Faculty Spotlight: Alyssa Sharkey

Monday, Jun 21, 2021
by Aimee Bronfeld, Center for Health and Wellbeing

A better life for all. That slogan, featured on a South African election poster for Nelson Mandela, is proudly displayed in the home of Alyssa Sharkey, lecturer at Princeton’s School of Public and International Affairs (SPIA) and senior health specialist for UNICEF. In fact, she considers the poster her “most prized possession,” reflecting admiration for a transformative world leader and the defining mantra of her career.

In this Spotlight, Sharkey, an affiliate of the Center for Health and Wellbeing (CHW), speaks candidly about formative experiences that shaped her concentration in health policy, programming and research along with her fierce desire to improve the lives of disadvantaged women and children across the globe.

Q. Was there anything about your upbringing, or personal background, that notably affected your interest in global health?

A. Yes… that’s fun to think about! I grew up on a farm in Maryland, but my dad traveled a lot for his work as an agricultural statistician, helping other countries set up systems to monitor their crops. He’d come back with stories of these really interesting, different places, and I always loved that stuff. To an extent, my dad influenced my interest in what’s happening around the world; I think I have the same wanderlust as him. Also, my mom was a special education teacher. Growing up, my family was very much focused on what we could do to make a positive impact on other people. That definitely played in role in who and where I am today, both personally and professionally.

Q. After receiving a Bachelor of Science from University of Maryland, you earned a Master of Health Science and a Ph.D. in Maternal and Child Health from Johns Hopkins Bloomberg School of Public Health. Why did you choose these areas of study and eventually focus your efforts on women and children?

A. I actually started my undergraduate program in a completely different field as an architecture major. Then I started volunteering in the community, working with homeless kids. It was something that just felt right, like this is what I should be doing with my life. So I switched my major to Family and Community Development, a broad degree that leads most students to careers in social work or family therapy.

However, through a stroke of serendipity, I stumbled upon an internship at the National Center for Education in Maternal and Child Health at Georgetown University. It was my first exposure to the whole area of public health, and specifically women and children... and I was really excited about it. So I went straight to Johns Hopkins for a Master’s degree in public health and subsequently accepted a position at the university’s Child and Adolescent Health Policy Center. I loved everything about that experience, but at that time in my life I was also interested in the world.

Q. Shortly after graduate school, you ventured to South Africa.  What brought you there?

A. I was fascinated by what was happening in that country... with apartheid and how, in 1994, South Africa suddenly shifted to democracy under Nelson Mandela. I was totally enamored by his leadership, his background, and his efforts to transform society. So once he was elected president, I immediately tried to figure out a way to get there.

It was a pretty special time, as South Africa was in the process of changing everything, including its health system, which had separate Departments of Health for Black Africans, mixed race people, and white people. After doing some research, I submitted a grant, in collaboration with someone from University of Cape Town, to set up a Child Health Policy Institute modeled after the policy center I was working in at Johns Hopkins. We received the funding, and off I went. Talk about an education. I was really young, 25 years old, and arrived with the optimistic but also somewhat arrogant idea that I was going to help this “new” country reach all of its women and children. I quickly realized that I was going to learn a lot while I was there. It was my first time seeing real poverty and disparities, and how policies affect every aspect of people’s lives.  The experience was shocking, and incredible, and changed my life; I was completely hooked on a career in global health.

Q. After that project at University of Cape Town, where you also earned a Master of Science in Medicine in Pediatrics and Child Health, you returned to the United States and worked in several non-government settings before landing at UNICEF and, more recently, Princeton University. How did those experiences influence your career?

A. After I returned from South Africa, I worked for a couple of NGOs. These small nonprofits provide a nice opportunity for innovation at a local level. You dig in, try to understand the context, and test out new strategies, which is a great contribution to the field of global health. However, a lot of times, the projects are not sustainable. There is often no link to the existing system, or government, to make sure that the innovation can be scaled up at a broader level and sustained over time. For that reason, I felt that UNICEF may be a better fit for me. However, about a year and a half ago, our family moved to Princeton and then in February I joined the faculty to take advantage of the opportunity to teach, learn, and collaborate with other people who are interested in global health.

Q.  You joined UNICEF in 2010, leading maternal and child health projects in various low and middle income countries from its offices in New York and South Asia. Why did you establish roots with the organization, and are there aspects of your work that are particularly rewarding?

A. At UNICEF, we try to work in partnership with the governments of different countries, listening to their priorities with regard to women’s and children’s health. We might not agree with them and sometimes advocate a different strategy. For example, we might suggest investing in widespread access to primary care services instead of building a new cancer hospital in a capital city. But we’ve found that supporting the priorities that countries establish on their own is a better way to operate, particularly to ensure sustainability. I really like that approach.

Over the years I’ve had different roles with the organization, which has kept me from getting bored. But one of my favorite things about working at UNICEF is that my colleagues are from all over the world. It makes such a difference in subtle, surprising ways. People come from diverse places and have had diverse experiences, so they have very different ideas, perspectives and values. I have a colleague, for example, who was born in South Sudan, grew up in a refugee camp in Uganda, and went on to become a medical doctor and an epidemiologist, and another co-worker who lost her family in the Rwandan genocide yet sought a career that promotes the wellbeing of families across the globe. I feel so lucky to collaborate with people like that.

Q. Tell me about your current role at UNICEF.

A. In my current position, I wear two different hats. One is based on implementation research, which involves supporting program managers in the field to generate evidence to identify and fix their implementation problems. For example, they may have identified that they’re not reaching a particular group, such as adolescent girls, but are missing data to better understand what is going on. I assist them with quick, micro-research projects to provide that information, which enables them to make immediate changes rather than waiting for a big evaluation at the end.

I’m also working on a project, funded by the Bill & Melinda Gates Foundation, that aims to improve on immunization equity. Immunization is one of the world’s most successful global health programs, but still there are about 20 million children who don’t benefit from vaccinations. We’re trying to figure out who those kids are, where they are located, and how we can reach them. They may be in places affected by conflict, or living in urban slums or really remote areas, or maybe they’re part of a nomadic population. At the same time, we consider the issues facing women, or the gender barriers that might influence outcomes. For example, some women might have to ask their husbands for permission to take their children to the doctor. Immunization is just the entry point. Often these kids need everything; they’re probably malnourished and don’t have access to water, sanitation, or schooling. We look for the most deprived children in the world and develop strategies to meet their needs, with a focus on equity.

Q. Would you say that inequities are more pronounced in low and middle income countries, or is it an issue that does not discriminate based on wealth?

A. Often we find that equity is more dependent on a nation’s government than wealth. The U.S. is a great example. Although we’re a rich country, we have substantial inequities. Our mortality rate, for instance, is much higher for Black women than white women. Then there are countries that don’t have our wealth but are more equal in terms of health care. Equity is driven by the extent to which a government is committed to meeting every person’s needs.

Nevertheless, in many of the countries where I work, the people who are the most disadvantaged are suffering the most. They’re more likely to be exposed to the problems that create poor health and to face the burden of disease, and they’re more likely to suffer the consequences. I think that’s true globally. The challenge of disparities – and how those disparities can be so easily exacerbated whenever there’s a crisis, whether it’s a pandemic, an earthquake or something else – is universal.

Q. Immunization equity, a focal point of your work, is at the forefront of global health as we roll out vaccines for COVID-19. What are some of the obstacles that may impede successful implementation and access, both here in the United States and around the world?

A. Generally speaking, immunization has been successful because we have infrastructure and data to support the implementation of vaccination programs. But still, there are a lot of countries that won’t have widespread COVID-19 vaccination for another couple of years. That’s partly because most of the big producers of vaccines are in the rich countries. Furthermore, the existing immunization systems generally target children and women when this vaccine effort prioritizes health care workers, the elderly and others at high risk for exposure and severe disease. Then you have challenges with the vaccine itself… some vaccines have to be stored at certain temperatures and transported in a certain way, which could be a huge problem for some countries.

It’s also important to mention the uptick in vaccine hesitancy, which we’re seeing even in this country. The issue originated here in the U.S. but social media across the world has enabled misinformation, or even disinformation (intentional falsehoods), to spread like wildfire. Hesitancy comes down to who people trust; if they don’t feel like they can trust their government, they will resist the vaccine.

Q. Has the COVID-19 pandemic exacerbated other children’s health issues?

A. Along with the World Health Organization, UNICEF has been closely monitoring health care services that have been disrupted as a result of COVID-19. Over the past 18 months, especially last March and April, a lot of immunization campaigns and services just stopped, which is terrible in countries where kids need to get treatment for malaria or need antibiotics for pneumonia. By and large, kids aren’t dying from COVID but they are suffering in other ways. Many children are not receiving preventive health services or vaccines. Another issue that we’re very concerned about is that kids are out of school. When schools closed in Sierra Leone during the 2014 west African Ebola epidemic, for example, many teenage girls never went back. They ended up getting married or pregnant, and it completely changed the trajectory of their lives. UNICEF is trying to figure out how to best protect children’s health and welfare as we navigate the COVID crisis.

Q. What brought you to Princeton’s Center for Health and Wellbeing?  How does it complement your work at UNICEF?

A. My husband [Patrick Sharkey], a professor of sociology and public affairs, and I moved here from New York after accepting jobs with SPIA. I was particularly excited about what’s happening at the Center for Health and Wellbeing, which offered me the opportunity to teach and collaborate with extremely talented people who are doing related work.

This past spring, I taught a Task Force called “How Can We Immunize Every Child in the World?” and this fall I’ll be teaching a course addressing health inequities in the United States and globally – looking across socioeconomic, gender, racial and ethnic groups that influence health. Next spring I’m hoping to teach a graduate course as well. I love sharing my experiences with young people who are passionate about global health and introducing them to the field. In fact, one of my students will be interning with me at UNICEF this summer.

As we return to campus in the fall, I’d like to get more engaged with some of the research going on in women’s and children’s health.

Q. Are there any avenues, in particular, that you’d like to explore further?

A. I am interested in working across sectors to address the social determinants of health so we can develop better programs for women and children. It’s important to consider the broader context in which people are living. For instance, if we want to reduce maternal and child mortality, then we need to prevent child marriage and keep girls in school because maternal education is one of the biggest predictors of child mortality; the children of women who are less educated have much worse outcomes. We also need to build roads or improve transport, particularly to meet the needs of people living in remote, rural areas who sometimes have to walk hours to get to a clinic. These kinds of interventions are critical for helping women and children stay healthy and alive.

I’m looking forward to working with Princeton’s epidemiologists, immunologists and experts in other disciplines to expand my research and global initiatives targeting maternal/child health. It would be fun to engage on some joint, multi-sectoral work that supports better implementation of the interventions we know can save lives.

Q. Do you have any advice for students interested in pursuing a career in global health?

A. My first piece of advice to any young person who has an interest in global health is to go overseas. Just pick up and go to another country, immerse yourself, learn, understand the context. You have to be in a low or middle income country to really understand what works (or doesn’t work) and why. That kind of move can really jump-start a career in global health. Sitting in an office in New York City or Washington, D.C. just doesn’t have the same currency when you are applying for a job.

Learning a second language is important, too. One of my biggest regrets in life is not speaking fluent French, which would have been so helpful for my work in West and Central Africa.

Q. What keeps you busy outside of work?

A. Aside from my two teenagers – who keep us really busy – I volunteer with a local refugee resettlement group called I-RISE and serve as a Court Appointed Special Advocate (CASA) for children in foster care. Also, last summer, my husband and I set up a Mutual Aid Group for Mercer County. Through this project we’ve helped multiple New Jersey families that have been affected by the pandemic… paying a utility bill, donating groceries, or delivering a new bed. It’s not about doing something big; it’s about doing something small to support people who are suffering and to help them feel like they are part of a nurturing community. It can be a really rewarding experience for the donors as well. We look forward to growing this organization in the coming months to address the evolving needs of those we serve.