EMERGING INFECTIOUS DISEASES AND ONE HEALTH: GOALS AND HOW WE CAN GET THERE
– Dr. Aruna Muthumanickam (Internal Medicine Resident)
Our daily lives today intersect with animal ecosystems in more complex ways than we’ve imagined. Animals are engaged in the food sector, in transportation, sports, as educational tools, and raised as domestic companions. The inevitable consequence is that pathogenic bacteria, viruses, fungi and parasites can jump ship from animals to humans and result in what we call Zoonotic Diseases. Some of the common zoonotic infections that have raised the most concern are Rabies, Plague, Salmonellosis, Avian Influenza, NIPAH virus, and now the emerging coronaviruses (including SARS and MERS). The modes of transmission are multifold and include direct contact with bodily fluids of animals including saliva, mucus, feces, urine, (through petting, scratches, etc.), contact with aquarium, chicken coops, soil, etc., via vectors (ticks and mosquitos and fleas), foodborne including unpasteurized raw milk, undercooked meat and eggs, or fruits and vegetables and water contaminated with feces from an infected animal. It has been well-known that 6 out of 10 infectious diseases in humans are spread from animals, that 75% of the newer infectious diseases are zoonotic.
Since zoonoses do not discriminate based on geographical boundaries and anatomical differences in species, the approach to tackling it must also be more holistic and forward-looking. Hence, the One Health approach. One Health fundamentally is not a new concept. It is an approach that recognizes that control of disease is based on the shared experience of living on this one planet; a tale as old as time. And although the subjects; humans and animals are different, the core principles of disease prevention and preservation of life mandate that our goals and actions be similar, if not same.
The goal of maintenance of human health is fundamental to progress, but the One Health approach cannot work without recognizing that ecological preservation and wildlife conservation are just as important. This is due to certain undeniable facts; water and air form essential media for the transmission of disease, inappropriate land usage is known to displace animal populations, and two-thirds of the antibiotics used worldwide are used in food production animals, aquaculture, horticulture, etc. As a result, zoonoses are not just a medical problem. Cooperation between wildlife conservation societies and the health industry, on the foundation of a common goal of disease prevention and environmental protection, is the backbone of One Health.
Transdisciplinary cooperation is also essential among other participants such as veterinarians, ecologists, technology developers, health ministries, medical laboratories, pharmaceutical researchers and animal husbandry organizations, to name a few. Data sharing, by ecologists, researchers and other scientists, is an important way to promote a uniform understanding of current disease patterns. This data needs to be devoid of geographical boundaries, and in real-time. The way to achieve this is by increasing focus on infrastructure development by establishing more diagnostic laboratories and further enhancing the network and capacity of present laboratories such that they are able to collect large amounts of clinical and epidemiological information, process, analyze and dissipate their findings so as to achieve a rapid diagnosis. The only way to make the most of diagnostic labs is to ensure that they are present at geographical epicenters of disease, and this requires cooperation with government and civil agencies. With increased globalization, travel and trade, it is critical that governments of neighboring countries, have a mutual understanding of the ongoing infectious disease patterns in their region and have an honest dialogue about their resources, and cooperative measures that they are willing to take to achieve their common mitigation goals.
It is important to focus on certain public health measures such as the establishment of surveillance systems with newer modalities of action such as remote sensing and molecular epidemiology. These systems should ideally facilitate transboundary surveillance and allow for timely foreshadowing of disease patterns. Other public health interventions such as vector control, and integration of laboratories, rapid response teams and mainstream medical care facilities, need to be implemented to achieve efficient epidemic preparedness at all levels.
Civilians are just as integral to the fight against zoonoses, forming an intricate link between humans and animals by virtue of being pet owners, travelers, and consumers of food and drink. As a result, there needs to be increased public education about primary prevention measures at the ground level. This translates to increased spread of awareness about personal protection during camping trips by park authorities, increased public health awareness about human and pet hygiene, better dietary and cooking practices, increased emphasis on vaccination, etc.
The only organic approach to combating zoonoses in the foreseeable future lies on the hinges of One Health. The renewal of the Manhattan principles of 2004, and the establishment of the Berlin principles of 2019, stands as a testimony to the commitment and belief of healthcare organizations and policymakers in this holistic ideology. However, on the trajectory towards a disease-free era, One Health is not a pit-stop. We need to be in this for the long-haul.
- Sukhyun Ryu, Bryan Inho Kim, Cheng Siang Tan, Byung Chul Chun. One Health Perspectives on Emerging Public Health Threats. J Prev Med Public Heatth. 2017 Nov; 50(6): 411-414. [PubMed]