Research options for controlling Zoonotic disease in India, 2010-2015

BACKGROUND: Zoonotic infections pose a significant public health challenge for low- and middle-income countries and have traditionally been a neglected area of research. The Roadmap to Combat Zoonoses in India (RCZI) initiative conducted an exercise to systematically identify and prioritize research options needed to control zoonoses in India. METHODS AND FINDINGS: Priority setting methods developed by the Child Health and Nutrition Research Initiative were adapted for the diversity of sectors, disciplines, diseases and populations relevant for zoonoses in India. A multidisciplinary group of experts identified priority zoonotic diseases and knowledge gaps and proposed research options to address key knowledge gaps within the next five years. Each option was scored using predefined criteria by another group of experts. The scores were weighted using relative ranks among the criteria based upon the feedback of a larger reference group. We categorized each research option by type of research, disease targeted, factorials, and level of collaboration required. We analysed the research options by tabulating them along these categories. Seventeen experts generated four universal research themes and 103 specific research options, the majority of which required a high to medium level of collaboration across sectors. Research options designated as pertaining to 'social, political and economic' factorials predominated and scored higher than options focussing on ecological, genetic and biological, or environmental factors. Research options related to 'health policy and systems' scored highest while those related to 'research for development of new interventions' scored the lowest. CONCLUSIONS: We methodically identified research themes and specific research options incorporating perspectives of a diverse group of stakeholders. These outputs reflect the diverse nature of challenges posed by zoonoses and should be acceptable across diseases, disciplines, and sectors. The identified research options capture the need for 'actionable research' for advancing the prevention and control of zoonoses in India

Working together for prevention and control of zoonoses in India

Despite calls for collaborations across animal and human health sectors to control zoonoses, a ‘black-box’ approach to collaborations means there is limited understanding of their drivers, characteristics and dynamics. In this thesis, I develop insights into multisector ‘One Health’ collaborations by examining the case of three zoonotic diseases in two states in India. Over nine months of fieldwork, I interviewed policy actors spread across different sectors, functions and administrative levels, and observed the practices of professionals in the field and in their offices. I used the examples of anthrax, brucellosis and leptospirosis to examine One Health collaborations in the states of Tamil Nadu and Gujarat in India.The identification, measurement and response to zoonoses are complex undertakings requiring specialist expertise. Consequently, discourses and practices around zoonotic diseases are dominated by technical experts. The process of synthesizing and reinterpreting scientific knowledge, in turn, is influenced by politics and power dynamics underlying the experts’ disciplines, sectors and institutions.Across all three zoonoses, I found that it is narratives about diseases, rather than actual disease burdens orrisks, which drive public perception and policy response. The way collaborations ultimately emerge is conditioned by the disease characteristics and is influenced by an interplay of the disease discourses, the political cultures of the state and the practices employed by decision-makers at all levels. In all cases, collaborations do occur, sometimes facilitated by formal guidelines, but very often through everyday practices, in spite of bureaucratic strictures. All cases of collaboration are underpinned by informal networks. Such initiatives, frequently led by middle-level bureaucrats, while responsive to local concerns, are much messier than the processes envisioned in the dominant programmatic literature on ‘One Health’. In order for One Health partnerships to be sustainable, I argue that it is important to develop a nuanced approach to understanding the politics and dynamics underlying multisector collaborations

Cost-effectiveness of traffic enforcement: case study from Uganda

BACKGROUND: In October 2004, the Ugandan Police department deployed enhanced traffic safety patrols on the four major roads to the capital Kampala. OBJECTIVE: To assess the costs and potential effectiveness of increasing traffic enforcement in Uganda. METHODS: Record review and key informant interviews were conducted at 10 police stations along the highways that were patrolled. Monthly data on traffic citations and casualties were reviewed for January 2001 to December 2005; time series (ARIMA) regression was used to assess for a statistically significant change in traffic deaths. Costs were computed from the perspective of the police department in $US 2005. Cost offsets from savings to the health sector were not included. RESULTS: The annual cost of deploying the four squads of traffic patrols (20 officers, four vehicles, equipment, administration) is estimated at$72,000. Since deployment, the number of citations has increased substantially with a value of $327 311 annually. Monthly crash data pre- and post-intervention show a statistically significant 17$603 per death averted or $27 per life year saved discounted at 3$300 GDP per capita). CONCLUSION: The costs of traffic safety enforcement are low in comparison to the potential number of lives saved and revenue generated. Increasing enforcement of existing traffic safety norms can prove to be an extremely cost-effective public health intervention in low-income countries, even from a government perspective

Costs analysis of a population level rabies control programme in Tamil Nadu, India

The study aimed to determine costs to the state government of implementing different interventions for controlling rabies among the entire human and animal populations of Tamil Nadu. This built upon an earlier assessment of Tamil Nadu’s efforts to control rabies. Anti-rabies vaccines were made available at all health facilities. Costs were estimated for five different combinations of animal and human interventions using an activity-based costing approach from the provider perspective. Disease and population data were sourced from the state surveillance data, human census and livestock census. Program costs were extrapolated from official documents. All capital costs were depreciated to estimate annualized costs. All costs were inflated to 2012 Rupees. Sensitivity analysis was conducted across all major cost centres to assess their relative impact on program costs. It was found that the annual costs of providing Anti-rabies vaccine alone and in combination with Immunoglobulins was \$0.7 million (Rs 36 million) and \$2.2 million (Rs 119 million), respectively. For animal sector interventions, the annualised costs of rolling out surgical sterilisation-immunization, injectable immunization and oral immunizations were estimated to be \$ 44 million (Rs 2,350 million), \$23 million (Rs 1,230 million) and \$ 11 million (Rs 590 million), respectively. Dog bite incidence, health systems coverage and cost of rabies biologicals were found to be important drivers of costs for human interventions. For the animal sector interventions, the size of dog catching team, dog population and vaccine costs were found to be driving the costs. Rabies control in Tamil Nadu seems a costly proposition the way it is currently structured. Policy makers in Tamil Nadu and other similar settings should consider the long-term financial sustainability before embarking upon a state or nation-wide rabies control programme

Meanings and Mechanisms of One Health Partnerships: Insights from a Critical Review of Literature on Cross-government Collaborations

Key messages Multisector collaborations are complex political enterprises, which incorporate within themselves, different visions around, objectives, mandates, function and success. Collaborations can take various forms which allow practitioners to choose the form of collaboration that is most relevant to their requirements. Most collaborations consist of partners who pursue different individual and institutional agenda and who exercise different amounts of influence. Collaborations should learn how to manage rather than minimize these differences. While there are no fixed parameters for success, given the dynamic contexts within which multisector collaborations function, they can result in unintended outcomes. Collaborations that are responsive to changing internal and external dynamics are more likely to thrive.Complex health policy challenges such as antimicrobial resistance and other emerging infections are driven by activities in multiple sectors. Therefore, addressing these also requires joint efforts from multiple sectors as exemplified in the One Health approach. We undertake a critical review to examine the different ways in which multisector partnerships have been conceptualized across multiple disciplines and thematic areas. We started with a set of six articles from the disciplines of health, nutrition and public administration that reviewed conceptual frameworks within their respective fields. We conducted backward citation tracing using the bibliography of the six articles to identify other articles in the same and related fields that conceptualized multisector partnerships. We identified 58 articles published from 1967 to 2018 from the fields of global health, infectious diseases, management, nutrition and sustainability sciences indicating that multisector partnerships have been a topic of study across different fields for several decades. A thematic analysis of the 58 articles revealed that multisector partnerships assume a variety of forms and have been described in different ways. Partnerships can be categorized by scope, scale, formality and strength. Multisector partnerships emerge in conditions of dynamic uncertainty and sector failure when the information and resources required are beyond the capacities of any individual sector. Such partnerships are inherently political in nature and subsume multiple competing agendas of collaborating actors. Sustaining collaborations over a long period of time will require collaborative approaches like One Health to accommodate competing political perspectives and include flexibility to allow multisector partnerships to respond to changing external dynamics

Social science in epidemics: Rift Valley fever lessons learned

Summary considerations - The current media landscape has the potential to facilitate the rapid development and spread of mis- and disinformation. Social media can also be used to quickly and effectively counter mis- and disinformation. Such positive opportunities must be identified and maximised. - Mis- and disinformation can proliferate when there is a lack, or conversely, an overabundance of information. Their spread can lead to non-compliance with public health measures, perpetuate political conflict and discrimination, and cause negative psychological and social effects. - Social media are global in scope, yet the behaviour of social media users is locally specific. Rapid assessments are needed to fully understand people's favoured channels, most trusted sources, level of literacy and media literacy, and preferred languages and formats for receiving and sharing messages. Such details are essential in order to best communicate with multiple population groups in an emergency. - Public bodies should ensure that the information they share through social media is factual and originates from official sources (such as the WHO, CDC, Ministries of Health etc). They should push information and consistent messaging through multiple channels. A lack of up-to-date information can create a vacuum that is filled by speculation. Reporting inaccurate information should be the responsibility of all � from news agencies to individual users. - People are more inclined to believe and share information when the message is clear and simple, when they trust the source of the message and the channel through which it was conveyed, when the message aligns to their pre-held beliefs, and when the message resonates with them emotionally (e.g., drawing on humour, fear or disgust); text heavy messages do not hold people's attention in the same way as emotional content. People have a greater level of assurance and trust in consistent information which they see featured on multiple sources, whatever those sources may be. The same is also true of mis- and disinformation - If mis- and disinformation are not addressed as they arise, they can proliferate. Identifying and directly addressing false information and rapidly debunking �rumours' can be very effective and create space for reliable and relevant information to circulate. Rumours often reflect underlying anxieties or pre-held social or political positions and beliefs; it is important to address their underlying causes. Communications that are solution-focused, promote a sense of self-efficacy, hope and agency, whilst building on existing resources and strengths can help mitigate fear and foster compliance with public health recommendations. - In rapidly evolving situations such as health emergencies, it is acceptable for official sources to acknowledge that there are unknowns and to reassure the public that they will convey new information when it emerges. This transparent approach challenges people who circulate information that is not supported by evidence. - Trust is also generated by when two-way dialogue is enabled. Accessible channels must allow people to ask questions, the answers to which are reflected in the information being shared. In this way, people are provided with pertinent information and see their realities and concerns acknowledged in broader communication. - Trusted experts and �social influencers' should be used to help communicate information in an engaging way and are often more trusted than official sources. Official bodies should collaborate with social influencers to amplify key messaging. - Rather than censoring information which risks it moving to more private platforms such as WhatsApp, it may be more effective to flag information as inaccurate and flood the same channels with factual information. - Further research is needed to better understand the sources and motivations behind health misinformation and to analyse the effectiveness of measures aimed at stemming its flow and mitigating its harmful effects

Meanings and mechanisms of One Health partnerships: insights from a critical review of literature on cross-government collaborations

Complex health policy challenges such as antimicrobial resistance and other emerging infections are driven by activities in multiple sectors. Therefore, addressing these also requires joint efforts from multiple sectors as exemplified in the One Health approach. We undertake a critical review to examine the different ways in which multisector partnerships have been conceptualized across multiple disciplines and thematic areas. We started with a set of six articles from the disciplines of health, nutrition and public administration that reviewed conceptual frameworks within their respective fields. We conducted backward citation tracing using the bibliography of the six articles to identify other articles in the same and related fields that conceptualized multisector partnerships. We identified 58 articles published from 1967 to 2018 from the fields of global health, infectious diseases, management, nutrition and sustainability sciences indicating that multisector partnerships have been a topic of study across different fields for several decades. A thematic analysis of the 58 articles revealed that multisector partnerships assume a variety of forms and have been described in different ways. Partnerships can be categorized by scope, scale, formality and strength. Multisector partnerships emerge in conditions of dynamic uncertainty and sector failure when the information and resources required are beyond the capacities of any individual sector. Such partnerships are inherently political in nature and subsume multiple competing agendas of collaborating actors. Sustaining collaborations over a long period of time will require collaborative approaches like One Health to accommodate competing political perspectives and include flexibility to allow multisector partnerships to respond to changing external dynamics

Rabies control in India: a need to close the gap between research and policy

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Moving from rabies research to rabies control: lessons from India

BACKGROUND: Despite the availability of effective interventions and public recognition of the severity of the problem, rabies continues to suffer neglect by programme planners in India and other low and middle income countries. We investigate whether this state of 'policy impasse' is due to, at least in part, the research community not catering to the information needs of the policy makers. METHODS & FINDINGS: Our objective was to review the research output on rabies from India and examine its alignment with national policy priorities. A systematic literature review of all rabies research articles published from India between 2001 and 2011 was conducted. The distribution of conducted research was compared to the findings of an earlier research prioritization exercise. It was found that a total of 93 research articles were published from India since 2001, out of which 61% consisted of laboratory based studies focussing on rabies virus. Animals were the least studied group, comprising only 8% of the research output. One third of the articles were published in three journals focussing on vaccines and infectious disease epidemiology and the top 4 institutions (2 each from the animal and human health sectors) collectively produced 49% of the national research output. Biomedical research related to development of new interventions dominated the total output as opposed to the identified priority domains of socio-politic-economic research, basic epidemiological research and research to improve existing interventions. CONCLUSION: The paper highlights the gaps between rabies research and policy needs, and makes the case for developing a strategic research agenda that focusses on rabies control as an expected outcome

Antioxidant activities of aqueous extracts from nine different rose cultivars

Rose petals have been applied as food additives in teas, cakes and flavor extracts. The aim of this research study was to explore and reveal the antioxidant potential of aqueous extracts of rose petals belonging to nine genotypes of rose (wild as well as hybrid). The in vitro antioxidant activities of roses were studied by lipid peroxidation assay, DPPH radical scavenging assay, iron chelation assay, phosphomolybdenum reduction assay and total phenolic and flavonoid contents. The aqueous extract showed inhibition against lipid peroxidation (TBARS), induced by prooxidants (10 µM FeSO4) in mice liver homogenate. The free radical scavenging activities of the extracts were determined by scavenging of the DPPH radical. Extracts also showed metal chelating activities and high antioxidant activity in the phosphomolybdenum assay. The high content of phenolics and flavonoids detected in aqueous extracts may be responsible for the antioxidant activity. Amongst the different rose genotypes, screened, Rosa moschata (musk rose) was found to carry slightly higher antioxidant potential, owing to its higher phytochemical content