Contributing to One World, One Health A strategic framework for Reducing Risks of Infectious Diseases at the Animal–Human–Ecosystems Interface Subhash.

Contributing to Contributing to One World, One HealthOne World, One Health

A strategic framework for Reducing Risks of A strategic framework for Reducing Risks of Infectious Diseases at the Infectious Diseases at the

Animal–Human–Ecosystems InterfaceAnimal–Human–Ecosystems Interface

Subhash MorzariaSubhash Morzaria

Joint FAO-OIE-WHO-UNICEF-UNSIC-WB presentationSharm El Sheikh Ministerial Conference on HPAI

Egypt25-26 October 2008

UNSICRegional Workshop for UN Country Teams, 30-31 March 2009

Overview of the Overview of the presentationpresentation

Origin and the development of the Strategy

Components of the Strategy1. Introduction2. HPAI Achievements and Lessons Learned3. EIDs and Existing IDs and their Impacts4. The Strategic Framework5. Specific Objectives and Outputs6. Cross Cutting Issues7. Institutional Issues8. Financing the Framework

Conclusions and Way Forward

Origin and the development of the Strategy

Components of the Strategy1. Introduction2. HPAI Achievements and Lessons Learned3. EIDs and Existing IDs and their Impacts4. The Strategic Framework5. Specific Objectives and Outputs6. Cross Cutting Issues7. Institutional Issues8. Financing the Framework

Conclusions and Way Forward

IntroductionIntroductionNew Delhi recommendation, Dec 2007 Disease entrenched in several countries

Continued risk of re-emergence and pandemic flu

HPAI still a priority

Also recognition HPAI is one of many other E/rEIDs Address the larger issue of EIDs at animal-human-

ecosystem interface using OWOH approach

New Delhi recommendation, Dec 2007 Disease entrenched in several countries

Continued risk of re-emergence and pandemic flu

HPAI still a priority

Also recognition HPAI is one of many other E/rEIDs Address the larger issue of EIDs at animal-human-

ecosystem interface using OWOH approach

GenesisGenesis

Planning meeting in Geneva (FAO, WHO, OIE, UNICEF with UNSIC and WB) between 3-4 June 2008 to discuss strategy development

Based on the broad discussions in Geneva, outline for the Strategy agreed upon by mid June 2008

LATEST joint document (FAO-WHO-OIE-UNICEF-WB) finalized in mid October 2008

This is still a STRATEGIC FRAMEWORK with key concepts for WIDER CONSULTATION

Planning meeting in Geneva (FAO, WHO, OIE, UNICEF with UNSIC and WB) between 3-4 June 2008 to discuss strategy development

Based on the broad discussions in Geneva, outline for the Strategy agreed upon by mid June 2008

LATEST joint document (FAO-WHO-OIE-UNICEF-WB) finalized in mid October 2008

This is still a STRATEGIC FRAMEWORK with key concepts for WIDER CONSULTATION

Lessons learned… Lessons learned… Economic development and

disease

Disease control and livelihoods

Role of wildlife and transmission

Understanding epidemiology

Effective communication strategies

Cross-sectoral collaboration

Political commitment

Economic development and disease

Disease control and livelihoods

Role of wildlife and transmission

Understanding epidemiology

Effective communication strategies

Cross-sectoral collaboration

Political commitment

EIDs: main EIDs: main characteristicscharacteristics

Studies show over the last 50 years:One new disease every year

>70% are zoonotic, % increasing

Many are of transboundary in nature

Wide and significant impacts (SARS/HPAI)

Global significance, international public good

Studies show over the last 50 years:One new disease every year

>70% are zoonotic, % increasing

Many are of transboundary in nature

Wide and significant impacts (SARS/HPAI)

Global significance, international public good

Economic Impact of EIDEconomic Impact of EID

Figures are estimates and are presented as relative size.

1996 1997 1998 1999 2000 2001 2002 20031994 1995 2004 2005 2006

$50bn

$40bn

$30bn

$20bn

$10bn

Est

imat

ed C

ost

BSE UK, $10-13bn Foot & Mouth

Taiwan, $5-8bn

Foot & MouthUK

$25–30bn

Avian Flu Asia,$5–10bn

BSE U.S., $3.5bn

BSE Canada$1.5bn

Avian Flu, NL$500m

SARSChina, Hong Kong,Singapore, Canada

$30-50bn

Nipah, Malaysia$350-400m

Classical Swine Fever, Netherlands

$2.3bn

BSE Japan $1.5bn

HPAI, Italy$400m

Impact of pandemic influenza

Loss to the global economy•US$2 trillion

Prevention is cost-beneficial

Loss to the global economy•US$2 trillion

Prevention is cost-beneficial

Drivers for emergence and spread

(Human factors)Less developed nationsMore developed nations

70

65

60

55

1950

75

80

85

90

95

2000

05

10

15

0

1

2

3

4

5

6

7

8Billions

Total

Global Population: 1950-2015

Source: US Bureau of the Census

>90% population growth in Africa, Asia and L. America

Poverty on the rise

Rapid economic development

Huge demand for livestock

Rapid evolution of farming systems

>90% population growth in Africa, Asia and L. America

Poverty on the rise

Rapid economic development

Huge demand for livestock

Rapid evolution of farming systems

Increasing food Increasing food demanddemand

Farming systems: Numbers and Farming systems: Numbers and densitydensity

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

19

61

19

64

19

67

19

70

19

73

19

76

19

79

19

82

19

85

19

88

19

91

19

94

19

97

20

00

20

03

Duc

k M

eat

Pro

du

ctio

n

(T

ons)

China

Cambodia, Indonesia, Lao, Thailand and Vietnam

• In 2007, over 21 billion food animals were produced for over 6 billion people

• By 2020 the demand for animal protein up by 50% mainly in developing countries requiring over 30 billion animals

Wildlife factorWildlife factor Forest encroachment

Nipah, Hendra and Ebola

Bush meat (HIV and chimpanzee)

Exotic animal farming SARS

Trade in exotic animals Monkey pox, psittacosis 37.8 million counted animals imported in USA from

163 countries in 2000-2004

• Vector ecology and distribution (flies, ticks, mosquitoes)

• Invading pathogen adaptation with new vectors

• Migratory patterns

Climate change - Climate change - diseasesdiseases

Spread of pathogensSpread of pathogens(globalized travel and trade)(globalized travel and trade)

Increase in international air travel (5%/yr)

Large shipments of livestock

Animals can be any part of the world in time shorter than the IPs of many diseases

Increase in international air travel (5%/yr)

Large shipments of livestock

Animals can be any part of the world in time shorter than the IPs of many diseases

Pathogen risk factorsPathogen risk factors

All p

atho

gen

sE

IDs

OIE

list

Human Domestic animals Domestic carnivores

16

VirusesBoth DNA and RNA

viruses representedRNA highly likely as EID

High mutation rate, no repair mechanisms

Small, Ubiquitous, Intrusive

Ebola, Marburg, Nipah, Hendra, Lassa, Hanta, Influenza, Polio, Hepatitis, FMD, West Nile, Rabies, Yellow fever, SARS

Cleaveland, S., Laurenson, M.K. &Taylor, L.H (2001). Phil. Trans. R. Soc. Lond. 356, 991-999

Goal Goal Diminish the threat and minimize the global

impact of epidemics and pandemics due to highly infectious and pathogenic diseases of humans and animals

Broader vision Public health and food safety Food security Livelihoods of poor and vulnerable people

Focus Focus

Emerging and re-emerging infectious diseases

at the animal-human-ecosystems interface with

epidemic and pandemic potential causing

wide ranging impacts

OWOH Manhattan PrinciplesOWOH Manhattan Principles

Developed by WCS in 2004 in New York

Increasingly being adopted to address pathogen jumps between animals and humans

Holistic approach encompassing interfaces among the human, animal and ecosystem health domains

Proposes an international, interdisciplinary, cross-sectoral approach to disease emergence and control

Major thrusts/objectives Major thrusts/objectives 1. Preventive action and root causes and drivers

2. Building more robust public and animal health systems (IHR 2005, OIE Standards)

3. Strengthening the national and international emergency response capabilities

4. Better addressing the concerns of the poor: developed to developing economies potential to actual disease problems focusing on locally important diseases

5. Promoting cross sectoral and multi-disciplinary approach

6. Conducting strategic research

PrioritiesPriorities Country Level

Long term, improve disease control capacity, including the public and animal health and food safety services based on good governance compliant with WHO IHR and OIE standards

Country and Regional Levels Short to medium term establish risk-based disease surveillance

in humans and animals to identify diseases at source (hotspots, human-animal interface)

International Level Medium to long term strengthen capacity to improve ‘horizon

scanning’ to support countries to respond early and control infectious disease events (GLEWS).

Risk-based surveillance for Risk-based surveillance for sources of infectionsources of infection

Hotspots(Range of researchable issues)

Entrenchment animal/human/ecosystems

population density

A-Zoonotic/wild B-Zoonotic/domestic

D-Vector-borneC-Drug resistant

Cross cutting issues•Surveillance at three health domains •Biosecurity•Bioterrorism•Socio-economics•Development issues•Communications strategies at different levels

•Private-public partnership•Monitoring and evaluation

Cross cutting issues•Surveillance at three health domains •Biosecurity•Bioterrorism•Socio-economics•Development issues•Communications strategies at different levels

•Private-public partnership•Monitoring and evaluation

Strategy Components Strategy Components cont…cont…

Institutional IssuesInstitutional Issues Guiding Principles

Country level initiation and implementing stronger intersectoral collaboration and political commitment

Country, regional and international levels coordinated action that brings together those working on human, animal and ecosystems health

International level engaging international institutions drawing on their unique mandates and complementary expert base

Permitting rapid engagement of a broader range of stakeholders, including regional organizations in order to respond effectively to a variety of disease threats

Financing FrameworkFinancing Framework

FUNDING FOR THE FOLLOWING KEY AREAS:

Responding to the ongoing avian influenza crisis Strengthening public and animal health services Improving surveillance: special attention for hotspots

and strengthening wildlife surveillance Providing funds for emergency response

1. Supporting communication and social mobilization

2. Conducting strategic research

3. Supporting international organizations for regional and global initiatives

Preliminary cost estimatesPreliminary cost estimates HPAI support

Annual funding needs over next 3 years: US$542–735 million

Estimated cost of funding the OWOH Strategic Framework to 2020 Average per year:

• Scenario 1: US$ 852 million (43 low income countries)• Scenario 2: US$1,343 million (139 eligible countries)

Total• Scenario 1: US$ 10,228 million• Scenario 2: US$ 16,116 million

Funding sourcesFunding sources Existing donors Non-conventional donors and foundations Emergency funds

Country level fund for emergencies and compensation UN Central Emergency Response Fund

FAO Special Fund for Emergency and Rehabilitation

OIE’s World Animal Health and Welfare Fund The World Bank and the Regional IFIs Industry and other private sector Meat exporting countries

ConclusionsConclusions HPAI and EIDs are a complex problem

Multidisciplinary, multisectoral and multi-partnerships

Global challenge, requiring global solutions

Builds on HPAI successes and lessons learned

FAO, OIE, WHO, UNICEF, UNSIC and WB support

Stakeholders buy in and ownership important

Sharm El Sheikh Sharm El Sheikh responseresponse

All the respondent countries strongly supported the OWOH Framework

All the donors see this as synergistic with their future objectives EC Canada USDA Australia, Germany, Japan, Sweden

Canada to support Winnipeg Meeting (16-19 March 09) Globally advance the framework Priority actions for implementation

Winnipeg ResponseWinnipeg Response

Wide range of interest groups (16-19 March 09)

Academic community Research Institutes Donors Countries Regional Organizations

USAID InitiativeUSAID Initiative

EPT Programme, Components Detect Identify Respond Prepare

Next stepsNext steps Conducting wider consultation with countries,

regions and other key partners Political commitment at country level Importance of cross-border collaboration

Developing implementation strategies and plans

Mobilizing resources for implementation

Establishing timeframes for the above actions

CMC

Collaboration enhanced due Collaboration enhanced due HPAIHPAI