Joined Efforts to Combat Infectious Disease Threats are Proactive, Capable, and Inclusive
This blog was originally posted on Science Speaks in US Policy and Funding on October 25, 2017.
The following is a guest post by Farley Cleghorn, Anita Bhuyan, Jabulani Nyenwa, and Scott Moreland of Palladium
Health, finance, agricultural ministers and others gather this week in Kampala, Uganda, for the 4th Global Health Security Agenda (GHSA High-Level Ministerial Meeting. Participants will take stock of progress and chart future directions for country, regional, and international responses to advance global health security. The GHSA, to which more than 50 countries around the world have committed, aims to protect communities from infectious disease threats. The potential for infectious diseases and anti-microbial resistance to wreak havoc on population health and the global economy remains a clear and present danger.
At the heart of the GHSA is the intersection of human, animal, and environmental health, as some 60 percent of known human pathogens and 75 percent of emerging ones are zoonoses (transmittable from animals to humans). Multisectoral collaboration is vital to break down barriers across these sectors, and many countries—including Uganda—have established One Health platforms to link efforts to detect, prevent, contain, and respond to infectious diseases. These are essential efforts, but gaps remain that require innovative approaches and consistent attention. We highlight a few of these issues here.
Shift from Reactive to Proactive
Health systems have tended to operate in a reactive fashion to emerging disease threats, often responding only after an outbreak has occurred and a fair amount of health and economic damage has transpired. Outside of outbreak situations, however, spurring political will and investment for a proactive approach remains a challenge. Moreover, weaknesses in surveillance and information systems, within and across sectors, limit the ability of countries to anticipate, detect, and rapidly mobilize for potential threats early.
To be more proactive, capacity to generate and use better evidence of many kinds is needed—from routine surveillance, to outbreak detection, to analytic modeling that makes the short- and long-term risks and the investment case for action (and the costs of inaction) more concrete for decision-makers. Palladium is supporting governments in sub-Saharan Africa to address these critical gaps. For example, with the U.S. Agency for International Development and the Food and Agriculture Organization, we are designing a modeling tool for the Africa Sustainable Livestock 2050 initiative. The model outputs will help policymakers explore the impacts of population growth, demand for livestock as food, and agricultural practices on human, animal, and environmental health. The aim is to help African countries avert what happened in Asia with livestock intensification and the spread of avian influenza. Pandemic influenza remains the biggest potential threat to human health.
Don't Neglect Capacity Gaps for Multisectoral Action
Participants at a recent WHO- and WHO World Organization for Animal Health (OIE)-organized regional workshop in Tanzania agreed on the importance of veterinary and other animal health specialists to several of the GHSA's 19 Joint External Evaluation (JEE) components. In many countries, however, the JEE process reveals relatively stronger capacity in the human health sector compared to the animal health sector, especially surveillance systems and human and financial resources.
A deliberate effort must be made to strengthen the animal health sector, which is one of the major objectives of One Health collaboration. While the animal health sector retains the mandate for disease prevention and control in animals, a multisectoral approach gives the human health sector an opportunity to aid in strengthening capacities in the animal health sector. Doing so will help countries meet both their International Health Regulations and Performance of Veterinary Services requirements. And, detecting pathogens of pandemic potential in wild and domestic animals before spill over to humans will have a significant impact in lives and resources saved.
Prioritize Inclusion of Communities
This week's GHSA meeting rightly highlights the importance of engaging communities in the response. Too often, zoonotic diseases are initially misdiagnosed and underreported, predominately among the remote, poor, and other marginalized populations with limited access to health and other services. Investment in community health systems—often a missing building block in the health system—must be strengthened. A rights-based approach, in which communities are empowered through a more inclusive, bottom-up process, is essential for fostering ownership and driving accountability and sustainability of pandemic responses.
Communities that feel included can promote healthy behaviors, link those affected by outbreaks to formal health services, and foster resilience—as recently brought to the forefront by the Ebola crisis in West Africa in which community health workers were instrumental in contact tracing, identification of potential cases, community sensitization on safe practices, data collection, and more. Community interventions can be very rewarding because that is where everything links up: humans, animals, and the environment.
Further, steps must be taken to develop strategies to address the role of gender in disease preparedness and response. Women's roles in livestock production, care-taking for the sick, and limited control over household decision making and resources can increase their vulnerability. A gender-integrated response should start with community mapping before a crisis to understand how women and men would differently use local infrastructure and services that are likely to be affected during an outbreak. Among other recommendations, the response should also commit to sustaining essential services during outbreaks; better target compensation to women and men directly affected by outbreaks (not just "households"); and integrate strategies against gender-based violence.
The global health community cannot underestimate the need to proactively coordinate across sectors to address the risks and needs of all affected populations. With engaged communities, detection and response systems in place, and an approach that considers the capacity needs of all stakeholders, we just may be positioned to respond efficiently and effectively the next time we face a significant outbreak.
Farley Cleghorn, MD, leads Palladium's global health practice. Anita Bhuyan is a senior technical writer; Jabulani Nyenwa, MD, is director of health & education for the Europe, Middle East, and Africa region; and Scott Moreland, PhD, is a senior fellow in the data informatics and analytical solutions practice in the Americas region, at Palladium.