The Real World: One Health - zoonoses, ecosystems and wellbeing

Zoological Society of London Symposium:
The Real World:
One Health - Zoonoses, ecosystems and wellbeing
Jeremy Farrar
E: j.farrar@wellcome.ac.uk
T: @jeremyfarrar
Conflicts of interest Wellcome Trust

196X – 1979
Singapore
Malaysia
Aden Yemen
Cyprus
New Zealand
Libya
UK
1980 – 1995
University College London
Edinburgh
Melbourne
Oxford & UCSF
1995 – 2013
Viet Nam

3.3 million malaria deaths averted
Bed nets and Artemisinin Combination Therapy
Communication, Understanding

1976
2014
The world has changed and will change much more
Environment, People, Wildlife, Nutrition, Migration, Technology, Society

Infections and Non-Infectious Diseases

The ‘new’ global health
Endemic infections and NCD
Drug resistance
Trauma
Plus 2016 MERSCoV
H7N9
Ebola
EV71 & EV68
Resistant Malaria
Chikungunya
Hepatitis E
Cholera
Salmonella
Zika
Dengue

United Nations
World Health Organisation
Food and Agriculture Organisation
World Organisation of Animal Health

Global health – What is it and Who Cares?
You and me
Fragile Health Systems, Research & Development, Governance
Global Health - time to see it for what it is?
Public Health, Medicine, Research and Societies
Environment, demographics, migration, animal,
nutrition, human, virology, social science, anthropology
Infections and Non-Communicable Diseases
Resilience amid fragmented health systems
Surveillance and Response
National, regional and global governance
Sharing of data and share in the benefits of that data
Trust

Global Health – 21st Century Silo’s

Integration
Centre of Gravity in a Changing World
Global Health Leadership
Research & Development - Market or Society Failure?
Resilient Health systems and capacity
Smarter sustainable surveillance and response
Trust, Incentives & True Equitable Sharing
Global Health @21st Century

Global health – What is it and Who Cares?
You and me
Fragile Health Systems, Research & Development, Governance
Global Health - time to see it for what it is?
Public Health, Medicine, Research and Societies
Environment, demographics, migration, animal,
nutrition, human, virology, social science,
anthropology Infections and Non-Communicable Diseases
Resilience amid fragmented health systems
Surveillance and Response
National, regional and global governance
Sharing of data and share in the benefits of that data
Trust

Integration
Centre of Gravity in a Changing World
Global Health Leadership
Research & Development - Market or Society Failure?
Resilient Health systems with Surge Capacity
Smarter sustainable surveillance and response
Trust, Incentives & True Equitable Sharing
Global Health @21st Century

First, in today's world, it's important to recognize that if certain
conditions are met — biologic shifts in a pathogen, changes in the
interactions between humans and our environment, fragile health
systems, international indifference, high population mobility, customs
and culture, urbanisation, and a lack of trust in authorities
— what might once have been a limited outbreak can become a
massive, potentially uncontrollable epidemic.
EDITORIAL
The Ebola Emergency — Immediate Action, Ongoing Strategy
Jeremy J. Farrar, M.D., Ph.D., and Peter Piot, M.D., Ph.D.
N Engl J Med 2014; 371:1545-1546

Second, classic “outbreak control” efforts are no longer sufficient for an epidemic
of this size.
What is required is large-scale, coordinated humanitarian, social, public health, and
medical response, combining classic public health measures with safe and effective
interventions including behavioral changes, therapies, and when possible,
vaccination. An appropriate response, moreover, requires an appreciation of the
culture of the societies in the affected countries and deployment of interventions
with the population's consent. Development of interventions in collaboration with
the affected communities and rebuilding of trust are essential to their success.
These integrated efforts will need to be accompanied by much better coordination
and real-time, open sharing of information across diverse disciplines and with all
the players involved, from civil society, national governments, nongovernmental
organizations, and academic institutions to regional and international organizations
and, when appropriate, the military.
EDITORIAL
N Engl J Med 2014; 371:1545-1546

Third, the development of diagnostic tools, therapies, and vaccines (at least up
through the acquisition of phase 1 safety data) for these relatively rare but
inevitable and potentially devastating epidemic diseases must be prioritized during
interepidemic periods, with an accepted, preapproved, and ethical mechanism for
accelerating development and testing such interventions when epidemic situations
arise. We believe that in this epidemic, we are reaching the limit of what classic
containment can achieve.
Despite great improvement over the past decade, there is still a need for better
surveillance, sharing of data in real time, and rapid action based on the available
information. But we cannot think that surveillance alone will bring such events
under control. We have become better at picking these things up; we now must
also learn to act more effectively.
EDITORIAL
N Engl J Med 2014; 371:1545-1546

Secretary-General Appoints High-Level
Panel on Global Response to Health Crises
Report of the
Ebola Interim Assessment Panel
WHO Blueprint for R&D

There is a tide in the affairs of men
Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our ventures.
1597
William Shakespeare Julius Cesar IV.ii.269–276
Global Health………… our opportunity for change

The Real World: One Health - zoonoses, ecosystems and wellbeing

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The Real World: One Health - zoonoses, ecosystems and wellbeing