Seeing the beast whole: When holistic approaches ‘come out of Powerpoints’ for better health

Purvi Mehta, Capacity Strengthening Officer

Head of capacity strengthening ILRI, Purvi Mehta-Bhatt delivered a lively presentation yesterday in New Delhi explaining how capacity building is an ‘impact pathway’ linking agriculture, nutrition and health for human well being (photo credit: ILRI).

Yesterday in New Delhi, Purvi Mehta-Bhatt, head of Capacity Strengthening at the International Livestock Research Institute (ILRI), was one of three speakers to make a presentation during a side session at the international conference ‘Leveraging Agriculture for Improving Nutrition and Health’ being put on this week by the International Food Policy Research Institute (IFPRI).

Saying it was ‘great to be home, in India’, Mehta-Bhatt, who is an Indian national based at ILRI’s Nairobi headquarters, started her 12-minute talk by getting down to basics—the basics of an elephant, that is. She told a ‘small story’ of an elephant that landed in a land where nobody had seen an elephant before. Everyone looked at this new beast in different ways, each seeing only a part of the animal. Even though all were looking at the same object, each interpreted the beast very differently, according to the small part they could see of it and according to their own interpretations. ‘This is pretty much the story of the three sectors we are talking about—agriculture, nutrition and health,’ said Mehta-Bhatt.  ‘We are all in our own silos’, she said, and need to see the beast whole.

Mehta-Bhatt sees capacity strengthening work as an important ‘impact pathway in linking these three sectors together’.

‘A piecemeal approach won’t work,’ she warned.  And although ‘this is nothing new’, she said, we still have limited capacity and understanding in this area, and only a few concrete case studies to show where linking different stakeholders in a health outcome has worked. As someone recently complained to her, it’s all very well talking about bringing all stakeholders together, but when has that ever ‘come out of Powerpoints’?

‘Capacity development is not just about training programs,’ says Mehta-Bhatt; ‘it goes beyond individual capacity building; it brings in systemic cognizance and impinges on institutional architecture, and all this happens in a process of co-learning, where messages are taken both from lab to land and from land to lab.’

Among ongoing ILRI initiatives that make use of multi-national, multi-disciplinary and multi-sectoral capacity building approaches are an ILRI-implemented Participatory Epidemiology Network for Animal and Public Health (PENAPH) with seven partners; a NEPAD-sponsored Biosciences eastern and central Africa Hub facility managed by ILRI in Nairobi and hosting many students from the region; a Stone Mountain Global Capacity Development Group of 11 members that is mapping existing capacities in the field of ‘one-health’ and co-led by the University of Minnesota and ILRI; and an EcoZD project coordinated by ILRI that is taking ecosystem approaches to the better management of zoonotic emerging infectious diseases in six countries of Southeast Asia and helping to set up two regional knowledge resource centres at universities in Indonesia and Thailand.

All of these projects, she explained, have capacity strengthening as a centrepiece; all are working with, and building on, what is already existing at the local and regional levels; and all are being conducted in a process of co-learning.

Mehta-Bhatt finished by finishing her elephant story. Capacity development, and collective action for capacity development, she said, can link the three sectors—agriculture, nutrition and health—allowing them not only ‘to recognize the elephant as a whole but to ride it as well.’

Watch the presentation by Purvi Mehta-Bhatt here:

Edinburgh-Wellcome-ILRI project addresses neglected zoonotic diseases in western Kenya

Woman Feeding Cow

‘Neglected diseases are diseases of neglected peoples’—Eric Fèvre

Animals and people live close together throughout the developing world. Chickens, goats, pigs, cows and other farmed animals range freely in and out of rural homesteads as families go about their daily lives. This space-sharing by people and their livestock makes good use of the small plots of land managed by the world’s many smallholder farmers; food that might otherwise go to waste can be fed to the animals, for example, while animal manure feeds the cropland by fertilizing it. Most of the world’s smallholder farmers depend on their animals for milk, meat and eggs to feed their families, with the surplus generating much-needed regular household income.

However, such close proximity to their animals puts many people at risk of ‘zoonotic’ diseases, which are those transmitted between people and animals. Remarkably, more than 60% of all human diseases are infections they can get from animals and more than 70% of today’s emerging diseases, such as bird flu, are zoonotic.

Because human and animal health are particularly intertwined in poor countries where people and livestock live in such close proximity, efforts to improve human health in the developing world need to focus on improving animal as well as human health. This makes it necessary for medical and veterinary experts to collaborate and for livestock farmers and herders to be made aware of the disease risks their animals pose to the health of their households.

A project begun in 2009 and funded by the Wellcome Trust, with other support from the International Livestock Research Institute (ILRI), is studying neglected zoonotic diseases and their epidemiology to raise levels of health in poor rural communities. The project, People, Animals and Their Zoonoses, is based in Kenya’s Busia District, which sits on the country’s western border, with Uganda.

Eric Fèvre, who is working jointly for the International Livestock Research Institute (ILRI) and the University of Edinburgh, is the project’s principal investigator and leader. Fèvre says this study is important.

‘Zoonotic diseases are a great burden on poor communities’, Fèvre says. ‘In a poor household where animals and people are in regular close contact, there is a significant chance of zoonotic diseases spreading. Typically in such areas, animals have access to human waste, there is little preventative health services for livestock and there is poor-quality food and forage for people and animals.’

With insufficient and/or unreliable health infrastructure and with many poor people not readily seeking professional medical attention, these diseases often go underreported or misdiagnosed. Complicating and aggravating this already serious health situation, he says, is that ‘in some cases, other non-zoonotic infections may already be present.’

Furthermore, as reported in the May 2010 issue of Veterinary Record, Fèvre says:

‘While malaria is undoubtedly a very serious health issue, its overdiagnosis hides many other problems. To compound this, people in marginalised communities can easily fall off the policy radar – many may be born, live and die without official record being made of them and, as such, they have a weak, or nonexistent, political voice. Thus, while the diseases are grouped as “neglected zoonotic diseases,” it would be equally correct to identify them as “diseases of neglected populations”.’

The Kenya zoonotic study is a four-year project that brings together ILRI scientists in Kenya with researchers from the School of Biological Sciences at the University of Edinburgh and from the Kenya Medical Research Institute, the latter of whom are already working in much of Kenya’s Western and Nyanza provinces. These epidemiologists, veterinarians, medical health professionals and laboratory technologists will visit over 500 homesteads in Busia to collect data and samples from people and livestock; those people found ill will be treated or referred to specialists.

The project data will be used to quantify the place of zoonoses in the context of other infectious diseases and to refine our understanding of factors that put people and livestock at risk. The study team also aims to come up with diagnostic tests that can be used in the field and to design cheap, easy-to-implement health interventions for both people and livestock. The project is focusing on bovine tuberculosis, cysticercosis, brucellosis, Q-fever, Rift Valley fever and trypanosomiasis (in cattle) /sleeping sickness (in people) and their impacts on both livestock and the people.

The results of this project are expected not only to improve the health aspects of the relationship between people and their livestock in western Kenya but also to provide important background for future research and policymaking on zoonotic issues.

More information can be found at www.zoonotic-diseases.org

The May 2010 issue of the Veterinary Record gives an excellent account of this ambitious human-animal health project: http://veterinaryrecord.bvapublications.com/misc/about.dtl (subscription required).

How livestock diseases and their control impact poor people

This themed issue of Philosophical Transactions B, provides an overview of some of the issues relating to infectious diseases of livestock.

At the beginning of the 21st Century, the world is faced with a changing landscape of infectious diseases that affect man and animals. Most livestock pathogens that emerge and re-emerge are capable of being transmitted to man and an increasing number are distributed by insect vectors. Globalisation defines the world of pathogens and the recent emergence and spread of swine flu provides a topical illustration of the threats presented by zoonotic viruses that can be moved rapidly around the world by the occupants of our ‘global village’. Whilst distribution via air transport represents an extreme, the transmission of pathogens by insect vectors is increasingly linked to the effects climate change and new vector-borne diseases, such as bluetongue, are now occurring for the first time in Northern Europe.

However, old and persistent diseases remain in most parts of the world must be dealt with. Some, such as foot and mouth disease, present significant ongoing restrictions to national and international trade and may have devastating financial impacts when they are introduced in to FMD-free areas.

The future looks to be much, much more of the same. The scientific community will need to be fleet-of-foot to deal with some unexpected disease threats and the world of zoonotic infections will drive the animal and human disease research specialists to work closer together.

A ‘One Medicine’ way of working will be increasingly necessary to optimise control of disease at the livestock-man interface and all major livestock diseases will need to be considered for their potential to interrupt or damage the pipeline of food supplies – especially if effective control is lost.

This special issue includes articles by ILRI scientists Brian Perry and Delia Grace and another by  Solenne Costard et al. They describe the impacts of livestock diseases and their control on growth and development processes that are ‘pro-poor’.

Taking a value-chain approach that includes keepers, users and eaters of livestock, they identify diseases that are road blocks on ‘three livestock pathways out of poverty’. They discuss livestock impacts on poverty reduction and review attempts to prioritize the livestock diseases relevant to the poor. They note that a high impact of a disease does not guarantee high benefits from its control and recommend taking other factors into consideration, including technical feasibility and political desirability.

They conclude their paper by considering how we might better understand and exploit the roles of livestock and improved animal health by posing three speculative questions on the impact of livestock diseases and their control on global poverty:
(1) How can understanding livestock and poverty links help disease control?
(2) If global poverty reduction were the aim of a livestock disease control program, how would that program differ from our current model?
(3) How much of the impact of livestock diseases on poverty is due to disease control policies rather than the diseases themselves?

New threats, new thinking at the animal-human disease interface

To get serious about controlling emerging human disease, we're going to have to get serious about understanding and controlling their origin in animal disease, often in developing countries

 


As the world's governments raced to deal with a looming flu pandemic starting some two weeks ago, in late April 2009, World Health Organisation (WHO) officials confirmed that the world is better prepared than ever before to deal with a pandemic, thanks largely to six years of research and preparations to battle bird flu and SARS. Nearly 150 countries are now known to have drawn up contingency plans covering everything from the response of health services to travel restrictions and international co-operation.

Although it contains animal genetic components, the current influenza A(H1N1) virus has not been diagnosed in animals before and has spread from person to person, threatening an influenza pandemic which, according to scientists, is inevitable, even though no one can predict the timing. Three serious influenza pandemics occurred in the 20th century, with each new virus eventually infecting up to a third of the world over the course of one to two years: the 1918 ‘Spanish flu’ responsible for more than 40 million deaths, followed by the 1957 ‘Asian’ and 1968 ‘Hong Kong flu’, which killed between 1 and 3 million people worldwide,

The history of flu epidemics and pandemics, which can be traced back with some accuracy for the past 300 years, tells us that outbreaks occur somewhere in the world in most years and pandemics, which are epidemics that spread worldwide, at 10- to 50-year intervals. Despite influenza and its causative organism being the most studied of viral diseases and pathogens until the advent of HIV/AIDS two decades ago, little has been done in the past century to change the pattern of influenza infections.

 

2009 June 11 Swine flu update:

  • WHO on 11 June raised the pandemic alert level from phase 5 to 6, indicating a global pandemic outbreak
  • This will trigger drug makers to speed production of a swine flu vaccine and prompt governments to devote more money to containing the virus.
  • Although appearing less deadly than seasonal flu, experts worry the virus could mutate into a more lethal strain during the Southern Hemisphere’s coming flu season.
  • Experts also worry that poorer countries could be overwhelmed with cases they do not have the capacity to treat.
  • The last pandemic, the Hong Kong flu of 1968, killed 700,000 people worldwide. Ordinary flu kills 250,000 to 500,000 people each year

 

11 May 2009 brief from the World Health Organisation

For more information, we encourage our readers to read the WHO brief copied below and linked to here:
http://www.who.int/csr/disease/swineflu/assess/disease_swineflu_assess_20090511/en/index.html

This WHO brief of 11 May 2009 provides much useful background information for understanding expert concerns about the current new flu virus, particularly how it may affect the developing countries of the southern hemisphere, where the flu season is about to begin. These expert concerns include the following.

  1. The influenza A(H1N1) could mutate into a more lethal form in a subsequent wave of this pandemic, as the virus causing the 1918 pandemic flu did.
  2. Having not appeared in humans or animals before, scientists anticipate that pre-existing immunity to the virus will be low or non-existent, or largely confined to older population groups that have had flu vaccinations and therefore striking down more people of a younger age group, than viruses causing normal so-called 'seasonal flu'.
  3. This new flu virus, although as yet causing generally mild illness in the 29 countries outside Mexico where it has so far been confirmed, could cause severe illness in developing countries, particularly:
    • people suffering malnutrition
    • poor communities with inadequate health care
    • the greatly increased numbers of people now afflicted with chronic conditions such as heart disease and diabetes, conditions that can greatly increase the severity of illness this flu causes (although these chronic conditions afflicted mostly affluent populations until a few decades ago, a full 85% of people suffering them today live in low- and middle-income countries)
  4. As this new influenza A(H1N1) virus spreads to the southern hemisphere with the start of the flu season here, it may meet the H5N1 bird flu virus that is widely circulating among the poultry populations of some developing countries; no one knows how, under pressure of the new A(H1N1) human-to-human transmitted flu virus, the H5N1 bird-to-bird transmitted flu virus might change, including whether the latter, more lethal, bird flu virus could be helped to mutate into a form transmitted easily among people. (The more lethal H5N1 bird flu virus, now endemic in many areas, has thankfully to date been transmitted only rarely directly from person to person; almost all the people infected have received the virus from handling infected poultry, which has helped keep the virus from spreading widely among human populations.)

 

11 May 2009 Update

11 May 2009 Update As reported in Time Magazine this week (11 May 2009), ‘new research suggests that the WHO acted wisely in raising the pandemic alarm — and that the threat of H1N1 may not have passed. In a study released May 11 in the journal Science, researchers from Imperial College London, along with WHO staff and Mexican scientists, conclude that H1N1 is transmitted considerably easier than the regular seasonal flu and is about as deadly as the 1957 Asian flu, which killed about 2 million people worldwide. A World Bank study last year found that a pandemic of similar severity today might kill 14.2 million people around the world, and cut 2% from the global economy.’ 

 

7 May 2009 Update

As of 7 May 2009, there were 2,371 confirmed cases of swine flu in 24 countries and 46 deaths from this infection, all but 2 of the deaths occurring in Mexico. Scientists described 11 cases of Americans who were infected before the current outbreak with swine flus that partly matched the new epidemic strain that emerged in Mexico in March 2009. The first case was in December 2005. In articles published online in The New England Journal of Medicine, virologists from the US Centers for Disease Control and Prevention (CDC) described those cases, most of them in young people in the Midwest who touched or were near pigs. All had a ‘triple reassortant’ virus that combined human, swine and avian flu genes. The H1N1 flu now spreading out from Mexico also has those genes, as well as genes from Eurasian swine. The CDC reports that the pandemic does not appear to be petering out, that we appear to be still on the upswing of the epidemic curve, and that only about 10% of those infected had a travel history to Mexico.

 The role of livestock scientists in the developing world
Livestock scientists have a vital role to play in helping to predict, prevent and control zoonotic diseases, which are all those transmitted between animals and people. Remarkably, zoonoses make up more than 60% of all human infectious diseases and more than 70% of all emerging infectious diseases. These diseases occur most frequently in Asia and Africa, where limited resources hinder both surveillance and response. The growing threat of emerging diseases such as Nipah and SARS, and re-emerging diseases such as Rift Valley Fever and avian influenza, has served as a wakeup call to animal health and public health services that their collaboration is necessary if these threats are to be minimized. There is increasing recognition that, for a number of zoonotic diseases, the most effective way to protect the health of the public is to control disease in the animal host.

The work of livestock scientists working in and for developing countries has special relevance in tackling these animal-human diseases, because within developing countries today, fast changes in food systems wrought by skyrocketing demand for, and production of, livestock foods is creating new niches and transmission pathways for pathogens, with unprecedented numbers of diseases emerging and re-emerging in recent decades. New tools and approaches for managing diseases in developing countries are urgently needed.

 

The animal-human disease interface
Most pathogens (61%) that affect people also affect animals; such shared infecting organisms and infections are known as ‘zoonotic’. A full 71% of all the world’s emerging infectious diseases are zoonotic, or transmissible between people and animals. In addition to swine flu, bird flu and SARS, these diseases include such devastating plagues as BSE (mad cow disease), HIV/AIDS, ebola and Rift Valley fever. The bugs that cause these diseases are notorious for their ability to evolve. Flu viruses, for example, can change both from severe to mild and from mild to severe.

Researchers at ILRI have been working at the livestock-human disease interface, supporting better integration of veterinary and public health surveillance programs, for three decades. ILRI’s particular interests are aspects of zoonotic diseases that impact the world’s poorest communities, where animal husbandry is a way of life and a central means of livelihood for more than half a billion people. ILRI and its partners, for example, make evidence-based assessments of the different impacts on the poor of employing different disease-control methods, thereby helping policymakers determine optimal pro-poor strategies for different regions and agricultural production systems of the developing world.

ILRI works with many research institutions within developing countries to better control zoonotic diseases at local, national and regional levels. It works with WHO and its international network of institutions to bolster disease surveillance. It works with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) on participatory epidemiology, a grassroots approach to disease surveillance and control that is being successfully applied in the battle against bird flu in Indonesia. And it works with regional agencies such as the Africa Union / Inter-African Bureau for Animal Resources to improve laboratory testing and diagnosis of bird flu and other infectious livestock diseases.

ILRI and its partners are also investigating risk-based approaches that focus on key hazards and maximize benefits with available resources. With case studies in Africa and Asia, and concepts derived from ‘one medicine’ and ‘one health’, ILRI scientists argue that a ‘risk-analysis framework’ both can and should be extended to integrate risks to animal, human and environmental health.

The role of policy
ILRI also works with the International Food Policy Research Institute (IFPRI) and other institutions on providing evidenced-based policy support so that we don’t fall into the trap of doing more harm than good in our efforts to control infections, particularly in poor countries which can least afford such mistakes.

Some of the most profound consequences of disease threats are economic rather than medical, with inappropriate policies devastating local and national economies. Egypt’s on-going culling of its entire population of some 300,000 pigs, for example, is reported to be reigniting religious and economic tensions, and may end up doing more harm than good. The pigs are kept not by Egypt’s majority Muslim population, which views the animals as unclean, but by Egypt’s Coptic Christians, many of whom maintain pigs on the rubbish heaps of shantytowns, where entire families pick out organic waste to feed their pigs. On the other hand, Egyptian authorities may be trying to prevent a repeat of events two years ago, when they were criticized for not responding swiftly enough to an outbreak of bird flu, which killed 26 people in the country, three in just the last month.

‘Misconceptions and inappropriate responses can spread quickly during the early stages of a new disease outbreak,’ says John McDermott, a veterinary epidemiologist and ILRI’s director of research. ‘This “swine flu” is spread by people, not by pigs,’ he said. ‘So most authorities are appropriately focusing their current attention on stopping the spread of swine flu among people.’ (Bird flu, in contrast, is spread by birds, so authorities focus on controlling that disease within poultry rather than human populations.)  This new swine flu virus, and our reactions to it, like the more lethal bird flu and SARS before it, should provide us with many lessons for the future.

Research gaps
We still know little about the nature of this new influenza virus strain, other than its genetic makeup is a ‘mashup’ of human, bird and pig elements (making the name ‘swine flu’ something of a misnomer we shall probably have to live with; ‘Spanish flu’ didn’t originate in Spain, but the name stuck anyhow). We don’t know yet when it first made the jump from pig to person, why it has been so deadly in Mexico but not elsewhere, or how virulent it will eventually prove to be. The pathogenicity of a virus can become milder or more severe over time. Until now, the influenza A(H1N1) virus thankfully has proven relatively mild, with most of those infected responding well to usual flu treatments and recovering.

Our ignorance of this new strain of swine flu virus is partly due to our neglect of animal health matters. In rich as well as poor countries, veterinary health care and research remains chronically under-funded. And there is increasing need for disease control policymakers, agents and researchers to collaborate at the interface of the human-and-animal-health sectors, exchanging up-to-date information on disease outbreaks and transmission.

Controlling emerging infectious diseases
 ‘To get serious about preventing new zoonotic infections from spreading,’ says Carlos Seré, director general of the Africa-based International Livestock Research Institute (ILRI), ‘we need to get serious about veterinary resources. We need new ways to look for new pathogens infecting animals, new ways to assess those which may be most dangerous, and new ways to determine how they may be transmitted to people. We have just had a demonstration as to the danger of waiting for a new flu to emerge and begin spreading among people before trying to contain it.’

The influenza A(H1N1) virus is spreading rapidly because in our ever-shrinking, ever-globalizing world, pathogens are crossing species and borders with increasing ease. In such a world, says Seré, ‘we ignore veterinary health problems in developing countries at our peril.’ With high-quality collaboration among countries (rich and poor alike), scientific disciplines (e.g. socio-economics as well as genetics), and sectors (e.g. medical, veterinary, agricultural, environmental, wildlife), Seré argues, we can manage today’s emerging disease threats.
 
Because animals are the origin of most emerging diseases, they could play the same role that canaries did in the mines, in that case, alerting the coal workers to the presence of noxious gases or too little oxygen.

‘We should be spotting many infectious disease threats not in people, as we did in the case of this new flu virus,’ says Seré, ‘but rather in animal populations.’ That should give authorities more time to design and implement interventions to protect people from becoming infected. ‘But as we’ve seen in recent outbreaks of bird flu and Rift Valley fever, all too often it is people rather than animals that serve as our sentinels, sickening and dying after the disease has begun circulating in local livestock populations.’ That’s largely because in poor countries, livestock diseases tend to go unreported (it’s hard to tell one livestock disease from another in countries with spotty veterinary coverage) and/or underappreciated (people facing serious human health problems have little time to spare worrying about animal diseases), and/or ignored (it may be considered political suicide to report a disease outbreak that might have large economic consequences).

‘To find better ways of controlling human diseases,’ Seré concludes, ‘we’re going to have to find better ways of understanding and controlling diseases in both domesticated and wild animal populations. And we’re all going to have to work together, breaking down traditional barriers between organizations and scientific disciplines in the process. We need new thinking to tackle these new threats. And bringing diverse expertise together is the best way of staying on top of fast-evolving situations that threaten our global public health—as well as the well being of the world’s poorer livestock keeping communities.’

 

For more information contact

John Mc Dermott
Deputy Director General-ILRI
Nairobi, Kenya
Email: j.mcdermott@cgiar.org
Telephone: +254 20 422 3207

Climate and health experts warn that scientists must work together, or risk ‘disastrous consequences’ to human and animal health in Africa

Consensus: Spread of Malaria, Rift Valley fever, and Avian flu far more likely if researchers continue to ‘operate in silos’ and if solutions ignore local conditions.

human and animal health in Africa  

Faced with the prospect of more variable and changing climates increasing Africa’s already intolerable disease burden, scientists must begin to reach out to colleagues in other fields and to the people they want to help if they hope to avert an expected “continental disaster,” according to leading climate, health, and information technology experts, who met in Nairobi last week.

Climate change will further increase the already high variability of Africa’s climate, fostering the emergence, resurgence and spread of infectious diseases. “A warmer world will generally be a sicker world,” said Prof. Onesmo ole-MoiYoi, a Tanzania medical, veterinary and vector expert. “We scientists need to adopt a new way of working, one that makes African communities bearing the burden of disease part of the solution rather than part of the problem.” The separate fields of human health, animal health, climate, vectors and environment must come together to avert a “continental disaster,” according to leading experts who attended the meeting.

Patti Kristjanson of ILRI, which hosted the meeting, agreed. “We need to do things differently than we have in the past. The impact of disease will increase if we continue to operate in silos. Our only chance at reducing the impact of deadly diseases in Africa is to increase collaboration across the disciplines of environment and health, and in a way that involves local communities. Failure to do so could lead to disastrous consequences.”

The experts concluded a three-day meeting sponsored by Google.org and organized by researchers from the IGAD Climate Predictions and Applications Centre (ICPAC), the Kenya Medical Research Institute (KEMRI), the International Centre of Insect Physiology and Ecology (icipe), the International Livestock Research Institute (ILRI) and Google.org.

The meeting was one of the first on the continent to link climate and health researchers to reduce Africa’s infectious disease burden. The experts cited malaria, Rift Valley fever and bird flu as diseases poised to spread to new areas, along with an increasing threat of diseases such as Chikungunya and the emergence of as yet unknown disease pathogens, unless researchers, disease control workers and local communities share information and communicate faster and more strategically across their professions.

Prof. ole-MoiYoi of icipe and Kenyatta University stressed the importance of tapping the expertise of local communities. “By using bed-nets and anti-malarial drugs, and by removing the human-made breeding sites of mosquitoes, communities in the Kenyan Highlands have managed to stop recurrent malaria epidemics.”

“To combat disease, we need a holistic approach that involves local communities,” ole-MoiYoi said. “We can control malaria across Africa if we can divorce ourselves from the linear thinking that looks for ‘a’ solution and adopt an integrated approach.”

The World Health Organisation (WHO)estimates that changes to the earth’s climate are already causing five million more severe illness and more than 150,000 more deaths each year. By 2030, the number of climate-related diseases is likely to more than double.

Dr. Rosemary Sang, a researcher from KEMRI, described a case study of an outbreak of Rift Valley fever that claimed the lives of 155 Kenyans in late 2006 and early 2007. The virus is transmitted from livestock to people either through handling of infected animal material or by the mosquito vectors. Sang said the outbreak, which peaked 24 December, highlights most of the critical challenges researchers and health officials face in connecting data and advanced warnings to realities on the ground.

Kenya’s Garissa District, in the remote north-eastern corner of the country, experienced heavy rains and flooding starting in mid-October 2006, resulting in standing pools of water that became breeding sites for the mosquitoes that transmit Rift Valley fever. The first veterinary interventions did not take place until mid-January 2007, almost three months after the onset of the heavy rains, 2.5 months after mosquito swarms were reported, 2 months after the first livestock and 1.5 months after the first human cases were recorded, respectively.

"We need to move up our response times to these outbreaks,” said Sang. “All of the warning signs of an outbreak were there but we weren’t able to connect the dots.”

She cites poor tele-communication and roads in the region as major challenges. “Many of these areas lie outside mobile phone networks and far from health or veterinary clinics. As animals and then people began to get sick and die, the word didn’t get out fast enough.”

In the end, however, human and animal health officials, working together, were able to save the lives of more people in the 2006/07 outbreak than in the same region in 1998, when more than 600 people died from Rift Valley fever and millions of dollars were lost in livestock trade and tourism.

“The key is predicting outbreaks before they happen and preparing high-risk areas to act quickly to reduce the impact on communities,” said Sang.
Frank Rijsberman of Google.org called on technical experts to strengthen their capacity to predict and prevent infectious diseases. That will take more and better climate, vector, human and animal data, as well as more data sharing.

“The links between the climate and health research communities across Africa need to be strengthened,” Rijsberman said. “By sharing information we can stop some disease outbreaks and dramatically shorten our response time to others – which can not only save lives but also protect communities against subsequent severe economic losses.”

Mapping the way forward
The researchers pointed to climate models and new mapping software such as Google Earth and Health Map as useful tools for integrating vast amounts of environmental, health, and poverty data. “We’re working to identify the populations of people that are most vulnerable to disease and other external shocks,” said Phil Thornton of ILRI. “That includes communities that are at high risk for malaria because, for example, they are located both far from health clinics and near to water sources. We make these ‘vulnerability maps’ publicly available so that these high-risk communities can get the support they need to respond quickly and effectively to disease outbreaks.”

Google.org environmental scientist Amy Luers said better disease responses will also require tackling diseases at their root causes. “We scientists have to do a better job of informing the public of the underlying drivers of the spread of infectious diseases. The impacts of increasing populations and environmental degradation will require institutional and governance changes put in place for a ‘one health’ approach to human, animal and environmental well being.”

“We need to prepare now to avoid future catastrophe,” says Prof. ole-MoiYoi. “We are discovering that climate variability is playing a bigger and bigger role in the spread and severity of diseases across the globe. Our survival, and that of our environment, may depend on our joining hands to understand that environment. And our roles in it.”

One world, one health

Holistic approaches to controlling the 'perfect storm' of health problems in poor countries, particularly Africa's catastrophic disease burden, must include better control of diseases transmitted between animals and people.

A paper to be published this May 2006 in the Public Library of Science (PLoS) journal PLoS Medicine, a peer-reviewed open-access journal (available online at www.plosmedicine.org) advocates linking integrated work on ‘neglected’ tropical diseases with major global health partnerships recently formed to tackle the three most devastating diseases of the poor: malaria, TB and AIDS. The authors of the paper, which include development economist Jeffrey Sachs, argue that while new partnerships and initiatives have significantly raised funding and awareness of the need to scale up the fight against the ‘big three’ diseases, conspicuously absent is work on a group of ‘neglected tropical diseases’ that may threaten the poor as much as malaria, TB and AIDS and for which there are already cheap and effective control strategies. The authors propose that our success in controlling the big three may depend on a concurrent attack on this group of neglected diseases, which include three vector-borne protozoan infections (leishmaniasis, human African trypanosomosis and Chagas disease), three bacterial infections and seven kinds of helminth (worm) infections.

The potential benefits of taking a more holistic approach to disease control are being popularized in complementary initiatives advocating ‘one health’ strategies that simultaneously address human and animal health. (See, for example, a new book exploring grass roots ideas from East and Southern Africa on how to integrate wildlife, livestock and human health for both conservation and development: ‘One World, One Health’ is available online from LEAD, the Livestock, Environment and Development Initiative.

ILRI supports these holistic health approaches and further argues that another class of neglected diseases of the poor—‘zoonotic’ diseases, or those transmitted between people and animals—should be included. Zoonotic diseases account for a remarkable 75% of all human diseases and include such emerging diseases as avian influenza. Esther Schelling, a veterinary epidemiologist on joint appointment with the International Livestock Research Institute (ILRI) and the Swiss Tropical Institute, points out that zoonotic diseases are virtually excluded from most health initiatives ‘because they’re simply not accounted for’. ILRI is helping to ensure that they are accounted for and that methods to control them are friendly to the poor.

Two papers on this topic by Schelling and colleagues are available online:
British Medical Journal article
Lancet article

Carlos Seré, director general of ILRI, says that with the sequence in recent years of BSE (‘mad cow disease’), foot-and-mouth disease, and now bird flu, there is definitely increasing interest in zoonotic diseases.

‘Donors like the Welcome Trust’, he says, ‘are increasing their investment in tropical animal disease research. Our own strategy is to develop appropriate methods for researchers and policy-makers to evaluate the risk of these zoonotic diseases and together identify the most promising strategies and policies that can help to reduce such risk, particularly for the poor. We have activities specifically looking at zoonoses such as brucellosis and bovine TB, and we are building up our expertise in food safety issues. Strengthening our expertise on food safety and the risks posed by zoonoses is central to two of ILRI’s strategic research themes, the first on sustaining lands and livelihoods which involves protecting human health, and the second on improving livestock-related market opportunities in domestic and international markets, which are increasingly threatened by such food safety concerns.’

In relation to bird flu, Dr Seré explains, ‘ILRI will not be the virologists or poultry specialists. But we have comparative strength in systems analysis, which combines social science with epidemiology and animal genetics and other lab bench research to address complex health problems. We do this in conjunction with partners who bring more specific expertise, such as in poultry or vaccines. What we specifically bring to the picture is a “poverty lens” to understand the implications of health problems, issues and control strategies on the poorest populations in the world.’

‘Clearly, research is not a “rapid deployment tool”’, he says. ‘There are other organizations—such as the World Health Organisation (www.who.org), the Food and Agriculture Organization of the United Nations (www.fao.org), and the World Animal Health Organisation (www.oie.org) —that have a regulatory mandate and policy responsibility and are linked directly to governments. ILRI’s comparative advantage is in the longer term: in understanding the issues and in providing sound technical research to back these agencies which are doing the short-term response work. As we see more and more that boundaries don’t work, that disease is a global problem, we encourage industrialized countries to share their resources with developing countries, not just out of enlightened self-interest, but also, for example, to ensure food safety for their domestic consumers. And finally, we are particularly interested in helping developing countries to build their own research capacity to understand, model and control complex disease problems.