The Global Animal Health Initiative: The Way Forward “Veterinary and Public Health Collaboration”

1. The Global Animal Health Initiative: The Way Forward “Veterinary and Public Health Collaboration” October 10, 2007 The World Bank Washington D.C. Lonnie King, DVM, MS, MPA Director National Center for Zoonotic, Vector-Borne, and Enteric Diseases Centers for Disease Control and Prevention, Atlanta, GA

2. Historical Epidemiologic Transitions – 1st Transition • 10,000 years ago • New social order due to agriculture • Zoonoses through animal domestication • Increases in infectious diseases • Epidemics in non-immune populations

3. Coincided with mid-19th century Industrial Revolution Decreases in infectiousdisease mortality Increasing life expectancy Improved nutrition Antibiotics “Diseases of Civilization” – cancer, diabetes, cardiovascular diseases Environmental problems Chronic diseases Historical Epidemiologic Transitions – 2nd Transition

4. Historical Epidemiologic Transitions – 3rd Transition • Last 25 years • Emerging infectious diseasesglobally • New diseases and increases in mortality; first since 19th century • Re-emergence • Antimicrobial resistance • 75 percent of diseases are zoonotic • Anthropogenic factors of emergence; the microbial “perfect storm”

5. Factors in Emergence • Microbial adaptation and change • Host susceptibility to infection • Climate and weather • Changing ecosystems • Economic development and land use • Human demographics and behavior • Technology and industry

6. Factors in Emergencecontinued • International travel and commerce • Breakdown of public health measures • Poverty and social inequality • War and famine • Lack of political will • Intent to harm

7. Convergence Model Genetic and Biological Factors Physical and Environmental Factors Animals E I D Humans Wildlife Social, Political, and Economic Factors Ecological Factors

8. Convergence of Human and Animal Health: Drivers • Ecological risk and climate change • Population dynamics • Growing governance gap • Global “foodscapes” • Microbial swarms • Technology and social actions and involvement

9. Examples of Emerging/Re-emerging Infectious Diseases Emerging and Re-emerging Infectious Diseases

11. Multihost Pathogens • 60% of all human pathogens are zoonotic • 80% of animal pathogens • Ecological generalists

12. 1993 – Hanta virus • 1994 – Plague (India) • Ebola virus (Zaire) • 1996 – New Variant of CJD (UK) • H5N1 influenza (Hong Kong) • 1998 – Nipah virus (Malaysia) • 1999 – West Nile • 2000 – Rift Valley Fever • 2001 – Anthrax • 2002 – Norwalk-like viruses • 2003 – SARS • 2004 – Marburg Virus • 2005 – H5N1 Influenza • 2006 – E. coli CDC’s Most Significant Global Epidemics Over the Last 15 Years

13. Global Population: 1950-2015 Total Billions 8 Less developed countries 7 More developed countries 6 5 4 3 2 1 65 1950 55 60 75 80 85 90 95 2000 05 10 15 70 0 Source: US Bureau of the Census Trends in Global Population

14. Rapidly Increasing Urbanization 2000 • 47% world population living in urban areas 2030 • 60% world population living in urban areas

15. Concentrated Animal Feeding Operations (CAFOs) Their Impact on Food Safety and Healthy Environments

16. Livestock 2020 –The Next Food Revolution • Global increase and demand for protein and food of animal origin • Shift from poverty of 1-2 billion people to middle class • “Westernization” of Asia and Latin America • Concerns with sustainability • Increases in emerging zoonoses through the concentration of people and animals

17. Last year, over 21 billion food animals were produced to help feed a population of over 6 billion people resulting in trillions of pounds of products distributed worldwide. Projections toward 2020 indicate that the demand for animal protein will increase by 50%, especially in developing countries.

18. Microbial View

19. Importance of Agricultural Trade Already 40% of all trade in agriculture, fisheries and forestry occurs between developing and developed countries. More than 20% of all US imports are food products (more than 8 million shipments a year).

20. Human population density Poultry population density Source: FAO, WHO, Rimsa, Mexico City April 2005

21. 140 60 120 50 100 40 80 Mean normalized crop production Human and animal density 30 60 20 40 10 20 0 0 50 100 150 200 250 300 350 400 450 500 Distance to Bangkok (km) human population (nb/km2/10) soybean (10 tons/km2) maize (tons/km2) chicken (nb/km2/10) pigs (nb/km2/10) cassava (tons/km2/2) Figure 1.2. Human and livestock densities, and main feed production areas as affected by the distance to Bangkok Source: Gerber and others 2005.

22. Safe Food begins with healthy animals

23. Ecosystem

24. Waterborne Zoonoses Humans Animals Waterborne Disease Microbial Pathogens Water Environment

25. World’s Most Dangerous Animals

26. West Nile Virus in the Western Hemisphere

27. Incidencepermillion .01-9.99 10-99.99 >=100 AnyWNVactivity WNV Neuroinvasive Disease Incidence, by County, US, 2000 N=19

28. Incidencepermillion .01-9.99 10-99.99 >=100 AnyWNVactivity WNV Neuroinvasive Disease Incidence, by County, US, 2001 N=64

29. Incidencepermillion .01-9.99 10-99.99 >=100 AnyWNVactivity WNV Neuroinvasive Disease Incidence, by County, US, 2002 N=2946

30. Incidencepermillion .01-9.99 10-99.99 >=100 AnyWNVactivity WNV Neuroinvasive Disease Incidence, by County, US, 2003 N=2866

31. Incidencepermillion .01-9.99 10-99.99 >=100 AnyWNVactivity WNV Neuroinvasive Disease Incidence, by County, US, 2004 N=1142

32. Incidencepermillion .01-9.99 10-99.99 >=100 AnyWNVactivity WNV Neuroinvasive Disease Incidence, by County, US, 2005 N=1294

33. Incidencepermillion .01-9.99 10-99.99 >=100 AnyWNVactivity WNV Neuroinvasive Disease Incidence, by County, US, 2006* N=1339 * Reported as of November 7, 2006

34. The Perfect Microbial Storm:Ravenna, Italy • A Virus from Africa (an alphavirus – Chikungunya) • A mosquito from Asia (Aedes albopictus: tiger mosquito) • A tourist from India (1.25 million human cases in 2006) • A report of 270 people infected with Chikungunya in Ravenna, Italy • Globalization is key to the future of infectious diseases • E.g. global tire trade; 2.1 billion airline passengers/yr; climate change; and, a shift of competent vectors worldwide - Bloomberg Report 9/25/07

35. Ae. albopictus, the Asian Tiger Mosquito Initial Discovery Site near Port of Houston, Texas, USA, 1985

36. Used Tires Stored at Other Locations

37. There is no where in the world from which we are remote and no one from whom we are disconnected PNAS, 2004

39. Climate Change’s Impact on Infectious Diseases • Vector-borne diseases • Water-borne diseases • Agriculture Production • Migration of Animals • Changing ecosystems for wildlife and animals • Built environment • Human-Animal Interface • Ecologies and a new research portfolio • Evidence-based public health impact

42. Nipah Virus

43. Virus Carriers Fruit bats

44. SARS

45. Horseshoe bat

46. Lessons Learned From SARS • Importance of: integrated surveillance; prompt epidemiologic investigations; and, lab capacity • Disruption of multiple economic sectors • Global implications of local problems • Need for critical linkages and partnerships

47. OIE-CDC Collaborating Center for Emerging and Re-Emerging Zoonoses • First collaboration between CDC and an international animal health organization • Enhance pathogen discovery • Improve diagnostics • Cooperation in better understanding the convergence of human and animal health • Linkage of health system professionals • Jointly contributing to establishing a global applied research portfolio • Improve global preparation in identifying and responding to microbial threats • Enhance surveillance

48. Annual Global Trade inExotic Animals • 4 million birds • 640,000 reptiles • 40,000 primates • Illegal trade unknown – estimate $4-6 billion - Wildlife Conservation Society

49. “Double, double toil and trouble; Fire burn, and caldron bubble.” William Shakespeare

50. Compelling Vision • Accelerating prevention, control, & elimination of ecology-mediated microbial threats • Systems approach with cross-cutting themes • Global organization Ecosystem Health Animal Health Human Health