Global health issues may seem geographically distant, but they directly impact our local community through travel, immigration, emerging infectious diseases, and interconnected global economies. The ‘global’ in global health refers to the scope of problems, not just their location, which can be infectious diseases with pandemic potention.

UNC’s global and local engagements with resource-limited settings and underserved populations here and abroad, result in complementary and connected advancements in care for North Carolinians.

The Institute for Global Health and Infectious Diseases (IGHID) is the convergence of UNC’s interdisciplinary global work in the health sciences, with faculty members representing all health sciences at Carolina. Global health research, education and service are more important than ever to the state of North Carolina, demonstrated below.

 

 

Keeping North Carolina Safe

Infectious disease outbreaks and epidemics are increasing both in severity and frequency, and the vast majority originate from animals with an increasing number of people around the world living in closer proximity to animals due to deforestation, land use change and climate change. North Carolina directly benefits from the work of global health researchers working in other countries, monitoring disease and containing outbreaks. For years, William Fischer (Pulmonary) and David Wohl (ID) have contained diseases like Ebola, in West Africa, setting up field treatment units during outbreak settings to isolate and effectively care for patients. Their work in Liberia has directly informed emerging pathogen response and preparedness in North Carolina.

 

 

Civilian Biodefense

This experience was key to UNC Health becoming a designated Regional Emerging Special Pathogens Treatment Center, one of only a dozen medical units in the U.S. with capacity to respond to emerging pathogens during medical and public health emergencies. Should a civilian or a member of the military arrive at RDU Airport, or Fort Bragg, with a suspected pathogen, they would be transported to UNC Health and admitted to a special emerging pathogens treatment unit. There would be no better place to receive this special care than UNC.

North Carolina will be prepared because these global health researchers are working in other countries, monitoring disease, and containing outbreaks before they spread. Currently, Fischer and Wohl are training staff across N.C. to respond to disease threats.

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Covid-19

Infectious disease specialists consistently draw on global health experiences as demonstrated during the COVID-19 pandemic.

 

• UNC’s pop-up Respiratory Diagnostic Center (RDC) was put in place over a weekend, directly informed by Wohl and Fischer’s Liberian field experience with Ebola.
• ‘Task-shifting’ and community engagement learnings from the HIV response in rural Africa brought COVID-19 testing, treatment, and vaccination to medically underserved communities in NC, led by Michael Herce (ID)
• Just as remarkable, Carolina’s state-of-the-art surveillance laboratory, built in 9 weeks, became Carolina’s frontline defense again Covid. This was based on Amy James Loftis’s (IGHID-CTU) experience building a biocontainment lab in Liberia, with limited resources, as well as the Global Clinical Trials Unit’s history of research excellence.

Bringing Innovations Home

Innovations developed in low-resource settings—where economic constraints and emerging markets create incentives—help address inequities in health care knowledge, access, and quality in North Carolina. As trauma centers and obstetric units close in rural North Carolina, many face lengthy travel to access obstetric care. Now, gestational age evaluation and clinical care choices can be made faster, avoiding delays and costs, anywhere.

Obstetric Ultrasound On Smartphone

Jeff Stringer (Global Women’s Health-OBGYN) has proven that a revolutionary point-of-care probe connected to a smartphone can accurately estimate gestational age using deep-learning AI, anywhere in the world. Michael Kosorok (Biostatistics-Gillings School) worked with Stringer on the deep learning and data analysis. This study involved pregnant women in Chapel Hill and Lusaka, Zambia. In low-resource settings, this low-cost tool will eliminate the need for high cost equipment and trained sonographers.

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Eye Health & Vision Screening

Emily Gower (Ocular Epidemiologist-Gillings School) is applying a program she used to screen vision in Ethiopia and Tanzania, using a smartphone, to rural North Carolina. As people age, there’s a clear correlation between eye health and quality of life. Most vision impairment is avoidable, but access to eye care and eye health education is limited in rural areas of North Carolina. Vision screening with a smartphone meets this need.

 

Gower first introduced the tool in Africa to diagnose and treat trichiasis in low-resource settings. Now, she’s training people in North Carolina to screen vision, in New Bern and Fayetteville, where she’s finding high rates of refractive error that can easily be solved with new prescription glasses. A low-cost personalized corrective-lens eyeglasses kit will improve the accessibility and affordability of vision care.

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Bringing New Therapies to NC

The Global Clinical Trials Unit (CTU) brings new treatments and interventions for communicable diseases to the people of North Carolina. These also change guidelines for disease. During the pandemic, this infrastructure for facilitating high quality research brought the Moderna and Novavax trials to UNC. CTU scientists work with trial participants in Chapel Hill, Greensboro, Vietnam and Malawi.

 

HPTN 052 was a landmark clinical trial showed early anti-retro viral therapy for HIV infection prevented transmission, changing HIV care in NC, the US and world. (2011-Myron Cohen-ID) HPTN 084 determined an injection of long-acting antiviral cabotegravir is highly effective for preventing HIV. CDC issued guidelines for its usein the US. (2022-Mina Hosseinipour-ID)

Protecting the Health of North Carolinians

Insects With Global Reach,Tracking Vector-Borne Diseases

Former U.S. Army Captain Ross Boyce (ID & Epidemiology-Gillings School) applies approaches that he has honed in his work in western Uganda to reduce the prevalence of malaria, to study a rare mosquito-borne disease found in Western North Carolina. Known as La Crosse Encephalitis, the Appalachian region is one of the largest hotspots in the nation, and young children are the most susceptible. Boyce’s team is testing mosquito samples and collecting data that will lead to the creation of new diagnostic tools. He is characterizing the illness through a partnership with Mission Hospital, and working to improve prevention andcontrol programs that can be adopted by local agencies. As an epidemiologist, Boyce identifies the spatial and temporal distribution of vector-born diseases, including “hotspots” and targets areas for interventions.

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Food Labeling to Improve Health

Marissa Hall (Health Behavior-Gillings School) and Lindsey Taillie (Nutrition-Gillings School) are applying learnings from Taillie’s evaluation of Chile’s first national regulation to jointly mandate front-of-package warning labels, to an effort to add warnings on sugar-sweetened beverages in North Carolina and the U.S. This study, conducted in the U.S. and Mexico, will provide evidence for a U.S. government sponsored nutrition label.

Hispanic adults face disparities in obesity, type 2 diabetes, and nonalcoholic fatty liver disease, driven by higher consumption of sugar-sweetened beverages. More than 40 countries have adopted easy-to-understand, front-of-package nutrition information showing which foods are more or less healthful. So far, the U.S. has not required front-of-package labeling, relying instead on the food industry’s voluntary efforts which can be confusing, compared to “excess sugar” stop signs in Mexico, the Nutri-Score system used in France, or the Health Star Ratings in New Zealand. Only recently did the idea of a mandated, government-sponsored label gain traction in the U.S.

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Education & Training

Did you know? Research by Sylvia Becker-Dreps (Family Medicine) shows students with global health experience are more likely to work in underserved rural areas of North Carolina. Global health experiences give students skills to address complex health challenges, wherever they arise, and this includes the health needs of diverse populations within North Carolina.

UNC is a global university because faculty have harnessed the power of strategic partnerships, with other universities, businesses, civil societies and governments, to create platforms for ongoing research and bilateral education and training. They apply what they learn in one context to inform solutions in another, giving students and trainees deep, contextual learning experiences directly applicable to fields of study.

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