DGHI20 Reflections: Michael Merson

Michael Merson, M.D., was leading an interdisciplinary research center on HIV/AIDS at the Yale University School of Public Health when in spring 2006 he heard about an intriguing experiment. Duke – a university he knew primarily for its basketball team – was launching a global health program that promised to be different from those popping up at other schools around the same time.  

“Most of the global health initiatives at that time were in medical schools or public health schools,” says Merson, who had previously directed the World Health Organization’s Global Program on AIDS before moving to Yale. “Duke was the only place that was looking to create something that worked across the whole campus, and that was exciting to me.”

Merson signed on in July 2006 to become the founding director of the Duke Global Health Institute (DGHI), leading the institute through a remarkable first decade of expansion and innovation. By the time Merson retired as director in 2017, the institute had grown to include more than 60 faculty and launched education programs for students at every degree level. During his tenure, Merson also held roles as Duke’s vice president and vice provost for global affairs and as vice chancellor of the Duke-NUS Medical School in Singapore, where he helped launch the SingHealth Duke-NUS Global Health Institute, serving as its first director.

To kick off our series of interviews exploring key moments in DGHI’s 20 years of impact and innovation, we asked Merson, now a professor at the NYU School of Global Public Health, to reflect on DGHI’s earliest days – and some of the significant milestones that helped define the institute’s growth and success. This conversation has been edited for length and clarity.

How did you first hear about Duke’s plans to launch a global health institute?

I was finishing up 10 years as dean of public health at Yale, and I didn’t know what my next step was. That was when many universities were starting to get seriously interested in global health, and a lot of new programs were being formed all over the country. So I was reading about these programs, and someone told me that Duke was starting an institute. I knew (former Duke president) Dick Brodhead from his time as dean of Yale College, and we had talked about starting a global health program at Yale College. I had a lot of admiration for Dick, and it sounded like an exciting opportunity to have a university-wide institute. 

As you said, a lot of universities were getting into global health at that time. What was unique about Duke’s approach?

It was going to be an institute that was bridging the entire campus. That was interesting to me, because I had experienced running a big, interdisciplinary center at Yale, and it was clear to me that to really make a difference in global health required a broad approach involving many disciplines and professions. 

So when you arrived in fall 2006, what was at the top of your to-do list?

That’s a very interesting question, because you know, I did not know Duke. I didn’t know about the faculty and they didn’t know me. So I spent my first year really getting to know the university. I think in that first year, I met with more than 200 people. And three months after I started, there was an article in the Duke Chronicle accusing me of doing nothing, and asking when this person who had been recruited to lead the institute was going to get serious. And, well, maybe that was true. But I felt like I needed that time to see where we had strengths, where we could grow, and to work on the support systems we needed to be successful. 

I had been given a $30 million startup fund, but in the beginning, we really had nothing. I had no staff. For a while, it was just me and (former DGHI human resources manager) Tammy Sorrell working in the basement of Trent Hall. We had to hire faculty and staff, to figure out how to take on grants, handle finances and all the things you need to make the institute run. 

I think the institute had seven faculty initially, but within five years, you had grown that to more than 40. What were the keys to building that community?

First, I wanted to be sure that anyone already doing global health work felt like they could be part of the institute. I had tremendous respect for the Hubert-Yeargan Center, and the work Ralph Corey had done. Kate Whetten had important global projects related to health disparities. Sherryl Broverman had an educational program going with undergrads. There were some others, and I tried to ensure everyone felt included in what we were building. 

I spent much time building relationships. I had monthly meetings with the deans, because I really wanted the institute to be seen as university-wide. This included the humanities, because they were doing work on culture that I thought was very relevant to global health. We wanted experts in global policy, the environment, engineering, nursing and of course medicine. I wanted to collaborate with every school, and we achieved that. 

At the same time, I was very careful to appoint faculty who were committed to investing time in the institute. There were no courtesy appointments. We hired people who could spend substantial time helping to build the institute. We needed to grow, but we wanted to grow with the people who would make a difference. 

With the faculty growing so quickly, it must have been challenging to coalesce activities around a few priority locations. How did you nurture those deeper, bilateral relationships DGHI is so well known for today?

Here was the situation we faced: We’re hiring more and more faculty, and many had their own projects in specific countries, and we have students who want to go abroad as part of their education and training. And so you think, can we really work with all these institutions where everyone is working? Is that really going to be sustainable? So I asked (former DGHI deputy director) Randy Kramer to figure out where we had some comparative advantage, where we had enough people working to create a long-term collaboration. And we invested in developing those sites. 

We didn’t shut any collaborations off, but we did encourage faculty to work at those locations. We wanted to focus as much as we could, particularly to have places where we could send our students. And we were very sensitive about all  these being true partnerships – they needed to know we respected them and their priorities. 

It’s striking to look back at those early years and see the broad range of education programs that were introduced. What drove the development of those programs?

So a few years before I came to Duke, all of the freshmen read the book about Paul Farmer (“Mountains Beyond Mountains”), and so there was already great interest among undergraduate students in global health. We had started a global health certificate, but it was clear there was demand for more. I was told that only departments could offer majors, and so we began working with (Trinity) College on a co-major, which was really groundbreaking for an institute. It was a very long approval process, and (DGHI professor and current Trinity dean)  Gary Bennett really led the way.

When the co-major launched (in 2013), I felt like we had really arrived at the university, because there was such enthusiasm among the students and the faculty. I think within the first two years we were the sixth most popular major. And the undergraduate experience is so central at Duke. It was so important for us to have strong involvement there. 

The earlier creation of the master’s degree in global health (in 2009) was also groundbreaking because I had to make the argument to the Academic Council that it belonged with us, and not with a school. We were able to show this was a degree that required an interdisciplinary faculty, but as an institute, we couldn’t grant the degree. And so it was housed in the Graduate School, which was important because it put the degree in the center of campus. It reinforced the idea that we were not part of the medical school or part of campus, but a unified institute that worked across the entire university. The MS degree also allowed us to enroll residents from the Hubert-Yeargan Center’s Global Health Pathway, and it was important to support their clinical training.

One other program I think was innovative was the doctoral scholars program. This was part of the idea to bring all parts of campus together. We would bring into one program doctoral students from various schools and departments. For example, you’d have a Ph.D. student in environmental science talking with a doctoral student in, say, law. It was another way we tried to embrace the whole campus and think of global health in a comprehensive, multidisciplinary way.

Were there other milestones during that first decade that made you feel that the institute was on the right track, that you were building something that would last?

I think our success in fund raising was really critical. We set up a wonderful advisory board, and I spent a lot of my time trying to raise money for the Institute. (Former DGHI development director) Josh Bond had me out on the road meeting with people every month, and we raised around $65 million for the institute. And then of course there was the gracious ($20 million) gift from Melinda Gates.

The 2015 Gates Foundation gift … how did that come about?

As I understood, Melinda was ready to make her next gift to Duke, but it wasn’t clear what she wanted to support. Then in 2013, she came to give the commencement address, and Dick (Brodhead) asked me to be Melinda’s host for the weekend. I think Dick probably had the gift in mind. And Melinda being Melinda, she had a lot of questions about the institute. It was a great privilege and honor to spend so much time with her.

And one amazing thing about that gift was that half of it was a matching grant, which meant we had to raise money that would be matched by the gift. We wanted to endow some faculty chairs, and we were able to find donors who were happy to do that. They paid for half, and Melinda’s gift paid half. But Melinda insisted that her name not be on the chairs. She let the others have their name on it, and I thought that was incredibly gracious. 

Any advice for DGHI as it embarks on its next 20 years?

Well, I think it’s a very different time. DGHI arrived in a golden moment for global health. We started when there was a tremendous belief and enormous support from the U.S. and European governments and others for global health and we were seeing great progress in reducing mortality and morbidity in many low-income countries. But that time is over, and I don’t think it helps to look back. 

I do think there’s a great future for the institute, for sure. The study of global issues, the need for health equity, the desire to make a difference in the world – that’s all still there. But I think it’s a matter of how we fit into the context of today’s and tomorrow’s world. What will be the health challenges in Kenya, Nepal or Peru five or 10 years from now? How are we going to take advantage of all the exciting innovations in front of us and on the horizon? What about using AI platforms to achieve better health? Are we going to be serious about addressing non-communicable diseases and global mental health? How are we going to help resource poor countries reach true health sovereignty? How do we restore trust in global health, in vaccines? What do students need to know to succeed in tomorrow’s environment? If we’re looking forward and thinking about how to adapt to those challenges, we’ll continue to be successful.