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The Transition

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The AIDS Pandemic

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Abstract

This chapter describes the decisions involved in appointing Michael Merson as the new Director of the Global Programme on AIDS (GPA), and the evolution of his career that brought him to the position. The global AIDS community reacted strongly to Jonathan Mann’s resignation and Merson’s appointment. Some viewed it as an attempt by World Health Organization (WHO)’s Director-General Hiroshi Nakajima to shift the focus of GPA away from Mann’s human rights approach to a more biomedical one. After assuming leadership of the program, Merson was faced with the task of addressing GPA’s budget, developing its priorities, and managing both internal and external evaluations, all while delivering on the donors’ expectations for the program.

Within this chapter the singular pronouns I and my refer to Michael Merson alone, whereas the plural pronouns we and us generally refer to Michael Merson and Stephen Inrig jointly. Where we or us refers to Michael Merson and his colleagues at WHO, the object of the pronoun is clarified by context.

The original version of this chapter was revised to correct misspellings.

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Notes

  1. 1.

    For the purposes of this text, we will use the term AIDS to encompass both AIDS and HIV unless otherwise specified.

  2. 2.

    Michael Merson., et al. “Cholera on Guam, 1974 Epidemiologic Findings and Isolation of non-toxinogenic Strains.” American Journal of Epidemiology 105.4 (1977): 349-361; and Michael Merson, et al. “Travelers’ diarrhea in Mexico: a prospective study of physicians and family members attending a congress.” New England Journal of Medicine 294.24 (1976): 1299-1305.

  3. 3.

    Daniel Haulman. “Operation Babylife and New Life.” Air Moblity Command Museum. Available at https://amcmuseum.org/history/operation-babylift-and-new-life.

  4. 4.

    Numbers taken, and extrapolated back to 1980s, from Danzhen You, Jin Rou New and Tessa Wardlaw on behalf of the United Nations Inter-agency Group for Child Mortality Estimation, “Levels & Trends in Child Mortality, Report 2012: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation,” Geneva: UNICEF, 2012 http://www.apromiserenewed.org/wp-content/uploads/2015/03/UNICEF_2012_child_mortality_for_web_0904.pdf

  5. 5.

    Robert Hogan, Interview by Michael Merson, New Haven, CT, August, 2002.

  6. 6.

    Hiroshi Nakajima, Interview by Michael Merson, Poitiers, October 13, 2002.

  7. 7.

    Anthony Piel, Interview by Michael Merson, Sharon, CT, December 22, 2001; Letter from Anthony Piel to Mike Merson, 22 December 2001.

  8. 8.

    Ibid.

  9. 9.

    Walt Dowdle, Interview by Michael Merson, New Haven, CT, August, 2002; Nakajima confirmed, in our interview with him, that he felt he needed to hire an American. See Hiroshi Nakajima, Interview by Michael Merson, Poitiers, October 13, 2002.

  10. 10.

    Walt Dowdle, Interview by Michael Merson, New Haven, CT, August, 2002.

  11. 11.

    Hiroshi Nakajima, Interview by Michael Merson, Poitiers, October 13, 2002; Mohammed Abdelmoumene, Interview by Michael Merson, Geneva, October 28, 2014.

  12. 12.

    Robert Hogan, Interview by Michael Merson, New Haven, CT, August, 2002.

  13. 13.

    James P. Grant, “Letter to Michael Merson, March 22, 1990,” New York: UNICEF, 1990; Louis Sullivan, “Letter to Hiroshi Nakajima, April 11, 1990,” Geneva: United States Mission to International Organizations, 1990; “AIDS Program Gets Acting Head Following Resignation of Dr. Mann,” The Associated Press, March 21, 1990.

  14. 14.

    Walt Dowdle, Interview by Michael Merson, New Haven, CT, August, 2002.

  15. 15.

    Roy Widdus, Interview by Michael Merson, New Haven, CT, October, 2001.

  16. 16.

    Michael Kirby, “Global Commission on AIDS, Third Meeting, Geneva, 22–23 March 1990: AIDS—Third Meeting of GCA.” Unpublished Document.

  17. 17.

    Marjory Dam, Interview by Michael Merson, New Haven, CT, September 29, 2001.

  18. 18.

    Walt Dowdle, Interview by Michael Merson, New Haven, CT, August, 2002.

  19. 19.

    “U.N. body appoints new AIDS director,” The Toronto Star, March 21, 1990, A22; “WHO appoints acting director of global AIDS program,” Xinhua General News Service, March 21, 1990, Item No: 0321027; “Dr. Michael H. Merson Appointed Acting Director For Global AIDS Programme.” World Health Organization Press, March 26, 1990.

  20. 20.

    For the purposes of this text, we use the term sexually transmitted disease(s) and the abbreviation STD rather than the other term sexually transmitted infection(s) or STIs.

  21. 21.

    Robert Hogan, Interview by Michael Merson, New Haven, CT, August, 2002.

  22. 22.

    James Curran, Interview by Michael Merson, New Haven, CT, March 9, 2002.

  23. 23.

    “AIDS: 6th Meeting of Global Management Committee of the WHO Global Programme on AIDS,” Washington, DC: US Department of State, May 15, 1990.

  24. 24.

    James Curran, Interview by Michael Merson, New Haven, CT, March 9, 2002.

  25. 25.

    “AIDS: 6th Meeting of Global Management Committee of the WHO Global Programme on AIDS,” Washington, DC: US Department of State, May 15, 1990.

  26. 26.

    Robert Hogan, Interview by Michael Merson, New Haven, CT, August, 2002.

  27. 27.

    Ann Gibbons, “New Head for the WHO Global Program on AIDS: do changes at the World Health Organization signal a new direction for its international AIDS program?” Science, June 15, 1990, 248:1306–7.

  28. 28.

    Michael Merson, “GPA Diagnosis, April 16, 1990;” Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990;” Mike Merson, Interview with Stephen Inrig.

  29. 29.

    Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990.”

  30. 30.

    Michael Kirby, “Global Commission on AIDS, Third Meeting, Geneva, 22–23 March 1990: AIDS—Third Meeting of GCA.” Unpublished Document.

  31. 31.

    “U.N. body appoints new AIDS director,” The Toronto Star, March 21, 1990, A22; Thomson Prentice “World AIDS specialists fall out over key programmes for action,” The London Times March 21, 1990; Christie McLaren, “Canadian groups fear departure will hurt global fight against AIDS,” The Globe and Mail, March 21, 1990; “WHO officials’ departure worries Canadian AIDS groups,” Xinhua General News Service, March 21, 1990; Item No: 0321203.

  32. 32.

    Michael Merson, Personal notes, March 1990.

  33. 33.

    Global Programme on AIDS, Report of the External Review of the World Health Organization , Global Programme on AIDS, Geneva: World Health Organization, January 1992, 7.

  34. 34.

    Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990.”

  35. 35.

    Michael Merson, “Workplan request from Acting Directors, GPA; April 9, 1990”; Michael Merson, “GPA Diagnosis, April 16, 1990”; Michael Merson, “Confidential Memorandum to the Deputy Director-General on the Revised Structure for GPA, April 23, 1990.”

  36. 36.

    Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990”; “AIDS: 6th Meeting of Global Management Committee of the WHO Global Programme on AIDS,” Washington, DC: US Department of State, May 15, 1990.

  37. 37.

    For more on the various issues and concerns related to the National Programs, decentralization, budget, internal and external reviews, see “AIDS: 6th Meeting of Global Management Committee of the WHO Global Programme on AIDS,” Washington, DC: US Department of State, May 15, 1990; Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990”; Michael Merson, “GPA Diagnosis, April 16, 1990.”

  38. 38.

    Michael Merson, “GPA Diagnosis, April 16, 1990,” Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990,” Walt Dowdle, Confidential Memorandum to Michael Merson, April 26, 1990.

  39. 39.

    “AIDS: 6th Meeting of Global Management Committee of the WHO Global Programme on AIDS,” Washington, DC: US Department of State, May 15, 1990.

  40. 40.

    Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990,” Global Programme on AIDS, “Progress Report Number 6, May 1990,” Geneva: World Health Organization, WHO/GPA/DIR/90.4, 7.

  41. 41.

    Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990.”

  42. 42.

    Ross Noble, Interview by Michael Merson, Geneva, October, 2001.

  43. 43.

    “AIDS: 6th Meeting of Global Management Committee of the WHO Global Programme on AIDS,” Washington, DC: US Department of State, May 15, 1990.

  44. 44.

    Global Programme on AIDS, Report of the External Review of the World Health Organization , Global Programme on AIDS, Geneva: World Health Organization, January 1992, pp. i–ii.

  45. 45.

    Ibid.

  46. 46.

    Deborah Mesce, “White House Hopes New Visa Policy Will End Boycott Threat,” The Associated Press, April 14, 1990.

  47. 47.

    Vitaly Makarchev, “World Health Assembly Session To Discuss Environment, AIDS,” TASS, May 7, 1990.

  48. 48.

    Lars Kallings, Interview by Michael Merson, New Haven, CT, September, 2002.

  49. 49.

    Manuel Carballo, Interview by Michael Merson, New Haven, CT, November, 2002.

  50. 50.

    Ann Gibbons, “New Head for the WHO Global Program on AIDS: do changes at the World Health Organization signal a new direction for its international AIDS program?” Science, June 15, 1990, 248:1306–7.

  51. 51.

    Ibid.

  52. 52.

    Thomas Coates, Interview by Michael Merson, New Haven, CT, February, 2002.

  53. 53.

    Lars Kallings, Interview by Michael Merson, New Haven, CT, September, 2002.

  54. 54.

    Ibid.

  55. 55.

    Ibid.

  56. 56.

    Thomas Coates, Interview by Michael Merson, New Haven, CT, February, 2002; Lars Kallings, Interview by Michael Merson, New Haven, CT, September, 2002.

Author information

Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Michael Merson (Wolfgang Joklik Professor of Global Health)

  2. Mount Saint Mary’s University, Los Angeles, CA, USA

    Stephen Inrig (Director, Health Policy and Management Program)

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  1. Michael Merson
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  2. Stephen Inrig
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Merson, M., Inrig, S. (2018). The Transition. In: The AIDS Pandemic. Springer, Cham. https://doi.org/10.1007/978-3-319-47133-4_8

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  • DOI: https://doi.org/10.1007/978-3-319-47133-4_8

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