Transcript While history may never repeat itself, man always does

The Global Animal Health Initiative:
The Way Forward
“Veterinary and Public Health Collaboration”
October 10, 2007
The World Bank
Washington D.C.
Lonnie King, DVM, MS, MPA
Director
National Center for Zoonotic,
Vector-Borne, and Enteric Diseases
Centers for Disease Control and Prevention,
Atlanta, GA
Historical Epidemiologic
Transitions – 1st Transition
• 10,000 years ago
• New social order due to
agriculture
• Zoonoses through
animal domestication
• Increases in infectious
diseases
• Epidemics in nonimmune populations
Historical Epidemiologic
Transitions – 2nd Transition
• Coincided with mid-19th century
Industrial Revolution
• Decreases in infectious
disease mortality
• Increasing life expectancy
• Improved nutrition
• Antibiotics
• “Diseases of Civilization” – cancer,
diabetes,
cardiovascular diseases
• Environmental problems
• Chronic diseases
Historical Epidemiologic
Transitions – 3rd Transition
 Last 25 years
 Emerging infectious diseases
globally
 New diseases and increases in
mortality; first since 19th century
 Re-emergence
 Antimicrobial resistance
 75 percent of diseases are zoonotic
 Anthropogenic factors of emergence;
the microbial “perfect storm”
Factors in Emergence
• Microbial adaptation and change
• Host susceptibility to infection
• Climate and weather
• Changing ecosystems
• Economic development and
land use
• Human demographics and
behavior
• Technology and industry
Factors in Emergence
continued
• International travel and commerce
• Breakdown of public health
measures
• Poverty and social inequality
• War and famine
• Lack of political will
• Intent to harm
Convergence Model
Genetic and
Biological
Factors
Physical and
Environmental
Factors
Animals
EID
Humans
Wildlife
Social, Political,
and Economic
Factors
Ecological
Factors
Convergence of Human and Animal
Health: Drivers
• Ecological risk and climate
change
• Population dynamics
• Growing governance gap
• Global “foodscapes”
• Microbial swarms
• Technology and social actions and
involvement
Emerging and Re-emerging
Infectious Diseases
Multihost Pathogens
• 60% of all human
pathogens are
zoonotic
• 80% of animal
pathogens
• Ecological generalists
CDC’s Most Significant Global
Epidemics Over the Last 15 Years
• 1993 – Hanta virus
• 1999 – West Nile
• 1994 – Plague (India)
• 2000 – Rift Valley Fever
• Ebola virus (Zaire)
• 2001 – Anthrax
• 1996 – New Variant of CJD
• 2002 – Norwalk-like viruses
(UK)
• H5N1 influenza (Hong Kong)
• 1998 – Nipah virus
(Malaysia)
• 2003 – SARS
• 2004 – Marburg Virus
• 2005 – H5N1 Influenza
• 2006 – E. coli
Trends in Global Population
Global Population: 1950-2015
Total
Less developed countries
More developed countries
Billions
8
7
6
5
4
3
2
1
0 1950
55
60
65
70
75
Source: US Bureau of the Census
80
85
90
95 2000 05
10
15
Rapidly Increasing Urbanization
2000
- 47% world population
living in urban areas
2030
- 60% world population
living in urban areas
Concentrated Animal Feeding
Operations (CAFOs)
Their Impact on Food Safety and
Healthy Environments
Livestock 2020 –
The Next Food Revolution
• Global increase and demand for protein and food of animal
origin
• Shift from poverty of 1-2 billion people to middle class
• “Westernization” of Asia and Latin America
• Concerns with sustainability
• Increases in emerging zoonoses through the
concentration of people and animals
Last year, over 21 billion food animals
were produced to help feed a
population of over 6 billion people
resulting in trillions of pounds of
products distributed worldwide.
Projections toward 2020 indicate
that the demand for animal protein
will increase by 50%, especially in
developing countries.
Microbial View
Importance of Agricultural Trade
Already 40% of all trade in agriculture, fisheries
and forestry occurs between developing and
developed countries. More than 20% of all US
imports are food products (more than 8 million
shipments a year).
Human population density
Poultry population density
Source: FAO, WHO, Rimsa, Mexico City April 2005
Human and animal density
140
60
120
50
100
40
80
30
60
20
40
10
20
0
0
50
100
150
200
250
300
350
400
450
Distance to Bangkok (km)
human population (nb/km2/10)
soybean (10 tons/km2)
maize (tons/km2)
chicken (nb/km2/10)
pigs (nb/km2/10)
cassava (tons/km2/2)
Source: Gerber and others 2005.
500
Mean normalized crop production
Figure 1.2. Human and livestock densities, and main feed production areas as affected by the
distance to Bangkok
Safe Food begins with healthy animals
Ecosystem
Waterborne Zoonoses
Animals
Humans
Waterborne
Disease
Microbial
Pathogens
Water Environment
World’s Most Dangerous Animals
West Nile Virus in the Western Hemisphere
WNV Neuroinvasive Disease Incidence,
by County, US, 2000
N=19
Incidence per million
.01-9.99
10-99.99
>=100
Any WNV activity
WNV Neuroinvasive Disease Incidence,
by County, US, 2001
N=64
Incidence per million
.01-9.99
10-99.99
>=100
Any WNV activity
WNV Neuroinvasive Disease Incidence,
by County, US, 2002
N=2946
Incidence per million
.01-9.99
10-99.99
>=100
Any WNV activity
WNV Neuroinvasive Disease Incidence,
by County, US, 2003
N=2866
Incidence per million
.01-9.99
10-99.99
>=100
Any WNV activity
WNV Neuroinvasive Disease Incidence,
by County, US, 2004
N=1142
Incidence per million
.01-9.99
10-99.99
>=100
Any WNV activity
WNV Neuroinvasive Disease Incidence,
by County, US, 2005
N=1294
Incidence per million
.01-9.99
10-99.99
>=100
Any WNV activity
WNV Neuroinvasive Disease Incidence,
by County, US, 2006*
N=1339
Incidence per million
.01-9.99
10-99.99
>=100
Any WNV activity
* Reported as of November 7, 2006
The Perfect Microbial Storm:
Ravenna, Italy
• A Virus from Africa (an alphavirus – Chikungunya)
• A mosquito from Asia (Aedes albopictus: tiger mosquito)
• A tourist from India (1.25 million human cases in 2006)
• A report of 270 people infected with Chikungunya in
Ravenna, Italy
• Globalization is key to the future of infectious diseases
• E.g. global tire trade; 2.1 billion airline passengers/yr;
climate change; and, a shift of competent vectors
worldwide
- Bloomberg Report 9/25/07
Ae. albopictus, the Asian Tiger Mosquito
Initial Discovery Site near Port of Houston, Texas, USA, 1985
Used Tires Stored at Other Locations
There is no where in the world
from which we are remote and
no one from whom we are
disconnected
PNAS, 2004
Climate Change’s Impact
on Infectious Diseases
– Vector-borne diseases
– Water-borne diseases
– Agriculture Production
– Migration of Animals
– Changing ecosystems for wildlife and animals
– Built environment
– Human-Animal Interface
– Ecologies and a new research portfolio
– Evidence-based public health impact
Nipah Virus
Virus Carriers
Fruit bats
SARS
Horseshoe bat
Lessons Learned
From SARS
• Importance of: integrated surveillance;
prompt epidemiologic investigations; and,
lab capacity
• Disruption of multiple economic sectors
• Global implications of local problems
• Need for critical linkages and partnerships
OIE-CDC Collaborating Center for
Emerging and Re-Emerging
Zoonoses
• First collaboration between CDC and an international
animal health organization
• Enhance pathogen discovery
• Improve diagnostics
• Cooperation in better understanding the convergence of
human and animal health
• Linkage of health system professionals
• Jointly contributing to establishing a global applied
research portfolio
• Improve global preparation in identifying and responding
to microbial threats
• Enhance surveillance
Annual Global Trade in
Exotic Animals
•
•
•
•
4 million birds
640,000 reptiles
40,000 primates
Illegal trade unknown – estimate $4-6 billion
- Wildlife Conservation Society
“Double, double toil and trouble;
Fire burn, and caldron bubble.”
William Shakespeare
Compelling Vision
• Accelerating prevention, control, & elimination of
ecology-mediated microbial threats
• Systems approach with cross-cutting themes
•
Global organization
Ecosystem Health
Animal Health
Human Health
The Convergence of Human and
Animal Health
In practice, no aspect of disease control, especially in poor
communities, can be tackled effectively without simultaneous
attention to people’s livelihoods and the frequent disincentives
that they encounter as they are expected to participate in
disease control efforts.
- Ministries and departments across government
- Professional groups: medical, veterinary, and
environmental
- NGO and private sector working with communities and
governments
David Nabarro MD
UN System InfluenzaCoordinator
Determinants of Success to Address
Threats from the convergence/Pandemics
• Political leadership and will
• Effective alliances with civil society and the public sector
• Capabilities and resources to scale-up effective systems
for direction, coordination, and management
• Support and integrated plans for long-term strategies to
reduce risks from animal and human diseases
• Collaborations among all stakeholders: sharing
information, surveillance findings, samples for detection
and identification and effective communication
• Full community engagement especially among those
affected
• Resisting specialization and separation and the
incentives that drive this behavior
- Dr. David Nabarro
Neglected Zoonotic Diseases
• Understanding “One Health: people, livestock and wildlife
• Role of livestock as income: 70% of rural poor
• Communities at risk: 800 million poor livestock keepers
• Dual burden
Neglected Zoonotic Diseases
• Another example of health disparities: inverse
relationship the lower the income the higher the risk
• Need to raise the profile
• Significant under-reporting
• Human Health and Animal Health Continuum
• Risk to human health is often best controlled by animal
programs
Endemic and Emerging Zoonoses
• “The need to fight zoonotic diseases especially in the
poorest populations of the world is incontestable – from
a moral perspective, a human rights perspective and an
economic perspective, as well as a global goods
perspective.”
The Control of Neglected Zoonotic Diseases; A Route to
Poverty Alleviation - 2006
“As the HIV disease pandemic surely should
have taught us, in the context of infectious
diseases, there is nowhere in the world from
which we are remote and no one from whom
we are disconnected.”
 IOM, 1992
Emerging Retrovirus Zoonoses
• 2 new retroviruses –
Cameroon – Africa
• Human T-lymphotropic virus
(HTLV) types 3 and 4
• Recovered from hunters of
nonhuman primates
• Role of bushmeat and
butchering primates
• STLV and HIV with
similar origins
Foresight Analysis
• EID are the “New normal”
• Expect 3-4 new EID annually; 8-34 by 2015
• 87 new EID since 1980 – 58 viruses - 49 RNA
- mostly zoonotic
• Found worldwide but proximity to animal
populations or products is the key risk factor
• Change in the host-pathogen ecology will be the
most important single driver
Current and Projected Importance of Factors
Influencing Emergence
FACTOR
Human demographics and behavior
Technology and industry
Economic development and land use
International travel and commerce
Microbial adaptation and change
Breakdown of public health measures
Climate change and weather
Changing ecosystems
Poverty and social inequality
War and famine
Lack of political will
Intent to harm
2007
2017 2027
Mechanisms By Which Important
Factors Will Impact Emergence
Mechanism Influencing Emergence
FACTOR
Human
vulnerability
Human demographics and behavior
Economic development and land use
International travel and commerce
Climate change and weather
Poverty and social inequality
Environmenta
l
and zoonotic
exposure
Person-toperson
transmission
Microbial
evolution
Risk
Number of catastrophes between 1970 & 2003
Source: Swiss Re, Sigma No. 1, 2004
Interdependence:
The Shrinking World
• 1 billion people will soon cross international borders each
year or 25/second
• Tightly coupled system: unprecedented vulnerability
• Threats spread faster, further, and non-linear
• Increased threats of global pandemics
• Strategic risk analysis: significant risk of developing
countries with under funded public and animal health
systems
• “If the forest is dry enough and dense enough…”
If a forest is dense & dry enough…
• Worldwide, 25
people/second cross
national borders
• Increasingly densely
connected network
• Lessons from
monocultures
Convergence Challenges
• Impact and influence beyond health – goods, services
and economies
• A shift from problem solving to managing dilemmas
• A new global interdependence and connectivity
• Factors creating the microbial storm are well entrenched
• A great future for complexity: simple but not simplistic
• Reconciliation of great change with habitual and
traditional thinking and ways of working
• Adopting a “One Health – One Medicine” mindset and
strategy
Convergence Challenges
(cont.)
• The role of governments, educational institutions, and
society
• Animal and human health are a continuum of causality
and events and need to be viewed as a continuum and
integration of strategies
• Recognizing the moral and ethical imperative: health
disparities
• Inclusion of diverse communities, thinking, and tools
• The need for new leaders and new ways of leading
• Unprecedented events call for unprecedented responses:
A call to action – Who? How? When? Where? Why?
Consensus of Recommendations
•
•
•
•
Improve infrastructures
Integrate surveillance strategies and diagnostics
Increase R&D investments
Focus on prevention not just reaction and
response – e.g. avian influenza
• Build a new infectious disease workforce
• Consider a global perspective
Consensus of Recommendations
• Improve disease reporting with appropriate
incentives
• Design global strategies and interventions
• Create Zoonotic and EID centers
• Meet the critical need for leadership and new
skills
• Address public understanding and appreciation