International One Health Day 2017 - Transdisciplinary Workshop in Berlin / Germany

Would you be surprised if someone told you that the environment has a great impact on your health? And have you ever wondered if you can transmit your cold to your beloved pet? As volunteers for the Non-Governmental Organisation Vétérinaires Sans Frontières e.V. Germany we care about these kind of questions. The correlation between environment and our status of health sounds logical and significant to us. In combination with learning about diseases, which can be spread between humans and animals, so-called zoonosis, we are finding ourselves in the middle of the One Health approach.

© VSF-G

The One Health approach

One Health's catchphrase by the American Veterinary Medical Association goes as the fallowing: "One Health is the collaborative effort of multiple disciplines - working locally, nationally and globally - to attain optimal health for people, animals and the environment." [1]

We, the volunteers, are fascinated by the One Helath approach and have made it our goal to spread its message. Consequently, we organised once more a transdisciplinary workshop on behalf of the International One Health Day 2017.

It was funded by Engagement Global and the Federal Ministry for Economic Cooperation and Development [2]​,​ and for this project’s implementation, students of medicine and veterinary medicine worked together. As last year’s event was taking place at the Free University Berlin, the university for future veterinarians, the latest workshop was held at the Charité-Universitätsmedizin Berlin, the medical students’ university. We are drawing closer together. 

Zoonotic diseases and tuberculosis  

Zoonosis are communicable diseases which can be transferred between the species.  We have not yet answered the question if you can infect your pet with your cold. Luckily, it is pretty unlikely.

However, there are many zoonoses, which urgently need a collaborative concept of defense. The workshop’s focus lied on tuberculosis as a transmissible disease, for which experts with different scientific and clinical backgrounds were invited as speakers. And, most encouragingly, the varied audience included students and professionals of medical, veterinary, public health, geography, biology and further related fields of studies. 

Tuberculosis’ causing agent in humans is Mycobacterium tuberculosis, but the type Mycobacterium bovis can be spread between humans and animals, especially cattle. It is unknown, if cattle can be infected by M. tuberculosis, too. Both, bovine and human tuberculosis are mainly spread via air droplets and mainly affect the respiratory system. 

Should veterinarians be more aware of this disease or the physicists?

 

Since 1997, Germany has gained the bovine tuberculosis free status, but 46 new cases were reported in 2013. In comparison: there were 6000 reported cases of human tuberculosis in 2016 in Germany.  

First of all, Ralf Otto-Knapp, an expert of the Central Committee for the Fight against tuberculosis in Germany talked about the history of tuberculosis and the development of testing methods. Do you know the symptoms of tuberculosis in humans? Before we are answering this question, we need to differentiate between two kind of tuberculosis infections. Firstly, the latent tuberculosis, of which an estimated 2 billion people are affected without showing any symptoms as their immune system is strong enough to keep the bacteria wrapped-up in the lung tissue. 

Secondly, patients with active tuberculosis show the following symptoms: coughing (blood), chest pain, unintentional loss of weight, chills, fever etc. In addition, the expert also informed about the new webpage dzk-tuberkulose.de,​ which is newly developed to inform people about the disease and about the chances to fight against it.

What, on the other hand, are the symptoms of bovine tuberculosis in the animals?  DVM Fischer-Tenhagen of the Free University broadened the minds not only of the medical students, but impressed the audience with her expertise on bovine tuberculosis. In her passionate talk, she explained the spread and the undertaken control measurements in Germany and diagnostic methods in the veterinary clinic. 

Many affected cows do not show any symptoms, which is named asymptomatic. In symptomatic individuals the disease can cause a slight fever, the lymph nodes swell and the cows are coughing and appear weak. Next to symptoms which are linked to the respiratory system, the mycobacteria can infect the digestive system and may result in diarrhoea and constipation. 

Furthermore, the diagnostic is challenging and next to well-known tests with tuberculin, Fischer-Tenhagen referred to another diagnostic method: the so called Hero- Rats​. These rats are trained to identify positive samples and show a high sensitivity and specificity. 

How relevant is tuberculosis nowadays?  

Professor Dr. Timo Ulrichs, Head of Department International Emergency and Disaster Relief and Global Health at the Akkon University for Human Science, gave a talk about tuberculosis as a worldwide problem for humans and about the infection itself. He reminded the audience about the 9.6 million new cases (source from the year 2014) and the actual relevance of this nearly forgotten sickness. 

For sure, it is more relevant for the less wealthy countries, according to Prof. Ulrichs, but because of the globalisation process it is an issue the whole world needs to be aware of.

Furthermore, with the new rise of tuberculosis in Eastern European countries, the disease may be associated with refugees. People leaving their countries because of civil wars face many challenges and a long way to safer places. Under these extreme circumstances their health and immune defence suffers and they are at a higher risk of contracting infectious diseases.  

Last but not least, the audience gained insights on the relevance of tuberculosis for societies relying on pastoralism. Antonia Braus from Vétérinaires Sans Frontières e.V. ​Germany gave an insight on how animal health is becoming increasingly important, especially to people in the pastoral communities, as their lives directly depend on their animals. In addition, she explained some challenges that tuberculosis presents, such as the difficulty of differentiating types of bacteria. Through insufficient hygiene measures, bacteria from the gastrointestinal tract can reach the outer genital organs and can induce an atypical infection of the urogenital tract, leaving the tuberculosis undiagnosed. Braus stressed the importance of educating and raising awareness around proper hygiene and prevention measures. She also mentioned the need for more research on zoonoses, e.g. Brucellosis.

(Veterinary) Public Health and the One Health approach 

All speakers of this event agreed on a collaborative approach to tackle this global challenge.  

Cooperatively with the expert DVM Baumann, Head of the FAO Reference Centre for Veterinary Public Health, Prof. DVM Doherr of the Faculty of Veterinary Medicine of the Free University Berlin gave the guests an insight into the concept and the veterinarian contribution to the One Health principles. Firstly, the guests were given a general overview of the One Health approach and its national and global development in the last years. They outlined that veterinarians still need to be taken more into consideration for Public Health guidelines and highlighted that veterinary skills are crucial to tackle Global Health challenges, e.g. control and prevention of outbreaks and especially zoonoses. 

World Café and the participants’ opinion 

After a break with snacks, drinks, and friendly conversation, the evening resumed with the interactive part of the workshop: the World Café. ​The participants divided into groups and visited separate tables, each held by one expert, to exchange opinions and discuss the various topics. With a total of five tables and individual themes, each group got to visit three before the plenum reunited to gather their final thoughts.

At the first table, participants reflected on the concept of One Health. They discussed the importance of collaboration and the presence of intergovernmental organisations such as the World Organisation for Animal Health (OiE) and the World Health Organization (WHO). However, some believed this might not be enough, as there is little to no direct contact with national governments, that are far more impactful locally. Some wondered, within Germany, do we need a Federal Ministry to promote and further the One Health movement? Globalisation was also discussed, especially the influence it can have on diseases. For instance, as large migration movements have been entering Europe in recent years, Eastern European countries have witnessed a new rise of tuberculosis. How can we solve this problem without discouraging globalisation? Most emphasis, participants agreed, should be placed on creating a prominent dialogue.

Next, bovine tuberculosis and diagnostic procedures were discussed at the second table. Participants agreed that a highly sensitive, primary screening would be best to minimize patients that go undiagnosed. A second screening to examine patients more closely could follow. Most essential is the applicability of the procedure, especially when imagining is used in newly industrialised and developing countries. It must be mobile and cost efficient. Before such procedures are realised, it is crucial to educate and raise awareness around safe and clean handling of animals.

Tuberculosis can be considered as a poverty associated disease. At the third table, participants discussed this correlation using examples learned in the previous presentations. Antimicrobial resistance is more prevalent in Asian countries, where awareness about the correct usage of antibiotics is lacking. What are further explanations for the rising numbers of tuberculosis cases next to poverty? For instance, an HIV infection can enhance the mechanisms of a tuberculosis infection. “Needle sharing”is the most frequent cause for HIV in the Ukraine, proving once more the importance of awareness around hygiene in countries across the map. To achieve a higher level of awareness, and better disease prevention, a strategy needs to be developed. For achieving this, a participant noted, we need to reconcile academia and society, remain pragmatic and realistic. 

At the fourth table, participants tackled the broad topic of zoonoses. A student summarised the main issue with a simple sketch on the board. She drew a line as a time axis, wrote animals on the left end, humans on the right, and marked the middle. She then explained that diagnostic procedures are only applied once a zoonosis has clinically appeared in human patients and drew an arrow to the right of the middle mark. Our goal would be to shift the arrow to the left, meaning that we should work on detecting zoonoses before they reach humans, studying the animals more carefully. Here, it would perhaps be useful to have more organisational collaboration. The Food and Agriculture Organization (FAO) sometimes serves as a halfway point between the OiE, associated with animals, and the WHO, associated with humans. However, participants felt that no organisation fully bridges the gap and that this is especially needed to deal with the issue of zoonoses. Public services could be of help, along with further research in epidemiology and the development of vaccines. 

Finally, to provide some cultural and societal insight, participants at the fifth table learned more about pastoralism. Vétérinaires Sans Frontières e.V. ​Germany has a long tradition of working with pastoralists in Eastern Africa, and is supporting animal health activities to enhance food security of the community. Participants at the VSF table were talking about cheap and effective ways of preventing diseases like brucellosis and tuberculosis to be spread. They also dived into political issues as they were discussing the role of women in pastoral societies and how strengthening their influence in economical matters can lead to more advanced and thus safer milk production.

Our concrete demands on policy makers 

Lively discussions and new ideas were held and exchanged at all tables, which results were summarised and presented by a student from each group in the end. All participants and experts together then drafted demands to politicians and universities, named in the following:

●      stronger cooperation between the three Global Health leaders - WHO, FAO and OIE - as well as national organisations and ministries 

●      more funding into One Health research

●      more education of the general public about zoonoses

●      better connection between universities and study fields, through tandems or shared courses

A very informative, eye-opening and exciting evening drew to an end. Everyone came together once more for a drink and a snack, and many contact details were exchanged. Highly motivated and full of new ideas, the participants of the transdisciplinary workshop finished the evening and were already promising their return for next year’s event! 

 

Sources and Notes:

[1] "One Health : A New Professional Imperative" (PDF). American Veterinary Medical Association. 15 July 2008. Retrieved 2017-11-23.

[2] Funded by Engagement Global with financial support of the Federal Ministry of Economic Cooperation and Development. The editor is responsible for the content of this publication; the described positions do not represent the perspective of Engagement Global gGmbH and the Federal Ministry of Economic Cooperation and Development.  [4] Source: ECDC/WHO Regional Office of Europe. Tuberculosis surveillance and monitoring in Europe 2017. More at www.ecdc.europa.eu. Retrieved 2017-11-26.