The Global Animal Health Initiative:The Global Animal Health Initiative:The Way ForwardThe Way Forward

““Veterinary and Public Health Collaboration”Veterinary and Public Health Collaboration”October 10, 2007October 10, 2007The World BankThe World BankWashington D.C.Washington D.C.

Lonnie King, DVM, MS, MPALonnie King, DVM, MS, MPADirectorDirector

National Center for Zoonotic,National Center for Zoonotic,Vector-Borne, and Enteric DiseasesVector-Borne, and Enteric Diseases

Centers for Disease Control and Prevention,Centers for Disease Control and Prevention, Atlanta, GAAtlanta, GA

Historical Epidemiologic Historical Epidemiologic Transitions – 1Transitions – 1stst Transition Transition

• 10,000 years ago10,000 years ago• New social order due to New social order due to

agricultureagriculture• Zoonoses through Zoonoses through

animal domesticationanimal domestication• Increases in infectious Increases in infectious

diseasesdiseases• Epidemics in non-Epidemics in non-

immune populationsimmune populations

Historical Epidemiologic Historical Epidemiologic Transitions – 2Transitions – 2ndnd Transition 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

Historical Epidemiologic Historical Epidemiologic Transitions – 3Transitions – 3rdrd Transition 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 EmergenceFactors in Emergence

• Microbial adaptation and changeMicrobial adaptation and change• Host susceptibility to infectionHost susceptibility to infection• Climate and weatherClimate and weather• Changing ecosystemsChanging ecosystems• Economic development and Economic development and

land useland use• Human demographics and Human demographics and

behaviorbehavior• Technology and industryTechnology and industry

Factors in EmergenceFactors in Emergencecontinuedcontinued

• International travel and commerceInternational travel and commerce• Breakdown of public health Breakdown of public health

measuresmeasures• Poverty and social inequalityPoverty and social inequality• War and famineWar and famine• Lack of political willLack of political will• Intent to harmIntent to harm

Physical and Environmental

Factors

Ecological Factors

Humans

Wildlife

Animals

E I D

Social, Political, and Economic

Factors

Genetic and Biological Factors

Convergence ModelConvergence Model

Convergence of Human and Animal Health: Convergence of Human and Animal Health: DriversDrivers

• Ecological risk and climate Ecological risk and climate changechange

• Population dynamicsPopulation dynamics• Growing governance gapGrowing governance gap• Global “foodscapes”Global “foodscapes”• Microbial swarmsMicrobial swarms• Technology and social actions and Technology and social actions and

involvementinvolvement

Emerging and Re-emerging Infectious Emerging and Re-emerging Infectious DiseasesDiseases

Examples of Emerging/Re-emerging Infectious Diseases

Multihost PathogensMultihost Pathogens

• 60% of all human 60% of all human pathogens are pathogens are zoonoticzoonotic

• 80% of animal 80% of animal pathogenspathogens

• Ecological generalistsEcological generalists

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

• 1993 – Hanta virus

• 1994 – Plague (India)

• Ebola virus (Zaire)

• 1996 – New Variant of CJD (UK)

• H5N1 influenza (Hong Kong)

• 1998 – Nipah virus (Malaysia)

• 1999 – West Nile

• 2000 – Rift Valley Fever

• 2001 – Anthrax

• 2002 – Norwalk-like viruses

• 2003 – SARS

• 2004 – Marburg Virus

• 2005 – H5N1 Influenza

• 2006 – E. coli

Trends in Global PopulationTrends in Global Population

Less developed countries

More developed countries

706560551950 75 80 85 90 95 2000 05 10 150

1

2

3

4

5

6

7

8Billions

TotalGlobal Population: 1950-2015

Source: US Bureau of the Census

Rapidly Increasing UrbanizationRapidly Increasing Urbanization

20002000- 47% world population 47% world population

living in urban areas living in urban areas

20302030- 60% world population 60% world population

living in urban areasliving in urban areas

Concentrated Animal Feeding Concentrated Animal Feeding Operations (CAFOs)Operations (CAFOs)

Their Impact on Food Safety andTheir Impact on Food Safety andHealthy EnvironmentsHealthy Environments

Livestock 2020 –Livestock 2020 –The Next Food RevolutionThe Next Food Revolution

• Global increase and demand for protein and food of animal Global increase and demand for protein and food of animal originorigin

• Shift from poverty of 1-2 billion people to middle classShift from poverty of 1-2 billion people to middle class• ““Westernization” of Asia and Latin AmericaWesternization” of Asia and Latin America• Concerns with sustainabilityConcerns with sustainability• Increases in emerging zoonoses through the Increases in emerging zoonoses through the

concentration of people and animalsconcentration of people and animals

Last year, over 21 billion food animals Last year, over 21 billion food animals were produced to help feed a population were produced to help feed a population

of over 6 billion people resulting in of over 6 billion people resulting in trillions of pounds of products trillions of pounds of products

distributed worldwide. Projections distributed worldwide. Projections toward 2020 indicate that the demand toward 2020 indicate that the demand for animal protein will increase by 50%, for animal protein will increase by 50%,

especially in developing countries.especially in developing countries.

Microbial ViewMicrobial View

Importance of Agricultural TradeImportance of Agricultural Trade

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

Source: FAO, WHO, Rimsa, Mexico City April 2005Source: FAO, WHO, Rimsa, Mexico City April 2005

Poultry population densityPoultry population density

Human population densityHuman population density

Figure 1.2. Human and livestock densities, and main feed production areas as affected by the distance to Bangkok

Hum

an a

nd a

nim

al d

ensi

ty

140

120

100

80

60

40

20

0

Mea

n no

rmal

ized

cro

p pr

oduc

tion60

50

40

30

20

10

0

Distance to Bangkok (km)50 100 150 200 250 300 350 400 450 500

Source: Gerber and others 2005.

human population (nb/km2/10)

chicken (nb/km2/10) cassava (tons/km2/2)

maize (tons/km2)soybean (10 tons/km2)

pigs (nb/km2/10)

Safe Food begins with healthy animalsSafe Food begins with healthy animals

EcosystemEcosystem

Waterborne ZoonosesWaterborne Zoonoses

Animals Humans

MicrobialPathogens

WaterborneDisease

Water Environment

World’s Most Dangerous AnimalsWorld’s Most Dangerous Animals

West Nile Virus in the Western HemisphereWest Nile Virus in the Western Hemisphere

Incidence per million.01-9.99

10-99.99

>=100

Any WNV activity

WNV Neuroinvasive Disease Incidence,WNV Neuroinvasive Disease Incidence,by County, US, 2000by County, US, 2000

N=19

WNV Neuroinvasive Disease Incidence,WNV Neuroinvasive Disease Incidence,by County, US, 2001by County, US, 2001

N=64

Incidence per million.01-9.99

10-99.99

>=100

Any WNV activity

WNV Neuroinvasive Disease Incidence,WNV Neuroinvasive Disease Incidence,by County, US, 2002by County, US, 2002

N=2946

Incidence per million.01-9.99

10-99.99

>=100

Any WNV activity

WNV Neuroinvasive Disease Incidence, WNV Neuroinvasive Disease Incidence, by County, US, 2003by County, US, 2003

N=2866

Incidence per million.01-9.99

10-99.99

>=100

Any WNV activity

WNV Neuroinvasive Disease Incidence, WNV Neuroinvasive Disease Incidence, by County, US, 2004by County, US, 2004

N=1142

Incidence per million.01-9.99

10-99.99

>=100

Any WNV activity

WNV Neuroinvasive Disease Incidence,WNV Neuroinvasive Disease Incidence,by County, US, 2005by County, US, 2005

N=1294

Incidence per million.01-9.99

10-99.99

>=100

Any WNV activity

WNV Neuroinvasive Disease Incidence,WNV Neuroinvasive Disease Incidence,by County, US, 2006*by County, US, 2006*

N=1339

* Reported as of November 7, 2006

Incidence per million.01-9.99

10-99.99

>=100

Any WNV activity

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

• A Virus from Africa (an alphavirus – Chikungunya)A Virus from Africa (an alphavirus – Chikungunya)• A mosquito from Asia (Aedes albopictus: tiger mosquito)A mosquito from Asia (Aedes albopictus: tiger mosquito)• A tourist from India (1.25 million human cases in 2006)A tourist from India (1.25 million human cases in 2006)

• A report of 270 people infected with Chikungunya in A report of 270 people infected with Chikungunya in Ravenna, ItalyRavenna, Italy

• Globalization is key to the future of infectious diseasesGlobalization is key to the future of infectious diseases• E.g. global tire trade; 2.1 billion airline passengers/yr; E.g. global tire trade; 2.1 billion airline passengers/yr;

climate change; and, a shift of competent vectors climate change; and, a shift of competent vectors worldwideworldwide

- Bloomberg Report 9/25/07- Bloomberg Report 9/25/07

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

Used Tires Stored at Other LocationsUsed Tires Stored at Other Locations

PNAS, 2004

There is no where in the world There is no where in the world from which we are remote and no from which we are remote and no

one from whom we are one from whom we are disconnecteddisconnected

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

NipahNipah Virus Virus

Virus CarriersVirus Carriers

Fruit batsFruit bats

SARSSARS

Horseshoe batHorseshoe bat

Lessons LearnedFrom 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 OIE-CDC Collaborating Center for Emerging and Re-Emerging ZoonosesEmerging and Re-Emerging Zoonoses

• First collaboration between CDC and an international First collaboration between CDC and an international animal health organizationanimal health organization

• Enhance pathogen discoveryEnhance pathogen discovery• Improve diagnosticsImprove diagnostics• Cooperation in better understanding the convergence of Cooperation in better understanding the convergence of

human and animal healthhuman and animal health• Linkage of health system professionals Linkage of health system professionals • Jointly contributing to establishing a global applied Jointly contributing to establishing a global applied

research portfolioresearch portfolio• Improve global preparation in identifying and responding Improve global preparation in identifying and responding

to microbial threatsto microbial threats• Enhance surveillanceEnhance surveillance

Annual Global Trade inAnnual Global Trade inExotic AnimalsExotic Animals

• 4 million birds4 million birds• 640,000 reptiles640,000 reptiles• 40,000 primates40,000 primates• Illegal trade unknown – estimate $4-6 billionIllegal trade unknown – estimate $4-6 billion

- Wildlife Conservation Society- Wildlife Conservation Society

““Double, double toil and trouble;Double, double toil and trouble; Fire burn, and caldron bubble.” Fire burn, and caldron bubble.”

William Shakespeare

Compelling VisionCompelling Vision

• Accelerating prevention, control, & elimination of Accelerating prevention, control, & elimination of ecology-mediated microbial threatsecology-mediated microbial threats

• Systems approach with cross-cutting themesSystems approach with cross-cutting themes• Global organizationGlobal organization

Animal Health Human Health

Ecosystem Health

The Convergence of Human and The Convergence of Human and Animal HealthAnimal Health

In practice, no aspect of disease control, especially in poor In practice, no aspect of disease control, especially in poor communities, can be tackled effectively without simultaneous communities, can be tackled effectively without simultaneous attention to people’s livelihoods and the frequent disincentives attention to people’s livelihoods and the frequent disincentives that they encounter as they are expected to participate in that they encounter as they are expected to participate in disease control efforts.disease control efforts.

- Ministries and departments across government- Ministries and departments across government - Professional groups: medical, veterinary, and- Professional groups: medical, veterinary, and environmentalenvironmental - NGO and private sector working with communities and- NGO and private sector working with communities and governments governments David Nabarro MDDavid Nabarro MD UN System InfluenzaCoordinatorUN System InfluenzaCoordinator

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

• Political leadership and willPolitical leadership and will• Effective alliances with civil society and the public sectorEffective alliances with civil society and the public sector• Capabilities and resources to scale-up effective systems Capabilities and resources to scale-up effective systems

for direction, coordination, and managementfor direction, coordination, and management• Support and integrated plans for long-term strategies to Support and integrated plans for long-term strategies to

reduce risks from animal and human diseasesreduce risks from animal and human diseases• Collaborations among all stakeholders: sharing Collaborations among all stakeholders: sharing

information, surveillance findings, samples for detection information, surveillance findings, samples for detection and identification and effective communicationand identification and effective communication

• Full community engagement especially among those Full community engagement especially among those affectedaffected

• Resisting specialization and separation and the Resisting specialization and separation and the incentives that drive this behaviorincentives that drive this behavior

- Dr. David Nabarro- Dr. David Nabarro

Neglected Zoonotic DiseasesNeglected Zoonotic Diseases

• Understanding “One Health: people, livestock and wildlifeUnderstanding “One Health: people, livestock and wildlife• Role of livestock as income: 70% of rural poorRole of livestock as income: 70% of rural poor• Communities at risk: 800 million poor livestock keepersCommunities at risk: 800 million poor livestock keepers• Dual burdenDual burden

Neglected Zoonotic DiseasesNeglected Zoonotic Diseases• Another example of health disparities: inverse Another example of health disparities: inverse

relationship the lower the income the higher the riskrelationship the lower the income the higher the risk• Need to raise the profileNeed to raise the profile• Significant under-reportingSignificant under-reporting• Human Health and Animal Health ContinuumHuman Health and Animal Health Continuum• Risk to human health is often best controlled by animal Risk to human health is often best controlled by animal

programsprograms

Endemic and Emerging ZoonosesEndemic and Emerging Zoonoses

• ““The need to fight zoonotic diseases especially in the The need to fight zoonotic diseases especially in the poorest populations of the world is incontestable – from a poorest populations of the world is incontestable – from a moral perspective, a human rights perspective and an moral perspective, a human rights perspective and an economic perspective, as well as a global goods economic perspective, as well as a global goods perspective.”perspective.”

The Control of Neglected Zoonotic Diseases; A Route to The Control of Neglected Zoonotic Diseases; A Route to Poverty Alleviation - 2006Poverty Alleviation - 2006

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

IOM, 1992IOM, 1992

Emerging Retrovirus ZoonosesEmerging Retrovirus Zoonoses

• 2 new retroviruses – 2 new retroviruses – Cameroon – AfricaCameroon – Africa

• Human T-lymphotropic virus Human T-lymphotropic virus (HTLV) types 3 and 4(HTLV) types 3 and 4

• Recovered from hunters of Recovered from hunters of nonhuman primatesnonhuman primates

• Role of bushmeat and Role of bushmeat and butchering primatesbutchering primates

• STLV and HIV withSTLV and HIV withsimilar originssimilar origins

Foresight AnalysisForesight Analysis

• EID are the “New normal”EID are the “New normal”• Expect 3-4 new EID annually; 8-34 by 2015Expect 3-4 new EID annually; 8-34 by 2015• 87 new EID since 1980 – 58 viruses - 49 RNA87 new EID since 1980 – 58 viruses - 49 RNA

- mostly zoonotic- mostly zoonotic• Found worldwide but proximity to animal Found worldwide but proximity to animal

populations or products is the key risk factorpopulations or products is the key risk factor• Change in the host-pathogen ecology will be the Change in the host-pathogen ecology will be the

most important single drivermost important single driver

FACTORFACTOR 20072007 20172017 20272027Human demographics and behaviorHuman demographics and behavior

Technology and industryTechnology and industry

Economic development and land useEconomic development and land use

International travel and commerceInternational travel and commerce

Microbial adaptation and changeMicrobial adaptation and change

Breakdown of public health measuresBreakdown of public health measures

Climate change and weatherClimate change and weather

Changing ecosystemsChanging ecosystems

Poverty and social inequalityPoverty and social inequality

War and famineWar and famine

Lack of political willLack of political will

Intent to harmIntent to harm

Current and Projected Importance of Factors Influencing Emergence

FACTORFACTOR

HumanHumanvulnerabilityvulnerability

EnvironmentaEnvironmentall

and zoonoticand zoonoticexposureexposure

Person-to-Person-to-personperson

transmissiontransmissionMicrobialMicrobialevolutionevolution

Human demographics and behaviorHuman demographics and behavior

Economic development and land useEconomic development and land use

International travel and commerceInternational travel and commerce

Climate change and weatherClimate change and weather

Poverty and social inequalityPoverty and social inequality

Mechanisms By Which Important Factors Will Impact Emergence

Mechanism Influencing Emergence

RiskRisk

Number of catastrophes between 1970 & 2003Source: Swiss Re, Sigma No. 1, 2004

Interdependence: The Shrinking World

• 1 billion people will soon cross international borders each 1 billion people will soon cross international borders each year or 25/secondyear or 25/second

• Tightly coupled system: unprecedented vulnerabilityTightly coupled system: unprecedented vulnerability

• Threats spread faster, further, and non-linearThreats spread faster, further, and non-linear

• Increased threats of global pandemicsIncreased threats of global pandemics

• Strategic risk analysis: significant risk of developing Strategic risk analysis: significant risk of developing countries with under funded public and animal health countries with under funded public and animal health systemssystems

• ““If the forest is dry enough and dense enough…”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 Worldwide, 25 people/second cross people/second cross national bordersnational borders

• Increasingly densely Increasingly densely connected networkconnected network

• Lessons from Lessons from monoculturesmonocultures

Convergence ChallengesConvergence Challenges

• Impact and influence beyond health – goods, services Impact and influence beyond health – goods, services and economiesand economies

• A shift from problem solving to managing dilemmasA shift from problem solving to managing dilemmas• A new global interdependence and connectivity A new global interdependence and connectivity • Factors creating the microbial storm are well entrenchedFactors creating the microbial storm are well entrenched• A great future for complexity: simple but not simplisticA great future for complexity: simple but not simplistic• Reconciliation of great change with habitual and Reconciliation of great change with habitual and

traditional thinking and ways of workingtraditional thinking and ways of working• Adopting a “One Health – One Medicine” mindset and Adopting a “One Health – One Medicine” mindset and

strategystrategy

Convergence Challenges Convergence Challenges (cont.)(cont.)

• The role of governments, educational institutions, and The role of governments, educational institutions, and societysociety

• Animal and human health are a continuum of causality Animal and human health are a continuum of causality and events and need to be viewed as a continuum and and events and need to be viewed as a continuum and integration of strategiesintegration of strategies

• Recognizing the moral and ethical imperative: health Recognizing the moral and ethical imperative: health disparitiesdisparities

• Inclusion of diverse communities, thinking, and toolsInclusion of diverse communities, thinking, and tools• The need for new leaders and new ways of leadingThe need for new leaders and new ways of leading• Unprecedented events call for unprecedented responses: Unprecedented events call for unprecedented responses:

A call to action – Who? How? When? Where? Why?A call to action – Who? How? When? Where? Why?

Consensus of RecommendationsConsensus of Recommendations

• Improve infrastructuresImprove infrastructures• Integrate surveillance strategies and diagnosticsIntegrate surveillance strategies and diagnostics• Increase R&D investmentsIncrease R&D investments• Focus on prevention not just reaction and Focus on prevention not just reaction and

response – e.g. avian influenzaresponse – e.g. avian influenza• Build a new infectious disease workforce Build a new infectious disease workforce • Consider a global perspective Consider a global perspective

Consensus of RecommendationsConsensus of Recommendations

• Improve disease reporting with appropriate Improve disease reporting with appropriate incentives incentives

• Design global strategies and interventions Design global strategies and interventions • Create Zoonotic and EID centers Create Zoonotic and EID centers • Meet the critical need for leadership and new Meet the critical need for leadership and new

skillsskills• Address public understanding and appreciation Address public understanding and appreciation