Chris Beyrer will become the next director of the Duke Global Health Institute on Aug. 30.
Beyrer currently serves as the inaugural Desmond M. Tutu professor of public health and human rights at the Johns Hopkins Bloomberg School of Public Health. As a prominent leader in infectious disease epidemiology and international collaboration, he has worked at the intersection of health and human rights for HIV/AIDS treatment and prevention to secure health equity for underserved communities.
In an interview with The Chronicle, Beyrer shared his journey and inspiration behind pursuing a career in global health, his visions and goals as director of DGHI and the challenges he foresees in taking the position at Duke.
This interview has been edited for length and clarity.
The Chronicle: What is your educational background and what inspired you to pursue a career in global health?
Chris Beyrer: The thing that led me most directly into global health and the work I have done since was during my senior year, where I did field placement work in Sri Lanka. At that time, I thought I might go into medical anthropology, as I was on this rather amazing country island and I apprenticed with two ayurvedic traditional physicians and was able to live in some rural communities. I found it to be the most exciting, exhilarating and interesting experience. I realized at that point that cross-cultural work and global work were something that I really wanted to be a part of my career.
After taking several years off between college and medical school to travel, I spent quite a bit of time in India and Nepal and I ended up volunteering at a Tibetan refugee camp in North India. This experience made me realize that although I was having an extraordinary time while learning a great deal, I didn’t have any skills to benefit the people I was living and working with. I really wanted to have a meaningful impact for them and not just for my own interests, so I went to medical school at the State University of New York, Downstate Medical Center College of Medicine.
I eventually trained in epidemiology at Johns Hopkins University and did an infectious disease fellowship. When I was in training during the late 80s and early 90s, there was no effective AIDS/HIV treatment. It took 15 years of research to get to antiviral therapy, which we didn’t have until 1996. What we had was prevention, education, behavioral interventions and HIV vaccines. I felt that working in HIV prevention and vaccine research was the only way out of the pandemic, so that is what I trained in.
TC: Reflecting on your time at Johns Hopkins University, what are some of the experiences and work that you would consider most profound and rewarding?
CB: My first job after training was to set up HIV vaccine trial sites in Chiang Mai, Thailand. It was my first time out of training, but I ended up staying for five years, while also being on the faculty of Johns Hopkins University as a research associate. Those five years in Thailand were my grounding in how to do collaborative work with investigators, physicians, nurses, communities and people affected by HIV/AIDS as well as how to do that in ways that are truly collaborative.
I came back to Johns Hopkins University in 1997 and I have been based in Baltimore ever since. I came back to take leadership of what was then the Johns Hopkins Fogarty AIDS International Training and Research Program and that program involved not just Asia but a number of countries in Africa and Latin America. Until 1997, I had never been to Africa, but I was suddenly running a number of research and training programs for Johns Hopkins investigators in Ethiopia, Malawi, Uganda and South Africa, so I traveled to all of those countries and I spent a great deal of time working collaboratively with universities, hospitals, clinics and community groups, which were profound experiences.
At that time, there was effective antiviral therapy. People living in the United States and Europe were going back to work and school. We called it the “Lazarus effect” where people literally got up from their death beds and started to get back to life.
In Africa, people were dying in enormous numbers. In fact, it was the peak of the loss of life and it was an extraordinarily challenging and difficult time. The fight for global access and global equity in health began, which initiated a great amount of activism and community engagement I was involved with. There was a global commitment, led by the U.S. with many other partners, to try and provide AIDS care and antiviral therapy across Africa and across the developing world. Being a part of that whole movement and seeing people living and thriving was one of the most powerful things I have ever experienced.
TC: Could you describe some of your prior leadership experiences and work?
CB: In 2014, I was elected president of the International AIDS Society. I also served as co-chair of several international AIDS conferences including the 2016 International Aids Conference held in Durban, South Africa. It was a landmark meeting in many ways and brought forth the reality of African epidemics as being characterized as heterosexual epidemics, very different from what we were seeing in the West where people with the most burden of disease were gay and bisexual men, people who inject drugs and sex workers. Part of what we tried to bring forward was the fact that yes, there are gay and bisexual men all over the continent and in fact their HIV rates were substantially higher than other men in their same communities.
The same was true for sex workers and, in fact, the group with the highest rates of HIV infection were sub-Saharan African women sex workers. I was one of the people who led the effort to move away from simplistic views and understand the heterogeneity of HIV risks and why it is so important that nobody is excluded, that we address people at the margins and address the structural reality of laws that criminalize and penalize people that make it so much harder to provide services for.
Through this work, I founded the Center for Public Health and Human Rights at Johns Hopkins University, one of the first human rights centers in a department of epidemiology, because we really wanted to bring evidence-based and population-based approaches to human rights as well as to bring human rights to public health. We are working in more than 20 different countries and we have a large number of faculty. It has been powerful to work at the interface of health and human rights.
TC: What drew you to the Duke Global Health Institute?
CB: The Duke Global Health Institute is one of the leading global health institutes in the country, if not the world, and it was founded and previously led by a friend and mentor of mine, Michael Merson, Wolfgang Joklik professor of global health.
What really impressed me about DGHI is fundamentally the focus on equity that is so committed to the idea that everybody deserves access to healthcare and that health equity both for underserved communities in the United States and underserved communities globally is really the glue that holds the DGHI together. That is just so consistent with my values, what I care about and what I think is so fundamental to the idea that health is a human right and that we really need to extend the health franchise. Not having access to healthcare is a threat to human dignity, which is the principle that underlies all human rights.
TC: What visions and goals do you have as director of DGHI?
CB: I would like to address systemic racism and biases in our healthcare system. I think that is very much a part of global health leadership that can help to take on.
In terms of goals, I think it is really important to grow DGHI faculty, support junior faculty and students, and be able to really work on the support of early-stage investigators. We need a new cadre of people working in global health and must support the next generation of global health investigators, and that is not just Americans who want to work in global health. That also includes our partners at collaborative institutions, it is the next generation of researchers in Kenya, Tanzania and Singapore who want to engage in this work. Doing that in a genuinely collaborative way is really what people talk about in terms of decolonizing global health.
I think that we have really an unprecedented opportunity that has come out of all the suffering from COVID-19. We have understood how interconnected we all are and how important scientific advances are, but we also have had terrible failures with equity and social justice. We have to work on global equity and that is not only important from a human and ethical and moral perspective, but also from a scientific perspective.
Global health has never mattered more, and Duke has a really important role to play in that.
TC: What challenges do you foresee as being the director of DGHI?
CB: You have to take a position like this with a lot of humility because honestly, it is going to be a very steep learning curve for me. I have a steep learning curve in terms of learning a great number of new people and grasping where DGHI’s strengths are, where work needs to be done and what needs focus and intention.
I think there are some structural realities in global health that we also really have to take on. There has been increasing centralization and bureaucratization of the way grants are funded and managed globally. I have heard consistently from faculty that it is getting harder to do this important work and that we really need to focus on the mechanisms of how we actually do global health work, how we fund it and how we do it in collaboration and partnership. I know that is a big challenge at every institution and whoever steps into this role would face it, so I am certainly going to face it as well.
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Amy Guan is a Pratt senior and a senior editor of The Chronicle's 119th volume.