doi:10.1038/nindia.2014.97 Published online 22 July 2014
India needs to tweak her public health policy on eradication of endemic and emerging zoonotic diseases by replacing the pathogen-centric approach with a holistic human-animal-environment approach. Public health experts and scientists at an international conference looking at a variety of zoonotic pathogens – bugs which jump from animals to humans – felt that India urgently needs to put in place a ‘One Health’ programme that focuses on factors beyond pathogens.
The introduction of a ‘One Health’ programme would need multi-dimensional changes in the system, the experts said speaking at the recently-concluded International Conference on Host-Pathogen Interactions (July 12-15, 2014) organized by the National Institute of Animal Biotechnology (NIAB) in Hyderabad. While Bangladesh has a stated ‘One Health’ policy, and Nepal is working towards it, India doesn’t have one in place yet. India’s response has by far been reactive, jumping from one outbreak to the next.
In population-dense developing and poor countries, close interactions of people with livestock and wildlife help zoonotic pathogens jump from animals to humans. This has put millions of people, especially small livestock farmers in developing countries, at grave risk.
“The greatest burden of endemic zoonoses falls on one billion poor livestock keepers,” said Purvi Mehta, Asia head of the International Livestock Research Institute (ILRI). According to an ILRI study, 13 zoonoses are the cause of 2.4 billion cases of human disease and 2.2 million deaths per year. The highest zoonotic disease burden, with widespread illness and death, are on Ethiopia, Nigeria, Tanzania and India.
Girish Sohni, president of the BAIF Development Research Foundation pointed out that endemic diseases were not a new phenomenon but needed a fresh eradication approach with concerted surveillance, diagnostics, and control of endemic and emerging infectious diseases.The Thailand model, which emphasizes on building capacity by strengthening epidemiological teams at the provincial and district levels to face the threat of infectious diseases, offers a workable blueprint.
According to Dan Schar, Regional Emerging Infectious Diseases Advisor to USAID-Thailand, the ‘One Health’ concept should include collaborative efforts, multidisciplinary work groups, to attain optimal health for people, animals and the environment, he added.
Given the huge scale of battling zoonotic diseases, India has a long way to go in terms of human and material resources to implement One Health, said Manish Kakkar of the Public Health Foundation of India. The source of disease is at the human-animal-environment interface. “The interface has become dynamic,” he said. In order to work toward controlling, eradicating, and intervening, “we have to work at different levels.”
The problems, he said, lie at a systems level. For instance, in the context of Japanese encephalitis that kills many children every year in the Gorakhpur district of Uttar Pradesh, it isn’t enough to have the vaccine to control the disease. “That’s not how it works,” he said. At the pathogen level, studies should be carried out whether the current vaccine can give protection against all the genotypes, Kakkar suggested. At the individual level, in remote and backward areas, research should focus on whether the nutritional status of people is adequate to respond to vaccine in one or two doses.
“At the environment level, parameters such as how close animals are living with people, their educational and cultural backgrounds need to be factored in. We also need system-level research into whether these affected people are able to access the vaccines,” Kakkar added.