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One Health: From Ideas to Action

REPORT on

Regional Workshop Held at Hyatt Regency Hotel

Port of Spain, Trinidad and Tobago

February 28th-March 1st 2013

Submitted by:

Dr. Sandra Vokaty

PAHO/WHO Subregional Advisor on Veterinary Public Health

PAHO/WHO Office in Trinidad and Tobago

March 2013

TABLE OF CONTENTS

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CONTENTS CONTENTS ..................................................................................................................................................... 2

GLOSSARY OF TERMS AND ACRONYMS ........................................................................................................ 5

EXECUTIVE SUMMARY .................................................................................................................................. 6

INTRODUCTION ............................................................................................................................................. 8

WORKSHOP OBJECTIVES AND EXPECTED OUTCOMES ................................................................................. 8

WORKSHOP PARTICIPANTS AND FACILITATORS ........................................................................................... 8

METHODOLOGY ............................................................................................................................................ 9

WORKSHOP ACTIVITIES ............................................................................................................................... 10

OPENING CEREMONY ............................................................................................................................. 10

SESSION 1: Introduction to One Health ................................................................................................. 10

SESSION 2- Panel Discussion - One Health Issues – Caribbean Perspective ........................................... 11

Videos .................................................................................................................................................. 15

SESSION 3 Panel Discussion No 2: International examples of One Health approaches ......................... 16

SUMMARY LIST OF PRIORITIES ............................................................................................................... 25

Facilitator Observations .......................................................................................................................... 26

RECOMMENDATIONS ................................................................................................................................. 28

Next Steps: .......................................................................................................................................... 29

CONCLUSIONS OF THE WORKSHOP ............................................................................................................ 29

WORKSHOP EVALUATION ........................................................................................................................... 30

APPENDICES ................................................................................................................................................ 31

Appendix 1 List of workshop speakers and participants ................................................................ 31

Appendix 2 - Background information on One Health........................................................................ 44

Appendix 3 - Workshop Agenda ......................................................................................................... 47

Appendix 4 - Opening Ceremony Speeches ........................................................................................ 51

Appendix 5 - A Brief Introduction to One Health ................................................................................ 57

APPENDIX 6 - Ms. Patricia Aquing CARPHA/CEHI, Unit Manager Environment Health ..................... 71

Appendix 7 Professor Abiodun A. Adesiyun....................................................................................... 73

Appendix 8 - Dr. Martín S. Minassian - International examples of One Health approaches - OIE .... 78

Appendix 9 - Dr. Joseph Annelli ........................................................................................................ 80

Appendix 10 – Dr. Cedric Lazarus, Livestock Development Officer .................................................... 85

Appendix 11 – Work Group Questions ................................................................................................... 90

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Appendix 12 – Craig Stephen: Recap of Day 1 .................................................................................. 91

Appendix 13 One Health Tool Kit ...................................................................................................... 93

Appendix 14 Workshop Evaluation .................................................................................................. 94

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Acknowledgements

PAHO/WHO acknowledges the generous support of the Public Health Agency of Canada, the United

States Department of Agriculture, the Canadian Food Inspection Agency, the Food and Agriculture

Organisation of the United Nations and the World Organisation for Animal Health (OIE) in providing

financial resources for this workshop. It also expresses it appreciation to Veterinarians without Borders

Canada, that provided the workshop facilitators as volunteers as well as their airline tickets.

Special thanks to Barry Stemshorn and Craig Stephen who provided their expertise as facilitators on a

voluntary basis. Also thanks to Nick Previsich and Erin Leonard of PHAC who were very instrumental in

organizing the workshop.

Thanks to Lynette Dolly and Karen Bart-Alexander for their rapporteur services to produce the report.

And great appreciation to Annmarie Seetaram and Debra Banfield-Roach of PAHO/WHO Trinidad and

Tobago who provided logistical support.

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GLOSSARY OF TERMS AND ACRONYMS

APHIS Animal and Plant Health Inspection Service

CABI Centre for Agricultural Bioscience International

CARICOM Caribbean Community

CEHI Caribbean Environmental Health Institute

CFIA Canadian Food Inspection Agency

CIAS Caribbean Invasive Alien Species Network

CMO Chief Medical Officer

CPHD Caribbean Plant Health Directors meeting

CARPHA Caribbean Public Health Agency

CSF Classical Swine Fever

DALYs Disability-adjusted life years

FAO Food and Agriculture Organisation of the United Nations

IICA Inter American Institute for Cooperation on Agriculture

NCD Non communicable disease

OAS Organization of American States

OH One Health

OIE World Organisation for Animal Health

PAHO/WHO Pan American Health Organisation/World Health Organisation

PANAFTOSA Pan American Foot and Mouth Disease Centre (of PAHO/WHO)

PVS Performance Vision Strategy (OIE assessment tool)

PTV-1 Porcine Teschovirus 1

PHAC Public Health Agency of Canada

RIMSA Interministerial meeting on Health and Agriculture in the Americas

USDA United States Department of Agriculture

UWI University of the West Indies

VBD Vector Borne Diseases

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EXECUTIVE SUMMARY

The Pan American Health Organisation’s Veterinary Public Health Program organized a sub-regional

workshop entitled “One Health: From Ideas to Action” on February 28 and March 1st, 2013 in Port of

Spain, Trinidad and Tobago. The workshop was a collaboration between PAHO/WHO, the Public Health

Agency of Canada, the Canadian Food Inspection Agency, the United States Department of Agriculture –

Animal and Plant Health Inspection Service (USDA-APHIS), the World Organisation for Animal Health

(OIE) and the Food and Agriculture Organisation of the United Nations.

Thirty eight (38) delegates comprising senior decision makers in Public Health, Animal Health and the

environment from eight Caribbean countries participated in the workshop, as well as technical personnel

from CABI, CARPHA, FAO, IICA, OIE, PAHO/WHO, USDA-APHIS and Ross University, St. Georges

University and the University of the West Indies. Participating countries included the Bahamas,

Barbados, Grenada, Guyana, Jamaica, St. Lucia, Suriname and Trinidad and Tobago. The workshop

facilitators were Dr. Barry Stemshorn of the University of Ottawa and Dr. Craig Stephen of the Centre for

Coastal Health and the University of Calgary.

Participants worked in groups to develop One Health project ideas and action plans to create greater

awareness in their countries and the Caribbean region. The projects proposed for further development

included:

(1) Application of a One Health approach to vector borne diseases. This project idea focused on threat

identification and management, including strengthening surveillance and diagnostic capacity,

standardisation of test protocols, the development, selection, and implementation of intervention

strategies, as well as coordinating emergency response mechanisms. The group suggested exploration of

disease transmission mechanisms for vector borne diseases as well as the development of

communications strategies. Examples of vector borne diseases included dengue hemorrhagic fever and

leptospirosis.

(2) Sustainable land and water use: In response to environmental resource conflicts for small island

developing states, the project idea was to conduct a situational analysis of existing policies and practises

in the Caribbean regarding the issues of sustainable land and water use, to determine which existing

activities could benefit from a One Health approach, or where gaps exist that could be addressed with a

One Health Approach. This would then provide a basis to develop future larger projects.

(3) Development of mechanisms to integrate surveillance information to be used in decision making.

The integrated surveillance system would include public health and animal health surveillance data as

well as climactic data in order to monitor and detect trends, as well as to predict outbreaks. This project

would help to increase compliance with International Health Regulations core components 10 and 11.

(4) Development of Caribbean regional and national One Health policies. This work group decided that a

policy framework would be necessary to break down the barriers between the agricultural, environmental

and health sectors that currently prevent multisectoral collaboration. The group proposed to formulate

and circulate a One Health concept note to workshop participants and Permanent Secretaries in the

Ministries of Health, Agriculture and the Environment, for review and feedback. The One Health policy

would be discussed at CARICOM meetings of Chief Veterinary Officers and Chief Medical Officers, in

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preparation for adoption by Ministers of Health, Agriculture and the Environment at COHSOD and

COTED meetings respectively. CARICOM’s assistance would be requested in order to develop the

Caribbean One Health policy. Action plans would then be developed in order to implement the policies.

At the national level, countries were encouraged to use existing multisectoral committees to promote and

adopt One Health approaches. Rather than creating new structures, instruments such as memoranda of

understanding could be used to facilitate intersectoral collaboration.

The participants agreed to create more awareness and understanding of One Health when they returned to

their organisations and countries. Some of their commitments included:

(1) Advocacy: briefing their Ministers, Permanent Secretaries, and supervisors on the workshop and

promoting a One Health approach in their countries.

(2) Communicating the One Health approach through their professional networks and peer groups, such

as NGOs, professional bodies and organisations (veterinary and medical Associations), friends, civil

society, businesses, and IHR focal points.

(3) Adding Value - Examining the ways in which the One Health approach can be introduced into

existing activities and projects and add value to multisectoral groupings through this approach

(4) Academia – The university representatives gave a commitment to apply a One Health approach into

studies through the curriculum design. They also promised to generate some research to provide

examples for areas of One Health. However, some funding would be required.

(5) CARPHA is well positioned to be a leader in the One Health Approach as it is in its formative stages

and can choose to have a more integrated approach as relevant regional organizations have come under

one umbrella.

At the end of the workshop the Evaluation Report showed that the objectives were achieved because :

• 92.2% of the participants agreed that there was an increased awareness of how to apply the One

Health approach to issues at the human-animal–environmental interface in the Caribbean region.

• 94.4% of the participants agreed that a Caribbean network of professionals in human, animal and

environmental health who are motivated to champion, promote and utilize an intersectoral One

Health approach had been created.

• 84.6% of the participants agreed that the One Health priority issues and activities were brought to

the fore and recognized for further development into a regional proposal.

The program content and delivery were very highly rated by the majority of the participants as being

relevant, having met expectations, well organized, effectively presented, provided opportunities for peer

interaction and presenter/ participant interaction, and useful.

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INTRODUCTION The Pan American Health Organisation’s Veterinary Public Health Program organized a sub-regional

workshop entitled “One Health: From Ideas to Action”, in Port of Spain, Trinidad and Tobago on 28

February and 1 March 2013. One Health is a term used to represent the collaborative efforts of multiple

disciplines working locally, nationally and globally to attain optimal health for people, animals and the

environment. The workshop was a collaboration between PAHO/WHO, the Public Health Agency of

Canada, the Canadian Food Inspection Agency, the United States Department of Agriculture – Animal

and Plant Health Inspection Service (USDA-APHIS), the World Organisation for Animal Health (OIE) and

the Food and Agriculture Organisation of the United Nations.

WORKSHOP OBJECTIVES AND EXPECTED OUTCOMES The workshop had the following objectives:

(1) To inform, discuss and solicit ideas on how to apply the One health approach to issues at the

animal-human-environmental interface in the Caribbean region.

(2) To create a Caribbean network of professionals in human, animal, and environmental health

who are motivated to champion, promote and utilize an intersectoral One Health approach.

(3) To recognize One Health priority issues and activities in the Caribbean for further development

into a regional project proposal.

Expected workshop outcomes included:

(1) Increased awareness of One Health approach among Caribbean policymakers and professionals in

public health, environmental and agricultural health.

(2) A Caribbean network of professionals in human, animal and environmental health who are

motivated to champion, promote and utilize an intersectoral One Health approach to solving

Caribbean issues where human, animal and environmental health overlap.

(3) A list of One Health priority issues and activities for further development into a regional project

proposal for donor funding.

WORKSHOP PARTICIPANTS AND FACILITATORS Due to the intersectoral nature of the One Health theme, representatives of the veterinary services, the

Ministry of Health and Ministry of the Environment were invited from the Bahamas, Barbados, Grenada,

Guyana, Jamaica, St. Lucia, Suriname and Trinidad and Tobago. Technical professionals were invited

from the Public Health Agency of Canada, the FAO, OIE, IICA, Caribbean Public Health Agency, University

of the West Indies, St. Georges University, USDA-APHIS and CABI Bioscience. The list of facilitators and

participants appears in Appendix 1.

Workshop facilitators included Dr. Barry Stemshorn of Ottawa University and Dr. Craig Stephen of the

Centre for Coastal Health in British Columbia and the University of Calgary.

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METHODOLOGY Background information on One Health appears in Appendix 2. The workshop agenda appears in

Appendix 3. The activities included mini lectures, two panel discussions, two video presentations and a

great deal of small group and plenary discussions. Participants were placed in four groups, randomly

chosen, to determine various aspects of One Health and to discuss those areas of importance that would

move One Health forward in the Caribbean region and then share their thoughts in the plenary session.

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WORKSHOP ACTIVITIES

OPENING CEREMONY Speakers in the Opening Ceremony were the PAHO/WHO Representative in Trinidad and Tobago, the

Consul in the Canadian High Commission in Trinidad and Tobago and the Chief Medical Officer of

Trinidad and Tobago. The Opening Ceremony speeches are found in Appendix 4.

SESSION 1: Introduction to One Health

Dr. Craig Stephen, Director, Centre for Coastal Health, Faculty of Veterinary Medicine and Faculty of Medicine, University of Calgary. Dr. Craig Stephen gave a background of his entry to One Health and delivered a power point

presentation to demonstrate and explain One Health. He stated that while he was in grade school

people were concerned with dying from nuclear war, in University from pollutants, the environment

with SARS came late. While doing his PhD he felt nature was out to get him. He added that Hippocrates

had said “know the person that has the disease more than the disease that has the person”.

One Health was defined as “the collaborative effort of multiple disciplines working locally nationally and

globally to attain optimal health for people, animals and our environment.” He added that “Our Health

was dependent on interactions with the world around us “

Dr. Stephen spoke of how humans moved through different stages of health with chronic diseases and

the age of emerging diseases. When they thought they had won the war on infectious diseases, along

came HIV and SARS that drove people to work together. While the deaths may not have been many

from SARS, the economic impact was great. Globally, one had to look at the social and environmental

systems and the travel of humans from one country to the next as diseases could be transmitted

through travel.

Aquaculture was becoming the next big food production and one had to look not only at how to

produce but the impacts of disease. Bats transferred Nipah virus to pigs. When trees were cut with

deforestation, the bats moved to continue to life in trees. Endemic zoonotic agents killed people who

got diarrhoea as there was a link between diseases, food and poverty.

One Health moved upstream to look at the socio-ecological system for solutions. More than the absence

of disease, one had to look at meeting the needs for daily living, being resilient to stress and change and

being able to meet expectations. Attention needed to be paid to the social and environmental

determinants of health. Climate change and the rise in sea levels, had affected fisheries and arable land

for farming. One Health was not just about people, one also had to look at wildlife such as frogs, bats

and other creatures.

The objective was reciprocal care of human, animal and environmental health. The emphasis was on

collaboration and cross-sectoral solutions. It must be action oriented. The rationale included more

efficient use of expertise and resources, and prevention being cheaper than treatment. Most current

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pressing health issues occur at the interface, including pollution, emerging infectious diseases, climate

change, food and water safety and security. Doctors and Vets had to get together. Health the

environment, public health, animal health, food and agriculture all must get together. Dialogue must

continue and it must be determined how to create an integrated approach. One Health provided a

systems approach for systemic problems. (See Appendix 5 PP presentation)

SESSION 2- Panel Discussion - One Health Issues – Caribbean Perspective Moderator: Dr. Barry Stemshorn, Veterinarians Without Borders (VWB) Canada University of Ottawa

Panellists: Ms. Patricia Aquing, CARPHA, Unit Manager Environmental Health (former CEHI).

Professor Abiodun A. Adesiyun, Director and Professor of Veterinary Public Health, School of

Veterinary Medicine, University of the West Indies.

Dr. James Hospedales, Executive Director, Caribbean Public Health Agency (CARPHA).

Following is a summary of the presentations by the panelists:

Environmental health issues in the Caribbean: Ms. Patricia Aquing, CARPHA, Unit Manager

Environmental Health.

Ms. Aquing’s discussion centered around “the environment as a determinant of health: controlling

or managing environmental factors which impacted on human health; improving environmental

parameters in order to reduce the impact on human health” The approach to one health must be

people centered.

One of the main concerns was water quality and availability. The government of Trinidad and

Tobago had 32 pieces of legislation dealing with water and 6 agencies looking at water resources.

Other concerns were air quality (which included the effects of tobacco smoke) climate change,

disaster preparedness, hazardous materials and hazardous waste, land use planning, liquid waste

disposal, medical waste management and disposal, noise pollution, occupational health and

industrial hygiene, water illness prevention, water quality, solid waste management, toxic chemical

exposure and vector control. How liquids were disposed of with toxic chemicals getting into the

water must be examined. Water was both a political and business issue and considered the new oil

as in many countries water was scarce. In the Caribbean, water was under serious threat as it was

scarce in countries such as Antigua, Barbados, Grenada, and the Bahamas. In 2009, there were

drought conditions in the Caribbean and schools had to be closed, tourists packed their bags and

left, plants malfunctioned. Additionally, 75% of wastewater was untreated and beach pollution was

the result of stressed water. There were also distribution and source issues that arose from poor

water resource management.

There must be behaviour change among the population to deal with health issues. Dengue was the

result of not managing solid waste properly. There was a need to link environmental health data to

epidemiological data. Working through the multilateral environmental agencies, frameworks for

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action could be developed. Multilateral Environmental Agreements provided an international

framework for guiding national and regional actions.

CEHI was working with 13 countries in the region looking at a framework for integrated water

resources management. (See Appendix 6)

Animal Health issues in the Caribbean: Professor Abiodun A. Adesiyun, Director and Professor

of Veterinary Public Health, School of Veterinary Medicine, University of the West Indies.

Various animal diseases, zoonotic and not zoonotic were discussed. Most of the English Caribbean is

free of rabies. However, rabies is found in wildlife in Grenada, Guyana, Suriname and Trinidad and

Tobago, and sometimes spreads to domestic animals. Dog rabies is found in Belize and Haiti, where

it can spread to humans through dog bites. The suggested approach was import control,

vaccination, and control of the mongoose and vampire bat populations. It may be necessary to

vaccinate small ruminants and equines as well as cattle.

Leptospirosis was widespread in livestock and pet animals in the region. The role it played in

livestock production was great as even vaccinated animals were becoming infected and sick. There

was a potential threat to the tourist industry upon which much of the Caribbean depended. The

approach to be taken to Leptospirosis control was through vaccination and rodent control. The

prevalent serovars in animals need to be identified and compared to the serovars in commercial

vaccines. Some vaccine development may be necessary.

Brucellosis existed in water buffalos in Trinidad. The RB51 vaccine had been found ineffective in

water buffalo. The recommended approach was test and slaughter. Toxoplasmosis was affecting

small ruminants. There was a need for new studies.

Ticks and tick-borne diseases affected domestic and wild ruminants including cattle, sheep, goats,

antelope and buffalo. Tick borne diseases, particularly heartwater had an effect on the economy as

some of those animals provided meat especially in the small islands.

Salmonellosis also occurred in the region and the problem existed in piglets, lambs, calves, kids, and

also in the poultry industry. Salmonella may also be present in imported eggs or day old chicks.

CAREC used to do testing of viral diseases, but that was hardly done anymore.

Common food borne pathogens included Listeria, Campylobacter and Salmonella. Screwworm was

found in Jamaica and Trinidad and Tobago. Classical Swine Fever was present in Cuba, Haiti and the

Dominican Republic. Teschen’s Disease was found in pigs in Haiti, with neurological signs. Although

Classical Swine Fever and Teschen’s are not zoonotic, their presence poses a risk to neighbouring

Caribbean countries.

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Some physicians were not very familiar with the diagnosis, prevention and treatment of zoonotic

diseases.

A One Health cross sectoral approach was required to deal with the various diseases that were

carried cross borders. It was also important to identify the diseases that cut across the region and

institute strategies and preventive measures. (See Appendix 7)

Public Health issues in the Caribbean: Dr. James Hospedales, Executive Director, Caribbean

Public Health Agency

Dr. Hospedales, who assumed his present post eight days before the workshop, saw planet earth as

overheating and overpopulated. He suggested persons read the book “The Unnatural History of the

Sea” and one would understand what was happening in the world. There was disregard for the

planet and grave public health issues in the Caribbean. Only six to seven Caribbean countries had

public health laboratories.

He added that training was being undertaken but public health training was highly technical and did

not provide exposure to collaboration and negotiation skills which would help to meet the need to

work together across interests.

There were also non-communicable diseases such as hypertension, obesity and diabetes that were

major concerns along with HIV and other infectious disease like HIV, yellow fever, leptopirosis along

with food borne diseases which created even more hardships. There was a need for partnering

across disciplines. Work was being done with food producers to change to healthier oils away from

transfat acids.

The E coli outbreak brought some disciplines together to lessen the threat to society. Some

agencies did not work well together and wanted to protect their turf but they must get together.

CARPHA would work to bring the various disciplines together to promote partnership. This panelist

broached the subject of violence as a disease that was widespread in the Caribbean and drew

attention to the roles of information systems and public health leadership.

Dr. Hospedales ended with a biblical quotation Philippians Chapter 2 Vs. 4 “Look not everyman on

his own things, but every man also on the things of others.”

PLENARY SESSION:

Following the presentations by the panellists, the following points were raised:

A systems approach was the way of the future but people were still working in silos and had not

made serious efforts to apply the systems approach to diseases and health. The talk was there

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at the higher levels but, not at the front line. Behaviour modification was required. A systems

approach was easy to say but more challenging to do. The way to get it done was to make

connecting somebody’s job so that there will be commitment. In Tobago they did submit

information on vector control but the legislation was not there. A systems approach would

highlight the deficiency. Clinical practitioners were making diagnoses using case definition but,

patient record keeping and surveillance were not discussed outside of medical schools.

Programmes/projects - There was a need to develop programmes not just projects, as projects

had a finite shelf life and if programmes were developed they would be more sustainable.

When a project was ended, the information should be transferred to make it more sustainable.

Silos - At the Rio Conference 1992, UNDP had an agreement from all countries to set up

Sustainable Development Councils to guide policy and work together. There was a need to

bring the sectors together.

Behaviour modification – There were numerous pieces of legislation that overlapped, what was

needed was enforcement and compliance. More complex than the legislation was individual

commitment. Moral suasion and public awareness were also required.

Lab Facilities – In many instances there was no lab support to make diagnosis in cases of dengue

and leptospirosis. As a result, many cases went undiagnosed.

Turf – Getting people to work together was challenging as they protected their turf. Although a

Minister might commit to implementing the One Health approach, that did not make it likely to

happen. One sector would not allow investigation to take place by another sector. A bottom up

approach would be required to make it happen. An attempt was made in 2004 by CAREC to

bring professionals together to deal with food borne diseases. Teams were developed and

Jamaica was fairly successful. At the higher level there was a need to determine what prevented

people from working together. It was also pointed out that various countries had different

interests.

Income distribution – Zoonotic challenges with food borne diseases overlap with socio

economic challenges. Less than 1% of the world population owned more than 37% of the world

resource and there were disparities in the use of resources. There was a demonstrated

relationship between waste disposal actions at the lower socio-economic levels and food borne

diseases. Systems and procedures should be set in place to mitigate the factors and change

behaviour.

Research level – There was more interaction at the research level. Funding was required for

research but many countries had moved out of the “poor class” and considered rich so that

funding was not being received. In some instances all the components were available,

technology, library, data base, PR but they were not able to dissect the findings to put them

together. There was no communication specialist to market the information as they did not

understand the psychology of how people received and treated information. No matter how

great the scientific work is, if it is not communicated and marketed, it will be lost.

Social media – Social media should be used to get the message across. An example was given in

India of a farmer being given a basic mobile phone so that market prices could be

communicated to him. The middle man could no longer take advantage of him as he had the

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information at hand with which to negotiate price. One had to look at the most efficient way to

get the message across. There was a significant gap between research findings and the

popularization of those findings. The targets to be reached have not been sufficiently dissected.

Every research program should have a strong communication component.

Sample transhipment - Jamaica, Barbados and Trinidad had good leptospirosis laboratories.

Several countries had to ship samples to another country for testing but this was very

challenging. In some instances Customs refused to allow transhipment, and calls had to be

made before it would be permitted through. It was also difficult to get airlines to agree to

transport samples. More education had to be done with doctors to encourage them to work

quickly on acquiring samples and sending them for testing.

Relationship Building- The observation was made that more focus should be placed on team

building among the younger professionals. An example was given of a Professor of Medicine

who was invited to speak to veterinarians and did not know what he should tell them.

Videos

A Video on One Health produced by Public Health Agency of Canada was shown during the lunch

break. It gave examples of the multidisciplinary nature of One Health. It discussed climate

change, diseases and the environment. It revealed new insights to health. Pandemic H1N1

virus that affected pigs and humans was discussed. The CDC in the US had set up a one health

umbrella to have people working together. Support for the One Health concept in Manitoba,

Quebec and other Canadian provinces were explained. One Health was the catalyst for change

as diseases posed many challenges.

The video emphasized the need to have healthy people, living healthy lifestyles and wanting to

solve the world’s health problems by understanding each other’s cultures and breaking down

boundaries.

Video No 2 – A World United Against Infectious Diseases: Cross Sectoral Solutions was about

the Avian Influenza H5N1 Virus outbreak in Thailand and showed a young boy who became

infected from sick chickens and was hospitalized. The video highlighted the importance of

collaboration between human and animal health sectors and across countries and continents in

preventing the spread of the disease. Key features of the One Health approach included better

coordination and more trust, improved surveillance, early detection, proper diagnosis and

timely treatment. The video was produced for and distributed at the Prince Mahidol Award

Conference in Bangkok, Thailand in January 2013.

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SESSION 3 Panel Discussion No 2: International examples of One Health

approaches Moderator: Dr. Craig Stephen, Director, Centre for Coastal Health, Faculty of Veterinary Medicine and

Faculty of Medicine, University of Calgary.

Panelists:

OIE: Dr. Martin Santiago Minassian

APHIS: Dr. Joseph Annelli

FAO: Dr. Cedric Lazarus

• OIE: Dr. Martin Santiago Minassian - International examples of One Health approaches -

Veterinary Services as a Global Public Good

Dr. Martin Santiago Minassian focused on the veterinary services as global public goods and their

activities as public investment priorities. This applied particularly to the control and eradication of

infectious diseases which have international and intergenerational benefits. Failures in one country

could endanger other countries and the planet. Good veterinary governance prevents animal and

zoonotic diseases from affecting animal and human health, poverty, food security and safety and

trade.

The OIE PVS Tool evaluates 4 components of the veterinary services, i.e. (1) human, physical and

financial resources (2) technical authority and capability, (3) interaction with stakeholders and (4)

access to markets. The PVS Pathway includes a PVS evaluation of the veterinary services and a PVS

gap analysis. The results could be used to prepare specific investment programs to improve their

veterinary services. Legislation is a critical component of the veterinary services role as a

competent authority.

A pilot project for the development of a specific OIE PVS Tool for “One Health” was currently in

progress, with the participation of the WHO. This was intended to improve the effects of the

activities of the Veterinary Services on Public Health, focusing on the collaboration and shared

responsibilities with the Competent Authorities in Public Health. (See Appendix 8)

• USDA APHIS: Dr. Joseph Annelli - Enabling Policy Environments for One Health Approaches:

View from the Public Sector

This presentation began with examples of the OH approach in action and used the USDA

involvement in non-traditional and non-program animals and disease agents as a reference

point. One Health was the major driver to change corporate culture. He then went on to show

the incidence of Reported Human Infections with Influenza A Variant Viruses in the US from

2005 to 2012 and explained that influenza required a One Health approach due to its complex

ecology and risk of interspecies transmission. This was followed by an explanation of the

Influenza A (H3N2) virus and its movement between pigs and people. He discussed the role of

swine fairs in outbreak of this virus in the US between July to October 2012 and explained how

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the One Health approach was used in investigation and reporting, as well as developing

prevention policies, communication tools and joint outreach activities. The public health

guidance recommended that people at high risk for serious flu complications should avoid pigs

and swine barns at agricultural fairs during 2012. Animal health measures included examination

of pigs as they entered the fair, monitoring swine health during the fair, prompt isolation of sick

pigs and collecting samples for laboratory diagnosis, and prompt reporting of illness by the fair

organisers. (See Appendix 9)

• FAO: Dr. Cedric Lazarus - One Health in FAO- Using a multidisciplinary framework to address

food security and decrease hunger

Dr. Lazarus began with an introduction to the strategic objectives of FAO and Food Security

then proceeded to show that the organization adopted a one health approach on a regular basis

throughout the agrifood chain from agricultural inputs to consumers. Feed can be contaminated

from bird droppings, or contamination can take place during transportation to slaughter. Wild

meat was an important source of protein in some countries and food safety and security must

be addressed. The risk of eating Apes who may carry the Ebola virus must be considered.

Pesticides and other chemicals were not controlled in some countries where the laws were

archaic. One Health would assist in improving food quality.

One Health has been adopted by the FAO in Rome but was still in its infancy in the organization.

Dr. Lazarus explained how the FAO was attempting to operationalize One Health through

hosting of a workshop in 2011, the establishment of an interdisciplinary working group in 2012

and extensive ongoing consultations and focus group discussions to further develop the OH

methodology and mainstream it in FAO. FAO had been examining key areas of its work to

determine how they would benefit from OH operations. They had also been conducting

thematic analysis and he articulated the conceptual themes of One Health and showed how

they related to the operations of FAO. These conceptual themes were described as political will,

leadership and governance; partnership and communication; cross cutting programmes and

policies; capacity and infrastructure; and concept testing and validation. They worked to collect

data for evidence based polices to be developed.

The next steps for the FAO were defined as consultations with the Caribbean stakeholders,

finalization and validation of the FAO concept and development of a mainstreaming process for

One Health. Dr. Lazarus completed his presentation with six examples of the OH concept at

work in the FAO such as:

Antimicrobial resistance of food-borne pathogens

Wild meat, livelihoods and sustainability

Task Force on wild life and ecosystem health

Wildlife investigation in livestock disease and public health

Pesticides

Aquatic animal health and food safety (See Appendix 10)

18

Plenary Discussion

One Health approach: opportunities and considerations for One Health approaches in the Caribbean –

participants.

A summary of discussions on the presentations delivered are as follows.

• Funding constraints prevented third world countries from getting involved in projects and

programmes to enhance One Health. Funding was not available for animal health research. It

was emphasized that the FAO was not a funding Agency. FAO can partner with UWI and other

Agencies to apply for project funds. Funding can be sought from non traditional funding

countries like Norway, Sweden, or Australia. In the FAO, most of the funding went to Asia and

the former Soviet Union. Countries such as the Caribbean were considered not poor enough to

receive funding. The OIE can assist countries to connect with donors to acquire funding for

improving veterinary services.

• Strategic Planning – The approach to strategic planning for One Health should be adopted. The

OIE should be invited to assist in developing a gap analysis and with small wins One Health can

be implemented. USDA was giving significant amounts of money to FAO and had a roundtable of

groups that received funding for projects. The Defence Reproduction Agencies were putting

together a project for OH. Leadership training can be facilitated by USDA to create change

agents for OH in countries. Each country needed to do its own self assessment and develop a

strategic plan

• Climate Change –It was suggested that one health could be incorporated into climate change

adaptation projects. Issues dealing with the global environment were funded by UNDP under

the Global Environment Facility and one can go to the website and see what was available there.

• Funding: - A 14 million grant was given by an Agency for coastal areas and One Health activities

or projects could be included in such ventures. Other focal areas included land management,

bio diversity and water issues. Small grants programmes were sometimes being given but the

Caribbean was experiencing donor fatigue and there was a need to map donor funding activity

in the region. The Germans had moved in to assist in climate change concerns and approaches

could be made to source funds from them. The Caribbean had graduated out of that range of

donor funding because it is considered too rich. The private sector must also be included in

sourcing funding. There was need for a strategic approach to resource mobilization. It was

recommended that donor agencies take a One Health approach when funding.

• Training – There was a need to train for tomorrow, persons in the one Health concept. It was

felt that there were large gaps existing in human capacity.

• Collaboration – Getting people to work together in a team approach dealing with common

issues was necessary. A project format for training at country level was required as something

had to be done with food borne diseases.

19

WORK GROUP DELIBERATIONS

Work groups identified priority issues for a One Health approach and then each group selected one issue

for further discussion and development. The priority issues for the application of the One Health

approach were derived from the discussions of the four working groups and from the Work Group

Questions (See Appendix 11). The following is summary of the workgroup deliberations.

Work Groups # 1 & 3 combined

Group 1: Suggested issues for One Health approach:

1. Cooperation and coordination:

Sharing and integrating data and databases

Neglected tropical diseases

Biosafety

Invasive species

Data sharing – OIE and International Health Regulations

Food borne diseases

2. Surveillance and diagnosis

Standardised diagnostic procedures and quality assurance

Capacity building (vet diagnostic labs).

3. Occupational health

Who is susceptible

Taking action

Based on a consensus generating approach, the group agreed that: 'Threat identification and

management using Vector borne disease as an example’ was a problem which could be addressed

by the application of the One Health Approach.

Project idea: Application of a One Health approach to Vector borne diseases

In moving further to identify a list of issues which will require actions to address the problem cited

above, (by using the one health approach), groups 1 and 3 joined efforts. The collaboration resulted

in the identification of the following list of priority actions to address the problem cited.

Priority Actions

Priority Actions

Multisectoral, multidisciplinary, multinational coordination of efforts

A review of the existing situation of vector borne diseases in the Caribbean using current

data, and adopting a standardised methodology.

Across all aspects, a gap analysis needs to be performed, ensuring that the variance in

availability and capacity of diagnostic laboratory facilities between countries is addressed.

Standardization of methodologies for surveillance and diagnostic tests. Standardization of

laboratory protocols between countries was useful for uniformity and for comparing results

20

across countries. Diagnostic procedures need to be enhanced and standardised. Some

countries have public health laboratories that do not accept samples from animals

Creation of Centres of Excellence for diagnostic testing for Vector Borne Diseases. There are

countries within the region which possess vast and long standing experience in the use of

laboratory based technologies to manage specific vector borne diseases. These centres can

be supported to become centres of excellence related to the specific disease they are

currently primarily engaged in.

Surveillance to generate baseline data and identification of wild life reservoirs

Exploring disease transmission mechanisms for VBDs

Developing, selecting, and implementing VBD intervention strategies, including

environmental control to reduce vectors.

Capacity building on One Health for technical and human resources. Targeted training

workshops should be conducted.

A model was needed for implementation as buy-in was required at the regional level.

Model was described as a framework or guiding approach for the implementation and

achieving support.

Land use and development planning

Development of a communications strategy including a communication plan for the public.

Delegates in Public Health, Environment, and Health agreed to take the One Health message

and to sensitise their divisions to the point of getting clinical health involved. Persons in the

public sector were looking to change behaviour.

Policy- legislation and enforcement

Disaster planning – coordinating emergency response mechanisms.

Addressing the effects of climate change

A clean-up campaign would be an advantageous intervention, to reduce solid waste that

attracts insects and rodents.

Project implementation – Specific projects should be identified and developed with specific

steps for implementation. This would avoid several activities going on at the same time and

duplication taking place, making it also difficult to measure the success.

Identification of funding sources for One Health projects

Monitoring and evaluation are key components of any project or programme.

The efforts of the group were then directed to identifying activities to address these issues. These were

named as:

Performing a gap analysis: the review above communications strategy including a

communication plan for the public.

Delegates in Public Health, Environment, and Health agreed to take the One Health message

and to sensitise their divisions to the point of getting clinical health involved. Persons in the

public sector were looking to change behaviour.

Policy- legislation and enforcement

21

Disaster planning – coordinating emergency response mechanisms.

Addressing the effects of climate change

A clean-up campaign would be an advantageous intervention, to reduce solid waste that

attracts insects and rodents.

Project implementation – Specific projects will lend itself to performing a gap analysis using

the data obtained.

Performing a priority assessment: the gap analysis will contribute to the process of

identifying the priority areas for actions.

Committed efforts with the objective of standardising operations related to threat

identification and management (using vector borne diseases as an example) must be

supported.

Design, implementation, monitoring and evaluation of interventions based on the priority

assessment performed in 3 above.

The next steps, identified by the group in terms of activities to enact the broad actions cited

above were:

Activity 1: Advocacy and sharing - Advocate and share workshop information with supervisors

and decision-makers. Representatives of the various agencies committed to networking with

their institutions and human health institutions to promote the one health approach.

Collaboration should be established with the CaribVET network, the Caribbean Invasive Alien

Specie Network, and One Health should be discussed on the annual meetings of the Chief

Medical Officers, Chief Veterinary Officers, the Caribbean Plant Health Directors meeting,

CARICOM Secretariat, environmental health officers. A brief should be prepared on the One

Health approach and workshop, as well as a visual presentation on the One Health vision and

how to operationalize.

Activity 2: Communication - Participants agreed to take the information gained to the wider

community through their networks. Networking with civil society could take place to build

awareness and sensitise them about the advantages of One Health. While a great deal of

bureaucracy existed in some areas, approval was not required for individual group participants

to engage with NGOs, technical groups and professional organisations. This level could be the

avenue for implementation.

Activity 3: A renewal and reinvigoration of the one health concept among academic institutions

through the representatives from such organizations present. These institutions included UWI,

Ross and St. Georges School of Public Health. A commitment was given to communicate the One

Health approach to absent academic institutions such as CIRAD, St. Matthews, University of

Guyana, University of Trinidad and Tobago, University of Technology, Monroe College, and

Guyana School of Agriculture. The consensus was that the one health concept should be

mainstreamed in academic institutions and evidenced by relevant research projects, student

22

interest groups, lectures and curriculum design and content. However, some funding would be

required.

Activity 4: A commitment was expressed to build awareness among the disciplines of the

participants of the group through the use of sensitization seminars. For example, One Health

seminars would be organized for Public Health Inspectors, Environmental Health officers and

Veterinary Public Health officers.

Work Group#2 List of priority issues for One Health approach

1. Disaster management and climate change 2. Threats to biodiversity and impact on human and animal health and the environment (climate

change) 3. Environmental resource conflicts in Small Island Developing States 4. Lack of integrated surveillance information from Environment, Environmental Health, Animal

Health and Human Health in decision making or addressing problems in these areas.

The following 2 issues were selected by group 2 for further development into project ideas. Issue 2A: Environmental resource conflicts in Small Island Developing States

Proposal 2A: Application of the One Health approach for sustainable land and water use

A good initial project was felt to be a Situational Analysis of existing approaches in the Caribbean to the

issues of sustainable land and water use, to determine which existing activities could benefit from a One

Health approach, or where there were gaps that could be addressed with a One Health Approach. This

would then provide a basis to determine larger future projects.

Proposed Next steps: Put together a task force to write a proposal to obtain funding for this project.

Issue 2B: Lack of integrated surveillance information from Environment, Environmental Health, Animal Health and Human Health in decision making or addressing problems in these areas. Proposal 2B: Develop mechanisms to integrate surveillance information to be used in decision making.

Cross cutting issues:

1. Policy development and uptake (regional level meetings)

2. Advocacy, communication and awareness. The stakeholder constituents have to be identified

and these included Government, the Private Sector, Meteorological Offices, Education, Health,

civil society, donors, etc.

3. Capacity building

4. Data, research and surveillance

5. Strategic partnerships

23

Ideas from Group 2

Next Steps:

Activity 1: Advocacy

Make a case/advocate for One Health approach to senior officers and heads of departments.

Obtain buy-in from them and work with them to model a way forward for implementation.

Generate a brief on the One Health approach and develop a visual presentation covering

both vision and operationalization.

Conduct a national consultation and identify national champions

Activity 2: Identify champions

Identify regional champions and use regional stakeholders as vehicles to carry the message of One Health in sustainable land and water use.

Collaboration to be established with Caribvet, Caribbean Invasive Alien Species Network, CARICOM, CPHD Meeting and Annual Meeting of CMOs

Activity 3: Networking - Network among NGOs, professional bodies, civil society, businesses to mainstream One Health.

Recommendation: CARPHA is well positioned to be a leader in the One Health Approach as it is in its formative stages and can choose to have a more integrated approach as relevant regional organizations have come under one umbrella.

What we can do when we return to our positions on Monday to push the One Health Agenda:

Next steps

(1) Review International Health regulations – Undertake a review of international health regulations to determine which would benefit from a One Health approach.

(2) Add Value - Examine the ways in which the One Health approach can be introduced in present activities and add value through this approach to multi sectoral groupings.

(3) Sharing Information - Share information and use resources to build awareness and facilitate

similarity of message. For example, discuss One Health with professional organizations in home

countries and at upcoming professional meetings. One person in academia (Vet School) was

going to introduce One Health to new intakes of students.

(4) Ministers of Health - Seek out opportunities to introduce One Health for example to new

Ministers of Health and new intakes of students. In Grenada there had been a recent election,

providing a unique opportunity to promote the approach to Ministers with fresh eyes.

(5) Situational Gap Analysis - Use a Task Force to conduct situational gap analysis on land and

water use.

(6) Proposal Writing - Build a proposal from the situational and gap analyses

(7) Training - Conduct cross sectoral training workshops and stakeholder consultations

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(8) Communication tools: Communication tools are needed in order to be able to spread a

consistent message. e.g. a presentation, literature etc.)

(9) CARPHA - Recommend CARPHA as the lead agency for championing the One Health approach

Work Group #4

Issues for consideration of a One Health approach

1. Food and water insecurity - Looking also at the food supply chain. The rising cost of food and its

effect on regional food security. The recommended solution was to have one regional food

security policy. Biosafety can be added.

2. Waste disposal – There was a lack of solid waste management and this could be seen in the

cruise ship industry, disposal of pesticides, livestock waste and e-waste.

3. Policy and Legal Framework for One Health - Across sectors. Institutional strengthening.

There was a need for social change. Development of policy, institutional and legal framework for

One Health

Project Idea: Developing a policy, institutional and legal framework for One Health in the Caribbean

Actions

1. Assessment and diagnosis - Do an assessment and diagnosis of what already exist through a

desktop study. Some countries had a framework and others did not.

2. Focal Points - Establishment of focal points in each country to feed into regional network.

3. Examination of Structures – Use of existing structures, such as intersectoral working groups and

committees, to promote and adopt a One Health approach. Examination and development of the

required instruments such as:

protocols

memoranda of understanding

legislation

advocacy at the highest level

regional policy

4. Stakeholder involvement – The regional One Health stakeholders include CARPHA, CAHFSA,

CARICOM Secretariat, PAHO, FAO, IICA, OIE, other international and regional agencies. National

stakeholders include the Ministries of Health, Agriculture and the Environment. PAHO and the FAO

will take the lead to bring these Ministers together to discuss One Health. The RIMSA meeting is

convened by PAHO every 2 years and brings together Ministers of Agriculture and Health.

5. Preparation and circulation of a concept paper which provides a background and justification for a

One Health policy, and can be used for advocacy purposes. PAHO (Sandra), the FAO (Cedric) and

25

the Deputy Director of Veterinary Public Health of Trinidad and Tobago (Sham) will prepare this

concept note by 3rd week of March and circulate it to the policy working group for comment.

6. Circulate concept note – This will be circulated to the Permanent Secretaries of Agriculture, Health

and the Environment as well as workshop participants for comments and finalization by mid-April.

7. Regional policy and decision making meetings- Get policy concept paper on agenda of next CVO,

CMO, COTED (Agriculture & Environment) and COHSOD Meeting for Health. CVOs will lead the

initiative to get it on COTED’s agenda with support from PAHO, FAO, IICA and OIE. Ministry of

Health participants will sensitise CMO’s. Workshop participants from environmental sector

(Ministries, CEHI etc) will sensitise Permanent Secretaries and Ministers of the Environment.

8. CARICOM Support - Ask CARICOM to provide support for establishment of one health policy in the

region, after COTED and COHSOD approval.

9. Policy development - Develop a policy with input from all stakeholders.

10. Action Plan - Once a regional One Health policy is developed, a regional action plan should be

developed for policy implementation, including the priority projects developed in this workshop.

11. Create a regional One Health network with regional and national focal points.

Policy activities at the national level:

1. Concept note can be used for One Health advocacy in Caribbean countries.

2. Existing Structures - Use existing structures to mainstream One Health, such as multisectoral

committees, e.g. the Central Board of Health in Jamaica.

3. Participant trip reports can be presented to policymakers in countries – e.g. Permanent Secretaries

etc.

4. Workshop report can also be used to create awareness and understanding among policymakers.

5. Identify existing projects in which One Health concept can be infused and mainstreamed.

6. Consider MOU’s, and other existing instruments that can facilitate One Health.

7. Monitor and evaluate One Health policies, programmes and projects to measure benefits of One

Health approach (if any).

SUMMARY LIST OF PRIORITIES A summary of the list of priority areas for action coming out of the workshop were:

1. Groups 1 & 3 - Vector borne disease from a policy and planning and interdisciplinary perspective

respectively for the application of the One Health approach.

26

2. Group 2 - Sustainable land and water use for the application of the One Health approach

3. Group 4 - The institutional and legal policy framework for One Health.

Cross Cutting Issues

Several issues were deemed to be common to each priority area. These issues were:

Research

Stakeholder participation

Communication

Training/Capacity Building

Policy

Legislation

Funding

Planning

Intersectoral collaboration

Governance

Facilitator Observations The day’s session opened with a powerpoint presentation from Facilitator Dr. Craig Stephen who

explored the themes that emerged from the discussions of the previous day. The themes were

identified as:

The co-ordinated use of natural resources exploring food security and land use; water security;

biodiversity and health outcomes

Threats which were seen as

(1) Specific “etiologies” – lepto, antimicrobial resistance, pesticides

(2) Environmental change – disaster management

(3) Themes – foodborne, vector-borne diseases

-Information which spoke to issues of surveillance and sharing

-Governance covered policy issues and coordination

-Capacity looked at surveillance, training and leadership

Dr. Stephen then discussed the interrelationship between specific threats, root causes and the role that

collaboration can play. His flowchart diagram is found in Appendix 12.

Dr Craig Stephen made several observations regarding the workshop. They were:

(1) There was support and advocacy for developing the One Health approach based on the

enthusiasm and ideas that were apparent among the participants

27

(2) Given that some common themes were emerging, participants were encouraged to try to think

of transportable, approaches, concepts, tools and mechanisms.

(3) They were also advised to balance finding the project with having flexibility.

Dr. Stephen spoke of the process of implementing the OH approach which he articulated as

prevention (including risk and impact assessment), detection, assessment (multi perspective),

action(multi sectoral intervention, awareness building ), evaluation (multisectoral). The entire

process was overridden by capacity building and “permission”. This OH process will add value to

existing projects.

Dr. Stephen shared the importance of evaluation in the process. He said that if they were able to get

that organized they would be way ahead because no one else was doing that in the world. He drew

attention to the process of behaviour change where there was a need to prime audiences. It can be

done by sharing what One Health meant, what its strengths were and how it fitted into the health

agenda. He said that another important question was “What makes effective collaborative teams?”

The answers he offered were shared problems and passionate leadership. He pointed out that the

leader did not have to be a Minister.

The Facilitator, Dr. Barry Stemshorn pointed to some of the available tools that could be used for

priming up audiences. They were:

the workshop presentations

The background paper in the workshop package with its references and footnotes.

The One Health Tool Kit (See Appendix 13)

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RECOMMENDATIONS The following is a summary of the recommendations of the participants:

1. Systems Approach - A systems approach was required to carry forward the One Health concept

and someone should be designated to develop an approach.

2. Social Media - Communication Specialists properly sensitized to the One Health approach

should be utilized to spread the message about One Health on the social media.

3. Lab Facilities - A concerted effort must be undertaken to improve the lab facilities in many

countries. Labs for animal samples must also be developed. Where labs were not possible

Customs education and networking were required to allow specimens to be transhipped freely.

4. Funding – New sources of funding must be tapped for the Caribbean countries for their projects

and programmes. Suggestions were made to tap non traditional sources of funding, for

example, Sweden, Germany, Australia etc. Funding for One Health approaches to Climate

Change and environmental projects can be sourced from GEF and other donors.

5. Gap Analysis - A gap analysis is required to determine the deficiencies in the respective areas of

Human and Animal Health and the environment. The OIE should be invited to assist in

developing a One Health gap analysis and with small wins, One Health can be implemented.

6. Strategic Planning – The approach to strategic planning for One Health should be adopted The

OIE should be invited to assist in developing a gap analysis and with small wins One Health can

be implemented.

7. Capacity Building – Training programmes in the One Health approach for students in universities

must be developed and implemented across disciplines. Training programmes should also

developed for persons already working in the various sectors to sensitize them to One Health. A

format for training at country level was required.

8. Collaboration – Getting people to work together in a team approach dealing with common

issues was necessary.

9. CARICOM support - Support from CARICOM will be required to develop the Caribbean One

Health policy and to obtain political support.

10. CARPHA - CARPHA will be asked to play an important role in the development and adoption of

One Health and the various agencies and government institutions must network with them

regularly. CARPHA can be the regional agency to champion the causes of One Health in the

region.

11. Integration – Establish tripartite focal points for One Health at a national level to feed into

regional focal points.

12. Legislation-Draft and implement legislation to support the One Health approach.

13. Transhipment of Samples: A procedural approach for the transshipment of samples in the

region should be agreed upon and supported by MOUs.

14. Use of existing structures – Wherever possible, existing multisectoral committees should be

used to promote and adopt a One Health approach

15. Proposals/Action Plans- Each group should be required to continue to develop a proposal and

action plan for funding and implementation through online collaboration.

16. Follow up- Have a recall meeting in six months time to evaluate progress.

29

Next Steps:

The participants agreed to do the following when they return to their organisations and countries

1. Advocate for a One Health approach to superiors and heads of departments.

2. Develop a brief on the One Health approach and the workshop

3. Prepare a visual presentation on One Health in order to obtain buy in.

4. Conduct national consultations and designate national champions.

5. Establish collaboration with CaribVET to create regional champions.

6. Presentations at Caribbean Invasive Alien Species Network, annual meeting of Chief Medical

Officers, Caribbean Plant Health Directors meeting, CARICOM Secretariat, Environmental

Health officers.

7. Networking among NGOs, professional bodies and organisations (Veterinary and Medical

Associations), friends, civil society, businesses, IHR focal points.

8. Coordinate IHR and OIE reports to create shared understanding

CONCLUSIONS OF THE WORKSHOP The general conclusions of the workshop were as follows

1. Workshop -The opening speakers set the tone for the One Health workshop and for a

continuance for the process in the future.

2. Objectives The objectives of the workshop were achieved as delegates stated they strongly

agreed by responding with a one or two that the objectives were met.

3. Networking - The delegates will continue to network with each other and expand the One

Health concept to others.

4. Commitment -The delegates participated enthusiastically and committed to continuing the

process of One Health.

5. Silos and Turf - One Health continued to have difficulty in progressing as persons involved in the

animal and human health sectors continued to work in silos afraid of divesting of their turf.

6. Programmes - There was a need for programmes to be developed to make the implementation

of One Health more sustainable.

7. Legislation - In many countries a lack of legislation was hampering the implementation of One

Health. Where there were laws they were not being enforced.

8. Lab facilities - Many countries did not have lab facilities to undertake proper diagnosis and

when specimens had to be sent overseas problems existed with Customs clearance. Some

Human labs would not accept animal samples adding to the challenges of having the

information to make diagnosis.

9. Funding - Countries of the Caribbean have been removed from the countries considered poor

enough to access funding from many agencies and this hampers their abilities to implement the

One Health requirements as they should be.

10. Standardization – Processes were being done differently in many countries and across countries

making it difficult to track information and make informed decisions.

30

WORKSHOP EVALUATION

At the end of the workshop the Evaluation Report showed that the objectives were achieved because :

• 92.2% of the participants agreed that there was an increased awareness of how to apply the One

Health approach to issues at the human-animal–environmental interface in the Caribbean region.

• 94.4% of the participants agreed that a Caribbean network of professionals in human, animal and

environmental health who are motivated to champion, promote and utilize an intersectoral One Health

approach had been created.

• 84.6% of the participants agreed that the One Health priority issues and activities were brought to the

fore and recognized for further development into a regional proposal.

The program content and delivery were very highly rated by the majority of the participants as being

relevant, having met expectations, well organized, effectively presented, provided opportunities for

peer interaction and presenter/participant interaction, and useful. The results of the workshop

evaluation appear in Appendix 14.

31

APPENDICES

Appendix 1 List of workshop speakers and participants

Opening Ceremony Speakers

Dr. Bernadette Theodore-Gandi Country Representative PAHO/WHO Representation in Trinidad and Tobago Briar Place 10-12 Sweet Briar Road St. Clair, Port of Spain Trinidad, W.I. Tel: 868-622-4202 ext 42001 FAX: 868-628-4719 Email: gandiber@trt.paho.org Dr. James Hospedales Executive Director CARPHA Communication Desk 16-18 Jamaica Blvd Federation Park Trinidad & Tobago Tel: 1-868-622-4261-2 Mr. Chris Brown Counsellor The High Commission of Canada Maple House, 3-3A Sweet Briar Road St. Clair Port of Spain Trinidad and Tobago Tel: 1-868-622-6232 Email: chris.brown@international.gc.ca Dr. Akenath Misir Ag. Chief Medical Officer Ministry of Health 63 Park Street Port of Spain Trinidad and Tobago Tel: 1-868-625-0066 Email: cmo@health.gov.tt

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Facilitators

Dr. Craig Stephen, DVM PhD Director Centre for Coastal Health Nanaimo, BC CANADA Tel: 1-250-740-6366 Email: cstephen@ucalgary.ca or cch@viu.ca Professor Faculty of Veterinary Medicine and Faculty of Medicine University of Calgary (as a volunteer for Veterinarians Without Borders Canada) Dr. Barry Stemshorn Senior Fellow, Graduate School of Public and International Affairs University of Ottawa (as a volunteer for Veterinarians Without Borders – Canada) 124 rue Champêtre Gatineau, Québec, Canada J9H 6W4 Tel: 819-778-3438 Fax: 819-778-3469 email: barry@BStemshorn.com

CABI

Mr. Naitram Ramnanan Regional Representative and IAS Coordinator CABI Gordon Street Curepe Tel: 1-868-662-4173 Fax: 1-868-663-2859 Email: n.ramnanan@cabi.org

CARPHA

Ms. Patricia Aquing Environmental Health Unit Manager Caribbean Public Health Agency/CEHI P.O Box 1111, The Morne Castries St. Lucia Tel: 1-758-452-2501 Fax: 1-758-453-2721

33

Email: paquing@cehi.org.lc Ms. Lisa Indar Manager, Food Borne Diseases CARPHA 16-18 Federation Park Jamaica Boulevard Port of Spain Tel: 1-868-622-4261 Email: indarlisa@carpha.org

FAO

Dr. Cedric Lazarus Livestock Development Officer Food and Agriculture Organization FAO Sub-regional Office for the Caribbean Second Floor, United Nations House Marine Gardens Christ Church Bridgetown Barbados Tel: 1-246-426-7110 Email: cedric.lazarus@fao.org

IICA

Dr. Maxine Parris-Aaron Agricultural Health Specialist Inter-American Institute for Cooperation on Agriculture (IICA) Lot 18 Brickdam Stabroek Georgetown Guyana Tel: 592-(2)26-8347 Fax: 592 (2) 25-8358 Email address: maxine.parris-aaron@iica.int

OIE

Dr. Martín S. Minassian Technical assistant World Organization for Animal Health OIE Regional Representation for the Americas

34

Representación Regional de la OIE para las Américas Paseo Colón 315, 5° "D" C1063ACD, Buenos Aires, Argentina Tel: 0054-11 43 31 39 19 Fax: 0054-11 43 31 51 62 Email: m.minassian@oie.int

PAHO/WHO

Dr. Alexandra (Sandra) Vokaty, Subregional Advisor in Veterinary Public Health PAHO/WHO Representation in Trinidad and Tobago Briar Place 10-12 Sweet Briar Road St. Clair, Port of Spain Trinidad, W.I. Tel: 868-612-2018 FAX: 868-628-4719 Email: vokatyal@paho.org Dr. Eldonna Boisson Advisor, Disease Surveillance and Epidemiology Pan American Health Organization, Trinidad and Tobago 1st Floor, Briar Place 10-12 Sweet Briar Road St. Clair, Port of Spain Trinidad, W.I. Tel: +1-868-612-2021 (Direct line) Tel: +1-868-612-2000 ext. 42021 Fax: +1-868-628-4719 E-mail: boissoel@paho.org Dr. Carlene Radix Consultant, Health Services Administration PAHO/WHO Representation in Trinidad and Tobago Briar Place 10-12 Sweet Briar Road St. Clair, Port of Spain Trinidad, W.I. Tel: 868-622-4202 ext 42007 FAX: 868-628-4719 Email radixcar@paho.org

USDA APHIS

Dr. Joseph Annelli Director, One Health Coordination

35

USDA APHIS One Health and Interagency Collaboration Center APHIS-Veterinary Services 4700 River Road, Unit 59 United States of America Tel: 301 851-3600 E-mail: Joseph.F.Annelli@aphis.usda.gov

Universities

Dr. Esteban Soto Assistant Professor of Bacteriology Ross University School of Veterinary Medicine P O Box 334 BASSETERRE St Kitts Tel: 869.465.4161 Email: esoto@rossvet.edu.kn Professor Rosina (Tammi) Krecek Professor of Parasitology Ross University School of Veterinary Medicine 630 US Highway 1 North Brunswick, New Jersey 08902 Tel: 869-665-3196 Email: tkrecek@rossvet.edu.kn Professor Christine Carrington Professor University of the West Indies Department of Preclinical Sciences Faculty of Medical Sciences St. Augustine Tel: 1-868-684-8803 Fax: 1-868-662-1873 Email: christine.carrington@sta.uwi.edu Professor A.A.Adesiyun Director, School of Veterinary Medicine Faculty of Medical Sciences University of the West Indies St. Augustine, Trinidad and Tobago Tel: 1-868-645-4481 Fax: 1-868-645-7428 Email aadesiyun@fms.uwi.tt or abiodunadesiyun@hotmail.com Dr. Christopher Oura

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Senior Lecturer in Veterinary Virology School of Veterinary Medicine Faculty of Medical Sciences University of the West Indies Eric Williams Medical Sciences Complex Uriah Butler Highway Mount Hope Trinidad Tel: 1-868-725-4263 Email: chris.oura@sta.uwi.edu

Dr. Satesh Bidaisee Associate Professor of Public Health and Preventive Medicine St. George's University, School of Medicine Department of Public Health and Preventive Medicine University Center, Grenada, W.I. Grenada Tel: 1-473-439-2000 Fax: 1-473-444-1219 Email – sbidaisee@sgu.edu

Bahamas

Ms. Melony McKenzie Director Department of Environmental Health Services Ministry of the Environment and Housing Farrington Road P.O. Box SS 19048 Nassau N.P. Bahamas Tel: 1-242-376-4127 Fax: 1-242-322-8086 Email: melonymckenzie@bahamas.gov.bs

Barbados

Ms. Ingrid Lavine Senior Environmental Technical Officer Environmental Protection Department Ministry of the Environment, Water Resources and Drainage Government of Barbados L.V Harcourt Lewis Building Dalkeith St. Michael

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Barbados Tel: (246) 310-3600 Fax: (246) 228- 7103 Email: ilavine@epd.gov.bb

Mr. Desmond Anderson King Deputy Chief Environmental Officer Ministry of Health 3rd Floor, Frank Walcott Building Culloden Road, St. Michael Barbados Tel: 246 467-9300 Email:- desmond.king@barbados.gov.bb or daking_16@yahoo.com Dr. Vicki Aimey Veterinary Officer Veterinary Services Ministry of Agriculture The Pine, St Michael Barbados Tel. (246) 427-5492 or 427-5073 Fax: (246) 429-2143 E-mail: vaimey26@hotmail.com

Grenada

Mr. Michael Andre Worme Chief Environmental Health Officer Ministry of Health Ministerial Complex Botanical Gardens, Tanteen St. George’s Grenada

Tel: 1-473-440-3485 Fax: 1–473-440-4127

Email – amworme2@hotmail.com

Mr. Daniel Roland Lewis Chief Agriculture Officer Ministry of Agriculture, Forestry and Fisheries Ministerial Complex Botanical Gardens, Tanteen St. George’s Grenada

Tel: 1-473-440-2708 Fax: 1–473-440-4191

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Email dannypoo2009@hotmail.com

Guyana

Dr. Colin James Director, Veterinary Public Health Department Ministry of Health Liliendaal East Coast Demerara Guyana Tel number: 592-619-7262 Fax: 592-222-5643 Email address: hogancoli@yahoo.co.uk Dr. Bob Ramnauth Medical Doctor, General Surgeon, Environmental Specialist Ministry of Health c/o GPHC New Market Street Georgetown Guyana Tel: 592-639-8125 Email: bobandy2002@yahoo.com Dr. Dindyal Permaul Chief Executive Officer Guyana Livestock Development Authority Agricultural Road Mon Repos, East Coast Demerara Guyana Tel: 592-220-6557 / 623-8973 Fax: 592-220-6557 Email: glda1910@gmail.com

Jamaica

Dr. Linnette Peters Policy and Programme Director

Veterinary Public Health Ministry of Health Oceana Complex 2-4 King Street Kingston Jamaica Tel:- 1-876-967-1466

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Fax: 1-876-967-1280 Email:- petersl@moh.gov.jm

Mr. Donovan Stanberry Permanent Secretary The Ministry of Agriculture & Fisheries Hope Gardens Kingston 6 Jamaica Telephone: 876-927-1790 Fax: 876-927-1904 Email: psoffice@moa.gov.jm Dr. Osbil Watson Chief Veterinary Officer Ministry of Agriculture and Fisheries Veterinary Services Division 193 Old Hope Road P.O Box 309 Hope Gardens Kingston 6 Jamaica Tel: 1-977–2489/9250 Fax: 1-977-0885 Email: oowatson@moa.gov.jm

St. Lucia

Dr. Perlinda Dupre Veterinary Officer Veterinary and Livestock Services Division Ministry of Agriculture, Food Production, Fisheries and Rural Development Balata St. Lucia Tel: 1-758-268-1421 Fax: 1-758-450-4581 Email: perlidad@gmail.com Mr. Wenn Gabriel Chief Environmental Health Officer Ministry of Health c/o Sir Stanislaus James Building Waterfront Castries St. Lucia Tel: 1-758-468-3706 Fax: 1-758-451-9892 Email: gabwren@gmail.com

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SURINAME

Mr. Steven Relyveld Permanent Secretary, Ministry of Labour, Technological Development and Environment Wagenwegstraat 20b Paramaribo Suriname Tel: 597-47-2858 Fax: 597-41-0465 Email: secdir@atm.gov.sr/relyveldsteven@yahoo.com Dr. Lesley Resida Director, Bureau of Public Health Ministry of Health Rodeleruislaan 22 Paramaribo Suriname Tel: 597-497-978 Fax: 597-491-452 Email: dirbog@hotmail.com

Dr. Edmund Rozenblad Director of Animal Husbandry Ministry of Agriculture, Animal Husbandry and Fisheries Department of Animal Production and Health Veterinary Service Corantijnstraat no. 5 Paramaribo Suriname Tel: 597-47-9112 ext. 2101 Fax: 597-40-4407 Email: Edmund.Rozenblad@lvv.gov.sr

Dr. Astrid van Sauers Veterinary Officer Ministry of Agriculture, Animal Husbandry and Fisheries Letitia Vriesdelaan 8-10 Paramaribo Suriname Tel: 597-872-0238 Fax: 597-40-4407 Email: astrid_vs@yahoo.com or astrid.vansauers@lvv.gov.sr

Trinidad and Tobago

Mr. Julius Smith

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Environmental Biologist Ministry of the Environment and Water Resources Floor 26 Tower D Waterfront, Wrightson Road Port of Spain Trinidad Tel 1 (868) 623 3158 ext 216 Fax 1 (868) 624 2455 Email: julius.smith@gov.tt Dr. Vishwanath Andy Partapsingh County Medical Officer of Health (Ag.) Division of Health and Social Services Tobago House of Assembly Public Health Services Department Robinson Street Scarborough Tobago Tel: 1-868-639-37-51 Fax: 1-868-639-6964 Email: vpartaps@jhsph.edu Dr. Sham Bissessar Deputy Director Ministry of Health Veterinary Public Health City Drugs Building 42 Charlotte Street Port of Spain Trinidad Tel: 1-868-625-3842 Fax: 1-868-623-9347 Email: arkle66@hotmail.com

Ms. Maureen Acosta Chief Public Health Inspector Ministry of Health Furness Withy Building Wrightson Road Port of Spain Trinidad Tel: 1-868-625-9437 Fax: 1-868-625-9437 Email: maureenacosta76@yahoo.com

Dr. Simon Titus Chief Veterinary Officer Ministry of Food Production

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80 Abercromby Street Port of Spain Trinidad Tel: 1-868-625-5997 Fax: 1-868-625-5993 Email: smtitus30@gmail.com

PAHO/WHO WORKSHOP -WORKING GROUPS

GROUP 1

Colin James Guyana Esteban Soto St. Kitts Joe Annelli USDA - APHIS Julius Smith Trinidad & Tobago Vicki Aimey Barbados Wenn Gabriel St. Lucia Maxine Parris-Aaron IICA Lisa Indar ` CARPHA Chris Oura SVM – Trinidad Lesley Resida Suriname Group 2 Christine Carrington UWI Steven Relyveld Suriname Carlene Radix PAHO Andre Worme Grenada Rosina (Tammi) Krecek Ross, St. Kitts Perlinda Dupre St. Lucia Edmund Rozenblad Suriname Martin Minassian OIE Patricia Aquing CARPHA Group 3 Maureen Acosta Trinidad & Tobago Daniel Lewis Grenada Naitram Ramnanan IAS Abiodun Abesiyun UWI Astrid Van Sauers Suriname Melony McKenzie Bahamas Dindyal Permaul Guyana Vishwanath Andy Partapsingh Tobago Group 4 Sham Bissessar Trinidad & Tobago Cedric Lazarus FAO

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Linnette Peters Jamaica Ingrid Layne Barbados Osbil Watson Jamaica Desmond A. King Barbados Bob Ramnauth Guyana Donovan Stanberry Jamaica Sandra Vokaty PAHO/WHO

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Appendix 2 - Background information on One Health

One Health – A Workshop to Identify Opportunities in the Caribbean

Barry Stemshorn and Craig Stephen

Issues spanning human, animal and environmental health influence how we produce safe and

sustainable food, how we detect and manage environmental pollution, how we adapt to climate change

as well as how we manage recently emerged and long known infectious diseases. The purpose of the

workshop was to explore the needs and opportunities in the Caribbean to create collaborative teams

spanning human, animal and environmental health to deal with pressing “one health” issues affecting

the region.

There are two major schools of thought with regard to the scope of One Health. One focuses mainly on

the goal of preventing pandemic zoonotic diseases in people. Participants at an international

consultation on One Health in 2009 focused largely on human burdens of disease from epidemic

zoonoses. They concluded that the One Health concept provided a framework for preventing emerging

zoonotic diseases, instead of simply responding to them once they have occurred. A study by the World

Bank has provided evidence that such approaches are cost-effective . The second school of thought

takes a broader view of One Health as an approach to managing a continuum of health risks and to

seeking benefits from the interactions of environment, animals and people. This latter view has many

similarities to strategies for sustainability, health promotion and eco-health.

Between these definitions is the recognition that animals and our shared environment can contribute to

societal well being in a variety of ways. For example, a compendium of One Health case studies

prepared for the Public Health Agency of Canada reflects such approaches to a number of zoonotic and

food borne diseases . In another case, the European Commission‘s webpage on One Health reflects a

wider view of societal impacts related to human-animal interactions. The impacts on disability-adjusted

life years (DALYs) have been significant for a small number of emerging diseases in some communities,

but a bigger cost in terms of DALYs comes from endemic and familiar infectious diseases such as

zoonotic diarrheal diseases that continue to cause large amounts of suffering and death in people. Even

diseases that are limited to animal populations can have significant impacts on human health.

Controlling non-zoonotic infectious disease in domestic animals (such as Rinderpest, Foot and Mouth

Disease or African Swine Fever) can confer important public health benefits as livestock provide critical

services to bring people out of poverty , including food, transport, fertilizer, fuel and economic security.

Severe animal diseases can lead to reductions in trade and tourism and result in tremendous public

anxiety.

One Health approaches can offer positive benefits to society. For example, effective long-term

approaches to food security must address environmental sustainability, animal welfare and productivity

as well as human well-being including issues of equitable access to nutritious food. Conservation of

nature has the dual benefit of reducing risks for emerging infections and providing socio-economic

benefits through ecotourism and natural resource use, such as sustained ocean fisheries. Animals also

45

provide important early warning signals for emerging risks to human health. Field observations of

animals and nature have provided some of the best clues to distribution and effects of pollutants that

threaten people.

Despite this range in conceptions of One Health, there are shared practices and perspectives that cross

the spectrum of definitions that can be viewed as a continuum.

For the purposes of this workshop, “One Health” referred to an interdisciplinary approach to minimizing

harms and maximizing benefits from the co-management of human, animal and environmental health.

Opportunities in the Caribbean

The Caribbean Cooperative in Health’s Regional Health Framework (2010-2015) emphasized the need

to develop cross-cutting, inter-programmatic, trans-sectoral, holistic approaches to the challenges facing

health in the Caribbean. The following is an initial list of possible issues used to spark thinking and

discussion at the workshop. Although not exhaustive, the list illustrates possible areas of activity for

future Caribbean One Health teams and projects.

1. Food security

In considering what might be done in the Caribbean one must recall the resolve of Ministers at the

RIMSA 16 meeting in Santiago, July 2012, to address nutrition and food security issues, building on the

Declaration of Cochabamba on “Food Security in the Americas” that was adopted by OAS member

countries in April 2012. These declarations of OAS and PAHO member countries reflect their leaders’

concerns about the need to address the global challenge to feed 9 billion people by 2050 while

managing the environmental footprint of agriculture .

2. Non-communicable diseases

A demographic and epidemiological shift occurring in the Caribbean has made non-communicable

diseases the most important health challenge in the region. The Caribbean Commission on Health and

Development pinpointed obesity (often combined with malnutrition) as one of the principal factors

affecting many of the diseases affecting the expanding burden of non-communicable diseases. They also

recognized that any strategy to combat obesity will need to take into account both social and agriculture

policy. Access to locally produced nutritious foods will be a cornerstone of success.

3. Emerging and re-emerging infectious diseases

Emerging and re-emerging infectious diseases are one of the recognized health challenges to

development in the Caribbean according to the Caribbean Cooperative in Health (III). Dengue fever,

cholera and other diseases of concern to the International health regulations still exist and the re-

introduction of malaria remains a threat. Integrated approaches to issues such as vector management

are critical to dealing with threats for emerging and re-emerging infectious diseases.

4. Endemic Zoonoses and neglected tropical diseases

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The poor and vulnerable are disproportionally affected by endemic zoonoses and neglected tropic

diseases. While some of these diseases, such as schistosomiasis, are on the verge of elimination in the

Caribbean, others continue to cause illness and suffering and are at risk for increasing in the region .

Control and elimination of these diseases requires an inter-sectoral approach bridging public health,

social services, animal health and environmental interventions.

5. Climate Change adaptation

The Caribbean is vulnerable to the predicted impacts of climate change and can anticipate effects on

food security and the pattern of emerging and endemic infectious diseases. Environmental changes can

have profound impacts on both human and animal populations. Extreme weather events appear to be

more frequent and the impacts on both tourism and agriculture can have dramatic effects on the

economic well-being of small island states.

6. Environmental pollution

Protection of safe, secure water supplies, proper disposal of solid wastes and vulnerability to ocean

pollution are key Caribbean issues . These issues are relevant to human health, livestock health, food

protection and the preservation of wildlife. Coordinated inter-sectoral strategies are required to ensure

that there are means to detect pollutants early so that actions can be taken to prevent or mitigate their

effects. Using animals as sentinels, tracking changes in contaminants of marine foods and using team-

based educational strategies are some of the options for a holistic approach to environmental pollution.

7. Control of Invasive Alien species

Invasive species can bring new pathogens as well as new ecological risks to the Caribbean and thereby

threaten people, indigenous wildlife (terrestrial and marine) and livestock. Both the WHO and OIE are

turning their attention to invasive species and their effects on human and animal health and trade.

One Health approaches may well be useful to advance this broad agenda through a wide variety of

initiatives including:

• Control of pests and diseases that affect human, animal and/or agricultural health and

productivity,

• Development and implementation of sustainable production systems on large, medium and

micro scales.

8. Leadership and team building

Experience has shown that effective One Health initiatives generally require leadership that is attuned

to and promotes cross-institutional collaboration in multiple ways1. Work on any one or more of the

afore-mentioned topics could be supported by initiatives through appropriate educational institutions in

the region, possibly in partnership with institutions abroad.

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Appendix 3 - Workshop Agenda

Caribbean Sub- Regional Workshop “One Health: From Ideas to Action”

Hyatt Regency Hotel, Wrightson Road, Port of Spain, Trinidad and Tobago 28 February to 1 March 2013

Day 1

Thursday 28 February 2013

8:00 a.m. – 9:00 a.m. Registration

9:00 a.m. - 10:00 a.m. Opening Ceremony

Opening Ceremony Agenda

9:00 a.m. – 9:05 a.m. National Anthem

9:05 a.m. – 9:10 a.m. Safety briefing by Hyatt Regency

9:10 a.m. – 9:20 a.m. Opening remarks on behalf of PAHO/WHO,

Dr. Bernadette Theodore-Gandi, PAHO/WHO Country Representative, Trinidad

and Tobago

9.20 a.m. – 9.30 a.m: Opening remarks on behalf of PHAC and CFIA

Mr. Chris Brown, Counsellor, Canadian High Commission

9:30 a.m. - 9:50 a.m. Feature address

Dr. Akenath Misir, Acting Chief Medical Officer, Ministry of Health, Trinidad and

Tobago

9:50 a.m. - 10:10 a.m. C O F F E E B R E A K

10:10 a.m. – 10:20 a.m. Workshop objectives and agenda

10:20 a.m. – 10:40 a.m. Participants introduce themselves

10:40 a.m. – 11:10 a.m. Introduction to One Health

Dr. Craig Stephen, Director, Centre for Coastal Health, Faculty of

Veterinary Medicine and Faculty of Medicine, University of Calgary.

11:10 a.m. – 12:15 a.m.

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Panel Discussion No. 1: One Health Issues – Caribbean perspective

Moderator: Dr. Barry Stemshorn, Veterinarians Without Borders (VWB) Canada and University of

Ottawa

• Environmental health issues in the Caribbean: Ms. Patricia Aquing, CARPHA, Unit Manager

Environmental Health.

• Animal health issues in the Caribbean: Professor Abiodun A. Adesiyun, Director and Professor

of Veterinary Public Health, School of Veterinary Medicine, University of the West Indies.

• Public health issues in the Caribbean: Dr. James Hospedales, Executive Director, Caribbean

Public Health Agency.

12:15 p.m. L U N C H

13:15 p.m. – 14:00 p.m. Panel Discussion No. 2: International examples of One Health approaches

Moderator: Dr. Craig Stephen, Director, Centre for Coastal Health, Faculty of Veterinary Medicine

and Faculty of Medicine, University of Calgary.

• OIE: Dr. Martin Santiago Minassian

• APHIS: Dr. Joseph Annelli

• FAO: Dr. Cedric Lazarus

14:00 p.m. – 14:30 p.m.

Plenary discussion on One Health approach: opportunities and considerations for One Health

approaches in the Caribbean – participants.

14:30 p.m. C O F F E E B R E A K

14:45 p.m. – 16:30 p.m.

Work Group session #1: identify key issues for possible projects in the Caribbean

Question: What priority problems or issues in the Caribbean would be better addressed by a One Health

cross-sectoral approach?

16:30 p.m.

Reports from Work Groups

End of Day 1 – overnight assignment to reflect on what they heard.

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Day 2

Friday 1 March 2013

9:00 a.m. – 9.15 a.m. Recap of Day 1:

Dr. Craig Stephen, Director, Centre for Coastal Health, Faculty of Veterinary Medicine and Faculty of

Medicine, University of Calgary.

Dr. Barry Stemshorn, Senior Fellow, Graduate School of Public and International Affairs, University of

Ottawa.

9:15 a.m. – 10:00 a.m. Work Groups session #2 - Refine project topic(s)

Questions:

Any revision to issue(s) identified for action?

What would you do to address the priority issue(s)?

What do we need to do to address the problem?

10:00 a.m – 10:15 a.m. C O F F E E B R E A K

10:15 a.m. – 12:00 noon Work Groups session #3 - Implementation: Who?

Questions:

Who do we need to work with to address the problem(s)?

Who needs to be involved to address the problems and questions:

• Which sectors? (government, private, academia)

• Which countries?

• Which disciplines? (animal, health and/or environment)

• How would we bring them together?

12:00 noon to 13:00 p.m. L U N C H

13:00 p.m. - 14:00 p.m.

Work Groups session #4 – Implementation: What?

Questions

What would we need to address the problems)?

What resources would be needed – consider infrastructure, human resources, and finances?

50

14:00 p.m. – 14:15 p.m. C O F F E E B R E A K

14:15 p.m. – 16:30 p.m.

Work groups report back to plenary and discuss: 30 minutes per group

16:30 p.m. – 16:45p.m. Workshop evaluation

16:45 p.m. – 17:00p.m. Wrap up and next steps: Barry and Craig

17:00 One Health calypso: Dr. Satesh Bidaisee, Assistant Professor, St. George’s University, Grenada.

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Appendix 4 - Opening Ceremony Speeches

4.1 Welcome Remarks on behalf of PAHO/WHO

Dr. Bernadette Theodore-Gandi, PAHO/WHO Representative in Trinidad & Tobago On behalf of the Pan American Health Organisation/World Health Organization, and our new Director,

Dr. Carissa Etienne who assumed office in February, it gives me great pleasure to welcome you all to

Trinidad and Tobago and to this Caribbean One Health workshop. I am also delighted at all the

institutional partners that have supported this workshop, and wish to thank the Public Health Agency of

Canada, the Canadian Food Inspection Agency, the United States Department of Agriculture Animal and

Plant Health Inspection Service (USDA APHIS), the World Organisation for Animal Health (OIE) and the

Food and Agriculture Organisation of the United Nations (FAO) for your generous support to this

initiative. Hopefully, the partnership and collaboration will continue into the future as we chart the way

forward for One Health in the Caribbean. Welcome and thank you to Dr. Barry Stemshorn and Dr. Craig

Stephen who have travelled from Canada as volunteers with Veterinarians without Borders Canada to

facilitate this workshop and share their wealth of One Health knowledge and experience. We do

appreciate your contribution.

I also want to welcome all the national participants from the Bahamas, Barbados, Grenada, Guyana,

Jamaica, St. Lucia, Suriname and Trinidad and Tobago to the workshop. The Pan American Health

Organization (PAHO), founded in 1902, is the world’s oldest international public health agency. It

provides technical cooperation and mobilizes partnerships to improve health and quality of life in the

countries of the Americas. Our Veterinary Public Health Programme, with our main collaborative centre

in PANAFTOSA in Brazil, focuses on three main areas namely;

1. Food safety and the prevention of food borne diseases

2. The prevention, control and eradication of zoonotic and emerging infectious diseases

3. The eradication of foot and mouth disease in the Americas and strengthening of national

capacities in animal disease surveillance.

The program contributes to the strengthening of national institutions in knowledge management and

communications, information services and epidemiology surveillance. It focuses on the health risks at

the human – animal-ecosystems interface and tries to develop and implement strategies to reduce such

risks.

The Pan American Health Organisation holds the RIMSA meeting every two years. This is a regional

forum of Ministers of Agriculture and Ministers of Health in the Americas to cooperate and coordinate

on veterinary public health issues. The theme of the 16th RIMSA meeting held in Santiago, Chile in July

2012, was “Agriculture – Health – Environment: joining forces for the well being of the peoples of the

Americas”. At this meeting and the preceding Inter-American Commission on Food Safety meeting, the

Ministers concluded that global food production has responded to worldwide demand by expanding the

areas for crop and livestock production and by increasing agriculture productivity, but not the nutritional

52

quality of the food that is produced. Inequity and inequality continue to affect large segments of the

global population. About one billion people worldwide are undernourished, and a larger number suffer

the consequences of excessive or unbalanced energy consumption. This constitutes a major risk factor

for disabilities, illnesses and death from chronic malnutrition and non communicable diseases. In order

to satisfy food requirements for the growing human population, global agriculture production must

increase by 70 per cent by the year 2050. It is important to ensure that this increase is achieved without

environmental degradation.

RIMSA 16 recognised the need for coordination between public health and animal health services for

theprevention, early detection, control and elimination of the risks that animal diseases pose to public

health and to trade in animal products. Nearly two thirds of the known human pathogens are of animal

origin and three quarters of emerging human infectious diseases are zoonotic, predominantly from wild

animal species. Animal influenzas are becoming a potential threat to poultry and swine production, and

may cause pandemics with severe social and health impacts that require continuous coordination and

exchange of information between animal and human surveillance systems.

Most Caribbean countries’ economies are heavily dependent on tourism. The World Travel and

Tourism Council in its 2007 Travel and Tourism Economic Research study ranked the Caribbean first of

thirteen regions in terms of the contribution of the tourist industry to the regional economy. This high

economic dependence on tourism results in a high level of vulnerability to global economic recession,

public health threats, including outbreaks of infectious and food-borne diseases as well as

environmental threats and natural disasters such as hurricanes, earthquakes, volcanic eruptions and

flooding.

Some drivers of emerging infections diseases at the human-animal-environment interface include

catastrophic natural events such as hurricanes and earthquakes, habitat disruption from agricultural

practices, climate change, consumption of food and water and the movement of people, animal and

goods. For example, the upsurge in Leptospirosis in animals and people in the Caribbean is related to an

increase in the rat population, usually coupled with flooding. The causes of the rat population explosion

are probably related to availability of food, habitat and perhaps diminished rodent control measures. A

“One Health” complex analysis of the root causes and contributing factors would help to design a

multifaceted detection, prevention and response plan.

One Health proposes an international, interdisciplinary, cross sectoral approach to surveillance,

monitoring, prevention, control and mitigation of emerging diseases, as well as environmental

conservation. Global economic, social and cultural contexts of health and disease must be considered,

along with human, animal and ecosystem factors, in order to formulate holistic strategies for disease

detection, prevention and response. This framework represents a significant paradigm shift away from

the traditional siloed approach to human, animal and ecosystem health.

The above factors demonstrate the inter-sectoral nature of emerging public health threats in the

Caribbean, and offer a compelling argument to adopting a multi-sectoral approach t designing

sustainable solutions. The ‘One Health’ concept offers a holistic approach to problem solving that

53

incorporates the health, agricultural and environmental dimensions, including stray animals and wild

life.

I am very pleased that this workshop is bringing together professionals from Ministries of Health,

Agriculture and the Environment to discuss issues of common interest and to begin to brainstorm on

possible solutions. To move forward on this issue, will demand a multi-sectoral and interdisciplinary

approach to tackle the challenges. Thank you to Dr. Akenath Misir, The Chief Medical Officer of Trinidad

and Tobago, for representing the Honourable Minister of Health, Dr. Fuad Khan, and for opening the

workshop.

I wish to thank you all for taking the time to participate. I hope that you will find it interesting, that you

will form new partnerships and that we will all work together to improve environmental, agricultural

and human health in the Caribbean.

4.2 Welcome Remarks on behalf of Canada Mr. Chris Brown, Consul, Canadian High Commission

Dr. Akenath Misir, Chief Medical Officer of Trinidad & Tobago

Dr. Bernadette Theodore-Gandi and Dr. Alexandra Vokaty, Pan American Health Organization/World

Health Organization Representatives in Trinidad & Tobago, Representative of other NGOs and

Government Ministries, Specially invited guests, Members of the media

Good morning and welcome.

I am very pleased to be able to say a few words on behalf of the Government of Canada, the Public

Health Agency of Canada and the Canadian Food Inspection Agency. Unfortunately, travel restrictions

have precluded senior officials from these two Agencies from participating in person but they have been

instrumental in helping to fund this important workshop.

Canada is pleased to have partnered with the Pan American Health Organization in the creation of this

workshop and I’d especially like to acknowledge the hard work of Dr. Sandra Vokaty in making this

workshop a reality. The Pan-American Health Organization has been and will continue to be an

important partner for Canada in its efforts to improve the health of people in the Americas.

As many of you know, Canada has a long history of collaboration with countries in the Caribbean region.

For instance, we are currently celebrating 50 years of diplomatic relations with Trinidad and Tobago.

The Canadian High Commission has very active political and trade programs, and offers full service

immigration, passport and consular assistance services as well. Many Canadians travel to the Caribbean

region, with over 2 million visitors annually. And we have over 3000,000 visits from the Caribbean to

Canada each year. The frequent exchange of goods and people makes the underlying premise of One

Health more important than ever. Diseases know no boundaries and we must work together across

disciplines to be effective in resolving health threats at the animal – human – environment interface.

54

Some of you might be aware that the Public Health Agency of Canada was created in 2004, born in part

out of the SARS crisis. It was created to: prevent disease and injury, promote health, prepare and

respond to health emergencies, provide research and surveillance, and strengthen the public health

system in Canada. Many of these activities are similar to those of the newly created Caribbean Public

Health Agency (CARPHA). The Public Health Agency of Canada was pleased to have contributed to the

creation of CARPHA and looks forward to continuing this relationship as CARPHA grows in stature and

importance throughout the Caribbean.

Even though Canada is a large and relatively affluent country, it faces similar challenges to countries in

the Caribbean region, including food safety, climate change and emerging disease threats. We are

beginning to see the value of broad intersectoral collaboration to respond to these challenges. Our

health and agriculture departments and agencies are making progress in working together more

effectively, but we need to also bring in our colleagues within the Department of the Environment and

other relevant federal government departments to take a Hone Health approach. In addition, we also

need to incorporate social, cultural and economic factors when we look at infectious diseases to truly

understand the impacts and to generate possible solutions.

I think your workshop is an incredibly important opportunity to apply innovative solutions to issues of

real importance to the Caribbean region – issues of economic sustainability as well as issues of human,

animal, and environmental health. We will look forward to hearing about the outcome of your

deliberations and next steps.

Please accept my sincere best wishes for a productive meeting. Thank you for this opportunity. Merci.

4.3 Feature Address

Dr. Akenath Misir, Acting Chief Medical Officer, Ministry of Health, Trinidad and Tobago

Good morning ladies and gentlemen, It is for me a privilege and pleasure to being greetings on behalf of Honorable Minister of Health Dr. Fuad Khan whose Cabinet and other Sate duties prevent him from being amongst this extremely distinguished gathering this morning. May I take this opportunity to welcome all visitors to our beautiful twin island Republic especially any first time visitors. I am sorry that you missed our Carnival celebrations by a couple weeks but you should plan for next year. A demonstration one health, let’s say mental health: ideas in action especially chipping and dancing would become self-evident. The creativity of our people will certainly be involved as we solicit ideas on how to apply this One Health approach to the issues of animal-human-environmental interface in the Caribbean region. One world one health from ideas to action and its latest manifestation of “one health: From Ideas to Action” should keep delegates fully engaged over the next two days and I am certain that as we collate our recommendations and action agendas the collective wisdom from participants will definitely contribute to a furtherance of this critical pursuit. One cannot help but marvel and be impressed by the stakeholders involved. Suffice it to say that this is of extreme significance.

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We in Trinidad and Tobago are gratified that you chose to host this meeting in our country and hope that your stay will be enjoyable and productive. It is our desire to become a premier centre for hosting of international conferences and with the advent of the Caribbean Public Health Agency referred to as CARPHA out fervent hope is that this will transform our approach to public health and become a beacon for others to emulate. If I may make a premature judgement I believe that it can be safely reported that workshop outcomes of increased awareness of One Health approach as well as a Network of professionals is virtually complete based on the following : EA from a media house last night posed the question and I quote : “whether the consumption of horse meat is safe. I know for instance that the drug phenylbutazone is used in race horses and has been found to cause cancer in human beings.” Our colleagues in the media are already on board with the One Health approach.!! May I pay obeisance to Calvin Schwabe and the many others whose contributions have brought us to where we are currently. I look forward to the list of One Health priority issues and activities for further development into a regional project proposal for donor funding. One Health is not alone in this holistic approach to the interconnectedness of human, animal, and ecosystem health. Here in Trinidad & Tobago we have undertaken a number of initiatives to protect and promote the health of our citizens including the Partners Forum and the Social Determinants of Health Committee. Both Cabinet appointed committees bring together multi-disciplinary teams from both public and private sectors whose mission is to adopt a holistice approach to health and to implement measures or interventions in their respective domains that will assist in protecting and promoting public health. Additionally, at the Ministry of Health we are repeating the mantra of “health in all policies” or “healthy public policy” ever mindful of the fact activities emanating from many Ministries may have negative health consequences. The United National 2011 High Level Meeting on Prevention and Control of NCDs was triggered by the Port of Spain Declaration which transpired right across the street from this hotel. I mention this to highlight the fact that many epidemiologists are describing ecological and environmental factors that may explain the increasing burden of chronic diseases and the fact that the usual poor diet, sedentary lifestyle may not be the complete explanation. Indoor air pollution in low income countries poses great risks of death and disability. At the Ministry of Health we continue to maintain divisions/units like the Veterinary Public Health Unit, the Environmental Health Unit, National Surveillance Unit, Emergency Services and Disaster Coordinating Unit and the Occupational Health and Safety Unit in keeping with holistic approach to health. Currently as we attempt to become complaint with the International Health Regulations 2005 a number of emerging and remerging diseases are within our radar. May I take this opportunity to remind delegates and participants that “The cost of inaction is too high; the World Bank estimates that a pandemic of Avian Influenza (AI) would cost $3 trillion dollars world wide. May I also remind this august gathering of some of the recommendations from previous conferences, specifically those from the 2009 meeting in Canada:

Foster political will – Multi-level ministry political will is crucial to driving the concept forward.

Support partnership and collaboration – Finding new ways to work together and build new attitudes is essential. This will require leadership and commitment to make multidisciplinary collaboration a common practice or the norm.

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Build capacity (infrastructure and skills) – The building of knowledge, skills and attitudes at the local level is important. There is a need to encourage the academic community to develop and implement integrated curricula and to foster trans-disciplinary collaboration.

Develop communication strategies/plans – Media should be engaged as a partner. This will require investment in training. Working with the media is critical to getting information to the public and other target audiences.

Provide incentives for reporting adverse events – Incentives are important to encourage key actors to report in a timely manner.

Encourage stakeholder and community engagement – Everyone who is part of these issues needs to understand their role and contribution. This will require the engagement of stakeholders and communities in concepts.

Develop supra-country approaches – In addition to a multidisciplinary/transdisciplinary approach.

On behalf of Honourable Minister, may I take this opportunity to one again warmly welcome all delegates and wish you enjoyable and productive deliberations. Thank you for your attention. Let’s start the workshop.

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Appendix 5 - A Brief Introduction to One Health

A Brief Introduction to One Health

As seen by

Craig Stephen DVM PhD

University of Calgary

And

Centre for Coastal Health

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A Concept as Old as Time

Our Health is Dependent on Interactions With The World Around Us

When I was in grade school

• Global forces were a threat to my health

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When I was in university

• My environment was a risk to my health

http://www.biodivcanada.ca/default.asp?lang=En&n=25C1932D-1

Soon after my PhD

• Nature was out to get me

http://www.healthydisease.com/wp-content/uploads/2012/10/Emerging-Infectious-Diseases.jpg

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And now

• Add all of the past on top of exponential human population growth and climate change

http://www.scielosp.org/img/revistas/bwho/v81n12/fig_2_0443.gif

Current health states remind us aboutthe need to think about

interdependencies

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Age of Emerging Infectious Diseases

Why the change now, if One Health is a very old concept

• Emerging diseases surprised us

• In the 1970’s we had “won the war on infectious disease”

• HIV came

– Followed regularly by new diseases

• SARS, BSE, toxigenic E coli, Hantavirus, Dengue, etc

– Large social impacts

• Economics of zoonoses, social disruption of HIV

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Economics of Emerging Diseases caught our attention

Emergence was found to be a complex socio-ecological phenomenon

http://www.zoonoses.csiro.au/images/Annex1Figure1.png

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Modern life can increase disease risks

Factor Example Disease

Human demographics Centralization of food and

water supply

Cryptosporidium, E coli

Human behaviour and

technology

Pet trade, drug use, food

preferences

SARS, Monkey Pox

Jumping ecological borders Agricultural trade,

international travel

Mad Cow, Airport Malaria

Ecological change New interfaces, climate

change

Lyme, parvicapsula

Agricultural practices Opportunities for wild-

farmed mixing

Avian Influenza, Nipha virus

Pathogen evolution and

population change

Selective pressures

imposed by husbandry

practices

Swine flu, antibiotic

resistance

Policy outside of health affects healthex 1. Food production and drug use

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Policy outside of health affects healthex 2. Forestry

http://ars.els-cdn.com/content/image/1-s2.0-S1386653202002688-gr2.jpg

Attention on emerging disease lead to interest in endemic zoonoses, which linked

disease, food and poverty

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One Health moves us upstream and looks at the socio-ecological system for solutions

Sustaining health

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Health

• More than the absence of disease

– Meeting the needs for daily living

– Being resilient to stress and change

– Being able to meet expectation

• Require attention to the social and environmental determinants of health

http://lakechamplainea.wordpress.com/about/

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http://www.kingsnake.com

Not just people

What is One Health

• Objective – reciprocal care of human, animal and environmental health

• Targets – prevention and promotion achieved by looking at determinants of health found in socio-ecological relationships

• Approach – emphasis on collaboration and cross-sectoral solutions. Action oriented

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Why?

• Prevention is cheaper– Socio-ecological damage is hard to detect and solve to

resolve

• Efficiencies– Upstream determinants have multiple benefits

– Better use of shared expertise and resources

• Many of the current and pressing health issues are at the interface– Pollution, EIDs, climate change, food and water safety

and security,

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The International Dialogue

Struggling with messy problems

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One Health moves us towards systems approaches for systems problems

http://static.weadapt.org/initiatives/images/22/original/4d8b3eb63fe45Oxfam_Approach_to_CCA.png

More Options

Thank you

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APPENDIX 6 - Ms. Patricia Aquing CARPHA/CEHI, Unit Manager Environment Health

The environment is a determinant of health: controlling or managing environmental factors

which impact on human health; improving environmental parameters in order to reduce

impact on human health.

Environmental health addresses all human-health-related aspects of both the natural and built environment. Environmental health concerns include:

Water Quality/ water availability Air quality, including both ambient outdoor air and indoor air quality, which also

comprises concerns about environmental tobacco smoke. Climate change and its effects on health. Disaster preparedness and response. Hazardous materials management, including hazardous waste management,

contaminated site remediation, the prevention of leaks from underground storage tanks and the prevention of hazardous materials releases to the environment and responses to emergency situations resulting from such releases.

Land use planning, including smart growth. Liquid waste disposal, including city waste water treatment plants and on-site waste

water disposal systems, such as septic tank systems and chemical toilets. Medical waste management and disposal. Noise pollution control. Occupational health and industrial hygiene. water illness prevention, including from swimming pools, spas and ocean and

freshwater bathing places. Water Quality (safe for drinking) Solid waste management, including landfills, recycling facilities, composting Toxic chemical exposure whether in consumer products, housing, workplaces, air, water

or soil. Vector control, including the control of mosquitoes, rodents, flies, cockroaches and

other animals that may transmit pathogens.

Water: ( the new “oil”) Availability: Caribbean a water scarce region ; In many countries, the

annual per capita freshwater availability falls far below the 1,000 cubic meter commonly used to

measure scarcity.

1. Reliance on rain fall to feed surface intakes and replenish groundwater: climate variability increasing frequency of droughts. DOMINICA between 5000mm and 9000mm per annum/ ANTIGUA 1140mm (45"); 2. Excessive rainfall cause Increased flooding and the risk of disease outbreaks:

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3. Poor water resources management with demand exceeding supply (agriculture, tourism competing with domestic and industrial use. 4. Promotion of Rainwater Harvesting as a water augmentation measure (health aspects/disinfection, storage)

5. Water safety planning HACCP methodology based on a risk management approach (useful in time of disasters and for overall improved management 6. Quality: Poor watershed management/agricultural run off/dumping of solid waste/chemical pollution/ salinisation of water lens through over extraction/aquifers at risk. Human Health impacts (diarrhoeal diseases)

7. IWRM (Integrated Water Resources Management): a framework for water management in

the region. Multiple stakeholder involved, including the users and managers of water.

Waste Management (solid and liquid): poor disposal practices; leptospirosis; flies, mosquitoes.

Statistics are not readily available but the visual inspection is convincing enough. Leachate from landfills

into the ground (water contamination)

Waste water: pollution the most pressing environmental problem: discharge of waste water, poorly

treated sewage, malfunctioning sewage treatment plants: coastal and marine environment; tourism

products severly impacted. 75% of packaged sewage treatment plants not functioning and 65% of cases

examined discharged into the aquatic environment (freshwater and saltwater)

Indoor Air quality: home and office buildings; respiratory problems, skin diseases, (materials/poor

housekeeping, ambient issues. Airconditioning, moisture,: tropical architecture/ designs needed

Climate change: impacts all aspects of development: a cross cutting issue

Environmental Health Impact Assessment: planning tool which integrates human health and environmental concerns.

Behaviour change among the population necessary

Reference to Multilateral Environmental Agreements (Chemicals), LBS Protocol (water

quality guidelines) for One Health activities. These provide an international framework for guiding

national and regional actions.

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Appendix 7 Professor Abiodun A. Adesiyun

One Health Issues ...Caribbean Perspective

Presentation at the Caribbean One Health Workshop held at Port of Spain.

February 28 - March 01, 2013

A.A. Adesiyun, Director, School of Veterinary Medicine, University of the West Indies.

Animal Health

Introduction I am basing my contributions on Caribbean countries in the context of CARICOM community. I have been given the mandate to discuss Animal Health issues in the context of One Health. Furthermore, I have been directed to highlight those diseases that span at least 2 preferably 3 of the domains ( animal, human and environmental health). A number of the diseases that fall into this category will therefore be zoonotic agents including those that are food-borne (farm to table), disease that directly affect production which may also directly or indirectly affect the economy of Small Island States e.g. small ruminant production. It is my intention to mention for discussion diseases that affect the Caribbean region in general as well as those limited to certain countries.

a. Rabies:

Category I: Rabies never been reported or successfully eradicated – most of English

speaking Caribbean

Category II: Rabies controlled in pets (dogs and cats) but present in wild animals:

Trinidad and Tobago, Grenada, Guyana and Suriname – vampire bats and mongoose.

Category III: Rabies still in dogs that are transmitters to humans --- Belize, Haiti.

Approach that is being taken, or could be taken, to better address the issues through

crosss-sectoral collaboration:

Import control—associated problems- effectiveness, duration

Vaccination: dogs, cats and cattle

Control of wildlife populations—mongoose and vampire bats

With reports in smaller ruminants (goats) and equine—need to explore the need

to vaccinate these animal species.

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b. Leptospirosis in livestock and pet animals.

Widespread across the region causing morbidity and mortality in dogs and cats and

livestock. It also causes problems in humans.

Issue of prevalent serovars in animal population – domestic, dogs and rodents

Serovars used in vaccines in the various countries

Need to explore the possibility of developing vaccines

Approach that is being taken, or could be taken, to better address the issues through

cross-sectoral collaboration :

Vaccination

Rodent control

c. Brucellosis – cattle and

taken, to better address the issues through cross-sectoral collaboration :

d. Need for regular testing of water buffalo in Trinidad

Mainly a problem in water buffalo; a problem in cattle

Brucella abortus biovar 1

Trial on efficacy of Brucella abortus rb51 VACCINE---INEFFECTIVE

Some workers at one of the slaughter houses have tested positive for

brucellosis

Most countries in the region free of the disease

Approach that is being taken, or could be livestock

Continue with test and slaughter policy

e. Ticks and tick-borne diseases (emphasis on surveillance and disease prevention

and control of the Tropical Bont Tick – Amblyomma variegatum)

Anaplasmosis

Babesiosis

Heartwater is an infection, noncontagious, tick-borne diseases of domestic

and wild ruminants, including cattle, sheep, goats, antelope and buffalo.

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The disease is caused by an intracellular rickettsial parasite, Cowdria,

ruminantium, and is transmitted by a number of species of ticks in the genus

Amblyomma.

Effect on small ruminants with regard to meat production

Effect on the economy/meat supply to Small Island States

Approach that is being taken, or could be taken, to better address the issues

through cross-sectoral collaboration :

Vector control

f. Salmonellosis

Regional occurrence

Problem in young animals – piglets, lambs, calves, kids,

Problem in the poultry industry – Salmonella Enteritidis – imported eggs or

day-old chicks.

Important from Salmonella-free farms from abroad???

Approach that is being taken, or could be taken, to better address the issues

through cross-sectoral collaboration :

Regular monitoring of prevalence in neonatal diarrhoea

Regular testing of layer farms and table eggs

Importation from only Salmonella-free farms in the region and abroad-

making sure to prevent spread across the region.

g. Common Food-borne pathogens of public health and economic (trade and

tourism) importance

Listeriosis

Campylobacteriosis

Salmonellosis

Impact on exportation – Listeria

Approach that is being taken, or could be taken, to better address the issues

through cross-sectoral collaboration :

Delimeat--for Listeria monocytogenes

Campylobacteriosis – broilers

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Salmonellosis – table eggs

h. Screwworm infestation

All countries may be susceptible

Priority possibly in Jamaica and T&T

Screwworm—associated myiasis

Affected livestock production, dogs

Reported human cases

Approach that is being taken, or could be taken, to better address the issues

through cross-sectoral collaboration :

Eradication programme in Jamaica unsuccessful

Control programmes in place

i. Classical Swine Fever

Emphasis on Haiti

CSF is present in three Caribbean countries: Cuba, Haiti and the Dominican

Republic.

Classical swine fever (CSF) is a viral transboundary animal disease that is highly

contagious among domestic and wild pigs, such as boars and peccaries

Disease is characterized as having a varied clinical picture

Hinder production, trade, and the livestock economy in the region

It is among the diseases included in List A of the Office International des

Epizooties (OIE)

j. Encephalomyelitis by Teschovirus

Emphasis on Haiti

Since January 2009, a teschovirus PTV-1 serotype has been circulating in pigs in

Haiti.

The virus does not affect humans, but it is causing important losses to Haiti pig

producers resulting in acute encephalomyelitis in pigs with an infectivity of 30 to

40 per cent and a mortality of 40 to 50 per cent.

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Infection of pigs occurs by ingestion or inhalation of products contaminated by

faeces, urine or oral secretions of infected animals, the virus being very

resistant in the environment.

Pigs of all ages are susceptible and clinical signs include fever, anorexia,

depression and incoordination, followed by painful hypersensitivity, paralysis

and death within three to four days.

Muscle tremors, stiffness or rigidity, nystagmus, seizures, changes in or loss of

the voice, opisthotonus and clonic spasms of the legs may be seen.

Although mild cases may recover, progressive paralysis, beginning in the

hindquarters, amy be observed in the advanced stages with death in up to 90

percent of the cases resulting from respiratory paralysis.

Risk for introduction into other CARICOM countries

k. Avian Influenza

Ongoing monitoring and surveillance and vulnerability of the live-bird market in

selected countries.

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Appendix 8 - Dr. Martín S. Minassian - International examples of One Health approaches -

OIE

Technical Assistant- OIE Regional Representation for the Americas

m.minassian@oie.int

Veterinary Services as a Global Public Good

The definition of “public goods” was created in 1954 by the economist Paul Samuelson. Public goods are

both non-excludable, since their consumption does not prevent others to have access to them, and non-

rivalrous, because the use by one individual does not reduce the availability to others.

A Global Public Good has the added characteristic of its worldwide availability (universality), and also its

trans-generational dimension.

The OIE considers the Veterinary Services as a Global Public Good and their activities as a public

investment priority, with these characteristics:

- In relation to the control and eradication of infectious diseases, the benefits are international and intergenerational in scope.

- Countries depend on each other - Animal health systems are neither a commercial nor a strictly agricultural good. - Failure of one country may endanger the entire planet

Good Veterinary Governance, or the provision and management of Public Goods and Services, acts as a

buffer, containing animal and zoonotic diseases from reaching their effects on animal and human health,

poverty, food security and safety, and trade.

The OIE Tool for the Performance of Veterinary Services (OIE PVS Tool)

Based on the “Performance Vision and Strategy for Veterinary Services” Tool developed by IICA, the OIE

PVS Tool can be considered as a more exhaustive qualitative evaluation tool. It includes the evaluation

of four fundamental components, as follows:

- Human, physical and financial resources - Technical authority and capability - Interaction with stakeholders - Access to markets

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Each fundamental component is divided into Critical Competencies, which are considered as

unavoidable responsibilities for the Veterinary Services.

These Critical Competences already include those related to “One Health” principles (i.e coordination

with other organizations, shared responsibility, Laboratory diagnosis, epidemiological surveillance, food

safety and others), being then an unavoidable component of efficient Veterinary Services.

All of the Critical Competences are based on the Chapters 3.1 and 3.2 of the OIE Terrestrial Animal

Health Code, and Chapter 3.1. of the Aquatic Animal Health Code.

As one of the objectives is the permanent improvement of the Veterinary Services, the PVS Tool is part

of the PVS Pathway, which includes the PVS Gap Analysis Tool, a quantitative evaluation of a country’s

needs and priorities based on the results of the OIE PVS Evaluation. The outcome of the PVS Gap

Analysis can be used by government authorities and potential funding partners to prepare specific

investment programs.

As Veterinary Services act as law enforcement institutions, many times the laws itself act limiting the

improvement in the Veterinary Services, hence the provision of experts for the updating of Legislation is

one of the components of the PVS Pathway.

The OIE PVS Tool and “One Health”

A pilot project for the development of a specific OIE PVS Tool for “One Health” is currently in progress,

with the participation of the WHO. This is intended to improve the effects of the activities of the

Veterinary Services on Public Health, focusing on the collaboration and shared responsibilities with the

Competent Authorities in Public Health.

More information is available at the OIE Website: www.oie.int

“Good governance and financing of efficient Veterinary Services”, Scientific and Technical review of the

OIE , Vol. 31 (2), August 2012

http://web.oie.int/boutique/index.php?page=ficprod&id_produit=1073&fichrech=1&lang=en

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Appendix 9 - Dr. Joseph Annelli

Safeguarding Animal Health

Enabling Policy Environments for One

Health Approaches:

View from the Public Sector

Joseph F. Annelli DVM, MS

Director, One Health Coordinator Office,

Senior Advisor for Agriculture and Health Systems

Office of the Deputy Administrator, Veterinary Services

Animal and Plant Health Inspection Service (APHIS)

United States Department of Agriculture

4700 River Road, Riverdale, MD 20737

Improving the global health of people, animals, ecosystems, and society

Safeguarding Animal Health

One Health in Action Examples

• USDA involvement in non-traditional and non-program animals and DZ agents

• Demonstrate and support why a OH approach is needed to address issues at the AHEI

• Role of veterinarians – surveillance, epi investigations, prevention measures, applied research, diagnostics, communications --educate clients – where do you go for information?

2Improving the global health of people, animals, ecosystems, and society

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Safeguarding Animal Health

Outbreaks of Influenza A (H3N2) virus among People

and Swine Associated with Fairs, 2012

• Content

3

John Korslund, DVM

Improving the global health of people, animals, ecosystems, and society

Safeguarding Animal Health

Reported Human Infections with

Influenza A Variant Viruses in the US -

2005-2012• Increased detections of interspecies

transmission of influenza virus between pigs and people have been reported

• 36 cases reported from Dec 2005- April 2012

• H3N2v, H1N1v and H1N2v

• Limited H-to-H is likely to have

occurred

• Because of its complex ecology and

risk of interspp transmission

influenza requires a “OH approach”

4Improving the global health of people, animals, ecosystems, and society

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Safeguarding Animal Health

Influenza A (H3N2) virus

• Influenza A H3N2 variant virus (H3N2v) with the matrix (M) gene from the 2009 H1N1 pandemic virus

• In pigs, referred to as H3N2pM

• Detected in U.S. pigs in 2010 and humans in July 2011

• Appears to spread more easily from pigs to people than other variant viruses

5

Safeguarding Animal Health

Outbreak of H3N2v

• Between July 12 and October 11, 2012

– 306 cases in people from 10 states

– 16 people hospitalized; 1 death

• Recently, also cases of H1N2v (3), H1N1v (1)

• The main RF for infection is exposure to pigs, (direct contact) mostly in county and state fair settings

6

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Safeguarding Animal Health

Impact on the fairs• The number of human infections in 2012 was

unprecedented– approx 80% had direct swine contact

– More than 90% are children (<18 yo)

– A typical case is a child in 4-H

• Cancel certain swine shows and activities fair organizers should bar swine from fairs this year– Increase in case counts?

– Change in the case counts?

– Change in severity?

– Change in the virus?

7

Safeguarding Animal Health

Investigation and Response

• Collaboration between Federal, State, and local public health and animal health agencies and organizations

• At Federal level, APHIS, CDC and NIFA (4-H) all involved in joint response activities

• Monitoring outbreak and state-based joint investigations

• Jointly developed communication materials

• Prevention/control outreach to 4-H leaders, 4-H’ers, fair organizers, veterinarians, public

8

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Safeguarding Animal Health

What can be done at fairs?

Guidance documents• Anyone at high risk for serious flu

complications* who is planning to attend a fair where pigs will be present should avoid pigs and swine barns at the fair this year.

* Includes children younger than 5, people with certain chronic conditions like asthma, diabetes, heart disease, weakened immune systems, pregnant women and people 65 years and older

9

Safeguarding Animal Health

What can be done at fairs?

• Thorough exams at check-in

• Ongoing monitoring of swine health; involve the kids and parents―it’s a teachable moment

• Prompt isolation of sick pigs

• Collect swab samples (NAHLN lab or NVSL)

• Prompt reporting by fair officials of human ILI to public health and animal health authorities

• Length of exhibition

• Good communications & timely decision-making

10

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Appendix 10 – Dr. Cedric Lazarus, Livestock Development Officer

Using a multidisciplinary framework to address food security

and decrease hunger

One Health in FAO

Cedric Lazarus, Livestock Development OfficerFAO Sub-regional Office for the CaribbeanBridgetown, Barbados

FAO and Food Security

Strategic objectives1. Eradicate hunger, food insecurity and

malnutrition

2. Increase/improve provision of goods and

services from agriculture, forestry and

fisheries in sustainable manner

3. Reduce rural poverty

4. Enable more inclusive/efficient food and

agricultural systems at local, national and

international levels

5. Increase the resilience of livelihoods to

threats and crises

FAO tries to apply OH principles/approaches on regular basis: How well?

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Security and safety of agri-food chain

Farm

Transport

Slaughter/

Processing

Restaurant/Retail

Distribution/

Imports

Consumer

Inputs Contamination source?

One Health at FAO•Still in its infancy

•FAO Corporate One Health Workshop (2011)

• Recommendation: Establish OH Inter-disciplinary Working Group

•OH IDWG established (2012)

• >20 members

• nutrition, plant, food safety, fisheries, forestry/wildlife, animal health, agri-food

industry, land/water, legal, communication, extension/research, etc.

• Secretariat (multi-disciplinary)

•Secretariat

• Extensive on-going consultations (within FAO and outside)

• Regional consultations, including in the Caribbean (to be done)

•Key objectives

• Adapt OH to FAO and further develop FAO’s OH concept

• Validate it

• Mainstream OH in FAO

• Cascading effect to member countries

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Developing FAO OH Concept

• Focus group discussions are on-going

• Three groups (5-8 participants)

– Mixed disciplines and sectors

• Facilitator/full discussion records

• A priori questions

– e.g. Key areas of FAO’s work that would considerably benefit from

utilization of OH approach

• Thematic analysis

– 3 narratives, code list/pre-testing, coding, theme development

• Discussions and consensus

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One Health Conceptual Themes

Political will and commitment

•Political will (senior management level?)

•Leadership (e.g. IDWG?)

•Governance (e.g. assigning clear roles and

responsibilities, decision making)

Partnerships and communication

•Stakeholders (e.g. public-private)

•Collaboration networks

•Partnerships (in/out FAO)

•Communication(in/out FAO)

•Coordination (in/out FAO)

Cross-cutting programs and policies

•Multi-disciplinary

•Cross-sectoral

•Complex science to policy issues

(e.g. AMR, food safety/security, animal-wildlife-

fishery/plant/environmental health, zoonoses)

Capacity and infrastructure

•Resources / funding (e.g. equity)

•Planning (e.g. inclusive, strategic)

•Guidance (e.g. member-countries)

•Training / education (e.g. in FAO, )

•Raise awareness

Priority functions and integration - concept testing/validation (pilot projects)

•Capacity assessment and development

•Surveillance (e.g. OH surveillance initiatives)

•Risk analysis (e.g. risk assessment, risk management)

Next steps

Consult with regions, including the Caribbean

Finalize FAO’s OH concept

Reminder: not perfect concept, but reasonably acceptable,

might/will evolve over time

Validate through pilot projects

Develop process for mainstreaming

Strong linkages with the FAO mandates and five new strategic

objectives

Members needs

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FAO One Health Concept at work

*Antimicrobial resistance of food-borne pathogens

*Wild meat, livelihoods and sustainability

*Task Force on wild life and ecosystem health

Wildlife investigation in livestock disease and public health

Pesticides

Aquatic animal health and food safety

Thanks to the following:

Dr. Andrijana Rajic, FAO Rome

Dr. Lindsey McCrickard, FAO Rome

Dr. Juan Lubroth, FAO Rome

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Appendix 11 – Work Group Questions

1. Identify key issues for possible projects in the Caribbean.

Question: What priority problems or issues in the Caribbean would be

better addressed by a One Health cross-sectorial approach?

2. Refine project topic(s)

Question:

Any revision to issue(s) identified for action?

What would you do to address the priority issue(s)?

What do we need to do to address the problem?

3. Implementation: Who?

Questions:

Who do we need to work with to address the problem(s)?

Who needs to be involved to address the problems and questions:

Which sectors? (government, private, academia)

Which countries?

Which disciplines? (animal, health and/or environment)

How would we bring them together?

4. Implementation: What?

o What would we need to address the problems)?

o What resources would be needed – consider infrastructure, human resources, and finances?

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Appendix 12 – Craig Stephen: Recap of Day 1

Themes

• Coordinated use of natural resources– Food security/land use– Water security– Biodiversity and health outcomes

• Threats– Specific “etiologies” – lepto, AMR, pesticides– Environmental change – disaster management– Themes – foodborne, vector-borne

• Information– Surveillance, sharing

• Governance– Policy, coordination

• Capacity– Surveillance, training, leadership

Specific threats

Facilitating collaboration

Root causes

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Next steps

• Each group decide on 1 strategic issue

Cross sectoral

impact

acceptable

pervasive

feasible

risk perception

others priority

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Appendix 13 One Health Tool Kit

One Health Tool Kit

USDA APHIS VS One Health Program - http://www.aphis.usda.gov/animal_health/one_health/

• YouTube Video – US Chief Veterinary Official on One Health - http://www.youtube.com/watch?v=TUixEIbSID4

US Center for Disease Control OH Program - http://www.cdc.gov/onehealth/

• Stone Mountain Meeting – http://www.cdc.gov/onehealth/archived-meetings/march2009-may2010.html#one

One Health Global Network - http://www.onehealthglobal.net/

One Health Initiative - http://www.onehealthinitiative.com/

FAO in One Health - http://www.fao.org/docrep/012/ak731e/ak731e00.pdf

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Appendix 14 Workshop Evaluation

PAHO/WHO WORKSHOP EVALUATION

Twenty Six participants responded to the Evaluation

On a scale of one to 4 with one being strongly agree to 4 strongly disagree the following were

the scores

Percentages

1)Workshop Objectives 1 2 3 4 1. To inform, discuss and solicit ideas on how to apply the One Health

approach to issues at the animal-human-environmental interface in the Caribbean region

16/26-61.5%

8/26 30.7%

1/26 3.8%

1/26 3.8%

2. Create a Caribbean network of professionals in human, animal and environmental health who are motivated to champion, promote and utilize an intersectoral One Health approach

13/26 56.0%

10/26 8.4%

3/26 11.1%

0

3. Recognize One Health priority issues and activities in the Caribbean for further development into a regional project proposal

11/26 42.3%

11/26 42.3%

4/26 15.0%

0

Program Content and Delivery

Percentages

Content and Delivery 1 Strongly Agree

2 3 4 Strongly Disagree

The workshop content was relevant to my work 17/26 65.3%

7/26 26.9%

1/26 3.8%

1/26 3.8%

The workshop met my expectations 10/26 38.4%

14/26 53.8%

2/26 7.6%

0

The workshop was well organized 20/26 76.9%

5/26 19.2%

0 1/26 3.8%

Presenters were effective in delivering/facilitating the workshop 17/25 68%

7/25 28%

0 1/25 4%

There were adequate opportunities to interact with my peers 19/25 76%

3/25 12%

3/25 12%

0

There were adequate opportunities to interact with workshop presenters

16/26 61.5%

9/26 34.6%

1/26 3.8%

0

The information I learned will be useful in my future work 18/25 72%

6/25 24%

1/25 4%

0

*NB. 26 participants completed the evaluation forms and this is represented in the columns above for

example 16/26, 7/26, 1/26, or 19/25, 3/25, etc. The appropriate % is stated in the row below the

number of persons responding.

3. What was the most effective part of the workshop? Why?

- The breakout sessions facilitated a deeper sharing of perspectives from participants

- Presentations, especially Craig’s, Lazarus and group work

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- Break outs allowed for sharing of ideas

- The groupwork/brainstorming sessions

- Networking

- Working group sessions created more effective participation

- Networking-there was adequate time for this to happen

- Day 1- it broadened my perspective and gave me a better idea of the issues that concern other

stakeholders and what they consider priorities

- Stimulating a OH culture and approach in my work

- The introduction to the OH approach and opportunities to meet and discuss common areas of

concern

- Interaction and discussion

- Group work and presentations/ contributed subjects of significance

- The selection of the participants included a very good cross section of professionals who

contributed to the development and promotion of One Health

- Recognizing the need for an OH approach

- Collaboration and participation

- The bringing together of the relevant personnel and the attendant networking opportunities

- getting collaboration between the different agencies because of the working groups formed

- the workshop sessions and reporting sessions. They served to increase participants awareness

of the topic and ongoing activities and initiated the networking process

- environment topics

- the way the workshop was organized with relevant interventions

- The presentation on Introduction to one health by Dr. Stephen/Some of the issues identified for

One Health approach

- Group activities offered the chance of interaction

- The expert resource personnel energy and good guidance and the wonderful interaction which

resulted

- met and made new and renewed some old strategic partnerships

- Awareness of One Health

4. What was the least effective part of the workshop? Why?

- The workshop was of very short duration and so encouraged rush of ideas

- Incorporating entire Caribbean countries

- Post lunch session (before break) on Day 2- lost energy and focus for group

- Is it already implemented somewhere….yes….difficulties met…..can we learn in advance from

that?

- Evaluation of OH concept

- time frame too short

- Getting specific projects since this would involve further discussion regionally

- Unclear assignments to the group

- The working group sessions since some participants did not grasp the concept of One Health but

were very vocal

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- It is hard to say. Maybe there was not any.

5. Describe two ways in which you could change your work to include One Health as a result of

attending this program:

- Sensitize staff and seniors/ use OH as an umbrella to incorporate on going projects

- Be more inclusive in routine work in which OH is applicable

- inclusiveness of activities with shareholders/ sharing of information

- incorporate the OH concept in my regular programme of work or on going projects

- potential research proposals/all info for students

- Strengthen collaboration with the other countries across health and agriculture/ orient staff

within my agency on OH approach

- Develop formal mechanisms to interact with other stakeholders(MOUs, regular inter-sectoral

meetings)/ request budgetary support for formal mechanisms

- Research projects already integrate human and animal health and I will try to ensure that

environmental aspects are incorporated

- Think OH while developing research projects in the future/ Discuss issues for potential

collaboration in other disciplines

- Share with Director and continue to reach out to colleagues in agriculture and health

- Briefing of colleagues/briefing of decision makers

- Emphasis on greater collaboration with the stakeholders/ promoting the use of the one health

approach as a teaching tool

- Promote/ Educate

- more collaboration

- Data sharing with other ministries/ Formation of task forces to tackle relevant problems

- Seek to involve all possible stakeholders in any activity which can serve to increase the

implementation of the concept of OH/ Advise my superiors about the concept and advocate for

changes in our work programme to include the concept.

- Involving other disciplines/Team building

- Network more the contacts made to disseminate information throughout the region/ Use

contacts to obtain information

- Beginning to utilize the One Health approach in project proposals/Creating awareness among

peers and other health professionals

- Promoting the One Health concept/ including the participation from other organizations

- Do more organizing with other partners/Use the experience gained to influence the OH strategy

in my workplace

- Teach One health/ Our Vet students want to begin a One Health Club(Ross)

6. Please list any topics you would like to see addressed in future workshops:

- Monitoring and evaluation

- One Health policy /leadership/regional projects applying thee one health concept

- OH approach by the medical and public health community

- Findings to Caribbean

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- Integrated surveillance approach for animal and human health/surveillance system

- Leadership/ negotiation strategies

- One health approach to monitoring , surveillance and detection of emerging pathogens

- Identify specific OH projects for implementation

- Same goals just with the OH concept in mind/there will be more focus on trying to convince

others of concept

- examples of problems met and how problems were solved

- IHR

- A One health regional policy

- Integration of poverty issues in the OH approach/One health and its impact on international

trade

- examples of One Health activities in the countries

- To learn what priority areas were identified and how they have been moved forward .

7. General Comments:

- Excellent start for the region towards the recognition of the need to take the OH approach

- Good workshop

- Great workshop/very much worthwhile/good facilitators/ participants kept focused throughout

the 2 days.

- An enjoyable and informative workshop that gave the opportunity to network with others who

can increase the efficiency and impact of our work. I was disappointed we did not arrive at more

concrete projects but the outcome was helpful nonetheless.

- A useful workshop to introduce the OH concept to many people

- Thank you for giving me this opportunity

- Well done workshops with excellent presenters and facilitators

- A very good workshop with the need for follow up

- Great

- Well organized and productive workshop. It is important that the momentum generated here will

not be lost

- A very well organized and useful workshop

- Very productive and informative workshop. Well organized, timely and included many of the best

minds on the subject / Enthusiastic and motivated participants.

- Maybe a time slot could have been allocated to regional organizations/ institutions to develop

joint collaborative projects.

- A good workshop

- Great meeting . Well organized

- An excellent workshop which was well organized and the different experts and professionals

together added to the quality of the workshop.

- Excellent opportunity to increase awareness , create a network of Caribbean professionals and a

list of one health priority issues and a donor funding proposal. Thank you for a great opportunity.

- Keep up the excellent work Dr. Vokaty and Team.