Overview of the presentation

1. Contributing to One World, One HealthA strategic framework for Reducing Risks of Infectious Diseases at the Animal–Human–Ecosystems InterfaceSubhash MorzariaJoint FAO-OIE-WHO-UNICEF-UNSIC-WB presentationSharm El Sheikh Ministerial Conference on HPAIEgypt25-26 October 2008UNSICRegional Workshop for UN Country Teams, 30-31 March 2009

2. Overview of the presentation Origin and the development of the Strategy Components of the Strategy Introduction HPAI Achievements and Lessons Learned EIDs and Existing IDs and their Impacts The Strategic Framework Specific Objectives and Outputs Cross Cutting Issues Institutional Issues Financing the Framework Conclusions and Way Forward

3. Introduction New Delhi recommendation, Dec 2007 Disease entrenched in several countries Continued risk of re-emergence and pandemic flu HPAI still a priority Also recognition HPAI is one of many other E/rEIDs Address the larger issue of EIDs at animal-human-ecosystem interface using OWOH approach

4. Genesis Planning meeting in Geneva (FAO, WHO, OIE, UNICEF with UNSIC and WB) between 3-4 June 2008 to discuss strategy development Based on the broad discussions in Geneva, outline for the Strategy agreed upon by mid June 2008 LATEST joint document (FAO-WHO-OIE-UNICEF-WB) finalized in mid October 2008 This is still a STRATEGIC FRAMEWORK with key concepts for WIDER CONSULTATION

5. Lessons learned… Economic development and disease Disease control and livelihoods Role of wildlife and transmission Understanding epidemiology Effective communication strategies Cross-sectoral collaboration Political commitment

6. EIDs: main characteristics Studies show over the last 50 years: One new disease every year >70% are zoonotic, % increasing Many are of transboundary in nature Wide and significant impacts (SARS/HPAI) Global significance, international public good

7. Economic Impact of EID SARS China, Hong Kong, Singapore, Canada $30-50bn $50bn $40bn $30bn Foot & Mouth UK $25–30bn Estimated Cost $20bn Classical Swine Fever, Netherlands $2.3bn BSE Japan $1.5bn Avian Flu Asia, $5–10bn $10bn BSE UK, $10-13bn Foot & Mouth Taiwan, $5-8bn HPAI, Italy $400m BSE Canada $1.5bn BSE U.S., $3.5bn Nipah, Malaysia $350-400m Avian Flu, NL $500m 2004 2006 2003 2005 1996 1997 1998 1999 2000 2001 2002 1994 1995 Figures are estimates and are presented as relative size.

8. Impact of pandemic influenza • Loss to the global economy • US$2 trillion • Prevention is cost-beneficial

9. Less developed nations More developed nations 65 1950 55 60 75 80 85 90 95 2000 05 10 15 70 Drivers for emergence and spread (Human factors) Global Population: 1950-2015 • >90% population growth in Africa, Asia and L. America • Poverty on the rise • Rapid economic development • Huge demand for livestock • Rapid evolution of farming systems Total Billions 8 7 6 5 4 3 2 1 0 Source: US Bureau of the Census

10. Increasing food demand

11. Farming systems: Numbers and density 2,500,000 China Cambodia, Indonesia, Lao, Thailand and Vietnam 2,000,000 1,500,000 Duck Meat Production (Tons) 1,000,000 500,000 0 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 1964 1961 • In 2007, over 21 billion food animals were produced for over 6 billion people • By 2020 the demand for animal protein up by 50% mainly in developing countries requiring over 30 billion animals

12. Wildlife factor • Forest encroachment • Nipah, Hendra and Ebola • Bush meat • (HIV and chimpanzee) • Exotic animal farming • SARS • Trade in exotic animals • Monkey pox, psittacosis • 37.8 million counted animals imported in USA from 163 countries in 2000-2004

13. Climate change - diseases • Vector ecology and distribution (flies, ticks, mosquitoes) • Invading pathogen adaptation with new vectors • Migratory patterns

14. Spread of pathogens(globalized travel and trade) Increase in international air travel (5%/yr) Large shipments of livestock Animals can be any part of the world in time shorter than the IPs of many diseases

15. Pathogen risk factors All pathogens EIDs OIE list Human Domestic animals Domestic carnivores

16. Viruses • Both DNA and RNA viruses represented • RNA highly likely as EID • High mutation rate, no repair mechanisms • Small, Ubiquitous, Intrusive • Ebola, Marburg, Nipah, Hendra, Lassa, Hanta, Influenza, Polio, Hepatitis, FMD, West Nile, Rabies, Yellow fever, SARS Cleaveland, S., Laurenson, M.K. &Taylor, L.H (2001). Phil. Trans. R. Soc. Lond. 356, 991-999 16

17. Goal • Diminish the threat and minimize the global impact of epidemics and pandemics due to highly infectious and pathogenic diseases of humans and animals Broader vision • Public health and food safety • Food security • Livelihoods of poor and vulnerable people

18. Focus Emerging and re-emerging infectious diseases at the animal-human-ecosystems interface with epidemic and pandemic potential causing wide ranging impacts

19. OWOH Manhattan Principles Developed by WCS in 2004 in New York Increasingly being adopted to address pathogen jumps between animals and humans Holistic approach encompassing interfaces among the human, animal and ecosystem health domains Proposes an international, interdisciplinary, cross-sectoral approach to disease emergence and control

20. Major thrusts/objectives • Preventive action and root causes and drivers • Building more robust public and animal health systems (IHR 2005, OIE Standards) • Strengthening the national and international emergency response capabilities • Better addressing the concerns of the poor: • developed to developing economies • potential to actual disease problems • focusing on locally important diseases • Promoting cross sectoral and multi-disciplinary approach • Conducting strategic research

21. Priorities • Country Level • Long term, improve disease control capacity, including the public and animal health and food safety services based on good governance compliant with WHO IHR and OIE standards • Country and Regional Levels • Short to medium term establish risk-based disease surveillance in humans and animals to identify diseases at source (hotspots, human-animal interface) • International Level • Medium to long term strengthen capacity to improve ‘horizon scanning’ to support countries to respond early and control infectious disease events (GLEWS).

22. Risk-based surveillance for sources of infection Hotspots (Range of researchable issues) Entrenchment animal/human/ecosystems population density

23. A-Zoonotic/wild B-Zoonotic/domestic C-Drug resistant D-Vector-borne

24. Cross cutting issues Surveillance at three health domains Biosecurity Bioterrorism Socio-economics Development issues Communications strategies at different levels Private-public partnership Monitoring and evaluation Strategy Components cont…

25. Institutional Issues • Guiding Principles • Country level initiation and implementing stronger intersectoral collaboration and political commitment • Country, regional and international levels coordinated action that brings together those working on human, animal and ecosystems health • International level engaging international institutions drawing on their unique mandates and complementary expert base • Permitting rapid engagement of a broader range of stakeholders, including regional organizations in order to respond effectively to a variety of disease threats

26. Financing Framework FUNDING FOR THE FOLLOWING KEY AREAS: • Responding to the ongoing avian influenza crisis • Strengthening public and animal health services • Improving surveillance: special attention for hotspots and strengthening wildlife surveillance • Providing funds for emergency response • Supporting communication and social mobilization • Conducting strategic research • Supporting international organizations for regional and global initiatives

27. Preliminary cost estimates • HPAI support • Annual funding needs over next 3 years: US$542–735 million • Estimated cost of funding the OWOH Strategic Framework to 2020 • Average per year: • Scenario 1: US$ 852 million (43 low income countries) • Scenario 2: US$1,343 million (139 eligible countries) • Total • Scenario 1: US$ 10,228 million • Scenario 2: US$ 16,116 million

28. Funding sources • Existing donors • Non-conventional donors and foundations • Emergency funds • Country level fund for emergencies and compensation • UN Central Emergency Response Fund • FAO Special Fund for Emergency and Rehabilitation • OIE’s World Animal Health and Welfare Fund • The World Bank and the Regional IFIs • Industry and other private sector • Meat exporting countries

29. Conclusions HPAI and EIDs are a complex problem Multidisciplinary, multisectoral and multi-partnerships Global challenge, requiring global solutions Builds on HPAI successes and lessons learned FAO, OIE, WHO, UNICEF, UNSIC and WB support Stakeholders buy in and ownership important

30. Sharm El Sheikh response • All the respondent countries strongly supported the OWOH Framework • All the donors see this as synergistic with their future objectives • EC • Canada • USDA • Australia, Germany, Japan, Sweden • Canada to support Winnipeg Meeting (16-19 March 09) • Globally advance the framework • Priority actions for implementation

31. Winnipeg Response • Wide range of interest groups (16-19 March 09) • Academic community • Research Institutes • Donors • Countries • Regional Organizations

32. USAID Initiative • EPT Programme, Components • Detect • Identify • Respond • Prepare

33. Next steps • Conducting wider consultation with countries, regions and other key partners • Political commitment at country level • Importance of cross-border collaboration • Developing implementation strategies and plans • Mobilizing resources for implementation • Establishing timeframes for the above actions

34. Collaboration enhanced due HPAI CMC