Over the past decade, PREDICT partnered with foreign governments, universities, and other organizations to advance One Health initiatives [19]. In collaboration with local partners, the PREDICT project strengthened capacity for viral surveillance at high-risk animal-human interfaces. Also, when requested by host country government partners, PREDICT provided support during disease outbreaks by incorporating animal sampling into investigations, expanding laboratory analyses to look for novel viruses, and promoting the growth of a trained One Health workforce.
Rapid outbreak response and containment
During the widespread EVD outbreak in West Africa in 2014, the Democratic Republic of Congo (DRC) experienced its own separate and unique Ebola virus disease outbreak. Unlike West Africa, DRC has a long history of Ebola outbreaks and substantial capacity for response, due in part to a long-running partnership between l’Institut National de Recherche Biomédicale (INRB), the national infectious disease reference laboratory, and other partners like PREDICT. Many experts from the Viral Hemorrhagic Fever Unit of the INRB were deployed in West Africa when the outbreak in DRC occurred. As a result, PREDICT was requested to support laboratory testing. Suspect cases were sampled, specimens were shipped to the PREDICT laboratory at INRB for analyses, and Ebola virus was detected within 1 day of receiving the specimens. Importantly, the strain of Ebola virus detected was distinct from the strain causing the West Africa epidemic, ruling out linkages between the two outbreaks. Following the prompt testing and pathogen identification, the DRC government was able to access the affected area and respond rapidly with contact tracing, dispatching a mobile laboratory, and quarantining suspected cases, leading to swift containment with only 66 cases reported over the two-month duration of this outbreak.
The PREDICT team was also able to assist with collection of wildlife samples from the outbreak area. Contact tracing later identified the likely source of the outbreak as an infected wild animal that had been found dead and butchered for food. This information was key to identifying high-risk practices to target for disease prevention. The rapid response and field investigations informing on prevention measures illustrate what is achievable when an in-country One Health workforce is trained, employed, and ready to act. Such prevention arguably becomes even more important when country capacity to rapidly respond to outbreaks is lacking, especially in fragile areas of high vulnerability to both disease threats and their impacts (e.g. resulting from weak governance structures). The impacts of the on-going EVD outbreak in DRC, which began in Kivu DRC in August 2018, highlight the challenge of responding to a disease outbreak in a remote location where access and control efforts have been substantially impeded by violence and insurgency. These reinforce the need for continued capacity strengthening and integration of sectors at national and sub-national levels, tailored to the local risk context and stakeholders to promote relevance, sustainability, and ownership.
Prevention of human disease outbreaks
Currently, response to outbreaks around the world is highly reactive, with control measures employed once an outbreak in humans has been detected. PREDICT activities in Bolivia demonstrated that monitoring for zoonotic viruses in wild animals can be a valuable early detection tool for preventing disease outbreaks, particularly in landscapes undergoing substantial alteration, such as deforestation, where breakdown of natural barriers leads to increased contact between wildlife and people.
Yellow fever (YF) is a zoonotic viral hemorrhagic disease [25] that is perpetuated in a transmission cycle involving mosquitos and non-human primate hosts. Because New World primate hosts are especially susceptible to YFV infection, acute clusters of mortality in these populations can signal YFV activity and alert authorities to increased risk of human infection, thereby serving as an early warning system.
In 2012, staff at a wildlife sanctuary in Bolivia, who had received training in wildlife disease surveillance through PREDICT, discovered six dead howler monkeys (Alouatta sara) near the park. In collaboration with the sanctuary, PREDICT investigated the mortality event. Post-mortem examinations and diagnostic testing performed at the University of San Andres’ Institute of Molecular Biology and Biotechnology, PREDICT’s partner laboratory in Bolivia, indicated infection by a flavivirus, the family of viruses to which YFV belongs. PREDICT partners reported the results to the Ministry of Health, while conducting further laboratory analyses to confirm that infection was caused by YFV. The Ministry of Health, Pan-American Health Organization, and PREDICT conducted a joint risk assessment followed by a prompt cross-sectoral, coordinated response in the affected area. The response included preventive YF human vaccination, public education and outreach, and mosquito control to reduce risk of infection.
Although YF outbreaks had never been documented in Bolivian primates, authorities were able to implement preventive measures in the surrounding area within 1 week of detection of the mortality event. No human cases of YF were subsequently reported, suggesting the value of early warning systems for increased zoonotic disease risk, local pathogen detection capacity, effective collaboration channels across sectors, and prompt implementation of public health measures for preventing pathogen spillover from animals into people.
Systematic coordinated data sharing and national One Health platforms
PREDICT worked with foreign government partners to establish a systematic One Health approach to communicating findings stemming from disease surveillance. The process involved sharing laboratory results with designated points of contact in the ministries representing public health, livestock/agriculture, and wildlife, which facilitated discussions on coordinated solutions. It also established open communication channels that enabled more rapid coordinated responses to disease outbreaks. In Rwanda and Tanzania, this collaborative approach was the impetus for PREDICT’s involvement in the development of national One Health platforms in the countries.
In Rwanda, PREDICT-trained personnel served on the Government of Rwanda’s One Health Steering Committee. The committee, which is made up by representatives from the animal and human health and environmental sectors, applied “a participatory and consensus building process” to develop an integrative framework for solving problems at the animal-human-environmental interface [26]. As part of the committee, PREDICT team members aided in the development of a One Health Strategic Plan in 2015 [26]. The plan references commitments to enhance cross-sectoral collaboration and increase One Health workforce capacity in Rwanda. It outlines an implementation strategy covering organizational structure and pooling and mobilizing resources [27]. The Steering Committee oversees the plan, including prioritization of resource allocations, and coordinates the technical aspects of the strategy, which are integrated into the annual action plans of the implementing partners. If successfully operationalized, Rwanda’s One Health Strategic Plan will lead to more efficient and timely responses to disease threats [27].
For example, following the avian influenza (AI) outbreak in neighboring Uganda in 2017, the Rwanda Agriculture Board, in collaboration with representatives from the National One Health Steering Committee, conducted a field investigation of an avian mortality event in Rwanda. In the process of their investigation, they conducted public sensitization around AI risk through informal community meetings and radio broadcast. Although AI was not confirmed in Rwanda, the collaborative efforts initiated by the committee raised critical awareness and led to improvements in Rwanda’s National Contingency Plan against AI highlighting the benefits of this plan to improving preparedness.
Alongside Rwanda, Tanzania also launched its One Health Strategic Plan in 2015. This plan laid the groundwork for multi-sectoral coordination and established a One Health Coordination Unit overseen by a One Health Steering Committee, comprised of secretaries of participating ministries and supported by five technical working groups. Tanzania was the first country to undergo a self-assessment using the World Health Organization (WHO) Joint External Evaluation (JEE) tool, which is a voluntary, collaborative process to assess a country’s capacity to prevent, detect, and rapidly respond to public health threats [28]. PREDICT representatives served in one of the technical working groups using the tool to evaluate strengths, gaps, and priority actions for enhancing national health security. The assessment was instrumental for encouraging cross-sectoral communication and identifying activities in which ministry partners could work together to combat disease threats. The process paved the way for developing the Tanzania National Action Plan for Health Security, which addresses gaps identified by the evaluation. As a culmination of these efforts, Tanzania formally launched the first national One Health Platform and One Health Strategic Plan in 2018 [29].