Bring formal and informal interdisciplinary networks together to meet infectious disease outbreaks and challenges
Dr. John Mcdermott
It is now well recognised among policymakers that pandemic-prone as well as endemic zoonoses can be prevented and controlled through intersectoral coordination (ISC). The Roadmap to Combat Zoonoses in India (RCZI) Initiative embarked on a study in Intersectoral Partnerships for Zoonoses Prevention and Control in India: An Assessment2013, with the aim of identifying operational contours of such a mechanism. Dr. John Mcdermott, Director, CGIAR Research Programme – Agriculture for Nutrition and Health, International Food Policy Research Institute steered these discussions, playing a key role in developing a draft framework for ISC outlining how it would address issues related to zoonoses prevention and control. Excerpts from an interview with him.
Can you share any successful models globally that have demonstrated impact of ISC, especially during zoonotic outbreaks?
Following a weak response of health system to SARS, Canada integrated veterinary and public health diagnostic and surveillance systems into one agency and invested in information, knowledge management and communications, to support ISC. In Uganda, intersectoral organisations were formed to tackle sleeping sickness and rabies. Thailand placed more emphasis on using information systems and analysis to plan health systems, including broader intersectoral analysis. Lessons ranged from information and communication innovations, to learning from SARS, institutional reforms in public health in Canada and economic benefits gleaned through operational research.
Based on your experience, what are the challenges a country like India faces while embarking on ISC?
Important roadblocks to ISC in developing countries include limited capacity of technical specialists to understand broader development challenges and limited investments in information and knowledge systems to plan better cross-sectoral programmes.Moreover, individual sectors, such as health and their sub-sectors (public/community health, hospitals) are struggling to implement their own programmes, let alone ISC. Therefore, for ISC, choosing high-priority initial targets (outbreak response capacity or control of few zoonoses) for cross-sectoral work has to be done wisely.
Can intersectoral coordination also accrue economic benefits?
It definitely pays to invest in ISC. Financial integration is a critical dimension that must be factored in while planning ISC for zoonoses prevention and control. Evidence must be collated to build a case that demonstrates how it can reduce time and cost with significant economic benefit. Conversely, show that opportunity cost of not investing in ISC to contain zoonotic diseases can be steep.
What is the role of institutional reforms post disease outbreak, in the context of ISC?
The SARS outbreak in Canada in 2003, led to 42 deaths in Toronto alone. The crisis led to innovations and rigorous work in the area of microbiology to find the causative organism. It left people in shock, pointing towards silos in the health system where information and knowledge failed to get transmitted in a timely manner to reach relevant audiences. Delays led to huge loss of life but the crisis paved the way for institutional reforms translating into a complete change in the approach to deal with infectious diseases. The result was an integration of animal health and veterinary health into one public health agency, leading to operational savings and opportunities for human and animal health professionals to work together more closely.
Recognising economics as a crucial pathway to approach policy makers, a major challenge which the crisis showed was reluctance on part of human health professionals to talk in terms of benefits and cost. The spotlight had always remained on cost effectiveness and not really looking at losses in terms of human deaths. In this context if individual sectors like animal health were considered, the losses might not seem very significant but looking at losses across sectors would point to massive losses.
Comparing the intervention cost for Brucellosis with individual parameters like total health benefits, household income loss, agricultural benefits but the difference between cost and benefits was not very high. On the other hand, while mapping interventions’ cost with total societal benefits, there was a huge difference validating total benefits of controlling zoonotic diseases being much more than actual cost itself. Since these estimates and comparisons were not being done, it hindered the process of advocating for One Health for zoonotic diseases with policymakers.
Any ‘must do’s to achieve ISC, especially to strengthen zoonoses prevention and control?
This is an area where ISC is easiest because of the dynamics of infectious diseases being similar across species and importance of animals as reservoirs for emerging infections in humans well recognised. We must foster formal/informal interdisciplinary networks (disease control, molecular biology, epidemiology, economics) to work together to develop and apply tools, methods and approaches. Also, engage these networks to form more formal response teams around specific infectious disease outbreaks/challenges