Why does Sikkim need to be more serious about the ‘One Health’ approach?

Nitesh R. Pradhan & Dr. Basant Ramudamu Sikkim has not witnessed a massive health outbreak for a long time, but experts say that the state can’t stay redundant. With unexpected global outbreaks such as COVID-19, the importance of inter-disciplinary health approach has been felt by stakeholders. One such approach, also recommended by the World Health […] The post Why does Sikkim need to be more serious about the ‘One Health’ approach? appeared first on The Sikkim Chronicle - Sikkim News.

Why does Sikkim need to be more serious about the ‘One Health’ approach?

Nitesh R. Pradhan & Dr. Basant Ramudamu

Sikkim has not witnessed a massive health outbreak for a long time, but experts say that the state can’t stay redundant. With unexpected global outbreaks such as COVID-19, the importance of inter-disciplinary health approach has been felt by stakeholders. One such approach, also recommended by the World Health Organisation (WHO) is the “One Health approach”, which is a need of the hour, especially for a small state like Sikkim. This is not new, but it has become more relevant in recent years, as many factors have changed interactions between people, animals, plants and the environment as a whole.

One Health is an approach to designing and implementing programmes, policies, legislation and research, in which multiple sectors communicate and work together to achieve better public health outcomes. It’s a collaborative effort of multiple disciplines working locally, nationally and globally, to attain optimal health for people, animals and the environment.

“Our department has been very serious in this approach; as to maintain good public health, environmental and animal health is as important,” says Dr Thinlay, Joint Director, Sikkim Anti-Rabies & Animal Health (SARAH).

Since, Sikkim is strategically located, sharing international borders with Nepal, China and Bhutan, and a state border with West Bengal, hence, compared to other states, Sikkim is highly vulnerable to numerous trans-boundary diseases, especially with zoonotic importance. “Transportation of animals for personal, entertainment or agricultural purposes increases the possibility for the introduction and subsequent presence of such diseases. Thus, Sikkim has a higher risk for such health predicament”, states Dr Thinley.

As per him, since it is considered that public health is at a crossroad, the increasing convergence of human and animal health is creating new complex challenges and One Health approach is the only way-forward for timely prevention, containment and eradication of such diseases.

Many health and animal activists are of a similar opinion that One Health approach which was initiated as a concept should be a movement. “We feel that there is a dire need for such an approach, as the facility at SARAH is also highly burdened,” says animal rights activist, Michelle Karthak Lepcha, who is also a member of The Guardians, Sikkim.

An official at the state’s forest department says that this approach can mitigate the growing health crisis, but suffers due to some teething problem in its implementation.

“Sikkim is doing better than any other state in the country, but we need more resources and inter-departmental mechanism for swift and proper responses,” he tells.

There are many avenues where One Health approach is particularly relevant which include food safety, the control of zoonoses (diseases that can spread between animals and humans, such as flu, rabies and Rift Valley Fever) and combating antibiotic resistance (when bacteria changes after being exposed to antibiotics and become more difficult to treat).

Sikkim so far has a better record than other parts of the country in the containment of zoonotic diseases, however, the growing external threat such has COVID-19 pandemic has again posed a question on how to mitigate such challenges which come as a surprise to even public health experts.

Sikkimese stay in close contact with animals with an ever-growing population expanding rapidly to other geographic areas resulting in more people living in close contact with wild and domestic animals, both livestock and pets. These animals have traditionally played an important role for food, fibre, livelihood, travel, education or companionship. The forest cover in Sikkim has seen a minimal decline along with climate change, which is a global phenomenon. This has resulted in the planet experiencing climate change and intensive farming experiences. Coupled with disruptions in environment and habitat has further propelled diseases to spread from humans to animals and vice-versa. Tourism of both domestic and international travellers along with trade and commerce due to globalisation has further contributed to spreading diseases across the world. Because of these interactions, animals also can sometimes serve as early warning signals of potential human outbreaks. Tracking diseases in animals help to keep domestic and wild animals healthy and also can help prevent illnesses and disease outbreaks in people.

The issues in Sikkim include zoonotic diseases, anti-microbial resistance, food safety and food security, vector-borne diseases, environmental contamination and other health threats shared by people, animals and the environment. Involving cooperation between various disciplines and sectors can benefit the fields of non-communicable diseases, occupational health, chronic diseases, mental health and injuries.

The health of the animals is interlinked to the health of humans. Maintaining the ecosystem, alongside providing food has been part of this relationship. Therefore, it has many direct and indirect impacts with diseases of animal origin like Nipah virus, Ebola virus, Middle East Respiratory Syndrome (MERS), influenza, etc. Many microbes that infect both animals and humans share the eco-system they live in. Efforts by just one sector cannot prevent or eliminate the problem.

“Many professionals with a range of expertise who are active in different sectors, such as public health, animal health, plant health and the environment, should join forces to support One Health approach,” says Veterinarian, Dr Basant Ramudamu.

Stakeholders in Sikkim have stated, that to effectively respond to and prevent outbreaks of zoonoses and food safety problems, epidemiological data and laboratory information should be shared across sectors.

Government officials, researchers and workers across sectors at the local, national, regional and global levels should implement joint responses to health threats. The internal health agency, WHO has been working closely with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE) to promote multi-sectoral responses to food safety hazards, risks from zoonoses, and other public health threats at the human-animal-ecosystem interface and provide guidance on how to reduce these risks.

So far, in the Himalayan state of Sikkim, professionals in human health (doctors, nurses, public health practitioners, epidemiologists), animal health (veterinarians and those specialized in veterinary public health, veterinary microbiology, veterinary parasitology, veterinary epidemiology, paraprofessionals, agricultural workers), environment (ecologists, wildlife experts), and other areas of expertise have felt a need to communicate, collaborate on and coordinate activities. Other relevant players in a One Health approach could include law enforcement, policymakers, agriculture, communities and even pet owners. No person, organization or sector can address issues at the animal-human-environment interface alone. By promoting collaboration across all sectors, this approach can achieve the best health outcomes for people, animals and plants in a shared environment, experts suggest.

“Sikkim has been doing good, but we cannot be lethargic in our efforts. For a shared environment between animals, plants and humans, a concerted effort by all would be a step forward,” stresses Dr Thinley Bhutia.
The country as a whole requires a robust health mechanism to address the issue related to zoonotic diseases, 75% of which is known to have originated from animals.

The disease control mechanism in India is bi-phasic. It includes vertical disease control programs such as the National Vector-Borne Diseases Control Programme, pilot projects for rabies and leptospirosis control that have been incorporated in the 11th Five Year Plan (2007-2011). The second strategy includes the provision of ad-hoc assistance for outbreak investigations and control. India’s response is mostly reactive, which means controlling one outbreak after another.

Likewise, a dedicated zoonotic disease diagnostic cum research centre is much needed in a small state like Sikkim. With already an overburdened health department as the only centre, the state has a system which needs urgent revamp and addition to animal health infrastructure. Hence, most of the recent emerging diseases in Sikkim being zoonotic, a centre dedicated to the study, identification, diagnosis, and control of zoonotic diseases is a need of the hour.

The students of veterinary science of Sikkim have also felt the need for the establishment of common Disease Diagnostic Laboratory where (animal and human test samples) common diseases can be both diagnosed as well as studied. The collaborative approach of the diagnostic laboratory will help minimise the financial burden to the government if the same equipment and laboratories are utilized for diagnosis (e.g. tuberculosis in human as well as livestock if samples are tested in a common platform, then it will be easier to study about its epidemiology and will further help control the disease. Similarly, if the x-ray facility located in a particular area if used for both the sectors, then there will be no need to invest in heavy equipment. Likewise, the laboratory for the blood test, urine analysis or any other common samples can be tested from both the sectors. This will also let the researchers understand the nature of organisms in a better way.

Further, it is felt that there is need for strengthening veterinary institutions and services in the state. The most effective and economical approach is to control zoonotic pathogens at their animal source. It calls not only for close collaboration at local, regional and global levels among veterinary, health and environmental governance but also for greater investment in animal health infrastructure. This calls for strict health surveillance to incorporate domestic animals, livestock and poultry too.

In Sikkim, the regular diet includes a diet of animal protein. Thus, loss of food animals on account of poor health or disease to becomes a public health issue, even though there may be no disease transmission, and we lose 20% of our animals this way.

There could not be a stronger case for reinventing the entire animal husbandry sector to be able to reach every livestock farmer, not only for disease treatment but for prevention and surveillance to minimise the threat to human health.

Early detection at animal source can prevent disease transmission to humans and the introduction of pathogens into the food chain. Therefore, a robust animal health system is the first and crucial step in human health. Disease surveillance needs to go beyond humans and encompass preventive health and hygiene in livestock and poultry, improved standards of animal husbandry for greater food safety and effective communication protocols between animal and public health systems. We need to prioritize locally prevalent diseases that might come under One Health approach. Once we identify them, we may work out on them further.

The current scenario of rumours linked to the zoonotic nature of COVID-19 has unnecessarily affected the poultry industry to a great extent.
However, according to findings published on 17 March 2020, in the journal ‘Nature Medicine’, SARS-CoV-2 has evolved naturally, as scientists found no evidence of it being made in a laboratory or engineered otherwise. The outbreak brings to sharp focus the need to address threats to ecosystems and wildlife.

According to WHO, coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). As the world is racing towards detecting the origin of coronavirus and awaits a new vaccination, stakeholders are awaiting the implementation of cohesive and concerted efforts through the implementation of a holistic and sustainable way forward for better identification and understanding of the complex man-animal-plant relationship that is interlinked in co-dependency.

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