Need for a coordinated One Health approach for the Asian continent

The implementation of strategic disease prevention and control mechanisms is essential, in any country, to decrease new infections, decrease the number of people currently infected, and reduce disease-related morbidity and mortality in local settings. As standard practice, routine control measures are implemented for endemics and sporadic measures are used for unexpected outbreaks. Infection prevention and control is a practical and evidence-based approach, affecting various aspects of healthcare, including hand hygiene, surgical site infections, injection safety, antimicrobial resistance, and how hospitals work during and outside of emergencies.¹. This requires each nation to be self-sufficient with advanced, high-tech laboratories to enhance surveillance, expertise, and vaccine manufacturing and distribution capabilities. In addition, they must develop the necessary protocols for the provision of medical care and medical hygiene standards to prevent/control diseases effectively. In addition, the emphasis on the concept of ‘One Health’ at the global level recognizes the interconnectedness of people, animals, plants and the environment, advocating for a collaborative, multi-sectoral and transdisciplinary approach, urging the creation of resilient systems to Nacional level. level. However, there are differences between nations in their programs and investments to support disease prevention and control, and this is a cause for concern, especially in low- and middle-income countries, where increased population pressure negatively impacts the provision of medical and medical care. hygiene standards caused by secondary infections.

A coordinated cross-country management of public health problems serves as a useful approach to overcome deficiencies in different countries. Efforts in this direction are already underway and exist in the form of ‘Centers for Disease Control and Prevention’ on different continents including the US, Europe, Africa and Australia. The oldest of these is the US Center for Disease Control and Prevention, which was established in 1964 and the others were established later: the European Center for Disease Control and Prevention (2005), the African Center for Disease Control and Prevention (2017) and the Australian Center for Disease Control (2023). The European CDC and the African CDC have ‘nations’ as member states, while the US and Australian CDCs have ‘internal states’ as member states. The COVID management measures adopted by these CDCs serve as a foolproof framework for achieving coordinated disease control across countries and addressing public health challenges, effectively overcoming programmatic and infrastructure gaps in multiple countries. One Health (OH) strategies and best practices adopted by these CDCs in managing COVID are summarized below.

USA: The US CDC’s One Health Office collaborates with partners globally and within the United States to address OH challenges, prepare for outbreaks and emergencies, strengthen surveillance, and educate people about OH prevention. animal diseases. They support zoonotic outbreak investigations, engage experts from different sectors, and promote a multi-sectoral One Health approach. The Bureau also assists states with One Health research on SARS-CoV-2 infections in animals and developed a surveillance infrastructure for SARS-CoV-2. Fosters collaboration and information sharing through the Federal One Health Interagency COVID-19 Coordination Group².

Europe: The European Center for Disease Prevention and Control (ECDC) coordinates work in two key functions: One Health and Prevention and Behavior Change. Its mission is to strengthen Europe’s defenses against infectious diseases through surveillance, outbreak preparedness and response support, scientific advice, public health training and communication. ECDC maintains a strong laboratory capacity with an integrated network of EU reference laboratories to support national laboratories and promote testing methods and data reporting. Molecular surveillance improves epidemiological surveillance of communicable diseases and helps track infection patterns and sources of outbreaks. ECDC’s approach includes support for the whole genome sequencing infrastructure, the public health bioinformatics and genomic epidemiology training program (GenEpi-BioTrain), the EU/EEA laboratory capacity surveys (EU LabCap) and the European Antimicrobial Consumption Surveillance Network. ECOVID-Net combines epidemiological and virological surveillance of COVID-19 to inform decision makers, while ECOVID LabNet coordinates microbiological activities³.

Africa: The African Center for Disease Control and Prevention (ACDC) uses the Regional Coordination Centers for surveillance, preparedness, emergency response activities and collaboration with the National Public Health Institutes (NPHI) of Member States . ACDC strengthens laboratory systems through AFCAD (African Collaborative Initiative to Advance Diagnostics), implements biosafety and biosecurity initiatives⁴and establishes quality management systems. Its surveillance programs include antimicrobial resistance control, cross-border disease surveillance, digital disease surveillance, mortality surveillance, and the One Health programme.⁵. To control COVID, ACDC and the Youth Division of the African Union Commission (AUC) jointly designed the Bingwa Vaccination Initiative, establishing a network of youth champions across the continent to promote vaccination against COVID-19.

Australia: The newly established Australian Center for Disease Control improves pandemic preparedness and response, with a focus on chronic disease prevention. Ensures continued preparedness, response to infectious disease outbreaks, and prevention of communicable and noncommunicable diseases.⁶. The CDC launched the ‘Living with COVID-19’ service to test and connect positive patients with health care services, and the National Coronavirus Helpline offers 24-hour advice on COVID-19 and vaccines.

Coordinated One Health Approach: Lessons for Asia

The Asian continent is home to a group of 48 countries divided into five regions: East, Southeast, Center, South and West. It is predominantly dominated by low- and middle-income countries (LMICs) that face high population pressures and have inadequate disease control infrastructure, mechanisms, and standards. Promoting the One Health approach in a coordinated way can go a long way in supporting countries to prepare for and respond effectively to outbreaks and emergencies. By leveraging regional technology and experience for multisectoral surveillance, this approach helps fill gaps and strengthens overall effectiveness. Given the diversities on the political, economic, social and cultural fronts, the following factors should be considered for the formation of CDC and the establishment of a coordinated One Health approach for the Asian continent:

1. Establishment of CDC at subcontinental level: The wide range of diversities, disparities, and disputes among Asian nations makes the idea of ​​building an integrated system for all Asian countries seem unattainable. The possible solution could be subcontinental integration in areas where regional cooperation treaties/associations such as the Association of Southeast Asian Nations (ASEAN), the South Asian Association for Regional Cooperation (SAARC), the Gulf Cooperation Council , the Eurasian Economic Union (EEU) and the Shanghai Cooperation Organization (SCO) already exist. Among the five Asian regions, South Asia has established and reflected stronger and more sustainable regional cooperation through the ASEAN and SAARC associations, and therefore the establishment of a South Asia CDC is expected to be indomitable. and productive.
2. Associations and collaborations: By forging alliances and collaborations with national authorities and public health institutes in the region, subcontinental/regional CDCs can benefit from their expertise in addressing health emergencies, thus promoting a coordinated One Health approach. This would also help develop an integrated network of reference laboratories throughout the region to strengthen clinical and public health laboratory systems.
3. Data integration between countries: A South Asian CDC and One Health coordinated approach requires multisectoral data from all member countries. Coordination with the Ministries of Foreign Relations of the member countries is extremely important for the integration of data. Regional cooperation established in the South Asian region can assist in coordination with ministries of member countries.
4. Harmonization of surveillance policies and systems: The regional CDC should support the strengthening of health systems for the prevention of diseases in the member states. This approach can harmonize policies and surveillance systems over time, establishing an early warning and response platform for health threats, mapping health hazards and risks at the regional and national levels, building the capacity of public health through targeted training programs and strengthening the coordinated One Health approach in the region to combat cross-border threats to health, including communicable diseases.

IQVIA is committed to supporting One Health initiatives in the UK, India and many countries in Africa, across various aspects of disease control, including surveillance, capacity building and system strengthening. The National Center for Disease Control (NCDC) in India is currently undergoing a comprehensive overhaul as it transforms to absorb and accommodate the One Health approach through strengthened surveillance infrastructure, improved of skills among grassroots officials and technical officers, instituting solid monitoring mechanisms and an Integrated Health Information Platform. Wrapping these initiatives with an additional line: ‘inter-country coordination’ for disease control in the South Asian region would elevate NCDC as a regional hub for the region.

¹https://www.who.int/health-topics/infection-prevention-and-control#tab=tab_1
²https://www.cdc.gov/onehealth/what-we-do/index.html
³https://www.ecdc.europa.eu/en/about-ecdc/what-we-do
⁴https://africacdc.org/programme/laboratory-systems-and-networks/
⁵https://africacdc.org/programme/surveillance-disease-intelligence/
⁶https://www.health.gov.au/our-work/Australian-CDC