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15 January, 2019 11:12:36 AM


One Health and the microbes

While we have been living better, longer lives, infectious diseases have been working on a comeback, and today they are pounding at the door
Mohammed Abul Kalam, PhD
One Health and the microbes

For a healthy planet, the health of all living creatures is equally important. One Health is a fairly new concept that prioritizes an interdisciplinary approach in science — to preserve the health of animals, humans and the environment.

It is an approach that can be extended to any problem.
The history of One Health can be traced to the term “One Medicine,” coined by veterinary epidemiologist Calvin Schwabe and the later 12 Manhattan Principles, published by the Wildlife Conservation Society in 2004. They are: (1) Recognize the essential link between human, domestic animal and wildlife health and the threat disease poses to people, their food supplies and economies, and the biodiversity essential to maintaining the healthy environments and functioning ecosystems we all require (2) Recognize that decisions regarding land and water use have real implications for health. Alterations in the resilience of ecosystems and shifts in patterns of disease emergence and spread manifest themselves when we fail to recognize this relationship.(3) Include wildlife health science as an essential component of global disease prevention, surveillance, monitoring, control and mitigation (4) Recognize that human health programs can greatly contribute to conservation efforts (5) Devise adaptive, holistic and forward-looking approaches to the prevention, surveillance, monitoring, control and mitigation of emerging and resurging diseases that take the complex interconnections among species into full account (6) Seek opportunities to fully integrate biodiversity conservation perspectives and human needs (including those related to domestic animal health) when developing solutions to infectious disease threats (7) Reduce the demand for and better regulate the international live wildlife and bushmeat trade not only to protect wildlife populations but to lessen the risks of disease movement, cross-species transmission, and the development of novel pathogen-host relationships.

 The costs of this worldwide trade in terms of impacts on public health, agriculture and conservation are enormous, and the global community must address this trade as the real threat it is to global socioeconomic security (8) Restrict the mass culling of free-ranging wildlife species for disease control to situations where there is a multidisciplinary, international scientific consensus that a wildlife population poses an urgent, significant threat to human health, food security, or wildlife health more broadly (9) Increase investment in the global human and animal health infrastructure commensurate with the serious nature of emerging and resurging disease threats to people, domestic animals and wildlife.

Identifying a new deadly virus:The 1999 Nipah virus encephalitis outbreak in Malaysia is a classic example of a high-impact disease that was contained with the help of One Health principles. Nipah virus infected more than 265 people and killed 40 percent of them. This virus also caused significant disease in pigs in Malaysia, which led to the culling of domestic pig herds. When the outbreak was first reported, the Malaysian government hastily responded by vaccinating against Japanese encephalitis virus (JEV). Since JEV is endemic in that region, this seemed like a logical decision.

However, it soon became apparent that the outbreak was not caused by JEV. It took a tremendous amount of effort of international collaboration to bring together a team of veterinarians, clinicians, epidemiologists, environmental scientists, anthropologists and wildlife specialists to tackle this outbreak. Subsequently, Malaysia developed policies to minimize contact between wildlife (bats) and domestic animals (pigs). This approach reduced the possibility of Nipah virus transmission from wildlife to other animals and humans.  Although the term One Health had not been coined yet, these experts used similar principles — to form interdisciplinary teams to contain an infectious disease at the human-animal-environment interface.

Tackling antibiotic resistance: The growing problem of antimicrobial resistance (AMR) is known to most. As bacteria around us become resistant to the full spectrum of antibiotics, we are struggling to discover newer replacement drugs. The problem of AMR is multifaceted. It involves an intricate network between humans, animals and the environment.

As a medical sociologist, I grew up believing in the forward trajectory of progress in science and medicine – that human health would continue to improve as it had for hundreds of years. As I progressed through my own career in health sciences, I continued to be optimistic.Now I have serious doubts.Science is still working well, but deadly obstacles are blocking the way between research and progress in the field.The threat to humankind is grave and growing worse by the day, but for reasons that escape my colleagues and me, there appears to be shockingly little collective will to do much about it.

In the month of November(Nov. 12-18) wasWorld Antibiotic Awareness Week. We need to talk about this threat. We need to develop models of public-private co-operation — to incentivize, fund and invest in antibiotic drug discovery and development.

Penicillin led to complacency:Here’s the problem: about 75 years ago, science brought penicillin into public use, , opening a new era in infectious disease control, much as sanitation had done before that. Infectious diseases such as pneumonia and strep, which had commonly been fatal even in my grandparents’ day, were tamed — at least for a time.

With cheap, abundant and effective antibiotics at hand, people in the developed world became complacent about controlling infection.But this whole time, while we have been living our better, longer lives, infectious diseases have been working on a comeback, and today they are pounding at the door. In fact, they are already breaking down the door. Market will not meet demand:In a fast-forward example of Darwinian adaptation through natural selection, bacteria and other microbes are evolving to survive antibiotics. They will continue to adapt and they will succeed unless humanity builds new layers of defence in the form of new antibiotics and other creative approaches.

Unfortunately, they are not yet available on the commercial market, and they may never get there unless something changes to make them viable — not as drugs, but as commodities.The critical impediment to producing new antibiotics turns out to be our own economic model, which trusts the market to meet the demand. The invisible hand, as philosopher and economist Adam Smith called it, is not working here, and what’s at risk is all of the progress that antibiotics has made possible.

Hospitals under threat:Without intervention — where the public, through their governments around the world, cooperates with the private sector to help incentivize, fund and invest in antibiotic drug discovery and development — the end of effective antibiotics will be frightening.

It will happen gradually, but it will certainly happen. The first stages are already here in the form of multi-antibiotic-resistant infections that threaten the basic function of hospitals.Next, we’ll see common procedures like dental hygiene appointments and joint replacement surgeries cancelled permanently due to the risk of infection.

People of all ages will begin to die again from illnesses that we have become used to treating with Taka 1000 or Taka 2000 worth of pills. Those who don’t die will be sick more often and for much longer, driving up the cost of care.Life expectancy could fall back to where it was in the early 1900s, and the golden era of antibiotics would prove to have been but a brief, happy blip in history.It doesn’t have to be this way. Let’s turn our awareness into action.

As humans, we need to regulate the use of antibiotics. Antibiotic stewardship is critical to prevent the over, and often unnecessary, use of these drugs. The rise of AMR is increasing the burden on our public health infrastructures globally. In order to limit this problem, the involvement of multiple governmental agencies, non-profits, research institutions and, more importantly, the dedication and determination of the public, is required.  In Bangladesh, antibiotics are freely available without a prescription.. How do we change this practice? What role does the government play in setting out policies restricting the distribution of over-the-counter antibiotics? Are big pharmaceutical companies lobbying governments and providing physicians and pharmacists with incentives to “sell” more antibiotics?

In certain regions of the planet, antibiotics are used in agricultural animals such as cattle to boost their growth (as used for Qurbani cows in Bangladesh).

These antibiotics can enter our food chain through meat and other dairy and animal products or give rise to resistant bacteria..

These are complicated questions. In certain situations, dairy produced from cattle enables a farmer to put food on the table for his or her family. There needs to be a principle of compensation, rather than penalties, for more compliance from the farming community. But again, where does a government in a resource-starved situation find the money for compensation?

Thus, antibiotic resistance is not just a biological problem; it is indeed a true One Health problem, which will require a tremendous team effort at the global level.

One Health is allowing health scientists, physicians, veterinarians, social scientists, economists and more importantly, local communities, to connect and communicate to solve the emerging problems of tomorrow.

The writer is Former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh




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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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