Presented by Fred Unger and Hung Nguyen at the 2nd International One Health Conference 2019, Malang, Indonesia, 10–11 October 2019.

1. Eco Health & One Health:
Concept, applications and impact
The 2nd International One Health Conference 2019
Faculty of Veterinary Medicine, University of Brawijaya
Malang, Indonesia, 10-11 October 2019
Fred Unger and Hung-Nguyen Viet
International Livestock Research Institute

2. Main campuses: Nairobi, Kenya
and Addis Ababa, Ethiopia
Hanoi office (SE ASIA region):
- Food safety, one health & ASF
ILRI offices
International Livestock Research Institute
Reduce
poverty
Improve
food and
nutrition
security
Improve
natural
resources
and
ecosystem
services

3. Vets, PH, animal science, social-science, economist &
communication
Good environment to practice One Health!

4. Overview of presentation
• Context of Emergening infectious
diseases
• One Health & Eco health
• Historical excurse & concept
• Application (Zoonosis, food safety, AMR)

5. Context of Emerging infectious
diseases (EIDs)

6. Emerging Infectious Diseases
Diseases that have recently increased in incidence or in
geographic or host range – e.g., tuberculosis, cholera, dengue
fever, Japanese encephalitis, West Nile fever, and yellow fever,
African swine fever…
Diseases caused by new variants assigned to known pathogens
– e.g., new strains of influenza virus, HPAI, SARS and Ebola virus
Bacteria newly resistant to antibiotics, notably the multiple
antimicrobial resistant strains – e.g. E. coli 0:157, MRSA…

7. Zoonotic Pathogens/Parasites:
the mostly likely to emerge
*Palmer et al. 1998. Zooneses: biology, clinical practice and public health control. Oxford
University Press.
1,415 - Number of known human pathogens
175 (12.4%) - Number causing emerging diseases
133 (76%) - Number causing emerging
diseases which are zoonotic
(Taylor et al., 2001, Cleveland et al., 2007)

8. Important factors leading to the emergence of
infectious diseases
• Overpopulation and urbanization
• Population movement and animal trade
• Intensified livestock production
• Agriculture and changing land use
• Water and sanitation
• Climate changes
• Drug resistance
Coker et al. Emerging infectious diseases in southeast Asia: regional challenges to control.
Lancet. 377. 2011

9. How to mitigate these challenges
• Complex health issues need innovative, integrated approaches
• Strengthening the capacity of professionals working in the
human, animal and environmental health sectors
• Sharing required in resource-scare environment
• Need to widen scope
 Beyond HPAI and SARS (making opportunities
available)
 “Systems” approach vs. focus on specific diseases
 Looking beyond animal health / human health
• Need for more coordination of efforts including research
projects to make impacts

10. One Health & Eco Health

11. Brief history of integrative thinking in medicine
Ancient greek to medieval age, point of intersections :
• Animals were used to work out anatomy and physiology of humans
• Anmals were studied in order to find relations or comparisons with
humans
Chou Dynasty in China (11-13th century): integrated public health
system including medical doctors and veterinarians.
Human medicine in the medieval European universities, Claude
Bourgelat, first veterinary school in Lyon (1762) heavily criticised for
creating linkages between human and veterinary curriculum.
19 - 20th century: both sciences specialised to an extent that their
association was hardly visible

12. History of integrative thinking in medicine, cont.
19th Century: Increasing 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
Described life cycle of Trichinella.
• Correctly asserted that these worms
could also cause human infections
through contaminated pork (1860)
• Demonstrated that if the infected
meat is first heated is safe for
humans
• Led to the establishment of meat
inspection, which was first adopted
in Berlin (1860)
• Prussia (1875), Germany (1900)

13. Parallel Evolution of One Health & EcoHealth
Proposed the term
zoonoses and
“between animal
and human
medicine there is no
dividing line” .
Defined One Health
as “the collaborative
effort locally,
nationally, and
globally – to attain
optimal health for
people, animals and
our environment.”
Proposed One
Medicine as a unified
approach to human
and veterinary for
zoonoses control.
Ernst Haeckel
(German Biologist,
1834-1919).
1860’s – Haeckel
proposes ecology
as the study of
organism in their
environment
“The land ethic simply
enlarges the
boundaries of the
community to include
soils, waters, plants,
and animals, or
collectively: the land….
Land Health is the
capacity of the land for
self-renewal”
Aldo Leopold, American
ecologist, 1887-1948).
Robert Virchow,
German
physician/pathologist
(1821-1902)
Calvin Schwabe (1927-
2006): veterinary
epidemiologist/
parasitologist
19th Century 20th Century 21st Century
EcoHealth was
launched as forum
for researchers and
practitioners &
specific research
and development
focus of IDRC
EcoHealth and Intn’t
Association for Ecology &
Health (2004-present)
American Veterinary
Medical Association
One Health Initiative
(2008- present)
Wilcox, 2013 modified
One
Health
Eco Health

14. Eco Health & One Health
Different traditions/background
• EcoHealth originated in biological ecology an land
conservation practice.
• One Health originated in medicine and veterinary practice
Many similarities
• Both arrived at the same conclusion: the global problem of
disease emergence requires an integrated approach (scope is
different)

15. Recent years:
Further recognition of One Health/Eco Health
– Wide range of initiatives emerged
– Recognized by major donors
– Operationalised by international organisations/institutions
(FAO, WHO & OIE)
– Various One Haelth academic programs emerged
• MSC in One Health in leading universities worldwide
– University of Utrecht, Royal Vet Colleague, University of Minnesota
– City University of Hongkong, position of Chair Prof for One Health
• One Health Resource Centers
– Increasing amount of peer reviewed literature and text
books

16. One Health and Eco Health
applications
Control of zoonoses, food borne diseases and
AMR/AMU using One Health

17. Example 1: Brucellosis in Mongolia

18. Synoptic view of benefits and costs of animal brucellosis mass
vaccination in Mongolia
Distribution of Benefits
0
5000000
10000000
15000000
20000000
25000000
30000000
Intervention
cost
Public
health
benefits
Private
health
benefits
Household
income
loss
Total Health
Benefits
Agricultural
Benefits
Total
Societal
Benefits
Sector
US$

19. Example 2:
One Health food safety research in Vietnam
Safer PORK and Taskforce project in Vietnam

20. Introduction - pork and food safety in Vietnam
Pork is an important component of the Vietnamese diet
• The most widely consumed meat: 29.1Kg/person
• >80% comes from very small or small farms
• 76% of pigs are processed in small slaughtering
• Preference for fresh “warm” pork supplied in traditional markets
(>80% of all pork marketed)
Food safety among the most pressing issues for people
in Vietnam, more important than education or health care

21. Pork safety assessments and pathways towards safer pork
PigRISK (2012-2017) http://pigrisk.ilriwikis.org SAFE Pork (ongoing)
Research questions
Is pork safe in Vietnam?
Methods:
Quantitative and qualitative risk assessment
Assess cost of food borne diseases (FBD)
(hospitalisation)
Cross-contamination Salmonella (household)
• One Health team
Vets, MD, social science, economist
(quantitative & behavioural), com experts
and private sector
• Risk based approach
• Farm to fork
Research questions
What are faesable options for safer pork?
Methods:
Food safety (FS) performance of value chain
FS interventions
Risk communication

22. Results from risk assessment under Pig RISK
Microbial Risk assessment:
Salmonella contamination 44 to 83% of pork across different retail contaminated
with Salmonella
Misperception towards risk – public most concerned on chemical hazards but
major health risk related to microbiological hazards
Risk for pork consumer: 1 – 2 person out of 10 (17%) estimated to suffer
Salmonella caused food borne diseaes annually
Chemical risk assessment: Risk due to chemical hazards is low (heavy metals,
grow promoters and antibiotics)
Hospitalization costs of foodborne diarrhoea per treatment episode: USD 107
Is pork safe? SAFE Pork: Focus on food safety
interventions along pork value chains

23. Investments in FS can save lives and $$$
94 million people
• Cases of foodborne diseases (FBD) by Salmonella in pork at
17%: 16 million get sick annually
• Proportion of illnesses hospitalized 20% - 3.2 million
(based on data from USA and Australia)
• Cost $ 107 to treat a case: $342 million
• Potential intervention at retail to reduce 20% FBD burden:
$ 68 million saved
(this does not include the cost of
treating cases who are not hospitalized)
Potential health impact – FBD Vietnam
Based on PigRISK results

24. Pilot intervention / behaviour change
The pilot trial also demonstrated that
technical solutions must go along with
behaviour change of butchers.
The improvement in hygiene (using grid
versus floor) was indicated by lower
coliform load (p = 0.002) on the carcass
surface compared to the control.
Private sector (canteens) attracted by food safety practice change

25. Safe PORK – “light touch” interventions
Slaughter: Reduce contamination of pork
Portable ozone machines to plug into water supply
Slaughter grid to avoid floor slaughter
Simple, rapid tests that detect contaminated food
Could be used directly by retailers or consumer

26. Safe PORK – interventions
• Retailer package (Vet, PH, economist,
social science)
— Tailored package: antimicrobial cutting
boards, cotton cloths, frequent W&D
• Increasing transparency and traceability in food system
24 hour on farm camera, branding and certification
(Private sector)

27. SAFE Pork – interventions
Assessment of the potential to use nudges
for improved food safety behaviour & practice
(Behavioural economist)
Risk communication
 Media, risk assessors, value chain actors – training & materials
Consumer:
 Awareness campaigns
(All & com experts)

28. Vietnam food safety task force : translational research
Vietnam Food Safety (FS) Task Force
• Led by national FS researchers
• Engagement – Government
e.g. through WB funded FS assessment
• New WB Food Safety Initative focus on
4 urban centers (2021 onwards)
Meeting with DPM Vietnam, 2 Dec 2016 (Photo:
Tuyet Hanh) Launch of report with DPM Vietnam, 2018

29. Example 3: Lao PDR
Managing Parasitic Food Borne diseases through an inter-ministerial platform
One Health in practice

30. Savannakhet PFBD research Oct 2017
Decision makers
Public
health (MD,
army
health)
Scientists
Vets
6 Ministries involved focusing on One Health in practice !
Integrate pig borne parasitoses in health campaigns targeting O.V. (Human health
sector lead implementation)
Emerging role of Ministry of Defence throughout the project

31. Example 4: Loa PDR
Cost Benefit of an Integrated approach to
control cysticercoses in Northern Laos

32. Objective: To determine cost effectiveness of the integrated pig and human control
of T solium, soil transmitted helminths (STHs) and classical swine fever vaccination
Integrated pig- and human health intervention
Method: Mai District of Northern Laos, cross-sectional, 49 Households
Interventions (various scenarios):
- Pigs: T. solium (Tsol18) vaccination and oral dewormer and/or pig health package
including Classical swine fever (CSF) vaccination
- Humans: T. solium and/or soil transmitted helminths interventions
- Combination of both
Results:
Most cost effective in terms of net cost per DALY averted:
Human T. solium/STH intervention and T. solium & CSF vaccination in pigs: 14 USD
At least 5 times more cost effective than all other scenarios.
Conclusion:
Sustainable control of T. solium should not be done isolated, particularly the
inclusion of CSF vaccination significantly optimizes the societal outcomes

33. Example 5:
Canada
- Canadian Integrated Program for Antimicrobial Resistance Surveillance, CIPARS
- Canadian Science Center for Human and animal Health

34. • Estimated that resistance at least doubles the cost of treating a bacterial
infection per year to indirect and direct health care costs in Canada (CCAR,
2002).
• Recognized that an integrated AMR surveillance systems are needed to
implement interventions to enhance prudent use practices in human and
veterinary medicine.
• 1997. Founding of an National surveillance system to monitor AMR/AMU was
formally recommended at national consensus conference “Controlling
Antimicrobial Resistance: An Integrated Action Plan for Canadians”
• Intially co-convined by Health Canada and the Canadian Infectious Diseases
Society
– Further endorced by other committees and stakeholders including animal feed
sector
Canadian Integrated Program for Antimicrobial Resistance
Surveillance (CIPARS) - A call for action
www.phac-aspc.gc.ca/cipars-picra/index-eng.php

35. Canadian Integrated Program for Antimicrobial Resistance
Surveillance (CIPARS)
www.phac-aspc.gc.ca/cipars-picra/index-eng.php

36. 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.
27. November 36

37. One Health lab to
save cost in Canada
Estimated 26% savings on operational cost of the Canadian Science
Centre in Winnipeg. An opportunity for SEA countries?

38. Final reflections

39. Addressing new global challenges from the emergence of
infectious diseases and underlying drivers require new
integrated approaches
Observed increased application of integrated approaches
 Networks, research and academia
 Developed centres of excellence for education and training
There is more evidence on One Health approaches
 cost effectiveness & impact
Final reflections

40. Resources

41. Resources
• Systems Thinking
• Transdisciplinary Research
• Participation
• Sustainability
• Gender and Social Equity
• Knowledge to Action
http://www.idrc.ca/EN/Resources/Publications/Pages/ID
RCBookDetails.aspx?PublicationID=1051
ecohealth.net
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

43. Cartoon: K. Herweg
Integrating Perspectives and Perceptions of different fields

44. Vets & OneHealth in Practice
VETERINARIAN
Professional
Body
Business
aspects
PH
Govt?Society
Patient
Case
Client
Lobby for
better links to
MDs
Wider role in
health
provision
Reporting
unusual
events
Joint courses
Advice on
zoonoses risk
informed on
complex cases
Meet your MD
counterpart!!
Modified after Gilbert
T. Solium &
CSF vacc

45. Terima kasih
Acknowledgement:
• Delia Grace, ILRI
• Hanoi University of Public Health
• National Institute of Animal Science
• Vietnam National University of Agriculture
• USydney (Australia) and RVC (UK)
• National University of Laos
• Anna Okello (ACIAR) & John Allen (CSIRO)
• Swiss TPH

46. This presentation is licensed for use under the Creative Commons Attribution 4.0 International Licence.
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