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
Overview

• One Health concept and

transdisciplinarity
• Examples of One Health application
(Zoonoses, Food safety, AMR)
• One Health, Ecohealth and beyond
Good environment to practice One Health!

• International Livestock Research

Institute (ILRI) (www.ilri.org)

• Hanoi University of Public Health

(www.huph.edu.vn)
Context of Emerging infectious
diseases (EIDs) and drivers in
SEA
 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…
 Infectious Disease Emergence at Global level

from from
wildlife non-
wildlife

drug- vector-
resistance borne

Jones et al – Nature - 2008

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

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)

http://www.cdc.gov/onehealth Expanded One Health encompasses any

issues related to human, animal and
environment health
 What is One Health?

• Recognition of inextricable linkage of human,

livestock, companion animal and wildlife
health.
• Adding values from closer cooperation of Veterinar
human and animal health. y
medicine

• More knowledge
• Better health (human or animal) medicine
Human Environmen
tal science
• Economical benefits/ savings
 Benefits of One Health
• 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, humanOne medicine, and public
Health Initiative Task Force: Final Report, July 15, 2008

health
 Example 1:
Zoonotic disease understanding and
control using One Health
11. Oktober 2017 Präsentationstitel 19
Synoptic view of benefits and costs of animal brucellosis mass
vaccination in Mongolia

Distribution of Benefits

3
0
0
0
0
0
0
0
US
$

2
5
0
0
0
0
0
Interv ention 0Public Private Household Total Health Agricultural Total
cost health health inc ome Benefits Benefits Societal
benef its benef its loss
2 Benef its
0 Sec t
0 or
0
Is it profitable to control rabies by dog mass vaccination in African
city?
Weekly human exposure (blue) and rabid dogs (red) in N’Djaména

4
Rabied dogs / Exposed

I
3
Y
humans

0
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
11. Oktober 2017 Präsentationstitel 21
Statistical relationship of human exposures – dog
rabies
2 human exposures / rabid dog

14

12

10
Exposed Humans

0
-1 0 1 1 2 2 3 3 4
-2
Rabid Dogs

11. Oktober 2017 Präsentationstitel 22

11. Oktober 2017 Präsentationstitel 23
Comparative profitability of rabies control in N‘Djaména
Zinsstag et al. (2009) PNAS 106(35):14996-5001

Cost effective zoonosese control Proposed cost-sharing scheme

Dog and human vaccination

Human vaccination alone

Präsentationstitel
 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 Administration

Authorities
Commune Vet groups Medical station All levels
Village Paravet Medical staff

All local social organization

Remarks Inter-disciplinary team Activities

The multi-layers stakeholders Field: Questionnaires
The Inter-disciplinary Clinical examination
Practical tool to assess into One Health Medical guidance
Tradition and Modem Movable Lab: Epidemiological study
Efficiency and capacity building Treatment/Sent to the
hospitals
Experiences from parasitic project: Ha Tinh, Bac Giang, Lai Chau, Son La, Dien Bien
Medic-Vet team: Interview-ClinEx-Treatement? [QuaiTo 051206]
 Example 2:
One Health food safety research in
Vietnam

PigRISK and Taskforce project in Vietnam

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
 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
 Approach:
risk analysis or risk-based decision making
Can it be present in food?
Hazard identification Can it cause harm?

What harm does it cause?

How does harm depend on How and to what extent does it
dose? get from source to victim?

Hazard characterization Exposure assessment

What is the harm?

What is its likelihood?
Risk characterization Participatory methods
fit well

Risk communication
31
 PigRISK: Pork safety
PigRISK in(2012-2017)
project Vietnam (2012-2017)
Food safety risk assessment along the pork value
chain
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

Farm Transportation to SH Slaughterhouse Retailer Consumers

• Feed in bags, remaining feeds • Liver • Pork • Consumption

at the cages, environment • Kidney survey
1,275 samples (farms, slaughterhouse, market) collected during 1 year
 PigRISK – QMRA for salmonellosis

Estimated annual salmonellosis

Age and gender groups 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)

The annual incidence of foodborne salmonellosis in the Asian region including

Vietnam was 1% (range 0.2-7%) (Havelaar 2015)

Dang Xuan Sinh et al, 2016, IJPH

 Selected key results: Chemical risk
assessment

Most of samples: negative or did not exceed current MRL

Tuyet Hanh et al, 2016, IJPH
 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
 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!
 Policy translation: food safety

2011 Meeting with VFA, Photo: CENPHER 2012 Meeting with DAH
Photo: CENPHER

2016
Meeting with DPM Vietnam, 2 Dec 2016 (Photo:
Tuyet Hanh)
 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
 Example 3:
One Health for AMR surveillance in
Canada
Canadian Integrated Program for Antimicrobial Resistance
Surveillance (CIPARS)
www.phac-aspc.gc.ca/cipars-picra/index-eng.php
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

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

11. Oktober 2017 42

 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?
Transdisciplinary process
 Resources
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

• Systems Thinking
• Transdisciplinary Research
• Participation
• Sustainability
• Gender and Social Equity
• Knowledge to Action
http://www.idrc.ca/EN/Resources/Publications/Pages/I
D RCBookDetails.aspx?PublicationID=1051
Integrating Perspectives and Perceptions & Overcoming Prejudice

Cartoon: K. Herweg
 Transdisciplinary process

 Integrates the social and natural sciences in a common

approach (interdisciplinarity), and simultaneously…
 Includes non-academic knowledge systems

One Health

Nat. Sci. Tech. Sci. Econ. Sci. Soc. Sci.

Discipline 1 Discipline 2 Discipline 3 Discipline n

Non-academic
actors
Adapted from
 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

transdisciplinary
Societ
y

Natural interdisciplinar Social

sciences science
y s
Science
Emerging career profile
When do we need Transdisciplinarity?

Herweg et al. (2010)

 Savanakhet PFBD research 10. 2017
Decision makers

Public
health (MD,
army
health)

Scientists
Vets
One Health and beyond
….EcoHealth
Ecohealth
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

11. Oktober 2017 53

Close contact between people and

11.10.2017 54
Ecohealth Field Building Leadership Initiative
in SEA: FBLI – Agriculture Intensification & Health
“Site based- concept”
• Yuanmou (CN)
• Hanam (VN)
• Chachoengsao (TH)
• Pangalengen , West Java (ID)
 One Health and Ecohealth programs in SEA

• INDOHUN
• THOHUN
EcoEID • VOHUN
• MYOHUN
EHRCs

GHI

Emerging Pandemic Threats

Program
PREDICT • RESPOND • PREVENT • IDENTIFY
Reflections on One Health implementation

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