After weathering the Covid-19 pandemic for more than a year and a half, the global population is learning to live with it. Public health experts inform us that the SARS-CoV-2 virus is henceforth going to remain endemic to humans. Australia and New Zealand have been forced to acknowledge that even sealed bubbles cannot keep out this virus and have had to fall back on the good old lockdown and vaccination strategy.
How well are we in India prepared to face such outbreaks in the future? The answer, unfortunately, is none too encouraging since efforts are still focused on managing the disease rather than striking at its roots. Let us not forget that some of the most advanced healthcare systems were brought to their knees by the pandemic. As the World Health Organisation (WHO) said in May, “influenza pandemics have killed, and will again kill, in millions….”
But to have a realistic chance of success in dealing with such pandemics, any response has to recognise, first and foremost, the need for a radical change in approach with respect to zoonotic diseases. Though public health experts have long been familiar with zoonotic diseases, with infections passed on from animals to humans like rabies and tapeworm, among others, they have begun to receive focused attention only in recent years.
The havoc wrought by the Covid-19 virus, believed to have originated from animals, has underlined the importance of controlling zoonotic diseases. This recognition comes as air travel and international trade have increased the movement of people, animals and animal products across the world, providing a catalyst for the spread of infectious diseases with a pandemic overwhelming the globe in a matter of days and weeks. Authorities and experts have been caught on the wrong foot by the pandemic since conventionally they are used to putting human health, animal health, environmental health and wildlife trafficking in separate disciplinary silos with little appreciation of the deep underlying connections between them.
According to the World Organisation for Animal Health (OIE), pathogens circulating in animal populations can threaten both animal and human health. “Pathogens – virus, bacteria or parasites – have evolved and perfected their lifecycles in an environment that is more favourable to them and ensures their continuity through time by replicating and moving from diseased host to a susceptible new host,” said the OIE in a Tripartite Concept Note issued in 2010 along with WHO and the Food and Agriculture Organisation (FAO). The problem had already surfaced by then and was not only reflected in academic circles but had become the topic of discussion at conferences on public health. For the first time a strategy framework for reducing risks of infectious diseases at the animal-human-ecosystem interface was released at the 6th International Ministerial Conference on Avian and Pandemic Influenza in 2008 in Sharm El Sheikh, Egypt.
The situation had been quite different just a decade earlier. Not much notice was taken of the first deaths from bird flu which were reported in 1997 from Hong Kong. The number of people infected was 18 of whom six died. Five years later (2003) two more cases were reported, again in Hong Kong, of which one was fatal while there was another case in mainland China. The following year (2004) leopard and tiger deaths were reported among zoo animals in Thailand and infections among poultry in South Korea. According to WHO’s epidemiological records, there were as many as 856 laboratory confirmed cases of avian influenza A (H5N1) and 452 deaths in 16 countries between 2003 and 2016.
For their part, public health experts had picked up on the warning signals and had begun to collect intelligence and sound warnings about precisely the kind of pandemic that struck the world in 2019. They began to put health surveillance systems in place by the 1990s. In 1997 WHO, for example, began collaborating with the Canadian government in setting up a Global Public Health Intelligence Network (GPHIN) which uses data analytics to scan world media for potential outbreaks of communicable diseases that result in epidemics and pandemics.
After in-depth analysis, they raise alerts for governments and public health bodies to act to contain the threat. The immediate trigger for setting up GPHIN was the outbreak of pneumonic plague in India in 1994: there were 896 cases and 54 deaths. The outbreak sparked panic among airport staff in Toronto, Canada, about air travellers from India. Canada decided to have an early warning system about outbreaks of communicable diseases and formed GPHIN.
The havoc wrought by the Covid-19 virus, believed to have originated from animals, has underlined the importance of controlling zoonotic diseases.
GPHIN achieved early success when it detected the 2003 SARS outbreak in China by monitoring media reports and other data. This use of data was in the early days of the worldwide coverage? afforded? by the internet. It next detected the H1N1 pandemic influenza in 2009 that killed over 12,000 people in the United States alone and a total of more than 150,000 people worldwide. It was also able to get early intelligence about the MERS outbreak in 2012 in Jordan.
GPHIN achieved early success when it detected the 2003 SARS outbreak in China by monitoring media reports and other data. This use of data was in the early days of the worldwide coverage afforded by the internet. It next detected the H1N1 pandemic influenza in 2009 that killed over 12,000 people in the United States alone and a total of more than 150,000 people worldwide. It was also able to get early intelligence about the MERS outbreak in 2012 in Jordan.
GPHIN’s accuracy was based on its ability to pick up early warning signs by monitoring a variety of media sources from around the world using machine learning and algorithms. Its analysts look for clues in such diverse sources as blogs, financial reports, social media, hospital data. Unusual fluctuations in hog futures, for instance, could indicate a swine flu outbreak. Higher sales of anti-viral drugs in a region were accurately flagged as an indication of an outbreak in China. Early warning plays a crucial role in preventing outbreaks from becoming pandemics.
Not much notice was taken of the first deaths from bird flu which were reported in 1997 from Hong Kong. The number of people infected was 18 of whom six died.
GPHIN’s successes can be traced to the wide net that it cast to gather clues. It gathered and analysed information not just about human health but also animal health as well as commerce in pharmaceuticals to pinpoint outbreaks. However, organisations like GPHIN have one weakness – they are a department of the government and have only as much independence of action as the government will allow. In the years following 2015, the Canadian government not only cut its budget but also clipped its wings. As no pandemic had broken out, the Canadian government was not convinced that public money spent on GPHIN was serving any useful purpose for Canadians by scanning data from around the world. A severely hobbled GPHIN failed to issue any alerts around the time of the Covid-19 outbreak in China for timely action by governments. The catastrophic consequences are there for everyone to see.
Having burnt its fingers by being overdependent on a single government, WHO got together with two other leading international organisations – FAO and OIE – and requested the US Centers for Disease Control and Prevention to help operationalise the concept of ‘one health’. The four got together in May 2010 in Stone Mountain, Atlanta, US, to map a joint plan of action to tackle health issues through the one health approach.
In this approach experts working in different sectors exchange information to work together. It took them four years before they came up with a blueprint for a collaborative global strategy to deal with health risks at the human-animal-ecosystems interface in 2014. As the US Centers for Disease Control and Prevention puts it, the approach is based on recognition of the interconnection between people, animals, plants and their shared environment. To view health in this perspective would necessarily mean collaborations would be between public health, animal health and environment departments, each alerting the other about diseases and the risks of spillovers.
The approach can be best illustrated with the case of rabies, a deadly zoonotic disease spread among humans mainly through dog bites that takes 60,000 lives every year all over the world. The threat of rabies, particularly in Asian and African countries, cannot be checked by prophylactic treatment alone or vaccines that are given after infection through a dog bite. An integrated approach would in addition mass vaccinate dogs and alert people about the fatal risk posed by rabies. This method has resulted in a significant reduction in rabies cases in Bangladesh.
GPHIN’s accuracy was based on its ability to pick up early warning signs by monitoring a variety of media sources from around the world using machine learning and algorithms.
In Peru, the adoption of a similar approach has worked in the case of tapeworm infections which results in neurocysticercosis or acquired epilepsy. An estimated third of 17 million cases of epilepsy is attributed to this flatworm, Taenia Solium, more commonly known as tapeworm, which passes into humans through infected pork. It was successfully brought under control in Peru through a combination of public health measures, communication about hygienic practices, mass deworming and vaccination of pigs.
Naturally, the environment cannot be left out since animals and humans are dependent on it. Globalisation has resulted in an economic boom but has also resulted in fundamental changes in human behaviour and lifestyles. Rapid urbanisation has led to the building of roads and cities where there once stood forests which have also been encroached upon due to rising demand for land for grazing and crops. When people live in close proximity to one another it makes it easier for diseases to spread. Encroachment on ecosystems sets off a chain reaction in which the region’s fauna is affected – which is believed to have close links with how infectious diseases evolve. Increased per capita meat consumption has led to high-density livestock operations that provide opportunities for large-scale animal disease outbreaks. Encroachment into forests increases the interaction of people and their livestock with wild animals and birds which are reservoirs of some of the viruses which have been responsible for recent outbreaks.
All this underlines the need for the adoption of an integrated inter-sectoral approach or the one health approach that fundamentally recognises that life as such has to be viewed holistically to preserve the health of each component of the system.