Disease, politics and food security: Rethinking animal health

World agriculture and food systems are changing and so the nature of disease dynamics that are intertwined with global politics, development and food security issues. The current African Swine Fever (ASF) epidemic that is spreading across the European Union and Asia is a case in point that exemplifies the limits of national disease surveillance and control systems. The speed with which the disease is spreading, defying national animal health response systems and shaking animal product markets points to something deeper than the mere transmission of the disease. It illustrates the complex environment in which these diseases unfold, demanding a broader understanding of the biological, environmental, socio-economic and political drivers of disease emergence and spread. It also highlights the need for smarter solutions to stop them.

As came out in the social media recently, African swine fever has become a major concern for the EU’s veterinary authorities and “could dramatically shake European identity and cohesion, at a time of rising populist movements and nationalism, and risks fueling mistrust in and between national governments, as well as the public, trading partners and stakeholders.” (Ilaria Capua and Mario Monti – nature communication)

The ASF epidemic is also of high concern in China since the disease first entered the country in August 2018, leading to massive culling of pigs and destabilizing the entire pig value chain. Considering the epidemiological features of the disease and the absence of vaccine, it is clear that the disease is here to stay and will have significant impact on the pig industry in China and the region.

This is obviously not the first time veterinary services have been under high pressure to deal with diseases of epizootic nature. During the last 15 to 20 years, animal and human health surveillance and response systems in many countries have been challenged to respond to a series of global health threats[1], fearing at times a “Contagion[2]” like movie scenario that portrays, in a very realistic way, the devastating social and human consequences of a global pandemic caused by a virus of combined pig and bat’s origin. Among them, Highly Pathogenic Avian Influenza H5N1 epidemic was a turning point that brought to the fore a complex web of interactions among humans, animals, pathogens and their ecosystems and underscored the role of globalization, politics, mass migration, climate change as well as large-scale commercial animal production as key drivers for disease emergence. It also highlighted the intimate link between animal diseases, food and nutrition security. Animal deaths, massive culling, market disruptions and the staggering cost of controlling these diseases through movement controls and biosecurity measures, have a direct impact on the food supply chain as well as the livelihood of smallholder farmers and vulnerable communities, especially when they occur in already fragile political and socio-economic contexts.

Fifteen years down the line, while we should not underestimate the progress made in dealing with veterinary public health threats, the success of these efforts should not lead to complacency, as risks remain.

We still live with a Sword of Damocles hanging over our heads rather unprepared to face the next pandemic wave or to deal with well-known animal pathogens. We are engaged in a war with invisible, million years old enemies (i.e. viruses, bacteria), smart little warriors that adapt faster than we do to new conditions, capable of changing their genetic structure to evade the host immune response in less time than it takes us to react or produce a new vaccine. So, what are these small enemies whispering us? That it is time to think bigger and revisit the way we address veterinary and other global public health threats by adopting a whole Food-Agriculture-Environment-Health approach, more effective and respectful of our environment, our planet and the integrity of our ecosystems

Beyond the traditional pathogen-centric approach

As pictured by the word “Crisis” in Chinese, made of two characters: “Wei Ji – 危机 –Danger and opportunity, each crisis is an opportunity to learn, adapt and do better. In this sense, the 2004 Highly Pathogenic Avian Influenza (H5N1) crisis that caught the world by surprise was clearly a turning point in veterinary public health history.

In the aftermath of this epidemic, the veterinary profession in a paradigm shift came up with a new approach that emphasizes multidisciplinary research and disease control interventions, which transcend the conventional silo approach when addressing veterinary public health risks. National authorities and the international community alike had to reinvent the way they respond to global disease threats. It opened up a new era of collaboration across disciplines, bringing together veterinarians, medical doctors, wildlife specialist, socio-economics, and anthropologists from the research, the private sector and government institutions, in an attempt to understand the drivers of emergence of these diseases, respond faster and in a coordinated manner. This approach, also known as “One Health”, involves a 'human-animal-ecosystems perspective' that focuses on the interaction of human social systems with natural ecosystems and the many interfaces that bring wildlife, domestic animal and human populations into contact. It is defined by the American Veterinary Medical Association (AVMA) as the “integrative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment.”

Rather than dividing expertise into separate 'stovepipes' of responsibility, One Health aims to increase the collaboration across a wide range of sectors, each of them bringing one piece of this complex human-animal-ecosystems-pathogen jigsaw.

Although the concept is more relevant than at any time in today’s complex world, it has stumbled on many issues of definition, scope and operationalization for governments, research institutions, NGOs, the private sector and policy makers while trying to implement it down to the grass-root level. It probably never reached its full potential for application and remains a topic of intense debate among experts. Despite a countless number of initiatives established during the past decades to create intersectoral committees, platforms, networks of networks that often dissolve as soon as the risk (or the funding) vanishes, government institutions and scientific disciplines often divide-up the responsibility and expertise in silos and multidisciplinary collaboration remains weak. Some countries have been at the forefront to put the concept into practice and made great strides in this endeavor, but still find it hard to maintain joint governance structures, sustain joint funding or measure its impact. A recent study of AMR governance in Vietnam points out at the need for full adhesion of stakeholders and the provision of appropriate resources to improve the national surveillance system and break existing silos (Marion Bordier, CIRAD). The study also recommends a participatory “learning by doing” process to guide, frame and mentor stakeholders through the identification of appropriate levels of collaboration.

The One Health concept also shares much similarity with other fashionable conceptual ideas such as “Resilience” or “Innovation” that have invaded our day-to-day professional jargon, becoming buzzwords with different meanings according to whom you talk to or lacking meaning at local level where it has no direct translation in local language. From its smallest common denominator (fostering collaboration between veterinarians and medical doctors), to its broadest definition (Planetary Health, One Planet One Health, One Global Health) that encourages the collaboration of a wide range of actors, the concept resonates differently beyond the veterinary community and among public health experts, environmental specialists and social scientists. Despite its shortcomings, being sometimes more philosophical than operational, I think it has been a useful tool and conceptual framework for advancing the research and bringing innovative and much needed ways of thinking in this area.

I personally embrace it from its broader perspective as an key approach to minimize the local and global impact of epidemics and pandemics through a holistic food systems lens, integrating food and nutrition security dimensions intimately correlated to Health issues. As such, it encompasses food safety and Antimicrobial Resistance (AMR) issues.

Having tried to implement the concept in various contexts in Africa and Asia, I took it as a chance to improve our capacity to prevent pandemic, respond faster to disease threats and address food security issues. Along the way, I also experienced challenges, confronted by the limitations of the concept in emergency and life-threatening situations such as the 2014 Ebola epidemic in West Africa, and the need for moving it one step closer towards today’s global food system challenges.

Why a "One - Food System - Health" Approach is needed?

The emergence of diseases or public health threats such as food safety issues or AMR is part of a larger political, socio-economic and environmental context that needs to be carefully understood while designing any surveillance or response system. Considering 70% of Emerging Infectious Diseases are of animal origins, the way we produce our food and raise livestock to meet an increased demand in animal protein matters. Preventing the emergence of livestock diseases which can affect our food and people’s health is not anymore just about being better prepared, rapidly identifying a threat (early warning) or responding swiftly (early reaction). It is also about addressing other major issues such as the impact of climate change, the vulnerability of our ecosystems, the impact of poverty and inequality on health, and the way consumers perceive these threats, increasingly asking for safer and healthier food.

Indeed, the loss of Biodiversity by the day, as reported in The State of the World’s biodiversity for food and agriculture, shows that plants and animals are more vulnerable to pests and diseases, making our food production systems less resilient and more vulnerable to shocks. The intensification of livestock production systems and the loss of genetic diversity of livestock has an impact on the health of animals and people. Closely related, the impact of climate change can contribute to a wider geographical distribution of infectious diseases, for example with a change in the distribution of vector-borne diseases (diseases such as Rift Valley Fever that are transmitted by mosquitoes could expand their geographical range due to a change in climatic conditions favorable to certain species of mosquito).

Animal welfare is also an area which requires more attention: if killing massive number of healthy but susceptible animals to halt the spread of a disease remains a key control measure today, it may take a different and rather unacceptable perspective in the eyes of the generations to come. Along the same line, the way animals are raised in intensive conditions and the lengthening of livestock market chains also means more stress for the animals during their life and during long distance transportation, with a direct impact on their health, including on food security and safety.

Ultimately, the simple act of choosing the food you want to eat and the way it has been produced is a Political Act that reflects the choices we make as citizen and consumers for the society we want to live in. Preventing and responding to veterinary public health threats requires today a different mindset, an whole One Food System Health approach that brings into the equation biodiversity loss, the effect of climate change, land degradation, water scarcity, poverty related issues and more. The same solutions used in the agriculture sector to produce more with less, in a sustainable way by favouring short value chains, local products, recreating a direct link between farmers and consumers and protecting the biodiversity, can also work on reducing the burden of infectious diseases in the livestock sector, hence on people.

It works better at local level

Experience shows that there are less barriers to work across disciplines at local level. It also goes hand in hands with the need to engage with communities at local level and make them part of the surveillance and control process. Indeed, controlling diseases independent of the social and political context and without the engagement of communities is of little interest and has limited impact. It is well reflected in Gandhi’s saying “What is done for me but without me is done against me”.

As above-mentioned, disease prevention and control, is part of a larger development context where local politics and economy, food security, the effects of climate change, migration, urbanization, and poverty play an important role. This is particularly important when diseases emerge in a context of instability, civil unrest or conflicts that exacerbate local tensions and prevent effective surveillance and response efforts.

In this sense, the Ebola outbreak in West Africa in 2014 was a true wake-up call. It highlighted the lack of trust of local communities in the way the disease was handled by governments, NGOs, international organizations and health authorities. A few years earlier, in the case of highly pathogenic avian influenza, it was also key to understand how the disease emerged and spread so that appropriate measures could be implemented. However, this knowledge was only gained once the motivations of the various players in the poultry sector and the overall structure of the industry and movements of poultry were understood. In some areas, we still have a poor understanding of the motivations of farmers and traders or do not have appropriate ways to motivate behavioral change to prevent or control diseases. In face of large epidemics, the way decisions are taken by farmers, traders, transporters and all stakeholders along the value chain must be analyzed and brought into the equation for controlling the disease. This applies to the current African Swine Fever epidemic that is spreading across Europe and

We need more social sciences. The contribution of social scientist to bring such a perspective in disease response interventions and the development of control strategies is invaluable. While this approach is not new and fully part of the One Health principles, I do not think the collaboration between veterinary epidemiologists and social scientists has ever reached its full magnitude.

The recently launched SoNarGlobal[3] programme, which aims at developing a global social sciences network for preparedness and response to epidemic threats and antimicrobial resistance, has the potential to fill in this gap and contribute to prevent dramatic situations such as the one observed during the Ebola epidemic in West Africa.

We need a new generation of One Health Silo fighters

In the world of specialists we live in, we need to create a generation silo fighters, trained to embrace the full complexity of global problems, including emerging infectious diseases and their connectivity with politics, religions, culture and economics. People that can “think like a mountain” to paraphrase the quote of a pioneer in applied ecology named Aldo Leopold (1887-1948), i.e. understand the full complexity of cause and effect in ecological processes and to plan and act on time scales of decades and centuries. One important lesson is that forming multidisciplinary teams is essential to deal with animal disease outbreaks or a public health threat, but it is not sufficient. It can only work if various partners work toward a common goal, led by a clear direction in order to fully contribute and achieve a common objectives.

One Health university curricula and professional trainings have been developped during the past ten years. One health MSc now exist in renown Universities as well as One Health Summer schools (see for example the One Health 2019 Summer School on the theme “One Health challenges in animal farming systems and food chains”) that help integrate students or professionals from various schools in common coursework, in order to foster familiarity and personal connections between future experts in various fields.

In the spirit of strengthening institutional capacity to implement the One Health concept, the recently published tripartite FAO, OIE and WHO guide to addressing zoonotic diseases in Countries (taking a multisectoral, One Health approach), also represents a landmark and fill an important gap in covering a wide range of topics from strategic planning, surveillance, workforce development, community engagement and measuring the impact of this approach.

Challenging the status quo

Through a ‘disruptive’ and ‘entrepreneurial’ approach, some innovations could be accelerated in this sector in order to overcome the current surveillance and disease control challenges animal health authorities are facing today. Data intelligence can be used to process big volumes of data and build models to solve complex problems relevant to One Health. From local to global levels, it also requires ambitious and transformative global projects, such as the Global Virome Project, that intends to “end the Pandemic era” by filling the knowledge gap for unknown viruses, including their ecology and drivers. Further thoughts should also be given as well to finding alternatives to massive livestock culling (including of healthy animals), which not only are psychologically and ethically disturbing but also have the potential to affect the food security and nutrition of the most vulnerable. Alongside, more thoughts should be given to allow trade of animal products in epidemic situations, based on strong risk analysis and management. The concept of humanitarian corridors applied to livestock trade through “trade corridors” or “commodity base trade” should be further explored and studied. This could reinforce the existing concepts of regionalization or compartmentalization, which are rarely used.

 Conclusion

In today’s world, the relationship between people, animals and their food is changing as a result of urbanization and the desertification of rural areas. As it happened in the agriculture and crop production sector, the lengthening of value chains in the livestock sector has created a disconnection between consumers and livestock producers while at the same time increased the risk of infectious disease spread across regions and continents. This means that high mortality, loss of animals from culling, or disruption of supply chains because of movement control, all have an even greater potential than before to destabilize food supplies and reduce food security, locally, regionally or globally.

The current ASF epidemic illustrates the limits of traditional animal health disease control and prevention systems. It has shown how the approaches based solely on scientific and technical solutions to deal with animal disease epidemics posing global threats have reached their threshold. Clearly, it is time to explore an alternative whole food system health approach to come with more effective response. Such response must be robust enough to deal with the unknown and responding to uncertainty and acknowledge the necessity to bridge state of the art disease control techniques to social, political and environmental sciences and practitioners.

In this context, the veterinary public health sector and all its partners need to reinvent the way it deals with global disease threats. This has started 15 years ago but has not completely fulfilled its expectations in light of the most recent disease events that happened in Africa, Europe and Asia. Clearly, more efforts are needed to address these global health challenges and help decision makers set the right questions and address them for the benefit of the poorest and most vulnerable who are in the frontline.

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[1] ESB, SARS, Nipah virus, Avian influenzas, Ebola, Zika, Middle East Respiratory Syndrome, Swine H1N1 Influenza to name a few

[2] Contagion is a 2011 American medical action thriller directed by Steven Soderbergh

[3] In January 2019, a project entitled SoNAR-Global (@SoNARGlobalEU) was launched at the Institut Pasteur in Paris. It brings the human and community perspective at the centre of public health pandemic threats surveillance and control.