The Duke Office of Global Affairs, Duke Global Health Institute, and the School of Medicine hosted a conversation this week centered around the global health challenges we currently face.
The event featured speakers A. Eugene Washington, chancellor for health affairs at Duke University and president and chief executive officer of the Duke University Health System, and Chris Beyrer, director of the Duke Global Health Institute and professor of medicine.
Throughout his career, Beyrer served as president of the International AIDS Society, an advisor to the U.S. President’s Emergency Plan for AIDS Relief and the HIV Vaccine Trials Network, among other organizations.
When the COVID-19 pandemic occurred, Beyrer pivoted to help run vaccine trials. He currently serves as a scientific liaison to the COVID-19 Vaccine Prevention Network.
Modern conflict and climate change
The world population will reach eight billion people this week, according to Beyrer. The population growth represents accomplishment in reducing infant mortality and increasing life expectancy, but overpopulation presents a new set of health-related challenges, he said.
“Eight billion people cannot live on this planet in the way that we are currently exploiting its resources, we will exhaust Earth's capacity to sustain our societies. And that's a function both of the overconsumption that is going on, but also these incredible inequalities, which have been sharply rising,” Beyrer said.
Beyrer emphasized that more privileged people have a moral obligation to mitigate the inequitable impact of overpopulation and overconsumption.
“The climate crisis is also a justice crisis, a social justice crisis. And it's a moral issue,” he said.
Beyrer also highlighted that devastating modern conflicts, especially the war in Ukraine, present challenges for public health.
“We have more displaced people with what's been happening with Russia and Ukraine, and a number of other conflicts which now have over 100 million internally or externally displaced people,” Beyrer said.
According to Beyrer, conflict-driven displacement and climate-driven migration are incentivizing right-wing, populist and anti-immigrant governments. Beyrer warned that the policies presented by these governments are unlikely to provide long-term solutions to modern public health problems.
In this landscape, one of the largest challenges of public health is staying apolitical and retaining scientific objectivity, Beyrer said. Yet, public health officials must advocate for issues of equity, which some construe as “choosing sides” and undermining scientific objectivity.
Equity in COVID-19 vaccine trials
Beyrer noted the importance of the government’s investments in infrastructure and medical professionals towards developing the COVID-19 vaccine.
In his work in COVID-19 vaccine trials, Beyrer advocated for including racially and ethnically diverse test subjects that corresponded with the population. He also ensured that at least a quarter of people in the trials were over the age of 65, “because that’s who’s really getting sick with COVID.”
Beyrer argued that diversity was a medical, not political, issue.
“If we don’t achieve equity, we're going to have more problems with hesitancy and mistrust,” he said.
Monkeypox
Following the rollout of the monkeypox vaccine, rates of monkeypox are decreasing. But the highest rates of monkeypox are among Black and Latinx gay or bisexual men, and the most at-risk populations were vaccinated at lower rates than their low-risk counterparts.
Beyrer argued that lower vaccination rates among at-risk populations can be a failure of public health messaging.
“Very often this is a failure of our public health system, such as it is to equitably distribute and get information out and reach communities that are lower resourced and have lower access to health information,” he said.
Duke’s role
Among the public health challenges posed by climate change, war, COVID-19 and monkeypox, Beyrer believes that Duke and other academic institutions can play a central role in addressing these challenges.
In particular, Beyrer hopes that the University can work toward creating sustainable solutions that prioritize the needs of specific populations.
“The key concept for what we need to work on is the intersections between health and global health work that we do and sustainability — sustainable livelihoods and sustainable societies,” he said.
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Zoe Spicer is a Trinity senior and an enterprise editor of The Chronicle's 120th volume.