Thought Leadership

Four pics, One Health: Can a joint “Approach” protect Nigeria from emerging disease outbreaks?

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Editor’s Note: The novel Coronavirus has taken centre stage as the virus spreads from China into other parts of the world and from animal-human to human to human infection. This brings to light the critical importance of understanding how animal health influences the spread of epidemics globally. In this week’s Thought Leadership piece, Dr. Ibrahim Mamadu, Country Preparedness and IHR Officer, WHO Health Emergencies Program, writes about how the current spread of animal related infectious diseases highlights the need for closer collaboration under the One Health agenda. 

Let’s play a game; let me give you four photos: a farm, an airport, a meat market and a hospital. Can you guess what ties all of these together? Can’t guess? The answer is “One-Health”.

What is this phrase, “The One Health Approach” that has suddenly become popular? It is a fact that over 75% of the emerging (new) and re-emerging diseases like Ebola and SARS that have affected humans over the past few decades have originated from animals (zoonotic) or animal products (meat, eggs), many of them with a potential to spread widely and to become global health security risks with major negative socioeconomic consequences.
So how do these infections from animals to humans start? I was told a story by a colleague that works in the animal sector about an inspection they did of an abattoir they went to inspect during a veterinary assessment. On getting there they noticed that there was no water and sewage system at the abattoir. There was only a shallow trench or gutter where all the waste material from the slaughterhouse flowed into. These include blood, body fluids and abdominal contents of slaughtered animals plus other waste liquids generated there.

Image source: NCDC

The local environmental officer had complained for a very long time about the lack of water. Finally, a borehole was sunk there, but with no provision for a waste liquid treatment system to process the biological liquids before they were discharged into the surrounding soil and ground water bodies. Can you see a problem brewing? It gets worse; the same gutter they always used to drain liquids now started getting fuller more quickly because the abattoir users had more water to wash things with. The abattoir was uphill from the village market, so the water from the abbatoir would run downstream into the village market and mix with ground water in the market and gather in pools.

The worst part of this story is that poor women that are fruit/vegetable sellers in the market would scoop water from these pools and sprinkle on their fruits and vegetables to make them more presentable for customers to buy! Now what if you bought and ate these fruits without carefully washing them? Can you imagine what would happen if an extremely contagious virus or bacteria from a slaughtered animal flowed with its blood/fluids, infected the soil, ground water and was even present on the fruits in the market?

This story has implications in public health, animal health and environmental health right? This is especially worrisome as the technical area of food safety is the business of all these sectors! This may be a very long way for a disease to spread from animals to humans but there are other shorter, more direct ways. It is well known that the farmers, slaughterers and butchers and bushmeat sellers in this country hardly ever use any personal protective equipment like gloves, aprons, or goggles for their eyes, when slaughtering and processing cattle, sheep, or chickens. They usually have blood or fluids splashing all over them including in their faces while they work, meaning that any of these animals’ infectious diseases could occasionally “jump” species and start infecting the butchers and possibly also start spreading from human-to-human. Can you see how an outbreak similar to the China one can originate anywhere in the world including right here in Nigeria?

Image source: NCDC

“One Health” is a concept first coined in 2004 in a US hosted symposium of the Wildlife Conservation Society in New York. They stated, “We are in an Era of One World, One Health. It is an approach to working collaboratively that was proposed to devise adaptive, multidisciplinary solutions to problems. In a nutshell most of our new and unusual human diseases like viruses, bacteria, fungi and parasites are gotten from animals, and both humans and animals live in an ecosystem that can help propagate these diseases; this is what is known as the Human-Animal-Environment interphase. These require joint activities across sectors like human health, Agriculture/Animal health and environment to prevent, rapidly detect and effectively respond to these threats.

Indeed, if you are up to date with public health news, you will know that a new virus has been detected to be causing pneumonia in the Wuhan region. It is a new coronavirus that is suspected to have jumped species from animals in a wet market to the sellers and food handlers processing and selling them and spread rapidly to several continents. Although China is showing a very aggressive public health response including the construction of new treatment facilities in a very short time, the infection has spread from animals to human now from human-to-human and has spread to multiple countries infecting about 5,974 people and has killed more than 132 people in China.  This has many similarities to the beginning of the massive SARS pandemic in 2003 that was declared a Public Health Event of International Concern (PHEIC) by WHO.

Figure from Pierre Formenty et al. Ecology of Zoonosis, the Lancet 2012 showing spillover of diseases from animals to human

Factors contributing to the risk of spread of these zoonotic diseases include population pressure, food security, economic growth, climate change, international travel and globalisation. Faster air, rail, road and sea transport means a new infection can spread across borders in as little as 36 hours calling for national public health authorities to increase surveillance especially at the points of entry at countries’ borders.
The potential for global spread of a new outbreak, known as a pandemic, is much higher today. The avian influenza H5N1 pandemic 2003 was a big example of the need for collaboration across sectors and disciplines. This led to the development of the “One Health Strategic Framework” in 2008 by the World Health Organisation (WHO), World Organisation for Animal Health (OIE), Food and Agriculture Organization (FAO), UNICEF, UN System Influenza Coordination and the World Bank to clarify the way forward to extend an intersectoral approach to many diseases’ emerging at that human-animal-environment interphase.
In 2010 a concept note was released by OIE, FAO and WHO to outline the way these agencies would work together to address health risks between the animal and human world globally. All WHO member countries have adopted the International Health Regulations 2005 and all OIE member countries have adopted the international standards of the OIE published in the OIE Terrestrial Animal Health Code. These two documents needed to be implemented in synergy by countries to maximise their benefit to protecting the world’s population.

Image source: WHO

We are doing quite a lot to ensure there is prevention of and preparedness for these zoonotic events, but the question is, is it enough? The United Nations agencies FAO, OIE and WHO have had a tripartite collaboration on zoonosis for quite some time, and in 2019 produced “A Tripartite Guide to Addressing Zoonotic Diseases in Countries”.

In our African region, the first meeting on One Health held in Libreville, Gabon in 2012 to outline the strategy for the continent. There was a subsequent inter-ministerial and technical meeting in Dakar, Senegal in 2016 where Ministers made political commitments and a regional One Health Strategic Roadmap for countries was developed to strengthen the One Health approach at home.

Nigeria has conducted the assessment under the WHO International health Regulations (2005), Joint External Evaluation (JEE) for Health Security capacities in 2017 and the animal sector’s OIE Performance of Veterinary Services (PVS) assessment for critical competencies in 2019. The country is much better prepared to provide a coordinated response to public health emergencies since the Ebola outbreak of 2014, especially with the establishment of a National public health institute. In the wake of this novel Coronavirus outbreak, the Nigeria Centre for Disease Control (NCDC) is coordinating a multisectoral technical group that is assessing and managing the risk of importation to Nigeria. Also, the Port Health Services unit of the Federal Ministry of Health in Nigeria has been placed on alert and has heightened screening measures at the points of entry.

Very recently, the Federal Ministry of Health along with the Nigeria Centre for Disease Control (NCDC), Agriculture and Rural Development, Environment and partners conducted a three day National Bridging Workshop on One Health. This brought together the findings of the mid-term assessment of the Joint External Evaluation (JEE 2017) scores and the Performance of Veterinary Services (PVS) 2019 assessments of the human, animal and environmental health capacities and critical competencies of the country to identify gaps, examine synergies and develop a National road map to improved One Health implementation in areas like joint surveillance, which is the process of watching out for new outbreaks or public health incidents, Joint Risk Assessments (JRAs), Laboratory integration, Coordination and joint responses to outbreaks of zoonotic conditions like Avian Influenza, Anthrax, Lassa fever, Monkeypox and Rabies.

This culminated in the launch of the National One Health Strategic Plan 2019–2023 by the Honourable Minister of State for Health with the Agriculture and Environment Minister’s representatives and other stakeholders.

Director General NCDC Dr. Chikwe Ihekweazu and the Minister of State for Health, Dr. Adeleke Mamora alongside other partners at the launch of the National One Health Strategic Plan. Photo source: NCDC

With this plan, these and other relevant ministries including Defense, Information and Finance, States and LGAs will align efforts towards implementation, alongside other related plans such as the National Action Plan for Health Security (NAPHS), the National Antimicrobial Resistance Strategic Plan, and the PVS Gap Analysis. All these plans contribute to the “One Health” approach towards global health security to try to prevent outbreaks like the one happening in China now. Most global outbreaks start locally and this collaboration across sectors can help Nigeria, Africa and the globe prevent the spread of infectious diseases and keep humans, animals, and the environment… safe.
We are doing quite a lot to ensure there is prevention of and preparedness for infectious diseases, but the question is, is it enough? Share your thoughts with us on social media using the hashtag #PreventEpidemicsNaija

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