One Health in Vietnam from Training & Research to Policy

Phuc Pham-Duc1, Fred Unger2, Hung Nguyen2 1Center for Public Health & Ecosystem Research (CENPHER), Vietnam One Health University Network (VOHUN), Vietnam 2International Livestock Research Institute, Hanoi, Vietnam

Regional workshop of the ComAcross project, 25-27 November 2015, Bangkok, Thailand

Outline

• One Health Training in Vietnam

• One Health Research – examples

• From evidences to decisions

• Challenges and way forwards

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Hanoi (Network Secretariat): • Hanoi School of Public Health • Hanoi Medical University • Vietnam National University of Agriculture

Thai Nguyen University of Medicine and Pharmacy Thai Nguyen University of Agriculture & Forestry

Thai Binh University of Medicine and

Pharmacy

Hai Phong University of Medicine and

Pharmacy

Bac Giang Agriculture and Forestry University

Nam Dinh University of

Nursing

Hue University of Medicine and Pharmacy Hue University of Agriculture and Forestry

Dak Lak: Tay Nguyen University - Faculty of Medicine and Pharmacy - Faculty of Veterinary and Animal Science

Can Tho •University of Medicine & Pharmacy •Faculty of Applied Biology and Agriculture

Hochiminh City: • HCMC University of Medicine and Pharmacy • HCMC University of Agriculture & Forestry

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VOHUN (Vietnam One Health University Network)

Vinh Medical University

3

OHW Objectives Objective 1 – to participate with government, academia, and other key partners in defining

OH workforce needs

(Talking to government and private sector regarding training and research needs) (University-Government-Private Sector engagement on training and other needs)

Objective 2 –to assist government ministries to train the future “One Health” workforce (Translating these needs into creating a new ‘graduate species’ to transform public health)

Objective 3 – to assist government ministries to train the current “One Health” workforce (Supporting governments and private sector by creating new in-service training initiatives)

Objective 4 – Support universities in strengthening faculty capacities for One Health teaching, research, and community outreach

(Strengthening faculties to train the new workforce)

Objective 5 – Provide organizational development support to One Health networks

(Strengthening networks for support of all initiatives and for sustainability)

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https://seaohunonehealth.wordpress.com/

Academic Curricula

(pre-service)

One Health Competencies

(Core & Technical)

Learning Objectives

Modules

Professional Development “Short

Course”

(in-service)

How to Make Your Curriculum a One Health Curriculum

• A strategic planning and MoU were agreed & signed (OHW: 2015-2019)

• One week field trip for International Veterinary Medicine students – OH clinical practices

• 60 students & 10 lecturers from 10 countries

• Seminars to introduce OH concept/approach • 17 universities/schools

• 150 lecturers & researchers

• 1,500 students (Preventive Medicine, Public Health & Vet.)

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Achievements

Development of OH training program (1)

1. Developed the training packages for OH elective

modules for Public Health student at the HSPH

11 lessons / 2 credits

4 case study: Streptococcus suis,

Leptospirosis, Rabies, Liver flukes

3. Developed a OH & Health Programs module at the Hai

Phong UMP

11 lessons / 2 credits

2. Developed the test evaluation for OH elective modules for Preventive Medicine student at the HMU

12 lessons / 3 credits

40 questions/lesson x 12 lessons

80% MCQ and 20% True/False questions

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4. Developing a training program for International Masters of Public Health – OH orientation

7 core modules : 24 credits

7 Elective modules: 8 credits

6. Developing a zoonotic disease module for Veterinary

Medicine student at the UAF

3 credits

7. Developing a OH field-based training program for human and animal health professionals

1 week (48 hours) in class

4 weeks field practices

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Development of OH training program (2)

5. Developing a training program for International Masters of Public Health majoring Environmental Health

International Masters of Public Health (OH orientation) • Program: 1 year • Core modules: 24 credits • Elective modules: 8 credits • Thesis: 8 credits • Students: Vietnam, Lao PDR, Cambodia, Indonesia,

Malaysia, Thailand

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One Health & Zoonosis Modules

• 3 Credits

• Faculties of Animal Science & Veterinary Medicine (7 Universities)

• Lesson 1: One Health concepts & approaches

• Lesson 2: Fundamentals of zoonotic diseases & ecosystem health

• Lesson 3: Zoonoses (bacteria & virus)

• Lesson 4: Zoonoses (parasites)

• Lesson 5: Using One Health approach in management and surveillance of zoonoses

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One Health & Zoonosis Modules (2 -3 credits)

OH field-based training course

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No Subject Number of hours

Theory Assignment Practice Total

I In class: 5 days

1 Basic concepts of One Health

Systems Thinking

4 4 0 8

2 Zoonoses fundamental 4 0 0 4

3 Zoonoses risk analysis 4 4 0 8

4 Applied epidemiology in investigation, detection,

organization, prevention and control zoonoses

3 5 0 8

5 Sampling 0 0 4 4

6 Planning, monitoring, evaluating and reporting 4 4 0 8

7 Cooperation interdisciplines 2 1 0 3

8 Guidance in writing research proposal 1 0 0 1

9 Communication 2 2 0 4

Total 24 20 4 48

II In Field: 4 weeks

III In class: 1 week

Result report 0 0 12 12

TOTAL 24 20 16 60

Strengthening University-Government Partnerships

1. Strengthening Universities-Government agencies

• Ministry of Health (MOH) / GDPM

• Ministry of Agriculture & Rural Development (MARD) /DAH

• Ministry of Education & Training (MOET)

• OH Partnerships / PAHI,

• Institutes: NIHE, NIVR, One Health Research

2. Strengthening Universities – International organizations

• USAID, WHO, CDC, ILRI, FAO, IDRC, WSC, OIE, etc.

OH continuing education course = OH field-based + FETP + AVET (VOHUN) (MOH) (MARD)

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What did we think?

• Agricultural intensification had closed relationship with ecosystem and human health.

• Livestock: advantages and disadvantages

• Livestock waste management, reuse.

• Any innovative changes are needed to develop the agricultural & livestock systems to increase production, at the same time preserving and enhancing natural resources.

• Using ecohealth approach to manage animal and human wastes

Better Human and Animal Waste Management in Hanam Province,

Vietnam – using Ecohealth / One Health Approach

What we did so far: (NCCR North-South program) 1. Community engagement (Local authorities) 2. Research ( PhD, MSc) But more focus on “Diseases”: Health Status, Diseases..

Focal Issue Sanitation & Health

Kim Bang district, Hanam, Vietnam

•Human, animal health & well-being •Environment •Social- economics

Understand the real situation of Agriculture intensification

Issues

Stakeholderworkshop Issues identified

•Design •Implement •Intervention •Dissemination

Communicate with

Stakeholders

engagement Community engagement

Researchers stay with

community (none-scientists)

What do we need?

Some research activities were carried out

• PRA: to identify emerging problems of local communities and issues related to agricultural and human waste managements.

• Baseline survey: 461 households • to explore the relationship between waste management practices and rural

household health status in the study sites

• to identify the current animal waste treatment methods

• Health risk assessment related to biogas-wastewater • Exposure assessment: 451 pig farms; Samples: 150

• Quantify the microbial and chemical indicators: E. coli, Salmonella, Giardia, Cryptosporidium, BOD & COD, pH, temperature

• Estimate the risk of infections and diarrhea by the specific pathogens

• Community-based intervention • Village regulation; good practice pig farm; behavior change communication.

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Risks of diarrhoea related to biogas wastewater

Increasing livestock production (MARD, 2013)

Environmental pollution caused by livestock waste becomes more severe (Đ.T.T.Sơn, 2011)

Biogas is commonly used for treatment of livestock waste (H.K.Giao, 2010)

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Biogas if not properly used -> the efficiently destroyed pathogens is low (V.T.Y.Phi, 2009; Jirina, 2012)

Most pig farms discharge biogas wastewater direct to public drainage (79%), irrigation (43%) (L.Q.Hương, 2014)

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Dose-response models (Sources: Haas et al., 1999, Howard et al., 2006)

Estimated single risks of infection

Exponential model (Giardia & Cryptosporidium)

Pinf(d) = 1 – exp(-rd)

β-Poisson model (E. coli)

Pinf(d) = 1 – [1+ (d/ID50)(21/α – 1)]-α

Where are:

- Pinf(d) : risk of infection in an individual exposed to a single pathogen dose (d)

- α: infectivity constants (E. coli: 0.1778)

- ID50: pathogen dose at which 50% of a population will be infected (E. coli: 8.6 x 107)

- r: infectivity constants (Giardia: 0.02 and Cryptosporidium: 0.00467)

- d (dose ingested) = μ x m

μ: concentration of organism/100mL

m: amount of water accidental ingested

Quantitative Microbial Risk Assessment (QMRA) (Hazard identification – Dose-response analysis – Exposure assessment

– Risk characterization)

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7

Maintaining biogas

Cleaning drainage

Irrigating corn crop

Irrigating fruit tree

Irrigating vegetable

Estimated single risk of diarrhoea Estimated single risk of diarrhoea

Estimated single risk of diarrhoea

Probability of diarrhea risk by E. coli

(12%), Crypto (25%), Giardia (5%)

Estimated average single risk of diarrhea

Community-based Intervention

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Reduce the health risks related to biogas-wastewater (human,

animals)

• Decreasing the frequency exposure to biogas-wastewater

• Reduction of pathogens in the biogas-wastewater (E. coli, Sal)

• Safe use of wastewater-irrigated products (vegetables, fish)

• Properly treatment of animal wastes by biogas system

Good Practice Pig-Farm (GPPF) in Vietnam

• understand the biogas operation and maintenance process

• aware the health risks related to biogas-wastewater (human & animals)

Good enforcement

the village regulation on

environmental sanitation

Effective behavior change communication

Increase skills for monitoring & prevention

of animal diseases

Village core group members (local authority, head of village, village health workers & para-vet.; pig holders) & Researchers

Community-Based Intervention

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Good Practice Pig-farm • Saving time, water,

electricity, money • More gas for cooking • Less smell, flies • Improving personal

hygiene practice • More friendly • Increasing productivity

Project framework Risk profiling

Risk assessment

Microbial Risk Assessment

Chemical Risk Assessment

Economics (eg health, CBA)

Value chain

Rapid assessment

Economic assessment

Animal Health Risk Assessment

…

….

Interventions

Action research 1

Action research 2

Action research 3

…………………

Engaging stakeholders and co-generating evidence, Advocacy, Communication, OM

1

2 3

4

Incentive-based interventions

Randomized Control Trials (RCT)

“Reducing disease risks & improving food safety in smallholder pig value chains in Vietnam” (PigRisk)

Risk assessment: Salmonella in pork production chain - Pig slaughterhouse and pork market.

Pathogen concentration (N)

Pf

Infection risk (P)

Farm Market Slaughter-

house Fork

Consumption

Exposure assessment

Exposure assessment

Risk

Pp Pr

Nf Np Nr

Source: Microbiological Risk Assessment Series No2-2002, No7-2008

RISK OF MICROBIAL CONTAMINATION IN THE CHAIN RISK OF INFECTION FOR CONSUMERS

• Established a Taskforce of risk assessment for food safety: MOH, MARD, Institutes, Universities, Private Sectors...

• Analyses of food safety policy in Vietnam and how research evidence informs policy.

• Stakeholder workshops were conducted to identify the scope of activities and priority issues in food safety.

• Training courses and follow-up along with case studies of risk assessment for food safety were held.

• Developed the guidelines for risk assessment on food safety (both microbial and chemical hazards).

• Dissemination workshops to development of policy on food safety.

Taskforce: Food Safety Risk Assessment

Capacity building

• Training courses for public health & veterinary professionals – MOH, MARD.

• Developed textbooks and guidelines on food safety risk assessment.

• Publication of a special edition of risk assessment in a Vietnamese journal;

• Policy briefs developed

…real situation of policy change

Identified issues

Research Results Policy

makers accepted

? Policy changed

From Evidences to Decisions

• Establish a working group / policy alliance group (PAG)

• Meetings, study site visits, dialogue, forum, etc.

• Mass media, communication event, linking websites

• Provide clear/concrete evidences, goals, targets (policy briefs)

• The message must be designed specifically for the policy makers to better reflect their needs

• The credibility of the “messenger” can be as important as the message itself

• Will & determination to move and wait for opportunities

• Stakeholders analysis – win without fighting

Example: Topics to be discussed

• The government is developing a strategy for developing livestock production;

• How recommendations issued by Ecohealth/One Health project can better be in line with current discussions on the policy?

• How the Working Group can assist CENPHER to design the research results in a message targeting decision makers?

• Who can be the best “messenger” to present Ecohealth project and results to decision makers?

Moving towards a One Health approach in Vietnam

• MARD-MOH joint inter-ministerial circular (16) on coordinated prevention and control of zoonotic diseases (May 2013)

• Establishment of new DAH division on veterinary public health as well as the Emergency Operations Center located in GDPM office

• OH is in the national strategies

• Emerging Pandemic Threats activities, VAHIP, SEA-EU-NET and associated donor commitment

• Recognition of the need to include wildlife in animal health efforts and zoonotic risks

• One Health Communication Network for journalists

• Institutional challenges: acceptance, policy engagement

• Capacity building: One Health Workforce

• Incentives: how to share credits, added values of One Health

• Deeper coordination between sectors on human and animal (and wildlife) health and the environmental agencies

• Improving the translation of evidence and research into policy

Challenges

Summary and conclusion

One Health in Vietnam

- Great attention and support from different level

- Training in good way, but limited research

- Inter-sectoral collaboration and policies: good enabling environment

Challenges and ways forward

- Capacity building: One Health Workforce

- More research & case studies

- Deeper coordination of sectors: further (re)-organization

- Resources

Acknowledgement