Editorial note: This article is the second of Fiji Sun's two-part series on One Health. The first can be found here.
Zoonotic diseases such as leptospirosis, COVID-19 and other communicable diseases have only recently made governments across the world acknowledge the importance of the One Health concept.
One Health encourages multisectoral and transdisciplinary collaboration to promote effective policies that relate to the “three healths”: animal, public and environmental health.
The aim of this focus is to build an understanding of why everyone’s (and everything’s) health is interdependent.
Fiji's Ministry of Health (MOH), Ministry of Agriculture and other stakeholders have held several dialogues focused on setting up the One Health concept of late, but there has been no formal and legal recognition of the One Health coordination mechanism in Fiji at the national level.
However, there have been pockets of engagement among stakeholders and ministries. The MOH is leading work on the community level to help address zoonotic diseases – diseases that are transmitted between animals and humans and vice-versa.
But this is still not enough. The need to have a national approach in addressing zoonotic diseases is paramount now more than ever, in the wake of both the global COVID-19 pandemic and recent leptospirosis outbreaks in Fiji.
What's working in Fiji?
Having a One Health set-up as an early warning system is not simple, says Simon Reid, an Associate Professor Global Disease Control at the University of Queensland.
The current taskforce, spearheaded by the MOH, holds collaborative meetings across the Biosecurity Authority of Fiji, veterinary services, Ministry of Agriculture and MOH.
However, these collaborative meetings are not always consistent.
“These meetings are really opening communication between them [stakeholders], so they develop an understanding of each other, and they build trust, and they build that ability to communicate,” Mr. Reid said.
“That is valuable so that when there is a problem, the communication between the partner is more likely to happen, and when it does happen it’s more likely to be productive because they understand each other.”
Mr. Reid said it would be difficult to justify directing resources towards something like a zoonotic disease program unless there’s evidence that the burden of the disease in people was so high.
“The burden of other diseases, particularly non-communicable diseases, is so high that’s where bulk of the resources go, and I guess it’s really looking at the benefits to the community of having these activities.”
“I think, even though I advocate for One Health, I wouldn’t advocate for money to be diverted. I think to run network where people come together and talk about problems and are willing to work together, that’s a very low cost, and that alone is a valuable resource,” he added.
Mr. Reid notes the serious of other public health concerns in the country, like preventive illnesses, which aren’t zoonotic in nature.
“In a situation like Fiji, it wouldn’t be the right decision to divert resources away from the critical care that’s required for people with heart disease and NCDs [noncommunicable diseases],” he said.
Why is the One Health concept important for Fiji?
For a small island nation like Fiji, becoming familiar with the One Health concept is important to understand how to tackle any pandemic, zoonotic disease or other health challenges that arise.
Having a One Health framework established would mean that stakeholders and line ministries could synergize their resources in promoting a healthier population more widely.
Permanent Secretary for Agriculture Vinesh Kumar said the One Health Concept avoided “information asymmetry” and allowed one team to work towards the public health goals.
“The One Health concept allows relevant stakeholders to form complementary policies where we can work together for a common goal, healthier animals, livestock, food sources, and population,” Mr. Kumar said.
COVID-19 and other zoonotic diseases have clearly shown that Fiji needs to have a resilient health infrastructure and an effective multisectoral approach in tackling these challenges.
In response to emailed questions, the Pacific Community (SPC) says global funding has been increased to help improve animal health and promote One Health priorities around the world.
“There is growing understanding of the One Health concept, which recognizes that the health and wellbeing of humans, animals and the environment are all interconnected,” SPC said.
The World Health Organization (WHO) regional office echoed similar sentiments, saying it was vital that governments continue to strengthen their health systems.
“As the COVID-19 pandemic has shown, the travel industry, education system and overall economy all rely on good health,” WHO said.
“So, we need to make the most of the unprecedented level of financial and political support that is currently available for the pandemic response to make sure that health systems across the Pacific are ready to face current and future health threats.”
The relevance of One Health for Fiji
Before the outbreak of the COVID-19 pandemic, Fiji and the globe were already dealing with diseases that directly relate to the relationship between animal and human health.
Studies have shown that up to 60% of the world’s human diseases – and 75% of new and emerging diseases – are zoonotic in origin.
Leptospirosis is one of these pathogens: a bacterium that spreads to humans through water and soil contaminated by infected animal urine. This zoonotic disease has claimed hundreds of lives in Fiji, and it continues to do so.
For this year, data released as of May 17 indicated that there have been 2068 laboratory-confirmed cases, 681 hospitalizations and 36 deaths because of leptospirosis.
Every year leptospirosis continues to threaten Fiji. Hence, the urgent need for a better way to undertake a multisectoral approach, including surveillance of emerging disease threats.
The One Health concept can help to bridge the gap on integrated surveillance between human health and animal health.
Focus areas for One Health
These include food safety, control of zoonoses and combating antibiotic resistance through plants and animals.
At the 8th Asia-Pacific World Workshop on Multisectoral Collaboration at the Animal-Human-Ecosystems Interface held in Bangkok, Thailand in April 2019, Fiji had listed five priority zoonotic diseases. They were:
2. Tuberculosis (TB);
3. Brucellosis (cases in humans are often neglected);
4. Arboviral diseases (dengue, chikungunya, zika); and
What do these zoonotic diseases have in common?
All zoonoses are transmitted from animals to humans or humans to animals.
Outbreaks of these zoonoses affect animal food production and welfare and can cause morbidity (suffering from a disease) and mortality (death from it).
In the case of leptospirosis, it is spread through pathogenic leptospires excreted in the urine of infected animals.
These infected animals include rodents, domestic pets, livestock, and wildlife.
In their response to inquiries for this article, the WHO noted: “Leptospirosis can spread when bacteria from the urine of an infected animal – such as a dog, cow, pig, or rat – gets into someone’s body. This can happen if the drinking water is contaminated or if dirty water splashes on someone’s eyes, nose, or mouth, or on a cut or scratch.”
Relevance of climate change
The Pacific Community reports that incidence of diseases such as leptospirosis have been known to increase during flooding and heavy rainfall.
With increased heavy rain and flooding in certain places, people tend to relocate. Most times, relocation means moving further inland where contact with wild animals is inevitable, an SPC spokesperson reported.
This increases chances of contracting zoonotic diseases such as leptospirosis.
Two severe floods in 2012 led to Fiji recording the highest number of leptospirosis outbreaks and fatalities to date. There were 576 reported cases and 40 deaths.
Seasonal rains and flooding provide ideal conditions for leptospirosis outbreak. Fiji’s tropical climate provides ample opportunity for bacteria to reproduce in mammals, including livestock, rats and domestic pets, which act as reservoirs for leptospirosis.
So why the urgent need for One Health?
Zoonotic diseases are spreading quickly now more than ever, and most are not confined to their country of origin. Take the outbreak of monkeypox, which began in Australia a few months ago but has now emerged as a global pandemic.
It is important to note that about 70 – 80% of infectious diseases in humans are caused by animals. These diseases emerge because their environments are being impacted by human encroachment, or because more wild animals are being taken away from their native habitats and are coming into direct contact with humans and other, domesticated animals, such as livestock.
There is also a growing concern that bacteria are increasingly becoming resistant to antibiotics because these powerful drugs have been overprescribed and over consumed for even minor maladies. These antimicrobial-resistant (AMR) bacteria may then infect humans and animals, and the infections they cause are harder to treat compared to non-resistant bacteria.
The WHO contends that approximately 700,000 people a year die because of AMR; that number could increase to 10 million people a year by 2050 if the situation isn’t brought under control.
The One Health framework could help Fiji effectively counter these outbreaks and AMR bacteria, by providing a robust health system, as well as policies that complement the roles of all stakeholders and ministries. But it needs the support of the Government –policy makers and politicians.
At the 8th Asia-Pacific World Workshop on Multisectoral Collaboration at the Animal-Human-Ecosystems Interface, member countries, including Fiji, were encouraged to seek high level political commitments for One Health.
Mr. Kumar said there were challenges because One Health required a multisectoral approach and keeping ministries and stakeholders engaged in the subject is difficult at times.
But for now, work related to One Health in Fiji has been exclusively driven by the MOH.
The working group set up by the MOH operates on the powers vested in the Minister and Permanent Secretary for Health. But this formal level of structure may not work for some ministries and stakeholders.
Hence, the need for an effective mechanism such as One Health to ensure a healthy human population, healthy animal population and a healthy environment.
This story was produced with the support of the Earth Journalism Network and was originally published by the Fiji Sun on September 10, 2022. It has been lightly edited for length and clarity.
Banner image: Cattle ranch in rural Fiji / Credit: Ronald Kumar.