Zoological Society of London Symposium:

The Real World: One Health - Zoonoses, ecosystems and wellbeing

Jeremy Farrar

E: j.farrar@wellcome.ac.uk

T: @jeremyfarrar

Conflicts of interest Wellcome Trust

196X – 1979SingaporeMalaysiaAden YemenCyprusNew ZealandLibyaUK

1980 – 1995University College LondonEdinburghMelbourneOxford & UCSF

1995 – 2013Viet Nam

VIET NAM

UK

3.3 million malaria deaths avertedBed nets and Artemisinin Combination Therapy

Communication, Understanding

1976

2014

The world has changed and will change much moreEnvironment, People, Wildlife, Nutrition, Migration, Technology, Society

Global air network

Infections and Non-Infectious Diseases

The ‘new’ global healthEndemic infections and NCDDrug resistanceTrauma

Plus 2016 MERSCoVH7N9EbolaEV71 & EV68Resistant MalariaChikungunyaHepatitis ECholeraSalmonellaZikaDengue

1918

2009

United NationsWorld Health OrganisationFood and Agriculture OrganisationWorld Organisation of Animal Health

Global health – What is it and Who Cares?

You and me

Fragile Health Systems, Research & Development, Governance

Global Health - time to see it for what it is?

Public Health, Medicine, Research and Societies

Environment, demographics, migration, animal,

nutrition, human, virology, social science, anthropology

Infections and Non-Communicable Diseases

Resilience amid fragmented health systems

Surveillance and Response

National, regional and global governance

Sharing of data and share in the benefits of that data

Trust

Global Health – 21st Century Silo’s

Integration

Centre of Gravity in a Changing World

Global Health Leadership

Research & Development - Market or Society Failure?

Resilient Health systems and capacity

Smarter sustainable surveillance and response

Trust, Incentives & True Equitable Sharing

Global Health @21st Century

Thank you

Global health – What is it and Who Cares?

You and me

Fragile Health Systems, Research & Development, Governance

Global Health - time to see it for what it is?

Public Health, Medicine, Research and Societies

Environment, demographics, migration, animal,

nutrition, human, virology, social science,

anthropology Infections and Non-Communicable Diseases

Resilience amid fragmented health systems

Surveillance and Response

National, regional and global governance

Sharing of data and share in the benefits of that data

Trust

Integration

Centre of Gravity in a Changing World

Global Health Leadership

Research & Development - Market or Society Failure?

Resilient Health systems with Surge Capacity

Smarter sustainable surveillance and response

Trust, Incentives & True Equitable Sharing

Global Health @21st Century

Singaporevia Viet Nam to UK

First, in today's world, it's important to recognize that if certainconditions are met — biologic shifts in a pathogen, changes in theinteractions between humans and our environment, fragile healthsystems, international indifference, high population mobility, customsand culture, urbanisation, and a lack of trust in authorities

— what might once have been a limited outbreak can become amassive, potentially uncontrollable epidemic.

EDITORIALThe Ebola Emergency — Immediate Action, Ongoing StrategyJeremy J. Farrar, M.D., Ph.D., and Peter Piot, M.D., Ph.D.N Engl J Med 2014; 371:1545-1546

Second, classic “outbreak control” efforts are no longer sufficient for an epidemicof this size.

What is required is large-scale, coordinated humanitarian, social, public health, andmedical response, combining classic public health measures with safe and effectiveinterventions including behavioral changes, therapies, and when possible,vaccination. An appropriate response, moreover, requires an appreciation of theculture of the societies in the affected countries and deployment of interventionswith the population's consent. Development of interventions in collaboration withthe affected communities and rebuilding of trust are essential to their success.

These integrated efforts will need to be accompanied by much better coordinationand real-time, open sharing of information across diverse disciplines and with allthe players involved, from civil society, national governments, nongovernmentalorganizations, and academic institutions to regional and international organizationsand, when appropriate, the military.

EDITORIALThe Ebola Emergency — Immediate Action, Ongoing StrategyJeremy J. Farrar, M.D., Ph.D., and Peter Piot, M.D., Ph.D.N Engl J Med 2014; 371:1545-1546

Third, the development of diagnostic tools, therapies, and vaccines (at least upthrough the acquisition of phase 1 safety data) for these relatively rare butinevitable and potentially devastating epidemic diseases must be prioritized duringinterepidemic periods, with an accepted, preapproved, and ethical mechanism foraccelerating development and testing such interventions when epidemic situationsarise. We believe that in this epidemic, we are reaching the limit of what classiccontainment can achieve.

Despite great improvement over the past decade, there is still a need for bettersurveillance, sharing of data in real time, and rapid action based on the availableinformation. But we cannot think that surveillance alone will bring such eventsunder control. We have become better at picking these things up; we now mustalso learn to act more effectively.

EDITORIALThe Ebola Emergency — Immediate Action, Ongoing StrategyJeremy J. Farrar, M.D., Ph.D., and Peter Piot, M.D., Ph.D.N Engl J Med 2014; 371:1545-1546

Secretary-General Appoints High-Level Panel on Global Response to Health Crises

Report of the

Ebola Interim Assessment Panel

WHO Blueprint for R&D

There is a tide in the affairs of menWhich, taken at the flood, leads on to fortune;

Omitted, all the voyage of their lifeIs bound in shallows and in miseries.On such a full sea are we now afloat,

And we must take the current when it serves,Or lose our ventures.

1597

William Shakespeare Julius Cesar IV.ii.269–276

Global Health………… our opportunity for change