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Investing in One Health to Reduce Risks of Emerging Infectious Diseases

DPHICON 2022

Dinesh Nair

World Bank

December 7th, 2022

Putting

Pandemics

Behind Us

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Pandemic risks are mainly driven by human activities

Drivers lead to spillovers and disease outbreaks, through a wide variety of mechanisms
Coupled with weak health systems and public health institutions, drivers can lead to epidemics and pandemics
Good development is likely to have an impact on emerging infectious diseases, reducing their pace of emergence

One Health mobilizes the interconnected nature of human, animal, and ecosystem health towards pandemic prevention and preparedness

One Health is a collaborative approach that explicitly combines human, animal and ecosystem health to prevent, detect, respond to, and recover from infectious diseases, with an endpoint of improving global health security and achieving gains in development.
One Health offers a practical framework to prevent pandemics, curb antimicrobial resistance (AMR), and reduce the burden of infectious diseases, addressing risks at the source.
One Health provides added-value over solutions that are implemented without consideration of this interconnectedness.

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Bank’s Global Engagement

Across sectors, 45 projects incorporate One Health approach

World Bank One Health Operations

~ US$ 1.5 billion in commitments

REDISSE (Regional Disease Surveillance Systems Enhancement) in West & Central Africa is an interdependent Series of Projects (ISOP, US$ 657 million) supporting surveillance in human and animal populations and epidemic preparedness

The COVID-19 response MPA offered a One Health menu of activities to strengthen health systems, coordination, capacity for surveillance and control, integrated communication. Seven percent (7%) of MPA projects have One Health components (2.8% of MPA financing totaling ~US$110.5 million)

One Health projects include the China Emerging Infectious Diseases Prevention, Preparedness project (US$300 million) to reduce risks of zoonotic and other emerging health threats

Agriculture & Food is one of the portfolios (with water, environment, inter alia) holding strong potential for One Health interventions and Health Security co-benefits (20 projects, ~US$363.4 million)

We will continue promoting awareness of the One Health approach in our operational engagement

~ US$ 1.5 billion in commitments

One Health Platforms for coordination
Joint Field Epidemiology Training
One Health approach to surveillance

Risk-based surveillance of zoonoses
Wet market regulations
One Health lens on policies
Public awareness of zoonotic risks

Prudent use of antimicrobials
Animal health management, biosecurity, and biosafety
Food safety, wet markets

Surveillance of vector borne diseases
One Health coordination
Communication and community engagement

Examples - How to mainstream One Health design in projects

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One Health engagements in India

One Health Interventions in Integrated Disease Surveillance Project (2004-12):

Project Restructured in 2007 to respond to Avian Flu (H5N1) an additional component with US$ 32.63 million
Animal Health subcomponent implemented by BIRD FLU cell under JS Dept of Animal, Dairy and Fisheries

Focus Areas	Achievements	Lessons
Establishment of 6 BSL2 Labs for Animal Health	Only 3 labs were functional by the end of the Project	Testing strategy should be based on specific need. AI antibody - which identifies past exposure - was used for identifying outbreaks Several innovative activities for surveillance of wild birds such as satellite mapping, GIS based animal disease surveillance and development of information system could not be reimbursed due to procurement constraints The collaboration between two sectors was sub optimal leading to separate missions and AMs (Only 1/3 of missions were joint) Institutional arrangements and incentives should be well aligned for effective OH coordination.
Avian Influenza Surveillance in domestic poultry	Rapid response teams at National, State and District levels; Stockpiles of PPEs and Vaccines at state and district levels
One Health Training	95% of planned veterinary and para veterinary staff trained; 25 staff received PG level training overseas

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Transforming India’s Public Health Surveillance System for Pandemic Preparedness

Uses Program for Results Instrument to incentivize shift from inputs to results

Provides US$ 136.35 for achieving results linked to One Health Outcomes in addition to strengthening institutional framework for One Health

Laboratories under NCDC AMR surveillance network increased from 35 to 220
Semi-annual bulletins on AMR trends published ($ 36.25 million)
Publication of treatment guidelines for rational use of antibiotics for common infections

Anti-Microbial Surveillance

Sentinel sites reporting zoonotic surveillance expanded from 25 to 100 (10% from animal health)
Sentinel sites reporting zoonotic diseases of human importance ($ 50 million)

Zoonotic disease surveillance

Priority zoonotic diseases identified and protocols for risk mapping developed
National risk map with hot-spots for zoonotic diseases of human importance prepared and updated to inform preventive measures ($ 50 million

National Risk maps of zoonotic diseases

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Resilient Kerala Program for Results

Strengthen Kerala’s public health systems for disease outbreak preparedness and prevention and expand One Health Coordination.
WB Funding : US$15M (12% of Project)
Specific OH activities include:

Establishing a One Health Platform to strengthen coordination, collaboration, networking, joint surveillance, preparedness, and response to counter zoonotic diseases.
Implementing community-based One Health surveillance practices by LSGIs.
Supporting an IT-enabled platform for Prevention of Epidemics and Infectious Diseases (PEID) cells at medical colleges to undertake operational and applied research.

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Key messages

India has high burden zoonotic diseases of public health importance . The recent outbreak of Avian Flu among birds in 15 states further highlights urgent need for OH. Pandemics and large provide a window of opportunity to improve policies and institutions for OH.
Putting in place effective institutional arrangements and incentives across sectors will improve effectiveness of One Health coordination. Better One Health coordination requires strong State Governments ownership and commitment for OH.
OH requires platforms that enable cross-sector information sharing including through digital technology and adjusting testing strategies based on specific context. One health research requires effective networking, coordination and information sharing among human, animal and environmental research institutes locally and globally.
Role of Private Sector in One Health often gets neglected – Poultry industry is largely under private sector while Dairy under the cooperative sector.

India has high burden zoonotic diseases of public health importance - Rabies, Brucellosis, JE, KFD, Scrub Typus etc. The recent outbreak of Avian Flu among birds in 15 states further highlights urgent need for OH.

During pandemics, emphasis will be on efficient surveillance and ensuring effective care to save lives. But pandemics and large outbreaks such as Ebola provide a window of opportunity to improve policies and institutions for OH.

Putting in place effective institutional arrangements and incentives across sectors improve effectiveness of One Health coordination.
Better One Health coordination requires strong State Governments ownership and commitment for OH and not just having one consultant in the State Surveillance Units.
OH requires platforms that enable cross-sector information sharing through digital technology and adjusting testing strategies based on specific context.
Role of Private Sector in One Health often gets neglected – Poultry industry is largely under private sector while Dairy under the cooperative sector.
One health research requires effective networking, coordination and information sharing among human, animal and environmental research institutes locally and globally.