One Health - A Framework for Optimising Health Outcomes PDF

One Health: A Framework for Optimising Health Outcomes Dr Jessica Clark School of Biodiversity, One Health and Comparative Medicine [email protected] Intended Learning Outcomes An understanding of the concepts and principles of One Hea...

One Health: A Framework for Optimising Health Outcomes Dr Jessica Clark School of Biodiversity, One Health and Comparative Medicine [email protected] Intended Learning Outcomes An understanding of the concepts and principles of One Health An appreciation of the scope of global challenges for which One Health has relevance Knowledge of specific examples of the application of One Health approaches Recognition of the opportunities and challenges in One Health  “One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment What is (including ecosystems) are closely linked and inter-dependent. The One Health? approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.” The One Health High Level Expert Panel (OHHLEP) Principles of equity, sustainability, stewardship and multisectoral collaboration, drawing on different types of knowledge and perspectives Adisasmito W. B., et al. PLoS Pathog 18(6): e1010537. https://doi.org/10.1371/journal.ppat.1010537  Human civilisation and the One Health state of the natural systems (current) Shift on which it depends Planetary towards Health systems dynamics Systems-based approaches to understanding and promoting health within socio-ecological systems The EcoHealth evolution Interdependence of the health of humans, animals of and the environment One Health (former) concepts Commonalities between human and veterinary One Medicine medicine (Calvin Schwabe) Adapted from: K. Grützmacher, WCS, OHHLEP Although drivers of illness and poor health are often anthropogenic, our solutions should not be anthropocentric We need to move towards a more ecological approach to health One Health scope across many interfaces Zoonoses (pathogens transmitted animals to people) Emerging infectious diseases Endemic zoonoses and neglected diseases Food systems, food security Agricultural production, land use, climate change, food safety International health and development Sustainable development goals Natural resources, biodiversity and conservation Ecosystem health, water/soil quality, carbon dynamics Antimicrobial resistance Environment, animals and mental health Human-animal bond Sustainable Development Goals (SDGs) UN 2030 Agenda for Sustainable Development (adopted in 2015) Expanded the aims of the Millennium Development Goals Key areas: Food security, poverty alleviation, climate change, social justice, peace, environmental protection, health One Health and the Sustainable Development Goals One Health provides a framework for achieving cross-cutting benefits that span multiple SDG goals and targets  Cross-cutting benefits of animal health interventions Marsh T. et al. Science Advances. 2016; 2:e1601410  Increasing demand for meat and milk Food, health, the planet & Overconsumption  Childhood stunting 2018 >30% (very high) 20-30% (high) Food, health, the planet & Underconsumption Source Food, health and the planet: regional realities Per capita consumption of animal source foods has declined in sub-Saharan Africa over past few decades 220 million in sub-Saharan Africa are under- nourished Levels of stunting are high, often associated with low consumption of animal-source foods High intake of animal source foods has been associated with improved growth, cognitive performance, motor development and increased activity in children Willett et al. (2019) Food in the Anthropocene: the EAT-Lancet Commission on health diets from sustainable food systems. Lancet.  Livestock are critical assets for many of the world’s poorest people Over 1 billion people rely on livestock for food security and livelihoods Important for crop production (traction, manure), social capital and social protection Issues around livestock diseases: Food security, food safety, malnutrition Incomes, livelihoods, expenditure on health and education Zoonotic disease problems Unsupervised use of antimicrobials Implications for land-use and rangeland health Mental health problems Photo: Dr Tiziana Lembo Consequences of livestock diseases: foot and mouth disease in Tanzania Casey-Bryars et al. (2018) Nature Ecology & Evolution 2: 1449-1457 The momentum behind One Health: Epidemics Ebola virus Highly pathogenic avian influenza Monkeypox Zika virus SARS-CoV-2 Key One Health Ebola Highly pathogeni Priorities virus c avian influenza Origins of emerging diseases Drivers of spillover and disease Monkey Zika SARS- emergence pox virus CoV-2 Zoonotic disease surveillance  Characteristics of emerging human and animal pathogens Viruses - particularly Generalist pathogens 61% of human RNA viruses - are over- that can infect a wide pathogens and 75% of represented among range of host species emerging human human, livestock and are over-represented in pathogens are domestic carnivore human and livestock zoonoses emerging diseases emerging diseases Wildlife represent important reservoirs of emerging pathogens 1. Taylor et al. (2001) Phil. Trans. R. Soc. Lond. B Biol. Sci. 356, 983–989 Drivers of disease emergence events Loh et al. 2014 Vector-borne and zoonotic diseases 15.  Numerous case studies show associations between land use and zoonotic disease risk Irrigation-based agriculture and Japanese encephalitis Deforestation and Plasmodium knowlesi Land-Use Agricultural practices and emergence of Nipah virus Change Leptospira infections and rice fields Lyme disease and forest fragmentation COVID-19 - growing global awareness of need for mechanisms and policies to https://ipbes.net/sites/default/files/2020-12/ IPBES%20Workshop%20on%20Biodiversity mitigate the role of land use %20and%20Pandemics%20Report_0.pdf change in emerging disease risk Plowright R. et al. 2021. The Lancet Planetary Health  Changing land-use, human behaviour and virus emergence: Nipah virus Agricultural intensification of pig farms adjacent to bat-attracting mango plantations in Malaysia provided the conditions for Nipah virus emergence in pig populations after spillover from fruit bats. Covering to prevent bats feeding on date palm sap Pulliam J. et al. (2011). Agricultural intensification, priming for persistence Photo from: Nahar et al. 2012, Health and the emergence of Nipah virus: a lethal bat-borne zoonosis. J. R. Soc. Promotio International 28(3).  Endemic Zoonotic Diseases Highest burden in poor and disadvantaged communities Livestock zoonoses often affect livestock health and productivity Impose a major burden on No. of poor livestock livestock- keepers/km2 dependent communities Tools are available for prevention and control of many endemic zoonoses The diseases One of more people or animals themselves are not per 100 affected by one or more ‘neglected’ zoonotic disease per year Grace et al (2012) Mapping of poverty and likely zoonoses hotspots. ILRI Factors contributing to the ‘invisibility’ of endemic zoonoses Lack of disease burden data Cycle Diagnostic challenges Limited diagnostic capacity of Non-specific clinical signs neglec Affect disadvantaged and t neglected communities Limited investment in prevention and control Halliday et al. (2015) Veterinary Record 176: 220-225 Epidemiology of human Decline in febrile illness in low- and Plasmodium falciparum infection middle-income countries prevalence 2000 (a) to 2015 (b) Fever is one of the most common symptoms among people in low- and middle-income countries Management of disease represents a clinical challenge Multiple causes (aetiologies), considerable local variation S Bhatt et al. Nature 526, 207-211 (2015) doi:10.1038/nature15335 Prasad et al. 2015. PLoS One 10(6): e0127962  Malaria – Overall Causes of febrile illness in Fungal (18.8%) 1.9% adults and adolescents, northern Tanzania Mycobacterial (12.5%) No diagnosis (33.2%) Clinical diagnosis Bacterial (61.6%) ALL INFECTIONS Bloodstream infections (27.8%) Other Malaria (38.4%) (61.6%) *These also cause production Brucellosis* (5.3%) losses in livestock Livestock vaccines available Chikungunya (5.7 %) Leptospirosis* (10.1%) but rarely deployed in Typhus group African settings rickettsiosis (1.0%) Q fever* (7.9%) Spotted fever group rickettsiosis (8.7%) Biggs et al., 2011; Prabhu et al., 2011; Crump et al., 2013 One Health Interventions: Targeting animals, protecting people Interventions and tools exist for prevention and control of many zoonoses at source Many animal vaccines available e.g. brucellosis, Q fever, leptospirosis, Rift Valley fever, toxoplasmosis, rabies……. Many benefits from interventions at source Reducing the disease burden in people and animals Preventive interventions at the animal source provide a broader ‘safety net’ than reliance on clinical management of human cases alone Necessary for elimination of infections involving animal reservoirs  Post-exposure prophylaxis (PEP) delivered as a medical Rabies intervention when people bitten management One health challenges and opportunities Mass dog vaccination to prevent transmission from animal reservoirs  The disease is an acute, Rabies: progressive encephalomyelitis Highest case fatality of any An exemplar disease of One Caused by viruses in the genus Health Lyssavirus opportuniti All mammals can be affected es and Credit: MYANMAR-ROHINGYA/REUTERS/DAMIR SAGOLJ Lankester et al. (2014) Science, 345: 1562-1564 > 99% of human deaths are caused by domestic dogs challenges usually through bite transmission  30 million people receive PEP every year (direct cost ~$1.7 billion/year) Rabies management The most vulnerable families face enormous challenges in accessing and affording PEP One health challenges and opportunities As a result ~ 60,000 people die of rabies every year Hampson K. et al. (2015) PLoS Negl Trop Dis 9(4): e0003709.  Global burden of canine rabies 37,000 deaths Annual rabies deaths/100,000 Cost: $6.7 billion Rabies primarily affects people in 179 deaths 21,000 deaths poor, rural Cost: $352 Cost: $1.2 communities in million billion Asia and Africa Hampson K. et al. (2015) PLoS Negl Trop Dis 9(4): e0003709. Human rabies only occurs in areas where dog vaccination coverage is low Human rabies deaths Dog vaccination coverage Hampson K. et al. (2015) PLoS Negl Trop Dis 9(4): e0003709.  Human rabies deaths: an indicator of inequalities Every hour more than 3,000 people in rabies-endemic countries are faced with life-threatening emergencies when bitten by dogs Inequalities in access to life-saving PEP Hampson K. et al. (2009) PLoS Negl Trop Dis 2(11): e339.  Rabies Prevention: Benefits of a One Health Approach Status Quo Under status quo >1 million human PEP (Gavi) rabies deaths from 2020-2035 in 67 PEP + dog vaccination endemic countries Fewest deaths occur when PEP access is improved alongside scaling up of dog vaccination Dog vaccination acts as a safety net to protect the most vulnerable WHO modeling consortium, Lancet Infectious Diseases United Against Rabies Forum Launched in 2020 “We have a bold vision: the global elimination of rabies by 2030. None of us can do it alone. But together, we can make rabies history.” Our Goal: Zero by 30 Partnership of WHO, OIE, FAO and public and private sector, and civil society  Allocation of resources across sectors Expenditure on human and dog rabies vaccination (2015) Afri Asia Latin ca America The Global Vaccine Alliance has approved investment in human vaccines BUT…parallel investments in mass dog vaccination prove to be challenging In Africa and Asia, only 4-6% of funds for rabies control and prevention are allocated to dog vaccination Cleaveland et al. (2017). Phil Trans Roy Soc Lond B. 372: 20160168 Auty et al. Rev. sci. tech. (2021) OIE 40(2): 483-495  Rabies Polio vaccination vaccination Charging for interventions Both immunisations aim to protect childhood health and prevent deaths Childhood immunization delivered free of charge Charging fees is only invoked for animal interventions https://www.unicef.org/ immunization  Livestock-based Livelihoods: Optimising Health, Food Security and Biodiversity Tanzania: 38% land comprises protected areas Tanzania has among the From Kihupi, N.I. et al (2015). J Agric Sci largest livestock populations in Landsat 2000 Landsat 2010 Sentinel 2016 Africa Cropland 9% Cropland 16% Cropland 29% A large proportion of the population is dependent on livestock Livestock Data: FAO Gridded Livestock of the World Challenges to health, livestock production and biodiversity arise from growing pressures on land in the face of human population Malignant Catarrhal Fever (MCF): Background A fatal viral disease of cattle transmitted from wildebeest Transmission risk highest during the wildebeest calving season Up to now, no treatments or vaccines have been available Prevention has relied on avoidance of high- quality grazing lands during the wildebeest calving season  Consequences of avoiding MCF 64% milk unavailable for 90% cattle herds sale or Cattle re-gain moved away from consumption (loss body condition principal family of up to 8% more slowly residence annual household income) Lankester et al. (2015) The economic impacts of malignant catarrhal fever on pastoral livelihoods. PLoS One9 (10). e110811  Environmental consequences of poor livestock productivity 197 5 Ma s Na ai M Re ion ara t s e al rv e Conversion of rangeland to 199 5 crop-based agriculture Ma s Na ai M Re tion ara s e al rv e Wildebeest populations strongly declined when wheat cultivation Mechanised agriculture expanded in theSerneels Serengeti-Mara associated with major & Lambin (2001) J Biogeography 28: 391-407 MCF Vaccination A new vaccine has been developed that provides partial protection against fatal MCF How are pastoralists in Tanzania likely to want to use the vaccine? What would be the impact of vaccination on: Food security and livelihoods Cattle movements and management Wildebeest movements Pasture quality  One Health: Evaluating Trade-Offs Potential benefits of a MCF vaccine Potential problems of a MCF vaccine Improved pastoral livelihoods and nutrition Increasing livestock numbers resulting in land (particularly children) degradation Reduced land use conflict Increasing human-wildlife conflict Counteracting sub-division of land Negative impacts on the wildebeest migration Maintaining ecological integrity of the ecosystem  Livestock food production in semi-arid rangelands: critical interactions between human, livestock and environmental health  Challenges in One Health Interdisciplinary and intersectoral challenges Different ‘languages’, issues of trust, control and influence Community engagement recognized as a priority but One Health still largely driven by ‘top down’ initiatives Challenges in funding for and implementation of preventive measures Large teams – costly, communication challenges, transaction costs Professional recognition and career progression  Opportunities in One Health Recognition of the need for more integrated and ecological approaches to tackling many global challenges including infectious diseases, epidemics, antimicrobial resistance, food security, environmental degradation. Ecologists and evolutionary biologists have critical expertise and are ideally placed to contribute to One Health interdisciplinary teams. Funding available – but subject to change - currently targeted towards pandemic prevention & response, and Any Questions? [email protected]  The multiple benefits of pastoral livestock systems High levels of biodiversity at moderate livestock grazing intensity Mobile pastoral systems are a productive form of land-use in arid and semi-arid rangelands Pastoralism evolved in response to environmental uncertainty and climate variability Pastoral livestock systems can be carbon neutral But…..in many parts of the world pastoral systems are under threat Muchira et al. (2008) Journal of Arid Environments. 72: 940-952 Herrero et al. (2008) Agriculture, Ecosystems & Environment 126 122-137 Assouma et al. (2019) Journal of Arid Environments. 162: 62-73  Impacts of FMD in Reduced household milk consumption Uganda Reduced income from sale of milk, Image and data courtesy of Susan Kerfua poultry, eggs and bananas (Nelson Mandela African Institution of Science  Land-use, climate, viral dynamics and emerging disease risk: Hendra virus Causes a fatal disease of horses and people Virus transmitted from flying fox species Habitat destruction => displacement of bats to new habitats in agricultural and urban areas Winter food shortages => high levels of of virus shedding from flying foxes, closer contact with horses Increasing risk of spillover transmission Eby et al (2022) Pathogen spillover driven by rapid changes in Photo: Doug Gimesy https://www.nationalgeographic.co.uk/ ecology.