One Health Newsletter

One Health Newsletter: Volume 15 Issue 1

Breaking Silos: One Health in Action in the Philippines

Author

Toni Rose (Cookie) M. Barroga

Over the past decade, the continuous threat of emerging and re-emerging diseases has reinforced the need for international health leaders and countries to address diverse global disease concerns with the unified One Health approach. The One Health approach recognizes that disease threats can be strategically managed when human and animal health, and environment sectors work together.¹ Since 75% of emerging human disease threats are from zoonotic origin, cooperation across different sectors will be critical for finding meaningful solutions.² However, the challenge lies in how to break organizational silos when there are differences in each sector’s priorities, institutional boundaries, and budgetary support.

In the Philippines, a country located in Southeast Asia, the concept of One Health has been utilized in addressing infectious disease concerns. At the national level, a multi-sectoral task force called the Philippine Inter-agency Committee on Zoonoses (PhilCZ) was institutionalized in 2011 through the issuance of Administrative Order No. 11 by the Office of the President of the Republic of the Philippines. The committee is composed of different agencies from the Department of Health (DOH), Department of Agriculture (DA), and Department of Environment and Natural Resources (DENR). PhilCZ serves as a collaborative platform to develop a national strategy to prevent, control, and eliminate zoonotic diseases. Furthermore, it is tasked to establish a functional and sustainable mechanism to strengthen the animal-human interface for the effective prevention, control, and elimination of zoonotic diseases.³

The Philippines One Health Approach towards Rabies

Rabies is one of the many zoonotic diseases where implementing One Health is relevant. Since prevention of rabies requires timely detection of rabies-positive animals and immediate post-exposure prophylaxis to bite victims, coordination between the human and animal health sector, including village officials, is important to prevent human deaths. Practical Inter-sectoral Linking, a tool developed by agriculture and veterinary authorities in the Philippines, focuses on the relevance of harmonious relationships across different sectors involved in the Rabies program. It contains an operational protocol and a practical network of key players which provides detailed guidance on how to respond to different trigger events such as animal bite incidents, laboratory-confirmed rabies-positive animals.⁴ The tool was rolled out to several pilot provinces which documented timely actions to 31 laboratory-confirmed rabies cases being investigated and saved 46 human lives during its first year of implementation.

International health organizations identified that mass dog vaccination (MDV) is the most cost-effective disease control strategy to eliminate Rabies since most human mortalities are due to the bite of domestic dogs ⁵. In 2014, the DOH transferred PhP 69.5 million (US $1.18 million) to DA as additional funding to purchase Rabies vaccines needed by local veterinary services which greatly increased the MDV coverage in the Philippines.⁶ Meanwhile, intensified education for young children, the most common bite victims, is also a core component of rabies program implementation in the Philippines.⁷ To increase children’s public awareness on rabies, the Department of Education (DepEd), with the Global Alliance for Rabies Control (GARC) initiative, finalized 72 lesson plans which integrated rabies-related information into public schools’ elementary curricula in 2019. The lesson plans, which are expected to benefit 24 million school children, focused on topics related to rabies, responsible pet ownership, animal bite reporting and management, and animal bite prevention.⁸

Figure 1. Dog owners line up during a mass dog vaccination activity organized by the local veterinary services of Caloocan City. (Photo Credits: Dr. Noverlee Calub,Bureau of Animal Industry, 2018, Caloocan City, Philippines

The Philippines One Health Approach towards HPAI

During the country’s first detection of Highly Pathogenic Avian Influenza (HPAI) in domestic poultry in 2017, human and animal health sectors joined forces to control the disease.⁹ As the veterinary services performed immediate depopulation in all the affected premises, the human health sector supplied influenza prophylactic medicine and monitored any onset of disease symptoms in field personnel. Several joint news releases and public interviews were conducted to convey to Filipinos that it was safe to eat poultry. Affected farm premises were cordoned off to ensure that only disease-free poultry would reach the market. Personal protective equipment, which was prepositioned in DOH’s regional offices, was provided to the veterinary outbreak response team. Due to workforce constraints, a group of army staff and firefighters offered to assist the poultry depopulation to contain the disease immediately.¹⁰ Veterinarians from DENR also spearheaded the conduct of wild bird surveillance after this first HPAI outbreak.

Figure 2. Dr. Oscar Cabanayan teaching one of the soldiers how to wear proper protective equipment during the first HPAI outbreak in the Philippines (Photo Credits: Dr. Ronnie Domingo, Bureau of Animal Industry, 2017, Pampanga, Philippines)

The Philippines One Health Approach towards AMR

Antimicrobial resistance (AMR) is another disease phenomenon that is gaining global attention due to the alarming rates at which humans are becoming resistant against critically important antibiotics. Overuse and misuse of antimicrobials are considered to be drivers of AMR; thus, global health organizations advocate antimicrobial stewardship to increase awareness of the judicious use of antimicrobials in livestock.¹¹ In the Philippines, the DA learned from the DOH’s two-decade-long Antimicrobial Resistance Surveillance Program (ARSP)—one of the pioneering AMR surveillance programs in the region. Using the lessons shared by the human health sector in the program’s inception, operationalization, and sustainability, the DA developed ARSP-Animal Health (AH) in 2018, where they discussed strategies and logistics to establish baseline AMR information on selected pathogens from healthy and clinically ill poultry, swine, and fish against a panel of antibiotics.¹² The ARSP-AH was jointly formulated by members from the government, private, and academic stakeholders, with the guidance of the Food and Agriculture of the United Nations.

Breaking organizational silos in order to find solutions to disease threats may be difficult to operationalize especially when each department or agency has its own mandate and targets to implement. With the case examples presented above in a resource-limited country such as the Philippines, it was demonstrated that when workforce, resources, and ideas come together for the common good, diseases can be managed, prevented, and controlled, thereby saving more human lives.

References

1. World Health Organization. One Health.https://www.who.int/news-room/questions-and-answers/item/one-health. Accessed October 6, 2022.

2. Taylor LH, Latham SM, Woolhouse MEJ. Risk factors for human disease emergence. Philosophical Transactions of the Royal Society of London Series B.Biological Sciences. 2001;356(1411):983-989. doi:10.1098/rstb.2001.0888.

3. Official Gazette. Administrative Order no. 10 series of 2011: Creating the Philippine Inter-Agency Committee of Zoonoses, Defining its Powers, Functions, Responsibilities, Other Related Matters and Providing Funds Thereof.https://www.officialgazette.gov.ph/2011/04/11/administrative-order-no-10-s-2011/. Accessed October 6, 2022.

4. Barroga TR, Gordoncillo MJ, Lagayan MG, et al. Practical inter-sectoral linking: Tool to rabies one health coordination to the grass-roots level.Zoonoses and Public Health. 2018;65(7):805-814. doi:10.1111/zph.12502.

5. World Health Organization and World Organisation for Animal Health. Report of the Rabies Global Conference on Dog-mediated Human Rabies.https://www.who.int/publications/i/item/WHO-HTM-NTD-NZD-2016.02. Updated 2015. Accessed October 8, 2022.

6. Manalo KJU. DA and DOH partner for 2016 Rabies eradication.https://www.bai.gov.ph/index.php/regulatory/item/31-da-and-doh-partners-for-2016-rabies-eradication-p69-5m-allocated-for-animal-rabies-vaccines. Published 2016. Accessed October 6, 2022.

7. Hampson K, Dobson A, Kaare M, et al. Rabies exposures, post-exposure prophylaxis and deaths in a region of endemic canine rabies.PLoS Neglected Tropical Diseases. 2008;2(11). doi:10.1371/journal.pntd.0000339.

8. Jayme S. Over 24 million school children to benefit from GARC's work in the Philippines. Global Alliance for Rabies Control.https://rabiesalliance.org/news/over-24-million-school-children-benefit-garcs-work-philippines. Published February 18, 2020. Accessed October 6, 2022.

9. Cruz ED, Jr MS. Philippines reports first avian flu outbreak, to cull 200,000 birds. Reuters.https://www.reuters.com/article/us-health-birdflu-philippines/philippines-reports-first-avian-flu-outbreak-to-cull-200000-birds-idUSKBN1AR0AS. Published August 11, 2017. Accessed October 6, 2022.

10. Mangosing FG. Army soldiers cull 6,000 chickens in battle vs Bird Flu. INQUIRER.net.https://newsinfo.inquirer.net/923767/avian-flu-bird-flu-pampanga-outbreak-flu-affected-chickens-philippine-army-soldiers. Published August 18, 2017. Accessed October 6, 2022.

11. Action Plan on Antimicrobial Resistance 2021-2025. https://www.fao.org/documents/card/en/c/cb5545en. Published 2021. Accessed October 6, 2022.

12. FAO Philippines. Philippines launches campaign on responsible use of antimicrobials. https://www.fao.org/philippines/news/detail/es/c/1171025/. Published November 2018. Accessed October 6, 2022.

 

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