WHO Initiative to Estimate The Global Burden Of Foodborne ... · for ongoing exchange and communication are few. It is like two people trying to assemble a jigsaw puzzle, each with

WHOWHOWHOWHOInitiative to EstimateInitiative to EstimateInitiative to EstimateInitiative to EstimateThe Global BurdenThe Global BurdenThe Global BurdenThe Global Burden

Of Foodborne DiseasesOf Foodborne DiseasesOf Foodborne DiseasesOf Foodborne DiseasesMilestones Milestones Milestones Milestones ––––

Year Four of the InitiativeYear Four of the InitiativeYear Four of the InitiativeYear Four of the Initiative

Claudia SteinClaudia SteinClaudia SteinClaudia SteinTanja KuchenmTanja KuchenmTanja KuchenmTanja Kuchenmüüüüllerllerllerller

Food Safety and ZoonosesFood Safety and ZoonosesFood Safety and ZoonosesFood Safety and Zoonoses

Foodborne Diseases Stakeholder DayFoodborne Diseases Stakeholder DayFoodborne Diseases Stakeholder DayFoodborne Diseases Stakeholder Day11 November 201011 November 201011 November 201011 November 2010

• Discuss: 10'

What are your key expectations for this meeting?

• Reporter:Person who has the next birthday!

Two Expectations

Your expectations for TodayGroups of 10

"Diseases commonly transmitted through food":

Bacteria, viruses, parasites, chemicals, bio-toxins

"Burden" = Morbidity, Disability, Mortality & more!

Foodborne Diseases –a global development issue

UN Millennium Development Goals (MDGs)

• 4 out of 8 MDGs –

affected directlyby foodborne diseases


Diseases of poverty:

• Poor food storage & preparation �� contamination

• Poor food regulatory systems and enforcement

• Diseases may have short duration but frequent �� high rates of absenteeism and medical expenses


Contributing to child mortality:

• Children particularly vulnerable to contaminated environments, incl. food

• 1.5 million child deaths from diarrhoeal diseases annually

• 'Tip of iceberg' of foodborne diseases

• Diarrhoeal diseases exacerbate malnutrition ��vicious cycle of morbidity & mortality

Food safety is just as important as food security

Food security withoutfood safety can cause

great harm

• Malnourished people are morevulnerable to foodborne diseases & more likely to die

• Contaminated food is rarely discarded in famine situations

2006 WHO Consultation to Develop a Strategy to Estimate the

Global Burden of Foodborne Diseases –

"What doesn't get "What doesn't get "What doesn't get "What doesn't get measured, doesn't measured, doesn't measured, doesn't measured, doesn't

get done"get done"get done"get done"

"How else to "How else to "How else to "How else to assess assess assess assess

effectiveness of effectiveness of effectiveness of effectiveness of food safety policies food safety policies food safety policies food safety policies & interventions?"& interventions?"& interventions?"& interventions?"

Recommendation 10Recommendation 10Recommendation 10Recommendation 10: : : : WHO to lead efforts & WHO to lead efforts & WHO to lead efforts & WHO to lead efforts &

appoint appoint appoint appoint Foodborne Foodborne Foodborne Foodborne Disease Burden Disease Burden Disease Burden Disease Burden

Epidemiology Epidemiology Epidemiology Epidemiology Reference Group Reference Group Reference Group Reference Group

(FERG)(FERG)(FERG)(FERG)

GoalGoalGoalGoal of Initiative: Provide of Initiative: Provide of Initiative: Provide of Initiative: Provide data & tools to enable data & tools to enable data & tools to enable data & tools to enable policypolicypolicypolicy----makers & other makers & other makers & other makers & other

stakeholders to set stakeholders to set stakeholders to set stakeholders to set evidenceevidenceevidenceevidence----based priorities in based priorities in based priorities in based priorities in food safety at country levelfood safety at country levelfood safety at country levelfood safety at country level

What is the FERG?

FERG = scientific expert group appointed by & advising the WHO Director General

• transparent selection process after public call for experts

• representing all regions of the world (North & South)• multi-disciplinary and multi-sectoral

• To provide estimates on the global burden of all relevant foodborne diseases, according to age, sex and regions

• To assist WHO to strengthen the capacity of countries to conduct burden of foodborne diseases studies & policy situation analyses

• To assist WHO in bridging the gap between collection of scientific evidence and food safety policy making.

What are the objectives of FERG?

FERG FERG FERG FERG –––– composition & processcomposition & processcomposition & processcomposition & process

WHO SecretariatWHO SecretariatWHO SecretariatWHO SecretariatCore or Core or Core or Core or

Steering groupSteering groupSteering groupSteering group Thematic Thematic Thematic Thematic Task ForcesTask ForcesTask ForcesTask Forces

1.1.1.1. Burden of Disease expert (Chair)Burden of Disease expert (Chair)Burden of Disease expert (Chair)Burden of Disease expert (Chair)2.2.2.2. Food & Agriculture OrganizationFood & Agriculture OrganizationFood & Agriculture OrganizationFood & Agriculture Organization3.3.3.3. Epidemiologists & expert scientists in:Epidemiologists & expert scientists in:Epidemiologists & expert scientists in:Epidemiologists & expert scientists in:

Microbiology/enteric diseasesMicrobiology/enteric diseasesMicrobiology/enteric diseasesMicrobiology/enteric diseasesChemicals/ToxicologyChemicals/ToxicologyChemicals/ToxicologyChemicals/ToxicologyParasitic diseasesParasitic diseasesParasitic diseasesParasitic diseasesZoonotic diseases Zoonotic diseases Zoonotic diseases Zoonotic diseases Cause attributionCause attributionCause attributionCause attributionDisease modelingDisease modelingDisease modelingDisease modeling

Ad-hoc resource experts

1. Enteric diseases2. Parasitic diseases3. Chemicals & toxins4. Source attribution5. Country Studies

• Burden of disease• Knowledge translation

External expertsExternal expertsExternal expertsExternal experts

Spot the FERG members!

FBD Burden - Action framework

Strategic framework

Assembling Assembling Assembling Assembling existing evidenceexisting evidenceexisting evidenceexisting evidence

Country studiesCountry studiesCountry studiesCountry studiesCountry Country Country Country BoDBoDBoDBoDcapacity builtcapacity builtcapacity builtcapacity built

Tools for countries to Tools for countries to Tools for countries to Tools for countries to assess effectivenessassess effectivenessassess effectivenessassess effectiveness

Burden of FBD Burden of FBD Burden of FBD Burden of FBD Country Study ProtocolsCountry Study ProtocolsCountry Study ProtocolsCountry Study Protocols

Capacity building Capacity building Capacity building Capacity building Modules Modules Modules Modules

for conducting studiesfor conducting studiesfor conducting studiesfor conducting studies

Food Safety Policy Food Safety Policy Food Safety Policy Food Safety Policy Situation AnalysesSituation AnalysesSituation AnalysesSituation Analyses


Tools for systematicTools for systematicTools for systematicTools for systematicburden of FBD studiesburden of FBD studiesburden of FBD studiesburden of FBD studies

Tools & mechanisms Tools & mechanisms Tools & mechanisms Tools & mechanisms facilitating facilitating facilitating facilitating

research upresearch upresearch upresearch up----taketaketaketake

for using for using for using for using BoDBoDBoDBoD datadatadatadata

ExchangeExchangeExchangeExchange

How to bridge the gap between researchers and policy-makers ?

WHO‘s Mission

„…shall be the attainment by all peoples of the highest possible level of health.“

Source: WHO‘s Consitution

WHO‘s Mission

It is responsible for:

• providing leadership on global health matters,

• shaping the health research agenda,

• setting norms and standards,

• articulating evidence-based policy options,

• providing technical support to countries, and

• monitoring and assessing health trends.

ResearchersResearch production

Policy-makersResearch utilisation

How to integrate research into policy ?

Linear Process

Peer-reviewed article

Global Atlas & Report

Two distinct communities

•‘Scientific’ (context free)

• Colloquial (contextual)

• Proven empirically

• Anything that seems reasonable

• Theoretically driven

• Policy relevant

• As long as it takes

• Timely

• Caveats

• Clear Message

Evidence

Evidence

Researchers'

Policy-makers'

Two distinct communities

•‘Scientific’ (context free)

• Colloquial (contextual)

• Proven empirically

• Anything that seems reasonable

• Theoretically driven

• Policy relevant

• As long as it takes

• Timely

• Caveats

• Clear Message

Evidence

Evidence

How to integrate research into policy ?

Researchers'

Policy-makers'

"...efforts by researchers and by decision makers seem to proceed largely independently.

Both have their own (often misplaced) ideas about the other's environment. Opportunities

for ongoing exchange and communication are few.

It is like two people trying to assemble a jigsaw puzzle,

each with half the pieces but each working in a separate

room."

Lomas J. Research and evidence-based decision making. Aust N Z J Public Health. 1997;21:439–441.

"...efforts by researchers and by decision makers seem to proceed largely independently.

Both have their own (often misplaced) ideas about the other's environment. Opportunities

for ongoing exchange and communication are few.

It is like two people trying to assemble a jigsaw puzzle,

each with half the pieces but each working in a separate

room."

Lomas J. Research and evidence-based decision making. Aust N Z J Public Health. 1997;21:439–441.

Various factors

influencing policy-making

Re se a rch

Pro

ble

ms

How to increase research up-take?

Pol

icy

Pol

icy

Research

Research

Capacity building Capacity building Capacity building Capacity building ModulesModulesModulesModules



Tools to increase reTools to increase reTools to increase reTools to increase re----search impact search impact search impact search impact

on policyon policyon policyon policy

ResearchersResearchersResearchersResearchers PolicyPolicyPolicyPolicy----makersmakersmakersmakers

Efforts to increase the up-take of evidence in policy-making

TrustTrustTrustTrust

UnderstandingUnderstandingUnderstandingUnderstanding

Need to institutionalisedialogue and exchange

Facilitate useFacilitate useFacilitate useFacilitate use

Within the CSTF

(KTPG)

Country level

(Platforms)




Tools to increase reTools to increase reTools to increase reTools to increase re----search impact search impact search impact search impact







Facilitate useFacilitate useFacilitate useFacilitate use

Within the CSTF

(KTPG)

Country level

(Platforms)

Mandate of the FERG 'Knowledge Translation and Policy Group'

Goal

improve global public health by making

food safety policies and practices more

evidence informed.

Strategies1. advise and support the FERG in (i) conceptualizing

and designing policy-relevant tools and methods, and (ii) engaging with global stakeholders to foster their commitment to food safety;

2. advise and support FERG selected country research teams in producing, accessing, packaging, and communicating evidence required for influencing food safety policies and practices; and

3. advise and support FERG selected national teams of food safety stakeholders in demanding, accessing and using evidence required for food safety policies and practices.





Tools for increasing reTools for increasing reTools for increasing reTools for increasing re----search impact search impact search impact search impact


for using for using for using for using BoDBoDBoDBoD datadatadatadata



ReliableData

Improving “usability”(Relevance,

time and simplicity)

Effective access to

Data

Effective & targeted

communication

Increase BoD

understanding and use




Facilitate useFacilitate useFacilitate useFacilitate useIncentives to use Data

Expected Results(among others)

Global Programme on Evidence for Health Policy

Quoted in Cook, E.T. (1913), The Life of Florence Nightingale, (London: Macmillan), volume 2, p.396, and cited by

J.Maindonald and A.M.Richardson, This Passionate Study: a Dialogue with Florence Nightingale, Journal of Statistics

Education ,Volume 12, Number 1 (2004).

I collected my figures with a purpose in mind, with the idea that they could be used to argue for change. Of what use are

statistics if we do not know what tomake of them? What we wanted at that time was not so much

an accumulation of facts, as to teach the men who are to govern the country the use of statistical

facts. (Florence Nightingale)

Alliance of current partners & collaborators

• US Department of Agriculture, FSIS (technical & $ support)

• US Food and Drug Administration, CFSAN (technical & $ support)

• Netherlands Ministry of Health, Sports & Welfare ($ support)

• Japanese Ministry of Health, Labour and Welfare ($ support)

• US Centers for Disease Control & Prevention (technical & $ support)

• Government of the Federal Republic of Germany (JPO to Secretariat)

• Government of the UK, Department of Health (3 secondments to Secretariat)

• Government of the Republic of Ireland (2 secondments to Secretariat)

• UN & other internationals (FAO, OIE, IARC, UNEP, WTO, World Bank)

• Multiple topic-relevant networks & institutes (e.g GFN, Med-Vet-Net, Int Collab of BoI studies, European CDC, Institute for Health Metrics and Evaluation)

In discussion process with:• Bi-laterals, multi-laterals, Foundations etc

Alliance of current partners & collaborators

• US Department of Agriculture, FSIS (technical & $ support)

• US Food and Drug Administration, CFSAN (technical & $ support)

• Netherlands Ministry of Health, Sports & Welfare ($ support)

• Japanese Ministry of Health, Labour and Welfare ($ support)

• US Centers for Disease Control & Prevention (technical & $ support)

• Government of the Federal Republic of Germany (JPO to Secretariat)

• Government of the UK, Department of Health (3 secondments to Secretariat)

• Government of the Republic of Ireland (2 secondments to Secretariat)

• UN & other internationals (FAO, OIE, IARC, UNEP, WTO, World Bank)

• Multiple topic-relevant networks & institutes (e.g GFN, Med-Vet-Net, Int Collab of BoI studies, European CDC, Institute for Health Metrics and Evaluation)

In discussion process with:• Bi-laterals, multi-laterals, Foundations etc

US$ 4.3 million raised to

date

Further US$ 3.5 million

required

Is this really necessary….?

• A lot of ground work never tackled before

• Many causes to be quantified

• Need to make link between causes and food

Chemicals and Toxins

Elemental contaminants

Lead, mercury, cadmium, manganese, arsenic

Mycotoxins

Aflatoxins, ochratoxin, fumonisin, trichothocenes

Food additives

Sulphites, nitrites/nitrates, benzoic acid

Pesticides

Organophosphates, carbamates, DDT, pyrethrins

Organic industrial contaminants

POPs, e.g. Aldrin, Dieldrin, Heptachlor, dioxins, PCBs, perchlorate, perfluorinated compounds

Veterinary drugs/residues

Antibiotics, hormones - but not antimicrobial residues

Seafood toxins

Tetrodotoxin, ciguatera, shellfish toxins, DSPs, PSPs, histamines in tuna

Process contaminants

Acrylamide, PAHs, choropropanol

Allergens

Peanuts

Natural toxicants

Cyanide in cassava, aminoglycosides

Radionuclides and depleted uranium

Is this really necessary….?

• A lot of ground work never tackled before

• Many causes to be quantified

• Need to make link between causes and food

Chemicals and Toxins

Elemental contaminants

Lead, mercury, cadmium, manganese, arsenic

Mycotoxins

Aflatoxins, ochratoxin, fumonisin, trichothocenes

Food additives

Sulphites, nitrites/nitrates, benzoic acid

Pesticides

Organophosphates, carbamates, DDT, pyrethrins

Organic industrial contaminants

POPs, e.g. Aldrin, Dieldrin, Heptachlor, dioxins, PCBs, perchlorate, perfluorinated compounds

Veterinary drugs/residues

Antibiotics, hormones - but not antimicrobial residues

Seafood toxins

Tetrodotoxin, ciguatera, shellfish toxins, DSPs, PSPs, histamines in tuna

Process contaminants

Acrylamide, PAHs, choropropanol

Allergens

Peanuts

Natural toxicants

Cyanide in cassava, aminoglycosides

Radionuclides and depleted uranium

Enteric pathogens

Adenovirus

Aeromonas

Astrovirus

Bacterial toxins (Bacillus ceerus)

Bacterial toxins (C perfringens)

Bacterial toxins (S aureus)

Brucella sp.

Campylobacter sp.

Clostridium botulinum

Cryptosporidium sp.

Cyclospora sp.

EAggEC

Entero-pathogenic E. coli (EPEC)

Entero-toxigenic E. coli (ETEC)

Enterovirus

Giardia sp.

Helicobacter pylori

Hepatitis A

Hepatitis E

Leptospirosis

Listeria monocytogenes

Mycobacterium bovis

Non cholera Vibrios

Norovirus

Prions

Rotavirus

Salmonella (non-typhoidal) sp.

Salmonella (typhoid)

Shiga-toxin producing Escherichia coli (STEC)

Shigella sp.

Vibrio cholerae O1/ O139

Yersinia sp.

Parasites

Ancylostoma duodenale

Angiostrongylus cantonensis

Angiostrongylus costaricensis

Anisakis simplex

Ascaris lumbricoides

Blastocystis hominis

Capillaria philippinensis

Clonorchis sinensis

Cryptosporidium spp

Cyclospora spp

Dicrocoelium dendriticum

Dientamoeba fragilis

Diphyllobothrium latum

Echinococcus spp.

Echinostoma spp.

Entamoeba histolytica

Fasciola spp.

Fasciolopsis buski

Gastrodiscoides hominis

Giardia intestinalis

Gnathostoma spinigerum

Heterophyes heterophyes

Hymenolepis nana

Isospora belli

Linguatula serata

Metagonimus yokogawai

Nanophytes salmincola

Opisthorchis felineus

Opisthorchis viverrini

Paragonimus spp.

Sarcocystis hominis (LOW priority)

Taenia saginata

Taenia solium

Toxocara spp

Toxoplasma gondii

Trichinella spp.

Trichostrongylus spp

Trichuris trichiura

Achievements to date –first results presented last year (2009)

Could be 1 Could be 1 Could be 1 Could be 1 miomiomiomio

higher than higher than higher than higher than

previously estimated




~18,000 deaths~18,000 deaths~18,000 deaths~18,000 deaths

~30% of epilepsy

~30% of epilepsy

~30% of epilepsy

~30% of epilepsy

1111----2% of 2% of 2% of 2% of populationpopulationpopulationpopulation

Achievements to date – burden resultsin peer-reviewed literature

Stakeholder recommendations 2009:implementation by WHO

• Aims– Provide overall verdict of progress made

– Identify what is going well (and must continue)

– Identify what would benefit from improvements or change

• Methods– Obtain views of FERG experts and stakeholder groups

• Questionnaire survey of FERG experts (46)

• Semi-structured interview of FERG experts (15) and stakeholders (5)

External mid-term evaluation

Thank you very much for your participation!

Results are truly anonymous to Secretariat

• Overall verdict

– Initiative progressing very well

– Initiative extremely important

– Leadership and management by WHO Secretariat exceptional

– Some threats identified which should be addressed (e.g.

Secretariat staffing, administrative processes)

– Some areas could potentially be enhanced (comms media,

travel service, revision of time frames)

Preliminary results

Enter the stakeholders

• WHO member states

• Bi/multi-lateral donors

• NGOs

• Consumer groups

• Industry

• Public & scientific media

What is the purpose of this stakeholder

meeting?

• Actively engage with the research conducted & FERG

• Open new channels for multi-sectoral technical cooperation

• Provide direct input into relevance of country studies

Stakeholder roles

at the meeting

• Suggest how country studies best meet

stakeholder needs

• Suggest how WHO

can bridge the

evidence-policy gap

• Suggest how collaboration in this

area can be improved

• Other suggestions!

For consideration inFor consideration inFor consideration inFor consideration inFERG plenaryFERG plenaryFERG plenaryFERG plenary12 November12 November12 November12 November

Extending the alliance of partners –get involved!

• Consider whether and how the Initiative is relevant to your work

• Consider how and to what extent you wish to engage with WHO and contribute to the outcome of the Initiative

• Expert scientific/technical input into Initiative

• Expansion of expert network & raising awareness of FERG

• Peer-review feedback on work of FERG

• Other practical inputs:

• Human resources to Initiative

• Funding for Initiative

What kind of input could be provided?

Global Programme on Evidence for Health Policy

ThankThankThankThank You.You.You.You.

Now would youNow would youNow would youNow would youplease closeplease closeplease closeplease closemy fridge my fridge my fridge my fridge ––––my food will my food will my food will my food will otherwise beotherwise beotherwise beotherwise beunsafeunsafeunsafeunsafe…………

Round 2:Round 2:Round 2:Round 2:Burden resultsBurden resultsBurden resultsBurden results

of selected causesof selected causesof selected causesof selected causes

1.1.1.1. AflatoxinAflatoxinAflatoxinAflatoxin contaminationcontaminationcontaminationcontamination2.2.2.2. Foodborne Foodborne Foodborne Foodborne TrematodesTrematodesTrematodesTrematodes

(parasites)(parasites)(parasites)(parasites)

WHO Initiative to Estimate The Global Burden Of Foodborne ... · for ongoing exchange and communication are few. It is like two people trying to assemble a jigsaw puzzle, each with

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