Friday, 3 December, 2021

Prioritising One Health Approach

Uttam Maharjan

The relations between humans, animals and the environment are interconnected. Humans and animals share the same environment and the components existing in the environment. As such, humans and animals not only share good things but also pathogens. Some pathogens are common to both humans and animals. As such, there are growing chances of diseases in animals getting transmitted to humans and vice versa. Such diseases are called zoonoses or zoonotic diseases.

Zoonotic diseases can be categorised into three groups: endemic, epidemic and emerging. Endemic zoonotic diseases exist in many parts of the world. They affect many humans and animals. Epidemic zoonotic diseases are scattered and irregular in incidence. Emerging zoonotic disease may be entirely new or may have occurred in the past. Such diseases are spreading rapidly across the world. In least developed countries, endemic zoonotic diseases account for around 20 per cent of morbidity and mortality in humans. The World Health Organisation (WHO) has identified eight diseases as neglected zoonotic disease: anthrax, bovine tuberculosis, brucellosis, cysticercosis, echinococcosis, leishmaniasis, rabies and human African trypanosomiasis. These diseases are harmful to both humans and animals.

Similar pathogens
According to the World Organisation for Animal Health, over sixty per cent of total infectious diseases, including 75 per cent of emerging and re-emerging diseases that infect humans originate in animals. This is because, several pathogens that affect animals also affect humans. In other words, pathogens affecting humans and animals are similar and grow in the environment shared by both humans and animals.

Zoonotic diseases are taking a toll on both human and animal health, besides causing huge economic losses. Owing to increasing population and destruction of forested areas and natural habitats of wildlife, contact between humans, animals and wildlife is increasing day by day. In developing countries like Nepal, the incidence of zoonotic diseases has been growing for the past few decades because of several factors. There is a low level of awareness of zoonotic diseases. Close contact with pets like dogs and cats, for example, is largely ignored by people. Most livestock farmers do not try to avoid proximity with farm animals.

In developing countries, hygiene and sanitation facilities are poor and the resources for the management of livestock farming and other activities like slaughtering animals in abattoirs are limited. This has also contributed to the risk of contracting zoonotic diseases. Moreover, traditional practices of drinking raw milk and raw blood and eating raw meat in certain communities have also increased the risk of contracting zoonotic diseases.

Further, use of counterfeit drugs and self-medication both in humans and animals have also aggravated the situation. Several antibiotics used for the treatment of diseases in humans are also used in animals for the treatment of their diseases but sometimes such antibiotics are also used in animals as growth promoters. Such misuse of antibiotics might give rise to antimicrobial resistance, which has become a severe problem now.

Given the complex nature of zoonotic diseases, the concept of the one health approach has emerged. Under the concept, humans, animals and the environment are taken as a single unit and efforts are made to attain the optimal health of humans, animals and the environment. The World Health for Animal Health, together with the World Health Organisation and the Food and Agriculture Organisation, has been promoting this concept since the 2000s. The incidence of highly pathogenic avian influenza, severe acute respiratory syndrome, Middle East respiratory syndrome and Ebola virus has given a nudge to the international medical community to promote the one health approach.

Nepal is a hotspot for many zoonotic diseases such as avian influenza, rabies, Japanese encephalitis, leptospirosis, brucellosis, tuberculosis, cysticercosis and fascioliasis. Altogether 39 zoonotic diseases have been identified in Nepal, out of which the government has listed nine diseases as prioritised diseases: rabies, avian influenza, Japanese encephalitis, leptospirosis, salmonellosis, brucellosis, cysticercosis, hydatidosis and toxoplasmosis.

Although Nepal has been practising the one health approach for the past few years, the outcomes leave much to be desired. Lack of coordination among the stakeholders concerned for inter-sectoral synergic action is glaring. The level of awareness of zoonotic diseases is low. The country is also poor in infrastructure and technology.
It is gratifying to note that the government brought out the One Health Strategy in 2076. As per the guidelines of the strategy, the government is now conducting one health-related activities. The strategy includes coordination and collaboration with stakeholders; integrated disease surveillance and laboratory services; capacity development for stakeholders; preparedness and response; and communication and advocacy.

Nepal has made efforts to promote the one health approach through donor-funded projects and in association with international agencies like the World Health Organisation, Food and Agriculture Organisation and the World Organisation for Animal Health and other national and international organisations. In the past, the government adopted the one health approach to control rabies and Japanese encephalitis but coordination remained poor.

Effective implementation
It is high time that the one health approach were made effective. For this, provincial and local governments can play a pivotal role in strengthening the approach. Awareness campaigns on zoonotic diseases for the public and on the one health approach for health professionals need to be given momentum across the country. Such campaigns have also been conducted across the county by governmental and non-governmental organisations for health professionals in the past.

The point is that such campaigns need to be continued with more vigour. The course on zoonotic diseases and the one health approach need to be incorporated in the curriculums of schools and colleges. By formulating the one health approach, the government has indicated that zoonotic diseases have been prioritised in public health. The government should see to it that the strategy is implemented in earnest to achieve the desired goals and outcomes.

(Former banker, Maharjan has been regularly writing on contemporary issues for this daily since 2000.