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One Health and food safety research in developing countries

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Presentation by Hung Nguyen-Viet, Sinh Dang-Xuan and Rortana Chea at a seminar on 'Food Safety and Antimicrobial Resistance: One Health Perspectives', Battambang, Cambodia, 12 August 2019.

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One Health and food safety research in developing countries

  1. 1. Photo Credit Goes Here Hung Nguyen-Viet , Sinh Dang, Rortana Chea International Livestock Research Institute (ILRI), HUPH (Vietnam), and NAHPRI (Cambodia) UBB, August 12, 2019 – Battambang, Cambodia ONE HEALTH AND FOOD SAFETY RESEARCH IN DEVELOPING COUNTRIES
  2. 2. OUTLINE • One Health and Ecohealth approach • Food safety in developing countries and approach • Capacity building and policy translation • Conclusions
  3. 3. CGIAR Research Centers CGIAR research is carried out by the 15 Centers, members of the CGIAR Consortium, in close collaboration with hundreds of partners, including national and regional research institutes, civil society organizations, academia, development organizations and the private sector. REDUCED POVERTY IMPROVED FOOD AND NUTRITION SECURITY FOR HEALTH IMPROVED NATURAL RESOURCE SYSTEMS AND ECOSYSTEM SERVICES EQUITY, CAPACITY AND ENABLING ENVIRONMENT
  4. 4. Improved food and nutrition security for health Improved natural resource systems and ecosystem services Reduced poverty International Livestock Research Institute (www.ilri.org) ILRI’s mission is to improve food and nutritional security and to reduce poverty in developing countries through research for efficient, safe and sustainable use of livestock — ensuring better lives through livestock.
  5. 5. • Food & nutrition security • Poverty eradication • Environment & human health Policies, institutions and livelihoods Sustainable livestock systems Feed and forage resources development Livestock genetics Animal & human health Impact at scale BecA-ILRI hub ILRI programs
  6. 6. HLPE 2017 Food Systems and Nutrition Report Food systems for diets and nutrition
  7. 7. One Health and Ecohealth
  8. 8. Challenges in Asia • Population and economic growth, environmental issues, intensive agriculture and livestock, food security, nutrition, politics… • Complex health issues (EID, AMR, NCD…) need innovative, integrated approaches. • Strengthening the capacity of professionals working in the human, animal and environmental health sectors to respond to, control and prevent outbreaks of EID is vital. • Need to widen scope: Looking beyond HPAI, “Systems” approach vs. focus on specific diseases, animal health / human health
  9. 9. Ecohealth
  10. 10. Introduction to Ecohealth EcoHealth: a comprehensive concept to look at health as an integrative component of the complex relation of human, animal and environment in socio-ecological contexts • Systems thinking • Transdisciplinarity • Participation • Sustainability • Gender & social equity • Knowledge to action Six Ecohealth Principles
  11. 11. What is One Health? Veterinary medicine Environmental science Human medicine • Understanding the linkages • Adding value • More knowledge • Better health (human or animal) • Economical benefits
  12. 12. One Health Research - show added value • Added value in terms of better health and well- being for humans and animals, financial savings and improved environmental services •  incremental value Example: OH added value Cost effective zoonosese control Proposed cost-sharing scheme Zinsstag et al., 2009, PNAS http://www.onehealthinitiative.com/publications/OHOW_Compendium_Case_Studies.pdf Veterinarians without Borders Canada, 2010 0 5'000 10'000 15'000 20'000 25'000 30'000 35'000 40'000 45'000 50'000 1 2 3 4 5 6 Time in years Cumulatednetpresentcostor rabies(US$) Cumulative net present costs without rabies dog vaccination Cumulative et present costs with PET and dog vaccination
  13. 13. • INDOHUN • THOHUN • VOHUN • MYOHUN EcoEID Emerging Pandemic Threats Program PREDICT • RESPOND • PREVENT • IDENTIFY EHRCs GHI One Health and Ecohealth programs in SEA
  14. 14. Food Safety in LMICs
  15. 15. Food safety is integral to the SDGs Traditional Image of Food Safety • Food safety is integral to: • Food safety (practice) contributes to: Food Safety critical to ACHIEVING the SDGs
  16. 16. 17Havelaar et al., 2015 • 31 hazards • Worldwide • 5 years period, various experts WHO – Global estimates of food borne diseases burden • Helminthes • Microbes • Toxins • Aflatoxins ?¿: Most important among these 4?
  17. 17. FBD- a new priority – most probably from ASF Millions DALYs lost per year (global) 0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000 14,000,000 16,000,000 18,000,000 20,000,000 Asia Africa Other developing Developed Other toxins Aflatoxins Helminths Microbial Havelaar et al., 2015 31 hazards • 600 mio illnesses • 420,000 deaths • 33 million DALYszoonoses non zoonoses Burden LMIC
  18. 18. Foods implicated in FBD Painter et al., 2013, Sudershan et al., 2014, Mangan et al., 2014; Tam et al., 2014; Sang et al., 2014 ; ILRI, 2016
  19. 19. GLOBAL ESTIMATES OF FBD BURDEN (IN DALY’S) Hazard group Foodborne illnesses (millions) Foodborne deaths (thousands) Foodborne DALYs (millions) All 600 420 33 Diarrheal 549 230 18 Invasive 36 117 8 Helminths 13 45 6 Chemicals 0.2 19 0.9 Havelaar et al., 2018
  20. 20. GLOBAL BURDEN OF FBD BURDEN, REGIONAL DIFFERENCES Africa America Eastern Mediterranean Europe Southeast Asia Western Pacific Havelaar et al., 2018
  21. 21. FBD burden is a significant (and growing) public health problem in emerging Asia China Indonesia Laos Malaysia Myanmar Philippines Thailand Vietnam Tuberculosis (2016) 148 1514 1820 146 1716 1063 299 414 HIV/AIDS (2016) 67 900 337 1080 904 25 1205 440 Malaria (2016) 1 50 36 1 31 3 3 1 Food-borne disease (2010) 272 693 933 293 711 293 685 390 WHO Statistics Comparative Public Health Burden: Disability Adjusted Life Years Lost Per 100,000 Jaffee, 2018, World Bank
  22. 22. Domestic costs may be 20 times trade costs Cost estimates for 2016 (US$ billion) Productivity loss 95 Illness treatment 15 Trade loss or cost 5 to 7 ‘Productivity Loss’ = Foodborne Disease DALYs x Per Capita GNI Based on WHO/FERG & WDI Indicators Database Illness treatment = US$27 x # of Estimated foodborne illnesses Trade loss or costs = 2% of developing country high value food exports Download here
  23. 23. FERG key results • Demonstrated that almost 1 in 10 people fall ill every year from eating contaminated • Children less than 5 years of age represent only 9% of the global population but 43% of disease burden was subjected to this group. • Highest burden observed for Africa (East and Central Sub-Saharan Region) followed by South East Asian region • Cosiderable regional difference on specific FBD burden • FBD are of a similar burden in order of magnitude as the “big three” infectious diseases
  24. 24. FERG limitations Due to its limitations the provided estimates are expected to be conservative which may result in underestimates rather than overestimates – E.g. In USA alone each year, 1 in 6 Americans get sick from eating contaminated food (CDC, 2016) – Vietnam, 1 reported FBD versus 100 unreported – Underestimates for Europe for Salmonella • Germany, approx. factor 7 for Salmonella • Europe, average approximately factor 42 • Poland, approx. factor 62
  25. 25. MORE INFORMATION • WHO website http://www.who.int/foodsafety/areas_work/foodborne- diseases/ferg/en/ • PLOS collection http://collections.plos.org/ferg2015 • Interactive tool https://extranet.who.int/sree/Reports?op=vs&path=/WHO_H Q_Reports/G36/PROD/EXT/FoodborneDiseaseBurden Havelaar et al., 2018
  26. 26. Research approach: what do we do to understand and improve food safety? • Situational analyses of food safety • Capacity building on risk-based approaches • Proof of concept: participatory risk assessment • Pilot testing interventions
  27. 27. 1. Actionable evidence on FBD burden associated with animal source foods (ASF) 2. Pilot incentive-based approach to improving food safety among ASF traders 3. Cambodian-led Theory of Change for improving food safety 4. Gender and equity research 5. Building capacity in food safety risk assessment, management, communication Safe Food Fair Food for Cambodia Project objectives
  28. 28. 1. Risk profiling 1. Scoping visits 2. Systematic literature review 3. Risk profiles 4. Training in risk ranking 5. Stakeholder prioritisation 2. Generate evidence on FBD Five Urban Survey Study QMRA Markets Cost of Illness Household Nutrition 3. Develop & test solutions for wet markets RCT intervention Taskforce Gender TOC NutritionImpact QMRA Markets Cost of Illness
  29. 29. Multi-pathogen survey in Cambodian traditional market • Pork and poultry • Salmonella & Staphylococcus aureus • Traditional markets in 25 provinces of Cambodia • Urban focus: Phnom Penh municipal and Siem Reap province
  30. 30. Pork Animal sourced food Chicken In traditional Market
  31. 31. PREMILINARY RESULTS • All samples of the first round was collected for the multi- pathogen survey in Cambodian markets in 25 provinces. In total 416 samples (pork = 156, pork cutting board=52) chicken (chicken meat = 156, cutting board = 52) were collected. 312 shop owners were interviewed during the sampling. • In total of 184 samples positive to Salmonella (36%) and 133 to S. aureus (32%). • Isolates are being kept for further analysis on antimicrobial resistance.
  32. 32. Cost of Illness in Phnom Penh and Siem Reap • 200 cases of foodborne diseases • Direct and indirect cost • Siem Reap: completed data collection • 100 more cases in health centers in Phnom Penh: ongoing
  33. 33. Capacity building and policy translation
  34. 34. Taskforce of Risk assessment for food safety in Vietnam • Linking research to policy • Taskforce: composed by experts from universities, research institutes, policy makers from the ministries (health, agriculture) • Risk analysis capacity development for researchers and policy makers • Taskforce now institutionalized and sustainable
  35. 35. Capacity building impact: curriculum development & trainings • Guidelines on FS risk assessment: more accessible and understandable in use in 17 universities, 7 cities • Curriculum developed to teach 200 students per year: majority of future food safety human resources • Trainings for veterinary and public health staff at ministry level • Hand-on training on risk assessment for researchers, students
  36. 36. Policy impact: translational research for interventions in modernizing food system • CGIAR/ILRI niche - risk assessment and policy / regulatory analysis for fresh foods in domestic markets • World Bank convenes overall support to government: ILRI led technical works • Upcoming projects based on WB report we led will improve food safety for 20 million people in major cities of Vietnam
  37. 37. • Stakeholder consultation • Risk assessment training
  38. 38. Savanakhet, Laos Foodborne parasitic disease research October 2017 Decision makers Public health (MD, army health) Scientists Vets
  39. 39. Research into use: Risk communication and management • Risk communication and management problem • Cysticercosis in schools in Bac Ninh • African swine fever and food safety
  40. 40. CONCLUSIONS1. One Heath and Ecohealth are good approach to address complex health issues 2. Food safety: huge health and economic burden of foodborne diseases in LMIC 3. Capacity to develop food safety research in LMIC is important, risk communication need 4. Research translation to actions and policy: timely and opportunistic 5. Food safety investment and interventions in long term, wide-reaching impacts likely require: training & technology, incentives, and enabling environment
  41. 41. Acknowledgement • Fred Unger, Sinh Dang, Delia Grace, Kristina Roesel, Silvia Alonso, Johanna Lindahl: ILRI • PigRISK and SafePORK team • Sothyra Tum, Chhay Ty, Rortana Chea, Melissa Youth and SFFF Cambodia team • BMZ project team • Vietnam Food Safety report team • ComAcross project in Laos: Vannaphone Phouthana • Funding: ACIAR, CGIAR A4NH, World Bank, BMZ, USAID through LSIL, IAFP
  42. 42. Bibliography • Hung Nguyen-Viet, Tran Thi Tuyet-Hanh, Unger, F., Sinh Dang-Xuan and Grace, D. 2017. Food safety in Vietnam: where we are at and what we can learn from international experiences. Infectious Diseases of Poverty 6: 39. http://hdl.handle.net/10568/79981 • Sinh Dang-Xuan, Hung Nguyen-Viet, Meeyam, T., Fries, R., Huong Nguyen-Thanh, Phuc Pham-Duc, Lam, S., Grace, D. and Unger, F. 2016. Food safety perceptions and practices among smallholder pork value chain actors in Hung Yen province, Vietnam. Journal of Food Protection 79(9): 1490–1497. http://hdl.handle.net/10568/77065 • Sinh Dang-Xuan, Hung Nguyen-Viet, Unger, F., Phuc Pham-Duc, Grace, D., Ngan Tran-Thi, Barot, M., Ngoc Pham-Thi and Makita, K. 2017. Quantitative risk assessment of human salmonellosis in the smallholder pig value chains in urban of Vietnam. International Journal of Public Health 62(Supplement 1): 93–102. http://hdl.handle.net/10568/77739 • Tran Thi Tuyet-Hanh, Dang Xuan Sinh, Pham Duc Phuc, Tran Thi Ngan, Chu Van Tuat, Grace, D., Unger, F. and Hung Nguyen-Viet. 2017. Exposure assessment of chemical hazards in pork meat, liver, and kidney, and health impact implication in Hung Yen and Nghe An provinces, Vietnam. International Journal of Public Health 62(Supplement 1): 75–82. http://hdl.handle.net/10568/77702 • Nguyen-Viet, H. et al (2018). Research and training partnership to assist policy and capacity building in improving food safety in Vietnam. Global Food Security