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One Health – an interdisciplinary approach in combating emerging diseases

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Presentation by Hung Nguyen-Viet, Delia Grace and Jakob Zinsstag at the International Symposium of Health Sciences (iSIHAT 2013), Kuala Lumpur, Malaysia, 20-21 August 2013.

Presentation by Hung Nguyen-Viet, Delia Grace and Jakob Zinsstag at the International Symposium of Health Sciences (iSIHAT 2013), Kuala Lumpur, Malaysia, 20-21 August 2013.

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  • 1. One Health – an interdisciplinary approach in combating emerging diseases Hung Nguyen-Viet1, Delia Grace2, Jakob Zinsstag3 1Hanoi School of Public Health 2International Livestock Research Institute 3Swiss Tropical and Public Health Institute Kuala Lumpur, Malaysia, 20-21 August 2013
  • 2. • Studies the health and well-being impacts of development factors using integrative approaches of Ecohealth/One Health with special focus on South East Asia with link to similar issues of Africa. • Focus on the link between health and agriculture, infectious and zoonotic diseases, chemical pollution, food safety and nutrition, from lab to the field.  Ecosystem Health / One Health  Food Safety  Health Impact Assessment Main research themes
  • 3. Outline • Disease situation at global level and new approaches needed • One Health: history, application, case studies • Regional initiative of One Health • Integrated approach and way forward
  • 4. DISEASE SITUATION AT GLOBAL LEVEL Context 4
  • 5. Emerging Infectious Diseases 1. Diseases that have recently increased in incidence or in geographic or host range – e.g., tuberculosis, cholera, malaria, dengue fever, Japanese encephalitis, West Nile fever, and yellow fever. 2. Diseases caused by new variants assigned to known pathogens – e.g., HIV, new strains of influenza virus, and SARS, drug resistant strains of bacteria, Nipah virus, Ebola virus, hantavirus pulmonary syndrome, and avian influenza virus. 3. Bacteria newly resistant to antibiotics, notably the multiple antimicrobial resistant strains – e.g., MRSA, and E. coli O157
  • 6. Infectious Disease Emergence at Global level Jones et al. – Nature - 2008 from wildlife from non- wildlife drug- resistance vector- borne
  • 7. 29.08.2013 7 Infectious Disease Emergence at Global level Morens et al., Nature 430, 242-249 (2004)
  • 8. Challenges  75% of all new, emerging, or reemerging diseases affecting humans at the beginning of the 21st century have originated in animals.  Global impact of new emergent diseases include HIV/AIDS, severe acute respiratory syndrome (SARS), H5N1 avian influenza, and the pandemic 2009 H1N1 influenza virus  Serious public health, economic, and development concerns Needs of updates
  • 9. • West USA & west Europe hotspots • Last decade: S America & SE Asia
  • 10. • Unlucky 13 zoonoses sicken 2.4 billion people, kill 2.2 million people and affect more than 1 in 7 livestock each year Greatest burden of endemic zoonoses falls on one billion poor livestock keepers
  • 11. Top Zoonoses (multiple burdens) • Assessed 56 zoonoses from 6 listings: responsible 2.7 billion cases, 2.5 million deaths • “Unlucky 13” responsible for 2.2 billion illnesses and 2.4 million deaths – All 13 have a wildlife interface – 9 have a major impact on livestock – All 13 amenable to on-farm intervention Priority zoonoses 0 20000 40000 60000 80000 100000 120000 140000 Deaths - annual 0 200000 400000 600000 800000 1000000 1200000 1400000 1600000 1800000 2000000 Top 13 zoonoses Next 43
  • 12. 12 0 20 40 60 80 100 Rich Poor Infectious disease • 40% disease is infectious • one twentieth total from animals • one fortieth total burden is zoonotic • ..one twentieth with under- reporting • 4% disease is infectious • one two hundredth total disease from animals (zoonotic or emerged) • one thousandth of the total disease burden zoonotic The burden of animal associated disease is borne by the poor Rich countries Poor countries Grace et al., 2012
  • 13. Important factors leading to the emergence of infectious diseases • Overpopulation and urbanization • Population movement and animal trade • Water and sanitation • Agriculture and changing land use • Livestock production • Climate • Drug resistance Coker et al. Emerging infectious diseases in southeast Asia: regional challenges to control. Lancet. 377. 2011
  • 14. HIV, TB, malaria Other infectious Mat//peri/nutritional CVD Cancers Other NCD Road traffic accidents Other unintentional Intentional injuries 0 5 10 15 20 25 30 2004 2015 2030 2004 2015 2030 2004 2015 2030 Deaths(millions) High-income countries Middle-income countries Low-income countries Mortality: global projection, 2004-2030
  • 15. Priority 3: Communicable diseases 0 10 20 30 40 50 60 70 80 “The big three” Neglected tropical diseases (NTDs) Burden of communicable diseases Burden(millionDALYs) Hotez et al. (2006) PLoS Medicine
  • 16. 29.08.2013 16 MORAN ET AL., PLoS MEDICINE; THE GLOBAL BURDEN OF DISEASE: 2004 UPDATE (WHO)
  • 17. HISTORY, APPLICATION, CASE STUDIES One Health: 17
  • 18. History of One Health and integrative thinking in medicine 19th to 20st century • Human medicine in the medieval European universities, Claude Bourgelat, first veterinary school in Lyon (1762) heavily criticized wanting human clinical training for the veterinary curriculum • 19th Century: Strong interest in comparative medicine: “Between animal and human medicine there is no dividing line – nor should there be. The object is different, but the experience obtained constitutes the basis of all medicine”. Rudolf Virchow (1821-1902) coined the term “zoonosis” • In the 20th century both medicines became increasingly specialised, separating themselves into multiple sub-disciplines
  • 19. The “One Medicine” by Calvin Schwabe‘s has its origins in his work with pastoralists in Sudan in the 1960s • «There is no difference of paradigm between human and veterinary medicine. Both sciences share a common body of knowledge in anatomy, physiology, pathology, on the origins of diseases in all species» Schwabe C. (1964, 1984 3rd Edition): Veterinary Medicine and Human Health. Williams and Wilkins, Baltimore
  • 20. “One medicine” as a General Medicine Schwabe C. (1964, 1984 3rd Edition): Veterinary Medicine and Human Health. Williams and Wilkins, Baltimore
  • 21. “One Health”– Addresses Zoonotic Dieases Robert Virchow (1821- 1902) : “…between animal and human medicine there is no dividing line” (Kahn et al., 2007). The American Veterinary Medicine Association defines One Health as “the collaborative effort of multiple disciplines-working locally, nationally, and globally – to attain optimal health for people, animals and our environment.” Calvin Schwabe (1927-2006): veterinary epidemiologist and parasitologist, described and promoted One Medicine and proposed a unified human and veterinary approach to zoonoses in his 1964 book Veterinary Medicine and Human Health. 19th century 20th century   
  • 22. ...encourages the collaborative efforts of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals, and our environment …endorsed by FAO, OIE and WHO... http://www.cdc.gov/onehealth One Health approach
  • 23. CDC STONE MOUTAIN meeting Davos, 2.2012 PMAC Bangkok 1.2013
  • 24. “One Health” can be defined as the added value in terms of lives of animals and humans saved, financial savings and improved ecosystem services from a closer cooperation of human and animal health as compared to single sector approaches. Zinsstag et al. (2012) Onderstepoort J Vet Res. 2012 Jun 20;79(2):E1-5. doi: 10.4102/ojvr.v79i2.492. From theoretical to operational definition
  • 25. Benefits of One Health • Improving animal and human health globally  collaboration among all the health sciences • Meeting new global challenges through collaboration  veterinary medicine, human medicine, environmental and social sciences, wildlife and public health • Developing centres of excellence for education and training  veterinary medicine, human medicine, and public health One Health Initiative Task Force: Final Report, July 15, 2008
  • 26. 29. August 2013 Präsentationstitel 26 Weekly human exposure (blue) and rabid dogs (red) in N’Djaména 0 1 2 3 4 5 6 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 weeks as of Jan. 1st 2000 Rabieddogs/Exposedhumans I Y One Health and Rabies control in N‘Djaména
  • 27. 29. August 2013 27 Statistical relationship of human exposures – dog rabies 2 human exposures / rabid dog -2 0 2 4 6 8 10 12 14 -1 0 1 1 2 2 3 3 4 Rabid Dogs ExposedHumans
  • 28. 29. August 2013 Präsentationstitel 28
  • 29. 29. August 2013 Präsentationstitel 29 Comparative profitability of rabies control in N‘Djaména Zinsstag et al. (2009) PNAS 106(35):14996-5001 Human vaccination alone Dog and human vaccination
  • 30. 29. August 2013 Präsentationstitel 30 Existing textbook knowledge of brucellosis transmission B. mellitensis B. abortus Sheep Goat Dog Human Milk Cattle Others Cattle Cattle Milk, Cheese
  • 31. 31 Mixed teams assessing human and animal health
  • 32. 29. August 2013 Präsentationstitel 32
  • 33. Synoptic view of benefits and costs of animal brucellosis mass vaccination in Mongolia Distribution of Benefits 0 5000000 10000000 15000000 20000000 25000000 30000000 Intervention cost Public health benefits Private health benefits Household income loss Total Health Benefits Agricultural Benefits Total Societal Benefits Sector US$
  • 34. Agent Orange and dioxin One Health: beyond zoonoses and apply NCDs?
  • 35. 76.9 millions litres of herbicides (including 49.3 millions litres of AO with 366 kg dioxin) were sprayed during the Operation Ranch Hand (1961- 1971)(Stellman 2003). Currently there are 28 dioxin hot spots in Vietnam, in which seven of them are very severe.
  • 36. Agent Orange and dioxin: Current exposure pathways
  • 37. One Health is useful here – integrated management of food chain of environment - animal /plant – human
  • 38. REGIONAL INITIATIVES One Health 38
  • 39. • INDOHUN • SEAOHUN • VOHUN •MYOHUN
  • 40. SEAOHUN Core Universities Hanoi School of Public Health Chiang Mai University Mahidol University Universiti Kebangsaan Malaysia Institut Pertanian Bogor Universitas Indonesia Universitas Gadjah Mada Universiti Putra Malaysia Hanoi Medical University Hanoi University of Agriculture 4 countries/10 universities/14 faculties
  • 41. South East Asia Universities One Health Network Inaugural Meeting in Bngkok, Thailand 24-26 May 2011
  • 42. Vision A South East Asia One Health University Network fostering sustainable trans-disciplinary capacity building to respond to emerging and re-emerging infectious and zoonotic diseases Mission To leverage the training, education, and research capacities of the university network to build the skills, knowledge and attitude base for One Health leaders SEAOHUN Vision and Mission
  • 43. SEAOHUN Objectives 1.To promote and advance the One Health approach for control of emerging and re-emerging infectious and zoonotic diseases 2.To improve the competencies of One Health professionals 3.To build a One Health evidence base through research activity 4. To build cadres of trained professionals to be One Health current and future leaders
  • 44. VIETNAM ONE HEALTH UNIVERSITY NETWORK (VOHUN) Hanoi (Network Secretariat): • Hanoi School of Public Health • Hanoi Medical University • Hanoi University of Agriculture Thai Nguyen University: • College of Medicine • College of Agriculture & Forestry Thai Binh University of Medicine Hai Phong Medical University Bac Giang Agriculture and Forestry University Nam Dinh University of Nursing Hue University: • College of Medicine and Pharmacy • College of Agriculture and Forestry Dak Lak: Tay Nguyen University, Faculty of Medicine and Pharmacy Can Tho •University of Medicine & Pharmacy •University of agriculture Hochiminh City: • HCMC Medicine and Pharmacy University; • HCMC University of Agriculture &-Forestry 15 UNIVERSITIES/FACULTIES (NOVEMBER 2011)
  • 45. Capacities, strengths and weaknesses Main research gaps: 1. Disease trends, risk, burden, prioritisation 2. Epidemiology of zoonoses 3. Qualitative and economic methods 4. Molecular epidemiology Grace et al. 2010, Ecohealth
  • 46. Disease prioritization 1 Avian Influenza 2 Rabies 3 Leptospirosis …. Remark: Classification was not well reflected by disease burden caused by zoonosis Impact of media attention, funding availability, donor perspective…
  • 47. INTEGRATED APPROACH AND WAY FORWARD 48
  • 48. Similar concepts • Ecosystem approach to health (IDRC) – Ecohealth – Considers human health is closely linked to animal and environmental health in a socio-ecological interactions • Veterinary Public Health (VPH) – Veterinary public health is defined as the contribution of veterinary science to public health • Agro-ecosystem Health (OVC and others) • Extension of health concept to whole ecosystem – Evolution from « one medicine » to « one health »
  • 49. Six principles of Ecohealth (Charron, 2012) • Systems Thinking • Transdisciplinary Research • Participation • Sustainability • Gender and Social Equity • Knowledge to Action http://www.idrc.ca/EN/Resources/Publications/Pages/IDRCBookDetails.aspx?Publicatio nID=1051
  • 50. Integrative approaches 51 Human healthHuman health One Medicine Societies, cultures, Economies, institutions, Policies Agroecosystem health Animal Health .livestock .CA .wildlife V P H. EcoHealth ONE HEALTH Incentives Values Preferences Culture Ignorance Governance Rule-breaking
  • 51. One Health / Ecohealth =Transdisciplinarity = Integrative Integrated research (interdisciplinary and trans- disciplinary research) uses system thinking to generate new knowledge and competences by combining principles, theory and methods of difference One Health research and application comprise practices of emerging disease prevention and control to mintage the risk of complete ecosystem.
  • 52. Transdisciplinary research (TD research)  Integrates the social and natural sciences in a common approach (interdisciplinarity), and simultaneously…  includes non-academic knowledge systems Nat. Sci. Discipline 1 Tech. Sci. Discipline 2 Econ. Sci. Discipline 3 Soc. Sci. Discipline n One Health Non-academic actors Definitions Adapted from Herweg et al. (2011)
  • 53. When do we need Transdisciplinarity? Herweg et al. (2010)
  • 54. Summary • Disease situation at global level is complex – then new approaches needed: One Health • One Health: Integrative approach, great benefit – but needs more validation by case studies at practical level • Current initiatives for One Health – Need of capacity building in SEA • System thinking and integrated approach – Trans-disciplinarity, inter-sectoral collaboration, working together
  • 55. Acknowledgements • Bruce Wilcox, Dirk Pfeiffer • David Waltner-Toews, Guelph University • Marcel Tanner, Esther Shelling • Tran Thi Tuyet Hanh, Le Vu Anh • Dr Stan Fenick, RESPOND Thank you for your attention! EmergingPandemicThreatsProgram PREDICT•RESPOND•PREVENT•IDENTIFY
  • 56. One Health – an interdisciplinary approach in combating emerging diseases Hung Nguyen-Viet1, Delia Grace2, Jakob Zinsstag3 1Hanoi School of Public Health 2International Livestock Research Institute 3Swiss Tropical and Public Health Institute Kuala Lumpua, 20-21 August 2013