Michael H Merson

Interim Chair and Clinical Professor of the Department of Global and Environmental Health

Professional overview

Michael Merson is Interim Chair of the Department of Global and Environmental Health and Clinical Professor of Global and Environmental Health. He is the William Joklik Emeritus Professor of Medicine and Global Health at Duke University, where he served as the founding director of the Duke Global Health Institute and as Vice President and Vice Provost for Global Affairs. His current research is focused on policy issues related to the response to pandemics, evaluating the rollout of Paxlovid in low-income countries and on ways to regain trust in public health.

Prior to NYU, he joined the faculty at Yale University as its first Dean of Public Health. Before entering academia, between 1980 and 1995, Dr. Merson served as director of the World Health Organization (WHO) programs on Diarrheal Diseases and Acute Respiratory Infections, and subsequently the WHO Global Program on AIDS. He has authored over 150 articles, is the senior editor of a leading global health textbook “Global Health: Disease, Programs, Systems, and Policies” and lead author of The AIDS Pandemic: Searching for a Global Response on the history of the global response to AIDS. He has served in advisory capacities for UNAIDS, WHO, the Global Fund to Fight AIDS, TB and Malaria, World Bank, World Economic Forum, Bill & Melinda Gates Foundation, and was an advisor to various private sector entities on the COVID-19 pandemic. He has two honorary degrees and is a member of the National Academy of Medicine.

Education

B.A., 1966, cum laude, Amherst College, Amherst, Massachusetts

M.D., 1970, summa cum laude, SUNY, Health Sciences Center at Brooklyn, New York

Honors and awards

Consortium of Universities for Global Health (CUGH) Distinguished Leadership Award (2018)

Duke Medical Alumni Association Distinguished Faculty Award (2017)

Master Teacher Award in Preventive Medicine, Downstate Medical Center (2010)

Outstanding Contribution to the Campaign Against HIV/AIDS, Russian Association Against AIDS (2000)

Connecticut Health Commissioner’s AIDS Leadership Award (1998)

Connecticut Health Commissioner’s AIDS Leadership Award (1997)

Frank Babbott Alumni Award (1995)

Surgeon General's Exemplary Service Medal (1993)

Commendation Medal, US Public Health Service; (1986)

Arthur S. Flemming Award for Outstanding Federal Service (1983)

Commendation Medal, US Public Health Service (1975)

Publications

Publications

Strategies used in the detection of Acute/early HIV infections. The NIMH multisite acute HIV infection study: I

Kerndt, P. R., Dubrow, R., Aynalem, G., Mayer, K. H., Beckwith, C., Remien, R. H., Truong, H. H. M., Uniyal, A., Chien, M., Brooks, R. A., Vigil, O. R., Steward, W. T., Merson, M., Rotheram-Borus, M. J., & Morin, S. F. (n.d.).

Publication year

2009

Journal title

AIDS and Behavior

Volume

13

Issue

6

Page(s)

1037-1045

10.1007/s10461-009-9580-8

Abstract

Abstract

Acute/early HIV infection plays a critical role in onward HIV transmission. Detection of HIV infections during this period provides an important early opportunity to offer interventions which may prevent further transmission. In six US cities, persons with acute/early HIV infection were identified using either HIV RNA testing of pooled sera from persons screened HIV antibody negative or through clinical referral of persons with acute or early infections. Fifty-one cases were identified and 34 (68%) were enrolled into the study; 28 (82%) were acute infections and 6 (18%) were early infections. Of those enrolled, 13 (38%) were identified through HIV pooled testing of 7,633 HIV antibody negative sera and 21 (62%) through referral. Both strategies identified cases that would have been missed under current HIV testing and counseling protocols. Efforts to identify newly infected persons should target specific populations and geographic areas based on knowledge of the local epidemiology of incident infections.

A global partnership in medical education between Duke University and the National University of Singapore

Williams, R. S., Casey, P. J., Kamei, R. K., Buckley, E. G., Soo, K. C., Merson, M. H., Krishnan, R. K., & Dzau, V. J. (n.d.).

Publication year

2008

Journal title

Academic Medicine

Volume

83

Issue

2

Page(s)

122-127

10.1097/ACM.0b013e318160b8bc

Abstract

Abstract

Duke University and the National University of Singapore (NUS) have partnered to launch a new medical school that brings the American style of postbaccalaureate medical education to Asia. The new institution, called the Duke-NUS Graduate Medical School (GMS) and located in Singapore adjacent to the Singapore General Hospital, admitted its inaugural class of students representing citizens of seven nations in August 2007. The project represents an investment of more than $350 million from three ministries of the Singapore government, and a commitment on Duke's part to provide senior leadership and recruit faculty from Duke, from other international locales, and from within Singapore itself. Graduating students who complete the four-year Duke curriculum will receive an MD degree awarded jointly by Duke and NUS, thereby distinguishing this school from medical education in most Asian institutions that award an MBBS degree after a five-year period of study that follows directly from secondary school. The emphasis of the Duke-NUS GMS is to prepare physician-scientists for academic careers, with plans for 20% of each class to complete a combined MD/PhD degree. This article describes events leading up to this partnership and details of the relationship, including curriculum, organizational structure, milestones, and goals.

Combination HIV prevention

Merson, M., Padian, N., Coates, T. J., Gupta, G. R., Bertozzi, S. M., Piot, P., Mane, P., Bartos, M., & For The Lancet HIV Prevention Series Authors, T. L. H. P. S. A. (n.d.). In The Lancet (1–).

Publication year

2008

Volume

372

Issue

9652

Page(s)

1805-1806

10.1016/S0140-6736(08)61752-3

Government-NGO collaboration and sustainability of orphans and vulnerable children projects in southern Africa

Rosenberg, A., Hartwig, K., & Merson, M. (n.d.).

Publication year

2008

Journal title

Evaluation and Program Planning

Volume

31

Issue

1

Page(s)

51-60

10.1016/j.evalprogplan.2007.08.005

Abstract

Abstract

Given current donor attention to orphans and children made vulnerable by HIV/AIDS, and the need for a new framework that recognizes the complementary roles of nations and non-governmental organizations (NGOs), this analysis reviews NGO-operated community-based orphans and vulnerable children (OVC) projects in Botswana, Lesotho, Namibia, South Africa, and Swaziland. There has been a lack of attention within the field of evaluation to inter-organizational relationships, specifically those with government agencies, as a factor in sustainability. We analyzed evaluations of nine OVC projects funded by the Bristol-Myers Squibb Foundation for the influence of government-NGO collaboration on project sustainability. For eight of the nine projects, evaluations provided evidence of the importance of the government partnership for sustainability. Government collaboration was important in projects designed to help families access government grants, initiate community-based solutions, and advocate for OVC rights through legislation. Government partnerships were also critical to the sustainability of two projects involved in placing children in foster care, but these showed signs of tension with government partners. In addition to the more common factors associated with sustainability, such as organizational characteristics, donors and NGOs should concentrate on developing strong partnerships with local and national government agencies for the sustainability of their projects.

The global health and diagnostic (flow) cytometry - Breakthroughs in HIV and tuberculosis

Merson, M. H., & Denny, T. N. (n.d.).

Publication year

2008

Journal title

Cytometry Part B - Clinical Cytometry

Volume

74

Page(s)

S4-S5

10.1002/cyto.b.20412

The history and challenge of HIV prevention

Merson, M. H., O’Malley, J., Serwadda, D., & Apisuk, C. (n.d.).

Publication year

2008

Journal title

The Lancet

Volume

372

Issue

9637

Page(s)

475-488

10.1016/S0140-6736(08)60884-3

Abstract

Abstract

The HIV/AIDS pandemic has become part of the contemporary global landscape. Few predicted its effect on mortality and morbidity or its devastating social and economic consequences, particularly in sub-Saharan Africa. Successful responses have addressed sensitive social factors surrounding HIV prevention, such as sexual behaviour, drug use, and gender equalities, countered stigma and discrimination, and mobilised affected communities; but such responses have been few and far between. Only in recent years has the international response to HIV prevention gathered momentum, mainly due to the availability of treatment with antiretroviral drugs, the recognition that the pandemic has both development and security implications, and a substantial increase in financial resources brought about by new funders and funding mechanisms. We now require an urgent and revitalised global movement for HIV prevention that supports a combination of behavioural, structural, and biomedical approaches and is based on scientifically derived evidence and the wisdom and ownership of communities.

A social cognitive model of health for HIV-positive adults receiving care in India

Tarakeshwar, N., Srikrishnan, A. K., Johnson, S., Vasu, C., Solomon, S., Merson, M., & Sikkema, K. (n.d.).

Publication year

2007

Journal title

AIDS and Behavior

Volume

11

Issue

3

Page(s)

491-504

10.1007/s10461-006-9161-z

Abstract

Abstract

In-depth interviews were conducted with 50 HIV-positive adults (23 women, 27 men) with access to care at a non-governmental organization in Chennai, India to gain a broad understanding of how they managed their HIV infection. Using a Social Cognitive Model of Health, we identified factors within the model's three domains-Personal, Environmental, and Behavioral-that are applicable to this socio-cultural context. The Personal domain's factors were a positive self-concept, family-focused goals, and treatment optimism; the Environmental domain comprised family-based support, treatment availability, access and quality, and HIV stigma and discrimination; and the Behavior domain's factors were medication adherence and health habits, sexual behavior, and social relationships and emotional well-being. Significant differences for many of the factors within the three domains were observed across married men and women, widowed women, unmarried men, and female sex workers. Implications for an enhanced intervention for HIV-infected individuals in similar treatment settings are discussed.

HIV and drug use in Eurasia

Heimer, R., Booth, R. E., Irwin, K., & Merson, M. (n.d.). In HIV/AIDS in Russia and Eurasia (1–).

Publication year

2007

Page(s)

141-163

10.1057/9780230603394_8

Abstract

Abstract

The twin epidemics of drug addiction and HIV simultaneously emerged in the Eurasia region in the late 1990s. Both were unanticipated by health establishments. Failure to act slowed the collection of detailed data and effective responses. In this chapter, we report on our observations and on those of our colleagues. To provide a proper sense of the problem created by the slow response of most of the governments in the region, this chapter combines a description of our experiences with the limited data available from scholarly sources.

Living with HIV infection: Perceptions of patients with access to care at a non-governmental organization in Chennai, India

Tarakeshwar, N., Krishnan, A. K., Johnson, S., Solomon, S., Sikkema, K., & Merson, M. (n.d.).

Publication year

2006

Journal title

Culture, Health and Sexuality

Volume

8

Issue

5

Page(s)

407-421

10.1080/13691050600859609

Abstract

Abstract

Through interviews, we examined explanatory frameworks of living with HIV infection among 50 HIV-positive individuals (23 women, 27 men) receiving care at a non-governmental organization in Chennai, India. Results were analysed according to three sets of issues, all of which were found to differ by gender: causal beliefs about HIV, impact of HIV, and care/treatment of HIV. HIV-positive participants attributed their infection to biological, moral and social causes, and the physical, financial and relationship dimensions of their lives were impacted upon by the infection. Furthermore, HIV-related stigma evoked fears about isolation and discrimination. Regarding care/treatment, men were most usually first initiated into the healthcare system while women often entered as a consequence of their partner's condition. Non-adherence to medication was reported by 32% of the participants due to financial constraints or side-effects. Although all participants were hopeful about a cure for HIV, women were less positive than men about treatment. Results highlight the importance of a gender-sensitive approach to HIV care, nuanced to accommodate an individual's gender, marital status and social background.

The HIV-AIDS pandemic at 25 - The global response

Merson, M. H. (n.d.).

Publication year

2006

Journal title

New England Journal of Medicine

Volume

354

Issue

23

Page(s)

2414-2417

10.1056/NEJMp068074

Uganda's HIV/AIDS epidemic: Guest editorial

Merson, M. (n.d.).

Publication year

2006

Journal title

AIDS and Behavior

Volume

10

Issue

4

Page(s)

333-334

10.1007/s10461-006-9120-8

Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo

Ntumbanzondo, M., Dubrow, R., Niccolai, L. M., Mwandagalirwa, K., & Merson, M. H. (n.d.).

Publication year

2006

Journal title

AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV

Volume

18

Issue

7

Page(s)

777-785

10.1080/09540120500412824

Abstract

Abstract

This study assessed the extent and correlates of the practice of engaging in unprotected intercourse for extra money among commercial sex workers (CSWs) in Kinshasa, Democratic Republic of the Congo. We conducted a cross-sectional survey using a structured, interviewer-administered questionnaire among a convenience sample of 136 CSWs. More than one-quarter of CSWs (26.5%) engaged in unprotected intercourse for extra money. These CSWs charged about 3.5 times more for unprotected intercourse than for protected intercourse. Multivariate logistic regression showed that CSWs who engaged in unprotected intercourse for extra money were significantly more likely to live or work in non-downtown (lower socioeconomic) areas of Kinshasa (odds ratio [OR]=3.07), to have at least one child less than six years of age (OR=2.95), and to know other CSWs who engaged in the same practice (OR=9.38). We hypothesize that desperate socioeconomic conditions combined with peer/social norms drive the practice of engaging in unprotected intercourse for extra money. Additional circumstances under which Kinshasa CSWs engaged in unprotected intercourse included intercourse with clients who tore their condoms to increase sexual pleasure (58.8% of CSWs), episodes of condom failure (56.8% of CSWs), and unprotected intercourse with regular noncommercial partners (only 5.3% of CSWs with noncommercial partners always used condoms with these partners).

Improving home-based care in Southern Africa: An analysis of project evaluations

Rosenberg, A., Mabude, Z., Hartwig, K., Rooholamini, S., Oracca-Tetteh, D., & Merson, M. (n.d.).

Publication year

2005

Journal title

Southern African Journal of HIV Medicine

Issue

19

Page(s)

30-36

10.4102/sajhivmed.v6i2.585

Abstract

Abstract

We describe lessons learned from independent evaluations of nine home-based care (HBC) projects in Lesotho, South Africa and Swaziland. Projects were funded through Bristol-Myers Squibb's Secure the Future (STF) initiative and evaluated through the STF Monitoring and Evaluation Unit (MEU) at Yale University. The objectives of this study were to: ■ Assess the management capacity of the HBC organisations reviewed, concentrating on monitoring and supervision mechanisms. ■ identify innovations in responding to the challenges of delivering care in resource-poor settings, and ■ explore the nature of linkages between HBC projects and governments. Specific strategies to assure quality are discussed, as are policy changes necessary to provide system-wide improvements in quality and the integration of HBC. These are particularly important as governments seek ways to use existing resources to make antiretroviral (ARV) roll-outs successful.

Global health and university patents

Kapczynski, A., Crone, E. T., & Merson, M. (n.d.).

Publication year

2003

Journal title

Science

Volume

301

Issue

5640

Page(s)

1629

10.1126/science.301.5640.1629

Estimating the cost of unmet HIV-prevention needs in the United States

Holtgrave, D. R., Pinkerton, S. D., & Merson, M. (n.d.).

Publication year

2002

Journal title

American journal of preventive medicine

Volume

23

Issue

1

Page(s)

7-12

10.1016/S0749-3797(02)00447-6

Abstract

Abstract

Background: Although new HIV infection cases have dropped from over 160,000 per year in the mid-1980s to 40,000 per year in the 1990s, HIV incidence has been relatively unchanged for a decade. This number of annual incident infections suggests that substantial, unmet HIV-prevention needs continue to fuel the HIV epidemic in the United States. Objectives: This study estimates the cost of addressing the unmet HIV-prevention needs in the United States and establishes a performance standard by estimating the number of HIV infections that would have to be prevented in order for these programs to be considered cost saving to society. Methods: Standard methods of cost and threshold analysis were employed in this study. Interventions needed to address unmet behavioral risks include services to reduce sexual risk of HIV infection, services to provide access to sterile syringes for people who cannot stop injecting drugs, HIV counseling and testing, and intensive preventive services to help HIV-seropositive people avoid transmitting the virus to others. Results: If brief interventions are utilized to address sexual behavior risk, the total program cost (over and above current resource levels) is just over $817 million; and if more expensive multisession, small-group interventions are used, the costs increase to over $1.85 billion. However, even the higher-cost program has a threshold of only 12,000 infections that must be prevented in order for the program to be considered a cost saving to society. Conclusions: Addressing the remaining unmet HIV-preventive needs in the United States will require a substantial commitment of resources. However, even a greatly expanded HIV-preventive program in the United States could pay for itself through savings in averted medical care costs.

Overcoming barriers to collaboration between basic behavioral scientists and public health scientists in research on mental disorders

Muehrer, P. R., Salovey, P., Afifi, A. A., Coyne, J. C., Kring, A. M., Merson, M. H., Prohaska, T. R., & Rozensky, R. H. (n.d.).

Publication year

2002

Journal title

Journal of Clinical Psychology in Medical Settings

Volume

9

Issue

4

Page(s)

253-265

10.1023/A:1020758416171

Abstract

Abstract

The behavioral and public health sciences both have a long and rich history supporting basic, translational, and applied research aimed at improving human lives and reducing human suffering. Through the complementary expertise of these disciplines, investigators have contributed to significant, worldwide improvements in mental and physical health. Further gains can be achieved through collaborative research among scientists in these 2 fields. Unfortunately, there are a number of barriers to such collaboration originating in different intellectual traditions, research methods, and the structure and values of academia. We identify these barriers and potential strategies for overcoming them. Several areas for future collaborative research appear promising, especially comorbid mental and physical disorders, adherence to interventions, stigma, and emotional processes. Theory-guided preventive interventions may represent especially fertile areas of collaborative effort.

Early detection: The next steps

Merson, M. H. (n.d.).

Publication year

2000

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

25

Page(s)

S157-S159

10.1097/00126334-200012152-00011

Effectiveness of HIV prevention interventions in developing countries

Merson, M. H., Dayton, J. M., & O’Reilly, K. (n.d.).

Publication year

2000

Journal title

AIDS, Supplement

Volume

14

Issue

2

Page(s)

S68-S84

Abstract

Abstract

Objective: To review the effectiveness of projects and programs in developing countries that aim to reduce sexual transmission of HIV infection or transmission related to injection drug use. Design: We identified 34 published studies undertaken in 18 developing countries that met rigorous inclusion criteria. These criteria included the length of follow-up, use of statistical analysis, the inclusion of a comparison group, and type of outcomes measured. Results: We found that behavioral change interventions are effective when targeted to populations at high risk, particularly female sex workers and their clients. Few studies have evaluated harm reduction interventions in injecting drug users (IDUs). Evidence on the effectiveness of voluntary counseling and testing programs was promising, and VCT was most effective when directed at discordant couples. Treatment of sexually transmitted diseases (STD) appears highly effective in reducing HIV/STD transmission, particularly in the earlier stages of the epidemic. Conclusions: This review demonstrates that HIV prevention interventions can be effective in changing risk behaviors and preventing transmission in low and middle-income countries. When the appropriate mix of interventions is applied, they can lead to significant reductions in the prevalence of HIV at the national level. Additional research is needed to identify effective interventions, particularly in men who have sex with men, youth, IDUs and HIV-infected persons. Structural and environmental interventions show great promise, although more evaluation is needed. (C) 2000 Lippincott Williams and Wilkins.

Enriching the mix: Incorporating structural factors into HIV prevention

Sumartojo, E., Doll, L., Holtgrave, D., Gayle, H., & Merson, M. (n.d.).

Publication year

2000

Journal title

AIDS

Volume

14

Issue

11

Page(s)

S1-S2

10.1097/00002030-200006001-00001

Global dimensions of the AIDS epidemic: Implications for prevention and care

Dayton, J. M., & Merson, M. H. (n.d.).

Publication year

2000

Journal title

Infectious Disease Clinics of North America

Volume

14

Issue

4

Page(s)

791-808

10.1016/S0891-5520(05)70134-3

Structural interventions in public health

Blankenship, K. M., Bray, S. J., & Merson, M. H. (n.d.).

Publication year

2000

Journal title

AIDS

Volume

14

Issue

11

Page(s)

S11-S21

10.1097/00002030-200006001-00003

Abstract

Abstract

Objective: To review structural interventions in public health, identify distinct approaches to structural interventions, and assess their implications for HIV-prevention interventions. Method: The MEDLINE, HealthStar, PsychInfo and Sociofile databases were searched on specific health issues, types of public health interventions, and conceptual topics (e.g. empowerment, social structure, and inequality) to compile a list of public health interventions in the United States. We excluded interventions focused on testing and surveillance unless they specifically facilitated prevention, and educational or media campaigns focused on increasing individuals' level of knowledge about a particular health problem. Results: The term 'structural' is used to refer to interventions that work by altering the context within which health is produced or reproduced. Structural interventions locate the source of public-health problems in factors in the social, economic and political environments that shape and constrain individual, community, and societal health outcomes. We identified two dimensions along which structural interventions can vary. They may locate the source of health problems in factors relating to availability, acceptability, or accessibility; and they may be targeted at the individual, organizational, or environmental levels. All together, this framework suggests nine kinds of structural interventions, and it is possible to identify examples of each kind of intervention across a range of public health issues. Conclusions: The relevance of this framework for developing HIV prevention interventions is considered. (C) 2000 Lippincott Williams and Wilkins.

Ethics of placebo-controlled trials of zidovudine to prevent the perinatal transmission of HIV in the Third World [1]

Merson, M. H., Simmons, R. J., Rogers, M. F., Dondero, T. J., Francis, D. P., Meidde, E. K., Blanche, S., Kim, R. J., Sharif, S. K., Tafesse, E., Murphy, T. F., Ijsselmuiden, C. B., Herrington, D., Piott, P., Glantz, L. H., Grodin, M. A., Lallemant, M., McIntosh, K., Jourdain, G., … Lurie, P. (n.d.). In New England Journal of Medicine (1–).

Publication year

1998

Volume

338

Issue

12

Page(s)

836-841

10.1056/NEJM199803193381213

Enhancing Awareness of Hospice Through Physician Assisted Living: Public Health Perspectives

Merson, M., & Bradley, E. H. (n.d.).

Publication year

1997

Journal title

Connecticut medicine

Volume

61

Issue

12

Page(s)

789-791

Abstract

Abstract

The provision, management, and financing of care for patients with irreversible diseases has become increasingly complex in this era of advanced medical technology. With enhanced capabilities of medicine to prolong life, clinical practice has taken on legal and ethical dimensions that reach beyond the traditional scope of medicine. This paper demonstrates that hospice represents a major area of public health practice and research. It argues for enhanced involvement of public health practitioners and academics in the design and evaluation of efforts to encourage appropriate use of hospice for patients with irreversible diseases. The physician assisted living intervention in Connecticut represents one such effort. However, ongoing educational efforts targeted at both the public and health care providers are needed to ensure that all those with irreversible diseases fully understand and have access to hospice care at the end of life.

Returning home: Reflections on the USA's response to the HIV/AIDS epidemic

Merson, M. H. (n.d.).

Publication year

1996

Journal title

Lancet

Volume

347

Issue

9016

Page(s)

1673-1676

10.1016/S0140-6736(96)91494-4

Global estimates and epidemiology of HIV-1 infections and AIDS: further heterogeneity in spread and impact.

Mertens, T. E., Belsey, E., Stoneburner, R. L., Beer, D. L., Sato, P., Burton, A., & Merson, M. H. (n.d.).

Publication year

1995

Journal title

AIDS (London, England)

Volume

9

Page(s)

S259-272