Cultivating Change,Together

2021-22 Impact Report

Facts, figures and field reports documenting the impact of the Duke Global Health Institute’s mission to advance health equity for communities around the world.

Featured Stories

Four projects that embody DGHI’s spirit of collaborative teamwork to address complex health problems

Addressing the Global Vaccine Gap

THE COVID GAP INITIATIVE

When DGHI’s Global Health Innovations Center began tracking COVID-19 vaccine distribution, it could have followed a typical academic route by publishing findings in a journal. Instead, the team built a global coalition of decisionmakers and advocates to deliver timely insights that have influenced vaccine strategies at the highest levels and helped countries get access to COVID treatments and protection.

Video by DGHI Communications

Closing a Racial Divide in Cancer Care

TOMI AKINYEMIJU and THE DUKE CANCER INSTITUTE

Research has shown that Black and Hispanic patients have less access to the best cancer care, and therefore experience worse outcomes. At the Duke Cancer Center, DGHI epidemiologist Tomi Akinyemiju is working to understand why those disparities in access persist – and what doctors can do to erase them.

Video by Jim Rogalski

A PEARL for Partnership

KENYA’S PARTNERSHIP FOR EDUCATION AND ACADEMIC RESEARCH LABORATORY (PEARL)

Built from a converted shipping container, this unique research and teaching lab is deepening collaborations between DGHI and Kenyan researchers on malaria and other infectious diseases. It’s also training local lab technicians how to take advantage of their most powerful diagnostic tool: a microscope.

Video by Veasey Conway

Feeling the Heat: Investigating a Mysterious Kidney Disease

NISHAD JAYASUNDARA and DGHI’s PARTNERSHIP IN SRI LANKA

In Sri Lanka, a rash of kidney disease is affecting farmers who grow rice in marshy parts of the island. DGHI’s Nishad Jayasundara is working with an interdisciplinary team of environmental and health researchers to unravel how climate change and water contamination may be driving the rise in kidney problems.

Video by Veronique Koch

By the Numbers

A look at some of the key data points from our research, teaching and global outreach in 2021-22

By the Numbers

Research Grants

Externally funded research grants earned by DGHI faculty in 2021-22

External Funding

$ 0 M

Total annual funding of all DGHI research grants in 2021-22

Publications

0 +

DGHI faculty were authors on more than 900 scholarly works during 2021-22, according to the Duke Scholars database

Countries

Countries where DGHI faculty have active research projects

Students in Field Research

Duke students participated in field-based global health research during summer 2022, working with partners in 18 countries

Duke Schools

Different Duke schools with DGHI faculty appointments, including Medicine, Arts & Sciences, Engineering, Environment, Public Policy, Nursing, Law and Business

Research-Driven

DGHI funding sources, 2021-22 ($ in millions)

Learners at all Levels

DGHI enrolled 350 global health students at the
undergraduate, graduate and doctoral levels in 2021-22

Global Presence

DGHI has active faculty-led research projects in 40 countries and student field research in 18 countries

2021-22 Highlights

Notable breakthroughs, innovations and accomplishments from across our missions

Research and Innovation

While the COVID-19 pandemic seemed to surprise the world, a study of the statistical probability of pandemics over time suggests they are far more likely than many imagine. The study, co-led by global environmental health associate professor William Pan, found the probability of experiencing a pandemic similar to COVID-19 is around 2 percent in any year. That means someone born in the year 2000 would have a 38 percent probability of experiencing one by now. Researchers calculated the probabilities by analyzing records of novel disease outbreaks dating back to the 1600s, but they also indicated the risk of such events is likely to be higher in the future due to an increase in novel zoonotic diseases and environmental change.
Since the emergence of COVID-19, clinicians have struggled to understand why the disease impacts some more severely than others. Chris Woods, a professor of medicine and director of the Hubert-Yeargan Center for Global Health, has led several research projects to identify signals to indicate when the disease may inflict more serious symptoms. In one study published in 2022, Woods’ team found that chemical differences in patients’ immune responses after being infected with the SARS-CoV-2 virus may predict how severe their symptoms will become. Such results offer a promising path for developing diagnostics that can help doctors identify which patients may be most affected by the disease.
In the United States, Black people with lung cancer are more likely to die than White patients with the disease. A study on barriers of care, led by DGHI associate professor Tomi Akinyemiju, found access to equal treatment was a key driver in the higher death rate among Black patients. An analysis of more than 3,000 advanced cancer patients showed that among Black patients treated with immunotherapy, the death rate was 15 percent lower than for the White population. The finding confirms prior research suggesting racial disparities in survival are mitigated if patients receive equal treatment.
A team of researchers led by Matthew Kelly, an associate professor of pediatrics and global health, made a discovery when they studied the bacteria in the upper respiratory tracts of infants in Botswana. They found the presence of a bacterial species known as Corynebacterium was associated with lowered risk of pneumococcal colonization, which causes pneumonia, the leading infectious killer of children in low- and middle-income countries. The findings could point to a new way to prevent pneumonia infections by harnessing the protective power of
New research is demonstrating the effectiveness of telemedicine in speeding up identification of hearing loss among children in rural communities. The study, led by DGHI assistant professor Susan Emmett, examined a handful of communities in rural Alaska who refer students screened for potential hearing problems to telemedicine appointments with specialists. The research found referral to telemedicine significantly reduced follow-up time, allowing for earlier identification and treatment of problems. Data scientists from DGHI’s Research Design and Analysis Core, including Elizabeth Turner, Joe Egger and Alyssa Platt, also contributed to the research, which adds to the evidence that telemedicine can be an effective strategy for referring patients in communities where access to specialized care is low.
Julian Hertz, an assistant professor of surgery and global health, led an interdisciplinary team of US and Tanzanian researchers in initiating a program aimed at improving evidence-based diagnosis and care of myocardial infarction (MI) in Tanzania. The program, based at the emergency department of Kilimanjaro Christian Medical Centre (KCMC), has yielded a marked decline of the 30-month mortality rate after an acute MI from 43 percent to 19 percent. The team’s next goal is to explore the barriers to care for both patient and provider and design an intervention to address the barriers and improve care for MI patients.
A study on the quality of end-of-life care ranked the United Kingdom as a top country in palliative care. The survey, completed by caregivers and palliative care experts from 81 countries, was led by Eric Finkelstein, executive director of the Lien Centre for Palliative Care and a professor at Duke-NUS Medical School and DGHI. The ranking was based on 13 weighted factors including proper management of pain and comfort, having a clean and safe space, being treated kindly, and treatments that address quality of life rather than just extension of life.
Research led by Manoj Mohanan, an associate professor with the Sanford School of Public Policy and DGHI, highlighted the underreporting of COVID-19 cases from the rural areas of India. While India had the second-highest number of reported cases of COVID-19 worldwide, most of the data was collected from the country’s urban areas. By identifying that the spread of COVID-19 was higher than expected in rural regions, the research helped inform new strategies for controlling the disease’s spread and deployment of health resources.
During the pandemic, Rae Jean Proeschold-Bell, a research professor at DGHI, conducted a trial testing three stress-management practices on a population of Methodist clergy in North Carolina. Preliminary results of the study showed mindfulness-based stress reduction reduced symptoms of anxiety and improved heart rate after six months. The findings address a critical need for mental health support for clergy, who often dealt with extreme stress and anxiety during the pandemic, but also may be applicable in low-resource settings where mental health resources are scarce.
A clinical trial in Vietnam was the first-ever carried out on talaromycosis, a rare disease that is a major cause of death among HIV patients in South and Southeast Asia, led by Thuy Le, an associate professor of medicine, molecular genetics and microbiology and a DGHI affiliate. The trial pointed to the use of amphotericin, an antifungal drug, as a life-saving treatment. Now, Le is spearheading a campaign to have talaromycosis on the WHO’s list of Neglected Tropical Diseases. This would push the disease to the top of the global health agenda and make it a focus of clinicians, researchers and policymakers.

Research
and
Innovation

Education

In 2020, DGHI introduced a new practice-based pathway for students in its Master of Science in Global Health program, aimed at giving students firsthand experience in global health practice and operations. The first five students to opt for the pathway graduated in May 2022 after completing internship-based project analyses. The pathway was created to provide opportunities for students to hone critical thinking and analytical skills sought by global health organizations and provide an alternative to original field-based research.
For a second consecutive year, students enrolled in DGHI’s Global Health Undergraduate Capstone Course partnered on hands-on projects with local and global health organizations in the Innovators in Healthcare network, a group organized by the Duke Global Health Innovation Center. In the course, a requirement for global health majors, students work in teams to help organizations evaluate and implement innovations that seek to expand access to healthcare and address health disparities in global and local communities.
In May 2022, the first Duke master’s students enrolled in DGHI’s Global Health Graduate Certificate program earned their degrees. The certificate, previously open only to doctoral students, was expanded to allow master’s and professional students across Duke to take interdisciplinary courses in global health as they pursue their primary field of study. The program allows students pursuing degrees in health-related fields such as nursing, public policy, engineering and environmental sciences to add global perspective and experience to their studies.
Twelve students from Duke and 24 students from countries such as Burkina Faso, India, Kenya, Nigeria, Rwanda, Zambia and Zimbabwe enrolled in the first online collaborative course in Global Surgical Care. The course, a partnership between DGHI and the University of Global Health Equity in Rwanda, explores global disparities in access to surgical care and programs and policies that can promote the growth of surgical care in low- and middle-income countries.
DGHI professor Kearsley Stewart and Ugandan-based clinician Joel Kibonwabake developed a Student Research Training (SRT) project to engage students in understanding and addressing the increasing burden of sickle cell disease in Kalangala, Uganda. Guided by the principles of community-engaged research, Duke and Ugandan undergraduate students worked over the summers of 2021 and 2022 on a range of projects to understand the barriers to sickle cell treatment and raise community awareness of the disease and its impact.
A Student Research Training (SRT) program team working with the Udayan Care Residential Program in India produced research to help advocate for and promote services for orphaned children and their caregivers. Students helped create training programs for Indian student interns to gather and track mental health data that can demonstrate the effectiveness of Udayan Care’s programs.
In a new project supported by Duke’s Bass Connections program, students began working with the Pamlico County Disaster Relief Coalition in eastern North Carolina to improve the county’s readiness to manage the health impacts of disasters such as hurricanes. The project, co-led by DGHI associate professor Sumi Ariely and visiting professor and Pamlico resident Diana Silimperi, is aiming to identify vulnerabilities in the county’s disaster preparedness and builds off previous work to aid the county’s COVID-19 response.

Partnership

Global health pioneers Paul Farmer and Agnes Binagwaho shared lessons from their 20-year partnership to advance global health during DGHI’s Victor J. Dzau Distinguished Lecture in Global Health, which took place on Jan. 26, 2022. Speaking in front of students at the University of Global Health Equity in Butaro, Rwanda, and a virtual audience of nearly 400, the doctors discussed a wide range of topics, including the impact of COVID-19, failures in the global response to the pandemic, and the need for community-driven healthcare decisions and priorities. It was among the last public appearances by Farmer, a Duke alumnus and guiding light in the formation of DGHI, before his death less than a month later.
An international team of environmental scientists, including Duke’s William Pan, Alexander Pfaff and Heileen Hsu-Kim, received the top prize in the Artisanal Mining Grand Challenge for developing the Mercury Capture System (MCS). The MCS is designed to prevent the release of mercury into the environment during phases of gold mining, potentially reducing mercury contamination by 35 percent. The system is being tested in the field at mining operations in Ecuador and Guyana.
In its efforts to achieve the universal health coverage standards outlined in the United Nations’ Sustainable Development Goals (SDGs), the government of Kenya enlisted DGHI’s Global Health Innovations Center (GHIC) to conduct research and analysis to evaluate plans for expanding access to primary care. GHIC’s analysis provided insights on adopting and scaling primary healthcare innovations in Kenya to support the achievement of universal healthcare. The research was commissioned by Kenya’s Ministry of Health, along with the United Nations SDG Partnership Platform.
Ugandan surgeons trained by Duke’s Division of Global Neurosurgery and Neurology (DGNN) performed surgeries on patients with brain tumors during a neurosurgery camp at Mulago National Referral Hospital. The effort, organized by the Duke East Africa Neurosurgery Program, marked the first camp led by local neurosurgeons who received most or part of their training through the DGNN-sponsored College of Surgeons of East, Central and Southern Africa Neurosurgery Fellowship. DGNN also donated the medical supplies and equipment for the camp.
DGHI researchers in emergency medicine, in collaboration with the Kilimanjaro Christian Medical Centre in Tanzania, launched a new training program for East African students to develop research skills and knowledge related to trauma care. Called TRECK, for Trauma Research Capacity Building in Kilimanjaro, the degree-granting program will train 10 master’s and two Ph.D. students from Tanzania and surrounding countries to lay the groundwork for innovative research addressing the rising prevalence of injuries and injury-related disabilities in low- and middle-income countries.
Shenglan Tang, DGHI’s deputy director and a professor of population health sciences, leads an effort to support China’s National Immunization Program in implementing strategies to expand immunization rates for vaccine-preventable diseases across the country. In 2022, Tang and colleagues published research outlining some of the key challenges that the program will need to meet to achieve the country’s ambitious goals for vaccination, The researchers cited priorities such as expanding routine immunization programs to include all vaccines recommended by the World Health Organization, ensuring uninterrupted vaccine supply, strengthening the healthcare workforce, and increasing and sustaining funding for vaccine campaigns.
DGHI associate professor Wendy Prudhomme O’Meara partnered with colleagues at Moi University in Kenya to launch an innovative experiment seeking to reduce the overuse of antimalarial drugs, one of the factors contributing to microbial resistance to the medicines. As part of a pilot project, Prudhomme O’Meara’s team arranged with the Kenyan government to allow a small number of private chemists to base the price of antimalarial drugs on the results of a rapid malaria test. Only those who test positive are able to purchase the drugs at subsidized prices, an incentive that appears to be working to cut use of the drugs by people who don’t have the disease. A similar conditional pricing project was recently launched in Nigeria.
In July 2021, Lloyd Williams, assistant professor of ophthalmology and a DGHI affiliate, worked with local doctors in Sierra Leone to perform the first corneal transplants in the West African country. Williams, who leads Duke’s Global Ophthalmology Program, trained doctors on the vision-restoring procedure, part of the program’s mission to build capacity to treat preventable blindness in low- and middle-income countries. In Sierra Leone, Williams is working with the country’s national eye program to encourage more people to train as ophthalmologists and increase awareness of the need for preventive eye care.
A long-running research project in Madagascar has been taking steps to train and empower more local scientists to study the country’s pressing issues related to the health impacts of environmental changes. DGHI students and faculty have been traveling to the island nation for several years to study environmental impacts of land use and the evolution of zoonotic diseases. During the COVID-19 pandemic, the team shifted leadership of data collection to their local partners. Since then, the study has supported research and training of several Malagasy graduate students. Six Malagasy research assistants joined the team, and the project is funding a workshop to train 10 Malagasy students on data collection and analysis methods.
To help fill a gap in mental health services in China, Wei Jiang, a professor of psychiatry and behavioral sciences and a DGHI affiliate, began offering biweekly online classes during the pandemic to train mental health professionals in the country. This spurred the development of China’s first training program for young mental health professionals in dialectical behavioral therapy (DBT). DBT is considered a promising therapeutic option for patients who have not responded well to other forms of therapy.

Partnership

Global
Health
Policy

Global Health Policy

Based on the high visibility and impact of its research tracking the global supply of COVID-19 vaccines, the Duke Global Health Innovation Center (GHIC) partnered with several external groups to launch the COVID Global Accountability Platform (COVID GAP). The effort combines real-time data and research on measures to control COVID-19, including purchases and supplies of vaccines and oral therapeutics, with advocacy for equitable vaccine distribution and increased pandemic funding from wealthy countries. The initiative’s research was cited in hundreds of reports by media and NGOs and is credited for influencing the World Health Organization’s target for vaccinating 70 percent of the world’s population by 2022.
As countries scrambled to vaccinate their citizens against COVID-19, DGHI policy researchers worked to provide help and resources to countries as they planned their vaccination campaigns. A survey of 28 low- and middle-income countries by the Center for Policy Impact in Global Health revealed countries were most concerned about vaccine supply, storage and distribution, and funding for vaccine campaigns. Further analysis by CPIGH researchers identified bottlenecks in vaccine supply and distribution that could be addressed to more quickly meet vaccination goals. The research helped underscore the need for more global cooperation to help low- and middle-income countries fund and implement vaccine campaigns.
A data-crunching system developed by DGHI researcher João Vissoci helped countries such as Brazil analyze plans for efficient distribution of COVID-19 vaccines. The system, which uses geographic information to compare healthcare resources and the populations who need them, allowed health officials to see where vaccines should be sent to cover the largest number of people efficiently. Vissoci has used similar systems to help Brazil and other countries assess gaps in the availability of services such as emergency and trauma care.
A five-year partnership between Duke’s Global Health Innovation Center, Innovations in Healthcare and other agencies culminated in the creation of the IGAD Regional Data Sharing and Protection Policy Framework. The framework is designed to advance the limited use of data to improve health and development outcomes, a major challenge facing countries with developing healthcare systems.
Healthy Eating Research, a federally funded research program housed at DGHI, sponsored 10 teams to lead short-term research into issues of food security, nutrition and the health impacts of the pandemic. The projects, which were designed to produce quick results that could immediately inform pandemic policies, helped identify gaps and improvements in nutritional programs to ensure people have access to healthy foods during the pandemic and in future health crises.
In a paper published in The Lancet Public Health, five researchers from Duke University and Duke Kunshan explored solutions to tackling tuberculosis (TB), a persistent health issue in China. Some of the challenges identified in the study were lack of coordination within TB control networks, an absence of policy coherence, and diversion of TB control resources toward COVID-19 control. Shenglan Tang, the study’s lead author and DGHI’s deputy director, noted the research underscores a need for more coordination across areas of government and healthcare administration to jumpstart progress against TB in the country.
The Sexual And Gender Minority Health Program (SGMH) hosted a two-day symposium to explore issues related to the physical and mental health of transgender youth and adults. The symposium was the first of its kind to bring together clinicians, researchers and advocates to discuss current research and policies related to transgender health and explore unanswered questions. Kate Whetten, a DGHI professor and co-director of the SGMH program, notes an important goal of the forum was to rise above political debates over transgender issues and work together to define a research agenda on transgender health, with the aim of identifying effective policies and interventions that protect the health of transgender individuals.

Reflections

The death of global health pioneer Paul Farmer in February 2022 affected the Duke community deeply. Farmer, a Duke alumnus and former member of the DGHI Board of Advisors, was a guiding light and inspiration for many in the institute. We asked some students and recent graduates, including several who benefitted from DGHI’s Paul Farmer Fund, which supports summer research experiences for undergraduate students, to share reflections on how Farmer’s legacy has shaped their learning and career goals.

Read full reflections from Ramya Ginjupalli, Don Nguyen, Zoe Hughes, Kate Kutzer and Lydia Smeltz.

As I pursue a career within public and global health, Dr. Farmer’s legacy continuously reminds me of not only the personal and individual impact we can have, but also our possibility to inspire the systemic change required to decrease inequities in healthcare delivery.

… He felt like a fictional hero, representing the good of humanity at its very core and what it means to dedicate your life to helping others.

Dr. Farmer’s teachings pushed me to consider how I could make good health reach more than just the individuals I could treat as a physician, how I could do as much good for the world’s poorest and sickest as I possibly could.

His efforts to address the AIDS and tuberculosis epidemics in Haiti represented “militant anthropology,” as he demonstrated that it is not enough to research how health systems can better support vulnerable populations. It is also our responsibility to take action.

Dr. Farmer dedicated his life to serving others and improving health equity and his legacy has allowed me to envision how my life can do the same for persons with disabilities.

From The Directors

It is the collective action of many, united by purpose and mission, that offers the most hope for our shared future.

In his book, To Repair the World, the late Paul Farmer counseled future global health practitioners and advocates that, “With rare exceptions, all of your most important achievements on this planet will come from working with others.” Those words, so fundamental to Farmer’s pioneering career as a physician and advocate for health equity, are not just sound advice for the next generation. They should be central to the mindset of any organization seeking to make a difference in the lives of others.

At the Duke Global Health Institute, we are fortunate to work with so many talented clinicians and scholars who live these values every day. We seek to advance health and well-being not for vulnerable and disadvantaged communities around the world, but with them — working side-by-side to identify priorities and strategize solutions. That means taking the time to build relationships, establish mutual trust, and create space for open dialogue and exchange.

All of the innovations and achievements you see in this report are the result of our commitment to true partnership. We are grateful to the many individuals and organizations that have enabled and propelled these projects around the world, including our outstanding global partners, our funders and donors, and the government and non-government agencies that support our researchers in innumerable ways.

We are proud of the progress we are making to erase disparities and advance health equity around the world, and we equally recognize that this progress is not ours alone to claim. As Paul Farmer well understood, it is the collective action of many, united by purpose and mission, that offers the most hope for our shared future.

Thank you for your support of the Duke Global Health Institute and your commitment to advancing global health,

Chris Beyrer, MD
Incoming Director

Dennis Clements, MD
Interim Director

Cultivating Change,Together

2021-22 Impact Report

Featured Stories

Addressing the Global Vaccine Gap

Addressing the Global Vaccine Gap

THE COVID GAP INITIATIVE

Closing a Racial Divide in Cancer Care

Closing a Racial Divide in Cancer Care

TOMI AKINYEMIJU and THE DUKE CANCER INSTITUTE

A PEARL for Partnership

A PEARL for Partnership

KENYA’S PARTNERSHIP FOR EDUCATION AND ACADEMIC RESEARCH LABORATORY (PEARL)

Feeling the Heat: Investigating a Mysterious Kidney Disease

Feeling the Heat: Investigating a Mysterious Kidney Disease

NISHAD JAYASUNDARA and DGHI’s PARTNERSHIP IN SRI LANKA

By the Numbers

By the Numbers

Research-Driven

Learners at all Levels

Global Presence

DGHI has active faculty-led research projects in 40 countries and student field research in 18 countries

2021-22 Highlights

Research and Innovation

Re­search and In­nova­tion

Edu­ca­tion

Education

Partnership

Part­ner­ship

Global Health Policy

Global Health Policy

Reflections

From The Directors

© 2022 DGHI All Rights Reserved

Research
and
Innovation

Education

Partnership

Global
Health
Policy