Tackling emerging infections at source

The issue of One Health was once again discussed in depth at the World Health Summit (WHS). Following on from last year’s workshop hosted by IAP this year IAP partnered with the One Health Platform to co-host a session on ‘Tackling emerging infections at source’.

Setting the scene, IAP Coordinator Peter McGrath noted that the WHS sits between two other major events in 2016 – the United Nations Environment Assembly held in Nairobi, Kenya, in May, and the forthcoming One Health/Eco-health congress scheduled for Melbourne, Australia, in December. He hoped that connections could be made across these meetings  to develop stronger partnerships.

On the theme of partnerships, Ab Osterhaus, founding chair of the One Health Platform, briefly introduced the Platform, its aims, its activities, including the organizations of congresses and building networks of researchers, and its reliance on a strong network of national and international partners.

Unfortunately, Balakrishna Pisupati of the United Nations Environment Programme (UNEP) in Nairobi was unable to attend as planned. He sent a message, however, reporting that the Second United Nations Environment Assembly (UNEA 2) focused on the topic of ‘Healthy Environment, Healthy People through a High Level Ministerial session, and that the World Health Organization and the Convention on Biological Diversity have launched a joint report on the contributions of ecosystems and biological diversity to human health and wellbeing. In December this year – as well as the event in Melbourne – the United Nations Biodiversity Conference scheduled to be held in Cancun, Mexico, will also have a special focus on biodiversity and health – confirming the growing interest of UN organizations in tackling the One Health nexus.

The first speaker, Fabian Leendertz of the Robert Koch Institute, Berlin, put this in perspective in his presentation that focused on emerging infections at the human-wildlife interface. Basing his talk on his own research with great apes and other primates across Africa, he noted that logging allows people access to previously pristine rainforest habitat as communities of farmers move into cleared land. This dynamic brings people into closer contact with primates, other animals consumed as bushmeat, as well as the communities of microbes that may (or may not) be able to infect humans.

Indeed, his talk could be summarised by a single photograph he took on the first day of a recent visit to Rwanda that showed a woman from a small farming community, a flock of goats and a gorilla all in the same jungle clearing.

Rajae El-Aouad of the Hassan II Academy of Science and Technology, Morocco, then recounted her country’s experience in dealing with the H1N1 avian flu epidemic of 2009. Fortunately, she recounted, Morocco had put in place a robust system of detecting, monitoring and tracking infections. This system included trained personnel in well-equipped labs around the country who were able to perform necessary diagnostic tests, as well as an online platform for doctors to input data and which collated data from across the country to provide a real-time overview of the situation.

The success of the national response in dealing with the epidemic was also due in large part to the leadership of a respected person (in this case from the military) who was able to motivate all stakeholders and ensure that each sector (public health, veterinary health, etc.) produced timely reports that kept everyone informed so that appropriate follow-up action could be implemented.

One feature of the preparations for such an event, said El-Aouad, was that the scientific personnel were trained in Morocco. This meant that they were more likely to stay in the country rather than leave for positions in Europe or the USA, which would be more likely if they had received training in such countries.

The lessons learned from the Moroccan experience showed the need to enforce a public health law in low and middle-income countries as a prerequisite for implementing a One-Health approach and to develop local public health, One Health and leadership programmes to train the relevant workforce to tackle the threats these countries are facing.

The final speaker in the session, Tony Capon, director of the International Institute for Global Health, United Nations University, Malaysia, advanced the discussions from the village and national levels presented by the previous speakers to the global level.

He focused on the Rockefeller Foundation-Lancet Commission report on planetary health, ‘Safeguarding human health in the Anthropocene epoch’

Earth’s environment provides us with a number of ecosystem services, explained Capon, but there are limits to how much we can exploit these. And in many cases we are at, or even beyond, these ‘planetary boundaries’. For example, the seas are being overfished – which will have consequences on food security for millions of people unless we develop truly sustainable aquaculture practices; air pollution from urban smog, indoor cooking stoves and forest clearance is damaging lungs and causing morbidity and mortality in many countries; and despite the best intentions of the world’s governments in ratifying the recent Paris COP21 climate change agreement, there are fears that it could be too little too late to prevent many of the predicted scenarios of global warming and its effects on agriculture, biodiversity, health and wellbeing.

Preserving forests, noted Capon, is one positive action that can provide a series of benefits with regard to emerging infections as well as reducing air pollution. Developing sustainable, healthy cities can also provide multiple benefits.

During the discussion, Omar Sey, Minster of Health, the Gambia, noted that the World Health Organization and the UN Food and Agriculture Organization (FAO) are convening a meeting in Senegal this coming November that will bring together the minsters of health, ministers of agriculture and ministers responsible for wildlife plus technical experts from 15 countries belonging to the Economic Commission of West African States (ECOWAS).

Such a cross-sectoral initiative was welcomed and encouragement was given to develop concrete resolutions such as suitable training and exchange opportunities for young scientists in the region. If successful, such meetings could become a model for other regions.

In the area of One Health, it is clear that actors from different sectors must come together to discuss and define multidisciplinary solutions to the traditional silos. For this reason, the WHS, which brings together high-level persons from policy/government, academia, NGOs and the private sector is an ideal forum for highlighting issues under the One Health banner.