Presentation by Hung Nguyen-Viet, Delia Grace and Jakob Zinsstag at the International Symposium of Health Sciences (iSIHAT 2013), Kuala Lumpur, Malaysia, 20-21 August 2013.

1. One Health – an interdisciplinary approach
in combating emerging diseases
Hung Nguyen-Viet1, Delia Grace2, Jakob Zinsstag3
1Hanoi School of Public Health
2International Livestock Research Institute
3Swiss Tropical and Public Health Institute
Kuala Lumpur, Malaysia, 20-21 August 2013

2. • Studies the health and well-being impacts of
development factors using integrative approaches
of Ecohealth/One Health with special focus on
South East Asia with link to similar issues of Africa.
• Focus on the link between health and agriculture,
infectious and zoonotic diseases, chemical
pollution, food safety and nutrition, from lab to
the field.
 Ecosystem Health / One Health
 Food Safety
 Health Impact Assessment
Main research themes

3. Outline
• Disease situation at global level and new
approaches needed
• One Health: history, application, case studies
• Regional initiative of One Health
• Integrated approach and way forward

4. DISEASE SITUATION AT
GLOBAL LEVEL
Context
4

5. Emerging Infectious Diseases
1. Diseases that have recently increased in incidence
or in geographic or host range – e.g., tuberculosis,
cholera, malaria, dengue fever, Japanese encephalitis,
West Nile fever, and yellow fever.
2. Diseases caused by new variants assigned to
known pathogens – e.g., HIV, new strains of
influenza virus, and SARS, drug resistant strains of
bacteria, Nipah virus, Ebola virus, hantavirus
pulmonary syndrome, and avian influenza virus.
3. Bacteria newly resistant to antibiotics, notably the
multiple antimicrobial resistant strains – e.g., MRSA,
and E. coli O157

6. Infectious Disease Emergence at Global level
Jones et al. – Nature - 2008
from
wildlife
from
non-
wildlife
drug-
resistance
vector-
borne

7. 29.08.2013 7
Infectious Disease Emergence at Global level
Morens et al., Nature 430, 242-249 (2004)

8. Challenges
 75% of all new, emerging, or reemerging diseases
affecting humans at the beginning of the 21st century have
originated in animals.
 Global impact of new emergent diseases include
HIV/AIDS, severe acute respiratory syndrome (SARS),
H5N1 avian influenza, and the pandemic 2009 H1N1
influenza virus
 Serious public health, economic, and development
concerns
Needs of updates

9. • West USA & west Europe hotspots
• Last decade: S America & SE Asia

10. • Unlucky 13 zoonoses sicken 2.4
billion people, kill 2.2 million people
and affect more than 1 in 7 livestock
each year
Greatest burden of endemic zoonoses falls on
one billion poor livestock keepers

11. Top Zoonoses (multiple burdens)
• Assessed 56 zoonoses from 6 listings:
responsible 2.7 billion cases, 2.5 million deaths
• “Unlucky 13” responsible for 2.2 billion
illnesses and 2.4 million deaths
– All 13 have a wildlife interface
– 9 have a major impact on livestock
– All 13 amenable to on-farm intervention
Priority zoonoses
0
20000
40000
60000
80000
100000
120000
140000
Deaths - annual
0
200000
400000
600000
800000
1000000
1200000
1400000
1600000
1800000
2000000
Top 13
zoonoses
Next 43

12. 12
0
20
40
60
80
100
Rich Poor
Infectious disease
• 40% disease is infectious
• one twentieth total from animals
• one fortieth total burden is
zoonotic
• ..one twentieth with under-
reporting
• 4% disease is infectious
• one two hundredth total disease
from animals (zoonotic or
emerged)
• one thousandth of the total
disease burden zoonotic
The burden of animal associated disease is
borne by the poor
Rich countries Poor countries
Grace et al., 2012

13. Important factors leading to the emergence of
infectious diseases
• Overpopulation and urbanization
• Population movement and animal trade
• Water and sanitation
• Agriculture and changing land use
• Livestock production
• Climate
• Drug resistance
Coker et al. Emerging infectious diseases in southeast Asia: regional challenges to control. Lancet. 377. 2011

14. HIV, TB, malaria
Other infectious
Mat//peri/nutritional
CVD
Cancers
Other NCD
Road traffic accidents
Other unintentional
Intentional injuries
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
Deaths(millions)
High-income
countries
Middle-income
countries
Low-income
countries
Mortality: global projection, 2004-2030

15. Priority 3: Communicable diseases
0
10
20
30
40
50
60
70
80
“The big three”
Neglected tropical diseases
(NTDs)
Burden of communicable diseases
Burden(millionDALYs)
Hotez et al. (2006) PLoS Medicine

16. 29.08.2013 16
MORAN ET AL., PLoS MEDICINE; THE GLOBAL BURDEN OF DISEASE: 2004 UPDATE (WHO)

17. HISTORY, APPLICATION, CASE
STUDIES
One Health:
17

18. History of One Health and integrative thinking in
medicine 19th to 20st century
• Human medicine in the medieval European universities, Claude
Bourgelat, first veterinary school in Lyon (1762) heavily criticized
wanting human clinical training for the veterinary curriculum
• 19th Century: Strong interest in comparative medicine: “Between
animal and human medicine there is no dividing line – nor should
there be. The object is different, but the experience obtained
constitutes the basis of all medicine”. Rudolf Virchow (1821-1902)
coined the term “zoonosis”
• In the 20th century both medicines became increasingly specialised,
separating themselves into multiple sub-disciplines

19. The “One Medicine” by Calvin Schwabe‘s has its origins in his
work with pastoralists in Sudan in the 1960s
• «There is no difference of
paradigm between human and
veterinary medicine. Both
sciences share a common
body of knowledge in
anatomy, physiology,
pathology, on the origins of
diseases in all species»
Schwabe C. (1964, 1984 3rd Edition): Veterinary Medicine
and Human Health. Williams and Wilkins, Baltimore

20. “One medicine” as a General Medicine
Schwabe C. (1964, 1984 3rd Edition): Veterinary Medicine and Human Health. Williams and
Wilkins, Baltimore

21. “One Health”– Addresses Zoonotic Dieases
Robert Virchow (1821-
1902) : “…between animal
and human medicine there
is no dividing line” (Kahn et
al., 2007).
The American Veterinary
Medicine Association defines
One Health as “the
collaborative effort of
multiple disciplines-working
locally, nationally, and
globally – to attain optimal
health for people, animals
and our environment.”
Calvin Schwabe (1927-2006): veterinary
epidemiologist and parasitologist,
described and promoted One Medicine
and proposed a unified human and
veterinary approach to zoonoses in his
1964 book Veterinary Medicine and
Human Health.
19th century 20th century   

22. ...encourages the collaborative efforts of
multiple disciplines working locally,
nationally, and globally, to attain optimal
health for people, animals, and our
environment
…endorsed by FAO, OIE and WHO...
http://www.cdc.gov/onehealth
One Health approach

23. CDC STONE MOUTAIN meeting
Davos, 2.2012
PMAC Bangkok 1.2013

24. “One Health” can be defined as the added value in
terms of lives of animals and humans saved, financial
savings and improved ecosystem services from a
closer cooperation of human and animal health as
compared to single sector approaches.
Zinsstag et al. (2012) Onderstepoort J Vet Res. 2012 Jun 20;79(2):E1-5. doi:
10.4102/ojvr.v79i2.492.
From theoretical to operational definition

25. Benefits of One Health
• Improving animal and human health globally
 collaboration among all the health sciences
• Meeting new global challenges through
collaboration
 veterinary medicine, human medicine,
environmental and social sciences, wildlife and
public health
• Developing centres of excellence for education
and training
 veterinary medicine, human medicine, and public
health One Health Initiative Task Force: Final Report, July 15, 2008

26. 29. August 2013 Präsentationstitel 26
Weekly human exposure (blue) and rabid dogs (red) in N’Djaména
0
1
2
3
4
5
6
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58
weeks as of Jan. 1st 2000
Rabieddogs/Exposedhumans
I
Y
One Health and Rabies control in N‘Djaména

27. 29. August 2013 27
Statistical relationship of
human exposures – dog rabies
2 human exposures / rabid dog
-2
0
2
4
6
8
10
12
14
-1 0 1 1 2 2 3 3 4
Rabid Dogs
ExposedHumans

28. 29. August 2013 Präsentationstitel 28

29. 29. August 2013 Präsentationstitel 29
Comparative profitability of rabies control in N‘Djaména
Zinsstag et al. (2009) PNAS 106(35):14996-5001
Human vaccination alone
Dog and human vaccination

30. 29. August 2013 Präsentationstitel 30
Existing textbook knowledge of brucellosis transmission
B. mellitensis B. abortus
Sheep
Goat
Dog
Human Milk
Cattle
Others
Cattle
Cattle
Milk,
Cheese

31. 31
Mixed teams assessing human and animal health

32. 29. August 2013 Präsentationstitel 32

33. Synoptic view of benefits and costs of animal brucellosis mass vaccination in Mongolia
Distribution of Benefits
0
5000000
10000000
15000000
20000000
25000000
30000000
Intervention
cost
Public
health
benefits
Private
health
benefits
Household
income
loss
Total Health
Benefits
Agricultural
Benefits
Total
Societal
Benefits
Sector
US$

34. Agent Orange and dioxin
One Health: beyond zoonoses and apply NCDs?

35. 76.9 millions litres of herbicides (including 49.3 millions litres of AO with
366 kg dioxin) were sprayed during the Operation Ranch Hand (1961-
1971)(Stellman 2003). Currently there are 28 dioxin hot spots in
Vietnam, in which seven of them are very severe.

36. Agent Orange and dioxin: Current exposure pathways

37. One Health is useful here – integrated
management of food chain of environment -
animal /plant – human

38. REGIONAL INITIATIVES
One Health
38

39. • INDOHUN
• SEAOHUN
• VOHUN
•MYOHUN

40. SEAOHUN Core Universities
Hanoi School of Public Health
Chiang Mai University
Mahidol University
Universiti Kebangsaan Malaysia
Institut Pertanian Bogor
Universitas Indonesia
Universitas Gadjah Mada
Universiti Putra Malaysia
Hanoi Medical University
Hanoi University of Agriculture
4 countries/10 universities/14 faculties

41. South East Asia Universities One Health Network Inaugural Meeting in
Bngkok, Thailand 24-26 May 2011

42. Vision
A South East Asia One Health University Network fostering
sustainable trans-disciplinary capacity building to respond to
emerging and re-emerging infectious and zoonotic diseases
Mission
To leverage the training, education, and research capacities of the
university network to build the skills, knowledge and attitude base
for One Health leaders
SEAOHUN Vision and Mission

43. SEAOHUN Objectives
1.To promote and advance the One Health approach for control of
emerging and re-emerging infectious and zoonotic diseases
2.To improve the competencies of One Health professionals
3.To build a One Health evidence base through research activity
4. To build cadres of trained professionals to be One Health
current and future leaders

44. VIETNAM ONE HEALTH
UNIVERSITY NETWORK
(VOHUN)
Hanoi (Network Secretariat):
• Hanoi School of Public Health
• Hanoi Medical University
• Hanoi University of Agriculture
Thai Nguyen University:
• College of Medicine
• College of Agriculture
& Forestry
Thai Binh
University of
Medicine
Hai Phong
Medical
University
Bac Giang Agriculture
and Forestry University
Nam Dinh
University of
Nursing
Hue University:
• College of Medicine and Pharmacy
• College of Agriculture and Forestry
Dak Lak:
Tay Nguyen University, Faculty of
Medicine and Pharmacy
Can Tho
•University of Medicine &
Pharmacy
•University of agriculture
Hochiminh City:
• HCMC Medicine and Pharmacy University;
• HCMC University of Agriculture &-Forestry
15 UNIVERSITIES/FACULTIES
(NOVEMBER 2011)

46. Capacities, strengths and weaknesses
Main research gaps:
1. Disease trends, risk,
burden, prioritisation
2. Epidemiology of
zoonoses
3. Qualitative and economic
methods
4. Molecular epidemiology
Grace et al. 2010, Ecohealth

47. Disease prioritization
1 Avian Influenza
2 Rabies
3 Leptospirosis
….
Remark:
Classification was not well reflected by
disease burden caused by zoonosis
Impact of media attention, funding
availability, donor perspective…

48. INTEGRATED APPROACH AND WAY
FORWARD
48

49. Similar concepts
• Ecosystem approach to health (IDRC) – Ecohealth
– Considers human health is closely linked to animal and
environmental health in a socio-ecological interactions
• Veterinary Public Health (VPH)
– Veterinary public health is defined as the contribution of
veterinary science to public health
• Agro-ecosystem Health (OVC and others)
• Extension of health concept to whole ecosystem
– Evolution from « one medicine » to « one health »

50. Six principles of Ecohealth (Charron, 2012)
• Systems Thinking
• Transdisciplinary Research
• Participation
• Sustainability
• Gender and Social Equity
• Knowledge to Action
http://www.idrc.ca/EN/Resources/Publications/Pages/IDRCBookDetails.aspx?Publicatio
nID=1051

51. Integrative approaches
51
Human healthHuman
health
One Medicine
Societies, cultures,
Economies, institutions,
Policies
Agroecosystem health
Animal
Health
.livestock
.CA
.wildlife
V P H.
EcoHealth
ONE HEALTH
Incentives
Values
Preferences
Culture
Ignorance
Governance
Rule-breaking

52. One Health / Ecohealth =Transdisciplinarity =
Integrative
Integrated research (interdisciplinary and trans-
disciplinary research) uses system thinking to generate
new knowledge and competences by combining
principles, theory and methods of difference
One Health research and application comprise practices
of emerging disease prevention and control to mintage the
risk of complete ecosystem.

53. Transdisciplinary research (TD research)
 Integrates the social and natural sciences in a common
approach (interdisciplinarity), and simultaneously…
 includes non-academic knowledge systems
Nat. Sci.
Discipline 1
Tech. Sci.
Discipline 2
Econ. Sci.
Discipline 3
Soc. Sci.
Discipline n
One Health
Non-academic
actors
Definitions
Adapted from Herweg et al. (2011)

54. When do we need Transdisciplinarity?
Herweg et al. (2010)

55. Summary
• Disease situation at global level is complex
– then new approaches needed: One Health
• One Health: Integrative approach, great benefit
– but needs more validation by case studies at practical level
• Current initiatives for One Health
– Need of capacity building in SEA
• System thinking and integrated approach
– Trans-disciplinarity, inter-sectoral collaboration, working together

56. Acknowledgements
• Bruce Wilcox, Dirk Pfeiffer
• David Waltner-Toews, Guelph University
• Marcel Tanner, Esther Shelling
• Tran Thi Tuyet Hanh, Le Vu Anh
• Dr Stan Fenick, RESPOND
Thank you for your attention!
EmergingPandemicThreatsProgram
PREDICT•RESPOND•PREVENT•IDENTIFY

57. One Health – an interdisciplinary approach
in combating emerging diseases
Hung Nguyen-Viet1, Delia Grace2, Jakob Zinsstag3
1Hanoi School of Public Health
2International Livestock Research Institute
3Swiss Tropical and Public Health Institute
Kuala Lumpua, 20-21 August 2013