One Health in Vietnam
from Training & Research to Policy
Phuc Pham-Duc1, Fred Unger2, Hung Nguyen2
1Center for Public Health & Ecosystem Research (CENPHER), Vietnam One Health University Network
(VOHUN), Vietnam
2International Livestock Research Institute, Hanoi, Vietnam
Regional workshop of the ComAcross project, 25-27 November 2015, Bangkok, Thailand

Outline
• One Health Training in Vietnam
• One Health Research – examples
• From evidences to decisions
• Challenges and way forwards
2/1/2016 2

Hanoi (Network Secretariat):
• Hanoi School of Public Health
• Hanoi Medical University
• Vietnam National University of Agriculture
Thai Nguyen University of
Medicine and Pharmacy
Thai Nguyen University of
Agriculture & Forestry
Thai Binh University of
Medicine and
Pharmacy
Hai Phong University of
Medicine and
Pharmacy
Bac Giang Agriculture and
Forestry University
Nam Dinh
University of
Nursing
Hue University of Medicine and Pharmacy
Hue University of Agriculture and Forestry
Dak Lak: Tay Nguyen University
- Faculty of Medicine and Pharmacy
- Faculty of Veterinary and Animal Science
Can Tho
•University of Medicine
& Pharmacy
•Faculty of Applied
Biology and Agriculture
Hochiminh City:
• HCMC University of Medicine and Pharmacy
• HCMC University of Agriculture & Forestry
2/1/2016
VOHUN (Vietnam One Health University Network)
Vinh Medical
University
3

OHW Objectives
Objective 1 – to participate with government, academia, and other key partners in defining
OH workforce needs
(Talking to government and private sector regarding training and research needs)
(University-Government-Private Sector engagement on training and other needs)
Objective 2 –to assist government ministries to train the future “One Health” workforce
(Translating these needs into creating a new ‘graduate species’ to transform public health)
Objective 3 – to assist government ministries to train the current “One Health” workforce
(Supporting governments and private sector by creating new in-service training initiatives)
Objective 4 – Support universities in strengthening faculty capacities for One Health
teaching, research, and community outreach
(Strengthening faculties to train the new workforce)
Objective 5 – Provide organizational development support to One Health networks
(Strengthening networks for support of all initiatives and for sustainability)
2/1/2016

https://seaohunonehealth.wordpress.com/

Academic
Curricula
(pre-service)
One Health
Competencies
(Core & Technical)
Learning Objectives
Modules
Professional
Development “Short
Course”
(in-service)
How to Make Your Curriculum a
One Health Curriculum

• A strategic planning and MoU were agreed &
signed (OHW: 2015-2019)
• One week field trip for International Veterinary
Medicine students – OH clinical practices
• 60 students & 10 lecturers from 10 countries
• Seminars to introduce OH concept/approach
• 17 universities/schools
• 150 lecturers & researchers
• 1,500 students (Preventive Medicine, Public Health &
Vet.)
2/1/2016 7
Achievements

Development of OH training program (1)
1. Developed the training packages for OH elective
modules for Public Health student at the HSPH
11 lessons / 2 credits
4 case study: Streptococcus suis,
Leptospirosis, Rabies, Liver flukes
3. Developed a OH & Health Programs module at the Hai
Phong UMP
 11 lessons / 2 credits
2. Developed the test evaluation for OH elective modules for
Preventive Medicine student at the HMU
 12 lessons / 3 credits
 40 questions/lesson x 12 lessons
 80% MCQ and 20% True/False questions
2/1/2016 8

4. Developing a training program for International Masters
of Public Health – OH orientation
7 core modules : 24 credits
7 Elective modules: 8 credits
6. Developing a zoonotic disease module for Veterinary
Medicine student at the UAF
 3 credits
7. Developing a OH field-based training program for
human and animal health professionals
 1 week (48 hours) in class
 4 weeks field practices
2/1/2016 9
Development of OH training program (2)
5. Developing a training program for International Masters
of Public Health majoring Environmental Health

International Masters of Public Health (OH orientation)
• Program: 1 year
• Core modules: 24 credits
• Elective modules: 8 credits
• Thesis: 8 credits
• Students: Vietnam, Lao PDR, Cambodia, Indonesia,
Malaysia, Thailand
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One Health & Zoonosis Modules
• 3 Credits
• Faculties of Animal Science & Veterinary Medicine (7 Universities)

• Lesson 1: One Health concepts & approaches
• Lesson 2: Fundamentals of zoonotic diseases &
ecosystem health
• Lesson 3: Zoonoses (bacteria & virus)
• Lesson 4: Zoonoses (parasites)
• Lesson 5: Using One Health approach in management
and surveillance of zoonoses
2/1/2016 11
One Health & Zoonosis Modules
(2 -3 credits)

OH field-based training course
2/1/2016
No Subject Number of hours
Theory Assignment Practice Total
I In class: 5 days
1 Basic concepts of One Health
Systems Thinking
4 4 0 8
2 Zoonoses fundamental 4 0 0 4
3 Zoonoses risk analysis 4 4 0 8
4 Applied epidemiology in investigation, detection,
organization, prevention and control zoonoses
3 5 0 8
5 Sampling 0 0 4 4
6 Planning, monitoring, evaluating and reporting 4 4 0 8
7 Cooperation interdisciplines 2 1 0 3
8 Guidance in writing research proposal 1 0 0 1
9 Communication 2 2 0 4
Total 24 20 4 48
II In Field: 4 weeks
III In class: 1 week
Result report 0 0 12 12

Strengthening University-Government Partnerships
1. Strengthening Universities-Government agencies
• Ministry of Health (MOH) / GDPM
• Ministry of Agriculture & Rural Development (MARD) /DAH
• Ministry of Education & Training (MOET)
• OH Partnerships / PAHI,
• Institutes: NIHE, NIVR, One Health Research
2. Strengthening Universities – International organizations
• USAID, WHO, CDC, ILRI, FAO, IDRC, WSC, OIE, etc.
OH continuing education course = OH field-based + FETP + AVET
(VOHUN) (MOH) (MARD)
2/1/2016 13

What did we think?
• Agricultural intensification had closed relationship with ecosystem
and human health.
• Livestock: advantages and disadvantages
• Livestock waste management, reuse.
• Any innovative changes are needed to develop the agricultural &
livestock systems to increase production, at the same time
preserving and enhancing natural resources.
• Using ecohealth approach to manage animal and human wastes
Better Human and Animal Waste Management in Hanam Province,
Vietnam – using Ecohealth / One Health Approach

What we did so far:
(NCCR North-South program)
1. Community engagement
(Local authorities)
2. Research ( PhD, MSc)
But more focus on “Diseases”: Health Status,
Diseases..
Focal Issue
Sanitation & Health
Kim Bang district, Hanam,
Vietnam
•Human, animal health & well-
being
•Environment
•Social- economics
Understand the real situation of Agriculture intensification
Issues
Stakeholder
workshop
 Issues
identified
•Design
•Implement
•Intervention
•Dissemination
Communicate with
Stakeholders
engagement
Community engagement
Researchers stay with
community (none-scientists)
What do we need?

Some research activities were carried out
• PRA: to identify emerging problems of local communities and issues related to
agricultural and human waste managements.
• Baseline survey: 461 households
• to explore the relationship between waste management practices and rural
household health status in the study sites
• to identify the current animal waste treatment methods
• Health risk assessment related to biogas-wastewater
• Exposure assessment: 451 pig farms; Samples: 150
• Quantify the microbial and chemical indicators: E. coli, Salmonella, Giardia,
Cryptosporidium, BOD & COD, pH, temperature
• Estimate the risk of infections and diarrhea by the specific pathogens
• Community-based intervention
• Village regulation; good practice pig farm; behavior change communication.
2/1/2016 16

Risks of diarrhoea related to biogas wastewater
 Increasing livestock production (MARD, 2013)
 Environmental pollution caused by livestock waste becomes more severe
(Đ.T.T.Sơn, 2011)
 Biogas is commonly used for treatment of livestock waste (H.K.Giao, 2010)
2/1/2016
 Biogas if not properly used -> the efficiently destroyed pathogens is low
(V.T.Y.Phi, 2009; Jirina, 2012)
 Most pig farms discharge biogas wastewater direct to public drainage
(79%), irrigation (43%) (L.Q.Hương, 2014)

February 1, 2016
Monday seminar18
Dose-response models (Sources: Haas et al., 1999, Howard et al., 2006)
Estimated single risks of infection
Exponential model (Giardia & Cryptosporidium)
Pinf(d) = 1 – exp(-rd)
β-Poisson model (E. coli)
Pinf(d) = 1 – [1+ (d/ID50)(21/α – 1)]-α
Where are:
- Pinf(d) : risk of infection in an individual exposed to a single pathogen dose (d)
- α: infectivity constants (E. coli: 0.1778)
- ID50: pathogen dose at which 50% of a population will be infected (E. coli: 8.6 x 107)
- r: infectivity constants (Giardia: 0.02 and Cryptosporidium: 0.00467)
- d (dose ingested) = μ x m
μ: concentration of organism/100mL
m: amount of water accidental ingested
Quantitative Microbial Risk Assessment (QMRA)
(Hazard identification – Dose-response analysis – Exposure assessment
– Risk characterization)

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
Maintaining biogas
Cleaning drainage
Irrigating corn crop
Irrigating fruit tree
Irrigating vegetable
Estimated single risk of diarrhoea Giardia
Estimated single risk of diarrhoea Cryptosporidium
Estimated single risk of diarrhoea E. coli
Probability of diarrhea risk by E. coli
(12%), Crypto (25%), Giardia (5%)
Estimated average single risk of diarrhea

Community-based Intervention
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Reduce the health
risks related to biogas-
wastewater (human,
animals)
• Decreasing the frequency
exposure to biogas-wastewater
• Reduction of pathogens in the
biogas-wastewater (E. coli, Sal)
• Safe use of wastewater-
irrigated products (vegetables,
fish)
• Properly treatment of animal wastes
by biogas system
Good Practice Pig-Farm (GPPF)
in Vietnam
• understand the biogas operation and
maintenance process
• aware the health risks related to biogas-
wastewater (human & animals)
Good
enforcement
the village
regulation on
environmental
sanitation
Effective
behavior change
communication
Increase skills
for monitoring
& prevention
of animal
diseases
Village core group members (local authority, head of village,
village health workers & para-vet.; pig holders) & Researchers

Community-Based Intervention
2/1/2016 21
Good Practice Pig-farm
• Saving time, water,
electricity, money
• More gas for cooking
• Less smell, flies
• Improving personal
hygiene practice
• More friendly
• Increasing productivity

Project frameworkRisk profiling
Risk assessment
Microbial Risk Assessment
Chemical Risk Assessment
Economics (eg health, CBA)
Value chain
Rapid assessment
Economic assessment
Animal Health Risk Assessment
…
….
Interventions
Action research 1
Action research 2
Action research 3
…………………
Engaging stakeholders and co-generating evidence, Advocacy, Communication, OM
1
2 3
4
Incentive-based interventions
Randomized Control Trials (RCT)
“Reducing disease risks & improving food safety in
smallholder pig value chains in Vietnam” (PigRisk)

Risk assessment: Salmonella in pork production chain - Pig
slaughterhouse and pork market.
Pathogen concentration (N)
Pf
Infection risk (P)
Farm Market
Slaughter-
house
Fork
Consumption
Exposure
assessment
Exposure
assessment
Risk
Pp Pr
Nf Np Nr
Source: Microbiological Risk Assessment Series No2-2002, No7-2008
RISK OF MICROBIAL CONTAMINATION IN THE CHAIN
RISK OF INFECTION FOR CONSUMERS

• Established a Taskforce of risk assessment for food safety: MOH,
MARD, Institutes, Universities, Private Sectors...
• Analyses of food safety policy in Vietnam and how research
evidence informs policy.
• Stakeholder workshops were conducted to identify the scope of
activities and priority issues in food safety.
• Training courses and follow-up along with case studies of risk
assessment for food safety were held.
• Developed the guidelines for risk assessment on food safety (both
microbial and chemical hazards).
• Dissemination workshops to development of policy on food safety.
Taskforce: Food Safety Risk Assessment

Capacity building
• Training courses for public health & veterinary
professionals – MOH, MARD.
• Developed textbooks and guidelines on food
safety risk assessment.
• Publication of a special edition of risk assessment
in a Vietnamese journal;
• Policy briefs developed

…real situation of policy change
Identified
issues
Research Results
Policy
makers
accepted
?Policy
changed

From Evidences to Decisions
• Establish a working group / policy alliance group (PAG)
• Meetings, study site visits, dialogue, forum, etc.
• Mass media, communication event, linking websites
• Provide clear/concrete evidences, goals, targets (policy briefs)
• The message must be designed specifically for the policy makers to
better reflect their needs
• The credibility of the “messenger” can be as important as the
message itself
• Will & determination to move and wait for opportunities
• Stakeholders analysis – win without fighting

Example: Topics to be discussed
• The government is developing a strategy for developing livestock
production;
• How recommendations issued by Ecohealth/One Health project can better
be in line with current discussions on the policy?
• How the Working Group can assist CENPHER to design the research
results in a message targeting decision makers?
• Who can be the best “messenger” to present Ecohealth project
and results to decision makers?

Moving towards a One Health approach in Vietnam
• MARD-MOH joint inter-ministerial circular (16) on coordinated
prevention and control of zoonotic diseases (May 2013)
• Establishment of new DAH division on veterinary public health as well
as the Emergency Operations Center located in GDPM office
• OH is in the national strategies
• Emerging Pandemic Threats activities, VAHIP, SEA-EU-NET and
associated donor commitment
• Recognition of the need to include wildlife in animal health efforts
and zoonotic risks
• One Health Communication Network for journalists

• Institutional challenges: acceptance, policy engagement
• Capacity building: One Health Workforce
• Incentives: how to share credits, added values of One Health
• Deeper coordination between sectors on human and animal
(and wildlife) health and the environmental agencies
• Improving the translation of evidence and research into policy
Challenges

Summary and conclusion
One Health in Vietnam
- Great attention and support from different level
- Training in good way, but limited research
- Inter-sectoral collaboration and policies: good enabling environment
Challenges and ways forward
- Capacity building: One Health Workforce
- More research & case studies
- Deeper coordination of sectors: further (re)-organization
- Resources

Acknowledgement