Slide1: 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


Historical Epidemiologic Transitions – 1st Transition: 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


Historical Epidemiologic Transitions – 2nd Transition: Historical Epidemiologic Transitions – 2nd Transition Coincided with mid-19th century Industrial Revolution Decreases in infectious disease mortality Increasing life expectancy Improved nutrition Antibiotics “Diseases of Civilization” – cancer, diabetes, cardiovascular diseases Environmental problems Chronic diseases


Historical Epidemiologic Transitions – 3rd Transition: Historical Epidemiologic Transitions – 3rd Transition Last 25 years Emerging infectious diseases globally 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”


Factors in Emergence: 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


Factors in Emergencecontinued: Factors in Emergence continued International travel and commerce Breakdown of public health measures Poverty and social inequality War and famine Lack of political will Intent to harm


Convergence Model: Physical and Environmental Factors Ecological Factors Humans Wildlife Animals E I D Social, Political, and Economic Factors Genetic and Biological Factors Convergence Model


Convergence of Human and Animal Health: Drivers: 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


Emerging and Re-emerging Infectious Diseases : Emerging and Re-emerging Infectious Diseases Examples of Emerging/Re-emerging Infectious Diseases


Multihost Pathogens: Multihost Pathogens 60% of all human pathogens are zoonotic 80% of animal pathogens Ecological generalists


Slide12: CDC’s Most Significant Global Epidemics Over the Last 15 Years


Slide13: Trends in Global Population


Rapidly Increasing Urbanization: Rapidly Increasing Urbanization 2000 47% world population living in urban areas 2030 60% world population living in urban areas


Concentrated Animal Feeding Operations (CAFOs): Concentrated Animal Feeding Operations (CAFOs) Their Impact on Food Safety and Healthy Environments


Livestock 2020 –The Next Food Revolution: 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


Slide17: 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.


Microbial View: Microbial View


Importance of Agricultural Trade: 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).


Slide20: Source: FAO, WHO, Rimsa, Mexico City April 2005 Poultry population density Human population density


Slide21: Figure 1.2. Human and livestock densities, and main feed production areas as affected by the distance to Bangkok Source: Gerber and others 2005.


Safe Food begins with healthy animals: Safe Food begins with healthy animals


Ecosystem: Ecosystem


Waterborne Zoonoses: Waterborne Zoonoses Animals Humans Microbial Pathogens Waterborne Disease Water Environment


World’s Most Dangerous Animals: World’s Most Dangerous Animals


Slide26: West Nile Virus in the Western Hemisphere


Slide27: WNV Neuroinvasive Disease Incidence, by County, US, 2000 N=19


Slide28: WNV Neuroinvasive Disease Incidence, by County, US, 2001 N=64


Slide29: WNV Neuroinvasive Disease Incidence, by County, US, 2002 N=2946


Slide30: WNV Neuroinvasive Disease Incidence, by County, US, 2003 N=2866


WNV Neuroinvasive Disease Incidence, by County, US, 2004: WNV Neuroinvasive Disease Incidence, by County, US, 2004 N=1142


Slide32: WNV Neuroinvasive Disease Incidence, by County, US, 2005 N=1294


Slide33: WNV Neuroinvasive Disease Incidence, by County, US, 2006* N=1339 * Reported as of November 7, 2006


The Perfect Microbial Storm:Ravenna, Italy: The Perfect Microbial Storm: Ravenna, 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


Slide35: Ae. albopictus, the Asian Tiger Mosquito Initial Discovery Site near Port of Houston, Texas, USA, 1985


Slide36: Used Tires Stored at Other Locations


There is no where in the world from which we are remote and no one from whom we are disconnected: PNAS, 2004 There is no where in the world from which we are remote and no one from whom we are disconnected


Slide39: Climate Change’s 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


Nipah Virus: Nipah Virus


Virus Carriers: Virus Carriers Fruit bats


SARS: SARS


Horseshoe bat: Horseshoe bat


Slide46: 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


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


Annual Global Trade inExotic Animals : Annual Global Trade in Exotic Animals 4 million birds 640,000 reptiles 40,000 primates Illegal trade unknown – estimate $4-6 billion - Wildlife Conservation Society


Slide49: “Double, double toil and trouble; Fire burn, and caldron bubble.” William Shakespeare


Compelling Vision: Compelling Vision Accelerating prevention, control, & elimination of ecology-mediated microbial threats Systems approach with cross-cutting themes Global organization Animal Health Human Health Ecosystem Health


The Convergence of Human and Animal Health: 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 people’s 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


Determinants of Success to Address Threats from the convergence/Pandemics : 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


Neglected Zoonotic Diseases: 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


Neglected Zoonotic Diseases: 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


Endemic and Emerging Zoonoses: 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


Slide56: “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


Emerging Retrovirus Zoonoses: 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 with similar origins


Foresight Analysis: 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


Slide59: Current and Projected Importance of Factors Influencing Emergence


Slide60: Mechanisms By Which Important Factors Will Impact Emergence Mechanism Influencing Emergence


Risk: Risk


Interdependence: The Shrinking World: 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…”


If a forest is dense & dry enough…: If a forest is dense & dry enough… Worldwide, 25 people/second cross national borders Increasingly densely connected network Lessons from monocultures


Convergence Challenges: 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


Convergence Challenges (cont.): 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?


Consensus of Recommendations: Consensus of Recommendations Improve infrastructures Integrate surveillance strategies and diagnostics Increase R&D investments Focus on prevention not just reaction and response – e.g. avian influenza Build a new infectious disease workforce Consider a global perspective


Consensus of Recommendations: 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