ROLE OF VETS IN ONE HEALTH APPROACH TO TACKLE THE EMERGING ZOONOSES LIKE COVID19

With Seven deaths and 416 active cases (reported as of March 23, 9 a.m. IST) of the novel coronavirus disease in biodiversity-rich India, experts underscore the need for the One Health framework in the country. One Health is a collaborative, multisectoral, and transdisciplinary approach linking human, animal, and environmental health.

One Health is a new dimension in viewing health. It

takes into account health and well being of man, animals and

nature or “Health for all” concept. The importance of this

dimension is exposed when individuals cannot derive a

solution especially in cases of disease threats or zoonoses.

Today world recognizes health not only as the physical, the

mental and the social wellbeing (as per WHO) but also as

spiritual, emotional, vocational, political dimensions. These

symbolize “One Health” in which a huge range of factors to

which other sectors besides health must contribute if all people

are indeed to attain a level of health that will permit them to

lead a socially and economically productive life. Human beings

are at the centre of concerns for sustainable development. They

are entitled to a healthy and productive life in harmony with

nature. There is a growing need to improve human and animal

health services to protect global health and food security. It is

observed that the limited resources for human and animal

health service have failed to produce the desired effect, but

collectively by adopting interdisciplinary or intersectoral

strategies (One Health approaches) we can face challenging

situations to achieve a paradigm shift in health service

provision. For this there has to be convincing arguments that

the costs of a major shift will generate substantial net benefits.

Health threats at the human-animal-ecosystem interface

have increased over the past decades, as pathogens continue to

evolve and adapt to new hosts and environments, imposing a

burden on human and animal health systems. The increase in

health threats to humans and animals is driven by multiple,

inter-related global factors generally related to human behavior

and environmental changes and also reflects the complexities

of the ecosystems in which humans and animals coexist.

Because reducing these risks cannot be achieved by one sector

alone, there is increasing convergence towards a One Health

approach that incorporates a cross-sectoral, multidisciplinary

mode of addressing these threats and reducing health risks.

Today’s highly mobile, interdependent and interconnected

world provides myriad opportunities for the rapid spread of

infectious diseases, and radio nuclear and toxic threats, which

is why updated and expanded regulations are necessary.

Why is animal health important to human health?———-

Animals have been an integral part of human life from time immemorial. From providing food to maintaining ecological balance they have had a varied role to play in human life. Animal health has both direct and indirect impacts on human health. The direct impact is the increased incidence of emerging diseases of animal origin like Nipah virus infection, Ebola virus disease, Middle East respiratory syndrome (MERS), influenza.

Not only zoonotic diseases but diseases like Foot and mouth disease (FMD) which is primarily a viral disease of animals causes a whopping loss of Rs. 20,000 crore (Rs. 200 billion) annually in India. This not only impacts the country’s economy but at the grassroots level affects the farmers’ livelihood, making them vulnerable. It is not wrong to say that animals serve as a means for a human to achieve physical, mental and social wellbeing.

Leaders within healthcare organizations of all shapes and sizes face a wave of challenges including globalization, the explosion of information technologies, concerns around environmental impacts, changing demographics, increased regulatory scrutiny, pending healthcare reform and, most recently, a global economic recession. Some of the major health threats faced in today’s world are

• Unsafe water, poor sanitation and hygiene can kill an

estimated 1.7 million people annually, particularly as a

result of diarrhoeal disease

• Emerging zoonoses like Avian Influenza and Vector-borne

diseases including malaria, dengue and leishmaniasis are

always a threat in developing world. For example Malaria

kills over 1.2 million people annually, mostly African

children under the age of five. Poorly designed irrigation

and water systems, inadequate housing, poor waste disposal

and water storage, deforestation and loss of biodiversity.

• Urban air pollution generated by vehicles, industries and

energy production kills approximately 800000 people

annually. Indoor smoke from solid fuels kills an estimated

1.6 million people annually due to respiratory diseases.

• Road traffic injuries are responsible for 1.2 million deaths

annually; low- and middle-income countries bear 90 per

cent of the death and injury toll. Degradation of the built

urban and rural environment, particularly for pedestrians

and cyclists, has been cited as a key risk factor.

• Toxic exposure like lead (Pb) can kill more than 230 000

people per year and causes cognitive effects in one third of

all children globally; more than 97% of those affected live

in the developing world. Similarly, common people are

exposed to residues of pesticides and other heavy metals in

the environment which can lead to health hazards like

cancer.

• Climate change impacts including more extreme weather

events, changed patterns of disease and effects on

agricultural production are estimated to cause over 150 000

deaths annually.

• Unintentional poisonings kill 355 000 people globally each

year in developing countries, where two-thirds of these

deaths occur, such poisonings are associated strongly with

excessive exposure to, and inappropriate use of, toxic

chemicals and pesticides present in occupational and/or

domestic environments

Emerging and communicable diseases

Many zoonotic diseases are emerging as a result of

environmental factors, including climate change, deforestation,

alterations of wildlife habi-tat, and other land use change;

human population growth; movement of human beings and

animals across borders; and increased production of food

animals. Infectious diseases account for 14 million deaths per

year, around 25 per cent of the world total. They are the

world’s leading killers of children and young adults. Six major

diseases currently cause 90 per cent of the deaths from

communicable diseases: AIDS, malaria, tuberculosis,

pneumonia, diarrhoeal diseases, and measles.

The global human population is estimated to reach 7

billion within the next few years and will increase its need for

land, food and energy. As global populations expand and shift, the healthcare sector is coming under increasing pressure. The

scope and emphasis of a One Health program are necessarily

influenced by the changing characteristics of human and

animal population it serves. The increased rate of population

growth, loss of biodiversity, changes in population density and

urban-rural movement requires a One Health dimensions to

solve the new problems thus created. Despite undoubted health

advances in many areas, poor health continues to be a

constraint on development efforts. According to the World

Bank estimates 970 million people were living below the ‘$1-a-

day’ poverty line in 2004, and 2,550 million (40 per cent of the

world population) below the ‘$2-a-day’ line (Chen and

Ravallion, 2007). Characteristics of extreme poverty include

very low income and lack of access to the basic necessities of

health and life – food, shelter, water and other living

requirements. High density of population contributes to the

spread of communicable diseases, so population pressure not

only drains food resources and leads to widespread

malnutrition, but also sets the stage for epidemics. Population

pressure, malnutrition and infection – thus constantly reinforce

one another. Thus a decrease in the number of young people in

relation to the old appears imminent. The vicious circle of

population pressure explains the effect of population on health.

This involves Population pressure >>> Food Shortage>>>

Malnutrition>>> Infection >>> High child mortality>>> High

birth rate.

Global Health status accurately reflects the quality of life,

or Human Development Index of our communities. In both the

developed and developing world, many of the most compelling

challenges derive from disparities or inequalities in the disease

burden between advantaged or wealthy communities (or nations)

and disadvantaged or poor communities. Health inequities are

avoidable inequalities in health between groups of people within

countries and between countries. Social and economic status and

their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat illness

when it occurs. In Bolivia, babies born to women with no

education have infant mortality greater than 100 per 1000 live

births, while the infant mortality rate of babies born to mothers

with at least secondary education is under 40 per 1000. Although

economic benefits have been gained in the past 25 years, it is

unequally distributed among rich and poor countries. Gender

biases in power, resources, entitlements, norms and values

damage the health of millions of girls and women.

Health Challenges like Water scarcity, climate change,

increasing incidence of drought and famine, malnourishment,

disease, rapidly rising costs for food and energy. The extinction of

endangered animal species and explosion of human population are

also the major challenges faced today, for which approaches like

One Health is needed. India is home to the greatest burden of

maternal, newborn and child deaths in the world. Infant mortality

rate declined from 83 per 1000 live births in 1990 to 44 per 1000

live births in 2011 and maternal mortality ratio reduced from 570

per 100,000 live births in 1990 to 212 in 2007-2009.

However, both remain high in comparison to other BRICS

countries. Animals and human beings often share exposure

risks from noninfectious disease threats, such as air and water

quality problems, pesticides, lead, and carbon monoxide. The

triple burden of disease (communicable diseases, non-

communicable diseases and other new infections) and the fact

that people can afford more and more expensive care and

treatment results in an increase of health expenditures that

confronts countries with real challenges on the ways to reduce

or freeze health expenditures rather than utilizing the country’s

resources on the disease prevention programmes.

Effects of climate change on human health can be

expected to be mediated through complex interactions of

physical, ecological, and social factors. These effects will

undoubtedly have a greater impact on societies or individuals

with scarce resources, where technologies are lacking, and where infrastructure and institutions (such as the health sector)

are least able to adapt. For this reason, a better understanding

of the role of socio-economic and technological factors in

shaping and mitigating these impacts is essential. Potential

risks to human health from climate change would arise from

increased exposures to thermal extremes (cardiovascular and

respiratory mortality) and from increases in weather disasters

(including deaths and injuries associated with floods). Other

risks may arise because of the changing dynamics of disease

vectors (such as malaria and dengue fever), the seasonality and

incidence of various food-related and waterborne infections,

the yields of agricultural crops, the range of plant and

livestock, pests and pathogens, the salination of coastal lands

and freshwater supplies resulting from rising sea-levels, the

climatically related production of photochemical air pollutants,

and the risk of conflict over depleted natural resources. The

global environment is rapidly changing, and animals and

human beings are exposed to shared environmental health

risks. Environmental disasters such as Hurricane Katrina wreak

havoc on both human and animal populations. Now humankind

became increasingly aware of the need for a more collective

approach such as One Health approach to tackle certain urgent

environmental problems.

We face a global situation where an estimated 925 million

people go hungry. The effects of food price increases are likely to

deepen the vulnerability of those who spend between 50% and

80% of their family budget on food, mostly basic staples. Chronic

and acute child malnutrition, low birth weights, and suboptimal

breastfeeding are estimated to cause the deaths of 3.5 million

mothers and young children every year. Furthermore, one in three

children under the age of 5 years born in developing countries

suffers from stunting due to chronic under nutrition. Efforts to

respond to food insecurity, food safety and food trade challenges

have addressed all four dimensions of food security namely,

availability, access, utilisation and stability. Rising prices present

a great opportunity for farmers to respond to growing demand. But farmers need inputs and cash to do this. Increases in extreme

weather events will damage crops and disrupt farming. Sea level

rise and flooding of coastal lands will lead to salination or

contamination of fresh water and agricultural lands, and the loss of

nursery areas for fishing. Drought and changing patterns of plant

and livestock diseases and pest infestations, reduction of income

from animal production, decreased crop yields, lessened forest

productivity, and changes in aquatic populations will all affect

food production and security. The regions which are already

suffering from food insecurity and malnutrition are most likely to

be adversely affected.

Good health depends on continuous supply of safe and

pure water. WHO estimates that the total global economic losses

associated with inadequate water supply and sanitation are US$

260 billion/year. The quality of water, whether used for drinking,

domestic purposes, food production or recreational purposes has

an important impact on health. Provision of public health

infrastructure has been key to economic, social, and industrial

development, and remains a challenge in many parts of the world.

In 2002, 21% of people living in developing countries did not

have sustained access to an improved water source, and 51% did

not have access to improved sanitation. Water of poor quality can

cause disease outbreaks and it can contribute to background rates

of disease manifesting themselves on different time scales.

Initiatives to manage the safety of water do not only support

public health, but often promote socioeconomic development and

well-being as well. Millions of people are exposed to dangerous

levels of biological contaminants and chemical pollutants in their

drinking-water due to inadequate management of urban, industrial

or agricultural wastewater. WHO estimates that more than 200

million people are affected by schistosomiasis and around 800

million more are at risk of infection. In addition, dangerously high

concentrations of chemical hazards, such as arsenic and fluoride,

originating from natural sources affect millions and cause

conditions such as cancer and fluorosis. The main health effects of

lack of access to clean water and sanitation are diarrhoeal and

other diseases caused by biological or chemical contaminants.

Terrorism, defined as use systematic violence, threat of

violence or terror against individuals, groups or Governments to

achieve a political objective is currently a global distribution and

growing interest for international public health problem. The

terrorism related violence affects the public health and the health

care services in an important way and in different scopes, among

them, increase mortality, morbidity and disability, generates a

context of fear and anxiety that makes the psychopathological

diseases very frequent, seriously alters the operation of the health

care services and produces important social, political and

economic damages. Terrorist attack may also disrupt public water

system and sanitary system. Hence it is imperative for to develop

preparedness and response plans in this context. There is a broad

scope for the tools that One health offers, particularly in areas

such as the epidemiological surveillance of terrorist attacks and its

impact on morbidity and mortality planning, execution and

evaluation of programmes of prevention, preparedness and

emergency response of the health system to terrorism,

intervention in mental health programs or programs of social

intervention, among many others.

The increased health threats resulted in global issues of

environmental sustainability and have equally affected the health

of humans and animals that are closely interconnected. The health

and sustainability consequences of global change are

economically, socially, medically, and environmentally costly,

and as such, their control can be considered a global public good.

The complexities and breadth of such threats demand

interdisciplinary solutions that address the connections between

human and animal health, as well as the underlying environmental

drivers that impact health. Increasingly, there is a push in the

global community to move from reductionist, reactionist

approaches to more holistic, preventive approaches that rely on

systems thinking. One Health concept is a growing global strategy

that is being adopted by a diversity of organizations and policy

makers in response to the need for integrated approaches. This

approach can be relevant to a wide range of global development goals. If knowingly or unknowingly nature is not used (disuse) or is overused (abuse) it would deteriorate. Healthy environment and healthy animals ensure healthy life for mankind.

In global health there has been significant progress

towards achieving the Millennium Development Goals but many

challenges remain. There have been reductions in child mortality

and gains in the treatment and prevention of HIV/AIDS,

tuberculosis, malaria, poliomyelitis and neglected tropical

diseases. The value of an activity or its impact may be reflected

by market prices, e.g. health treatment expenditures or production

losses avoided. But often, One Health risk mitigation activities

result in nonmarket outcomes such as avoidance of human distress

or death, feelings of consumer confidence, improved animal

welfare or conservation of an animal species, which do not have a

market value but nevertheless can be measured using one of the

many approaches available in economic theory, such as

contingent valuation. A change from a traditional sectoral

approach of health management to a holistic One Health approach

needs to compare the marginal benefits against the marginal costs

of such a change. The final outcome of One Health initiatives is

the avoidance or reduction of health threats in humans and

animals and translated into values using established economic

quantification methods. There is a financial gain for animal and

public health services to combine their resources to either attain a

critical mass that allows the establishment of some minimal

infrastructure and service provision or to enhance the delivery of

services by sharing cost-structures. Such cost-sharing initiatives

serve to reduce the investment required in individual programmes,

thus increasing the efficiency of a programme.

India’s policy on zoonoses-——–

In the current scenario, where about 816 zoonotic diseases (out of 1200 infectious) are known to have originated in animals (it is almost 75 percent), much is being neglected. There are bacterial, viral, parasitic, fungal zoonoses. To address such a heavy burden there should be a robust mechanism in India.

The disease control mechanism in India is bi-phasic. It includes vertical disease control programs such as the National Vector-Borne Diseases Control Programme, pilot projects for rabies and leptospirosis control that have been incorporated in the 11th Five Year Plan (2007-2011). The second strategy includes the provision of ad-hoc assistance for outbreak investigations and control. India’s response is mostly reactive, which means controlling one outbreak after another. India, with a huge burden of zoonoses, seems to be lacking in one health policy. The upcoming zoonotic research center is a step in the right direction.

References: -On request-