops and worked with patients through the same program, they took radically different approaches to their creations. Esme Trahair, a second-year medical student, was a humanities major in undergrad. Her piece combines historical perspectives with modern (although antiquated) mechanisms, emphasizing “the importance of remembering and learning from historical, outdated medical teachings.”

*For the Record* by Esme Trahair, 2022. Image Courtesy of SCOPES.

The work features a variety of perspectives, but also some clear motifs that could be key takeaways for future medical providers. Like Yoder, artist Kreager Taber explores the patient’s value of “home.” Exploring these motifs could allow for more personal, “upstream” healthcare.

This year’s SCOPES exhibition is held in the Mars Gallery in the Duke University Hospital Concourse. It is an initiative of the Trent Center for Bioethics, Humanities & History of Medicine at the Duke University School of Medicine. It will be on display August 9-September 29, and available for viewing online at this link.

P.S. If you are an MS1 student interested in participating in SCOPES, I have a link for you!

Post by Olivia Ares, Class of 2025

Benefits of Childhood Mental Health Intervention ‘Ripple Across Generations’

By Guest Post

On July 22, 2022

In Behavior/Psychology, Field Research, Global Health

Even before the COVID-19 pandemic, mental health challenges were the leading cause of poor life outcomes in young people. As many as 1 in 5 U.S. children aged 3 to 17 have a mental, emotional, developmental or behavioral disorder, according to the Centers for Disease Control and Prevention.

Now, that crisis has been exacerbated. Symptoms of depression and anxiety for children and adolescents have doubled during the pandemic.

Seventy percent of U.S. public schools reported an increase in the number of children seeking mental health services during the pandemic and many have struggled to meet the needs of those students, according to the latest federal data.

As the Biden administration and Congress consider policies and programs that could help curb these mental health challenges that children face, a group of Duke researchers may already have one answer.

Eighteen years after administering an intensive childhood intervention program called Fast Track, a group of Sanford School of Public Policy scholars has found that it not only proved effective at reducing conduct problems and juvenile arrests in childhood, it also improved family outcomes when the original children grow up and become parents themselves.

Their followup findings, which appeared in June in the Journal of Child Psychology and Psychiatry, show that girls who received the Fast Track intervention during first through 10th grades had improvements in several aspects of their family environments 18 years later.

Specifically, Fast Track reduced food insecurity in the mothers’ family environments, and lessened the mothers’ depression, alcohol and drug problems, and their use of corporal punishment.

“We knew the Fast Track early childhood intervention was successful at reducing aggressive behavior in childhood and criminal arrests in young adulthood,” said Drew Rothenberg, research scientist at the Duke Center for Child and Family Policy and lead author on the study.

“This research demonstrates that the early intervention doesn’t just benefit the children receiving the services,” he added. “It also improves the family environments those child form as adults, benefiting their own children. In other words, it looks like the effects of early intervention can ripple across generations.”

According to Rothenberg, the beneficial effects of Fast Track are just as large as those seen in prevention programs that only affect a single generation.

“Impressively, these beneficial effects were also almost as big as those seen immediately after the end of the Fast Track intervention 18 years earlier,” Rothenberg said. “Therefore, for mothers, Fast Track’s effects appear powerful across two generations of homes and are much longer-lasting than previous research suggested.”

“Surprisingly, the benefits of the Fast Track intervention on family environments formed as adults found for mothers did not extend to fathers,” said study co-author Jennifer Lansford, research professor at the Duke Sanford School of Public Policy and director of the Duke Center for Child and Family Policy.

Jennifer Lansford, Director of Duke Center for Child and Family Policy

“Even in contemporary society, women are still tasked with a greater proportion of child-rearing responsibility, and still more often called to create family routines and climate,” Lansford said. “Therefore, the beneficial Fast Track effects on reducing corporal punishment and increasing family food security may emerge only in mothers because mothers are still primarily responsible for the provision of parenting and procurement of resources for family meals, and consequently more likely to benefit from such intervention.”

Rothenberg said the findings suggest childhood mental health interventions can break maladaptive cycles and promote the development of healthy family environments when those children grow up and start their own families.

“With this evidence, we also demonstrate that investing in early childhood interventions won’t just pay off for today’s children but also for generations of children to come,” Rothenberg said.

Researchers surveyed 400 Fast Track participants who were now parents at age 34 about aspects of their current family environment. They wanted to assess whether parent substance use problems, depression, romantic partner violence, parent warmth, parent use of physical aggression and corporal punishment, family chaos, and food insecurity were better for adults who had participated in Fast Track as children than for adults who had been in the control group.

“We designed the Fast Track program to improve emotional awareness and interpersonal competence among children at high risk for peer conflict, antisocial and delinquent behaviors and life-course failure,” said study co-author Kenneth Dodge, the William McDougall Distinguished Professor of Public Policy Studies at the Duke Sanford School of Public Policy. Dodge is a member of the Conduct Problems Prevention Research Group that created the Fast Track program.

Participants had been drawn from high-risk elementary schools in Durham, North Carolina, Nashville, Tennessee, rural Pennsylvania and Seattle, Washington. Starting in first grade, students were randomly assigned to either receive Fast Track or be followed as a control group. Students who received the Fast Track intervention received social skills training, tutoring, and a social-emotional learning curriculum taught by teachers. Their parents received training in techniques to help the students manage their behavior.

The Fast Track project has been supported since 1991 by National Institute of Mental Health (NIMH) Grants R18MH48043, R18MH50951, R18MH50952, R18MH50953, R01MH062988, K05MH00797, and K05MH01027; National Institute on Drug Abuse (NIDA) Grants R01DA016903, K05DA15226, RC1DA028248, and P30DA023026; National Institute of Child Health and Human Development Grant R01HD093651; and Department of Education Grant S184U30002.

CITATION: “Intergenerational Effects Of The Fast Track Intervention on the Home Environment: A Randomized Control Trial,” William Andrew Rothenberg, Jennifer E. Lansford, Jennifer Godwin, Kenneth A. Dodge, William E. Copeland, Candice L. Odgers, Robert J. McMahon, Natalie Goluter, and Conduct Problems Prevention Research Group. Journal of Child Psychology and Psychiatry, June 15, 2022. DOI: 10.1111/jcpp.13648

Post by Sarah Brantley, communications director for Duke’s Center for Child and Family Policy