Agriculture TG, Health SG and South Asia

Human Development Matters Joint Seminar:

Interface between Agriculture and Health

to Strengthen Regional Health Security

24 Jan (Wed) 2017, 14:00 – 15:00, 61018 NW

Asian Development Bank

Yuki Shiroishi, Visiting Lecturer,

Department of Health Sciences, Kyushu University, Japan
 Contents
1. Increasing threats to health security
2. Work of the World Organization for Animal Health (OIE)
3. International regulations & standards on health security
 IHR and PVS, and their bridging

4. Key messages
• Intersectoral cooperation
• Regional cooperation
5. Steps to build “ADB’s One Health Approach”
 Increasing Threats to Health Security
1. Globalization
2. Urbanization
3. Climate Change
4. Natural Disasters
5. Emerging and Re-emerging Infectious Diseases
6. Zoonotic Diseases
7. Anti-microbial Resistance (AMR)
 Global Aviation Network

Source: Aapted from L. Hufnagel, et al. Forecast and Control of Epidemics in a Globalized
World, PNAS, October 19, vol. 101 no. 42, 2004
International Tourists Arrivals by Region (in million), 1950-2020

Source: UNWTO, Tourism Highlights 2008 Edition, UN World Tourism Organization

 Regional transport network, and development of
regional economic corridors accelerate movement of
people (migrants), animals and goods
(increase in type, volume, and speed)
 Production of Meat by Region, 1961-2007

Source: State of Food and Agriculture, FAO, 2009

 Why is Biosecurity Important?
Managing Movement Risk and Transboundary Animal Diseases (TADs)

Approximately 1 million large

ruminants are moving through
South-east Asia into China and
Vietnam annually
Source: Presentation made by Professor Emeritus Peter Windors, Sydney School of
Vetenary Science, in in the 30th Conference of the OIE Regional Commission for Asia,
the Far East and Oceania, in Malaysia 2017
 Increasing percentage urban in developing countries

50% Line

Total urban population by region in developing countries

Source: M.R. Montgomery, The Urban

Transformation of the Developing World,
Vol 319, Issue 5864, pp 761-764, Science,
8 Feb, 2008
 Hotspots of Potential Elevated Risk for Disease Outbreaks
under El Nino Conditions, 2006-2007

Source: Assaf Anyamba, et al.

Developing global climate
anomalies suggest potential
disease risks for 2006 – 2007.
International Health
Geography. 2006; 5:60
 Number of Reported Disasters by Country in 2015
Asia and the Pacific is the Hotspot of Naural Disasters

Source: EM-DAT (25th 2016): The OFDA/CRED, International Disaster Database

 Global Examples of Emerging and Re-emerging
Infectious Diseases

Source: DM Morens, et al., The challenge of emerging and re-emerging

infectious diseases, Nature 430, 242-249, 2004
 Zoonoses : One Health Concept

Importance of the zoonotic potential

of animal pathogens

➢ 60% of human pathogens are

zoonotic

➢ 75% of emerging diseases are

zoonotic

➢ 80% of agents with potential

bioterrorist use are zoonotic
pathogens
 Influenza Pandemics Reported
Reported human
Subtype
Name of pandemic Date Deaths case fatality rates
involved
(%)

1889–1890 flu pandemic possibly H3N8

1889–1890 1 million 0.15
(Asiatic or Russian Flu) or H2N2

1918 flu pandemic 20 to 100

1918–1920 2 H1N1
(Spanish flu) million

Asian Flu 1957–1958 1 to 1.5 million 0.13 H2N2

0.75 to 1
Hong Kong Flu 1968–1969 <0.1 H3N2
million

Russian flu 1977–1978 N/A N/A H1N1

2009 flu 18,000 to

2009–2010 0.03 H1N1/09
pandemic (worldwide) 284,500
Annual flu virus deaths 1976-77 to 2006- 3,000 to
N/A N/A
(USA only) 07 46,000
Source: Hilleman, M (19 August 2002). "Realities and enigmas of human viral influenza: pathogenesis,
epidemiology and control". Vaccine, 20 (25–26): 3068–87, and other sources.
 Prioritized 8 Pathogens of Emerging Infectious Disease
for Accelerating Research and Development
Reported human Viral
Pathogen case fatality Affected areas Transmission routes Zoonotic? infection
rate(%) ?
Africa, the
Crimean-Congo From ticks and animal.
1 10 - 40 Balkans, Middle
Human-to-human
Yes Yes
hemorrhagic fever East, Asia
From wild animals.
2 Ebola virus 25 - 90 West Africa
Human-to-human
Yes Yes

From wild animals.

3 Marburg virus 25 - 80 Arica
Human-to-human
Yes Yes

From food or household items

4 Lassa fever 1 - 15 West Africa contaminated by rodent urine or Yes Yes
feces
Middle East
Likely from animals to human:
5 respiratory ~ 36 Middle East
Human-to-human
Yes Yes
syndrome (MERS)
Severe acute
Asia, North Unknown but likely from bats to civet
6 respiratory ~ 15
America cats. Human-to-human.
Yes Yes
syndrome (SARS)
From contact with blood or organs of
7 Nipath virus 40- 75 Asia infected animals , and bites of Yes Yes
infected mosquitoes

~ 50 From contact with blood or organs of

8 Rift valley fever in hemorrhagic Africa infected animals, and the bites of Yes Yes
cases infected mosquitoes

Source: Created with the use of data given in WHO Blueprint for R & D preparedness and response to public health
emergencies due to highly infectious pathogens: workshop o prioritization of pathogens, 8-9 December 2015.
 Global Distribution of Relative Risk of an Emerging Disease Event

zoonotic pathogen from wildlife zoonotic pathogen from non-wildlife

Asia and the Pacific is

the Hotspot
of Emerging and
Re-emerging Diseases
drug-resistance pathogens vector-borne pathogens

Source: Reprinted form K. E. Jone, Global trends in emerging infectious diseases, Nature 451, 990-993, 2008.
Green represents the lowest risk level and red the highest.
Early Control of Zoonotic Disease is Both Cost-effective
and Prevents Human Disease

Source: Institute of Medicine (2009) Sustaining global surveillance and response systems
for emerging zoonotic diseases. Washington, D.C.: National Research Council
 Economic Impacts of Selected Infectious Diseases

Source: Karesh WB. Animal disease surveillance. Presentation at the Institute of

Medicine Forum on Microbial Threats; Washington, DC. December 12–13.2006
 Crude Mortality Rate for All Causes, Non-infectious
Diseases, and Infectious Diseases, 1900-1996

Armstrong GL et al, JAMA 1999;281(1):61-66

Dispersion of Antimicrobial Residues into Aquatic & Terrestrial Environments
after Antimicrobial Usage in Humans, Animals, and Agriculture
Use of Animicrobials as Growth Enhancer in Agriculture Sector

Source: WHO and FAO. Berker, et al. 2014

AMR in Animal Sector ----- The situation today
Antimicrobials are a precious necessity
for animal health and welfare and public
health, but currently:

 No control of antimicrobial agent

circulation in more than 100 countries

 Falsified product make up a majority of

circulating antimicrobials

 Challenge in many countries: unrestricted

access to antimicrobials by farmers
without veterinary oversight

World Organisation for Animal Health · Protecting animals, Preserving our future | 21
 Deaths Attributable to AMR Every Year,
Compared to Other Major Causes of Deaths
AMR in 2050

10 million

Source: Jim O’Neil, et al. Antimicrobial Resistance: Tracking a crisis for the health and
wealth of nations, The Review on Antimicrobial Resistance, December 2014
Death Attributable to AMR Every Year by Region by 2050

Source: Jim O’Neil, et al. Antimicrobial Resistance: Tracking a crisis for the health and
wealth of nations, The Review on Antimicrobial Resistance, December 2014
 Decline in Livestock Production Could Be Substantial
and Most Pronounced in Low-Income Countries
Low AMR-Scenario High AMR-Scenario

Source: Drug Resistance Infections: A Threat to Our Economic Future, September 2016,
World Bank
 Health Care Costs Reach Nearly $1.2 Trillion More
in the “High-AMR” Case in 2050

Source: Drug Resistance Infections: A Threat to Our Economic Future, September 2016, World Bank
 AMR’s Impact on World GDP from 2014 to 2050
(In trillion of US dollars)

Total GDP Loss

$ 100.2 Trillion

Source: Jim O’Neil, et al. Antimicrobial Resistance: Tracking a crisis for the health and
wealth of nations, The Review on Antimicrobial Resistance, December 2014
 Estimated Cumulative Economic Impact due to AMR
in the Western Pacific Region, 2016-2025 (in billion US$)

Total Cumulative
Economic Impact
(US$ 1.25 trillion)

Source: WHO, Economic Impact of Antimicrobial Resistance in the Western Pacific Region
by 2025 (forthcoming)
 OIE = Office International de Epizooties
or World Organization for Animal Health

a. Background
b. World Animal Health Information System
c. OIE Standards & SPS
d. One Health Approach
e. Performance of Veterinary Services (PVS)
 a. Background
An intergovernmental organisation established
20 years before the United Nations

1924 1945 2003

Creation of the
New Name:
Office Creation of the World Organisation for
International des United Nations Animal Health (OIE)
Epizooties (OIE)
Creation of the
WTO in 1995
 Headquarters in Paris (France)
 5 Regional Representation  181 Members
 8 Sub-Regional Representations in 2017
World Organisation for Animal Health · Protecting animals, Preserving our future | 29
 The OIE Delegates and Focal Points
126 Collaboration Centers + 418 Reference Laboratories
In each of the 181
Member Countries:
All Delegates
worldwide
meet once a year
(General Session)
One OIE Delegate
WORLD ASSEMBLY
OF DELEGATES:
OIE National Focal Points (8) The highest authority
• Animal disease notification of the OIE.
• Animal production and food
safety
• Animal welfare
• Aquatic animals
• Communication
Director General
• Laboratory Dr Monique ELOIT
• Veterinary Products
• Wildlife • the 6th Strategic Plan 2016-2020
World Organisation for Animal Health · Protecting animals, Preserving our future | 30
 4 pillars of the OIE
Improving animal health and welfare worldwide

STANDARDS
TRANSPARENCY EXPERTISE
International SOLIDARITY
trade of Collection and
World animal
animals and dissemination Strengthen
disease situation
animal of veterinary capacities
products scientific worldwide
information

including zoonoses under the mandate animal disease Capacity building

given by the WTO prevention and control tools and programmes
methods
 b. World Animal Health Information System
(WAHIS)
OIE Listed Diseases = 88 (terrestrial) + 28 (aquatic)
181 countries on line

Early Information
Monitoring
warning from the Annual
system
system reports

Immediate notification
Six monthly report Annual report
Follow-up & Final report

• Alert messages for • Information for all • Veterinary Services’

specific OIE-listed diseases capabilities
epidemiological twice a year • Vaccine production
events & for (including their • National laboratories’
emerging diseases presence or capabilities
• Follow-up of absence) • Animal population figures
outbreaks notified • Human cases for zoonoses
 Public Prevention
Veterinarians Countries
measures

Communication

WAHIS
VERIFICATION RUMOUR
TRACKING Notification

Official Veterinary
Confirmation
Services

Laboratories confirmation Early detection

Farmer Veterinarian Hunter Ranger Veterinarian Angler

+ non-official information tracking system

 C. THE OIE STANDARDS
CODES MANUALS

Health standards for trade

Biological standards for
in animals and animal
products diagnostic tests and vaccines

Set recommended actions to be used by Veterinary Authorities or other

Competent Authorities
To establish health regulations for the safe importation of animals and
animal products
To protect animal and human health and guard against zoonotic diseases
To avoid unjustified trade restrictions
 WTO SPS Agreement
Sanitary and Phytosanitary Measures
Article 2.1
“Members have the right to take sanitary and phytosanitary measures
necessary for the protection of human, animal or plant life or health,
provided that such measures are not inconsistent with the provisions
of this Agreement” (Entered into force with the establishment of the WTO on 1 January, 1995)

Objectives of the SPS Agreement?

Recognises
the right to protect Avoiding
human, animal, unnecessary
plant life or health barriers to trade
 THE “3 SISTERS”
Standard-setting organisations

Animal Health and

Food Safety Plant Health
Zoonoses
CODEX IPPC
OIE

Codex = Joint FAO/WHO Codex Alimentarius Commission

OIE = World Organisation for Animal Health (OIE)
IPPC = International Plant Protection Convention (FAO)

WTO SPS Agreement recognises OIE as a reference organisation

for international standards on animal health including zoonoses
 d. One Health Concept
A global strategy for managing risks at the
Animal – Human - Ecosystems interface

Tripartite agreement of 3 Directors General

3 Priorities

Rabies
Zoonotic Antimicrobial Global control of
influenzas resistance canine rabies

Can be extended. To be strengthened.

NEEDS in AMR in Animal Sector

Collabora- Multisectoral collaboration – a successful plan against

tion AMR is inherently interdependent

International standards to monitor AMR and

Standards antimicrobial usage, and good governance of all sectors
related to authorisation and use of antimicrobials

Capacity Building of technical capacity – to conduct surveillance

building of AMR and antimicrobial use, and AMR risk analysis

Information collection and sharing - monitoring and

Data surveillance data on AMR and antimicrobial use, and
AMR risk analysis

Country Support to countries - to successfully plan and

support implement national AMR strategies
World Organisation for Animal Health · Protecting animals, Preserving our future | 38
e. Performance of Veterinary Services (PVS)
OIE PVS Pathway is a global program to improve the capacity of a country's
Veterinary Services:

 To enable their countries to comply with the OIE international standards,

 To provide greater protection for animal health and public health and
reducing the threat for other countries.

Source: OIE
 OIE PVS Implementation Status by Country

PVS evaluation to be redone Gap analysis to be done

Source: Presentation by OIE Regional Activities Department, in the 30th Conference of the OIE Regional
Commission for Asia, the Far East and Oceania, in Malaysia 2017
 Regulation and Standards for Health Security
International Health Regulation Performance of Veterinary Service
(IHR) (PVS)
Focus on human health Focus on animal health
 13 IHR Capacities in IHR (Assessed Annually)
1 Legislation and policy 6 Risk communications 11 Food safety
2 Coordination 7 Human resources 12 Chemical
3 Surveillance 8 Laboratory 13 Radio nuclear
4 Response 9 Point of entry

5 Preparedness 10 Zoonosis

Self-evaluation (annual)
 Low Validity

Joint External
Evaluation (JEE)
WHO Western-Pacific Region
of IHR Performance
Status in 2015 after 2016
(every 5 years)
 Status of Joint Eternal Evaluation of IHR in DMCs by Operation Regional
Department (As of 3 August 2017)
Status of Evaluation
ADB No Expression Evaluation completed
Expressed
Department of Interest In pipeline Final report
interest No final report yet
completed
Papua New
Other Pacific
Guinea,
PARD Island Fiji
Kiribati,
countries
Micronesia
EARD PRC Mongolia
Pakistan,
Azerbaijan Afghanistan,
CWRD Uzbekistan Armenia,
Tajjkistan Kyrgyz Republic,
Turkmenistan
Vietnam, Lao PDR,
SERD Indonesia Philippines Myanmar, Thailand
Cambodia
SARD India Nepal Bhutan Maldives, Sri Lanka Bangladesh
Total number
of countries
5+ 3 5 4 9
Source: Compiled with the data available in JEE Dash Board, IHR M & E Framework in Strategic Partnership Portal,
WHO: https://extranet.who.int/spp/jee-dashboard
 Interface (bridging) between
Human Health and Animal Health
KEY MESSAGES
1. Regional Health Security is a Matter of Super-Urgency:
--- Asia and the Pacific is the Hot Spot.

2. Regional Health Security is an Essential Defensive

Mechanism to protect ADB’s and DMCs’ massive
investment, including infrastructure.

It may cause a catastrophic damage and loss to human and

economic development in many DMCs, and wipe out ADB’s
massive investment made in infrastructure for so many years in
Asia and the Pacific.

3. More should be done to strengthen “Preparedness”.

KEY MESSAGES
4. Regional Health Security is not just a matter of health sector
but a composite of all relevant sectors, i.e., “Inter-sectoral”

5. Particularly, Agriculture Sector’s role is very essential along

with Health and Other Sector’s. It can play a much bigger
role.

6. We need to realize that ADB is actually placed in a unique

and strong leading position to become a key player in
Regional Health Security in Asia and the Pacific. We can and
need to build “One Heath Approach within ADB”.
a. ADB operates in almost all sectors related to Regional Health
Security with massive investment and on policy and reform.
b. ADB has such a strong presence in Regional Cooperation in
respective region---- “Regional Health Security is essential for
National Health Security.“
 Potential Investment Areas (for discussion)
(1) Support to Implementation IHR (JEE) and PVS, and financing plans
(2) Support to bridging of IHR (JEE) and PVS
(3) Assessment and identification of country priority
(4) Identification of regional common agenda and coordination mechanism
a. Zoonosis ----- Surveillance (WHIS+) / Laboratory / Training
b. AMR --------- Surveillance / Laboratory / Training / Risk Communication
c. SPS ----------- Laboratory / Training / Codex / Quarantine
d. Animal movement management and biosecurity
e. Food safety
f. Private sector mobilization
g. Other
(5) Policy communication (including economic impact study, etc. )
Steps to Build “ADB’s One Health Approach” (1)

1. Brain storing by a working group of sector experts to agree on

an coordination mechanism (e.g., joint-task force) and discuss
key areas for investment and mode of operation to be used.
Agriculture / Health / + Other Sectors / + RCI

2. Technical meeting with specialized agencies, as required

(Need to move towards to a more regular consultation
mechanism.)
OIE / WHO / FAO / IOM ++

3. Country and regional need assessment with the use of data

available out of and JEE of IHR and PVS evaluation, and
through consultation with DMCs, specialized agencies and
donors.
Steps to Build “ADB’s One Health Approach” (2)

4. Inventory and review of on-going (and planned) projects

(supported by DMCs, ADB and other agencies), mapping of
components supported, and identification of key areas for
investment.
5. Develop health security strategy, with intersectoral and
regional cooperation, as an overall operation guideline.
6. Conduct ADB’s Internal advocacy
7. Explore a possibility to include health security components
in Sector Strategies and Operation Plans.
• Agriculture sector strategy --- 2030 +
• Health Sector OP --- 2030 +
• Other Sector’s Strategies and OPs +
• RCI OP --- 2030 +
Steps to Build “ADB’s One Health Approach” (3)
8. Explore a possibility to include health security components in
Sub-Regional Strategies
• CAREC - done (Animal health, Cross-border issues, etc. included)
• GMS - being updated (Animal health component to be included ? )
• SASEC - to come (Perhaps, it can start up with SPS, urban health, etc.)
• Pacific -?

9. Maximize the existing and upcoming opportunities which are

very positive about regional health security within ADB
• On-going and planned human health projects
• On-going and planned animal health, including SPS projects
• 4 projects financed by Health Security Fund under ADF-XII
(Next Phase to include animal health aspects ? )
• ADB/JICA Health MOU (health security included)
(An expanded scope include animal health aspect ?)
• Upcoming MOU with WHO, FAO, etc. (+ OIE?)
Thank you