The Global Animal Health Initiative:

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• The Global Animal Health Initiative
• The Way Forward
• Veterinary and Public Health Collaboration

October 10, 2007 The World Bank Washington
D.C. Lonnie King, DVM, MS, MPA Director National
Center for Zoonotic, Vector-Borne, and Enteric
Diseases Centers for Disease Control and
Prevention, Atlanta, GA
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Historical Epidemiologic Transitions 1st
Transition

• 10,000 years ago
• New social order due to agriculture
• Zoonoses through animal domestication
• Increases in infectious diseases
• Epidemics in non-immune populations

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Historical Epidemiologic Transitions 2nd
Transition

• Coincided with mid-19th century Industrial
  Revolution
• Decreases in infectiousdisease mortality
• Increasing life expectancy
• Improved nutrition
• Antibiotics
• Diseases of Civilization cancer, diabetes,
  cardiovascular diseases
• Environmental problems
• Chronic diseases

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Historical Epidemiologic Transitions 3rd
Transition

• Last 25 years
• Emerging infectious diseasesglobally
• New diseases and increases in mortality first
  since 19th century
• Re-emergence
• Antimicrobial resistance
• 75 percent of diseases are zoonotic
• Anthropogenic factors of emergence the
  microbial perfect storm

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Factors in Emergence

• Microbial adaptation and change
• Host susceptibility to infection
• Climate and weather
• Changing ecosystems
• Economic development and
• land use
• Human demographics and
• behavior
• Technology and industry

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Factors in Emergencecontinued

• International travel and commerce
• Breakdown of public health
• measures
• Poverty and social inequality
• War and famine
• Lack of political will
• Intent to harm

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Convergence Model
Genetic and Biological Factors
Physical and Environmental Factors
Animals
E I D
Humans
Wildlife
Social, Political, and Economic Factors
Ecological Factors
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Convergence of Human and Animal Health Drivers

• Ecological risk and climate
• change
• Population dynamics
• Growing governance gap
• Global foodscapes
• Microbial swarms
• Technology and social actions and involvement

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Emerging and Re-emerging Infectious Diseases
Examples of Emerging/Re-emerging Infectious
Diseases
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Multihost Pathogens

• 60 of all human pathogens are zoonotic
• 80 of animal pathogens
• Ecological generalists

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CDCs Most Significant Global Epidemics Over the
Last 15 Years
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Trends in Global Population
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Rapidly Increasing Urbanization

• 2000
• 47 world population living in urban areas
• 2030
• 60 world population living in urban areas

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Concentrated Animal Feeding Operations (CAFOs)
Their Impact on Food Safety and Healthy
Environments
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Livestock 2020 The Next Food Revolution

• Global increase and demand for protein and food
  of animal origin
• Shift from poverty of 1-2 billion people to
  middle class
• Westernization of Asia and Latin America
• Concerns with sustainability
• Increases in emerging zoonoses through the
• concentration of people and animals

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• Last year, over 21 billion food animals were
  produced to help feed a population of over 6
  billion people resulting in trillions of pounds
  of products distributed worldwide. Projections
  toward 2020 indicate that the demand for animal
  protein will increase by 50, especially in
  developing countries.

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Microbial View
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Importance of Agricultural Trade

• Already 40 of all trade in agriculture,
  fisheries and forestry occurs between developing
  and developed countries. More than 20 of all US
  imports are food products (more than 8 million
  shipments a year).

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Human population density
Poultry population density
Source FAO, WHO, Rimsa, Mexico City April 2005
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Figure 1.2. Human and livestock densities, and
main feed production areas as affected by the
distance to Bangkok
Source Gerber and others 2005.
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Safe Food begins with healthy animals
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Ecosystem
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Waterborne Zoonoses
Humans
Animals
Waterborne Disease
Microbial Pathogens
Water Environment
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Worlds Most Dangerous Animals
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West Nile Virus in the Western Hemisphere
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WNV Neuroinvasive Disease Incidence, by County,
US, 2000
N19
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WNV Neuroinvasive Disease Incidence, by County,
US, 2001
N64
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WNV Neuroinvasive Disease Incidence, by County,
US, 2002
N2946
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WNV Neuroinvasive Disease Incidence, by County,
US, 2003
N2866
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WNV Neuroinvasive Disease Incidence, by County,
US, 2004
N1142
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WNV Neuroinvasive Disease Incidence, by County,
US, 2005
N1294
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WNV Neuroinvasive Disease Incidence, by County,
US, 2006
N1339
Reported as of November 7, 2006
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The Perfect Microbial StormRavenna, Italy

• A Virus from Africa (an alphavirus Chikungunya)
• A mosquito from Asia (Aedes albopictus tiger
  mosquito)
• A tourist from India (1.25 million human cases in
  2006)
• A report of 270 people infected with Chikungunya
  in Ravenna, Italy
• Globalization is key to the future of infectious
  diseases
• E.g. global tire trade 2.1 billion airline
  passengers/yr climate change and, a shift of
  competent vectors worldwide
• 
  - Bloomberg Report 9/25/07

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Ae. albopictus, the Asian Tiger Mosquito Initial
Discovery Site near Port of Houston, Texas, USA,
1985
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Used Tires Stored at Other Locations
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There is no where in the world from which we are
remote and no one from whom we are disconnected
PNAS, 2004
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Climate Changes Impact on Infectious Diseases

• Vector-borne diseases
• Water-borne diseases
• Agriculture Production
• Migration of Animals
• Changing ecosystems for wildlife and animals
• Built environment
• Human-Animal Interface
• Ecologies and a new research portfolio
• Evidence-based public health impact

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Nipah Virus
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Virus Carriers
Fruit bats
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SARS
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Horseshoe bat
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Lessons Learned From SARS

• Importance of integrated surveillance prompt
  epidemiologic investigations and, lab capacity
• Disruption of multiple economic sectors
• Global implications of local problems
• Need for critical linkages and partnerships

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OIE-CDC Collaborating Center for Emerging and
Re-Emerging Zoonoses

• First collaboration between CDC and an
  international animal health organization
• Enhance pathogen discovery
• Improve diagnostics
• Cooperation in better understanding the
  convergence of human and animal health
• Linkage of health system professionals
• Jointly contributing to establishing a global
  applied research portfolio
• Improve global preparation in identifying and
  responding to microbial threats
• Enhance surveillance

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Annual Global Trade inExotic Animals

• 4 million birds
• 640,000 reptiles
• 40,000 primates
• Illegal trade unknown estimate 4-6 billion
• - Wildlife Conservation Society

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• Double, double toil and trouble Fire burn,
  and caldron bubble.

William Shakespeare
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Compelling Vision

• Accelerating prevention, control, elimination
  of ecology-mediated microbial threats
• Systems approach with cross-cutting themes
• Global organization

Ecosystem Health
Animal Health
Human Health
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The Convergence of Human and Animal Health

• In practice, no aspect of disease control,
  especially in poor communities, can be tackled
  effectively without simultaneous attention to
  peoples livelihoods and the frequent
  disincentives that they encounter as they are
  expected to participate in disease control
  efforts.
• - Ministries and departments across
  government
• - Professional groups medical, veterinary,
  and
• environmental
• - NGO and private sector working with
  communities and
• governments
• 
  David Nabarro MD
• 
  UN System InfluenzaCoordinator

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Determinants of Success to Address Threats from
the convergence/Pandemics

• Political leadership and will
• Effective alliances with civil society and the
  public sector
• Capabilities and resources to scale-up effective
  systems for direction, coordination, and
  management
• Support and integrated plans for long-term
  strategies to reduce risks from animal and human
  diseases
• Collaborations among all stakeholders sharing
  information, surveillance findings, samples for
  detection and identification and effective
  communication
• Full community engagement especially among those
  affected
• Resisting specialization and separation and the
  incentives that drive this behavior
• 
  - Dr. David Nabarro

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Neglected Zoonotic Diseases

• Understanding One Health people, livestock and
  wildlife
• Role of livestock as income 70 of rural poor
• Communities at risk 800 million poor livestock
  keepers
• Dual burden

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Neglected Zoonotic Diseases

• Another example of health disparities inverse
  relationship the lower the income the higher the
  risk
• Need to raise the profile
• Significant under-reporting
• Human Health and Animal Health Continuum
• Risk to human health is often best controlled by
  animal programs

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Endemic and Emerging Zoonoses

• The need to fight zoonotic diseases especially
  in the poorest populations of the world is
  incontestable from a moral perspective, a human
  rights perspective and an economic perspective,
  as well as a global goods perspective.
• The Control of Neglected Zoonotic Diseases A
  Route to Poverty Alleviation - 2006

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• As the HIV disease pandemic surely should have
  taught us, in the context of infectious diseases,
  there is nowhere in the world from which we are
  remote and no one from whom we are
  disconnected. 
• ? IOM, 1992

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Emerging Retrovirus Zoonoses

• 2 new retroviruses Cameroon Africa
• Human T-lymphotropic virus (HTLV) types 3 and 4
• Recovered from hunters of nonhuman primates
• Role of bushmeat and butchering primates
• STLV and HIV withsimilar origins

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Foresight Analysis

• EID are the New normal
• Expect 3-4 new EID annually 8-34 by 2015
• 87 new EID since 1980 58 viruses - 49 RNA
• - mostly zoonotic
• Found worldwide but proximity to animal
  populations or products is the key risk factor
• Change in the host-pathogen ecology will be the
  most important single driver

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Current and Projected Importance of Factors
Influencing Emergence
FACTOR 2007 2017 2027
Human demographics and behavior
Technology and industry
Economic development and land use
International travel and commerce
Microbial adaptation and change
Breakdown of public health measures
Climate change and weather
Changing ecosystems
Poverty and social inequality
War and famine
Lack of political will
Intent to harm
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Mechanisms By Which Important Factors Will
Impact Emergence

FACTOR Human vulnerability Environmental and zoonotic exposure Person-to- person transmission Microbial evolution
Human demographics and behavior
Economic development and land use
International travel and commerce
Climate change and weather
Poverty and social inequality
Mechanism Influencing Emergence
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Risk
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Interdependence The Shrinking World

• 1 billion people will soon cross international
  borders each year or 25/second
• Tightly coupled system unprecedented
  vulnerability
• Threats spread faster, further, and non-linear
• Increased threats of global pandemics
• Strategic risk analysis significant risk of
  developing countries with under funded public and
  animal health systems
• If the forest is dry enough and dense enough

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If a forest is dense dry enough

• Worldwide, 25 people/second cross national
  borders
• Increasingly densely connected network
• Lessons from monocultures

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Convergence Challenges

• Impact and influence beyond health goods,
  services and economies
• A shift from problem solving to managing dilemmas
• A new global interdependence and connectivity
• Factors creating the microbial storm are well
  entrenched
• A great future for complexity simple but not
  simplistic
• Reconciliation of great change with habitual and
  traditional thinking and ways of working
• Adopting a One Health One Medicine mindset
  and strategy

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Convergence Challenges (cont.)

• The role of governments, educational
  institutions, and society
• Animal and human health are a continuum of
  causality and events and need to be viewed as a
  continuum and integration of strategies
• Recognizing the moral and ethical imperative
  health disparities
• Inclusion of diverse communities, thinking, and
  tools
• The need for new leaders and new ways of leading
• Unprecedented events call for unprecedented
  responses A call to action Who? How? When?
  Where? Why?

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Consensus of Recommendations

• Improve infrastructures
• Integrate surveillance strategies and diagnostics
• Increase RD investments
• Focus on prevention not just reaction and
  response e.g. avian influenza
• Build a new infectious disease workforce
• Consider a global perspective

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Consensus of Recommendations

• Improve disease reporting with appropriate
  incentives
• Design global strategies and interventions
• Create Zoonotic and EID centers
• Meet the critical need for leadership and new
  skills
• Address public understanding and appreciation