Engaging Stakeholders in the Design of One Health Surveillance Systems: A Participatory Approach

Building a Logic Model to Foster Engagement and Learning Using the Case of a Province-Wide Multispecies Antimicrobial Use Monitoring System

Successfully designing and implementing a program is complex; it requires a reflexive balance between the available resources and the priorities of various stakeholders, both of which change over time. Logic models are theory-based evaluation approaches used to identify and address key challenges of a program. This article describes the process of building a logic model on advanced theories in complexity studies. The models aim to support a province-wide multispecies monitoring system of antimicrobial use (AMU), designed in collaboration with the animal health sector in Quebec (Canada). Based on a rigorous theoretical foundation, the logic model is built in three steps: (1) mapping, a narrative review of literature on similar programs in other jurisdictions; (2) framing, iterative consultations with project members to elaborate the logic model; (3) shaping, hypotheses based on the logic model. The model emerges from the reflexive balancing of current scientific knowledge and empirical insights to gather relevant information about stakeholders from interdisciplinary experts that led a 3-year consensus-building process within the community. Recognizing the challenge of unpacking theories for practical use, we illustrate how the process of an "open" logic model building could enable governance coordination in complex processes. Logic models are useful for evaluating public, private, and academic partnerships in One Health programs that characterize an adaptive governance process.

Implementation of One Health surveillance systems: Opportunities and challenges - lessons learned from the OH-EpiCap application

As the complexity of health systems has increased over time, there is an urgent need for developing multi-sectoral and multi-disciplinary collaborations within the domain of One Health (OH). Despite the efforts to promote collaboration in health surveillance and overcome professional silos, implementing OH surveillance systems in practice remains challenging for multiple reasons. In this study, we describe the lessons learned from the evaluation of OH surveillance using OH-EpiCap (an online evaluation tool for One Health epidemiological surveillance capacities and capabilities), the challenges identified with the implementation of OH surveillance, and the main barriers that contribute to its sub-optimal functioning, as well as possible solutions to address them. We conducted eleven case studies targeting the multi-sectoral surveillance systems for antimicrobial resistance in Portugal and France, Salmonella in France, Germany, and the Netherlands, Listeria in The Netherlands, Finland and Norway, Campylobacter in Norway and Sweden, and psittacosis in Denmark. These evaluations facilitated the identification of common strengths and weaknesses, focusing on the organization and functioning of existing collaborations and their impacts on the surveillance system. Lack of operational and shared leadership, adherence to FAIR data principles, sharing of techniques, and harmonized indicators led to poor organization and sub-optimal functioning of OH surveillance systems. In the majority of studied systems, the effectiveness, operational costs, behavioral changes, and population health outcomes brought by the OH surveillance over traditional surveillance (i.e. compartmentalized into sectors) have not been evaluated. To this end, the establishment of a formal governance body with representatives from each sector could assist in overcoming long-standing barriers. Moreover, demonstrating the impacts of OH-ness of surveillance may facilitate the implementation of OH surveillance systems.

Effective Stakeholder Engagement for Collation, Analysis and Expansion of Antimicrobial Resistance (AMR) Data: A CAPTURA Experience

BACKGROUND

An effective implementation of antimicrobial resistance (AMR) surveillance projects requires sustainable and multidisciplinary engagement with stakeholders from various backgrounds, interests and aims. The "Capturing Data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) project, funded by the Fleming Fund, initially targeted 12 countries in South Asia (SA) and Southeast Asia (SEA) to "expand the volume of historical and current data on AMR and antimicrobial usage" and support local agencies through capacity building activities.

METHODS

In this article, we focus on early stakeholder engagement activities and present overall statistics on AMR data collated from 72 laboratories across seven countries. This included 2.3 million records of antimicrobial susceptibility testing (AST) data, which were curated, analyzed, and shared back to the facilities for informed decision making.

RESULTS

Approximately 98% of the data collated by CAPTURA originated from laboratories based in SA countries. Furthermore, country-wide data were analyzed to identify commonly reported pathogens in each country, followed by descriptions of AST practices and multidrug-resistant (MDR) pathogens. Overall, we found meager adherence to standard guidelines to perform and record AST results, and a significant number of MDR pathogens were reported.

CONCLUSIONS

We conclude that close collaboration with the existing national mechanisms for identifying AMR data sources was crucial for the project's success. Although we show a vast retrospective dataset on AMR is available for data sharing in Asia, there remain critical gaps in data generation/management practice and analysis capacity for AMR data at most facilities.

Wastewater treatment plants: The missing link in global One-Health surveillance and management of antibiotic resistance

INTRODUCTION

As a global public health crisis, antibiotic resistance (AR) should be monitored and managed under the One-Health concept according to the World Health Organization (WHO), considering the interconnection between humans, animals, and the environment. But this approach often remains focused on human health and rarely on the environment and its compartments, especially wastewater as the main AR receptor. Wastewater treatment plants (WWTPs) not only are not designed for reliving AR but also provide appropriate conditions for enhancing AR through different mechanisms.

METHODS

By reviewing the research-based statistics on the inclusion of WWTPs in the One-Health/AR program crisis, this paper highlights the importance of paying attention to these hotspots, at first. Also, the importance and technical roadmap for the application of WWTPs in both surveillance and management of AR were provided. The current position of these facilities was also evaluated using strengths, weaknesses, opportunities, and threats (SWOT) analysis. In the end, the concluding knowledge gaps and research needs for future investigations were presented.

RESULTS

Despite the fact that wastewater matrices are the hotspot for AR dissemination, WWTPs appear under-represented in One-Health/AR literature. So, of the 414434 articles retrieved for One-Health only 1.5% (n = 6321) focused on AR and about 0.04% (n = 158) on WWTPs. The potential of WWTPs inclusion in AR surveillance has been confirmed by several studies, however, when it comes to its inclusion for management of AR, more evidence should be presented, which confirmed by SWOT results.

DISCUSSION

As such, WWTPs simultaneously provide opportunities for AR surveillance as it is assumed that this medium can reflect the reality of the corresponding society, and for managing unexpected crises which could impact the public. Nonetheless, there are still numerous considerations to change WWTPs role from Achilles' heel to Ajax' shield, including strengthening the research-based knowledge and conducting both surveillance and management strategies of AR under One-Health concept (One-Health/AR) in a clear straightforward framework.

A social-ecological systems approach to tick bite and tick-borne disease risk management: Exploring collective action in the Occitanie region in southern France

Ticks are amongst the most important zoonotic disease vectors affecting human and animal health worldwide. Tick-borne diseases (TBDs) are rapidly expanding geographically and in incidence, most notably in temperate regions of Europe where ticks are considered the principal zoonotic vector of Public Health relevance, as well as a major health and economic preoccupation in agriculture and equine industries. Tick-borne pathogen (TBP) transmission is contingent on complex, interlinked vector-pathogen-host dynamics, environmental and ecological conditions and human behavior. Tackling TBD therefore requires a better understanding of the interconnected social and ecological variables (i.e., the social-ecological system) that favor disease (re)-emergence. The One Health paradigm recognizes the interdependence of human, animal and environmental health and proposes an integrated approach to manage TBD. However, One Health interventions are limited by significant gaps in our understanding of the complex, systemic nature of TBD risk, in addition to a lack of effective, universally accepted and environmentally conscious tick control measures. Today individual prevention gestures are the most effective strategy to manage TBDs in humans and animals, making local communities important actors in TBD detection, prevention and management. Yet, how they engage and collaborate within a multi-actor TBD network has not yet been explored. Here, we argue that transdisciplinary collaborations that go beyond research, political and medical stakeholders, and extend to local community actors can aid in identifying relevant social-ecological risk indicators key for informing multi-level TBD detection, prevention and management measures. This article proposes a transdisciplinary social-ecological systems framework, based on participatory research approaches, to better understand the necessary conditions for local actor engagement to improve TBD risk. We conclude with perspectives for implementing this methodological framework in a case study in the south of France (Occitanie region), where multi-actor collaborations are mobilized to stimulate multi-actor collective action and identify relevant social-ecological indicators of TBD risk.

Developing One Health surveillance systems

The health of humans, domestic and wild animals, plants, and the environment are inter-dependent. Global anthropogenic change is a key driver of disease emergence and spread and leads to biodiversity loss and ecosystem function degradation, which are themselves drivers of disease emergence. Pathogen spill-over events and subsequent disease outbreaks, including pandemics, in humans, animals and plants may arise when factors driving disease emergence and spread converge. One Health is an integrated approach that aims to sustainably balance and optimize human, animal and ecosystem health. Conventional disease surveillance has been siloed by sectors, with separate systems addressing the health of humans, domestic animals, cultivated plants, wildlife and the environment. One Health surveillance should include integrated surveillance for known and unknown pathogens, but combined with this more traditional disease-based surveillance, it also must include surveillance of drivers of disease emergence to improve prevention and mitigation of spill-over events. Here, we outline such an approach, including the characteristics and components required to overcome barriers and to optimize an integrated One Health surveillance system.

Mapping food surveillance chains through different sectors

European countries are investing in strengthening disease surveillance from a One Health (OH) perspective. During the MATRIX project, in the context of the One Health European Joint Programme, existing surveillance chains across the sectors of animal health, food safety, and public health have been investigated through questionnaires. Provided information has then been selected to be displayed in a single slide using an implemented mapping template. Two real-life scenarios are presented as case studies: the surveillance activities in place in France for Salmonella in the pork meat food chain, and in Norway for Listeria monocytogenes in the dairy food chain. The results collected through the questionnaires and the lessons learnt during the mapping process are reported, to share the advantages and drawbacks of the methodology. Moreover, the presented template could be adjusted and applied to different contexts. Mapping the components of existing disease surveillance systems is a fundamental step in understanding the relationships between its components, and subsequently facilitating their collaboration and integration under a OH approach.

The Entrepreneurs: Dairy farmer perspectives on finding an industry solution for the surplus calf issue—A participatory case study

Current systems for managing surplus dairy calves are wrought with ethical and animal welfare concerns. Resolving complex problems in the dairy industry requires engagement from dairy farmers and other stakeholders. The main objective of this case study was to pilot a novel methodology to deepen our understanding of how dairy producers envision the future of surplus calves in Atlantic Canada, including identifying who they felt were important to speak to as they discussed this topic. A second objective was to understand the perspectives of a key group the producers requested to speak to, representing a variety of dairy industry partners, including veterinarians, genetics companies, and animal welfare scientists amongst others (referred to as the allied industry) on the future of surplus calves. To reach these objectives, we used an inclusive participatory approach that, to our knowledge, has not yet been applied to the surplus calf issue. This approach included a series of five participatory group discussions with volunteer dairy farmers from Atlantic Canada; the allied industry group was invited to two group discussions. Participants discussed the feasibility of creating a dairy beef system as a potential solution to the surplus dairy calf issue. During the discussions, participants were encouraged to make requests to speak to individuals that would help them design a dairy beef system. Audio-recorded transcripts were subjected to inductive qualitative content analysis where short descriptors were assigned to pieces of the discussion relevant to study objectives. Four key themes from the discussions included: (1) challenges with surplus calf production on the dairy farm, such as a lack of knowledge about what type of calf would be desired by the marketplace, (2) the role of leadership and partnership in the creation of a dairy beef system, including the need to overcome communication barriers between different stakeholders, (3) post-farm gate aspects of surplus calf production, including the desire to cater to a local market, and (4) ensuring that the proposed system is economically and socially viable. Knowledge gained from this type of participatory engagement can help stakeholders align their goals to resolve complex issues such as surplus calf management.

A participatory epidemiological and One Health approach to explore the community’s capacity to detect emerging zoonoses and surveillance network opportunities in the forest region of Guinea

The Ebola virus disease epidemic that threatened West Africa between 2013 and 2016 was of unprecedented health magnitude. After this health crisis, studies highlighted the need to introduce community-based surveillance systems and to adopt a One Health approach. This study aimed to provide preparatory insights for the definition of a community-based surveillance system for emerging zoonoses such as viral hemorrhagic fevers in Guinea. The objective was to explore the disease detection capacity and the surveillance network opportunities at the community level in two pilot areas in the forest region of Guinea, where the epidemic emerged. Based on a participatory epidemiological and One Health approach, we conducted Focus Group Discussions with human, animal and ecosystem health actors. We used a range of participatory tools, included semi-structured interviews, ranking, scoring and flow diagram, to estimate the local knowledge and perception of diseases and clinical signs and to investigate the existing health information exchange network and its related strengths and weaknesses. The results showed that there is heterogeneity in knowledge of diseases and perception of the clinical signs among actors and that there are preferred and more effective health communication channels opportunities. This preparatory study suggests that it is necessary to adapt the case definitions and the health communication channels to the different actors who can play a role in a future community-based surveillance system and provides recommendations for future surveillance activities to be carried out in West Africa.

Viral hemorrhagic diseases have a high risk of emergence in tropical regions. The consequences on public health are often disastrous in the low- and middle-income countries that face difficulties to control epidemics. This scenario has unfortunately occurred in West Africa between 2013 and 2016 with the Ebola virus disease epidemic. There is an urgent need to increase the capacity for rapid detection of the emergence of such diseases and adopting a One Health approach since most of them are zoonotic. Community-based surveillance seems appropriate to address this issue in the context of these countries. We collected preparatory data through semi-structured interviews of community actors in human health, animal health and ecosystem health in Guinea. We used participatory epidemiology that appears to be a consistent method to assess local knowledge and perceptions of diseases and clinical signs and to identify health information exchange network opportunities. We aimed to provide relevant recommendations for the design of adapted case definitions and surveillance network in the prospect of implementing a community-based surveillance system of viral hemorrhagic fevers in Guinea and future surveillance activities to be carried out in West Africa.

Role of regulatory capacity in the animal and human health systems in driving response to zoonotic disease outbreaks in the the Mekong region

We conducted a policy situation analysis in three Mekong region countries, focused on how the animal and human health systems interact to control avian influenza (AI). The study used scoping literature reviews aimed at establishing existing knowledge concerning the regulatory context. We then conducted a series of key informant interviews with national and sub-national government officials and representatives of producers and poultry farmers to understand their realities in managing the complex interface of the two sectors to control AI. We found signs of formal progress in establishing the policy and legislative frameworks needed to enable cooperation of the two sectors but a series of constraints that impede their effective operation. These included the competitive relationships involved, especially with budgetary allocations and mandates that can conflict with each other. Many local actors also view development partners (e.g., bilateral and multilateral donors) as having a dominant role in establishing these collaborations, limiting the extent to which there is local ownership of the agenda. The animal and human health sectors are not equally resourced, with the animal health sector disadvantaged in terms of surveillance and laboratory systems, human resources and financial allocations. Contrasting strategies for achieving objectives have also characterised the two sectors in recent decades, seeing a major shift towards the use of incentive-based approaches in the human health sector but very little parallel development in the animal health sector, largely dependent on command and control approaches. Successful future collaborations between the two sectors are likely to depend on better resourcing in the animal health sector, increasing local ownership of the agenda, and ensuring that both sectors can use the full range of regulatory strategies available to achieve objectives.

Critical Evaluation of Cross-Sectoral Collaborations to Inform the Implementation of the "One Health" Approach in Guadeloupe

In Guadeloupe, a French overseas territory located in the Eastern Caribbean, infectious and non-infectious diseases, loss of biodiversity, natural disasters and global change threaten the health and well-being of animals, plants, and people. Implementing the “One Health” (OH) approach is crucial to reduce the archipelago's vulnerability to these health threats. However, OH remains underdeveloped in Guadeloupe, hampering efficient and effective intersectoral and transdisciplinary collaborations for disease surveillance and control. A multidisciplinary research group of volunteer researchers working in Guadeloupe, with collective expertise in infectious diseases, undertook a study to identify key attributes for OH operationalization by reviewing past and current local collaborative health initiatives and analyzing how much they mobilized the OH framework. The research group developed and applied an operational OH framework to assess critically collaborative initiatives addressing local health issues. Based on a literature review, a set of 13 opinion-based key criteria was defined. The criteria and associated scoring were measured through semi-directed interviews guided by a questionnaire to critically evaluate four initiatives in animal, human, plant, and environmental health research and epidemiological surveillance. Gaps, levers, and prospects were identified that will help health communities in Guadeloupe envision how to implement the OH approach to better address local health challenges. The methodology is simple, generic, and pragmatic and relies on existing resources. It can be transposed and adapted to other contexts to improve effectiveness and efficiency of OH initiatives, based on lessons-learned of local past or current multi-interdisciplinary and intersectoral initiatives.