Elizabeth Fair: Making a Greater Impact in Global Health

By Sharon Brock

Elizabeth Fair

UCSF postdoctoral scholar Elizabeth Fair is helping to shape the future direction of Global Health Sciences (GHS). Since Global Health Sciences began only three years ago with the vision of Executive Director Haile Debas, Fair has been working alongside about 65 researchers from UCSF and UC Berkeley on strategic planning to determine the institute's mission and future goals, as well as to devise models for applying basic science to global health work over the next five to 10 years. To start, GHS, based at Laurel Heights, is creating long-term partnerships with institutions in less developed countries to train and invest in new leaders dedicated to global health. Currently, there are three visiting fellows from the Tanzanian National Institute for Medical Research and Muhimbili University College of Health Sciences, UCSF Global Health Sciences' partner university, in Dar es Salaam, Tanzania. Fair is also contributing to curriculum development in GHS for master's and PhD degrees in global health sciences. And she is organizing a postdoctoral society in global health to create opportunities for postdocs to combine their scientific research with their interest in improving health worldwide. "I'd like to set up a roster showing who's working where and what they are doing, so that they can be available for referrals or consulting," says Fair. "The majority of UCSF postdocs are from outside the US, and many return to their home countries to apply what they learned. I want to develop opportunities to tap into this knowledge base and formalize a network of scientists to make a greater impact." After attaining a joint bachelor's degree in anthropology and African studies from Harvard University, a master's in public health degree from Columbia University and a doctorate in epidemiology from Stanford University School of Medicine, Fair came to UCSF specifically to work with Philip Hopewell, a well-respected pulmonary physician who has worked with tuberculosis (TB) in San Francisco and internationally for 25 years. Working in the United States and abroad, Fair, 33, helps bring UCSF research and resources directly to the countries that need it most. "I hope to bridge the gap between research and those living with TB in other countries. We have all this great science, so my question is: How do we apply it practically?" says Fair, a native of Cambridge, MA. "My primary focus is translational research, which is translating basic science to applicable programming, policies and interventions in the field." Taking on TB The World Health Organization (WHO) estimates that 2 billion people - one-third of the world's population - are infected with Mycobacterium tuberculosis, and that about 8 million new cases of TB occur each year. The disease, which is transmitted through the air and predominantly affects the lungs, has plagued humans for more than 5,000 years. Although treatable, TB causes nearly 1.7 million deaths every year, primarily due to lack of access to effective treatment in underdeveloped countries. Controlling TB is no easy feat, Fair says. Challenges include difficulties in prevention due to the airborne transmission of the bacteria, and difficulties in diagnosis and assessment of chains of transmission due to the bacteria's unique ability to be latent for many years. And those suffering from TB face underlying issues of stigma and socioeconomic factors, such as limited access to quality care. "With my first research job in Bangladesh, I studied possible reasons for underreporting of TB among women, and found that they feared being abandoned by their husbands, as if it was genetic or untreatable," says Fair. "So I held informational clinics in villages to explain that anyone could catch it - since it was an airborne bacteria - to break down stigma and say that there was nothing to be ashamed of." Another tremendous challenge is ensuring completion of TB treatment. The treatment regimen - costing about $18 - consists of four drugs given for two months, followed by two of these drugs for an additional four months. Because of the length of treatment and the fact that patients often feel better after a few weeks of treatment, many stop taking the drugs before completion of a full course of therapy. This leads to treatment failure and relapses, and predisposes the population to drug resistance. Both the control of the disease and its treatment are adversely affected by HIV infection. Globally, TB is the most opportunistic infection and the most common cause of death in persons with HIV infection. HIV infection is causing TB case rates in sub-Saharan Africa to continue to increase at a time when the rest of the world is experiencing a decrease. "Visiting a hospital in Kenya, I learned that almost every patient we saw was HIV-positive," says Fair. "The two diseases are compounding each other's effects: People with HIV infection, especially when the disease is advanced, are much more susceptible to TB than immunocompetent individuals. And HIV is contributing to increased incidence of active TB in sub-Saharan Africa." Fair is also working with Hopewell by meeting with directors of national TB programs in five countries - Tanzania, Kenya, Mexico, India and Indonesia - to pilot-test implementation of the 17 International Standards for Tuberculosis Care. These standards, which address diagnosis, treatment and public health intervention, are backed by research and endorsed by multiple organizations such as the WHO, the US Centers for Disease Control and Prevention, the International Union Against Tuberculosis and Lung Disease, and the American Thoracic Society. "We have to consider that each country is culturally different, with different health systems and different perceptions of disease," Fair says. "So we basically offer the international standards and offer technical support in developing training materials, and then we let them run with it, allowing them to decide how the international standards can best be used, given their country's needs and epidemiologic context of disease." In the next year, Fair's assignments are to evaluate the impact of the international standards, as well as to develop an implementation guide with case studies from each pilot country that will help direct future use of the standards. "I think Elizabeth is doing extremely well," says Hopewell. "She has good quantitative skills, which is a major attribute for epidemiologists, but also good strategic thinking skills, which is extremely useful in evaluating the international standards." Fair's hopes for the future of TB are the discovery of a safe and effective vaccine, and development of better diagnostic tools and shorter therapies. In the short term, she hopes to improve basic standards of care for TB in the public and private health care sectors in high-burden countries, using the international standards, and to better address the co-epidemics of HIV and TB by integrating testing and clinical services for both diseases. Whether working in a UCSF lab or meeting with physicians in Kenya, Fair maintains a global perspective in TB control. "Taking a global approach to public health means seeing the big picture," she says. "In this era of globalization, international health disparities are everyone's problem. Africa and California are getting closer every day." Photo/Susan Merrell

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