One Health

When Ebola struck West Africa in 2014, thousands of doctors flew in from around the world to Liberia, Guinea, and Sierra Leone. They donned bulky white suits and big goggles, and worked to set up temporary field hospitals. On the doctors’ heels came millions of dollars in foreign aid. By the end of October 2014, the US alone had spent around $750 million on fighting the outbreak.

When large-scale health crises like Ebola happen, countries with underdeveloped medical infrastructure are unprepared to respond. As a result, their only option in containing the outbreak is to rely on foreign aid.

Tufts is part of an initiative to help these countries become more self-sufficient in anticipating and fighting epidemics. Professors from the medical and veterinary schools are partnering with professors at the University of Minnesota to develop the One Health Workforce (OHW). OHW is funded by the U.S. Agency for International Development (USAID), and it brings together veterinarians and doctors at universities throughout central and eastern Africa and Southeast Asia. The goal of the program is to create networks among these universities so the countries will be less reliant on international aid when a crisis does arise.

The presence of foreign aid during epidemics like Ebola and Zika is undoubtedly instrumental in ending them. Nevertheless, international assistance comes with its own set of complications. International organizations are not always aware of the cultural practices surrounding disease and death in foreign countries, which are vital to understand in order to prevent an outbreak from spreading. They are also only on the ground for a finite period, which makes creating lasting partnerships with organizations in country challenging.

“Even in the aftermath of Ebola, it was international NGOs coming in, telling people what to do, and leaving,” OHW Project Manager Kristina Bradford said. “Our goal is to better equip people in countries before the epidemic happens so they can respond when it does.”

As Bradford points out, the majority of foreign aid and attention countries receive is only provided during a crisis. A fraction of the same energy is spent predicting and preventing outbreaks before they happen.

OHW is one aspect of President Obama’s Global Health Security Agenda. One of the agenda’s goals is to assist countries in creating national response plans in the event that an epidemic breaks out. OHW is collaborating with other USAID programs to help countries create these plans. In addition, OHW connects universities within Africa and Southeast Asia and helps to develop their medical schools so that they can better anticipate and prevent the next epidemic.

The concept driving OHW’s interdisciplinary approach to epidemics is called One Health. One Health is the idea is that animal, human, and environmental health are all connected, and that we must take measures in all three areas to effectively predict and respond to epidemics in humans. This is why both veterinarians and doctors from universities around the world are included in the program.

“Current human population growth, livestock intensification, and rapid environmental changes are increasing the risks of pathogens being shared across species, so it makes good sense to take a proactive approach to educating the professionals who work at those interfaces,” said Dr. Felicia Nutter, Director of International Veterinary Medicine at Tufts’ Cummings Veterinary School.

This increased risk was evident in the most recent outbreak of Ebola. Patient zero was a two-year-old child in a village in southeastern Guinea. Before this, Ebola had never been seen in West Africa. So where did the disease come from?

Many scientists point to fruit bats though Apes and cattle also carry the disease, and contact with infected meat has been known to start other outbreaks. Ebola is what epidemiologists call a zoonotic disease—one that is transmitted from animals to humans. The CDC estimates that approximately 6 in every 10 infectious diseases are zoonotic, including chicken pox, measles, and HIV. A rise in development in areas such as Central and East Africa and Southeast Asia also mean that humans are moving further and further into areas traditionally reserved for wildlife, and thus are at a higher risk of receiving disease from animals.

OHW encourages experts in wildlife disease to work with doctors to anticipate the effects of these zoonotic diseases and then train their university students to respond to the threat.

Currently universities in the Democratic Republic of Congo, Ethiopia, Kenya, Tanzania, Rwanda, Uganda, Indonesia, Malaysia, Thailand, and Vietnam are connected through the One Health networks. These networks put on trainings for faculty, start student organizations, and develop modules to be used in the curriculum, all of which are centered on the concept of One Health.

Today, the Tufts faculty who are part of the program are more focused on providing the resources and expertise that the foreign universities need. They emphasize the importance of providing help where the networks request it instead of imposing their own agenda. For example, Dr. Hellen Amuguni, a Research Assistant Professor in the Department of Infectious Disease and Global Health at the Cummings School, recently spent a week in Kenya consulting with a university there on how to move their Masters of Public Health program online to increase access.

Widespread epidemics like Zika and Ebola are difficult to control because we live in an increasingly globalized world. But One Health is using this to its advantage, capitalizing on worldwide integration in order to combat these diseases.

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