One Health tripartite initiatives Updates from WHO perspective to address zoonoses and AMR issues Gyanendra Gongal WHO Regional Office for South East Asia New Delhi
Outlines One Health and priority areas Tripartite initiative for operationalization of One Health Avian influenza Rabies AMR and capacity building projects Zoonotic tuberculosis and brucellosis Key messages
One Health: International movement
Metamorphosis One Health IMCAPI 2007, New Delhi Need for holistic multidisciplinary approach in the wake of avian influenza crisis IMCAPI 2008, Sharm-Al-Sheikh Strategic Framework for One World One Health (FAO/OIE/WHO/UNICEF/UNSIC/WB) Public Health Agency of Canada hosted a consultation to further discuss the objectives in the Strategic Framework at Winnipeg, in March 2009 Expert consultation hosted CDC Atlanta, Stone Mountain (2010) IMCAPI 2010, Hanoi FAO/OIE/WHO Tripartite Concept Note High level Technical Meeting, Cancun (Nov. 2011) One Health Conference, Melbourne (February 2011), then the Netherlands (2012), Thailand (2014) and Australia (2016)
Potential areas for application of One Health Climate change Zoonoses AMR One Health Food safety Ecohealth Prevention of NCD
Tripartite collaboration for operationalization of One Health
Tripartite initiative for One Health Tripartite coordination at global, regional and country levels Implement HPED, IDENTIFY, EPT+, 4-way linking project and other projects Annual tripartite workshop since 2010 The main objective was to promote multisectoral coordination for zoonoses prevention and control in the Asia Pacific Region using One Health approach Avian influenza, rabies and AMR were identified as a model for operationalization of One Health
Tripartite (FAO/OIE/WHO) coordination Global Tripartite mechanism at global level Influenza (OFFLU and FLUNET) Rabies (Global rabies conference) AMR (Global Action Plan and coordination) Tripartite Priority Activities for 2017-2020 (in progress) Tripartite coordination mechanism at regional level (Asia-Pacific Region) Regional platform to facilitate One Health action Working with ASEAN, SAARC and SPC Epidemiological and lab. networking Support One Health initiative at country level
Asia-Pacific workshops for operationalization of One Health Place Month/Year Lead agency Sapporo (Japan) December 2010 WHO Chiang Mai (Thailand) January 2012 FAO Bali (Indonesia) November 2012 OIE Kathmandu November 2013 WHO Bangkok November 2014 FAO Sapporo November 2015 OIE Manila September 2017 WHO
Establish a functional coordination mechanism Establishment of coordination mechanism Planning Training (RRT, FET) Outbreak investigation Response Forum for interaction Networking
Key Components Zoonoses Coordination Mechanism Coordinated Response Surveillance information from human health sector Surveillance information from animal health sector Human Health Animal Health Coordination Mechanism Research Research Coordinated Risk Reduction
Avian influenza
Four-way linking concept Linking of data for influenza risk assessment Global (ongoing at HQ) National (in pilot countries) Aim of national level projects: To build capacities and mechanisms for governments to do integrated risk assessments Epi and virological data collected Data linked in time & space Data shared Data assessed jointly (for H5)
One Health approach 1. Policy development & bridging between the public health and animal health sectors Aligned strategies and approaches to issues of common concern Joint field projects Intersectoral laboratory networking 2. Surveillance, epidemiology & risk assessment Outcome-based support to national surveillance & data collection Data management and integration Risk assessment
Bringing things together Data sharing Networking Collaboration/coordination Making the blocks BIGGER Surveillance More data Epi Human Animal Virology
Rabies
Tripartite coordination for rabies Global Tripartite mechanism at global level Global rabies conference, Geneva, 10-11 Dec. 2015
Partnership for rabies elimination by 2030 WHO: Strategic Framework for Elimination of Human Rabies transmitted by Dogs in the South East Asia Region GAVI supported country studies (2016-17): building the case for investment through gathering data and experience OIE: Availability of dog rabies vaccines under the regional vaccine bank FAO: Step-wise approach for rabies elimination GARC, WAP, HSI, VBB and other INGOs Humane way of dog population management
Antimicrobial resistance FAO-APHCA/OIE Regional Technical Workshop on Brucellosis and Tuberculosis in Asia, Bangkok, 11-13 Sep 2017
Use of antibiotics in animals (and plants) intended for food can result in resistant bacteria being transmitted to human through the food chain
GAP Strategic Objectives 1. Improve awareness and understanding of AMR through education and training 2. Strengthen knowledge and evidence base through surveillance and research 3. Reduce the incidence of infection through effective hygiene and IPC measures 4. Optimize the use of antimicrobial medicines in human and animal health 5. Ensure sustainable investment through research and development
Strategic Objective 2 Need of integrated surveillance of AMR
GAP Strategic Objectives 1. Improve awareness and understanding of AMR through education and training 2. Strengthen knowledge and evidence base through surveillance and research 3. Reduce the incidence of infection through effective hygiene and IPC measures 4. Optimize the use of antimicrobial medicines in human and animal health 5. Ensure sustainable investment through research and development
Optimal use in food producing animals to protect consumers Ranking of medically important antimicrobials for risk management and containment of antimicrobial resistance mainly due to non-human antimicrobial use Developed by WHO since 2005, as recommended in a series of FAO-OIE-WHO expert meetings Updated on regular basis (2007, 2009, 2013, and 2016)
Addressing AMR using a One Health Approach: Building on the existing A multidisciplinary group of experts: WHO Advisory Group on Integrated Surveillance of AMR (AGISAR) A well established FAO/OIE/WHO Tripartite Collaboration on AMR
Just released a guidance (June 2017) Surveillance of resistance in animals, food, humans Surveillance of use in animals, humans Combined analysis and reporting http://apps.who.int/iris/bitstream/10665/255747/1/9789241512411-eng.pdf?ua=1
Capacity building activities Aims to build national capacity to implement the integrated surveillance of AMR through: Development of protocol, lab modules, guidance document Training courses (1-week long) Pilot projects (1 or 2 years long)
AGISAR Country Projects supported between 2010 and 2016 Lebanon Uzbekistan Venezuela India Costa Rica Senegal Uganda Viet Nam Colombia Peru Argentina Gambia Burkina Faso Ghana Togo Uruguay Paraguay Cameroon Rwanda Bangladesh Ethiopia Cambodia Kenya Tanzania
AGISAR country projects 2017 onwards The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. Palestine Albania Iran Bhutan Chad Japan Ecuador Suriname Ethiopia Thailand Philippines Argentina South Africa Tanzania Zambia Zimbabwe
Success stories
July 2017
Objectives Establishing in the Member States an Integrated Surveillance System to monitor ESBL producing E. coli in three main compartments, human, food chain and the environment Establishing a simple and standardize methodology to monitor ESBL producing E. coli Permit comparison among countries the presence of ESBLs in the 3 compartments Allowing the detection of the effect of interventions.
ESBL Ec Tricycle project: protocol development Simple surveillance across the three main sectors Simple microorganism and resistance mechanism as indicator ESBL E. coli Human Food chain Environment Timeline: 3 years (2016-2019)
Country Selection Work with WHO AMR Regional focal point from AFRO, EMRO, SEARO and WPRO Established a List of Minimal, technical and supportive, requirements Region Candidates Final Selection AFRO Ghana, Zimbabwe, Kenya Ghana EMRO Pakistan, Sudan Pakistan SEARO Sri Lanka, Bangladesh, Indonesia, India Bangladesh, Sri Lanka, Indonesia WPRO Vietnam, Cambodia, China In process
Tripartite Project on AMR in South-East Asia One-Health Secretariat with OIE/FAO/WHO staff at FAO office in Bangkok to coordinate joint activities with AMR surveillance as main driver Initial and Priority activities in 2018-2019: Demonstration project of integrated surveillance: ESBL E. coli Tricycle in 3 SEAR countries Joint monitoring of NAP-AMR implementation Building central database for national AMR surveillance data Support to AMR-related food safety activities (to be developed) Initiate activities in AMR surveillance in the environment (to be developed)
FAO-APHCA/OIE Regional Technical Workshop on Brucellosis and Tuberculosis in Asia, Bangkok, 11-13 Sep 2017 Zoonotic tuberculosis and brucellosis
A roadmap for zoonotic TB To be launched in October 2017 Multidisciplinary joint publication by The Tripartite (WHO/OIE/FAO) and The Union Advocates for concerted action through broad engagement across political, financial and technical levels including government agencies, donors, academia, non-governmental organizations and private stakeholders Highlights 10 key priorities under 3 core themes Proposes a timeline with key milestones
Tripartite collaboration Stronger inter-sectoral collaboration between the medical and veterinary professions to assess and evaluate the scale of the problem Because of the animal and public health consequences of M. bovis and brucellosis, disease surveillance programs in humans should be considered a priority. FAO is developing a roadmap for progressive control of brucellosis (A stepwise approach for progressive control of brucellosis in animals)
Key messages Everyone can contribute in promoting One Health by understanding interaction and interconnectivity of the issue There is a growing recognition of One Health, however, it has to be translated from concept into actions through country level activities Global challenge, requiring global solutions One size does not fit for all