Bett, Bernard K.

Hung Nguyen-Viet

Muloi, Dishon M.

Murphy, M.

Sinh Dang-Xuan

Unger, Fred

CGSpace

Protecting human health through a One Health approachHung Nguyen, Bernard Bett, Fred Unger, Mike Murphy, Dishon Muloi and Sinh DangCGIAR One Health Initiative and ICT4Health Kick-off workshop Hanoi, 3 August 2022One CGIAR OverviewMission:  To deliver science and innovation that advance transformation of food, land and water systems in a climate crisis.  Three CGIAR Action Areas       Five Impact AreasSystems Transformation Genetic InnovationResilientAgri-foodSystemsNutrition, Health & Food SecurityPoverty Reduction, Livelihoods & JobsGender Equality, Youth & Social InclusionClimate Adaptation & MitigationEnvironmental Health & BiodiversityPARTNERS9 CGIAR Initiatives being implemented in VIETNAMRESILENT AGRI-FOOD SYSTEMS:• Securing the Food Systems of Asian Mega-Deltas for Climate and Livelihood Resilience•Nature-Positive Solutions for Shifting Agrifood Systems to More Resilient and Sustainable Pathways• Sustainable Animal Productivity for Livelihoods, Nutrition and Gender Inclusion• Protecting Human Health Through a One Health Approach• Excellence in Agronomy for Sustainable Intensification and Climate Change Adaptation• Plant Health and Rapid Response to Protect Food Security and LivelihoodsSYSTEMS TRANSFORMATION:•Mitigate+: Research for Low-Emission Food Systems• Sustainable Healthy Diets Through Food Systems TransformationGENETIC INNOVATIONS:• SeEdQUAL: Delivering Genetic Gains in Farmers' Fieldswww.cgiar.orgWhy do we need an initiative for One Health? The challengesAntimicrobial Resistance (AMR) is a growing problemFood safety: large burden comparable to tuberculosis, malaria, and HIV/AIDS, but small investmentwww.cgiar.orgOne Health: new OHHLEP definition, 2021One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems.It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate changes and contributing to sustainable development.New One Health Tripartite (WHO, FAO, OIE) plus UNEP definition released November 2021 by the One Health High Level Expert Panelwww.cgiar.orgCGIAR/ILRI One Health Strategy A holistic approach to preventing pandemics/epidemics and other microbial threats from animals/environment Vision • To improve the lives, livelihoods and well being of people in the global south by building healthy, sustainable and resilient systems at the intersection of humans, animals and the environment.Key thematic areas• Epidemics and pandemics caused by (re)-emerging viruses• Endemic zoonoses• Food safety• Antimicrobial Resistancewww.cgiar.orgOne CGIAR initiatives on One HealthObjective is to protect human health by improving detection, prevention, and control of zoonoses, foodborne diseases and AMR in LMICsHow will we achieve this? • Generate evidence on risks and public and private returns to action• Evaluate impacts of technologies, tools, and approaches on health risks and economic outcomes• Integrating innovations into policies and programswww.cgiar.orgInitiative Components & StructureWP4: Environment (Water)improve water management to reduce infectious disease risksWP5: Economics, governance, and behaviorunderstand incentives for and constraints to behaviors affecting One HealthWP1: Zoonosesreduce disease emergence and transmission at wildlife-livestock-human interfacesWP2: Food Safetyreduce foodborne disease through capacity building of market actors and incentives for complianceWP3: AMRreduce emergence and spread of antimicrobial-resistant zoonotic pathogenswww.cgiar.orgSelected Innovationswww.cgiar.orgWhere we will work & Prioritization processResearch contexts:• Intensifying food systems• Informal food systems• Wildlife-livestock-human interfacesThemes/Research questions/Innovations selected based on potential for long-term impact on human infectious disease burdenwww.cgiar.orgWork Packages & Partners by CountryCountry Key Work Package Partners in countriesVietnam WP1, WP2, WP5*WP3, WP4Ministry of Agriculture and Rural Development, National Institute of Veterinary Research, Hanoi University of Public HealthBangladesh WP3 Food Safety Authority, Ministry of Livestock and Fisheries, Bangladesh Livestock Research InstituteIndia WP4WP2ICAR, Food Safety and Standards Authority of India; Office of the Commissioner of Food Safety – Odisha and AssamKenya WP1, WP3, WP5WP2National and country departments of veterinary services and public healthEthiopia WP2, WP4, WP5 One Health National Platform, Ministry of Agriculture (Livestock), Universities of Addis AbabaCote d’Ivoire WP1WP2One Health National Platform, Centre Suisse de Recherche en Cote d’IvoireUganda Leverage from other One Health projects in UgandaMinistry of Agriculture, Animal Industry and Fisheries, Inter-University Council for East Africa (IUCEA)*WP in bold: focus WP in the country, other: light activities in the country www.cgiar.orgImpact ForecastWomen benefiting from better zoonoses controlFemale food vendorsserved by innovationsPeople with 10-50% ofannual income benefitWomen preventedfrom entering povertyPeople preventedfrom entering povertyDALYS savedMedium to high certainty impacts by 2030www.cgiar.orgOne Health initiative in VietnamWork package 01: Zoonoseswww.cgiar.orgWP 1 – Zoonoses• Zoonoses – major threat to global health security, economy, and food security • COVID 19 pandemic demonstrates that prevention is better than cure – limit zoonoses spillovers• Enhance One Health partnerships in Kenya, Cote d’Ivoire and Vietnam • AIM: develop interventions for zoonoses at wildlife/livestock/human interfaces Photo credit: Frankfurt Zoological Societywww.cgiar.orgWP 1 – ZoonosesTitle:Developing One Health interventions for zoonotic disease risks in wildlife farms and their value chains in VietnamObjective:To minimize the health risks associated with wildlife farming through applied research and capacity building targeting wildlife farms and their value chains. www.cgiar.orgWP 1 – ZoonosesProject period: 2022-2024Study site: Lao Cai and Dong Nai provinces• Commune/Vinh Cuu and/or Tan Phu district• Commune/District in Lao CaiPotential partners:• National Institute of Veterinary Research• National Institute of Animal Science• Department of Animal Health• Nong Lam univ. and sub-DAHs, Sub-Department ofForestry protection• TRAFFIC and FAO...Specific objectives1. To improve knowledge, attitude and practices on zoonotic risks associated with wildlife farming/trade2. To improve surveillance and response to disease outbreaks in wildlife VC using a risk assessment framework and strengthened One Health partnerships3. Risk assessments data will be used to implement potential interventionswww.cgiar.orgWP 1 – ZoonosesMethodology• Systematic literature review – zoonoses in wildlife• To identify key wildlife farm value chain and related pathogens• To develop a risk assessment framework✓ Mapping and characterization of wildlife value chain✓ Quantifying potential risks of interspecies transmission• Survey and sampling (wildlife value chains and humans)• Capacity building (PhD, MSc, and undergraduate students)• Community-based interventions (2023 onward)=> Coordination with other initiatives to ensure synergies and joint impactWildlife animals(nature)Wildlife animals(farm)Farmer/VeterinarianSlaughtermen/ButchersFarmingHuntingHunter/Trader/VendorWildlife ConsumerMeatPetsCollector/VendorTrading SellingSlaughteringConsumptionSellingWildlife UserMeatMedicneMarkets/RestaurantsTradingSellingSellingSellingTradingMeatRestaurants/MarketsHome consumptionDomestic animalsContactingContactingLivestock farmer/VeterinarianCollector/SlaughterhouseTrading SellingMarkets/VendorFarmingMeatConsumersConsumptionConsumptionPets ContactingContactingContactingMeatData collection for mapping/assessmentLao Cai Dong NaiFGDs 10 groups 10 groupsQuestionnaire/Semi-structured interview 50-100 50-100Wildlife samples 500 500Human samples 50 50www.cgiar.orgWP1 – ZoonosesApr May Jun Jul Aug Sep Oct Nov DecFinalize concept note XDevelop and finalize study tools/protocols X XScoping study and project launch workshop X XDevelop a tool for risk assessment along the wildlife VC X X X XEthical application and approval X XConduct surveillance & monitoring:- A systematic literature review on zoonoses in wildlife VC X X- Field activities (epidemiological investigation) X X X X- Lab analysis (serological and/or DNA tests) X X X XExpert consultation workshops on risk assessment framework X XTechnical reports and publication  X XTimeline of activities and expected outputs for 2022www.cgiar.orgOne Health initiative in VietnamWork package 02: Food safetywww.cgiar.orgWP2 - Food safety componentBackground:Foodborne disease (FBD) is a major public health problem and presents a barrier to smallholder farmers who wish to sell in high value domestic and export marketsTitle: Food safety interventions in traditional pig slaughterhouses and pork shops in VietnamObjective:Reduce the burden of FBD focusing on high-risk livestock derived foods (pork), including traditional food systems, through enabling, capacitating and motivating food value chain actors (farm to fork)Research questions: 1. What technologies, training and information do VC actors need to improve food safety?2. What are the incentives and nudges that will motivate behavior change?3. How can the public sector provide an enabling regulatory environment and infrastructure?www.cgiar.orgWP2 – Food safety component Project period: 2022-2024Study site:• North: Thai Nguyen, Hanoi• Center: Thua Thien Hue• South: Dong Nai and Can ThoPotential partners:• National partners such as: OHP, DAH/Sub-DAH, NIVR, NIAS,…• Universities such as: HUPH, VNUA, Hue NLU, HCMC NLU, TUAF,…• Other international organizations: WB, WHO, FAO, CIRAD or NGOs or group: Rikolto, FSWG..• Other CGIAR initiatives (SHiFT, SAPLING, Plant Health…), and projects: SafeGRO, ASSETwww.cgiar.orgWP2 - Food safety component - Study design and activities Study design (similar across 5 provinces): 1. Intervention & training (Enabling and Capacitating)• Traditional slaughterhouse (Baseline and Endline evaluation)• Traditional retail/pork shops (RCT)2. Behavior/practice change monitoring & social marketing campaigns for retail and consumers (Motivating) Selection criteria for markets• Number traditional markets/province and number of pork retailers/market• Meeting certain criteria: accessibility, local support…Will be done through rapid assessment of existing marketsSlaughterhouse (traditional)• Number and location of slaughterhouse/province, pigs slaughtered/day• Certain criteria: Involved in other intervention, local support…www.cgiar.orgWP 2 Study - design and activities cont.Intervention at traditional pig slaughterhouses- Intervention package: Provide equipment (grid), slaughterhouse re-arrangement + Training- 6 slaughterhouse/province (e.g. 10 - 50 pigs slaughtered/day)- Linkages to and support from Sub-DAH are crucial for direction/policy influenceBase line/endline (30 slaughterhouses)- Observational checklist- Food safety indicator: Salmonella and/or coliformsPicture source ILRI 2020 SafePORK & SFFFwww.cgiar.orgWP 2 Study - design and activities cont.Intervention in markets and social marketing campaign 1. Traditional retail interventionAim: Test intervention package ✓ Randomized control trial in > 300 traditional retailers➢ About 12 markets (at least 6 control and 6 intervention markets) per province➢ Each market 5-10 retailers (plus 10 – 20 spill over retailers)2. Social marketing campaign (retailers and consumers) Aim: Assess behavior/practice change monitoring & potential spillover ✓ Four repeated rounds (quarterly) ➢ To monitor assess change and spillover (retailers)*➢ Social marketing campaign (in consumers buying pork) *in treatment and control group to access potential spillover from treatment to control www.cgiar.orgWP 2 Building up on evidence from Safe PORK (Vietnam) and SFFF (Cambodia)Inox grid, separate clean/dirty zones, cleaning & disinfection, and training, certification (as incentive)Food Safety Interventions at slaughter (300-1000 USD)Hygienic cutting board, separate meat/intestines/cooked products, cleaning & disinfection, scoring system for best retailers Food Safety Interventions at retail (40 USD)www.cgiar.orgWP 2-Food safetyEconomic Analysis: Theory of ChangeThe social marketing component underlying the economic analysis tests a simple theory of change:✓ Providing information to consumers via marketing materials & visible vendor ratings, to increase consumer understanding✓ As the salience of food safety as a product attribute increases, consumers are more likely to seek out vendors following good practices (for treated vendors this information is now public)✓ Increased consumer demand for safe pork should improve sales for food safe vendors, incentivizing other vendors to adopt safe practiceswww.cgiar.orgWP 2-Food safetyKey Expected OutcomesConsumer outcomes• Importance assigned to 'food safety' or 'cleanliness' in vendor selection (measured through consumer surveys)• Share purchasing pork from accredited vendors (tracked using coloured packaging material provided to participating vendors)Vendor outcomes• Observation of vendor practices (both to assess food safety risk & as an intermediate outcome in economic analysis)• Sales volume among study vendors in a given market (market share of safe food)• Comparison of profits across control/treated/spillover vendors (using observed sales and vendors survey reports of costs)www.cgiar.orgWP 2 Food safety-Timeline.Activities Mar Apr May Jun Jul Aug Sep Oct Nov DecConcept note draft and discussion Concept note finalization and survey tools draftsScoping study ethics submittedScoping study ethics in placePartnership engagements & staff/PhD recruitmentScoping fieldwork startsData from scoping work analyzed and study design finalizedEthics submission Survey protocols/tools & training partnersEthical approval, survey firm & materials for BL survey in placeBaseline survey startsImplement intervention at slaughterhouse and pork shopsTimeline of activities and expected outputs for 2022www.cgiar.orgOne Health initiative in VietnamWork package 03: AMR www.cgiar.orgWP3 - AMR component VietnamBackground:• AMR is now threatening healthcare systems globally • Humans and animals are all connected- similar antibiotics, shared environments and common AMR bacteria• Drivers of antibiotic use are exacerbating AMR  Dilemma of antimicrobials:o Essential to animals, humans and plantso Any use promotes selection of AMRmicroorganisms contributing to reducing theirtherapeutic efficacy over timeo Excess vs accessAMR cannot be eradicated but only managedAMU consumption for chicken and pig medicated feeds• 77.4 mg and 286.6 mg of in-feed antimicrobials were used to raise 1 kg of live chicken and pig, respectively.• 42.2 and 981.3 tons for Vietnamese chicken and pig production, respectively.Nguyen Van Cuong et al. 2016. EcoHealthwww.cgiar.orgWP3 - AMR component VietnamTitle: On farm interventions to reduce antibiotic use in poultry and pig systemsObjectives• To develop and test approaches to reduce AMU and AMR which have to potential for scaling• To conduct a cost effectiveness analsyis of tested interventions• To assess pathways for sustainable behavior and practice change www.cgiar.orgActivity 1: Probiotic trial at chicken (broiler) farmsObjective:To evaluate the effectiveness of probiotic added into chicken feed in terms of fattening productivity and reducing antibiotic usage and resistance.Partners:TUAF, DAH, NIVR, Sub DAHLinked to One Health field sideTrial designThree chicken (broiler) groups allocated across five different flocks will be fed by three types of feedTimeline: Start of trial Quarter 4 2022Treatment group 1: probioticTreatment group 2: antibioticsControl group: no antibiotic or probioticwww.cgiar.orgWP3 – Activities under discussion In collaboration with ICARS demonstration project in pigsa. Intervention 1: Vaccination in sows. This is a commercial E.coli vaccine they want to use to immunize sows. It will be imported.b. Intervention 2: Replacement of colistin with a narrow spectrum antibiotic (provide data to the government that you don’t need colistin to help with the colistin ban) Link to Vidapig2 projecta. Focus is on diagnostics, ASTs, moving towards developing treatment guidelines for pigs.Additional ideas could be discussed• Probiotics (extension of previous trial in pigs or in poultry) • Giving pigs additional colostrum• Research around reducing co-heading and stress factors• Effects of removing colistin in poultry production (cost benefit analyses)• Something around drug vendors• Quantification of antimicrobial consumption could be an RCT currently piloted in Kenyawww.cgiar.orgMore information on the One Health initiative:Protecting Human Health Through a One Health ApproachHow to Stop Food Systems from Feeding Pandemics: Embrace One HealthThank you@OneHealth_initiative

Protecting human health through a One Health approach

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Protecting human health through a One Health approach

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