Global Health True

Leaders

One Health Concepts

and Knowledge

Prof. Stan Fenwick

Tufts University

DI Yogyakarta I June 24-29, 2019

 ONE HEALTH is ~

“The collaborative efforts of multiple disciplines, working

locally, nationally and globally, to reach optimal health for
people, animals and the environment”
One world……..
• No country is isolated
• Wildlife, livestock, people and diseases do not respect boundaries
• Countries of the world are inter-dependent
• Knowledge, goods, services
• What happens in one country has impacts far beyond its borders
• ‘Butterfly effect’
 ONE HEALTH
Involves and integrates all sectors involved in maintaining good
health for humans, animals and the environment
Human and veterinary medicine
Public health
Epidemiology
Research
Environmental sciences
Social sciences
Economics
Politics
 WHAT ARE…

Complex Problems
(sometimes called “Wicked Problems”)

And why is the One Health approach essential for their

resolution?
 “Wicked Problems”

• Complex and tangled

• Difficult to define or to solve using standard approaches
• Many possible solutions all of which have multiple scenarios
• Solutions may generate unexpected consequences
• Often a symptom of another problem

(King, 2011)

Which brings us to One

Health!
 WHAT DO……

Malariologists, acarologists, entomologists, epidemiologists, bacteriologists, virologists,

parasitologists, chiropterologists, primatologists, zoologists, ornithologists, rodentologists,
ecologists, sociologists, anthropologists, hemipterologists, dipterologists, hydrologists,
biologists, archaeologists, geologists, palaentologists, meteorologists, agroecologists,
economologists (!) and other ‘ologists’…….

Have in common with veterinarians and public health professionals??

….all are disciplines that work on understanding and controlling

vector-borne diseases, most of which are zoonoses
How can H5N1 best be described?
An animal health problem?

A public health problem?

A food security problem?

An environmental health problem?

A trade problem?

An economic problem?

A political problem?

Or all of the above?

 Examples of One Health Issues
(all are complex problems or ‘wicked problems’)

Zoonotic disease surveillance, prevention, detection, response

Food safety from farm to fork

Public health issues at the animal human interface – e.g. pollution, intensive farming,
cross-species interactions, animal products trade

Wildlife health issues – human encroachment and increased interaction, bush meat
consumption, ecosystem degradation

Antimicrobial resistance – overuse in animals and humans, incorrect usage, spread of

resistant bacteria from animals to humans, residues and AMR bacteria in the
environment

Disaster preparedness – rescue and emergency services, disease risks, interactions

between animals and people
 Investigation and control of zoonotic diseases, and other
complex problems, is impossible without a trans-disciplinary
approach involving human, animal, environmental and other
scientific disciplines

http://www.oie.int/en/for-the-media/press-releases/detail/article/the-oie-introduces-its-new-one-health-web-portal/
 It would appear so…all of the following are important
zoonoses in various parts of the region

• Rabies • Leptospirosis
• Nipah virus • Anthrax
• MERS • Brucellosis
• HPAI (H5N1, H7N9, H9N2) • Streptococcus suis
• Japanese encephalitis • Foodborne bacteria
• Chikungunya • AMR bacteria
• Zika virus • Neurocysticercosis (T. solium)
• (Hantavirus) • Trichinellosis
• (SARS) • Opisthorchis/Clonorchis
• (Ebola) • Plasmodium knowlesi
• (Yellow fever)
 FAO-OIE-WHO Tripartite Alliance

Concept note published in 2010

The document “formalises the sharing

of responsibilities and the
coordination of actions to manage
health risks at the human-animal-
ecosystems interface”

• Surveillance and early warning

systems
• Consistency of standards (OIE
standards, IHR, Codex
Alimentarius)
• Evaluating and managing disease
risks
• Building capacity of health
authorities in member countries
3 Priorities of the Tripartite Alliance highlighted at
a High Level Technical Meeting in Mexico City in
2011

Animal influenza; Antimicrobial Resistance; Rabies

 The Global Health Security
Agenda (GHSA)
”We must come together to prevent,
and detect and fight every kind of
biological danger – whether its a
pandemic like H1N1, a terrorist
threat, or a treatable disease.”
President Barack Obama, 2011
 The Global Health Security Agenda
is committed to a multi-sectoral (OH) approach

➢ Human Health
➢ Animal Health
➢ Environmental health
➢ Agriculture
➢ Food Security
➢ Economic Growth
➢ Education
➢ Humanitarian Assistance
➢ National Security
➢ Foreign Affairs Prevent, Detect, Respond
➢ Defense
 Global Health Security

3
Risks
3
Opportunities
3
Priorities
© David Snyder/CDC Foundation

• Emerging • Public health framework • Prevent wherever possible

organisms • New lab and surveillance • Detect rapidly
• Drug resistance tools • Respond effectively
• Intentional • Successful outbreak
creation control
However, despite all our collective knowledge we don’t
always get it right, as working together across disciplines
does not come naturally!

~ rabies, west nile virus, avian influenza, BSE

 Lessons that need to be learnt from the
2014 Ebola epidemic

• Mounting a response after the onset of human-to-human

transmission leaves the world vulnerable

• "Events" once local can rapidly become global

• Weak infrastructure anywhere, health in particular, poses a threat

everywhere

• Early recognition of a potential threat allows for a global effort

to take pre-emptive steps
…as well as old diseases, new diseases are constantly emerging
or re-emerging and we need to be prepared!

Which is why a competent, well-trained OH workforce is

vital to prevent, detect and respond to global and regional
infectious disease threats…………
… and that was the goal of the USAID Emerging Pandemic
Threats programs (EPT1 and EPT2)

Goal of EPT1 - RESPOND

(2009-2014)

To improve the capacity of countries in high risk areas to respond

to outbreaks of emerging zoonotic diseases that pose a serious
threat to human health using a One Health approach

Goal of EPT2 - One Health Workforce

(2014-2019)

To employ the strengths of universities to prepare the OH

workforce in the competencies and skills for preventing,
controlling, detecting and responding to zoonotic diseases
…. SEAOHUN – the South East Asia One Health
University Network – was established in 2012 with
support from RESPOND!

21
South East Asia One Health University
Network

SEAOHUN

Launch of network name

 SEAOHUN OH Core Competency Project

In order to work together effectively to respond to

outbreaks of disease it is essential that future
professionals adopting the One Health approach have
a common platform – a set of Core Competencies –
enabling them to interact easily

and to

‘speak the same language’

 Skills and Attitudes
One Health Core Competencies

• Leadership
• Management
• Communication and Informatics
• Collaboration and Partnership
• Culture and Beliefs
• Values and Ethics
• Systems Thinking

All of these are linked closely to the efficient and effective

response to an outbreak of disease
 By integrating the One Health approach into
training……

• We ensure that One Health professionals are well-

trained for their roles

• We give multiple health-related professions the skills to

work collaboratively with each other and with
government, the private sector and communities

• We encourage health professionals from all sectors to

work together to develop and restructure health systems
to benefit from One Health and the OH approach
 Rudolf Virchow – the ‘Father of One Health’ 1821-1902

Physician and pathologist, coined the term ‘zoonosis’,

advocated for improved veterinary medicine and pioneered
social medicine; researched many zoonoses; identified the link
between Trichinella and trichinosis

“Between animal and human medicine there are no dividing

lines – nor should there be. The object is different but the
experience obtained constitutes the basis of all medicine”
 One Health in the 21st Century
• While OH has been advocated for many years for the
control of zoonoses, in reality responses were rarely
multidisciplinary

• However, in 1997 and 2003 the appearance and global

spread of Highly Pathogenic Avian Influenza H5N1, with
the potential for pandemic disease in people, was the
impetus for government departments and other agencies to
start to work together

• Since then a number of ‘new’ diseases have occurred that

have helped to maintain the global OH momentum
The Final Word From SEAOHUN!!

28
…and from OH Student Clubs!
Q&A Session
• Kamila: we need a coordinator, in this multidisciplinary who should be proper to
initiate the collaborative process?
• Answer: doesn’t matter what discipline you come from. What needed is a
charismatic leader that someone will follow, with the right innovative skills.
• Sinta: policy is important, but on the other hand, there is also important part of
one health. How to engage all of the researchers, NGOs, and all resources
connect with the government to make the policy.
• Answer: NGOs need to work very hard to get recognized by the government and
all resources, bringing people together to share ideas and make changes
• Yekti: The reality is not that ideal, several people still have narrow mind (esp
dentistry) for working only on their discipline.
• Answer: it’s a problem worldwide, it’s hard to get people to work together.
Started by gathering with multidiscipline colleagues, and exchange ideas.
THANK YOU