The consequences of emerging infectious diseases (EID) can be catastrophic. For example, estimates show that H5N1 highly pathogenic avian influenza (HPAI) has already cost over US$20 billion in economic losses. If it causes an influenza pandemic, it could cost the global economy around US$2 trillion. Therefore, investments in preventive and control strategies are likely to be highly cost-effective. Concerns about the potential for a pandemic have spurred worldwide efforts to control the H5N1 virus subtype. This virus spread out of the People’s Republic of China in late 2003 into the rest of Asia, then Europe and Africa. The success of these control efforts is reflected in the fact that over 50 of the 63 countries affected by the virus have managed to eliminate it. But H5N1 HPAI remains entrenched in several countries, and it still has the potential to cause a pandemic. Participants in the December 2007 New Delhi International Ministerial Conference on Avian and Pandemic Influenza recommended that the international community draw on experiences with HPAI and develop a medium-term strategy to address EID. It was agreed that a better understanding of the drivers and causes around the emergence and spread of infectious diseases is needed, under the broad perspective of the ‘One World, One Health’ (OWOH) principles. A strategic Framework has been developed jointly by four specialized agencies—Food and Agriculture Organization (FAO), World Organisation for Animal Health (OIE), World Health Organization (WHO), United Nations Children’s Fund (UNICEF)—and by the World Bank and the UN System Influenza Coordinator (UNSIC) following New Delhi Conference.
The Strategic Framework focuses on EID at the animal–human–ecosystems interface, where there is the potential for epidemics and pandemics that could result in wideranging impacts at the country, regional and international levels. The objectives and outputs of the Strategic Framework focus on some of the major drivers for emergence, spread and persistence of EID. The approach pursued in the Strategic Framework builds on lessons learned from the response to ongoing HPAI H5N1 infections. The objective of the Framework is to establish how best to diminish the risk and minimize the global impact of epidemics and pandemics due to EID, by enhancing disease intelligence, surveillance and emergency response systems at national, regional and international levels, and by supporting them through strong and stable public and animal health services and effective national communication strategies. National authorities play a key role in devising, financing and implementing these interventions. Successful implementation will contribute significantly to the overall goal of improving public health, food safety and security, and the livelihoods of poor farming communities, as well as protecting the health of ecosystems.
There are five elements that drive OWOH strategic framework:
- Building robust and well-governed public and animal health systems compliant with the WHO International Health Regulations (IHR 2005) and OIE international standards, through the pursuit of long-term interventions.
- Preventing regional and international crises by controlling disease outbreaks through improved national and international emergency response capabilities
- Better addressing the concerns of the poor by shifting the focus from developed to developing economies, from potential to actual disease problems, and through a focus on the drivers of a broader range of locally important diseases.
- Promoting wide-ranging collaboration across sectors and disciplines
- Developing rational and targeted disease control programmes through the conduct of strategic research.
The overall objective of the Strategic Framework represents an international public good. Its achievement will involve the strengthening of existing animal and public health surveillance, response, prevention and preparedness systems at the country, regional and international levels. Priority interventions and associated actions will be established by officials at the country level and will be prioritized with the help of experienced international agency personnel. They will be identified based on known areas of risk (‘hotspots’) for disease emergence and on research findings that point to new risks. The Strategic Framework does not propose prioritization of diseases to target: instead it brings benefits to poor communities and agricultural sectors by reducing the risks of infectious diseases that are important locally—e.g. Rift Valley fever (RVF), tuberculosis (TB), brucellosis, rabies, foot and mouth disease (FMD), African swine fever (ASF) and Peste des petits ruminants (PPR). This approach will not only control existing and often neglected infectious diseases, but will also promote surveillance for EID at a grassroots level by embedding global concerns within a local context.
Based on these considerations, the following six specific objectives have been identified as areas for possible priority emphasis by national authorities:
- Develop international, regional and national capacity in surveillance, making use of international standards, tools and monitoring processes
- Ensure adequate international, regional and national capacity in public and animal health—including communication strategies—to prevent, detect and respond to disease outbreaks
- Ensure functioning national emergency response capacity, as well as a global rapid response support capacity
- Promote inter-agency and cross-sectoral collaboration and partnership
- Control HPAI and other existing and potentially re-emerging infectious diseases
- Conduct strategic research.
Implementation of the Strategic Framework will be guided by key principles. These include the adoption of a multidisciplinary, multinational and multisectorial approach; the integration of technical, social, political, policy and regulatory issues; and the establishment of broad-based partnerships across sectors and along the research-to delivery continuum. They will include engagement of wildlife and ecosystems interests, the human and veterinary medical community and advanced research institutions (ARI).
National authorities will be encouraged to build on national strategies on EID, to engage with the private sector to strengthen local capacity and to promote long-term sustainability. This would include the strengthening of institutions already in existence, in addition to the structures, mechanisms and partnerships that have been developed in response to the HPAI crisis among international agencies (FAO, OIE, WHO and UNICEF) such as UNSIC, the Global Early Warning and Response System for Major Animal Diseases including Zoonoses (GLEWS), the Global Framework for Progressive Control of Transboundary Animal Diseases (GF-TADs), and the FAO/OIE Crisis Management Centre (CMC-AH), as well as those developed between the public and animal health sectors. This would be done without requiring the integration or fusion of their roles. The Strategic Framework will encourage the formation of flexible, formal and informal networks of partners, and will promote pro-poor actions and interventions. In considering options for financing implementation, key issues to be addressed include the benefit–cost ratio of various options, long-term sustainability, public versus private goods and the political commitment of key stakeholders. Donor funding will be sought, including a combination of grants and loans.
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