Contributing to Contributing to One World, One HealthOne World, One Health
A strategic framework for Reducing Risks of A strategic framework for Reducing Risks of Infectious Diseases at the Infectious Diseases at the
Animal–Human–Ecosystems InterfaceAnimal–Human–Ecosystems Interface
Subhash MorzariaSubhash Morzaria
Joint FAO-OIE-WHO-UNICEF-UNSIC-WB presentationSharm El Sheikh Ministerial Conference on HPAI
Egypt25-26 October 2008
UNSICRegional Workshop for UN Country Teams, 30-31 March 2009
Overview of the Overview of the presentationpresentation
Origin and the development of the Strategy
Components of the Strategy1. Introduction2. HPAI Achievements and Lessons Learned3. EIDs and Existing IDs and their Impacts4. The Strategic Framework5. Specific Objectives and Outputs6. Cross Cutting Issues7. Institutional Issues8. Financing the Framework
Conclusions and Way Forward
Origin and the development of the Strategy
Components of the Strategy1. Introduction2. HPAI Achievements and Lessons Learned3. EIDs and Existing IDs and their Impacts4. The Strategic Framework5. Specific Objectives and Outputs6. Cross Cutting Issues7. Institutional Issues8. Financing the Framework
Conclusions and Way Forward
IntroductionIntroductionNew Delhi recommendation, Dec 2007 Disease entrenched in several countries
Continued risk of re-emergence and pandemic flu
HPAI still a priority
Also recognition HPAI is one of many other E/rEIDs Address the larger issue of EIDs at animal-human-
ecosystem interface using OWOH approach
New Delhi recommendation, Dec 2007 Disease entrenched in several countries
Continued risk of re-emergence and pandemic flu
HPAI still a priority
Also recognition HPAI is one of many other E/rEIDs Address the larger issue of EIDs at animal-human-
ecosystem interface using OWOH approach
GenesisGenesis
Planning meeting in Geneva (FAO, WHO, OIE, UNICEF with UNSIC and WB) between 3-4 June 2008 to discuss strategy development
Based on the broad discussions in Geneva, outline for the Strategy agreed upon by mid June 2008
LATEST joint document (FAO-WHO-OIE-UNICEF-WB) finalized in mid October 2008
This is still a STRATEGIC FRAMEWORK with key concepts for WIDER CONSULTATION
Planning meeting in Geneva (FAO, WHO, OIE, UNICEF with UNSIC and WB) between 3-4 June 2008 to discuss strategy development
Based on the broad discussions in Geneva, outline for the Strategy agreed upon by mid June 2008
LATEST joint document (FAO-WHO-OIE-UNICEF-WB) finalized in mid October 2008
This is still a STRATEGIC FRAMEWORK with key concepts for WIDER CONSULTATION
Lessons learned… Lessons learned… Economic development and
disease
Disease control and livelihoods
Role of wildlife and transmission
Understanding epidemiology
Effective communication strategies
Cross-sectoral collaboration
Political commitment
Economic development and disease
Disease control and livelihoods
Role of wildlife and transmission
Understanding epidemiology
Effective communication strategies
Cross-sectoral collaboration
Political commitment
EIDs: main EIDs: main characteristicscharacteristics
Studies show over the last 50 years:One new disease every year
>70% are zoonotic, % increasing
Many are of transboundary in nature
Wide and significant impacts (SARS/HPAI)
Global significance, international public good
Studies show over the last 50 years:One new disease every year
>70% are zoonotic, % increasing
Many are of transboundary in nature
Wide and significant impacts (SARS/HPAI)
Global significance, international public good
Economic Impact of EIDEconomic Impact of EID
Figures are estimates and are presented as relative size.
1996 1997 1998 1999 2000 2001 2002 20031994 1995 2004 2005 2006
$50bn
$40bn
$30bn
$20bn
$10bn
Est
imat
ed C
ost
BSE UK, $10-13bn Foot & Mouth
Taiwan, $5-8bn
Foot & MouthUK
$25–30bn
Avian Flu Asia,$5–10bn
BSE U.S., $3.5bn
BSE Canada$1.5bn
Avian Flu, NL$500m
SARSChina, Hong Kong,Singapore, Canada
$30-50bn
Nipah, Malaysia$350-400m
Classical Swine Fever, Netherlands
$2.3bn
BSE Japan $1.5bn
HPAI, Italy$400m
Impact of pandemic influenza
Loss to the global economy•US$2 trillion
Prevention is cost-beneficial
Loss to the global economy•US$2 trillion
Prevention is cost-beneficial
Drivers for emergence and spread
(Human factors)Less developed nationsMore developed nations
70
65
60
55
1950
75
80
85
90
95
2000
05
10
15
0
1
2
3
4
5
6
7
8Billions
Total
Global Population: 1950-2015
Source: US Bureau of the Census
>90% population growth in Africa, Asia and L. America
Poverty on the rise
Rapid economic development
Huge demand for livestock
Rapid evolution of farming systems
>90% population growth in Africa, Asia and L. America
Poverty on the rise
Rapid economic development
Huge demand for livestock
Rapid evolution of farming systems
Increasing food Increasing food demanddemand
Farming systems: Numbers and Farming systems: Numbers and densitydensity
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
19
61
19
64
19
67
19
70
19
73
19
76
19
79
19
82
19
85
19
88
19
91
19
94
19
97
20
00
20
03
Duc
k M
eat
Pro
du
ctio
n
(T
ons)
China
Cambodia, Indonesia, Lao, Thailand and Vietnam
• In 2007, over 21 billion food animals were produced for over 6 billion people
• By 2020 the demand for animal protein up by 50% mainly in developing countries requiring over 30 billion animals
Wildlife factorWildlife factor Forest encroachment
Nipah, Hendra and Ebola
Bush meat (HIV and chimpanzee)
Exotic animal farming SARS
Trade in exotic animals Monkey pox, psittacosis 37.8 million counted animals imported in USA from
163 countries in 2000-2004
• Vector ecology and distribution (flies, ticks, mosquitoes)
• Invading pathogen adaptation with new vectors
• Migratory patterns
Climate change - Climate change - diseasesdiseases
Spread of pathogensSpread of pathogens(globalized travel and trade)(globalized travel and trade)
Increase in international air travel (5%/yr)
Large shipments of livestock
Animals can be any part of the world in time shorter than the IPs of many diseases
Increase in international air travel (5%/yr)
Large shipments of livestock
Animals can be any part of the world in time shorter than the IPs of many diseases
Pathogen risk factorsPathogen risk factors
All p
atho
gen
sE
IDs
OIE
list
Human Domestic animals Domestic carnivores
16
VirusesBoth DNA and RNA
viruses representedRNA highly likely as EID
High mutation rate, no repair mechanisms
Small, Ubiquitous, Intrusive
Ebola, Marburg, Nipah, Hendra, Lassa, Hanta, Influenza, Polio, Hepatitis, FMD, West Nile, Rabies, Yellow fever, SARS
Cleaveland, S., Laurenson, M.K. &Taylor, L.H (2001). Phil. Trans. R. Soc. Lond. 356, 991-999
Goal Goal Diminish the threat and minimize the global
impact of epidemics and pandemics due to highly infectious and pathogenic diseases of humans and animals
Broader vision Public health and food safety Food security Livelihoods of poor and vulnerable people
Focus Focus
Emerging and re-emerging infectious diseases
at the animal-human-ecosystems interface with
epidemic and pandemic potential causing
wide ranging impacts
OWOH Manhattan PrinciplesOWOH Manhattan Principles
Developed by WCS in 2004 in New York
Increasingly being adopted to address pathogen jumps between animals and humans
Holistic approach encompassing interfaces among the human, animal and ecosystem health domains
Proposes an international, interdisciplinary, cross-sectoral approach to disease emergence and control
Major thrusts/objectives Major thrusts/objectives 1. Preventive action and root causes and drivers
2. Building more robust public and animal health systems (IHR 2005, OIE Standards)
3. Strengthening the national and international emergency response capabilities
4. Better addressing the concerns of the poor: developed to developing economies potential to actual disease problems focusing on locally important diseases
5. Promoting cross sectoral and multi-disciplinary approach
6. Conducting strategic research
PrioritiesPriorities Country Level
Long term, improve disease control capacity, including the public and animal health and food safety services based on good governance compliant with WHO IHR and OIE standards
Country and Regional Levels Short to medium term establish risk-based disease surveillance
in humans and animals to identify diseases at source (hotspots, human-animal interface)
International Level Medium to long term strengthen capacity to improve ‘horizon
scanning’ to support countries to respond early and control infectious disease events (GLEWS).
Risk-based surveillance for Risk-based surveillance for sources of infectionsources of infection
Hotspots(Range of researchable issues)
Entrenchment animal/human/ecosystems
population density
A-Zoonotic/wild B-Zoonotic/domestic
D-Vector-borneC-Drug resistant
Cross cutting issues•Surveillance at three health domains •Biosecurity•Bioterrorism•Socio-economics•Development issues•Communications strategies at different levels
•Private-public partnership•Monitoring and evaluation
Cross cutting issues•Surveillance at three health domains •Biosecurity•Bioterrorism•Socio-economics•Development issues•Communications strategies at different levels
•Private-public partnership•Monitoring and evaluation
Strategy Components Strategy Components cont…cont…
Institutional IssuesInstitutional Issues Guiding Principles
Country level initiation and implementing stronger intersectoral collaboration and political commitment
Country, regional and international levels coordinated action that brings together those working on human, animal and ecosystems health
International level engaging international institutions drawing on their unique mandates and complementary expert base
Permitting rapid engagement of a broader range of stakeholders, including regional organizations in order to respond effectively to a variety of disease threats
Financing FrameworkFinancing Framework
FUNDING FOR THE FOLLOWING KEY AREAS:
Responding to the ongoing avian influenza crisis Strengthening public and animal health services Improving surveillance: special attention for hotspots
and strengthening wildlife surveillance Providing funds for emergency response
1. Supporting communication and social mobilization
2. Conducting strategic research
3. Supporting international organizations for regional and global initiatives
Preliminary cost estimatesPreliminary cost estimates HPAI support
Annual funding needs over next 3 years: US$542–735 million
Estimated cost of funding the OWOH Strategic Framework to 2020 Average per year:
• Scenario 1: US$ 852 million (43 low income countries)• Scenario 2: US$1,343 million (139 eligible countries)
Total• Scenario 1: US$ 10,228 million• Scenario 2: US$ 16,116 million
Funding sourcesFunding sources Existing donors Non-conventional donors and foundations Emergency funds
Country level fund for emergencies and compensation UN Central Emergency Response Fund
FAO Special Fund for Emergency and Rehabilitation
OIE’s World Animal Health and Welfare Fund The World Bank and the Regional IFIs Industry and other private sector Meat exporting countries
ConclusionsConclusions HPAI and EIDs are a complex problem
Multidisciplinary, multisectoral and multi-partnerships
Global challenge, requiring global solutions
Builds on HPAI successes and lessons learned
FAO, OIE, WHO, UNICEF, UNSIC and WB support
Stakeholders buy in and ownership important
Sharm El Sheikh Sharm El Sheikh responseresponse
All the respondent countries strongly supported the OWOH Framework
All the donors see this as synergistic with their future objectives EC Canada USDA Australia, Germany, Japan, Sweden
Canada to support Winnipeg Meeting (16-19 March 09) Globally advance the framework Priority actions for implementation
Winnipeg ResponseWinnipeg Response
Wide range of interest groups (16-19 March 09)
Academic community Research Institutes Donors Countries Regional Organizations
USAID InitiativeUSAID Initiative
EPT Programme, Components Detect Identify Respond Prepare
Next stepsNext steps Conducting wider consultation with countries,
regions and other key partners Political commitment at country level Importance of cross-border collaboration
Developing implementation strategies and plans
Mobilizing resources for implementation
Establishing timeframes for the above actions
CMC
Collaboration enhanced due Collaboration enhanced due HPAIHPAI
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