1. One Health Strategy for South Asia Progress and Prospects Building a sustainable program for dealing with emerging diseases for the future Roger Morris

2. The NEED New infections are more likely to emerge from animal populations than from human populations and tend to have lower host specificity than established infections. 60-75% of all emerging human infections are zoonotic. Taylor et al. (2001); Jones et al. (2008) The rate of emergence is increasing and has been attributed to the escalating interdependency between humans, animals and the environment. Jones et al., 2008 The ability to detect and respond to emerging infectious disease threats, in terms of “on the ground” expertise and physical capacity, is most constrained in the developing world. Paradoxically, this is where the likelihood of such disease emergence is the greatest. Jones et al., 2008 Control of zoonoses has been limited by the lack of integrated application of effective control measures in both animal and human populations. Okello et al., 2011; Sekar et al., 2011

3. April 2009 → pandemic H1N1 –Precipitated formal involvement in ‘one health training’ Regional training program in animal and human health epidemiology –Two-phase project in South Asia, 2010-2013 –Funded by the European Commission, administered by the World Bank through a grant to Massey University –Implemented in seven countries in South Asia –Similar activities in China and Mongolia One Health training

4. Phase 1: Master’s degree joint training of 68 human and animal health professionals across South Asia to build cross-sectoral collaboration Predominantly web-based learning plus face-to-face blocks in a blended-learning program Now extended to China and Mongolia (extra 19 students) Phase 2: Applied training through: 11 in-country disease investigations Involved 200+ participants and 1,000+ implementers, integrating human and animal health sectors Further advanced training in epidemiology and economics Supported by web-based platform, ‘Hubnet’ One Health training

5. Phase 1: Masters training program 68 Masters students

6. Brucellosis Rabies One Health evaluation CCHF (brucellosis) Leptospirosis Rabies Brucellosis review Brucellosis (Q fever, CCHF) Anthrax Rabies Leptospirosis Phase 2: Much wider participation Core - Phase 1 graduates Expanded involvement, 200+ contributors plus 1000+ implementers

7. Afghanistan

8. Anthrax case Anthrax surveillance training Dog bites Bangladesh

9. One Health Hubs –Developed as an organisational framework to facilitate cross-sectoral collaboration in each country –Foster leadership development and coordination of activities at both national and regional levels –Country Hubs are connected to form a ‘One Health Network’ in the South Asia Region Hubnet –Hubs are underpinned by an online collaboration and resource-sharing platform called ‘Hubnet’ Sustainability

10. Powerful web-based collaboration system, which allows geographically widespread people to work together on projects, exchange ideas, and consult experts and information sources Will include IRIS (Incident Response Information System) and other tools to support disease control action Building information resource component to update and inform people Hubnet

12. One Health Hubs: Part of the ‘SAR Regional Network’ 7 SAR countries with active Hubs

13. Hubnet for registered users IRIS – national information system HandiResponse – managing disease risks + detection HandiManager – managing disease control action Public information site (firewalled) Health information strategy Smart phone 40 satellite layers National data Disease data Health slate Policy analysis

14. IRIS is a very flexible system to support human and animal health. It can: Manage any disease outbreak in people or animals, running in any world language Manage disease surveillance and control programs in people and animals Support assessments of risk and response Could also manage crop disease, fire, flood... Incident Response Information System

15. Login to IRIS: Mongolia version

16. A generic web-based data management system which operates nationally Supports integration of data from different sources – can import data from other systems Stores both text and spatial data Powerful security for controlling access to data Smartphone and tablet data entry Easy to use data extraction Integration with linked analysis functions Can operate in any language Data management

17. Dashboard

18. Data Entry - Vietnam

20. Paro valley where Mysteria outbreak occurs

21. Households to be Interviewed in Mysteria investigation

22. Mapping disease outbreaks Brucellosis in Afghanistan on satellite image

23. Mapping avian influenza in Vietnam

24. Data analysis

25. Swasthya (health) slate does 33+ tests and collects health data on village people (+ animals??)

26. Example health slate applications Demographic dataHeart assessmentDiagnostic tests

27. Human and ANimal Disease Incident Response management software Tool for evaluating the likely effects of a new zoonosis establishing in a country Procedures to choose an appropriate surveillance strategy to detect the disease promptly should it arrive or arise “Surveillance portfolio” for the disease is chosen based on economic analysis HandiResponse

28. Risk landscape – environment plus cattle density

29. Human population density for India

30. Apply risk levels from map to each area of the country for the disease of concern Computer model tests how rapidly the disease would be detected with different surveillance strategies – traditional, risk- based, etc. Evaluate economic benefits and costs of each surveillance activity Select surveillance portfolio

31. Future plans – Massey University Encourage sustained action within region Provide resources and expertise to assist European Union four country one health project 2014-2016 - 2.2 Million Euros Twinning with academic institutions Funding for innovative information management Regional health risk management hub

32. Information management in EU project Further develop Hubnet and transfer management to the South Asia region Implement IRIS in participating countries Apply HandiResponse to diseases in countries Develop and apply HandiManager, a new tool to support disease control policy assessment and disease management

33. Integrated Education and Action for One Health EU/NZ funded project for Afghanistan, Bangladesh, Bhutan and Nepal – with partners in region and Europe Extend Masters program to cover wildlife and environmental health Six project staff per country, will gain Masters degree and investigate diseases 16 diseases covered, 4 per country Focus on design of control strategies

34. Disease Situation Assessment and Design of Appropriate One Health Strategies An evaluation tool will be developed to choose economically and epidemiologically appropriate ‘one health’ strategies for zoonotic disease control. Using this tool, investigations and evaluations will be undertaken for four diseases of humans and animals in each of the four countries. HandiManager CountryDisease 1Disease 2Disease 3Disease 4 AfghanistanTuberculosisRabiesQ feverZoonotic cutaneous leishmaniasis BangladeshNipah virusAnthraxRabiesHeavy metal poisoning BhutanAnthraxBracken fern poisoningFascioliasisTuberculosis NepalPorcine cysticercosisJapanese encephalitisTuberculosisZoonotic visceral leishmaniasis

35. Maintaining existing momentum Maintaining and extending relationships Carrying projects on from current successes to a broader platform of action Resourcing the continuing development of innovative tools to support effective action against health risks We all need to work together on this!!!! The challenges