Systematizing the One Health Approach in Preparedness and Response Efforts for Infectious Disease Outbreaks Proceedings of a Workshop (2022) / Chapter Skim
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6 Learning from the Past and Planning for the Future of One Health
6 Learning from the Past and Planning for the Future of One Health
Pages 83-108
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From page 83... ...
John Amuasi, co-chair of the Lancet One Health Commission and leader of the Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research-Kwame Nkrumah University of Science and Technology, Ghana, highlighted the role of prevention policy, the paradoxical nature of resistance to prevention efforts, and the impacts of health inequalities and prevention inequities on individuals and nations simultaneously facing poverty and viral outbreaks. Rajeev Venkayya, president of the global vaccine business unit at Takeda Pharmaceutical Company Ltd.
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Quick discussed current efforts to improve the data pathway to increase the speed with which infectious diseases can be detected and controlled. Highlighting that goals deemed impossible may actually be feasible, he provided examples of progress made in outbreak response over the past 50 years.
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Even the first few days of response to the initial case substantially affect the speed of exponential growth of an infectious disease. Thus, 1 Quick noted the "astute clinician" term applies to practitioners such as Carlo Urbani, the first person to identify severe acute respiratory syndrome (SARS)
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From page 86... ...
leveraging data to drive action. Strengthening this pathway involves generating robust data inputs, harvesting data, making data publicly available in real time, finding ways to navigate governmental efforts to limit data sharing, and incorporating novel sensors, Quick pointed out.
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Containing outbreaks requires informed, targeted action by a range of actors, and yet, our systems to detect and respond to outbreaks are w eak ‘100 days' Pandemic Timeline Critical Actions Response Actors Investigate and confirm Policy makers First case reported outbreak like governments and normative bodies Scale up testing, First cluster reported contact tracing Researchers in academia and NGOs Introduce voluntary First death reported quarantine Communicators like journalists and civic leaders Suspend movement Speed and scope of within containment zone Private sector emerging spread like business owners and Implement social execs distancing measures Emerging magnitude of General public (i.e., mortality and morbidity private citizens) Shut down travel FIGURE 6-1 Critical actions and response actors involved in outbreak containment.
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From page 88... ...
and FDA in containing it, and she outlined the activities of FDA's ASF work group. Sholly discussed key strategies of the FDA ASF Draft Response Plan.
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From page 89... ...
During this period, several countries in Eastern Europe reported the first cases of ASF, which were followed by uncontrolled spread and devastating impacts. While ASF is not a direct threat to human health or human food safety, it is a major threat to animal health and global food security, Huebner explained.
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From page 90... ...
Under the Food Safety Modernization Act Preventive Controls for Animal Food Regulation,6 FDA is involved in preventing food safety hazards of food for all animal species and applies primarily to non-farm facilities. The FDA ASF work group was formed in 2019 to coordinate a disease response plan promoting outbreak preparedness, said Huebner.
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From page 91... ...
FDA's ASF Draft Response Sholly remarked that the draft response plan created by the FDA ASF work group has been reviewed by FDA and USDA, and final comments are currently being addressed. The group used incident command prin ciples to manage an FDA ASF response.
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From page 92... ...
This includes collaborating with other stakeholders, identifying anticipated challenges specific to ASF, using risk mitigation, considering 8 The USDA African Swine Fever Response Plan: The Red Book is in draft form and can be found at https://www.aphis.usda.gov/animal_health/emergency_management/downloads/ asf-responseplan.pdf (accessed April 20, 2021)
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The success of any response plan relies on following the science and working as a team to expeditiously resolve an outbreak. Sholly closed with a quote from President Dwight Eisenhower, "In preparing for battle I've always found that plans are useless, but planning is indispensable." PARADOX OF GLOBAL POLICIES FOR PANDEMIC PREDICTION AND PREVENTION John Amuasi, Global Health and Infectious Diseases Research Group Kumasi Centre for Collaborative Research -- Kwame Nkrumah University of Science and Technology, Ghana Amuasi described the increase of national and individual challenges at the intersection of viral pandemic and poverty.
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From page 94... ...
health service delivery activities, such as surgeries for buruli ulcer, lymphatic filariasis, and trachoma. The Prevention Paradox Geoffrey Rose described a "prevention paradox" that occurs when population-based prevention health measures -- such as compulsory seatbelt laws, alcohol taxes, and mass immunization -- bring large benefits to a community but may offer little benefit to nonparticipating individuals (Rose, 1985)
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Prediction and Prevention Policy This prevention paradox can affect pandemic response mass vaccination efforts, said Amuasi. The challenge in working toward COVID-19 herd immunity when a percentage of the population resists being vaccinated underscores the utility of One Health approaches.
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Using an "upstream" approach, prevention policies often address the fundamental causes of health inequalities before problems arise, increasing the quality of human life and proving to be cost effective. However, prevention will not necessarily result in cost savings.
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This demonstrates that even strong global policies may be insufficient for the comprehensive global prevention of outbreaks, Amuasi stated. Given the prevention paradox, discrepancies in prevention efficacy emerge even within a country.
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He described the prototype pathogen strategy, which could substantially accelerate the time required to take a vaccine candidate to trial for an emerging threat. Outlining additional preclinical, clinical, and manufacturing efforts in preparing vaccine platforms in advance, Venkayya noted steps needed toward greater equity in vaccine access.
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From page 99... ...
This strategy involves identifying a range of tools and even candidate vaccines for virus families, reducing the time between a specific virus emerging as a pandemic threat and candidates being developed and taken to human clinical trials. Two years before COVID-19, Barney Graham and Nancy Sullivan outlined the exact approach that was later used to develop the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
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Venkayya remarked that this could substantially accelerate the timeline to clinical trial material and the availability of vaccines against an emerging pandemic threat. Preparing the Platforms A range of vaccine development activities can be performed in parallel to accelerate vaccine timelines, said Venkayya.
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This inequity has fueled consideration of the requirements to expand self-sufficiency in vaccine manufacturing beyond Europe, the United States, and parts of Asia to countries in all regions of the world. Venkayya noted that mRNA vaccines present an opportunity in this area.
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Venkayya remarked that shortening the vaccine development time will serve as a North Star for CEPI post-COVID-19. DISCUSSION Data-Sharing Considerations Given that improving outbreak response time relies on prediction c apability -- and that high-quality global data sharing is needed to advance that capability -- Daszak asked how the security of data and data users can be protected while simultaneously enabling better access to data.
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From page 103... ...
USDA has worked with their network of laboratories on testing and testing capacity in case ASF is ever detected in the United States. USDA's African Swine Fever Response Plan: The Red Book outlines sample collection and diagnostic testing and identifies the National Animal Health Laboratory Network in providing standardization and response testing for any foreign animal diseases.
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From page 104... ...
Balancing Vaccine Development Profitability and Access Equity Daszak noted that Venkayya is a member of the board of CEPI, which takes a global approach to vaccine development, as well as being employed by a for-profit pharmaceutical company. The vision of a broad vaccine platform toolkit would involve companies sharing development strategies, which could put profitability at risk, Daszak pointed out, and asked how for-profit companies will be able to collaboratively share data, frameworks, and access to the ultimate product.
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Daszak asked the speakers to identify some skills that will enable operationalization of a forward-thinking strategy; the predictive, global, and collaborative vaccine platform; and One Health on-the-ground approaches. Quick replied that a wide variety of skill sets can have an impact, so a student's particular talents will inform the areas that will be of most benefit to pursue.
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This adds diversity, and all forms of diversity bring value, said Daszak. Advancing a Proactive Response in a Political Climate Daszak noted that when a novel disease outbreak occurs, a global response requires governments' willingness to implement drastic response measures.
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Shifting to a Preparation Mindset for Disease X Daszak noted the difficulty in past years of mobilizing even a fraction of the billions of dollars spent on the COVID-19 response -- a disease that has cost trillions of dollars in losses -- toward Disease X preparedness.16 He added that "Disease X" is a misunderstood term, as some people erroneously believe that COVID-19 is Disease X, and therefore it is no longer necessary to prepare for it. Daszak asked how to shift the reactive psychology and instill the understanding in governments and taxpayers that funding Disease X preparedness can save billions of dollars and potentially millions of lives.
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From page 108... ...
Furthermore, the African Union is involved in efforts to speed vaccine development. Venkayya stated that this is the first time in history that tools are in place to be able to mitigate a pandemic threat; sustaining momentum could drive substantial change.
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