Communication and Coordination

Welcome.

 

The objective of this module is to provide you with foundational knowledge of two key themes of human, animal, and environmental health:

 

·         Antimicrobial resistance; and

·         The One Health Approach;

 

At the end of this module, you should be able to:

 

·         Describe the impact of AMR on human, animal and environmental life;

·         Explain the One Health approach; and

·         List stakeholders in the One Health approach.

 

First, let me tell you a story:

 

Flora Mugisa didn’t feel well. The 70-year-old had lost her appetite, grown thin, and complained of a heavy chest with severe pain. Her grandson thought she was going to die.

After months of feeling ill, Flora was diagnosed with tuberculosis. Doctors at two different hospitals in Uganda struggled to find an antibiotic that worked against the type of tuberculosis Flora had.

It wasn’t easy. In fact, the type of tuberculosis she had was resistant to several of the antibiotics typically used to treat tuberculosis. Flora spent 10 months in the hospital before she was well enough to go home. ("Antibiotic resistance: Real-Life Stories,")

Stories like Flora’s are becoming more and more frequent as bacteria and viruses evolve and become resistant to old treatments.

Antimicrobial resistance occurs when microorganisms that cause disease stop responding to antimicrobial drugs and medicines that were once effective in treating them.

In many cases, these new strains of old microorganisms have developed through the misuse or overuse of antimicrobials in food, agriculture, and human health.

 

***

 

Antimicrobial resistance

 

The availability and use of antimicrobial medicines has transformed the practice of human and animal medicine. Infections that were once lethal are now treatable.

 

In fact, the use of antimicrobial drugs has been instrumental in advancing human and animal health. Unfortunately, these drugs are at risk of losing their efficacy in humans and animals.

 

The overuse and misuse of antimicrobial agents in humans, animals and plants sectors have contributed to the waning effectiveness of antimicrobial drugs – including life-savings antibiotics.

 

When these drugs stop working, animals and humans are risk of illness or death from diseases that were once treatable or curable.

 

As part of its mandate, the ECOWAS Regional Center for Surveillance and Disease Control – or RCSDC – has made taking action against AMR a priority. RCSDC is not alone.

 

In May 2015, the 68^th World Health Assembly adopted the global plan on antimicrobial resistance. The objectives outlined in the AMR Global Action Plan are: ("OIE World Assembly of Delegates AMR Resolution No. 26," 2015)

 

·         Improve awareness and understanding of antimicrobial resistance;

·         Strengthen knowledge through surveillance and research;

·         Reduce the incidence of infection;

·         Optimize the use of antimicrobial agents; and

·         Ensure sustainable investment in countering antimicrobial resistance.  

Taking action against antimicrobial resistance requires an approach from several different fronts.

 One is to educate people about the dangers of AMR. Another is to reduce demand for antibiotics and other antimicrobial agents by preventing infections.

 Still another is to support the development and access to vaccines – that is, to reduce the demand for antibiotics by making them unnecessary in the first place.

Unfortunately, AMR often doesn’t share the high-level of awareness that draws attention other health issues in West Africa. A lack of regulatory capacity encourages black-market production and distribution of potentially poor quality and ineffective drugs.

Antimicrobial drugs are often sold in stores that are unlicensed or unregistered, and they’re also often hawked on the street by itinerant sellers. ("Nigeria National Action Plan for Antimicrobial Resistance,")

When antimicrobial drugs are overused or misused, they ultimately stop working. That’s a problem for all of us.

The ECOWAS region’s reliance on antimicrobials for treatment of diseases – such as Lassa fever – highlights the need for us to coordinate resources and respond to the threat of AMR in a way that’s bold and committed.

Surveillance is a key component of understanding the patterns of use and abuse of antibiotics and other antimicrobial drugs.

In 2015, the Global Antimicrobial Resistance Surveillance System – or GLASS – was launched. The aim of GLASS is to support surveillance and research in order to strengthen the evidence base on antimicrobial resistance.("Global Antimicrobial Resistance Surveillance System,")

 The objectives of GLASS are to:

 

·         Foster national surveillance systems and harmonized global standards;

·         Estimate the extent and burden of AMR globally, using selected indicators;

·         Analyze and report global data on AMR on a regular basis;

·         Detect emerging resistance and its international spread;

·         Inform implementation of targeted prevention and control programs; and

·         Assess the impact of interventions.

 

Because of its impact on animals, humans and the environment, tackling the problem of antimicrobial resistance requires the coordination of a variety of stakeholders.

 

Health sectors, veterinary sectors, and environmental sectors are all part of addressing the growing threat of AMR.

 

One Health approach

 

Every day, we hear about health challenges at the human – animal – and environmental interface. Diseases such as Ebola, influenza, rabies and Lassa fever – which can be transmitted between human and animals – cannot be effectively addressed by one sector alone.

 

The One Health approach to disease control and management emphasizes the interconnectedness of the health of humans, animals and ecosystems. (Destoumieux-Garzón et al., 2018)

 

In general, the term refers to taking a multisectoral, multidisciplinary approach and ensuring communication, collaboration and coordination among:

 

all relevant ministries;

·         agencies;

·         stakeholders;

·         sectors; and

 

 and across all disciplines:

·         public health,

·         veterinary medicine,

·         agricultural interests,

·         financial entities,

·         environmental leadership, and

·         consumers. ("Strengthening the IHR Through a One Health Approach,")

 

In short, pretty much everyone on earth has a stake in using a One Health approach to prevent, detect, report and respond to disease outbreaks.

 

Through One Health, issues and solutions are viewed through the lens of collaboration between everyone involved. One Health stakeholders are also stakeholders in efforts to combat antimicrobial resistance.

 

Why do we need a One Health approach?

 

Animals and humans are susceptible to many of the same types of diseases. Effective prevention and management of zoonotic diseases – those that may transition between animals and humans – requires cooperation and coordination between public health, animal health, and environmental partners.

 

One Health is critical to addressing health events at the human-animal interface, including food safety, food security, and antimicrobial resistance. And that’s not all.

 

Let’s take rabies. Targeting the animal source of the virus – dogs – and vaccinating them – effectively stops rabies in humans.

 

Ministers of Health, Livestock, Environment and Agriculture of ECOWAS countries have pledged to work towards the implementation of a regional One Health strategic framework. ("FAO and ECOWAS support One Health approach for health security in West Africa. ," 2016)

 

Regional Animal Health Centres throughout ECOWAS are also seen as key players in the expansion of the One Health approach. In terms of funding prioritization, the One Health approach should be among the first in line.

 

In the context of the International Health Regulations Monitoring and Evaluation Framework, taking a One Health approach means including – from all relevant sectors – the NATIONAL information, expertise, perspectives, and experience necessary to conduct the assessments, evaluations, reporting and preparedness activities. ("Strengthening the IHR Through a One Health Approach,")

 

So how do you bring all these players to the table?

 

Communication and coordination.

 

The benefits of an effectively implemented multisectoral, One Health approach for zoonotic diseases include:

·         Responses to zoonotic disease events and emergencies are more timely and effective.
All sectors have the information they need.
Decisions are based on accurate and shared assessments of the situation.

·         Accountability to each other and to decision makers ensures action by all sectors.

·         Regulations, policies, and guidelines are realistic, acceptable, and implementable by all sectors.

·         All sectors understand their specific roles and responsibilities in the collaboration.  

·         Technical, human, and financial resources are effectively used and equitably shared.

·         Gaps in infrastructure, capacity and information are identified and filled; and

·         Advocacy for funds, policies, and programmes is effective. (Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries, 2019)

 

As part of efforts to build collaboration and coordination in the One Health approach, WHO and OIE – the World Organization for Animal Health – and FAO put together an excellent guidebook.

 

It’s called: “Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Disease in Countries.”  

 

https://extranet.who.int/sph/sites/default/files/document-library/document/Tripartite-Guidance-EN-web%20single%20page.pdf

 

It’s a great resource for integrating the One Health Approach in your public health communication and coordination.

 

The Tripartite – WHO, OIE and FAO – also conduct National Bridging Workshops – or NBWs – to bring together people from public health and animal health services to improve collaboration between these two sectors. ("IHR-PVS National Bridging Workshop,")

 

You can learn more about National Bridging Workshops by contacting a focal point at WHO or OIE or by visiting https://extranet.who.int/sph/ihr-pvs-bridging-workshop

 

As with all preparedness activities, it’s best if multisectoral coordination mechanisms are in place BEFORE an emergency arises.

 

Where is your country in terms of having multisectoral coordination mechanisms in place? Your Joint External Evaluation will help you get idea of where you are, where you need to go, and what resources you need – to get there.

 

References:

 

Antibiotic resistance: Real-Life Stories.   Retrieved from https://www.who.int/campaigns/world-antibiotic-awareness-week/personal-stories/en/

Destoumieux-Garzón, D., Mavingui, P., Boetsch, G., Boissier, J., Darriet, F., Duboz, P., . . . Voituron, Y. (2018). The One Health Concept: 10 Years Old and a Long Road Ahead. Frontiers in Veterinary Science, 5, 14-14. doi:10.3389/fvets.2018.00014

FAO and ECOWAS support One Health approach for health security in West Africa. . (2016).   Retrieved from http://www.fao.org/africa/news/detail-news/en/c/452342/

Global Antimicrobial Resistance Surveillance System.   Retrieved from https://www.who.int/glass/en/

IHR-PVS National Bridging Workshop.   Retrieved from https://extranet.who.int/sph/ihr-pvs-bridging-workshop

Nigeria National Action Plan for Antimicrobial Resistance.   Retrieved from https://ncdc.gov.ng/themes/common/docs/protocols/77_1511368219.pdf

OIE World Assembly of Delegates AMR Resolution No. 26. (2015).   Retrieved from http://www.oie.int/fileadmin/Home/eng/Our_scientific_expertise/docs/pdf/AMR/A_RESO_AMR_2015.pdf

Strengthening the IHR Through a One Health Approach.   Retrieved from https://extranet.who.int/sph/one-health-operations

Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries. (2019). FAO, OIE, and WHO Retrieved from https://extranet.who.int/sph/sites/default/files/document-library/document/Tripartite-Guidance-EN-web single page.pdf.