Controlling emerging infectious diseases

Regional health security in Southeast Asia is at risk because officials are turning a blind eye to animal health and the prevention of zoonotic threats, Tsung-Ling Lee and Tikki Pang write.

Southeast Asia is a hotspot for emerging and re-emerging infectious diseases. Rapid population growth, urbanisation, climate change, an intensification of livestock production, increased human mobility and trade in livestock and wildlife across national borders, changes in land-use and deforestation all underpin and exacerbate the region’s susceptibility to infectious diseases, capable of achieving pandemic proportions.

Recognising the urgency of safeguarding Southeast Asia’s regional health security, the World Health Organization’s (WHO) regional office proposed a dedicated fund aimed at building preparedness for health emergencies occurring in the region during its recent meeting in Sri Lanka.

The Regional Committee, the highest decision-making body for WHO in Southeast Asia, announced the establishment of a new joint funding stream under the existing Southeast Asia Regional Health Emergency Fund (SEARHEF), which is responsible for the rapid disbursement of funds and deployment of emergency health professionals in post-disaster areas.

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While the initiative is welcome and timely, zoonotic threats—where a disease first emerging from an animal is capable of crossing species barriers to infect humans—to the region’s health security remain overlooked. Such neglect reflects the broader trend in global health security. Namely, zoonotic diseases are intentionally omitted in the International Health Regulations (IHR), the governing global legal architecture for international infectious disease control. While the IHR Monitoring Framework lists zoonotic diseases as “other hazards”, the regulations remain silent on the multi-sectorial engagement and coordination that is needed to combat this threat. Notably absent is any reference to the laboratory and surveillance capacities required to identify and track animal health.

At the regional level, the consistent neglect of zoonotic diseases as part of broader health security measures could be potentially catastrophic – Zika, H5N1, Nipah virus, Japanese encephalitis, MERS-CoV and influenza, for instance, transmit from animal to human. In fact, of the identified infectious diseases with pandemic potential, approximately 70 per cent have a zoological origin.

It remains unclear whether the SEARHEF will extend to integrate the surveillance of animal and human health systems at the regional level. Safeguarding regional health security is further complicated by widespread drug resistance, where readily available counterfeit drugs, coupled with fragile public health systems, have seen the emergence of newly resistant disease strains capable of spreading across and beyond the region.

Likewise, the high prevalence of antibiotic use in food-producing animals is particularly worrisome as resistant bacteria may be transmitted to humans through food consumption. Yet, surveillance information about the scale and frequency of unnecessary drug use in humans and animals, and laboratory capabilities for detecting novel, mutated strains in the region remains poor. In addition, for most viral diseases, treatment modalities and/or vaccines are not available.

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Moreover, the capability for pandemic preparedness and response varies widely across the region, despite the fact that Southeast Asia has always been susceptible to infectious diseases. Nonetheless, during the SARS and avian influenza (H5N1) outbreaks, the region cooperated relatively smoothly to organise outbreak responses. In fact, the immediate threats from, and the potential economic disruption of, SARS and H5N1 saw the adoption of cooperative agreements and health-related initiatives under the auspices of the Association of Southeast Asian Nations (ASEAN) and the Asia-Pacific Economic Cooperation.

However, the long-term commitments to these cooperative efforts that emerged out of these two outbreaks remain shallow. While the WHO notes Asia is relatively more prepared for possible pandemics as compared to other regions, questions remain as to the effectiveness of the existing surveillance mechanisms and transparency. In short, risk governance in Asia is fragmented with program duplications and reduced programmatic efficiency. Beyond WHO/SEARHEF and ASEAN, future preparedness should also involve close collaboration, information sharing and defining best practices with other relevant international organisations such as the Food and Agriculture Organisation of the United Nations and the International Organization for Animal Health.

Like any natural disaster, the social and economic impacts of an emerging infectious disease are difficult to predict. Robust public health systems, the strengthening of preparedness and response frameworks, surveillance risk assessments, risk communication, laboratory capabilities and the mobility of emergency health professionals remain critical to mitigating potential negative impacts.

Importantly, given the interconnectedness between animal, environmental and human health, it is crucial to place more emphasis on animal species as a shared reservoir for pathogenic transmission and spread as part of preparedness strategies. Focusing solely on laboratory capacity and the surveillance of human health can obscure the need to engage stakeholders beyond the health domain. Meaningful partnerships among the animal health, agricultural, forestry and trade sectors are necessary and fundamental to ensure coherence and operational efficiency in improving regional infectious disease control.