How WHO’s “One Health” Program Can Help India Tackle Monkeypox
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What is monkeypox?
Monkeypox, an infection that is rapidly spreading across the world, is a viral zoonotic disease. Zoonotic diseases are infections that jump from animals to humans and are responsible for about one billion infections and millions of deaths each year. A high density of livestock population, along with a poorly guarded animal-human interface and weak surveillance of diseases in animals, has made the world susceptible to zoonotic infections. Studies indicate that an estimated 60 percent of known diseases—including rabies, swine flu, and zika—and up to 75 percent of newly emerging infectious diseases are zoonotic in nature.
Shruti Sharma is a senior research analyst with the Technology and Society Program at Carnegie India, where she is currently working on exploring the challenges and opportunities in leveraging biotechnology to improve public health capacity in India.
Monkeypox is mostly found in the tropical rainforest areas of Central and West Africa. While its exact reservoir is still unknown, various animal species such as squirrels, rats, and non-human primates are susceptible to the monkeypox virus, making them potential carriers of the disease. As on August 4, 2022, the outbreak encompasses more than 26,000 reported cases across eighty-one countries.
How is the monkeypox outbreak affecting India?
As on August 3, 2022, India has reported nine cases of the monkeypox infection. The country reported its first case on July 14, after a traveler returned from the United Arab Emirates (UAE) to the southwestern coastal state of Kerala. A few days later, as more travelers returned from the UAE, India reported its second and third cases of the virus. The fourth case, detected on July 22, has no history of international travel, making it the country’s first case of local human-to-human transmission. India also reported its first monkeypox death on July 30, 2022, in Kerala.
Kerala’s health department ramped up its measures to screen all international travelers to contain the spread. In addition, the central government deployed a multidisciplinary team to support the state health authorities. The team comprises experts from the National Centre for Disease Control (NCDC), other senior experts from the Ministry of Health and Family Welfare (MOHFW), and representatives from Ram Manohar Lohia Hospital, New Delhi. The Indian government is also taking measures to enhance surveillance, promote rapid identification, and encourage isolation to reduce the risk of human-to-human transmission throughout the country. Moreover, the Indian Council of Medical Research (ICMR), the apex body for the formulation, coordination, and promotion of biomedical research in India, has trained fifteen research and diagnostics laboratories across the country to ensure early detection of the virus.
What is the “One Health” approach introduced by the World Health Organization (WHO), and how can it help in preventing zoonotic infections?
Last year, WHO Director-General Tedros Adhanom Ghebreyesus warned, “We don’t know when the next threat—the next disease X—will emerge,” and emphasized the need to adopt the “One Health” approach.
One Health, as defined by the WHO, can design and implement policies that facilitate conversations between multiple sectors to achieve better policy outcomes.
This approach can be a solution that links the monitoring of animal and human diseases. In the case of a few zoonotic diseases, animals provide an early warning to human beings. In other cases, humans manifest symptoms before the illnesses are detected in animals. Simultaneous monitoring of these health systems can serve as early warning mechanisms, which in turn will be crucial for detecting zoonotic infections in a timely manner in the future. In addition, the collaboration of experts involved in managing and improving plant, animal, human, and environmental health under the One Health approach could also be used to share pathogen genomic data that can be leveraged for the development of vaccines, diagnostics, or other therapeutics to prevent and respond to zoonotic infections.
However, implementing the One Health approach is challenging because most countries have separate disease surveillance programs pertaining to infections in plants, animals, and humans. The siloed nature of the programs is further exacerbated by a lack of communication and adequate data sharing among themselves, limiting the opportunities for detecting zoonotic infections at an earlier stage.
What are the policy challenges in implementing the One Health approach in India?
A prerequisite for the program is an effective and robust disease surveillance system, which India does not have at the moment for both humans and animals.
For the former, the MOHFW has set up an Integrated Disease Surveillance Program (IDSP) under the NCDC. This online reporting portal establishes surveillance committees at the central, state, and district levels. Information is relayed from the district unit to the state unit and then to the central surveillance unit on a weekly basis through the IDSP portal. In addition, the ministry also runs several other disease surveillance programs that sometimes gather data for the same disease with different case definitions and little to no coordination. This leads to different disease numbers being reported under different programs. Moreover, all disease surveillance programs only mandate a few institutions, mostly government-affiliated, to report disease outbreaks. This makes it difficult for private diagnostic laboratories or institutions to report diseases, which leads to severe underreporting of cases in India.
For the latter, the Indian Ministry of Fisheries, Animal Husbandry and Dairying has set up the National Animal Disease Reporting System, an online portal to record, monitor, and report livestock diseases in all states and union territories across the country. India also has the National Animal Disease Referral Expert System, another web-based interactive livestock disease database that operates under the Indian Council of Agricultural Research (ICAR), a body under the Ministry of Agriculture and Farmers’ Welfare. Lags in the relay of information from one ministry to the other sometimes delay the detection of these infections, which causes them to cross over to humans.
Overall, multiple disease surveillance programs set up under different ministries sometimes work in silos and collect data for the same disease with different parameters. This leads to convoluted, uncoordinated, and ineffective disease mapping in India, which makes it challenging to implement the One Health approach.
How can India overcome these barriers?
Collaboration between different ministries should be fostered to facilitate data sharing across various disease surveillance programs. Moreover, case definitions of diseases should be standardized to ensure accurate reporting of infections. To this end, the private diagnostic laboratories that detect infections in both humans and animals should also be brought into the formal disease surveillance circuit.
India realized the importance of the One Health approach after the coronavirus pandemic, and the National Institute of Animal Biotechnology, an autonomous research establishment of Department of Biotechnology, Ministry of Science and Technology, launched the One Health Consortium in 2021. This consortium consists of twenty-seven organizations spanning ICAR, ICMR, and several agricultural and veterinary universities as well as wildlife agencies across the country.
It is envisaged to initiate interdisciplinary collaboration between animal, human, and wildlife health experts. It will study the prevalence of ten zoonotic diseases across the country and five transboundary animal diseases (highly contagious or transmissible diseases that have the potential to spread rapidly across the globe) mainly along the Indian North-Eastern border to provide an early warning to all stakeholders.
Considering the seriousness that India has adopted at a domestic level to tackle zoonotic infections, New Delhi should start initiating discussions regarding One Health at multilateral platforms to strengthen global health security. The immediate opportunity for this lies in the G20 presidency that India is poised to take up later this year. Indian leaders can continue the discussions that have been started during the incumbent Indonesian presidency to implement the One Health program at a global scale.
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