The Hubert family believes that improving health worldwide begins at Rollins
By Pam Auchmutey
Last year, faculty in the Hubert Department of Global Health logged enough miles to circle the world 80 times.
The seventh floor of the Claudia Nance Rollins Building serves as their hub for improving the health of populations from Atlanta to Latin America, Africa, and Asia.
The department includes nearly 200 faculty with primary, joint, and adjunct appointments; more than $16 million in research funding; and 181 MPH students. In 2011, the department had 192 students—its largest student body ever.
Students are drawn to global health at Rollins for a number of reasons—the school's newly expanded facilities; its close ties to the CDC, CARE, the Task Force for Global Health, and other partners; opportunities to conduct hands-on research; and faculty who rank among the world's leading experts in infectious diseases, diabetes, safe water and sanitation, nutrition, the health of women and children, and faith and health.
The Hubert Department of Global Health also stands out as the first named department of global health in the country. Its name honors the generosity of Atlanta attorney Richard "Dick" N. Hubert 60L through the Hubert Foundation, created to fulfill the wishes of his late father, O.C. Hubert, to prevent hunger and disease. After overcoming a series of legal hurdles to settle the estate, the Hubert Foundation was established, with Dick Hubert and William Foege, then executive director of the Carter Center, as trustees.
"The excellence of global health at Rollins could not have been achieved without the support of the Hubert family and a dean like Jim Curran, who has a deep interest in preparing the future guardians of the world's health," says Foege, now Presidential Distinguished Professor Emeritus of International Health. "It is impossible to define the impact on health in every country, now and in the future."
Thanks to Foege's guidance, Hubert found a way to honor his father's wishes by helping Rollins fulfill its mission of improving health and preventing disease. "The school has the expertise and the sensitivity to deal with a global world," says Hubert.
Through Campaign Emory, the Hubert Foundation provided major gifts and pledges to create two endowed professorships; double support for the O.C. Hubert Fellowships in International Health, enabling more students to conduct global field research; and establish the Richard N. Hubert Fund for Global Health Excellence in research and education.
"Mr. Hubert's investment allows us to think outside the box to improve health outcomes and reduce disparities," says Carlos del Rio, Hubert Professor and department chair. He is one of three faculty experts who have helped raise Rollins' profile in prevention of pneumonia, diabetes, and HIV/AIDs, aided by the Hubert Foundation.
An ally against childhood pneumonia
Since 2000, children born in the United States benefit from the research of Keith Klugman, who helped develop the pneumonia vaccine that is now part of their immunization regimen. As a result, invasive pneumococcal disease among young American children has decreased by nearly 80%.
Children are less fortunate in the developing world, where pneumonia claims 800,000 lives annually—more than any other childhood disease. Klugman has made it his life's work to reverse that trend.
When the South African native joined Rollins in 2001, he was regarded as the world's leading expert on antibiotic resistance in pneumonia. Four years later, Klugman was named the William H. Foege Chair of Global Health, funded by the Hubert Foundation in honor of Foege's contributions to the field.
In 2003, the New England Journal of Medicine published the results of Klugman's landmark study that proved overwhelmingly that the pneumococcal vaccine had the potential to save the lives of thousands of HIV-positive and HIV-negative children. Since then, Klugman has pushed to make the vaccine available to children in Africa and Southeast Asia.
"One challenge in particular is developing the evidence to show that the vaccine, when implemented in routine immunizations, reduces children's deaths," says Klugman. "That is largely the focus of our current research at Rollins."
Klugman's team has begun to evaluate vaccine effectiveness in rural South Africa by looking at the ecology of the pneumococcal bacteria pre- and post-vaccine. Ultimately, they expect their results to show that the vaccine protects children up to age 5 and interrupts disease transmission to unvaccinated children and adults.
Bacteria resistance to vaccines remains an ever-present threat, leading Klugman and several collaborators to embark on the largest project ever to sequence the 20,000 pneumococcal genomes. Researchers will collect strains of the bacteria before and after the vaccine is rolled out in four countries in Africa and analyze existing strains in the United States, Asia, and South America. Through genetic sequencing of these strains, they hope to identify the genomic changes associated with bacterial escape from the vaccine.
Klugman is leading the five-year study, funded by the Bill & Melinda Gates Foundation, in collaboration with the CDC, the University of Cambridge in England, the National Institute for Communicable Diseases at Wits University in South Africa, the Wellcome Trust Sanger Institute unit in Malawi, the Medical Research Council in Gambia, and the Kenya Medical Research Institute.
Earlier this year, the Gates Foundation tapped Klugman to serve six months as its senior adviser on pneumonia prevention. Students also benefit from his expertise. A conversation with Klugman led MD/PhD student Michael Mina to study how influenza vaccines may impact diseases caused by bacteria.
Mina remembers that first meeting. "Keith told me, ‘I'm fairly confident that the influenza virus is responsible for most pneumococcal disease during flu season.' His comment stuck with me," says Mina. "He has this wonderful ability to think broadly about the different aspects of human biology and disease."
A network to curb diabetes
One floor above the Klugman laboratory, diabetes expert K.M. Venkat Narayan runs a different sort of "lab" consisting of a round table, a few chairs, and a whiteboard.
"This is where we brainstorm and design studies," says Narayan, the Ruth and O.C. Hubert Professor of Global Health.
The ideas generated at his small table touch people worldwide. Born and educated in India, Narayan has focused on prevention and control of diabetes for most of his career. In 2006, he left the CDC to build "something big and something global" at Rollins.
Today, he co-leads the Emory Global Diabetes Research Center in partnership with the Madras Diabetes Research Foundation in India, where he also runs a diabetes prevention study funded by the International Diabetes Federation with support from Lilly and Company. He is the principal U.S. investigator of the NIH-funded Global Center of Excellence for Prevention and Control of Cardiometabolic Diseases in South Asia, based at the Public Health Foundation of India in New Delhi. Center researchers in three cities in India and Pakistan follow 14,000 people to assess their risk of diabetes, cardiovascular diseases, chronic pulmonary disease, and some cancers. The center plans to add another 14,000 people in 2014. Another trial involving 1,200 people at 10 sites in India and Pakistan will focus on better delivery of low-cost diabetes care and the impact of organized care on diabetes complications.
"We are growing a huge enterprise to better understand who develops disease and why and the associated risk factors, all of which spawns new avenues of research," says Narayan. "Part of our mission is to assist countries in developing better systems of caring for those who require lifelong treatment for diabetes or cardiovascular disease."
Mentoring young researchers is integral to that enterprise. During the past five years, Narayan and other global health faculty have garnered funding to train 42 junior investigators from low- and middle-income countries and the United States.
This network will grow stronger with the start-up of the Emory Public Health Leadership and Implementation Academy, led by Mohammad Ali, assistant professor of global health, and funded by the Fogarty International Center at NIH. During the next five years, Rollins will train 60 professionals from India and Mexico to strengthen prevention of diabetes, cancer, mental illness, heart disease, and other noncommunicable diseases.
Shailendra Dandge, a pharmacologist from India, learned much at Rollins to develop his study on the effects of metformin, a drug used to treat diabetes, on vitamin B12 deficiency. Through his research, he will develop India's first guidelines for early detection of B12 deficiency to prevent neuronal injury.
"I have found a strong network at Rollins," say Dandge, one of six India Research Fellows in Noncommunicable Diseases who spent time in Narayan's lab last fall. "One thing I've learned is how to look at a problem comprehensively and then narrow its focus. In doing so, you realize you can work on different dimensions of a problem for 20 to 30 years."
Addressing HIV on multiple fronts
Carlos del Rio has been at the forefront of preventing infectious diseases for nearly 30 years. A respected voice in HIV/AIDs research and training worldwide, he works equally hard to overcome barriers to prevention and treatment locally and nationally.
Earlier this year, del Rio and his collaborators published the results of the Women's HIV SeroIncidence Study (ISIS), which showed that HIV rates for black women in Atlanta and five other U.S. cities are much higher than previously estimated by the CDC. The study is part of the HIV Prevention Trials Network (HPTN), a global collaborative funded by NIH to test nonvaccine interventions to prevent HIV transmission. Study findings will lead to better interventions for women at risk of HIV and related problems of food insecurity, poverty, domestic violence, and crime.
"An important factor impeding design of HIV prevention trials for U.S women is the inability to identify a definable group of women at high risk for HIV infection," says del Rio, the Emory site leader for the HPTN. "ISIS used novel recruitment strategies and identified a population with significant risk of HIV infection."
Training others is as important to del Rio as finding ways to prevent disease. Graduates of the Emory AIDs International Training and Research Program, which he has directed for 14 years, are helping control the global epidemic. A new consortium with Vanderbilt, Duke, and Cornell universities, led by del Rio and Narayan, is advancing global health training for early career health scientists from the United States. The Fogarty Global Health Program for Fellows and Scholars includes five university consortia that provide nearly a year of training in developing countries.
Timothy Love, a general surgery resident, and Ameeta Kalokhe, an infectious disease fellow, are the first participants from Emory. Love is in Ethiopia to help establish a registry to improve breast cancer screening, while Kalokhe is working with the National AIDs Research Institute in India to develop a scale for measuring domestic violence against married women.
"The philosophy in training is not only to build skills, but also to expose people to other contexts," says Narayan. "When a young U.S. investigator spends several months in a low- or middle-income country, it changes lives. They're also able to touch a lot of lives here."
Last fall, del Rio provided funding to support two doctoral students from his native Mexico to study at Rollins for six months. The Hubert professorship "allows me to support faculty, students, and others in their development," he says. "Mentoring is all about interacting and learning from others."
A growing reputation
Global health at Rollins is growing. In 2012, the school ranked first nationally in the number of MPH applicants in global health. Funding for faculty research increased by 27% between 2011 and 2012. Six of the 32 faculty with primary appointments hold endowed chairs, including former department chair Reynaldo Martorell, the Robert W. Woodruff Professor in International Nutrition. Future plans call for recruitment of more faculty specializing in chronic and communicable diseases.
"We would like to be the epicenter of global health at Emory and in Atlanta," says del Rio. "The support of the Hubert Foundation gives us an edge."
To learn about Keith Klugman's efforts to sequence pneumococcal genomes, view the video at bit.ly/pneumoniagenome.