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Decades of research groundwork fuels COVID treatments

Ralph Baric, PhD, was one of the 30,000 participants in last year’s Phase III clinical trials for Moderna’s coronavirus vaccine. Besides being one of the studied, he’s a world-leading expert on coronaviruses.

For the past 35 years, Baric, the William R. Kenan Jr. Distinguished Professor of epidemiology, has been developing and using unique methods to study coronavirus genetics, to investigate how they replicate and spread, and to test drugs that could help fight multiple coronavirus strains in the event of a future outbreak.

Baric and his team first conducted experiments in the mid-1990s suggesting that animal coronaviruses could jump to other animals fairly quickly. They later found that the viruses also had the potential to easily enter human cells. “We proposed that this family of emerging viruses are on the move and that we needed to be alert to their potential to cause human disease outbreaks,” he says. After the 2003 SARS-CoV outbreak in Southeast Asia, his group identified a number of zoonotic SARS-like coronaviruses that were poised for cross-species transmission, alerting the world of potential future outbreaks of this highly pathogenic respiratory virus.

Decades of fundamental groundwork meant that when the COVID-19 pandemic hit, Baric’s lab – one of the first places in the country to receive a sample of the virus to study – already had two potential treatments ready for clinical trials.

Remdesivir, the first experimental treatment shown in clinical trials to speed recovery time for COVID-19 patients, was developed in Baric’s lab as part of a years-long collaboration with Gilead Sciences and is being used in hospitals around the world. The lab has played a key role in the development and testing of Molnupiravir (EIDD-0128), which can be administered orally, and participated in the development of several human monoclonal antibody therapies.

Baric and his team – which includes expert virologists and assistant epidemiology professors Lisa Gralinski, PhD, and Timothy Sheahan, PhD, along with nearly 40 other faculty, postdocs, staff and students – have done pivotal research on antibody treatments, the Moderna and Johnson & Johnson vaccines, and other potential therapies. They developed and tested a new design approach for a universal vaccine that works against many different “high risk” SARS-related coronavirus strains and already have a paper under review describing this work.

“I can’t say enough about the extraordinary people in the lab. We were all working 16 to 18 hours a day and on weekends doing research, writing papers and engaging with a dozen federal task forces that were trying to get vaccines and drugs out to people and make policy,” Baric says. “It has been nonstop efforts by a community of dedicated researchers. So far, there are nine products we’ve been associated with that are in Phase II trials or being used in humans to prevent or treat COVID-19 infection, and some other drugs are also moving forward. That feels pretty good.”

Wastewater tests may show COVID hotspots

Scientists believe the number of asymptomatic people who are not tested for the coronavirus is significant. To account for asymptomatic carriers and to provide a more complete view of community health, Gillings researchers are quantifying SARS-CoV-2 concentrations in North Carolina wastewater samples.

Leading the study are Rachel Noble, PhD, the Mary and Watts Hill Jr. Distinguished Faculty member at the Institute of Marine Sciences and joint professor of environmental sciences and engineering at Gillings, and Jill Stewart, PhD, the Philip C. Singer Distinguished Professor of environmental sciences and engineering.

Studying concentrations of SARS-CoV-2 in wastewater is a way to better understand the prevalence of COVID-19 infections in a community, because not all who carry the virus have symptoms, and not all people seek clinical testing. Preliminary data showed an increase of SARS-CoV-2 in wastewater five to seven days before spikes in clinical cases, suggesting that viral concentrations in wastewater could be a key indicator for community spread.

“I am excited about the possibilities for wastewater surveillance for COVID-19 and other pathogens,” Stewart says. “Wastewater provides a composite sample for pathogens circulating in a community and includes symptomatic and asymptomatic cases. This type of information is useful for monitoring disease trends at the population level and is more cost effective than traditional epidemiological methods.”

Noble and Stewart collaborate with state agencies and universities across North Carolina to test wastewater systems in about a dozen large cities and smaller municipalities. Originally funded by the NC Policy Collaboratory, the study recently received additional support from the CDC to include more municipalities.

“Our original intent was to build capacity for wastewater surveillance, but we’ve realized that we have fantastic and diverse expertise across the state that can really lead progress in this area,” Noble says. “Not only are we building the pieces of a surveillance system, but we are thinking about the best ways to build surveillance systems for future pandemics. That’s really exciting.”

Vaccination study focuses on college students

Audrey Pettifor, PhD, professor of epidemiology, is co-leading a nationwide study to test how well COVID-19 vaccines prevent people from spreading the coronavirus to others.

As part of the national Prevent COVID U study conducted by the COVID-19 Prevention Network, UNC is recruiting students who have not yet been vaccinated or had COVID-19 to participate in the four-month trial, where they will be randomized to get the Moderna COVID-19 vaccine immediately or in four months. All participants will be asked to swab their nose daily to test for infection. They also will be asked to enroll their close contacts in the study to examine transmission if the main participant or their contact tests positive.

The study, sponsored by the National Institute of Allergy and Infectious Diseases, includes about 30 universities across the United States. Any university or community college student taking classes is eligible, whether they are studying on campus or online. Results are expected in the fall.

Early in the pandemic, Pettifor, an HIV/AIDS researcher with expertise in risk behaviors among adolescents, began applying her experience in HIV prevention to identify ways to control the spread of the coronavirus.

“There are not a lot of studies looking at the question of transmission – they infer transmission based on infection because if people don’t get the virus, they can’t transmit it,” Pettifor says. “This study is more rigorous and systematic, as the daily nasal swabs will allow us to examine viral dynamics among vaccinated individuals in great detail. Importantly, we will look at how well the vaccine works in the face of new variants that are circulating. We hope the study will answer the question of what you can do when you are vaccinated with a lot more certainty.”

Antibodies paint clearer picture of COVID-19 prevalence

The actual prevalence of COVID-19 is likely higher than estimates suggest due to asymptomatic infection, limited access to testing, and other factors. Ross Boyce, MD, MSc, assistant professor in the School of Medicine, and Allison Aiello, PhD, professor of epidemiology at Gillings, are co-leading antibody research to provide a clearer picture of the virus’s presence.

Aiello and Boyce launched a community-based study of nearly 200 residents in Chatham County, a central N.C. county whose demographics broadly reflect the state’s, to determine more accurate estimates of and risk factors for SARS-CoV-2 infection. Researchers collect nasal swabs every two weeks to test for asymptomatic infection and a blood sample monthly to test for antibodies indicating a prior or recent infection. They collaborate with other universities using similar protocols and surveys, so their data can be aggregated to identify trends in the prevalence of COVID-19 across North Carolina.

Boyce hopes the work in Chatham County will continue even as the pandemic recedes. “A lot of hard work goes into building a population-based cohort. Leveraging that work could advance our understanding of other public health problems,” he says. “If it’s sustained, the Chatham cohort could be a valuable and unique platform for researchers across the UNC community.”

Aiello also co-leads a longitudinal study of front-line health care professionals (HCPs) with Emily Ciccone, MD, MHS, clinical instructor at the UNC School of Medicine, following a group of UNC Health employees to examine risk factors for infection and change in antibody levels over time.

“As we were reviewing the antibody testing results over time for the HCPs and throughout the period when they received their vaccinations, it was evident that those who had prior SARS-CoV-2 infection were experiencing a higher antibody response to the first vaccination,” Aiello says. “When our team analyzed the data, we identified a statistically significant higher antibody response after vaccination among those with prior infection versus those without.”

Their findings offer hope that some who were infected with SARS-CoV-2 might be able to forgo a second vaccination – which could potentially change vaccine distribution strategies – but more research is needed to assess the durability of these responses.

Coordinating an international research response to coronavirus

Biostatistics Chair and Professor Lisa LaVange, PhD, is helping lead U.S. efforts to speed development of effective treatments for COVID-19 as part of Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV), a public-private partnership bringing together more than a dozen leading biopharmaceutical companies and government agencies to collaborate internationally on coronavirus research.

LaVange is a member of the Therapeutics Clinical Committee, co-chairs the ACTIV Master Protocol Subcommittee and is lead statistician on the ACTIV-1 clinical trial of immune modulators. The Therapeutics Clinical Committee focuses on testing potential therapeutic agents through a series of master protocols around the world, following the study design principles and framework developed by the Master Protocol Subcommittee early in the pandemic.

Master protocols allow scientists to evaluate multiple experimental drugs within a common clinical trial protocol using a shared infrastructure. Since the National Institutes of Health (NIH) convened ACTIV in March 2020, it has evaluated hundreds of potential therapeutic agents to prioritize for testing, designed and developed five master protocols for COVID-19 treatment trials, and leveraged existing NIH-supported networks to launch master protocols of prioritized therapeutic candidates.

“The ACTIV collaboration is like nothing I’ve ever seen – we’ve learned so much just in this one year about how to structure the trials, form partnerships, launch studies, and ensure results will be timely, interpretable and robust,” LaVange says. “We have a road map for how to get a public-private partnership together to solve the next public health problem of pandemic proportions.”

One of the few academics in the partnership, LaVange was invited to join ACTIV by NIH Director Francis Collins because of her expertise developing master protocols during her tenure as Director of the Office of Biostatistics in the U.S. Food and Drug Administration’s Center for Drug Evaluation and Research.

“Being part of ACTIV has been a satisfying experience professionally as a member of the public health community, and it’s been a great opportunity for the School,” she says. “I have been able to bring back trial design challenges in a rapidly evolving pandemic for use in classroom instruction as well as ideas about how to get students excited about public health research and the impact you can have.”

Helping healthcare workers balance family, work during pandemic

The closure of schools and daycare centers last year after the pandemic’s onset left parents who are health care professionals wondering how to care for both their children and their patients.

The UNC Task Force for Childcare for Healthcare Workers – led by Assistant Professor of Health Behavior Liz Chen, PhD, MPH, and alumna Hannah Prentice-Dunn, MPH, project manager at the UNC Lineberger Comprehensive Cancer Center – was created to help generate solutions for health care workers affected by school and daycare closings.

The task force quickly launched childcarenc.org, a website for health care workers in the Triangle that provides a needs-assessment survey, in-home COVID-19 safety suggestions, family guidelines, emergency services and resources offered by organizations across the state.

Chen also is helping people cope with COVID-19 through the mobile app Real Talk. Founded in 2017 by Chen and health behavior alumna Cristina Leos (MSPH, PhD ‘19), Real Talk crowdsources teen stories about mental health and other topics and pairs each story with helpful resources. As COVID-19 spread, app users described feeling worried about health concerns, having trouble coping with school closures, struggling with strained relationships and not having any sources of support. Real Talk created the first mental health resource guide available specifically for teens to help them deal with COVID-19 concerns.

Assessing risk across the Americas

Benjamin Puertas, DrPH, is helping to protect front-line workers and patients by working with the Pan American Health Organization (PAHO) to train health care workers and ensure the use of best practices in fighting COVID-19.

As PAHO’s adviser in human resources for 26 Caribbean countries, Puertas was deployed to Grenada when the pandemic first hit. By conducting risk assessments and trainings and analyzing capacity, he and the PAHO team increased the safety and efficiency of the response in Grenada’s hospitals.

Puertas monitors shortages of health care professionals across the Caribbean to ensure that reinforcements go where they’re needed most and advocates for measures that have proven effective in other countries. For example, instead of hiring doctors, Jamaica, with PAHO support, trained community health workers to do the contact tracing, triage and referral of COVID-19 patients.

“Many countries must put more effort into strengthening their health systems based on primary health care,” he says.

Expanding philanthropy by expanding equity

After receiving both bachelor’s and master’s degrees from the Gillings School, Edgar Villanueva, MHA, turned toward bringing more equity into philanthropy. Now, he’s been helping Native American communities, which are disproportionately affected by COVID-19, recover from the pandemic.

Based on the success of his first book, Decolonizing Wealth, Villanueva launched the Decolonizing Wealth Project (DWP) to help philanthropic organizations give more equitably by bringing more diverse voices to funding conversations. Through its Native American Community Response Fund, the DWP directed $2 million in pandemic aid through Native American-led nonprofits that work to alleviate food insecurity and inadequate access to housing and care, especially among elderly Native Americans.

“It’s not about charity; it’s about solidarity,” he says. “Native communities offer solutions to society’s most pressing problems. We must practice radical solidarity and understand that all of our suffering and thriving are mutual.”

Advancing equity through pandemic response

As emergency response director for the CDC Foundation, Gillings alumna Turquoise Sidibe, MPH, leads the Foundation’s 200-plus active COVID-19 projects.

The CDC Foundation is an independent nonprofit that channels philanthropic and private-sector resources to support the health-protection work of the U.S. Centers for Disease Control and Prevention (CDC). The Foundation supports CDC projects and manages its own international and domestic projects that advance the CDC’s work and mission.

While health equity has always been a focus for Sidibe, the COVID-19 pandemic brought them to the forefront. For example, she’s studying COVID-related resilience among Asian American, Black, Latinx, LGBTQIA and immigrant communities to learn what kind of social stigma comes with testing positive or having a family member test positive for COVID-19. Her goal is to create a model for collecting information on groups that are often underrepresented in existing data.

“My unit has a strong history of bringing a health equity lens into emergency response,” said Sidibe, a health behavior alumna. “The pandemic has increased awareness of this need, and there is a specific emphasis from CDC on making sure projects are equity focused. It’s important to be sure we’re making an impact in the communities with the most need.”

Sharing frontline workers’ COVID stories

As a summer intern for the North Carolina Institute for Public Health (NCIPH), Brandon Adams, a Master of Public Health (MPH) student in global health, helped develop NCIPH’s curation project called Behind the Numbers, which focuses on the experiences of COVID-19 frontline health care workers. The project relies on qualitative techniques to effectively collect the stories and feelings from those affected by this unprecedented time.

“What I love about this project is its emphasis on the mental health and support of our frontline workers,” said Brandon, who was recognized for his work in “Students Who Rocked Public Health 2020” by JPHMP Direct, the companion website of the Journal of Public Health Management and Practice.

Outreach efforts protect, support farmworkers

Graduate student Courtney Peragallo began her pursuit of a Master of Public Health degree in January 2020, but her work in global health started as an undergraduate when she took an internship related to her double-major of Spanish and public health.

In that internship, she worked with Spanish-speaking farmworkers at a nonprofit organization in the NC Farmworker Health Program (NCFHP), which serves migrant and seasonal farmworkers and their families. She then became a project coordinator with the NC Office of Rural Health as part of a disaster preparedness initiative for the farmworker community.

During the pandemic, Peragallo has been securing grants for projects to protect and support farmworkers and to provide rural outreach staff with personal protective equipment so they can keep themselves and their communities safe at mobile clinics in farmworker campsites.

“Outreach staff members are vital for farmworker populations, since they are most likely the first point of contact in a crisis, whether it be the COVID-19 pandemic or natural disasters,” she says.

Educating families, patients through volunteer work

An active volunteer, Vennela Avula, a student in environmental sciences and engineering, has helped three different organizations with COVID-19 outreach.

Working with Carolina Conexiones, a volunteer group within UNC Hospitals, Avula created easy-to-understand visuals on COVID-19 and other health issues that are targeted toward local Spanish-speaking populations. She also worked with Durham-area grocery stores serving Spanish-speaking customers to help implement social distancing protocols, hand out masks and provide shoppers with public health information.

As a volunteer at the Women’s Health Information Center at UNC Medical Center, during the pandemic Avula has given virtual maternity tours of UNC Hospitals to expecting women to update them on COVID-19 policies and prepare them for their labor and delivery.

Avula is also co-president of UNC’s chapter of GlobeMed, a national non-profit organization that fosters partnerships between university chapters and grassroots organizations around the world that is partnered with the Association for Health and Development Guatemala (ASSADE), a non-profit that provides primary health services and health education to rural and indigenous communities in Guatemala. GlobeMed members created infographic manuals on preventive education and mental health that ASSADE has used in Guatemalan communities to reduce the spread of COVID and give local residents tools to deal with pandemic-related stress.

Raising awareness of virus’ disparate impacts

Since the pandemic began, pediatrician and MPH student Khadijia Tribie Reid, MD, FAAP, has been increasing awareness about COVID-19’s disparate impact on communities of color, often due to higher rates of pre-existing conditions like cardiovascular disease and diabetes that make people more susceptible to the worst effects of the virus.

“Unfortunately, just in North Carolina, we’ve dealt with infant mortality rates twice as high for African American babies,” says Tribie Reid, who is enrolled in MPH@UNC’s Leadership in Practice concentration. “Babies less than one year old are more than twice as likely to die before the age of one than white babies.”

Tribie Reid, a pediatrician at MedNorth Health Center in Wilmington, studies increased risks of child maltreatment and childhood adversity during times of social isolation and during natural disasters. Her practicum will include a webinar presentation for regional child welfare stakeholders.

Clean air and water

The late Philip Singer, PhD, professor emeritus of environmental sciences and engineering, spent his career working to improve drinking water quality. As director of UNC’s Drinking Water Research Center, his research focused on minimizing human exposure to disinfection by-products (DBPs), substances that are created when the chemicals used to disinfect water react with organic material. DBPs can cause cancer, and Singer was devoted to lowering DBP concentrations to keep communities safe. In recent years, he served on the Flint Water Interagency Coordinating Committee, which provided guidance on long-term solutions to the lead problem in Flint, Michigan.

Construction began on a reservoir to triple the University’s water supply after severe droughts in the late 1960s, which led Daniel Okun, PhD, and his students to study Chapel Hill’s water supply. Finding that Cane Creek was a better source of high-quality water than the polluted Jordan Lake, they persuaded UNC trustees to drop a plan to integrate Jordan Lake waters into University Lake and instead build the Cane Creek Reservoir. The reservoir was built in 1989.

Research by Will Vizuete, PhD, associate professor of environmental sciences and engineering, on the geographic and chemical origins of large ozone concentration helped to inform the Texas Commission on Environmental Quality’s issuance of new air quality controls for Houston, where ozone pollution has been a public health concern for decades.

Improving care access and quality

Jo Anne Earp, ScD, professor emeritus of health behavior, has reduced the racial gap in breast cancer screening, diagnosis and treatment in eastern North Carolina. She founded the NC Breast Cancer Screening Program (NC-BCSP) to train lay health advisors as advocates for mammography screening for older Black women in five rural eastern N.C. counties.

After his research revealed that the way hospitals provide care to stroke patients has a significant effect on patient outcomes, epidemiology professor Wayne Rosamond, PhD, created the Stroke Care Collaborative registry, a network of hospitals across the state involved in quality improvement efforts in acute care of stroke patients and getting best practices for stroke care in place to improve stroke response time. He’s also researching how to improve heart attack survival rates by using drones to deliver automatic external defibrillators (AEDs). Rapid defibrillation increases chances of surviving a heart attack, but bystander use of AEDs remains low in part due to low AED placement and accessibility.

Children’s health

Jonathan Kotch, MD, former Carol Remmer Angle Distinguished Professor of Children’s Environmental Health in maternal and child health, has vastly improved child care workers’ awareness of ways to make children safer and healthier. He created the National Training Institute (NTI) to ensure that health and childcare professionals from every U.S. state and territory are available to train child care health consultants, who in turn provide assessments and guidance to out-of-home child care centers and family child care homes. The Institute has trained more than 4,000 child health care consultants and more than 300 trainers from all over the U.S., Europe and the U.S. Army.

In 2000, the U.S. Congress passed the Physical Education for Progress Act to expand physical education programs for K-12 students, based in part on results of a study by Gillings nutrition professors Penny Gordon-Larsen, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition; Barry Popkin, PhD, W. R. Kenan Jr. Distinguished Professor of nutrition; and Robert G. McMurray, PhD, that recommended increasing the frequency of physical education classes to boost the physical activity of schoolchildren, particularly those who are unfit or inactive. Additionally, Popkin’s research on soda and other sugary drinks, a common source of added sugar products that can contribute to obesity, has found that placing higher taxes on those beverages can effectively reduce consumer consumption.

In 2004, based on early research by Michael Kosorok, PhD, W.R. Kenan Distinguished Professor of biostatistics, the Centers for Disease Control and Prevention recommended that states institute newborn screening for cystic fibrosis (CF). CF is a progressive genetic disease that is the second most common life-shortening, childhood-onset, inherited disorder in the U.S. Kosorok and his colleagues used a controlled randomized trial to demonstrate that newborn screening for CF led to long-term benefits – such as improved growth and, in one study, cognitive development – due to early nutritional treatment. Since its implementation, N.C.’s screening test has identified between 30 and 34 newborns with CF each year.

Teen health & safety

In the 1990s, N.C. became one of the first states to adopt a graduated driver’s license model, where young drivers could gain more experience behind the wheel before receiving full driving privileges. Lew Margolis, MD, MPH, now professor emeritus in maternal and child health, and colleagues studied the effects of the new approach, and their findings – that teen motor vehicle deaths and hospitalizations dropped by 25 percent – led to the adoption of graduated licensing in every other state.

Studies by Steve Marshall, PhD, professor of epidemiology, in collaboration with researchers in the UNC College of Arts and Sciences’ Department of Exercise and Sports Science, have helped inform laws that were passed in 11 states to require special protocols for managing high school athletes who suffer concussions. In 2005, Marshall and colleagues’ study of retired professional athletes found that prior concussions are linked with an increased risk of mild cognitive impairment and with earlier onset of Alzheimer’s disease. The issue has gained more scientific and media attention since then, with further links suggested between concussion and depression.

Noel Brewer, PhD, professor of health behavior and health education, is a global expert in health communication, especially when it comes to the importance of human papillomavirus (HPV) vaccinations. He developed a training program that has helped thousands of health care providers in more than 15 states effectively communicate the importance of HPV vaccines and other adolescent vaccinations. He chairs the National HPV Vaccination Roundtable and has advised on vaccination for the World Health Organization, the Centers for Disease Control and Prevention, the President’s Cancer Panel under two presidents, and the National Vaccine Advisory Committee.

Kurt Ribisl, PhD, Jo Anne Earp Distinguished Professor and chair of the Department of Health Behavior, and Shelly Golden, PhD, associate professor and vice chair of health behavior, have investigated how pricing policies affect tobacco use, as well as how tobacco companies and retailers use marketing and product availability to promote smoking among youth. In 2016, New York City raised cigarette prices to $13 per pack based in large part on their pricing study.

Health care workforce and facilities

The work of George Pink, PhD, Humana Distinguished Professor of health policy and management, and Mark Holmes, PhD, health policy and management professor and director of the Cecil G. Sheps Center for Health Services Research, has helped small, rural hospitals across the country measure their financial strengths and weaknesses and improve quality. Critical-access hospitals (CAHs) are small, rural hospitals that are more vulnerable to financial distress because they serve small, isolated and in relatively low-income communities. Holmes and Pink created the CAH Financial Indicator system to help hospitals be more accountable for the money they spend while also improving quality. With hospitals often being one of the larger employers in a community, their financial stability is critical not only to the community’s health, but also to its economy.

Sandra Greene, DrPH, professor of the practice in health policy and management, is an expert on using data to analyze and improve health care in N.C. For years, she served on the North Carolina Health Coordinating Council, which steers the placement and construction of hospitals and related medical facilities. She also was instrumental in building the Carolina Cost and Quality Initiative, a massive data resource on the health care services that N.C. patients receive, to promote population-based research with the goal of improving the delivery and quality of care across the state.

Tom Ricketts, PhD, professor of health policy and management, has shared his expertise on the healthcare workforce with policymakers in N.C. and at the federal level. As director of the North Carolina Rural Health Research Program in the UNC Cecil G. Sheps Center for Health Services Research, he studied how the distribution of the state’s health care workforce affected access to care and the health status of North Carolinians, often calling lawmakers’ attention to looming shortages of doctors, allied health workers and other health care professionals. He also advised the U.S. Secretary of Health and Human Services on health policy issues.

A health services research expert, Becky Slifkin, PhD, is regularly consulted by federal and state staff and elected officials regarding the potential impacts of health care legislation, in particular rural health, Medicare, Medicaid and the Affordable Care Act.

In response, the North Carolina Occupational Safety and Health Education and Research Center (NC OSHERC) within the Gillings School created a new study, Carolina PROSPER (Promoting Safe Practices for Employees’ Return), to assist businesses in staying open or re-opening safely while maintaining a healthy workforce. The study was funded by the North Carolina Policy Collaboratory and is led by Gillings School Senior Associate Dean Laura Linnan, ScD, and Leena Nylander-French, PhD, professor of environmental sciences and engineering and director of NC OSHERC.

Using a Total Worker Health® (TWH) approach, the team developed technical assistance on best practices that encouraged worker safety for participating businesses. This included testing workplace surfaces for coronavirus, encouraging healthy behaviors, maintaining employee mental health, implementing infection control, improving ventilation, addressing ergonomic factors and strengthening leadership approaches. Carolina PROSPER is one of the first efforts to implement a TWH approach to worker safety and health during an emergency like the COVID-19 pandemic.

The PROSPER team is continuing to consult with area businesses and has applied for additional funding. The team hopes to continue their work with new businesses in the future, take advantage of existing collaborations and forge new partnerships to be able to deliver evidence-based occupational safety and health resources and guidance to businesses locally and nationally.

Faculty, students and alumni are working to address the most critical threats to public health and the environment, many of which have a disproportionate impact on vulnerable communities. These threats include climate change, COVID-19 and other viruses transported by airborne particles, hazardous agents in contaminated floodwaters, antibiotic resistance, air pollution from wildfires, water availability in low-income countries, and the impacts of extreme weather.

This work is uniquely possible at the Gillings School, where engineering, science and public health are found together and where health equity has always been a central part of our mission.

“As environmental scientists and engineers located within the top public school of public health, ESE is ideally positioned to provide holistic, intersectoral responses to mitigate and prepare for the pressing environmental challenges,” said Barbara Turpin, PhD, professor and chair of environmental sciences and engineering. “On the occasion of our centennial, we affirm our commitment to build public health resilience to climate and environmental change.”

ESE is celebrating throughout the year with a seminar series, paired student and alumni stories, student speed talks and a keynote lecture from alumnus Gary White, CEO of Water.org, which can be found at sph.unc.edu/ESE-centennial. Department leaders are also looking forward to an in-person celebration when the pandemic allows.

Salzberg, the Don and Jennifer Holzworth Distinguished Professor of environmental sciences and engineering, took the helm of The Water Institute in late 2019. Before joining UNC, Salzberg was the lead water adviser to five United States Secretaries of State, negotiated major international agreements, and created partnerships that strengthened the United States’ and capacity of communities around the world to address water challenges.

The Institute is respected globally for its policy-relevant research around drinking water, sanitation and hygiene (WaSH) and its annual Water and Health Conference. Salzberg believes The Water Institute is well-positioned to become a world leader on water if UNC can fully leverage its faculty expertise and strengthen key partnerships with regional and global organizations.

"The Research Triangle is one of the most water-rich areas in the world in expertise. If we can unite ourselves, the world will come to us."

“We are building off of an institution that has a great reputation on drinking water and sanitation, and we need to look toward getting this whole region to work on providing services where water is more scarce or suffers from contamination, drought and climate change,” Salzberg says. “How do we make this campus the No. 1 place in the world to work on and solve complicated water problems? We have tremendous capacity. There are 60-70 faculty connected to water in some way and others who could be. And the Research Triangle is one of the most water-rich areas in the world in terms of expertise. If we can unite ourselves, the world will come to us.”

He envisions The Water Institute serving as a university-wide platform for solving complex water problems by mobilizing the expertise, knowledge and research that the University has to offer – not only in environmental sciences but also in the business school, the law school, humanitarian studies, engineering, health and other areas of study. In addition to leveraging partnerships across campus, Salzberg wants to strengthen outside relationships and expand UNC’s reach across the globe.

“Water is a lens through which we can inspire people to solve human problems,” he says. “I’m here to change the way the world works on water, but I’m also here to change the way the University works. Wouldn’t it be great if we could mobilize everything we have to offer to solve critical conflicts across the world – and put these resources in people’s hands?”

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The Asheville MPH, with its concentration in Place-Based Health, has an administrative home in the Gillings School’s Public Health Leadership Program (PHLP). “It’s the only program of its kind in the country,” said Anna Schenck, PhD, PHLP director and associate dean for practice. “It was designed to celebrate and leverage the unique context of the western part of our state.”

The program uses connections that the Gillings School, UNC Asheville and MAHEC have in western N.C. to its advantage. Students, who are often employed in local health professions, learn to work with providers, community leaders and government officials to understand place in the context of public health.

The curriculum demonstrates agility and adaptability, both in its principles and its delivery, with a hybrid learning model that occurs in-person and online.

“We want to teach learners how to work with others, especially in an era of team-based care and population health.”

MPH student Hannah Robinson completed her practicum with Partners Aligned Toward Health in Yancey and Mitchell counties over the summer. Hannah supported the Summer Food Program by helping distribute fresh, local produce to the community.

That agility became critical in early 2020. In February, Johnson died after an eight-year battle with cancer, and the onset of COVID-19 in the weeks that followed rocked the program.

Pushing forward with the same resilience Johnson modeled, program leaders and students adapted modules to emerging issues from the pandemic. For MAHEC, the pivot was possible because it aligned with the MPH program’s case-based learning objectives.

COVID-19 magnified challenges local communities were already facing. Health care workers were thinly spread and had trouble communicating critical information. Insufficient broadband access only exacerbated this issue. Vulnerable populations were at high risk of outbreaks. And concerns grew around stress and its impact on substance abuse and opioid death rates.

Assistant Director Sarah Thach, MPH, and Director of Academic Affairs Amy Joy Lanou, PhD, have been leading the effort to integrate place-based coursework into the local public health response to these issues.

“We want to teach learners how to work with others, especially in an era of team-based care and population health,” Thach said. “We were able to quickly change existing plans to focus on COVID, and the students thought it was helpful to work on something very timely.”

Students have participated in COVID-19-related case studies, health assessments and volunteer opportunities. In their practica, they have helped design plans for testing, food distribution and more. Culminating experiences have engaged the Latinx community and higher education peers in health communication.

“Our partnership with MAHEC has been a real advantage in terms of being right up in the middle of the western N.C. pandemic response,” said Lanou. MAHEC’s leadership has been critical for obtaining funding and research support for MPH faculty, staff and student initiatives.

Through service and circumstance, the team has forged a strong bond with communities and within the program. Students and faculty work together with the knowledge that they will be colleagues even after graduation. In 2020, the program saw its first cohort graduate – over Zoom – and students continue to integrate coursework into practice today.

As the program evolves, Johnson’s enduring spirit lingers.

“One student said she felt him on her shoulder as she helped her organization pivot to address the pandemic,” Thach recalled. “As we oriented the Fall 2020 cohort to Travis’ legacy, we spoke of his vision, relentless optimism, deep connection with everyone he met and humility. Those are the lessons our students are reflecting on as they learn to meet community needs.”

One of the Gillings School’s greatest strengths is that collaboration is at the heart of its culture. The relationships the School has built over the years continue to expand its worldwide reach.

Peggy Bentley, PhD, former Carla Smith Chamblee Distinguished Professor of nutrition and associate dean for global health, was a key force behind many of the partnerships that give students the opportunity to practice public health in a real-world environment.

“It is really important for our students to get that practical experience,” said Naya Villarreal, MPH, Gillings global health associate director of research, innovation and global solutions. “We are grateful for Peggy’s vision and these partnerships that help us train the next generation of public health workers.”

“The fellowship program is a win-win-win.”

FHI 360 – an international nonprofit human development organization headquartered in Durham, North Carolina – spun out of UNC’s Carolina Population Center nearly 50 years ago. Since 2004, the Gillings-FHI 360 partnership has included research collaborations, sponsorship of the annual Water and Health Conference, and the FHI 360-UNC Global Health Research Fellowships, which have benefited 39 Gillings students with tuition and stipends, training, and mentorships.

“The fellowship program is a ‘win-win-win,’” said FHI 360 Chief Science Officer Timothy Mastro, an adjunct epidemiology professor at Gillings and a global health physician. “It’s a win for FHI 360 to get two-to-three incredibly bright graduate students each year; it’s a win for Gillings because we pay for tuition, which is a nice attractant when you’re recruiting students; and it’s a win for the students who do the program and get this wonderful mentoring experience.”

The School’s 11-year relationship with global nonprofit IntraHealth International has given more than 40 graduate students real-world experience as UNC-IntraHealth Summer Fellows. Fellows receive a $5,000 stipend to spend 10 weeks at the nonprofit’s Chapel Hill office, where they are fully integrated into the organization’s work – collaborating with staff, being guided by assigned mentors and gaining practical experience.

“The fellows always bring valuable perspectives to their individual projects and to IntraHealth as a whole,” said Emily Kiser, MPH, a Gillings alumna and IntraHealth strategy and development officer. “Each year we look forward to the infusion they bring of enthusiasm and new ideas.”

The School’s partnership with RTI International accelerates innovative clinical and public health programs. In 2018, RTI and Gillings launched a $500,000 initiative, UNC Gillings-RTI Initiative to Maximize Partnerships and Catalyze Teamwork (IMPACT), and jointly seeded three research projects. The active research portfolio of Gillings-RTI projects is more than $7 million; the number of RTI researchers who are adjunct faculty has doubled since this partnership began.

“North Carolina is fortunate to have these two amazing institutions here who can have even greater impact in the world by working together on critically important public health issues,” said Gillings Professor of the Practice Leah Devlin, DDS, MPH, who helped create the partnership.

Since 1999, the North Carolina Institute for Public Health (NCIPH) has been a bridge between academia and public health practice partners – providing training, coaching, technical assistance with community health assessments and accreditations, facilitating discussions with other partners, and other forms of support.

“One entity can’t do it all, but if we work together, much can be accomplished,” said NCIPH Director Doug Urland, MPA, who was a local public health director for almost 25 years before leading NCIPH. “We want to help communities build capacity so they can continue and sustain the work and have a lasting positive impact on health.”

Farther from home, Gillings has longstanding research-based partnerships in Malawi, Zambia, Vietnam and China, as well as the Galapagos Islands, where students and faculty travel to work with local health partners and researchers from other institutions.

Partnership examples through time

1940s: School faculty begin serving as consultants to health agencies in developing countries

1945: The School helps establish a Department of Health Education at the N.C. College for Negroes (NCC) in Durham.

1948: The School’s first field training station is established at the Orange-Person-Chatham District Health Department.

1950s: Faculty members help create a sanitary engineering program at the National University of Engineering (UNI) in Lima, Peru.

1960s: The School works with the Peace Corps to create the Malawi Public Health Program.

1973: Area Health Education Center (AHEC) was established to provide educational programs in areas that lacked easy access to major health centers.

1980s: The School expands work with voluntary health organizations, schools, local environmental agencies and corporations.

1985: The School of Public Health Board of Advisors is created, including various civic and advocacy groups, voluntary health organizations, professional associations, and government agencies.

1990: Gillings epidemiologists collaborate with Ulm University in Germany to create an International Summer School in Germany.

2007: Gillings professor Thomas Ricketts initiates a partnership with the French national school of public health.

2008: Gillings is designated a World Health Organization (WHO) Collaborating Center for Research Evidence for Sexual and Reproductive Health.

2012: Gillings forges a research partnership with the University of Cambridge that builds on the two universities’ complementary strengths and promotes multidisciplinary collaborations to undertake innovative research.

2017: The Water Institute at UNC is designated as a Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Center for Water and Sanitation.

“We want the best outcomes for our community, so we work on elevating the practice of public health at every turn,” says Harrison, an adjunct professor in the School’s Public Health Leadership Program. “It’s important to build or maintain community partner relationships and improve public health practice at the same time.”

Harrison began building these partnerships in 2012, inspired by the Academic Health Department (AHD) model. Like a teaching hospital trains aspiring doctors, AHDs educate the current and future public health workforce, strengthen the connection between public health practice and academia, and provide opportunities for research and service.

Key partners for GVPH include the North Carolina Institute for Public Health, Gillings students and faculty, other colleges and universities, the Research Triangle Institute, and community members. GVPH’s partnership with the Gillings School hinges on the work of Carmen Samuel-Hodge, RD, PhD, an associate professor in the School’s Department of Nutrition and a researcher at the UNC Center for Health Promotion and Disease Prevention.

"We want the best outcomes for our community, so we work on elevating the practice of public health at every turn."

Working on site at GVPH one to two days per week as an embedded researcher, Samuel-Hodge leads the department’s chronic disease prevention strategies, including interventions for improving nutrition and physical activity behaviors and the Minority Diabetes Prevention Program. She advises staff on evidence-based program implementation and has used her grant-writing expertise to help support the agency’s work in the community, which primarily focuses on mental health and substance use, youth well-being, and access to healthcare.

The partnership has been critical in securing an additional $1 million yearly in grant funds, as well as increased funding support from the county. New evaluation, quality improvement, grant management and project management strategies have been implemented in the agency. GVPH leads the region’s coordinated approach to child health as part of the Working on Wellness community coalition, collecting data and conducting analysis. It publishes in journals and presents at national conferences, which is uncommon for local health departments.

Samuel-Hodge’s research has become a model for using community engagement to solve health inequities. “Most of the evidence for public health interventions is generated from non-rural samples, so we don’t know if an intervention will actually work in a rural context where the resources are often limited,” she says. “How do you adapt what has been shown to work, to make it work in a different setting? A one-size-fits-all public health solution doesn’t work in practice – it ignores context and the need to adapt to people and place.”

An enthusiastic and dedicated philanthropist whose name and spirit will live on in the Gillings School of Global Public Health, Joan Gillings passed away Feb. 18, 2021.

Born in Philadelphia and raised in Michigan, she moved to Chapel Hill in the early 1970s with her two sons and joined the staff of the UNC Department of Biostatistics from 1974-1976.

The $50 million gift that Gillings and her former husband, Dennis, pledged to the School in February 2007 was transformative. It supports innovative research through the Gillings Innovation Labs, created the Experts in Residence program and has supported more than 100 Gillings Merit Scholars.

Joan Gillings fully believed in the School’s research mission and took time to talk with and listen to students, encouraging them and taking sincere interest in their goals and aspirations.

“Joan was a force of nature, a wonderful leader, a person with a big heart and a deeply generous donor who cared especially about our students,” says Barbara K. Rimer, DrPH, Alumni Distinguished Professor and School dean.