Presentation by Hung Nguyen-Viet, Dominic Travis, Dirk Pfeiffer, Suwit Chotinun, Jakob Zinsstag, Delia Grace, Boripat Siriaroonrat and Bruce Wilcox at the Ecohealth 2012 conference held at Kunming, China on 15-18 October 2012.

1. Framing the Problem of Emerging Zoonotic
Disease Risk Using a One Health Approach
Hung Nguyen-Viet, Dominic Travis, Dirk Pfeiffer, Suwit Chotinun, Jakob
Zinsstag, Delia Grace, Boripat Siriaroonrat, Bruce Wilcox

2. Content
 Conventional risk assessment
 Issues of risk assessment applied for EZDs
 Adjusted risk assessment framework based
on integrative methods
 Conclusion

3. Integrative Approach
• Integrative research approaches (One Health, Ecohealth)
are believed to be more effective for tackling the
complexity associated with emerging infectious diseases
than a single- or multi- disciplinary approach.
• Risk-based approaches have been widely used in
environmental health and epidemiology to identify critical
points where hazards can be controlled and hence risks
to human health reduced.
• Risk assessment: effective science-based tool for
informing decision-making

4. Hazard vs. Risk
Hazard: A biological, chemical or physical agent or condition
with the potential to cause an adverse health effect (Codex
Alimentarius 1999)
Risk : likelihood of identified hazards causing harm in
exposed populations in a specified time frame including the
severity of the consequences.
RISK = Chance*Hazard*Exposure*Consequence

5. Risk analysis
Risk analysis: describes how risks are dealt with
within the society
• Risk assessment (RA): Risk
Is there a problem and how severe the Risk management
problem is ? assessment
Decision
• Risk management: Risk
How to manage the problem? Communication
• Risk communication:
Communication of risks to managers, stakeholders, public
officials, and the public.
Source: Codex (1999)

6. “Risk” development
1994
1959 SPS
HACCP
1924 2001
OIE OIE-FS
1948 1962
WHO CODEX 1983
1945
FAO NAS
1970s
1950s QRA
1940s ADI
PSA 1980s 2000s
1990s
1960s PbRA MRA
Bioterrorism
PRA .
Grace (2011)

7. Application of Risk Assessment
• International standard risk assessment
frameworks: OIE/IUCN, Codex Alimentarius
• Import risk assessment
• Food safety risk assessment for animal source
foods
• Ecological risk assessment
• Natural disaster risk assessment
• (finances, banking…)

8. Codex Alimentarius risk assessment
framework
Hazard
identification
Risk Risk
Assessment Management
Hazard Exposure
characterization assessment
Risk
Communication
Risk
characterization

9. OIE/IUCN Release
assessment
Import risk
Exposure
assessment assessment
Consequence
assessment
Risk
assessment
Hazard Risk Risk
identification assessment management
Risk communication

10. Full Process
• Question formulation
• Hazard ID
– Establish criteria
• Draw a picture
– Identify critical control points
• Develop a model
– ID and evaluate data sources
– Input data (from monitoring or surveillance efforts)
• Run model
• Assess results and effects of data quality
– Sensitivity analysis and uncertainty
• Collect more data
• Rerun model

11. Issues of current risk assessment
• Conventional risk-based approaches applied to emerging
infectious diseases: limitations.
• Many possible determinants and factors operating at different
spatial and temporal scales
• Uncertainties resulting from both the lack of data and
unpredictability of the dynamics involved in the disease
emergence process
• Lack of resources to carry out risk assessment
• Specific and complex for public and policy makers
• Disconnection with reality

12. Emerging Infectious Diseases Research “Blue Print”
Wilcox and Colwell (2005)

13. Disease Emergence Multiple Causal Factors and Mechanisms
adapted from Daszak et al – Science - 2000

14. How to improve the current
conventional risk assessment
approach?

15. Adjusted risk assessment
• Assessment of ecosystem vulnerability and
resilience as a component of risk
assessment.
Hazard
identification
Hazard Exposure
characterization assessment
Risk
characterization

16. Adjusted risk assessment
• Assessment of ecosystem vulnerability and
resilience as a component of risk assessment.
• Risk assessment becomes interactive:
– categorizing and ranking hazards, vulnerable,
population, and ecosystems
– prioritizing risk issue in terms of funding, politic driven-
versus reality and societal needs using participation.
• Consider hazard, risk and risk drivers from
different perspectives including social aspect and
perception

17. Participatory Risk Analysis
(for food safety risk analysis in informal marketing system)
Participatory methods
Risk Risk
Assessment Management
Risk
Communication

18. Concept of participatory risk analysis
Grace et al (2011) Revue Africaine de Santé et de Productions Animales.

19. Conclusions and ways forward
• Risk assessment: effective science-based tool for
informing decision-making but represent limitations to
EZDs
• Need more integrative aspects and participation in risk
assessment involving an ecosystem perspective
(vulnerability and resilience of ecosystem, social,
perrception…)

20. Thank you!
Emerging Pandemic Threats Program
PREDICT • RESPOND • PREVENT • IDENTIFY