Former director of the government’s Institute of Epidemiology, Disease Control and Research (IEDCR) was involved at the outset of One Health work in Bangladesh. Speaking to Prothom Alo, he said, dogs spread rabies. People will not be completely safe from rabies unless dogs are injected with the anti-rabies vaccine. Similarly, anthrax is spread by cows and goats. Unless livestock is freed of anthrax, people remain at risk of contracting this disease. There are other examples of this. That is why the health of humans and animals is being considered in an integrated manner, rather than separately. This is the One Health approach or concept.
Based on observations over the past three decades or so, experts say that 75 per cent of the new diseases that are emerging or the old diseases that are emerging anew, come from animals or birds. There is relation between the increase of such contagions and the increase in people’s dependence on animals and human proximity with animals and birds.
After observing 1,461 diseases which afflict humans, the US National Academy of Sciences said that around 60 per cent of these have over more than one carrier. These can settle in the bodies of human, animals or birds. That means a germ of the disease can and does travel from a bird to an animal, from an animal to a human or from a bird to a human. This is a serious threat to public health. A large number of people may suddenly be afflicted by a particular disease. And the economic impact is also far reaching. New disease control programmes have to be devised.
One Health approach
Over the past two decades, the World Health Organisation, the World Food Programme and other UN bodies as well as international donor agencies like USAID along with internationally recognised health organisations, have been trying to popularise the concept of One Health globally.
The US Centre of Disease Control and Prevention (CDC) says One Health is a collaborative, multisectoral and transdisciplinary approach. This will be effective at a local, national, regional and global level. The goal of the One Health initiative is to achieve optimal health outcomes recognising the interconnection between people, animals, plants, and their shared environment.
As the global population increases, new settlements emerge. This requires land. And so forests are being depleted. Forests are also shrinking as a result of climate change and the expansion of agriculture and industry. This increases the chances of coming into contact with animals. Animals play a vital role in human life. Animals are required for food, leather, fur, travel, sport, education and companionship. Close proximity with animals, birds and their environment increases the risk of humans contracting their diseases. Also, with their surroundings and habitat being damaged, there is also the risk of new diseases emerging in animals.
In recent years, due to international travel and business, the global movement of people, animals and animal products has increased. That is why there is increased risk of contagious diseases spreading rapidly across borders and spreading globally.
In the recent past, germs or diseases spreading from wild and domestic animals has created quite a stir globally. The list includes anthrax, Q fever, Chagas disease, Type A influenza, Rift Valley fever, SARS, MARS, Ebola and HIV. Coronavirus is the latest addition to the list.
The situation in Bangladesh
Over the past 50 years, since the independence of Bangladesh, the country has seen the emergence of 19 new and resurging diseases. Epidemiologists say in 1977 for the first time in the country people contracted Japanese Encephalitis. This is a mosquito borne disease. These diseases -- HIV/AIDS, dengue, chikunguniya, Bird Flu, Swine Flu, Nipah -- all came from other countries to Bangladesh. Coronavirus is the latest.
Anywhere in the world there is the danger of diseases entering the human body from birds. Any diseases that newly emerges in the US, Africa or Europe, may arrive in Bangladesh within just a couple of years. Sometimes it takes a longer time and sometimes less. For example, HIV/AIDS, globally, was detected in Africa in 1980. The virus was first detected in Bangladesh in 1989. The Nipah virus was first detected in Malaysia in 1998. It was detected in Bangladesh four years later. Coronavirus was first detected in Wuhan, China, towards the end of December 2019. Within two and a half months, that is, in March 2020, it appeared in Bangladesh.
Certain old diseases are resurfacing in Bangladesh. This includes diseases such as dengue and anthrax. Even this year around 19,000 persons were treated in hospital for dengue in the country, with 71 of them dying. Public health experts apprehend the further spread of diseases like dengue in the future due to climate change.
These diseases also cause immense economic harm. According to a 2011 report of IEDCR, when avian influenza of bird flu broke out in the country in 2007, this spread to 52 districts. Around 2.4 million (24 lakh) chickens were culled at the time. Direct financial loss in 2007-08 stood at Tk 2.58 billion (Tk 258 crore). Overall financial loss due to bird flu was Tk 36 billion (Tk 3600 crore).
In 2010, livestock in 15 districts of the country were affected by anthrax. This year, 607 people in 12 districts contracted anthrax. The emergence of anthrax had an adverse effect on the meat and leather market.
One Health activities in the country
In 2008, representatives of 12 national and international agencies formed the One Health Bangladesh network. It now functions as a programme. IEDCR acts as the One Health Bangladesh secretariat.
One Health Bangladesh has around 400 members. They include physicians, veterinarians, agriculturalists, environmentalists, wild animal experts, anthropologists, economists, scientists of various subjects and activists.
The health and family welfare ministry, the fisheries and livestock ministry and the ministry for environment and forests in 2012, drew up a strategy paper to prevent and control contagious diseases by means of the One Health approach. The World Bank, FAO and UNICEF assisted in drawing up the strategy paper.
Speaking to Prothom Alo, member of the 26-member UN One Health high level expert panel and one of the founders of One Health Bangladesh, Professor Nitish Chandra Debnath, said several important tasks are being carried out by means of One Health: 1. IEDCR, the livestock department and the forest department jointly carry out surveillance and investigation on diseases a regular basis; 2. certain research is being carried out; 3. there are training programmes; and 4. There is the initiative to limit or control the use of antibiotics.
Concerned persons say that One Health Bangladesh organises regular conferences. They also have certain programmes to mobilise public awareness.
Scientists have still been unable to pinpoint exactly from which animal and how the virus entered the human body in 2019 in Wuhan, China. However, there is a strong perception that it came from the sea food market in Wuhan.
Diseases from wild or domestic animals can spill over into the human body. There is a global initiative to prevent this. Funded by USAID, the ‘Stop Spillover’ programme has been started up on an experimental basis in five countries of the world including Bangladesh. The other countries are Vietnam, Uganda, Kenya and Congo.
Connected to this initiative is the Massachusetts Institute of Technology, Harvard University, California University, Washington University, Glasgow University and a few other universities and public health institutions. The International Centre of Diarrhoeal Disease Research, Bangladesh (icddr,b) is also involved in the programme.
From September, at the initiative of icddr,b, a series of workshops have begun to determine what is to be done to prevent the spillover of disease from animals and birds to humans. Four workshops have been held so far. Joining the workshops are officials of the health directorate, the livestock department and the department of environment as well as scientists and a number of local and foreign public health experts and environmentalists.
Participants have identified over 25 areas where animal diseases are transmitted to humans. However, the process is on to determine a plan of action on a priority basis, focusing on two issues. One is poultry and the other is bats.
There is risk of disease spreading while transporting the poultry from the poultry farms, at the poultry market and even in restaurants. It was said at the workshop that the disease could spread while carrying poultry waste and when using it in the agricultural fields.
There is also risk of disease spread by means of bats. It has already been proven that Nipah virus spread by bats in Bangladesh. The Nipah virus is found in the bodies of bats. When a bat consumes date juice from the date palm tree, the virus gets mixed with the juice. When people drink the juice raw, they can get infected by the virus. The workshop said that the virus can enter a swine’s body from a bat. Bat hunters are also at risk of getting infected.
IEDCR advisor Mustuq Husain told Prothom Alo, “The workshop is attempting to map from which places, animals and birds the spillover can occur. Mapping is also being done on the various roles to be played in this regard and who will carry out these responsibilities. This is being done entirely through the One Health approach.”
* This report appeared in the print and online edition of Prothom Alo and has been rewritten for the English edition by Ayesha Kabir