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Need for a coordinated One Health Approach for the Asian continent
Aug 11, 2023
Implementing strategic disease prevention and control mechanisms is essential, in any country, to decrease new infections, lower the number of currently infected individuals, and reduce disease-related morbidity and mortality in the local settings. As a standard practice, routine control measures are implemented for endemics, and sporadic measures are employed for unexpected epidemic outbreaks. Infection prevention and control is a practical and evidence-based approach, which impacts various aspects of healthcare including hand-hygiene, surgical site infections, injection safety, antimicrobial resistance and how hospitals operate during and outside of emergencies1. This requires each nation to be self-reliant with advanced high-tech laboratories to enhance surveillance, expertise and vaccine manufacturing and distribution capabilities. Also, they need to develop necessary protocols for health care delivery and medical hygiene standards to effectively prevent/control diseases. Furthermore, the emphasis on the concept of ‘One Health’ at a global level recognizes the interconnectedness of people, animals, plants, and the environment, advocating a collaborative, multi-sectoral and transdisciplinary approach, urging the creation of resilient systems at the national level. However, there are differences among the nations in their programs and the investments to support disease prevention and control, and that is a matter of concern especially in the low- and middle-income countries, where higher population pressure negatively impacts the healthcare delivery and medical hygiene standards caused by secondary infections.
A cross-country coordinated management of public health issues serves as a handy approach to overcome the shortcomings in the different countries. Efforts in this direction are already underway and in existence in the form of ‘Centre for Disease Control and Prevention’ in the different continents including USA, Europe, Africa, and Australia. The oldest among these is the US Centers for Disease Control and Prevention which was established in 1964 and the others were established later – the European Center for Disease Prevention and Control (2005), the Africa Centre for Disease Control and Prevention (2017), and the Australian Centre for Disease Control (2023). The European CDC and the African CDC have ‘nations’ as Member States, while the US and Australian CDCs have the ‘states within’ as Member States. The COVID management measures adopted by these CDCs serve as a foolproof framework for achieving cross-country coordinated disease control and addressing public health challenges, effectively overcoming infrastructure and programmatic shortcomings in diverse countries. The One Health (OH) strategies and the best practices adopted by these CDCs in COVID management are summarized as under.
United States: The US CDC's One Health Office collaborates with partners globally and within the United States to address OH challenges, prepare for outbreaks and emergencies, strengthen surveillance, and educate people on disease prevention from animals. They support zoonotic outbreak investigations, engage experts from different sectors, and promote a multi-sectoral One Health approach. The Office also assists states with One Health investigations into SARS-CoV-2 infections in animals and developed surveillance infrastructure for SARS-CoV-2. It fosters collaboration and information exchange through the One Health Federal Interagency COVID-19 Coordination Group2.
Europe: The European Centre for Disease Prevention and Control (ECDC) coordinates work on two key functions: One Health and Prevention and Behavior Change. Its mission is to strengthen Europe's defenses against infectious diseases through surveillance, outbreak preparedness and response support, scientific advice, public health training, and communication. ECDC maintains a robust laboratory capacity with an integrated network of EU reference laboratories to support national laboratories and promote testing methods and data reporting. Molecular surveillance improves epidemiological communicable disease surveillance and aids in tracing infection patterns and outbreak sources. ECDC's focus includes supporting whole genome sequencing infrastructure, training programme in genomic epidemiology and public health bioinformatics (GenEpi-BioTrain), EU/EEA laboratory capacity surveys (EU LabCap), and the European Surveillance of Antimicrobial Consumption Network. ECOVID-Net combines epidemiological and virological COVID-19 surveillance to inform decision makers, while ECOVID LabNet coordinates microbiological activities3.
Africa: The Africa Centre for Disease Control and Prevention (ACDC) utilizes the Regional Coordination Centres for surveillance, readiness, emergency response activities, and collaborating with National Public Health Institutes (NPHIs) of Member States. ACDC strengthens laboratory systems through AFCAD (African Collaborative Initiative to Advance Diagnostics), implements Biosafety and biosecurity initiatives4, and establishes quality management systems. Its surveillance programs encompass anti-microbial resistance control, cross-border disease surveillance, digital disease surveillance, mortality surveillance, and the One Health Program5. To control COVID, ACDC and the Youth Division of the African Union Commission (AUC) co-designed the Vaccination Bingwa Initiative, establishing a continent-wide network of youth champions to promote COVID-19 vaccination.
Australia: The recently established Australian Centre for Disease Control enhances pandemic preparedness and response, with a focus on preventing chronic diseases . It ensures ongoing preparedness, response to infectious disease outbreaks, and prevention of communicable and non-communicable diseases6. The CDC launched 'Living with COVID-19' service to assess and connect positive patients to healthcare services, and the National Coronavirus Helpline offers round-the-clock advice on COVID-19 and vaccines.
Coordinated One Health Approach: Lessons for Asia
The Asian continent holds a group of 48 countries spread across five regions- East, South-eastern, Central, South, and West. It is pre-dominated by low- and middle-income countries (LMICs) that face high population pressures and have inadequate disease control infrastructure, mechanisms, and standards. Promoting the One Health approach in a coordinated manner can go a long way in supporting the countries for effective preparedness and responses to outbreaks and emergencies. By leveraging regional technology and expertise for multi-sectoral surveillance, this approach helps overcome inadequacies and strengthens overall effectiveness. Given the diversities in the political, economic, social, and cultural fronts, following factors should be considered for formation of CDC and establishing a coordinated One Health approach for the Asian continent:
- Establishing CDC at sub-continent level: The wide range of diversities, disparities, and disputes among Asian nations makes the idea of building an integrated system for all Asian countries seem unattainable. The possible solution could be a sub-continental integration in areas where regional cooperation treaties/associations such as Association of South East Asain Nations (ASEAN), South Asian Association for Regional Cooperation (SAARC), Gulf Cooperation Council, Eurasian Economic Union (EEU) and Shangai Cooperation Organization (SCO) are already existent. Among the five regions in Asia, South Asia has established and reflected a stronger and sustainable regional cooperation through the ASEAN and SAARC associations and hence, the establishment of a South Asian CDC is expected to be indomitable and productive.
- Partnerships and Collaborations: By forging partnerships and collaborations with national authorities and public health institutes in the region, the sub-continental/regional CDC can benefit from their expertise in tackling health emergencies, thus promoting a coordinated One Health approach. This would also help develop an integrated network of reference laboratories across the region to strengthen public and clinical health laboratory systems.
- Cross-country data integration: A South Asian CDC and the coordianted One Health approach requires multi-sectoral data from across the member countries. Coordination with the External Affairs Ministry in the member countries, is of utmost importance for data integration. The regional cooperation established in the South Asian region may aid in the coordination with ministries of the member countries.
- Harmonizing policies and surveillance systems: The regional CDC should support health system strengthening for disease prevention in the member states. This approach can harmonize policies and surveillance systems over time, establishing an early warning and response platform for health threats, mapping health hazards and risks at regional and country levels, building public health capacity through targeted training programs, and strengthening the coordinated One Health approach in the region to combat cross-border health threats, including communicable diseases.
IQVIA is engaged in supporting One Health related initiatives in UK, India, and many countries in Africa, on various aspects of disease control including surveillance, capacity building and system strengthening. The National Centre for Disease Control (NCDC) in India, has presently undergone a thorough overhaul by transforming itself to absorb and accommodate the One Health approach through strengthened surveillance infrastructure, skill enhancement amongst grassroot functionaries and technical officers, instituting robust monitoring mechanisms and a strengthened Integrated Health Information Platform. Enveloping these initiatives with an added line- ‘cross-country coordination’ for disease control in the South Asia region would elevate NCDC as a regional hub for the region.
1https://www.who.int/health-topics/infection-prevention-and-control#tab=tab_1
2https://www.cdc.gov/onehealth/what-we-do/index.html
3https://www.ecdc.europa.eu/en/about-ecdc/what-we-do
4https://africacdc.org/programme/laboratory-systems-and-networks/
5https://africacdc.org/programme/surveillance-disease-intelligence/
6https://www.health.gov.au/our-work/Australian-CDC