Q&A from our side event at the High-Level Political Forum

The following questions were put to the panel by Brooke's international attendee base, including those working in academia, civil society, international institutions and ministries.​

What should be done to ensure or encourage African Countries to implement (OIE) Global Guidelines especially in relation to veterinary paraprofessional who are critical in sustainable animal disease control?

Dr. Jean Phillipe Dop (OIE): The issue of integration of veterinary paraprofessionals (VPPs) into the national veterinary services is an important one and much can be done to effectively develop and utilise this potentially valuable human resource.  A workforce assessment is a critical first step.  It will enable the veterinary services to: identify gaps in the existing workforce in terms of numbers, skills and distribution; asess the available human, financial and education resources in the country; and, develop a workforce development plan that aligns the existing needs with the available resources. 

Such an exercise may reveal that the training of a cadre of veterinary paraprofessionals under the direction and guidance of veterinarians may be the most logical solution for filling personnel gaps in the national veterinary services.  If the assessment indicated that VPPs are needed, it is necessary to ensure that there is an enabling environment in place to facilitate their recognition, training, regulation and integration into the veterinary workforce.  This means legislation that recognises VPPs, a veterinary statutory body that sets qualification and performance standards and registers them, training institutions that provide effective training to ensure the required competencies for VPPs and good relationships between veterinarians and VPPs. 

Utilising tools available through the OIE Performance of Veterinary Services (PVS) Pathway such as the PVS Evaluation mission, the Veterinary Legislation Support Programme and the Veterinary Statutory Body Twinning Programme as well as the OIE Competency and Curricula Guidelines for Veterinary Paraprofessionals, countries can benefit from OIE support to assist in the creation of the necessary enabling environment for the effective utilisation of VPPs.  More information about these various elements of the PVS Pathway is available at https://www.oie.int/en/solidarity/pvs-pathway/ and https://www.oie.int/solidarity/options-for-targeted-support/

In a decade of accelerated action, what is the OIE doing to support government in development and improvement of animal welfare and health systems?

Dr. Jean Phillipe Dop (OIE): The OIE Performance of Veterinary Services (PVS) Pathway, which was initiated in 2007, is specifically designed to assist OIE Member States in their efforts to strengthen the capacity of their national veterinary services in support of compliance with the OIE standards on animal health and welfare contained in the OIE Terrestrial and Aquatic Animal Health Codes.  With regard specifically to standards on animal welfare, OIE added a Section on Animal Welfare to the Terrestrial Code in 2004 and the Aquatic Code in 2008 and these sections are continuously expanded and updated to reflect evolving standards.  In May 2017, all OIE Member Countries adopted the first OIE Global Animal Welfare Strategy which has four pillars: development of animal welfare standards; capacity building and education; communication with governments, organisation and the public; and, implementation of animal welfare standards and policies.  In 2018, the OIE signed a Memorandum of Understanding with the International Coalition For Animal Welfare (ICFAW), to work together on matters of mutual interest around the development and revision of animal welfare standards and the role of veterinarians in animal welfare.  The member organisations of ICFAW work in over 150 countries worldwide.

What is the reason why Africa and Asia has such low budget allocation to mass dog rabies vaccination - is it lack of awareness or resources by governments?

Dr. Sarah Cleaveland: I think this mostly reflects the fact that, in most countries, veterinary services are dwarfed by the human health sector and receive very limited resources in comparison to human health.  Even though many/most governments in African and Asian countries consider rabies an important disease, funds for rabies prevention are allocated primarily to the human health sector for human PEP (post-exposure prophylaxis) rather than for dog vaccination.  In general, there seems to be a very real barrier when it comes to governments or donors considering allocation of funds to the animal health sector for a public health intervention.  We need to do much more to make the case to governments and donors that resources for veterinary interventions provide a highly cost-effective solution – more so than medical interventions alone.

Is vaccination the only solution to rabies? What about in contexts with low resource availability.

Dr Sarah Cleaveland: In terms of WHO measures of cost-effectiveness, dog vaccination is considered highly cost-effective as a means of preventing human deaths from rabies.  It is more cost-effective to vaccinate dogs as part of rabies prevention strategies than to rely just on providing PEP to every human suspected of exposure to rabies.  In other words, even in resource poor countries, investing in dog vaccination is money well spent.

In terms of vaccination in comparison to other approaches, vaccination is also by far and away the best solution.  Although it may seem counter-intuitive, reducing dog populations is relatively ineffective as dog density seems to have little impact on rabies transmission (i.e. the R0 value for rabies is very similar in very high- and very low-density populations).  In terms of rabies control, we know that indiscriminate culling is particularly ineffective, can exacerbate spread of the disease and alienates communities, all of which will make rabies much harder to control in the future. Furthermore, methods for humanely reducing dog populations are almost always more costly than implementing dog vaccination campaigns.  So, if resources are limited and your objective is rabies control and prevention, the most effective use of resources is through implementation of mass dog vaccination campaigns.

Why do you think that in the 21st century we still have such a high rate of human mortality in humans due to rabies?

Dr Sarah Cleaveland: The sad truth is that so many human deaths from rabies are still occurring because of inequalities in access to health care as well as to veterinary services.  The vast majority of human deaths occur in Asia and Africa and affect poor people in rural communities where (a) dog rabies remains uncontrolled because of inadequate vaccination of the dog population and (b) where people struggle to access life-saving PEP (Post Exposure Prophylaxis) after being bitten by suspect rabid animals.  Rabies is stark indicator of health inequalities.

Most of the time, our problem about rabies is from stray dogs. What strategy do you have for that?

Dr Sarah Cleaveland: There are many misperceptions about ‘stray’ dogs and the terminology can be difficult. For example, in both Africa and Asia, although most dogs are free-roaming, the vast majority of dogs are owned and/or will have some level of care provided by individuals or households. 

Regardless of how we might define dogs, a key point is that around the world, enough dogs are accessible for vaccination - you need to vaccinate 70% of the dog population to control rabies - and in almost all cases, this target is feasible.  In rural Africa, vaccination is generally straightforward as almost all dogs can be handled and brought to vaccination points.  In urban populations, particularly in Asia, this can be more challenging – but it can be done, as demonstrated in Sri Lanka and by campaigns coordinated by Mission Rabies in India.  It requires training, teamwork and organisation, but it is feasible.

One other point to note is that emphasis is often placed on control of rabies in cities – but most rabies cases occur in rural areas, where dogs are generally highly accessible.  So it may be worth considering starting programmes in rural areas to allow teams to develop skills and gain confidence before embarking on campaigns in urban areas.

Don't you think that animal birth control combined with vaccination would be more effective strategy to reduce the incidence of rabies cases rather than mass vaccination only?

Dr Sarah Cleaveland: There are many reasons why animal birth control may be needed in a community, and it could play a useful supplementary role in controlling rabies, for example, if sterilisation extends longevity of vaccinated dogs.  But in Latin America, dog rabies has been brought to the brink of elimination through mass dog vaccination campaigns, without major investments in dog population control, so we know it is not essential.

 If resources are available, animal birth control programmes could certainly be integrated within a rabies program and could provide other benefits.  But animal birth control is usually costly and requires a high level of technical skill.  So, before being introduced it should be clear what outcomes the program is aiming to achieve (i.e. in relation to human health, control of dog nuisance behaviours, and/or animal welfare) and whether and how animal birth control is likely to offer the best use of the available resources.

Please also see my answer above about other solutions to rabies where I discuss the impact of culling.

As we all know, dogs and cats are a major source of zoonotic diseases and simultaneously have massive negative effects on wildlife, yet we are burdened by the fact that because communities do not rely on them for income, they are seldom willing to invest in animal care since there are no direct economic returns as there are with production animals. Do you have any thoughts on how we can lobby for sustainability in health and welfare programs for dogs?

Dr Sarah Cleaveland: This is an excellent question and captures exactly some of the key challenges in delivery of animal health services, particularly to the poorest communities, and in operationalisation of One Health.

However, rabies does provide an excellent platform and example for building the advocacy case. We know a lot about rabies, we have cost-effective interventions for eliminating it and saving lives, and when implemented, the rapid and tangible impacts are clearly recognised by communities, building trust and confidence and reversing cycles of neglect.   By investing in mass dog vaccination, it is not just rabies control that we can achieve. We can also build core competencies and strengthen response capability of health systems for other diseases and zoonoses.  For example, the skills and approaches needed for contact-tracing in rabies surveillance (for identifying animal bite victims for PEP), are very similar to those needed for contact-tracing of Covid-19.  Indeed, in some countries it is people working with rabies who have been providing the training and establishing the contact-tracing systems for national responses to Covid-19.

As animal health professionals, I think we need to be more creative and confident in making the case for animal health services.  Our work contributes in so many different ways towards multiple SDG targets, but we need to be more effective in making our voice heard.  This high-level policy forum provides an excellent platform.  Thank you to The Brooke for this opportunity!

Rai et al (2019) argue elegantly that achievement of SDG 8, almost by definition will ensure that SDG 5 will not be achieved.  By following a Business As Usual model, surely SDG 8 also undermines many of the other SDGs mentioned during this conference? Surely, without explicitly valuing women’s contributions to the economy, via inclusion in GDP, SDG 8 could result in adding to women’s “double- day”?

Antonio Rota (IFAD): I agree with such conclusion. This is why, in all the projects IFAD supports, we not only focus on the economic empowerment of women, but we also enable women and men to have equal voice and influence in rural institutions and organizations and achieve a more equitable balance in workloads and in the sharing of economic and social benefits between women and men. These three dimensions (economic empowerment; decision-making and representation; and equitable workload balance) need to go hand-in-hand. Existing social norms and the distribution of power and resources will need to be challenged, but it will allow us to avoid to adding to women’s “double- day”.

Carine Bambara (Brooke): On top of being its own separate goal, SDG5 is also a crosscutting theme, which means that in the application of any of the goals, gender equality and empowerment of women and girls must be implemented. The building back from covid-19 scenario gives us a unique opportunity as civil society to redefine decent jobs and ensure that unpaid care work is counted within the scope of SDG8 – The targets and indicators of the SDGs are reviewed every 4 years so there are opportunities to refine/amend/add to them.

MERS was a wakeup call for COVID. Was it a wakeup call for One Health and if so how? Did the One Health community make enough of MERS?

Laura Skippen (Brooke): this virus does not transmit easily from human-to-human, so whilst it has a high stated mortality rate (35% although this may be lower, as with Covid many mild cases will be missed) it tends to occur in small clusters around healthcare settings where there is very close contact. The OH community may not have made enough of MERS but as it would not (in its current variant) spread very easily from person to person, and the majority of the world’s population is not in close contact with Dromedary camels (a reservoir host that can transmit to humans) it probably did not capture the public imagination in quite the same way. The WHO states that 80% of reported cases are within Saudi Arabia so there could have been a case for a more localised OH campaign.

Diseases like COVID19 shift rapidly from a zoonosis profile to a human disease, because of high human-human transmission; how to maintain public attention on One Health?

Laura Skippen (Brooke): I believe their point here is that people are more concerned about the human-to-human transmission now so how do we keep the fact that this disease transferred from animals foremost in the public mind.

One idea would be by highlighting and educating people on the number of other diseases already known about which are zoonotic, and by a simplified explanation of how easy it is for viruses with high replication rates to make the ‘jump’ to infecting humans. The CDC ‘estimate that more than 6 out of every 10 known infectious diseases in people can be spread from animals, and 3 out of every 4 new or emerging infectious diseases in people come from animals.’

I think publishing more on topics like this in layman’s terms in widely read/watched media would maintain interest as would engaging sectors outside the health sectors. The main focus is often on scientists talking to other scientists in journals etc. but really that is preaching to the converted to some extent.

What were the biggest challenges faced whilst trying to implement One Health systems in Afghanistan?

Raymond Briscoe (DCA):

• A lack of coordination, information sharing (communication) between Ministries themselves, other organisations like the WHO, and those working on animal systems in the private sector
• Key stakeholders tend to work independently of each other
• NGOs play a big role to support the delivery of clinical  veterinary services through trained service providers but they are not adequately involved in disease control strategies
• There is a National Strategy for Zoonotic diseases, and a Zoonotic Control Committee is present but there is a lack of resources and technical/ administrative support
• Lack of understanding of what actually is meant by a One Health approach

In Afghanistan there is a need for the implementation of a comprehensive One Health program at the national, provincial, and local levels.

Can you comment on the presence of glanders in Kenyan donkeys? How does this disease impact upon your communities?

Laura Kavata (Brooke East Africa): We do not have glanders in Kenya. Brooke East Africa and Partner Vet team keep vigilant of any condition that is new. When communities notice any new condition on their donkeys, they report to the Local Health Service Providers or Brooke/Partner Vet teams who then report this to the Directorate of Vet Services and request for samples for analysis at the government laboratories. However, Kenya has never reported any glanders case.

Can you elaborate on how the SDGs are actually being measured?  The individual SDGs are very wide in their aims so what assessments are being done to measure their success?

Carine Bambara (Brooke): For a comprehensive look at indicators being tracked to measure the SDGs download this PDF from the UN's Sustainable Development site, each government in their Voluntary National Review (VNR) details exactly which of the given areas outlined in the document they have measured, for many it is difficult to track all of them. For a case study review showing how the UK government measured its progress against the SDGs for its Voluntary National Review last year (2019) please download this PDF from the UK government.  Civil society (i.e. NGOs and corporates) have also started to report against the SDGs by giving an overview of their contribution to each of the SDGs.

How would you say health students (veterinary and human) could get involved with the One Health approach, and with helping work towards making the SDGs a reality?

Klara Saville (Brooke): There are many initiatives that enable One Health. Some of these may be large scale research projects and others just conversations between individuals that makes the difference. So no contribution to One Health is too small and as students it is the perfect time to learn together with those from other disciplines and share ideas, perhaps creating projects that are applied within your current sphere of influence.

Explore resources and initiatives on One Health such as the One Health Commission website, engage with One Health issues on social media and sign up for alerts on ProMED mail. Don’t forget that the concept is broader than zoonotic infectious disease and AMR, the One Welfare approach highlights connections between human and animal wellbeing.

If a career in One Health is an ambition then a post graduate qualification may be a consideration. There are several excellent One Health MSc courses, some of which can be completed online. One Health PhD programmes have been established to enable partnerships across disciplines.

What do you think the effects of covid 19 and climate change will have on livelihoods for those who rely on working animals?

The contributions of working livestock to livelihoods are outlined on the Brooke website https://www.thebrooke.org/for-professionals/working-equines-vital-role-sustainable

During the Covid crisis horses, donkeys and mules are still out there working, and are more essential than ever to keep communities going amid the global pandemic. The communities Brooke works with are already marginalised, and it is probable that they will have to face some of the hardest challenges to their livelihood and resilience, as work shuts down or they become infected. The working livestock will feel the impact too, with fewer resources available there may be pressure for them to work harder with less food. They help people make a living and help people to obtain and transport food. They do the same with water, used both for washing and cooking. 

Brooke has continued to operate throughout the Covid crisis. Physical interaction with the community and service providers has been replaced with contact over phone and by radio. Brooke India is enhancing communication technology for field workers so that they can maintain contact with the communities they work with.

In regions and communities where we have established projects, staff are making sure useful information reaches people there. For instance, we are distributing prevention information at water points and animal health centres in Ethiopia, and in India we are connecting vulnerable people to government assistance.

With reference to climate change horses, donkeys and mules boost community resilience in the face of disasters and climate shocks. They enable communities to collect water or food from greater distances, helping families to relocate when needed, and even rebuild infrastructure. It is clear that animal welfare is also impacted by global heating with increasing frequency of droughts, flooding and disease spread.

My understanding is that the issue of animal health, including mass vaccinations, as well as neutering, need to be supported by various advocacy interventions to attract public attention and financing. So, could you share the examples of some advocacy and awareness-raising programmes that are being conducted in this regard?

Harry Bignell (Brooke): There is currently not sufficient consensus on policy priorities for animal health system strengthening, hence the launch of the action for animal health initiative https://actionforanimalhealth.org. We hope that this work will lead to more specific and targeted campaigns, such as the fight to eliminate rabies, which is an excellent example of a combined advocacy and awareness-raising campaign. 99% of human rabies comes from infected dog bites, and is always fatal when clinical symptoms emerge. It causes an estimated 60,000 deaths per year, and yet we know the solution to eliminate canine rabies (the biggest source of human rabies); mass dog vaccination, education, human postexposure prophylaxsis (PEP). This work was suffering from a number of factors including insufficient engagement with endemic countries, lack of prioritisation within WHO/OIE/FAO and limited resources. Covid-19 has put One Health and zoonotic disease on the political agenda alongside Global Public Health Security. It has provided the platform for campaigns such as this to gain wider attention and commitment.