Presented by Hung Nguyen-Viet and Jakob Zinsstag at a technical workshop of the Food and Agriculture Organization of the United Nations (FAO) regional initiative on One Health, Bangkok, Thailand, 11–13 October 2017.

1. One Health:
Concept and applications
Nguyen Viet Hung & Jakob Zinsstag
ILRI, HUPH, Swiss TPH
FAO Regional Initiative on One Health Technical workshop
Bangkok, October 11-13, 2017

2. Overview
• One Health concept and
transdisciplinarity
• Examples of One Health application
(Zoonoses, Food safety, AMR)
• One Health, Ecohealth and beyond

3. • Hanoi University of Public Health
(www.huph.edu.vn)
• International Livestock Research
Institute (ILRI) (www.ilri.org)
Good environment to practice One Health!

5. Context of Emerging infectious
diseases (EIDs) and drivers in
SEA

6. 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. E. coli 0:157, MRSA…

7. Infectious Disease Emergence at Global level
Jones et al – Nature - 2008
from
wildlife
from
non-
wildlife
drug-
resistance
vector-
borne

8. 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

9. Urbanization
Agricultural
intensification*
* Includes food production
Habitat
alteration
REGIONAL ENVIRONMENTAL CHANGE
Species’ Ecological-evolutionary Dynamics
Opportunistic habitat expansion/ecological release
Vector/Reservoir (domestication) Feral reservoir species
Wildlife transport Human encroachment
Host-Pathogen Dynamics
Emergence Processes of ‘Host-Parasite Biology’
Host switching (host novelty) • Breaching of pathogen persistence thresholds
Transmission amplification and genetic exchange (pathogen novelty)
Disease Emergence
ecosystem continuum
H
U
M
A
N
E
C
O
S
Y
S
T
E
M
N
A
T
U
R
A
L
E
C
O
S
Y
S
T
E
M
Global
climate
change
Population
Technological capacity
Socio-cultural organization
(Based on Wilcox and Gubler 2005)

10. Challenges
• Complex health issues need innovative, integrated approaches.
• Strengthening the capacity of professionals working in the human,
animal and environmental health sectors to respond to, control and
prevent outbreaks of EID is vital.
• Gaps in knowledge, networking, field capacity
• Need to widen scope
 Beyond HPAI (making opportunities available)
 “Systems” approach vs. focus on specific diseases
Looking beyond animal health / human health
• Need more coordination of research projects to make bigger impacts

11. What is One Health?

12. Brief history of integrative thinking in medicine
• Chou Dynasty in China (11-13th century): integrated public health
system including medical doctors and veterinarians.
“The foundations of veterinary medicine are as comprehensive and
subtle as those of human medicine and it is not possible to place one
above the other” Hsü Ta-ch’un 18th century
• Human medicine in the medieval European universities, Claude
Bourgelat, first veterinary school in Lyon (1762) heavily criticised
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

13. History of One Health
• The „one medicine“ by Calvin Schwabe‘s
has it‘s origins in his work with Dinka
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

14. http://www.cdc.gov/onehealth
The collaborative efforts of multiple
disciplines working locally, nationally and
globally to attain optimal health for people,
animal and our environment
(AWMA, FAO, OIE, WHO, UNSIC, UNICEF, WB)
Expanded One Health encompasses any
issues related to human, animal and
environment health
What is One Health?

15. Veterinary
medicine
Environmen
tal science
Human
medicine
• Recognition of inextricable linkage of human,
livestock, companion animal and wildlife
health.
• Adding values from closer cooperation of
human and animal health.
• More knowledge
• Better health (human or animal)
• Economical benefits/ savings
What is One Health?

16. • 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
Benefits of One Health

17. Example 1:
Zoonotic disease understanding and
control using One Health

19. 11. Oktober 2017 Präsentationstitel 19

20. 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$

21. 11. Oktober 2017 Präsentationstitel 21
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
Is it profitable to control rabies by dog mass vaccination in African
city?

22. 11. Oktober 2017 Präsentationstitel 22
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

23. 11. Oktober 2017 Präsentationstitel 23

24. Präsentationstitel
Comparative profitability of rabies control in N‘Djaména
Zinsstag et al. (2009) PNAS 106(35):14996-5001
Human vaccination alone
Dog and human vaccination
Cost effective zoonosese control Proposed cost-sharing scheme

25. International: E.g Belgium Project :
The University of GENT The Free University (VUB) [Vet], ITM (Belgium) [Medicine]:
National NIVR NIMPE
Provincial sDAH dept Preventive and control center
District Vet station Medical center
Commune Vet groups Medical station
Village Paravet Medical staff
All local social organization
Administration
Authorities
All levels
Experiences from parasitic project: Ha Tinh, Bac Giang, Lai Chau, Son La, Dien Bien
Inter-disciplinary team Activities
Field: Questionnaires
Clinical examination
Medical guidance
Epidemiological study
Treatment/Sent to the hospitals
Remarks
The multi-layers stakeholders
The Inter-disciplinary
Practical tool to assess into One Health
Tradition and Modem Movable Lab:
Efficiency and capacity building

27. Medic-Vet team: Interview-ClinEx-Treatement? [QuaiTo 051206]

28. Example 2:
One Health food safety research in
Vietnam
PigRISK and Taskforce project in Vietnam

29. PigRISK team 2012-2017
• Vietnam National University of
Agriculture
• Hanoi University of Public Health
• Local authorities in Hung Yen and
Nghe An
• Involved various Value chain actors
and groups

30. Growing concern about food safety and Pork in
Vietnam
Pork is an important component of the Vietnamese diet
• The most widely consumed meat: 56% of total meat intake (OECD,
2016)
• Annual pork consumption per capita in Vietnam: 29 Kg
• 83% comes from very small or small farms
• 76% of pigs are processed in small slaughterhouses, nearly 30,000
• Preference for fresh “warm” pork supplied
in retail traditional markets
(>80% of all pork marketed)
• affordable, address local demands
• often escape effective control

31. 31
Hazard identification
Hazard characterization Exposure assessment
Risk characterization
Risk communication
What harm does it cause?
How does harm depend on
dose?
Can it be present in food?
Can it cause harm?
How and to what extent does it
get from source to victim?
What is the harm?
What is its likelihood?
Participatory methods
fit well
Approach:
risk analysis or risk-based decision making

32. Microbial and Chemical Risk Assessment
• Salmonella risk pathways developed for producers, slaughterhouse and
consumers, quantitative microbial risk assessment (QMRA) risk for consumer
• Chemical risk assessment: antibiotic residues, banned chemicals, heavy metals
1,275 samples (farms, slaughterhouse, market) collected during 1 year
PigRISK: Pork safety in Vietnam (2012-2017)
Farm Transportation to SH Slaughterhouse ConsumersRetailer
• Feed in bags, remaining feeds
at the cages, environment
• Pork• Liver
• Kidney
• Consumption
survey
PigRISK project (2012-2017)
Food safety risk assessment along the pork value chain

33. PigRISK – QMRA for salmonellosis
The annual incidence of foodborne salmonellosis in the Asian region including
Vietnam was 1% (range 0.2-7%) (Havelaar 2015)
Age and gender groups
Estimated annual salmonellosis
incidence rate (Mean (90% CI)) (%)
Children (under 5 years old) 11.18 (0 – 45.05)
Adult female (6-60 years old) 16.41 (0.01 – 53.86)
Adult male (6-60 years old) 19.29 (0.04 – 59.06)
Elder (over 60 years old) 20.41 (0.09 – 60.76)
Overall 17.7 (0.89 – 45.96)
Dang Xuan Sinh et al, 2016, IJPH

34. Selected key results: Chemical risk
assessment
Tuyet Hanh et al, 2016, IJPH
Most of samples: negative or did not exceed current MRL

35. Economic impact of food borne diseases
• Costs per treatment episode and per hospitalization day for
foodborne diarrhea case were US$ 106.9 and US$ 33.6
respectively.
• 51.3%: Indirect cost (costs of times to patient, their relatives due
to the patient’s illness)
• 33.8%: Direct medical costs
• 14.9%: Direct non-medical costs (patient and their relatives)
Hoang Van Minh et al, 2015, JKMS

36. Pilot intervention option at medium slaughterhouse
- Separate dirty (before de-hairing) & clean (after de-hairing) zones
- On grid (instead of on floor) from evisceration till transport to market
- Clean rinsing water
Better practices!

37. Policy translation: food safety
Meeting with DPM Vietnam, 2 Dec 2016 (Photo:
Tuyet Hanh)
2011
2012
2016
Meeting with VFA, Photo: CENPHER
Meeting with DAH
Photo: CENPHER

38. Vietnam food safety: translational research
• CGIAR/ILRI niche - risk assessment and
policy / regulatory analysis for fresh
foods in domestic markets
• WB convenes overall support to
government
• Long-term (>10 year) engagement –
Government, WB, VN research, CGIAR
partners, CGIAR
Download here

39. Example 3:
One Health for AMR surveillance in
Canada

40. Canadian Integrated Program for Antimicrobial Resistance
Surveillance (CIPARS)
www.phac-aspc.gc.ca/cipars-picra/index-eng.php

41. Programmatic and financial gains from CIPARS,
compared to conventional single sector AMR-
surveillance
• Programmatic gains
• Increased systems knowledge from being connected to all involved
sectors.
• Accelerated time to detection of trends intervention potentially
reduce future disease burden in humans and animals.
• Profitability of CIPARS
• Financial savings when compared to single sector antimicrobial
resistance surveillance.
• Focused design (reduced and optimal sample size), centralized field
and institutional organization
• Centralized laboratory components, IT infrastructure and data
management, training, communication and evaluation.
11. Oktober 2017 41

42. Programmatic and financial gains of
integrated AMR surveillance  to be
assessed
11. Oktober 2017 42
• Parameters to
consider
• Efficiency (investment and
gains)
• Cost (increase and
decreases)
• Human resources
(reduction and possible
fostering at some points)
• Levels / steps in
AMR surveillance
• Sample collection
• Laboratory analyses
• Data warehousing
• Data analyses
• Communication with
interested groups,
stakeholders and policy
makers
• Risk management

43. One Health lab to save cost in Canada
Estimated 26% savings on operational cost of the Canadian Science Centre in
Winnipeg. A missed opportunity for SEA countries?

44. Transdisciplinary process

45. Resources
• Systems Thinking
• Transdisciplinary Research
• Participation
• Sustainability
• Gender and Social Equity
• Knowledge to Action
http://www.idrc.ca/EN/Resources/Publications/Pages/ID
RCBookDetails.aspx?PublicationID=1051
www.transdisciplinarity.ch
Since 2003 Transdisciplinarity-net (td-net) of the
Swiss Academies of Arts and Sciences
Facilitate mutual learning between problem
fields; Provide material; Contribute to foresight
and the dialogue between science and society

46. Cartoon: K. Herweg
Integrating Perspectives and Perceptions & Overcoming Prejudice

47. ➢ 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
Transdisciplinary process
Adapted from Herweg et al. (2011)

48. Key Characteristics and Principles of Transdisciplinarity
•Considering academic and non-academic
knowledge in the research process
•Value contributions of all stakeholders in the
generation of knowledge
Society
Social
sciences
Natural
sciences
transdisciplinary
interdisciplinary
Science
Emerging career profile

49. Herweg et al. (2010)
When do we need Transdisciplinarity?

50. Savanakhet PFBD research 10. 2017
Decision makers
Public
health (MD,
army
health)
Scientists
Vets

51. One Health and beyond
….EcoHealth

52. Ecohealth

53. 11. Oktober 2017 53
Ecosystem approaches to health
• Consider inextricable linkages between ecosystems, society and
health of animals and humans
• Contemporary complex health problems cannot be solved by
“reductionist” approaches and require ecological and social systems
thinking.
 Visit the website at ecohealth.net

54. 11.10.2017 54
Close contact between people and
livestock

56. Ecohealth Field Building Leadership Initiative
in SEA: FBLI – Agriculture Intensification & Health
• Yuanmou (CN)
• Hanam (VN)
• Chachoengsao (TH)
• Pangalengen , West Java (ID)
“Site based- concept”

57. • INDOHUN
• THOHUN
• VOHUN
• MYOHUN
EcoEID
Emerging Pandemic Threats Program
PREDICT • RESPOND • PREVENT • IDENTIFY
EHRCs
GHI
One Health and Ecohealth programs in SEA

58. • Institutional challenges: acceptance, policy
engagement
• Capacity building: One Health workforce
• Incentives: how to share credits, added values of One
Health among members, partners
• Deeper coordination between sectors on human and
animal (and wildlife) health and the environmental
agencies (also plant health)
• Improving the translation of evidence and research into
policy, more cases to show added values of One
Health/Ecohealth
Reflections on One Health implementation
2
3
1
4
5

59. Thank you for your attention!