One Health is traditionally defined as the collaboration of several disciplines working locally, nationally and globally to attain optimal health for people, animals, and the environment -- but what exactly does this mean, and what does it look like in practice?
Today’s episode of The Boma features food expert Hung Nguyen, co-leader of the Animal and Human Health Program at ILRI. Hung takes us through how his childhood in a rural area of north Vietnam sparked his interest in livestock, public health, and then One Health. One of the challenges to the One Health approach remains the collaboration of different sectors, something that Vietnam has been unusually successful at managing. Hung provides insight into Vietnam as a case study for successfully integrating One Health, and One Health as a core consideration for global health concerns.
ONE HEALTH AND WET MARKETS
Brenda: Welcome back to the Boma, a podcast from the International Livestock Research Institute where we discuss how sustainable livestock is contributing to development efforts in the global south.
Elliot: As you can probably tell, we are not Tim Offei-Addo. Tim will be back to hosting the Boma in a couple of weeks. But in the meantime, we will be your hosts. My name is Elliot Carlton.
Brenda: And I'm Brenda Coromina.
Elliot: And we are the new Princetonian Africa fellows with the International Livestock Research Institute.
Brenda: So with that being said, today, we're talking about One Health. What is it? And why should anyone care? So before we get started, what exactly is One Health?
Elliot: OK. Well, I'm certainly not an expert, but what I can say is that according to Ellery's website, One Health comprises the collaborative efforts of several disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment.
Brenda: That sounds a little bit complicated.
Elliot: Yeah, I think you're right. And there's probably a lot of nuance to how that One Health definition may actually be implemented in practice.
Brenda: So those questions in mind, today, we're going to hear from Hung Nguyen, who is co leader of the Animal and Human Health Program at the International Livestock Research Institute.
Elliot: He grew up in a very rural area in the north of Vietnam. And like almost all of the people in his village, his family grew crops and raised livestock
Hung: In Vietnam, in the 80s and 90s, I remember that was a very difficult time. Livestock was in really small scale and you know we had a few pigs, we had 10 or 20 chickens, we had the so-called muscovy ducks in the family, we had a small fishpond. For me, now working in agriculture, I realized that that was a time where Vietnam applied the so-called integrated agriculture. We had the house for people, next door you had all these animals living closely to us, and you had a fishpond to raise fish. But also you used the water to irrigate the garden of the house. And that actually allows you to closely see the nutrition cycle in this kind of area. When I grew up a little bit more, my family had buffalo and cattle, and actually, I was in charge of keeping them after school, and also helping people to do this thing. And on top of that, we had the crop activities -- the rice. Vietnam is a big rice producer.
Elliot: So it was growing up around so many animals that really spurred Hung’s interest in biology. And to begin with, he dreamed of becoming a medical doctor or a high school biology teacher. And he actually did end up teaching biology for a while in Hanoi.
Brenda: So how did Hung go from being a biology teacher in Hanoi to leading the animal and human health program at ILRI?
Elliot: OK, so he eventually went to Europe to study, first in France and then in Switzerland. And while he was there, the idea of applied research, specifically in relation to public health, began to attract him more and more.
Hung: I started with public health research with Swiss Tropical Public Health Institute which works in Southeast Asia and West Africa. And from public health, I moved to livestock on the aspect of health linked to the livestock.
Brenda: So, he switched from focusing on just public health to asking how public health is linked to the health of livestock, and that really marks the point where he became interested in a One health approach.
Elliot: Right. And I think those linkages are really the fundamental point about One Health. It brings together animal health, human health, and environmental health.
Hung: You need to put human health in the middle in relation to animal health and the environment. And whatever you do is really to bring these different disciplines to work together to improve the health of all of these elements we are talking about. And by doing that, it really brings added value for all of us. You see, it brings the added value in terms of saving the lives of people and animals, and also having a healthy life of the environment. But more importantly, I think that we need to talk about economic saving. By applying One Health, you can also save a lot of money for whatever at the country level, provincial level, or maybe at the global level.
Brenda: I suppose that's most obvious in so-called zoonotic diseases, which animals can pass to humans. If you keep the animals healthy, the humans stay healthy, too.
Elliot: Yeah, exactly. And I was an economics major in college, so I'm really interested in this idea that in addition to benefiting the health of humans, animals and the environment, One Health can also save money for communities around the world. Those economic savings are really important when we consider the benefits of implementing One Health at the community, country, or maybe even global level.
Brenda: That idea that One Health makes good economic sense came to Hung in a big way when he was studying in Switzerland, a team there took a close look at the case of Brucellosis in Mongolia.
Hung: OK, brucellosis, that is a zoonotic disease in cattle and ruminants., And when the animals are infected, that causes abortion. And because of that, we lose animals and reduce their productivity. To prevent that, the vaccine is available because it's a zoonotic disease that can be transmitted to humans, and humans can get sick. So the prevention is basically the vaccination. And most of the governments, they are not ready to do the mass vaccination for livestock in the country. And the example I showed from Switzerland to show that if you vaccinate all the livestock in Mongolia, they showed that the savings of costs for this type of intervention is best when you invest in a One Health way. It means that you vaccinate the animals, and that prevents the disease jumping from animals to human, and in the same time, you save lives for animals, you increase the productivity. And from the human side, you reduce all of these costs linked to the treatment if people get sick. And when you sum up all these things together, that brings a very big societal benefit.
Elliot: OK, so from a public health perspective, there's clearly a tremendous payoff in vaccinating animals. But what Hung is saying is that economically, vaccinating animals can allow us to save on the cost of treating people too. Where it starts to get tricky is at the crossroads of different sectors. So, for example, vaccinating livestock is usually a question for agriculture departments, whereas treating people is usually going to be a question for the Ministry of Health. So One Health really requires an interdisciplinary approach to work.
Brenda: Though I can imagine that there would be challenges getting different sectors to work together, even if it is for the benefit of everyone.
Elliot: Yeah, I think that's definitely true. And Hung has actually seen that up close.
Hung: By nature, I think that humans are not very good when bringing different sectors to work together. Because you are in a specific discipline, you have the interest to promote the sectors, maybe not really conscious that you undermine, or you reduce the partnership or collaboration with other sectors. So, it's about understanding of other sectors or other partners and really sharing the common ground, and you know, looking at the same opus. At the end, it means that you improve the health for the whole community. And from that, people need to maybe step back a little bit. Not too much being too proud of their discipline of the sector, even sometimes of their institution, because the partnership concept is so important in the sense that this is not because I have a contract with you, so I have to do the job. It's really giving and receiving things. I invest this thing, you do this thing, and it's the end, we have an output on outcomes that would be shared for different partners to make this work better.
Elliot: I've heard that Vietnam has been very successful at bringing the different sectors, disciplines, and government ministries together to tackle the challenge of One Health. Is that also your understanding?
Brenda: Yeah, and I think that there's probably some really important lessons that we can take away from Vietnam as a case study.
Elliot: So when we look at Vietnam, what exactly do we see? I mean, why does it work so well there?
Hung: I think that One Health started in Vietnam, really, when we had this avian influenza outbreak. And of course, that is actually avian influenza from the animal side. So, people from the Ministry of Agriculture and Rural Development—our short name is MARD—they took care of that and it jumped to human. And of course, that was the responsibility of Ministry of Health, the MOH in Vietnam. But of course, these two ministries could not work in separation. And very luckily, we had strong international support from the international community at that time. You have the World Bank, you have African Development Bank, you have EU. And actually, they created the partnership of different sectors to work together. And I can tell you something interesting. In Vietnam, of course, avian influenza was bad for people, but it was good for the veterinary or animal health sectors because it makes them important. People look at them in a more important dimension when they work on controlling avian influenza in the context of Vietnam.
Elliot: And if I can interject here for a second, I would guess that beyond just giving veterinarians a good feeling about their work, the question of support at the highest levels must be hugely important too.
Hung: The chair of this One Health partnership of Vietnam has been always at the ministerial and the government level. All these meetings, you have always one vice-minister of health, one vice-minister of agriculture, to co-chair together with some of the important development partners. The most recent development is in fact, the One Health partnership for zoonoses in Vietnam. It has more than 31 partners who work and help Vietnam to promote One Health. It didn't stop at the avian influenza. Afterwards, you know, it moved to the very relevant areas that we are working on, and now we talk about One Health, we talk about food safety, it’s very important areas because you can see all these health issues linked to the food borne diseases as these come from animals, it links to human consumption of all this food and also the environment. So food safety is the first area. The second area is obviously on this zoonotic disease and emerging infectious disease we have.
Brenda: Well, that's really interesting. But now my question is—and I'm not an expert on Vietnam—but I can imagine that getting animal, human and environmental health people to work closely together has not been entirely without challenges.
Hung: Now, let me tell you something about this intersectoral collaboration with One Health in Vietnam. We had a very strong collaboration between animal health and human health sectors. But the environment aspect or environmental involvement has not been very strong yet at the moment.
And I think that now for the next phase of One Health partnership, they really strongly engage and bring the Ministry of Environment and Natural Resources—the MONRE in Vietnam—into this table to strengthen the One Health partnership in the country.
Elliot: So to me, it seems like one of the biggest takeaways from Vietnam is that at the core of their success with One Health has been that high level support.
Brenda: Right. And I think that's what Hung is getting out when he talks about support from government, donors, partners, and a focus on crucial strategic issues.
Hung: There are several things. People have to understand that the head of the institution, the minister, the president, the universities, the director of research institutes, the head of the community have to understand and support this thing. Because sometimes it's not obvious for them to understand and to invest in this type of approach. So that is first thing. The second, sometimes it’s difficult to see how this credit of One Health is shared among the team. So in that discussion, sometimes medical doctors take a little bit the position that’s higher than the animal health people, and even for the environmental people. So the credit needs to be shared in a more equitable way. Really, the resources mobilized from the country level to implement the One Health approach is also sometimes challenging because, you know, when you look at most of the developing countries, to do One Health, the resources mostly come from outside. One of the recommendations in Vietnam, for example, when we went to the meeting, workshop, something like that, we always said, OK, we have great support from the international community and we wish to continue having that. So that is also time for this country to really realize that it's important for them to take One Health seriously and invest from their own resources.
Brenda: Well, from what we've heard, I wonder how does a global pandemic like COVID change things?
Elliot: Yeah, that's a really good question. On one hand, One Health is probably more relevant now than ever before. But on the other, because of the pandemic, some donor countries are actually cutting back on their aid to developing countries. And this means that it's going to end up falling more on the individual country to invest their own resources. And on a slightly different note, your question is actually making me think about the kind of hot topic that is wet markets right now. I mean, a lot of people have speculated that wet markets could have been the original source of COVID 19, and that has led some people to argue that perhaps banning wet markets entirely is the best way to prevent future pandemics. So what do you think? Is this realistic or even a good idea?
Brenda: OK, so I'm thinking it's not that simple. Hung is actually an expert on food safety and wet markets. As we learned in a previous episode. He went to Wuhan with the World Health Organization earlier this year to examine the origins of the COVID 19 pandemic. So let's hear from him. Is banning wet markets really a good idea?
Hung: I mean, the short answer from me is definitively not. We should not ban or close the wet market because if you close or ban these wet markets, now where will people in developing countries go to find food? 80-90% of food comes from the so-called traditional market. We do not prefer calling them wet markets very much in Vietnam, I would say traditional market. And when you move to a poorer country, that position of the wet market is even much more important. So you cannot close this market.
Elliot: So if closing down wet markets, or traditional markets, is a bad idea. Is there anything we can do to make them safer?
Hung: You can improve the infrastructure, you can put running water, you can provide soap. And these things can go a little bit further in terms of improvement. But one of the key things I want to mention here is sometimes it's not about providing infrastructure and facilities. It's really a change of thinking, of understanding, and of behaviour of these people. Not only the meat sellers, but also the consumers. They should also, you know, understand the system. Showing that they are smart buyers, putting a little bit of pressure so that these people selling pork or chicken in the market change or so, on doing better so that everyone can benefit at the end. Maybe they have to realize that paying a little bit more to get a better quality or safer food.
Brenda: Hung makes it very clear that there are not simple solutions to global health concerns. For example, we can't simply ban wet markets because, as you mentioned, that would eliminate 80-90% of food sources for people in developing countries. Instead, we need to see how we can improve the safety of these markets by investing in infrastructure and food security.
Elliot: And I think is what market example really demonstrates the importance of a One Health approach more generally. As you said, there are no simple solutions to global health concerns. These are really complex issues that we are talking about—things like animal diseases, wet markets and global pandemics. But I think that's also what ultimately makes One Health so important. If we take time to consider the relationship between environmental, animal and human health, I think we're going to end up having a better chance at addressing some of these issues.
Brenda: Absolutely. And I think that's a great place to live off for today. Thank you so much, Hung Nguyen for talking about One Health at the International Livestock Research Institute
Elliot: To learn more about One Health, you can visit the One Health Center in Africa section of the ILRI website and go to whylivestockmatter.org
Brenda: And last but not least, thank you to our listeners for joining us today. We hope that you will leave us a review. And if you enjoyed today's episode, please don't forget to subscribe. We'll catch you next time on the Boma. I'm Brenda Coromina.
Elliot: And I'm Elliot Carlton.