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EIO meeting, WHO Geneva| 4 March 2013
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The Human-Animal-Ecosystem Interface:
Strategy and collaborative activities within the tripartite partnership
Elizabeth Mumford
Department of Food Safety and Zoonoses
Why the human-animal-ecosystems interface?
Complex public health threats
– existing and emerging zoonoses – antimicrobial resistance
– food-borne zoonoses and other threats to food safety
Management /risk reduction : must consider the complexity of interactions among humans, animals, and the various
environments they live in
Requires communication and collaboration among the sectors responsible for human health, animal health, and environment
Working collaboratively improves efficiency and outcomes
EIO meeting, WHO Geneva| 4 March 2013
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"One Health" (at least, the WHO view)
A global “movement” with appreciable momentum
Recognizes complexity of interactions at the the human-animal- ecosystems interface
Means applying coordinated, collaborative approaches to address health threats
– across disciplines and across sectors – Broad and flexible
Is by definition non-exclusionary – can not be owned, institutionalised, or governed
ANYONE and EVERYONE can “do” One Health!
Human-Animal-Ecosystems work at WHO
WHO activities are implemented at the country and regional level, and at the international level by many departments within WHO headquarters.
WHO activities focus on public health aspects
work with partners having responsibility for other sectors as needed, e.g:
• OIE and FAO
• national ministries of health
• NGOs (e.g. MSF)
• other UN organisations (e.g. UNICEF, OCHA, UNSIC)
• World Bank
EIO meeting, WHO Geneva| 4 March 2013
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Human-Animal-Ecosystems work at WHO (2)
Understanding and reducing public health risks from
– Existing and emerging infectious diseases – Antimicrobial resistance in pathogens
Ensuring food security and safety along the food production chain
– Codex Alimentarius
– International Food Safety Authorities Network (INFOSAN)
Governance – IHR and PVS, Codex
Early warning
– Global Early Warning System for Major Animal Diseases (GLEWS)
Integrated risk assessment
Capacity building
– Global Foodborne Infections Network (GFN)
Building on international legal frameworks governing zoonotic diseases
WHO: International Health Regulations
http://www.who.int/ihr/
OIE: Terrestrial Animal Health Code
http://www.oie.int/eng/normes/Mcode/en_sommaire.htm
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What do the IHR call for?
Strengthened national capacity for surveillance and control, including in travel and transport
Prevention, alert and response to
international public health emergencies
Global partnership and international collaboration
Rights, obligations and procedures,
and progress monitoring
The tripartite, cross-sectoral collaboration, and “One Health”
Areas of OIE, WHO, and FAO work overlap where the interaction between animals, humans, and the
environments they live in impacts public health, animal health, and global health security
We have been working together on these issues long
before “One Health” emerged!
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The tripartite, cross sectoral collaboration, and “One Health”
(2) Together and separately, the OIE, WHO, and FAO have a key role in
“One Health” by providing collaborative and complementary efforts to support AH and HH internationally and with Member States
– Supporting national governance required for disease prevention, detection and control
– Strengthening national health systems
– important components are surveillance and risk assessment
The OIE, WHO, and FAO take cross-sectoral approaches to address health threats at the human-animal-ecosystems interface
Promoting and facilitating cross-sectoral relationships and collaborations in regions and countries
Reflection of technical and policy aspects between international and regional/national contexts
Human health technical aspects
and policy
Animal health technical aspects
and policy Aligned
technical aspects and
policy
Region / Country
Cross-sectoral collaboration
Animal health technical aspects
and policy Cross-sectoral
collaboration Human health
technical aspects and policy
Aligned technical aspects and
policy
International
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The Tripartite Concept Note (2010)
The Tripartite ‘touchstone’
Co-signed by the Executive Heads of FAO, OIE and WHO
Complementary agendas and new synergies:
– Normative work
– Public communication – Pathogen detection
– Risk assessment and management – Technical capacity building
– Research development
Building on existing infrastructure
So… like what?
National Veterinary Authority (CVO)
Ministry of Agriculture
National and subnational human
health surveillance systems
Ministry of Health
IHR focal point Official
Notification
National and subnational animal health surveillance
systems
Surveillance data projects/government
Verification
Verification
Rumours and unofficial information
Verification
Official Notification
Rumours and unofficial information
Rumours and unofficial information
International
EIO meeting, WHO Geneva| 4 March 2013
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GLEWS+ and Risk Assessment
Joint WHO, OIE, and FAO tool for quickly sharing information and assessing health events of potential international concern
– Relies on the existing surveillance and reporting systems in countries
“GLEWS+” evolved to support alignment and collaboration in the agencies’ risk assessments and risk communication activities
Joint standard risk assessments
– allow the agencies to optimize the use of both information and expertise existing in each sector
– more comprehensively understand the threats
– offer valid responses at the international, regional, and national levels
FAO-OIE-WHO 4-way Linking Project
• Aim
: Understand and effectively manage national health risks
• epidemiological and virological information from the AH and PH sectors must be available, be linked, and be jointly analyzed
• risks must be effectively communicated to national decision makers.
• Scope
: Avian influenza H5N1endemic countries/human cases(s)
• Goal
: Build national capacity for effective joint risk assessments
• Capacity to collect epi/vir data from AH/PH sectors and link in time &
space
• Mechanism for jointly undertaking regular risk assessments
• Communication among/between stakeholders and decision makers
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Two main activities:
1. Review national AH & PH systems
• Field to central government
• Epi and virological data collection, linking, communication, and analysis
• Identify linkages and technical/administrative constraints
2. National workshop – interactive and scenario based
• Importance of intersectoral communication
• Qualitative joint risk assessment
• Identify critical national data for sharing
• Country-based mechanisms/tools for sharing with national decision-making institution(s)
• Next steps and plan of action, and identify national staff responsible
Is essentially a national project
• Builds on national priorities, systems and mechanisms where they exist
• Continuous interaction with national authorities in AH & PH
• Implementation of action plan is responsibility of national government
FAO-OIE-WHO 4-way Linking Project (2)
Standard risk assessment format
• Assign likelihood and impact level and plot on 3x3 (or 5x5) tables
• Consider uncertainty
• Document justification
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And meanwhile, back at the global level….
FAO, OIE, WHO High Level Technical Meeting to Address Health Risks at the
Human-Animal-Ecosystems Interface (HLTM)
November, 2011, Mexico City
HLTM Vision
Build on preceding technical and policy meetings
– IMCAPI, Winnipeg OWOH, Stone Mountain OH, Melbourne OH Congress, Verona I and II emerging diseases…
– accomplished their specific objectives/ effectively moved the world closer to understanding, accepting, and applying cross sectoral
approaches.
Engage the ministerial level in member countries
– Identify general principles for cross-sectoral approaches
– Provide ministers with rationale and practical tools to facilitate implementation of these concepts
• to address health issues at the HAEI in their countries.
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HLTM
Participants from the PH, AH, agriculture and environmental sectors, international technical experts, and regional and donor organisations and partners (e.g. World Bank, UNSIC)
AMR, zoonotic influenza, and rabies used as ‘entry points’ for discussions
HLTM
Discussion
– plenaries
– facilitated working groups: Allowed participants to
• share their views and experiences
• identify overarching key elements for / constraints to effective collaboration
• define specific actions and concrete next steps
– panels: discussion of the outcomes of the working groups
Outcomes
– Broad consensus and commitment on intersectoral approaches
– Identified cross-cutting “key elements” , high priority technical actions, and overall direction forward
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HLTM: Key Messages
High-level political will, trust among stakeholders, cultural and
behavioural changes, and financial support are needed to establish cross-sectoral approaches
Strong governance structures and aligned legal frameworks,
building on existing mechanisms, are essential to achieving effective disease surveillance and response
Communication is crucial to ensuring cross-sectoral coordination
Actions and activities must address institutions and infrastructure at local, national, regional and international levels
Outlook
WHO is working with OIE and FAO and a wide spectrum of other partners to approach health risks at the human-animal-ecosystems interface cross-sectorally
It’s all about working to benefit countries
– within countries to develop capacities, bring practical solutions, build trust and ‘personal” networks among national institutions
– internationally to bring messages and increase political will of decision makers in Member States
The priority – both under IHR and within the tripartite - is on strengthening systems and core capacities in countries
– Work continues on specific priority topics
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Bottom line
Operationalising “One Health”
means:
– taking this approach in what you do, how you think on a daily basis – facilitating building relationships
among others
– always being trustworthy and promoting trust
