THE EMERGING “ONE HEALTH”AGENDA

IADGIFAD, Rome

May 4-5, 2010

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OUTLINE

• Where we came from• Where we are• Where we are going

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Do we know from whence we came?

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EMERGING AND RE-EMERGING INFECTIOUS DISEASES 1996 - 2003

EMERGING AND RE-EMERGING INFECTIOUS DISEASES 1996 - 2003

Some of the more recent threats:

• BSE

• SARS• H5N1

• H1N1• Y2K?

These are not one-off events• Known Pathogens -1,415; 61% of animal origin

• Spanish flu of 1918-1919 that killed between 50-100 million people

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Avian Flu, EU$500m

Economic Impact of Selected DiseasesEconomic Impact of Selected Diseases

1996 1997 1998 1999 2000 2001 2002 2003

$50bn

$40bn

$30bn

$20bn

$10bn

Source: Bio-Era. Courtesy of Dr. Will Hueston, Center for Animal Health and Food Safety, UM

Est

ima

ted

Co

st

BSE, UK $10-13bn Foot & Mouth

Taiwan, $5-8bn

1992 1993 1994 1995

Foot & MouthUK

$30bn

Avian Flu, AsiaUS, Canada

$10bn

2004

BSE, US $3.5bn

BSE, Canada$1.5bn

Lyme diseaseUS, $2.5bn

SARSChina, Hong Kong,

Singapore, Canada,…$50bn+

Nipah, Malaysia$350-400m

Swine Flu, Netherlands

$2.3bn

BSE, Japan 1.5bn

Do we know where we are?

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GLOBAL EFFORT TO CONTROL H5N1 AND H1N1• 7th Ministerial Meeting – Hanoi, April 20-2, 2010.

• Approximately US$3.9 B committed & US$2.7 B disbursed.

• WB alone has 72 operations in 60 countries.

We have learned along the way• Pandemic prevention and control requires a multi-sectoral effort -- Several Ministries.• A health systems approach is required: human-animal-ecosystems.

• Cost of control escalates with time --between detection and control.

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Do we know where we are going?

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“One Health” -- The Divergence of Views:

A Milestone in the Development of Health Systems and the “Health in All

Policies” Concept?

OR

Opportunistic collaborate if or when necessary?

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ONE HEALTH

“the collaborative efforts of multiple disciplines working locally, nationally and globally to attain optimal health for people, animals and our environment” (American Veterinary Medical Association 2008)

Pursuing that Paradigm in Operational terms means gradualism. Thus with respect to controlling zoonotic disease --pandemic potential and neglected:

“controlling these diseases at the human-animal-ecosystems interface” --the outcome is more effective and efficient Public Health services.

“One Health” Evolution

17-19 th century

Joint human and animal

health providers

20 th. century

Specialization human

medicine

Specialization veterinary medicine

IncreasedIntra-sectoralSpecialization

IncreasedIntra-sectoralSpecialization

20 -21 th. century

“One Health”

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Human health

Domestic Animal Health

Ecosystems health

Scope: Ecosystems Health Focus

This is a Cabinet level focus! Ministries of H ealth, Agriculture, Finance, Environment, Infrastructure, Interior, Military, To urism, Civil Society

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One Health Concept

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Does a “One Health Concept” make sense?• Faster understanding of biology and

epidemiology of newly emerging zoonotic diseases.

• Enhancing effectiveness and efficiency of surveillance and diagnosis of known (unknown?) diseases.

• Enhancing effectiveness of control and resource use.

• Enhancing efficiency of infrastructure dev.• Galvanize cross-sectoral and inter-disciplinary

collaboration at national and supra-national levels.

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Institutional Capacity Building a Prerequisite

I. Case-by-case “emergency” actionInefficient. Cooperation not sustainable, new emergency –new effort.

II. Permanent coordination mechanisms for contingency planning and emergency action

Preparedness plans: On legal basis or through less formal memorandum of understanding.

III. Permanent , multi-disciplinary inter-departmental task force “One Health” teams? Responsibility for surveillance, information sharing, business continuity and “fire-brigade”capacity.

IV. Merging of existing structures into independent agency Greater efficiency but low political attractiveness and doubtful economic justification.

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Vertical and horizontal orientation in disease prevention and control

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THANK YOU!

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