Talking Global Health with David Gittelman

ALBANY, N.Y. (Feb. 27, 2023) – We sat down for an interview with David Gittelman of the Department of Health Policy, Management, and Behavior to learn about his career in global health. Prof. Gittelman has traveled to more than 75 countries, many for his work with the CDC, the Peace Corps, the International Federation of Red Cross and Red Crescent Societies, and the Center for Global Health at UAlbany, where he is an affiliated faculty member and advisor.

What drew you to the field of public health, and to global health in particular? Did you always envision travel as part of your career, or did that interest develop later?

I entered the field of global health in a circuitous way. This may surprise you, but stamp collecting as a kid introduced the world to me, with stamps honoring WHO and UNICEF, smallpox eradication, malaria and TB control, and measles immunization. A junior year abroad at the University of Dakar, Senegal, solidified my interest in an international career and improved my French proficiency. An internship helping Vietnamese refugees in Macau and Hong Kong with the International Organization for Migration introduced me to international screening procedures for TB and sexually transmitted infections. Above all, it was my Peace Corps assignment in immunization programs in the Democratic Republic of Congo—and the chance to apply my French language skills—that fully jumpstarted my global health career.

By the time I started working for CDC on child health projects in Lesotho, I’d recognized the importance of understanding how public health systems function and how devoting time on the ground was critical to understanding and resolving challenges, especially in clinics and communities. Travel became integral to my work at CDC, whether monitoring immunization campaigns in Nepal and Albania, or developing malaria strategies in Senegal and DR Congo.

A lot of your work has been directed toward malaria prevention. Do you think the pandemic has caused any serious setbacks in this area? How about other global health efforts, like vaccination campaigns?

Malaria cases had already been increasing since 2016, but the highest annual increase in cases, incidence and mortality occurred in the first year of the pandemic. COVID-related shipping bottlenecks, staffing shortages at clinics, suspension of some community-based initiatives all contributed to setbacks in global progress. Global partners like WHO assisted countries early on to adapt malaria programs to COVID-19. But the effects of the pandemic linger.

Other global programs experienced significant setbacks. Countries suspended immunization campaigns from April 2020 and often reassigned staff to COVID-related duties. Many measles and polio campaigns were restarted later that year, along with global advocacy to bolster routine immunization services. But lockdowns and service disruptions sent global measles cases soaring in January to February 2022, with a nearly 80% increase in cases compared with early 2020.

So, for delivery of many priority health initiatives, I foresee years of recovery. And I also see these program areas as being ripe for students considering global health careers.

Do you think we will ever see the development of an effective malaria vaccine?

I’ve wondered the same over the years. I remember colleagues at CDC frustrated with early candidate vaccines. People in endemic areas couldn’t develop much additional protection given acquired immunity from previous infection. And like many microorganisms, the Plasmodium falciparum parasite that causes malaria evades vaccines.

Happily the outlook is better. In 2021 the WHO approved the first malaria vaccine, RTS,S, for use in children, and an improved version of the vaccine found a preliminary efficacy of nearly 80% in young children following trials in Burkina Faso. Now another vaccine that can be administered to adults, PfSPZ, is also under trial. The results are modest so far, but enough to prevent severe disease and potentially death in thousands of people in malaria-endemic areas. I am cautiously optimistic about a vaccine, but that won’t negate the need to promote our tried-and-true malaria prevention and control tools like mosquito nets and effective treatments.

What would you say is your biggest accomplishment?

I’m probably most proud of my efforts to hire, train, and mentor people who have become global health ‘stars’ here and abroad. I’m best and happiest working behind-the scenes to help elevate the skills and expertise of others. That’s also what I value most as adjunct faculty at UAlbany: mentoring students and hopefully inspiring them to pursue global health careers. A big part of that is promoting the emotional intelligence needed to build global networks and communicate effectively, conveying technical skill along with humility.

What is the role of cultural competency in global health?

Cultural competency is essential for success in global health. Learning a foreign language certainly opens doors to strong communication for working effectively abroad, but cultural competency can be more subtle. I learned that the hard way.

As an (overly) energetic young study-abroad student and Peace Corps Volunteer, my enthusiasm meshed well with my West and Central African co-workers who admired such energy. That approach fell flat in my first CDC job in Lesotho, where colleagues valued listening and quiet reflection. With self-reflection I learned to pull back in certain settings, keeping quiet until the time was right to comment. That put my co-workers at ease and led to better program success.

Cultural competency always has a focus when I advise students and colleagues preparing to go abroad. Preparation helps, like reading about the country’s history, accessing its arts (music, crafts, theater, local events), listening, and learning how to ask questions strategically.

The bottom line: anyone considering a global health career needs to learn these skills on the ground in countries. Pursue global health internships, don’t be afraid of making and learning from mistakes, consider the Peace Corps or any other entrée to field assignments. It’s a tough process, but ultimately incredibly rewarding.