Integrated management-based approach for surveillance and control of zoonoses in emerging livestock systems: South East Asia Pig & Poultry Partnership

Human populations repeatedly face new infectious disease challenges, many of which are of animal origin (zoonotic) and then become endemic in animal and human populations. These zoonotic risks may be worsened by rapid development and diversification of livestock production systems now occurring in low- and middle-income countries, especially in South East Asia. These emerging livestock systems (ELS) are linked to peoples' changing food consumption habits, economic status, aspirations and population shifts, and to political contexts. Key features of ELS include intensification of animal keeping, increased use of antibiotics, and extended supply chains - all of which can have disadvantages from a food safety perspective.

Headlines reasonably focus on the emerging zoonotic diseases, for example highly pathogenic influenza (HPAI), but it is the forgotten endemic zoonotic diseases, and primarily gastrointestinal (GI) infections that put the heaviest global burden on the health of poor people, and on productivity and profitability of their livestock (ILRI Report to DfID, 2012). It is estimated that zoonotic gastrointestinal disease, caused by bacteria such as Salmonella and Campylobacter and related antibiotic resistance, accounts for around 1 million human deaths per year globally with around 800 million people being affected, most of them children under five; a situation also reflected in our study countries Viet Nam and Myanmar which rank in the top 5 hotspots for rapidity and diversity of their ELS (ILRI report to DfID).

Our work tests the idea that diverse ELS, specifically pig and poultry production, upon which these people increasingly depend for food, are major sources of these infections. We also hypothesise that these zoonotic threats are impacted by the risk environment, and pathogen- and host-related factors and that these, in turn, will be affected by the scale and diversity of different ELS. Viet Nam and Myanmar are at different stages of rapid but different development trajectories and we will study these differences to support development of new One Health approaches.

Our proposal's aim is to exploit interdisciplinary expertise that includes social, biological, and governmental players from Myanmar, Viet Nam and UK to bring about step changes in pro-poor control measures using knowledge-driven and culturally relevant strategies that concomitantly improve animal health and productivity and thus improve and protect human health.

The objectives to achieve this aim involve parallel work in Viet Nam and Myanmar:
(1) To characterise pig and poultry production systems and supply chains.
(2) To characterise key stakeholders' existing perceptions and practices related to livestock disease, zoonotic risk and baseline preventive mechanisms.
(3) To identify the impact of different livestock systems on the prevalence and diversity of bacterial zoonotic infections and on antimicrobial resistance.
(4) To up-scale regionally accessible diagnostic laboratories
(5) To identify, pilot and evaluate appropriate and effective knowledge-based training programmes in ELS in Viet Nam and Myanmar, and consider how these might be translated to other contexts.

Our research will underpin improved food safety and wellbeing for consumers, improved economic security and health for food chain workers, community-level and environmental benefits from improved management of livestock intensification, evidence on which to base effective and culturally relevant policy for bacterial zoonosis control, pilot microbiology laboratories, infrastructure, and training as the basis for sustainable future surveillance for bacterial endemic zoonoses (to which surveillance for emerging zoonoses could be bolted), and zoonotic risk evaluation and control methods that can be adapted to other international contexts. Finally, the project provides novel academic insights into the role of interdisciplinary teams in tackling global health issues.

Increasing consumption of meat in developing countries, especially in SE Asia, is leading to new demands on pig and poultry supply chains and emergence of new production networks. The zoonotic threats posed by these changes are largely unknown. The project will deliver interdisciplinary understanding of interactions between (1) meat production, the environment and supply practices, (2) socio-economic and export pressures, cultural understandings and perceptions of risk to humans and livestock, and (3) the infection dynamics and diversity of zoonotic infections and antimicrobial resistance determinants in these systems. This understanding will provide baseline knowledge and inform the design and evaluation of interventions intended to strengthen the safety and robustness of meat supply chains in ways that build on existing formal and informal practices and contexts, implementable in dynamic SE Asian settings.

Our aim is to exploit interdisciplinary expertise including social, biological, and governmental players from Myanmar, Viet Nam and UK to bring about step changes in pro-poor control measures using knowledge-driven and culturally relevant strategies that concomitantly improve animal health and productivity and thus improve and protect human health. The objectives to achieve this aim involve parallel work in Viet Nam and Myanmar:
(1) To characterise pig and poultry production systems and supply chains.
(2) To characterise key stakeholders' existing perceptions and practices related to livestock disease, zoonotic risk and baseline preventive mechanisms.
(3) To identify the impact of different livestock systems on the prevalence and diversity of bacterial zoonotic infections and on antimicrobial resistance.
(4) To up-scale regionally accessible diagnostic laboratories
(5) To identify, pilot and evaluate appropriate and effective knowledge-based training programmes in ELS in Viet Nam and Myanmar, and consider how these might be translated to other contexts.

The following is a summary of the impacts, and routes for their delivery.
(1) Retail and subsistence consumer benefits through improved food safety and reduced prevalence of pig- and poultry-meat derived endemic bacterial zoonoses is a major impact target of our work. This will come through the uptake of training in knowledge-based management methods along the meat supply chain - from farm through butchery and retail, delivering safer products into consumers' homes. It will be assisted through shifts in government policy and legislation. Although much of this impact will come from earlier steps in the supply chain, our project includes the use and evaluation of consumer discussion groups allowing direct interaction training opportunities. Involvement of regional government in our consortium will enable fast-tracking of successful public health education programs for broader uptake.
(2) Our research will impact supply chain workers directly involved in our project (farmers, butchers, retailers) by offering improved economic stability through better animal health (including non-zoonotic infections) and productivity and reduced occupational exposure to bacterial zoonoses along the supply chains. This will be achieved through adaptations of the Farmer Field School Approach described in Pathways to Impact, with uptake on a larger scale being assisted by sDAH in Viet Nam and LBVD in Myanmar.
(3) At community level, we anticipate that methods to control the selection of antimicrobial resistance and its escape into local environments, watercourses and populations will be a significant impact. This will be achieved through farm-level training methods.
(4) A key area of impact will be at regional (policy implementation) and national governmental (policy development) level. At regional level we anticipate making a tangible step-change in infrastructure, capacity and training for surveillance and diagnostic investigation of bacterial endemic zoonoses of livestock and in-contact humans by up-scaling and up-skilling this capability. We anticipate that the laboratories we support in Myanmar and Viet Nam will obtain subsequent research funding, and that sDAH and LBVD will be convinced of the value in investing to maintain these capabilities. Our work also provides opportunities for interdisciplinary training of government (sDAH and LBVD) veterinary surgeons and epidemiologists for on-farm productivity assessment and intervention delivery. At national level we anticipate impacts in terms of influencing One Health policies across and between departments responsible for livestock and human health and for regulation of food safety surveillance, animal husbandry and health management recommendations. Finally, we see our new approach to designing bespoke training methods that account for risk perceptions as being an important impact leading to more effective results in government led training initiatives.
(5) At international level, we anticipate that outputs from our project will be taken up by non-governmental development, animal health and One Health agencies to enable translation of knowledge-based, culturally applicable training for reduction of endemic bacterial zoonoses in different countries. This will be achieved through, for example, collaborative support from FAO. In addition, we believe that the strong international consortium will encourage all participants in our project, from small-scale farmer to butcher to government official, to foster and cherish mutually valuable international linkages as sources of advice, support and friendship.
(6) The opportunity to build stronger teaching links between UK, VN and MM universities, veterinary and medical schools provides exciting opportunities for 2-way flow of One Health and development impacts at faculty and student levels. These opportunities will be facilitated by our partners at LBVD and sDAH.