Senior level buy-in Selection of priority .. Syndromic surveillance; D ysentery versus ac watery diarrhoea
H igh prevalence across N.China & Mongolia – internal spread ? R uminant movement W hich species Justification for adding toxoplasma
S election M ore on
S election M ore on
One Health approaches to prevent and control zoonoses
One Health approaches to prevent and control zoonoses Jeffrey Gilbert, ILRI CIAT-Asia, VientianeAgriculture, Fisheries & Conservation Department (AFCD) Workshop on “One Health: Past, Present, and Future” Hong Kong, 27 September 2011
ILRI: Overview• One of 15 international research centers of CGIAR (Consultative Group on International Agricultural Research)• Individual Centres set up in 1960s (IRRI 1960, ILRAD 1973, ILCA 1974)• CGIAR 1971: 19 northern Govts + IGO (FAO,WB,ADB …)• ILRI founded 1994; headquarters in Nairobi, Kenya• ILRI focus – livestock, livelihoods, IAR4D• ILRI: organized in 4 research ‘themes’: markets, biotechnology, people-livestock-environment, poverty-gender-impact
CG Reform To overcome the challenges and exploit the opportunities, the CGIAR has undergone reform. A new Strategy and Results Framework (SRF) will, for the first time, allow the CGIAR centers to function as a unified system, working together to pursue shared goals The 7 CGIAR Research Programmes* (formerly ‘mega-programmes’) Objective – to harmonize CRP-4: ‘Agriculture for Improved Health and Nutrition’• This research program aims to accelerate progress in improving the nutrition and health of poor people by exploiting and enhancing the synergies between agriculture, nutrition, and health through four key research components: value chains, biofortification, control of agriculture-associated diseases, and integrated agriculture, nutrition, and health development programs and policies. With IFPRI and ILRI as co- Lead Centers, this program will also involve 10 other CGIAR Centers. It has an initial 3-year budget of US$191.4 million.* http://www.cgiarfund.org/cgiarfund/research_portfolio
EcoHealth v OneHealth• Definitions open to debate: range from quite rigid to very flexible!• One-Health – biomedical focus: human + animal + wildlife;• EcoHealth: environment & socio-economic aspects – pioneered outside ‘traditional’ health• Personal opinion: OneHealth more theoretical, conceptual; EcoHealth more tangible?• Maybe it’s not so important … which ‘cola’
EcoHealth v OneHealth• Option to discuss history of EH/OH
EcoHealth One world – one health EcoHealth Human One Animal health Human Medicine health health Vet Pub O H. e n h e a l t h Agroecosystem health Societies Economies InstitutionsAdapted from Esther Schelling, STPH
EcoHealth ‘Pillars’ Trans-disciplinary: inclusive vision, full involvement of Researchers, community & decision-makers; Participation: consensus and cooperation not only within community, scientific & decision-making groups, but among them; Equity: gender, ethnic group; Sustainability.
EcoZD: Overview ‘EcoHealth Approaches to the Better Management of Zoonotic Emerging Infectious Diseases in the Southeast Asia Region’ Increase the knowledge, skills and capacity of research and infectious disease control personnel in Southeast Asia to understand the risks and impacts of Emerging Infectious Diseases and how feasible options can best be implemented and adapted; ‘Learning by Doing’ approach 4 years 2008 – 2012; extended to Aug 2013 6 countries in SE Asia region; Cambodia, China (Yunnan), Laos, Viet Nam, Indonesia, Thailand One of IDRC’s EcoHealth initiatives in SE Asia: APAIR/APEIR, EcoEID, BECA, FBLI
EcoZD: gestation The donor – IDRC www.idrc.ca & EcoHealth ILRI’s capacity Building on previous specific EID (EZD) initiative in the SE Asia region: APAIR Identify partners, point of contact, link to others Formation of research teams Develop and finalise research studies (incorporating aspects of EH) Mechanisms of implementation, funds transfer etc.
EcoZD: ComponentsCountry Teams choices for research:Cambodia: zoonotic risks for acute dysenteryChina (Yunnan): Brucellosis & ToxoplasmosisIndonesia: Rabies - BaliLao PDR: pig zoonoses (& non zoonoses)Thai-Viet: hygiene in small-scale poultryslaughterhousesViet Nam: zoonoses priority ranking‘EcoHealth’ Resource Centres:Chiang Mai UniversityUniversity of Gadjah Mada
CambodiaPartners:•Centre for Livestock Development (CelAgrid, NGO)•Department of Animal Health & Production•Department of Communicable Disease ControlResearch•Review of public health data: diarrhoea reporting by SMS•Choice of various low & high incidence areas (pilot sites)•Household surveys: Questionnaires & PRA•Longitudinal survey will follow selected households withlaboratory sampling•Expected outputs – to ascertain proportion of acute dysenteryin rural households attributable
China – Yunnan provincePartners:•Academy of Grassland & Animal Sciences•Animal Science & Veterinary Institute•Agriculture University•Institute of Endemic Disease Control & PreventionResearch:•Determine Brucellosis prevalence and priority in pilotareas by compiling retrospective data, undertaking cross-sectional surveys.•Toxoplasmosis?
IndonesiaPartners:•Centre for Veterinary & Analytical Studies (CIVAS)•Disease Investigation Centre Denpasar•Other expertsResearch:•Dog ecology: behaviour, demography , movement,fecundity•Socio-cultural relationship between people & dogs•Community Engagement (dog registration, sterilisation)
Lao PDRPartners:•Department of Livestock Production, MAF•Department of Hygiene & Prevention, MoH•National Agriculture & Forestry Research InstituteResearch:•Prioritising pig diseases – both zoonoses & non-zoonoses, by questionnaire and sampling 30 villages innorthern & southern provinces•Building on earlier research by ACIAR, and indeedfollowed by further ACIAR project
Thailand-VietnamPartners:•Chiang Mai University, Veterinary Faculty•Department of Livestock Development•National Institute of Veterinary Research, Hanoi•Sub-department of Animal Health, Hanoi•(Originally China involved)Research:•Improving hygiene in small-scale poultryslaughterhouses, beyond the upgrade hygiene producesbetter quality of product - issues of sustainability, policyimplications•Interview of slaughter-house owners, workers, markettraders etc
VietnamPartners:•Pasteur Institute•Nong Lam University•Department of Animal HealthResearch:•Originally priority ranking of zoonoses, initial expertopinion, retrospective phase to analyse surveillancedata, cross-sectional survey in pilot areas to ascertaincommunity priorities
Challenges: What language are we talking?Lingua franca Eg Latin America/ EcoSalud ‘Lost in translation’Biomedical v Social Sciences Medics & Vets (clinical / laboratory / epidemiology) Quantitative v Qualitative (ranking, dual health burden) Researchers, Decision Makers, CommunitiesNovel approaches to holistic integrated approaches One Health One Medicine EcoHealth Inexact / broad interpretation v H5N1Case studies & publications
Challenges: Resource & ScopeHuman ResourcesSupply & Demand Language Technical – including proposal writing/ methodololgy / analysis /paper-writing Market forces operatingIdentifying Champions (including to implement & to mentor)Level of counterparts (senior v junior)Scope of EcoZD‘Carte blanche’ v prescriptiveLearning by doing (& making mistakes!)Priority zoonoses +/- EIDEcoHealth approach – new ‘paradigm’Two-dimensional capacity-building requirementGreek temple analogyEHRC concept
EcoZD: Some of the Solutions Cambodia: champions identified, Govt senior level support China: silo syndrome, local expert to provide technical assistance, EH training materials in Chinese Indonesia: multiple champions, finding niche - focus on dog ecology, complementing other initiatives Lao PDR: pooling inputs/outputs with ACIAR project Thai-Viet: reduced to 2 countries, local experts identified to provide technical assistance, link to EHRC-CMU Viet Nam: 3 research contracts and individual priorities, difficulties deciding on priority, change approach/angle
‘EcoHealth Resource Centres’Partners:•Chiang Mai University, Thailand•Gadjah Mada University, Yogyakarta, IndonesiaDevelopment•Need for local capacity building•Target audience of undergraduates/postgrads – moreopen-minded(?)•Need to engage senior academics•Multiple disciplines (faculties) ‘under one roof’
‘EcoHealth Resource Centres’• Provision of relevant training for staff, students and outside participants;• Promotion of knowledge sharing and assimilation through making available books and peer-reviewed publications;• Conducting multi/trans-disciplinary EcoHealth research activities involving post-graduate students;• Preparing publications – from desktop/retrospective and prospective research; also position papers;• Providing advocacy for EcoHealth – other universities, government and communities.
Yet more challengesDefinitions/ Standardisation for curriculum development One Health / One Medicine / EcoHealth Who’s right? Eg ILRI & USAID at CMUBiomedical v Social Sciences Who leads? Quantitative v Qualitative – do they really mix? Will decision-makers & communities be convincedCase studies & publications Vital to get peer-reviewed publications as well as local language articles
Beyond EcoZD• EHRCs – Long term capacity building at various levels – No MSc or PhD of EcoHealth/OneHealth envisaged – Beyond communicable diseases – Own working definition and approach – refined as per context – Approach accepted – importance of ‘branding’• Country Research Teams – Case studies fully synthesized (and lots of lessons learned will surely emerge) – Maintain relationships & potential further collaboration