Integrating participatory approaches and traditional models to strengthen One Health responses to zoonotic diseases in India's changing environments

Zoonotic pathogens, that circulate between animals and humans, like the Leishmaniases, and Nipah and Chikungunya viruses, cause 60% of emerging infectious disease events worldwide and disproportionately affect people in tropical, resource-poor areas. Aside from impairing human and animal health, zoonotic diseases are detrimental to livelihoods and economies, for example, preventing small-holder farmers being lifted out of poverty by increasing livestock production. The impacts of zoonotic diseases are increasing and shifting globally, as the environment and societies undergo rapid change. Our lack of knowledge on how these pathogens circulate between wildlife, livestock (as well as possible insect and tick vectors) and people, and how people are exposed as they use the landscape makes it difficult to understand these changes in terms of impact, and to develop effective disease control strategies in many local settings. Effective management and understanding of zoonotic diseases requires cooperation of policy-makers and managers from across the animal health, human health, agriculture and environment sectors, from national and international decision-makers down to district managers that all interact with the disease system, as advocated by the global One Health initiative, that recognises the "interconnectedness of human health, wildlife and domestic animal health and the environment". Surveillance, decisions and policy need to be better integrated across sectors, and research that leads to informatics to support management decisions, like maps and forecasts must be informed by the knowledge, priorities and needs of local disease managers and policy makers. More-over, neglected endemic pathogens that affect poor communities need to be better represented in policy frameworks and surveillance systems.

Focussing in India as a key global hotspot for endemic and emerging zoonotic diseases and small-holder livestock communities, and bringing together a network of stakeholders with experts in public and animal health, ecology, epidemiology and social science, this project aims to reduce health, welfare and livelihood impacts of zoonotic diseases by better understanding links between surveillance, knowledge, research and models across sectors and improving current information systems that support intervention. The research underpinning these improvements will include:
(1) Mapping of key stakeholders in each sector, their priorities and needs for decision-support tools
(2) Identifying where surveillance data, knowledge and skills exist and could be leveraged across sectors to better understand and manage zoonotic diseases
(3) Understanding the full range of potential socio-ecological drivers that might cause disease impacts to increase
(4) Interpreting geographical patterns in disease impacts in relation to environmental data within models to disentangle social, climate and landscape factors precipitating disease for case-study diseases and settings and, in turn, predicting outcomes of intervention
(5) Building capacity in research, data analysis and cross-sectoral collaboration to underpin future One Health approaches in India.

Improved decision-support tools will help disease managers to better target vaccination and communication efforts towards the communities that are most at risk and help managers in agriculture and environmental sectors to understand how, for these communities, disease impacts may coincide with other negative impacts of environmental change.
The project platform and approach of co-developing research and decision support tools on zoonotic diseases with stakeholders across sectors, accounting for their needs and underlying ecological and social processes, will build significant capacity in science, policy and practitioners to respond to these emerging and endemic global threats.

Diseases transmitted from animals to humans (zoonotic diseases) cause 60% of emerging infectious events worldwide and disproportionately affect people in tropical, resource-poor areas. As well as their impact on human and animal health, zoonotic diseases are detrimental to livelihoods and economies. Although we know that the number and effect of these diseases are increasing globally, we still lack knowledge on how these diseases circulate between wildlife, livestock and people, and the extent to which changes in the landscape and anthropogenic activities are affecting disease emergence and spread. Effective disease control strategies requires cooperation of all relevant policy-makers and managers from across the animal health, human health, agriculture and environment sectors, from national and international decision-makers down to district managers responsible for managing diseases at the local scale. Focussing in India as a key global hotspot for zoonotic diseases this project aims to reduce health, welfare and livelihood impacts of zoonotic diseases by better understanding links between surveillance, knowledge, research and models across sectors and improving current information systems that support intervention. The research underpinning these improvements will include:
(1) Mapping of key stakeholders, their priorities and needs for decision-support tools
(2) Identifying where relevant knowledge exists to better understand and manage zoonotic diseases
(3) Understanding the full range of potential drivers that might cause disease impacts to increase
(4) Interpreting patterns in disease impacts to predict outcomes of intervention
(5) Building capacity across policy, research and practice.

The project platform and approach of developing research and decision support tools together with the relevant stakeholders across sectors will build significant capacity in science, policy and practitioners to respond to these emerging and endemic global threats.

Health, welfare and economic development impact: Benefiting practitioners
Our research addresses an area of economic development and welfare increasingly relevant to and important in Low and/or Middle Income Countries (LMICs) where threats from emerging and endemic zoonotic diseases are evolving in response to complex socio-ecological and environmental changes including environmental degradation, forest loss, human settlement and climate change. The project will help zoonotic disease managers in India by giving them increased access to inter-sectoral surveillance capacity and data (in a format that is adapted to their needs); strengthening disease management networks across environmental, government and private health sectors; and addressing the current disconnect between models and information systems for zoonoses, health policy and decision-making, to improve disease research and interventions of disease managers. Our proof of concept approach will help disease managers during and long after the project end to design and implement the One Health approach, laying the foundations for improved policy-setting for zoonotic diseases in India and beyond.

Scientific impact: Benefiting researchers
This project will strengthen the capacity of researchers in India and other LMICs through cross-sector scientific collaboration, post-doctoral training and global scientific understanding of the socio-ecological drivers and management of zoonotic diseases. The project will build and integrate capacity in ecological and epidemiological modelling and participatory methodology in India and the UK. It will streamline access to disparate data resources, especially beyond the human and animal health sectors, to underpin future research on emerging zoonoses. Relevant researchers from outside the project consortium will be involved from the start of the project through workshops and through a tailored training course in order to build long-term capacity and improve the inter-connectedness of researchers in India working on different aspects of zoonotic diseases. By the end of the project, researchers will be better aware of the range of data on zoonotic diseases, where it is held and by whom, and what can be done with that data to improve understanding and management of zoonotic diseases.

Policy impact: Benefiting cross-sectoral policy stakeholders
'Silo' thinking in policy sectors often results in a disconnected and piecemeal approach to disease management, and ineffective interventions. We will address this by identifying and engaging with stakeholders across the public health and animal health policy sectors and beyond. Our approach of jointly framing the problem and solutions from the start of the project through focussed and participatory workshops with all relevant policy stakeholders across sectors, and maintaining strong engagement throughout the project through a co-production of knowledge approach, will pave the way for effective cross-sectoral integration in this and future projects. We will ensure that the research we produce is not only tailored and relevant to the range of policy stakeholders affected by and affecting zoonotic diseases but also credible and legitimate, building on and integrating the knowledge and needs of policy stakeholders across sectors and scales. Policy stakeholder collaboration and engagement will be facilitated through a range of activities (multi-stakeholder workshops, interviews and questionnaire). We expect this strong focus on cross-sectoral and cross-disciplinary working will result in research that is more robust, with greater policy impact, and that it will strengthen the capacity of policy stakeholders to respond to zoonoses. Through our novel inter-disciplinary, integrative methods for understanding processes underpinning disease impacts, the project will transform the ability of policy stakeholders across human and animal health sectors to implement the global One Health initiative.