key: cord-0924057-gq4zdnxp authors: McKenzie, Joanna S.; Dahal, Rojan; Kakkar, Manish; Debnath, Nitish; Rahman, Mahmudur; Dorjee, Sithar; Naeem, Khalid; Wijayathilaka, Tikiri; Sharma, Barun Kumar; Maidanwal, Nasir; Halimi, Asmatullah; Kim, Eunmi; Chatterjee, Pranab; Devleesschauwer, Brecht title: One Health research and training and government support for One Health in South Asia date: 2016-11-29 journal: Infect Ecol Epidemiol DOI: 10.3402/iee.v6.33842 sha: e3169377d59bbef414c6f7e4b2b36ef7f65e2b1a doc_id: 924057 cord_uid: gq4zdnxp INTRODUCTION: Considerable advocacy, funding, training, and technical support have been provided to South Asian countries to strengthen One Health (OH) collaborative approaches for controlling diseases with global human pandemic potential since the early 2000s. It is essential that the OH approach continues to be strengthened given South Asia is a hot spot for emerging and endemic zoonotic diseases. The objectives of this article are to describe OH research and training and capacity building activities and the important developments in government support for OH in these countries to identify current achievements and gaps. MATERIALS AND METHODS: A landscape analysis of OH research, training, and government support in South Asia was generated by searching peer-reviewed and grey literature for OH research publications and reports, a questionnaire survey of people potentially engaged in OH research in South Asia and the authors’ professional networks. RESULTS: Only a small proportion of zoonotic disease research conducted in South Asia can be described as truly OH, with a significant lack of OH policy-relevant research. A small number of multisectoral OH research and OH capacity building programmes were conducted in the region. The governments of Bangladesh and Bhutan have established operational OH strategies, with variable progress institutionalising OH in other countries. Identified gaps were a lack of useful scientific information and of a collaborative culture for formulating and implementing integrated zoonotic disease control policies and the need for ongoing support for transdisciplinary OH research and policy-relevant capacity building programmes. DISCUSSION: Overall we found a very small number of truly OH research and capacity building programmes in South Asia. Even though significant progress has been made in institutionalising OH in some South Asian countries, further behavioural, attitudinal, and institutional changes are required to strengthen OH research and training and implementation of sustainably effective integrated zoonotic disease control policies. Major neglected endemic zoonotic diseases, such as rabies, continue to impact human and animal health in South Asia, with a disproportionate effect on poor and marginalised communities (4Á6). The occurrence of potential global human pandemics in the early 2000s was the driver for major international advocacy and funding to strengthen collaboration between the human health, domestic animal health, and wildlife health sectors in an OH approach (7, 8) . Supported by advocacy, expertise, and funding from international agencies, governments in South Asia formulated and implemented multidisciplinary collaborative frameworks and operational programmes to combat outbreaks of zoonotic diseases with pandemic potential, such as highly pathogenic avian influenza (HPAI, H5N1). There has been a lesser effort to support research and policy development for managing endemic zoonotic diseases, despite evidence of the high impact of these diseases (6) . The challenge is to extend the OH approach from disease issues of global concern to endemic or neglected zoonoses of national and regional concern (9), which in itself is likely to strengthen the ability to detect newly emerging diseases (10) . Some governments in South Asia have made significant progress with institutionalising a collaborative OH mechanism. However, policies for managing endemic diseases in the region are largely ad hoc (11, 12) . Zoonotic disease research is also largely ad hoc, and a large proportion of the research focuses on the development of vaccines, therapeutics, and diagnostic tests rather than evidence for policy formulation and implementation (13, 14) . There is a need for policy-relevant research, generating evidence of zoonotic disease impacts, and of the effectiveness and economic value of OH approaches (15, 16) , in addition to stakeholder perspectives to formulate sustainable policies for zoonotic disease control. Ideally, OH research should involve the integrated analysis and interpretation of data on human and animal health and their environments such that the research 'leads to insights that would not be visible without inter-sectoral collaboration, such as impacts of multi-host infections on humans, animal and ecosystem health and economics' (17) . Truly transdisciplinary research, the hallmark of OH or EcoHealth approaches, involves multidisciplinary teams addressing OH research questions within a common conceptual framework (18) . The investment in people through education and training is essential to build a workforce trained in effective multidisciplinary collaboration to formulate and implement sustainable endemic zoonotic disease control policies and to build capacity for detecting and managing emerging zoonotic diseases (7, 19) . In addition to strengthening technical expertise for research and policy formulation, studying within a collaborative framework builds relationships and respect for the roles and expertise of professionals in different sectors that are an essential component of collaboration. A range of OH research and training programmes have been implemented in the South Asian region since the outbreak of zoonotic diseases with a pandemic potential in the early 2000s, such as HPAI (H5N1) and Severe acute respiratory syndrome (SARS). The objectives of this article are to describe OH research and training and capacity building activities in South Asia in recent years and to describe the important developments in government support for OH in these countries. This will contribute to understanding the achievements and identifying the gaps where resources can be targeted to strengthen collaborative OH research, training, and advocacy to build an 'enabling environment' to move towards more effective integrated management of endemic and emerging zoonotic diseases in South Asia. Data and information on OH research projects, OH training and capacity building programmes, and government support for OH in South Asian countries were collected through a range of different approaches to generate a 'landscape analysis' of OH in the South Asian region. The major focus of this analysis was on the eight member states of the South Asian Association for Regional Cooperation (SAARC), notably: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Data on OH research were collected through searching peer-reviewed and grey literature, a questionnaire survey of people potentially engaged in OH research in South Asia, and personal contact with key people identified through the authors' professional networks. An initial search for peer-reviewed publications on individual zoonotic diseases by a country in South Asia provided information on the volume of research associated with each disease in each country. The search was conducted in all databases in Web of Science (WoS) for publications within a 20-year period from 1996 to 2016, to capture the period of the early HPAI outbreaks that were a major driver for global investment in an OH approach. The search terms for zoonotic diseases by country included key words that captured the range of names by which a disease is described in the literature and the country name. The total number of publications returned in each search was considered a reflection of the most commonly researched zoonotic diseases in each country. A second search was conducted to specifically identify publications on OH research in South Asia, using the keywords 'One Health' and 'South Asia' plus 'One Health' and individual country names. As not all publications on OH research included the term 'One Health', a second set of searches was conducted using the term 'humans and livestock' or 'humans and animals' or 'livestock and humans' or 'animals and humans' or 'humans and their animals' or 'humans and their livestock' or 'livestock and children' and country name for each of the South Asian countries. The papers were then reviewed to identify those that represented OH research as defined in the following two ways: 1. A multidisciplinary study on a health-related topic, involving people from two or more disciplines, including human health, domestic animal health, wildlife health, ecological, environmental, sociological, entomological and other. Multidisciplinarity was ascertained from the author affiliations in published papers. 2. A multidisciplinary, multi-study research programme on a health-related topic. The programme includes individual studies that may involve researchers from only one discipline and/or data collection from either human or animal populations, but the studies are designed in an integrated way within the programme so that the results of each study can be interpreted together and contribute to designing integrated approaches to zoonotic disease control. A questionnaire was distributed to 115 professionals who were potentially working in OH-related areas in the South Asia region using the Hubnet platform (www.hubnet.org. nz/) to collect information on OH research, training, and challenges in implementing an OH approach in South Asian countries. OH research was defined as above, and OH training was defined as 'Training, education or capacity building activities and programmes that involved people from two or more disciplines related to human health, domestic animal health, wildlife health or environmental health'. Training was separated into short-term training such as short courses, workshops, and seminars of less than 1 month; long-term training programmes of 1 month or more; and university undergraduate or postgraduate education. Additional information on OH training was collected by a Google search using the terms '[Country name]' and 'One Health'. Such a broad search was found to produce the most comprehensive information on OH activities in the South Asian countries. Results were reviewed, and activities that were defined as training were collated. Further information was obtained through the authors' professional networks. Government support for OH in each country was identified through the authors' knowledge of government initiatives and collection of further details through OH networks in each country. In addition to the database searches, information was available through a total of 61 completed questionnaires, ranging from 4 to 17 per country, and additional contacts through professional networks. The number of peer-reviewed publications on zoonotic diseases associated with each country identified through the WoS searches for the period 1996 and 2016 is shown in Table 1 . The publications were not checked to exclude duplicates and remove papers that did not relate to the disease and country in the search terms, and hence, these numbers over-estimate the actual number of publications. However, given similar errors occur across all search terms, the relativity of the numbers is likely to be reasonably accurate. India is clearly associated with the greatest number of zoonotic disease publications, with fewest from the Maldives. The highest number of publications was associated with visceral leishmaniasis and the lowest number with Q fever. A total of 41 peer-reviewed publications from South Asia included the term OH in the title or body of the text, of which 26 correctly related to OH in South Asia. An additional 11 papers representing OH research were identified through the search terms that included humans and animals and a further five through personal communications. Overall, a total of 42 published papers were identified as relating to OH, 34 of which represented OH field studies or zoonotic disease reviews that referred to human and domestic animal or wildlife health and the remaining eight represented commentary or perspectives on OH ( Table 2 ). The number of identified OH research programmes per country ranged from three (Pakistan) to seven (Bangladesh), with the exception of the Maldives, for which no OH research programmes were identified ( Table 3) . The vast majority of the identified programmes were aimed at studying specific endemic or emerging zoonotic diseases while few programmes were aimed at evaluating information of value for OH disease control programmes and policies. A wide variety of national and international institutes contributed to these programmes, while funding was mainly from multilateral (European Union (EU), World Bank, World Health Organization (WHO)) or bilateral (Canada, Japan, Netherlands, UK, USA) development cooperations, with the exception of certain Indian OH research programmes funded by the Indian Council of Medical Research. Details of the major OH training and education programmes conducted in the seven countries are shown in Table 4 . Massey University has implemented the largest OH training programme in the South Asia region, with an alumnus of 90 Master's degree and Postgraduate Certificate in Science graduates in the seven South Asian countries, and a wider group of approximately 2,000 people who participated in applied epidemiology training programmes. Other significant OH training and capacity building programmes are Relief International's (62) . While there have been many challenges to integrating the activities of the three large international organisations in the region, the tri-partite has facilitated inter-sectoral relationships and awareness of OH approaches through annual regional meetings on multisectoral collaboration for the prevention and control of zoonoses since 2010. Each of the three organisations individually contributes to strengthening OH in the region. The WHO South East Asian Regional Office is supporting the development of a regionally integrated rabies control programme. Changes to the WHO's International Health Regulations are a driver for the human health sector to report on zoonotic diseases. FAO's Regional Support Unit for SAARC is the only sub-regional institution and coordination mechanism in South Asia dealing with animal health, and OH components are incorporated where possible. OIE supports the strengthening of veterinary services, predominantly through the Performance of Veterinary Services tool (www.oie.int/ support-to-oie-members/pvs-evaluations/oie-pvs-tool/). Massey University implemented a regional OH capacity building programme to strengthen epidemiology and health risk management skills through integrated OH Master's education and applied epidemiology training, funded by the Avian and Human Influenza Facility (AHIF), administered by the World Bank from 2010 to 2013 (www.onehealthnet work.asia/node/313). Under the programme, an OH Hub was established in six countries, led by the two government institutions responsible for human and animal health in each country, providing a networking and communication platform for individuals from government, nongovernment, university institutions, professional bodies, and international organisations working in OH-related areas. The OH Network Á South Asia was established in Hubnet, a web-based communication and collaborative system developed by the Massey University, with a current membership of 249 professionals working in OH-related areas in South Asia. A national OH symposium was supported in each country, culminating with a regional OH symposium (Paro, Bhutan December 2013) during which nine regional resolutions were formulated to strengthen OH in the region (www.onehealthnetwork. asia/node/492). The One Health Association of South Asia is a second regional OH network facilitated by the EcoHealth Alliance with the mission of facilitating communication and cooperation among scientific and government agencies in member countries through meetings, workshops, research, and information exchange (63) . Other programmes are implemented in multiple countries in the region but not operating as full regional programmes. A second Massey University capacity building programme involving 24 human health, domestic animal health, and wildlife health professionals from Afghanistan, Bangladesh, Bhutan, and Nepal was implemented from September 2014 to October 2016, funded by the EU. Relief International's 'Fighting Zoonoses in Afghanistan, Bangladesh and Nepal' programme (www. devex.com/jobs/one-health-training-capacity-building-cons ultant-afghanistan-bangladesh-or-nepal-373076) was also funded by the EU, to reduce the incidence of zoonoses and alleviate their impact through community awareness, capacity building, and institutionalisation of OH. The United States Agency for International Development (USAID) funded PREDICT programme led by the University of California, Davis is implemented in Nepal, Bangladesh, and India with the aim of developing an early warning system to detect, track, and predict the emergence of new zoonotic pathogens in animals that could pose a threat to human health (www.vetmed.ucdavis.edu/ohi/ predict). The CDC is implementing both 3-month and 2-year Field Epidemiology Training Programs for public health and laboratory personnel in Pakistan, India, and Bangladesh, which include public health and animal health professionals. FAO is implementing Field Epidemiology Training Programs programmes for veterinarians in multiple countries. Afghanistan A number of international organisations have worked to facilitate collaboration through the signing of memoranda of understanding between the government institutes and general directorates responsible for human and animal health in Afghanistan. However, to date these have not resulted in sustainable collaboration once the supporting donor-funded projects ended. In May 2012, a National Zoonotic Disease Committee was established with the support of FAO and WHO. In 2013, Massey University facilitated the establishment of an OH Hub with focal points from the Afghanistan National Public Health Institute and the General Directorate of Animal Health and Production. However, neither organisation has remained active. Massey University, Health Protection Research Organisation, and Relief International are supporting collaboration in OH research through evaluation of zoonotic disease control policies and investigation of zoonotic disease outbreaks under the current EU-funded OH in South Asia programme. The dependence on donorfunded programmes and political instability create a challenging environment for establishing sustainable collaboration to manage zoonotic diseases in Afghanistan. Multisectoral committees were formed at all tiers of the government to manage HPAI (H5N1) in the early 2000s. Subsequently, the human and animal health sectors have continued to collaborate in controlling anthrax outbreaks, progressive implementation of a rabies control strategy, and containment of antimicrobial resistance. Bangladesh developed a Strategic Framework for OH Approach to Infectious Diseases in 2012 which was later endorsed by the Ministry of Health & Family Welfare, the Ministry of Fisheries and Livestock, and the Ministry of Environment and Forests, with the support of FAO, WHO, and the United Nations Children's Fund (www. iedcr.org/pdf/files/One%20Health/Strategic_framework_ for_One_Health_Bangladesh-26%20Jan.pdf). The Strategic Framework 'provides direction for prevention, early warning and control of emerging, re-emerging, and high impact infectious diseases at the humanÁanimalÁecosystem interface in Bangladesh'. Significant progress has been made in implementing the strategy, with the establishment of an Inter-Ministerial Steering Committee and an OH Secretariat in June 2016. The Secretary of Health is the initial chair of the Steering Committee which will be rotated every 3 years. The OH Secretariat initially comprising one officer seconded from the health, livestock, and forest sectors will be located at the Institute of Epidemiology Disease Control and Research, with support from the USAID Preparedness and Response project, FAO and CDC. 'OH Bangladesh' is the major professional OH network in Bangladesh, inaugurated in 2008. The National Coordination Committee, formed under this organisation, arranges monthly meetings and an annual international OH conference in Bangladesh. The OH Hub, Bangladesh, established in 2013, with focal points from the Institute of Epidemiology Disease Control and Research and the Department of Livestock Services and a membership of 44 (www.onehealthnetwork.asia/sites/bangladeshonehealth hub), is integrated with and supports the OH Bangladesh organisation. An extremely successful collaboration between the human and animal health authorities has responded to stamp out avian influenza outbreaks, forming a strong platform for the subsequent development of OH initiatives. The Ministry of Health and the Ministry of Agriculture and Forests in Bhutan have developed and approved an OH Strategic Plan 2016Á2020, which is pending approval of the Cabinet of Ministers. The plan is a 5-year strategic document that will guide all sectors and agencies involved in the preparedness and prevention of zoonoses and other public health risks through an OH approach. The Department of Public Health, the Department of Livestock, and Bhutan Agriculture and Food Regulatory Authority have jointly developed guidelines for the prevention and control of zoonotic diseases, namely, National Influenza Pandemic Preparedness and Response Plan for H5N1 and H7N9, National Rabies Prevention and Control Plans in Animals (2016), National Guidelines for Rabies Prophylaxis in Humans (2012), Guidelines for Preparedness, Surveillance, Control of Anthrax in Humans and Animals in Bhutan (2013). All these guidelines emphasise effective and timely communication of suspected or confirmed outbreaks, and collaboration among the aforementioned departments and other relevant sectors from central to field levels. A number of government-led initiatives established intersectoral platforms in response to the threat of potential pandemic diseases such as HPAI (H5N1) and SARS. An Inter-Ministerial Task Force and a Joint Monitoring Group were established in 2004 to facilitate collaborative multisectoral management of HPAI (H5N1) (64) . A National Standing Committee on Zoonoses was constituted by the Indian government in 2005 and headed by the Director of Health Services to recommend policies, operational research, and inter-sectoral collaboration on the control of zoonoses in the country (44) . In 2010, the CDC and the National Center for Disease Control in India signed a memorandum of understanding for the establishment of the India Global Disease Detection Regional Center to strengthen the Epidemic Intelligence Service of India, supporting emerging disease surveillance, improving preparedness and response to outbreaks, strengthening laboratory safety and bio safety, and improving zoonotic disease investigation and control (U.S. India Bilateral Cooperation on Public Health and Research, U.S. Department of State. Retrieved from www.state.gov/r/pa/prs/ps/2012/06/192275.htm). While these initiatives have responded to potential pandemic threats, they have not yet resulted in institutionalising an OH approach that supports the implementation of coordinated OH research programmes that contribute to the formulation and implementation of effective integrated policies for controlling zoonotic diseases. There was no evidence of OH activities in the Maldives, which has a small livestock population and veterinary services provided by Sri Lanka. The Department of Livestock Services and the Department of Health Services have collaborated to control HPAI (H5N1), Japanese encephalitis, and rabies, producing Pakistan demonstrated an exemplary collaboration between the Ministry of Health and the Ministry of Livestock to control an outbreak of HPAI (H5N1) in 2008 following identification of the first human avian influenza case in Pakistan in November 2007 (65) . A similar collaboration was implemented to manage H1N1 (swine flu) from 2010 to 2012. However, in 'peace time', especially after the devolution phenomenon, there has not been strong governmental support nor interprovincial efforts for expanding OH in Pakistan. The adoption of International Health Regulations by Pakistan in 2016 provides an opportunity for the revival of better coordination between federal and provincial governments to address the issue of zoonoses under an OH approach. However, strong political will is required to activate such joint efforts to better handle the public health issues in this part of the world. While an OH culture has not yet strongly formed at an institutional level, collaboration in zoonotic disease control arises as a result of the personal relationships between professionals in the human health, domestic animal health, and wildlife health sectors that have developed through the OH activities described above. It is a challenge to present a comprehensive picture of OH in South Asia, given the diversity of multiple countries and cultures, the multiple national institutions, and the multiple international institutions that are involved to varying extents with OH-related activities. Nevertheless, by integrating information from multiple sources, we were able to generate the first-ever landscape analysis of OH research, training, and government support in this very diverse region. Comparison of the peer-reviewed publications on zoonotic disease research with those that specifically relate to OH studies indicates that only a very small proportion of ad hoc research can be defined as truly multidisciplinary OH research. A similar situation was identified with respect to rabies research in India, despite efforts of the Roadmap to Combat Zoonoses in India to provide strategic direction for multidisciplinary zoonotic disease research through a strategic research agenda (4). While most animal health institutions in South Asia conduct zoonotic disease research, a large proportion of which estimates disease prevalence in animal populations, very few public health institutions conduct zoonotic disease research. As a result, there is a significant lack of reliable information on the burden of zoonotic diseases in human populations, despite evidence that the impact of some zoonoses is higher than that of malaria, and comparable to that of HIV/AIDS (47) . Reliable estimates of zoonotic disease burdens in humans as well as in animals are important for formulating effective zoonotic disease control policies. There is a major need for well-coordinated and well-designed zoonotic disease research programmes, integrated within an OH framework to produce information of value in both human and animal populations for the development of effective integrated OH disease control policies. To date, the most effective OH research appeared to be conducted within larger multidisciplinary, multicollaborator, multi-year research programmes, such as the PERIMILK programme in India and the Zoonoses and Emerging Livestock Systems programme in Bangladesh. Such large-scale programmes that provide a suitable framework for integrated OH research require considerable resourcing and effective management and leadership to integrate the multidisciplinary inputs necessary to produce information of value for zoonotic disease control policy. While these programmes have been supported by international funding sources, national organisations such as the Indian Council of Medical Research and the Indian Council of Agricultural Research have the potential to fund such multidisciplinary multi-study programmes. The OH strategies developed in Bangladesh and Bhutan provide the framework for collaborative leadership and coordinated funding and implementation of integrated OH research programmes in their countries. However, there is a clear need for ongoing national and international support to build OH research capacity through the implementation of integrated OH research programmes that are supported by education and training to strengthen these initiatives in South Asia. Most importantly, there is a need to develop sustainable research platforms within the region that can keep functioning beyond the lifespan of a single project and for continued advocacy for the OH approach to policy. Only a small number of truly integrated OH capacity building programmes have been implemented within the South Asia region, involving long-term education and training of health professionals from multiple sectors. Postgraduate OH education programmes are beginning to be offered within the region, notably the Centre for OH Education, Advocacy, Research and Training programme at Kerala University in India, the Masters of Applied Epidemiology in Sri Lanka, and the proposed OH Institute and associated OH-focused MSc at Chittagong Veterinary and Animal Sciences University in Bangladesh. The challenge is to create an OH education programme that is well-balanced and therefore attractive to both human health and animal health professionals. Joint education of professionals from different sectors is an effective way of building understanding and trust between disciplines, breaking down the barriers and misconceptions between the medical and veterinary professions. Effective OH training and education should facilitate participants towards a transdisciplinary conceptual framework that draws together disciplinary-specific theories, concepts, and approaches to address common problems. Participants' experience in Massey University's capacity-building programmes has shown that learning together in a joint postgraduate degree programme and working together in applied epidemiology projects and policy evaluation build understanding and relationships, which lay the foundation for implementing OH research and sustainable policies for managing emerging and endemic zoonotic diseases. Government support for OH Formulation and implementation of policies for collaborative integrated control of zoonotic diseases in human and animal populations is strongly dependent on the formation of a government-led OH strategy and institutionalisation of OH. Formal collaborative mechanisms were established in all South Asian countries in the mid-2000s to manage emerging disease threats such as HPAI (H5N1), H1N1, and SARS. However, sustainability of these collaborations for managing endemic zoonoses in 'peace time' has been very variable. Some countries have made significant progress towards building a strong OH network and institutionalising OH, while in other countries collaboration occurs as a result of individual advocates and where it is supported by donor funding. Bangladesh is the leading South Asian country with its One Health Strategic Framework signed by the three responsible Ministers in 2012 and is making steady progress implementing the strategy, with the establishment of an Inter-Ministerial Steering Committee for One Health and a One Health Secretariat in June 2016. The government of Bhutan is also making good progress towards a government-led Strategic Framework for One Health, with a strategic document signed by the relevant ministers and awaiting approval of the Cabinet of Ministers. While Nepal has not yet developed a national OH strategy, the establishment of district-level OH hubs serving as a single platform for issues associated with zoonotic disease control is a significant development. Some inter-sectoral collaboration occurs in Sri Lanka and Pakistan, and the collaborative networks, while largely dormant are activated and meet as and when required, but collaboration is not yet supported by a national government-led strategy. In India, the Public Health Foundation India leads initiatives and advocacy for an integrated OH approach to research and policy formulation for controlling zoonotic diseases. While national multisectoral committees have been established in India, these have not yet translated into effective collaborative research or policy formulation. In the absence of any governmental structure to support OH, collaboration in Afghanistan is still very ad hoc and largely dependent on donor-led advocacy and support. Substantial behavioural, attitudinal, and institutional changes are required to support effective OH research and training and the formulation and implementation of integrated zoonotic disease control policies. Significant progress has been made in some countries of South Asia in the 15 years since the early outbreaks of HPAI (H5N1). It is important that national and international agencies continue supporting this progress, in particular through integrated OH zoonotic disease research and education programmes that bring together professionals from different sectors over a sufficiently long period to build relationships, understanding, and respect for the roles and expertise of professionals in different sectors, generating a transdisciplinary conceptual framework to address common problems. One Health: the theory and practice of integrated health approaches Mapping of poverty and likely zoonoses hotspots Emerging and reemerging neglected tropical diseases: a review of key characteristics, risk factors, and the policy and innovation environment One Health: a perspective from the human health sector The neglected tropical diseases of India and South Asia: review of heir prevalence, distribution, and control or elimination The control of neglected zoonotic diseases. From advocacy to action The evolution of One Health: a decade of progress and challenges for the future Prospects for emerging infections in East and Southeast Asia 10 years after severe acute respiratory syndrome The neglected zoonoses Á the case for integrated control and advocacy Bringing together emerging and endemic zoonoses surveillance: shared challenges and a common solution Research options for controlling zoonotic disease in India Technical Report of the TDR Disease Reference Group on zoonoses and marginalized infectious diseases of poverty Research & policy disconnect: The case of rabies research in India The political economy of One Health research and policy. STEPS Working Paper 81 The business case for One Health Toward proof of concept of a one health approach to disease prediction and control One Health: the theory and practice of integrated health approaches Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education and policy: 3. Discipline, inter-discipline distance, and selection of discipline Building a foundation for 'One Health': an education strategy for enhancing and sustaining national and regional capacity in endemic and emerging zoonotic disease management Brucellosis and Coxiella burnetii infection in householders and their animals in secure villages in Herat province, Afghanistan: a cross-sectional study Crimean-Congo hemorrhagic fever Roosting behaviour and habitat selection of Pteropus giganteus reveal potential links to Nipah virus epidemiology Risk practices for animal and human anthrax in Bangladesh: an exploratory study Household animal and human medicine use and animal husbandry practices in rural Bangladesh: risk factors for emerging zoonotic disease and antibiotic resistance Pig illnesses and epidemics: a qualitative study on perceptions and practices of pig raisers in Bangladesh The application of One Health approaches to Henipavirus research A review of Brucella seroprevalence among humans and animals in Bangladesh with special emphasis on epidemiology, risk factors and control opportunities Innovating veterinary public health challenges of Bangladesh to integrate the concept of 'one world, one health' Improving human health through a One Health approach in Bangladesh Crimean-Congo hemorrhagic fever virus IgG in goats Investigation and control of anthrax outbreak at the humananimal interface Rabies control initiative in Tamil Nadu, India: a test case for the 'One Health' approach Exposure to cows is not associated with diarrhoea or impaired child growth in rural Odisha, India: a cohort study Protocol: a 'One health' two year follow-up, mixed methods study on antibiotic resistance, focusing children under 5 and their environment in rural India Seroprevalence of leptospirosis in man and animals in Tamilnadu Epidemiology and prevention of animal bite and human rabies in a rural community Á one health experiment Role of India's wildlife in the emergence and re-emergence of zoonotic pathogens, risk factors and public health implications One health national programme across species on zoonoses: a call to the developing world Rabies: beware of the dog Veterinary public health in India: current status and future needs Genesis of 'Veterinary Public Health' and route to 'One Health' One Health: a perspective from the human health sector Veterinary urban hygiene: a challenge for India One health approach: veterinary perspectives in global and Indian context Molecular characterization of Mycobacterium tuberculosis isolates from elephants of Nepal Status of tuberculosis in bovine animals raised by tuberculosis infected patients in Western Chitwan The burden of arasitic zoonoses in Nepal: a systematic review Epidemiology, impact and control of rabies in Nepal: a systematic review Emergence or improved detection of Japanese encephalitis virus in the Himalayan highlands? Seroprevalence of brucellosis in human, cattle, and buffalo populations in Pakistan Control of malaria in Pakistan by applying deltamethrin insecticide to cattle: a community-randomised trial Controlling malaria using livestock-based interventions: a One Health approach Morphological and molecular characterisation of Echinococcus granulosus in livestock and humans in Consensus report: preventive measures for Crimean-Congo hemorrhagic fever during Eid-al-Adha festival A One Health framework for the evaluation of rabies control programmes: a case study from Colombo City Twelve years of rabies surveillance in Sri Lanka Ticks infesting wild and domestic animals and humans of Sri Lanka with new host records Evaluation of a monoclonal antibodybased rapid immunochromatographic test for direct detection of rabies virus in the brain of humans and animals Analysis of hospital-based sentinel surveillance data on leptospirosis in Sri Lanka Prevalence and carrier status of leptospirosis in smallholder dairy cattle and peridomestic rodents in Kandy Carrier status of leptospirosis among cattle in Sri Lanka: a zoonotic threat to public health Zoonotic diseases: a guide to establishing collaboration between animal and human health sectors at the country level One Health Alliance of South Asia (OHASA): Predicting and preventing the next emerging disease on the Indian subcontinent Á sponsored by the Rockefeller Foundation Bird flu: diagnosis and treatment Avian influenza and program guidelines for its prevention and control in Pakistan. Undated We gratefully acknowledge all those who have provided information that has contributed to the OH landscape represented in this article. The authors have not received any funding or benefits from industry or elsewhere to conduct this study.