Health Security

Diseases caused by pathogens that affect animals, humans, and their shared environment (zoonoses) impact regional and global health security. Context-specific recommendations could help control animal-to-human pathogen spillover and mitigate the risk of epidemics and pandemics. Our objective is to share the codevelopment of a guidebook to counter zoonotic spillover in Southeast Asia and how participatory approaches and implementation science guided One Health actor groups towards a common goal. The project was a collaboration between the International Network for Governmental Science Advice Asia and the US National Academies of Sciences, Engineering, and Medicine. Experts in disciplines including virology, bioinformatics, wildlife conservation, biodefense, epidemiology, participatory research, and implementation science codeveloped behavior change and policy recommendations. Participatory exercises, including silent reflections, role-playing, and the “systems-thinking iceberg” enabled dynamic discussions that helped incorporate diverse perspectives. The team identified ways to overcome linguistic and discipline-specific language barriers, time differences, limitations to voluntary participation, and technological challenges. The frameworks and concepts that guided the team were the Consolidated Framework for Implementation Research, the principle that participatory approaches enable positive social learning, and the concept that interventions can be adapted to the local context but should not be reinvented. Participatory approaches can support One Health actor groups work toward a collective vision, which catalyzes a process that can improve local ownership, ultimately working to strengthen health security.

Risk assessments for emerging infectious disease threats are often conducted independently of affected communities. Participatory approaches to risk assessment present an opportunity to integrate community knowledge early in the risk-based decisionmaking process. We conducted a scoping review to understand the breadth of evidence from human, animal, and environmental health disciplines for integrating community participation in steps of the risk assessment process. A systematic literature search in PubMed, Scopus, Ei Compendex, Embase, Web of Science, and Global Health Database identified 4993 articles, of which 138 met inclusion criteria for the review. The types of participatory approaches described in the risk assessment literature varied by degree of community involvement, types of communities engaged, and activities implemented to engage communities. There was substantial evidence from environmental contamination and climate change studies on conducting hazard and exposure assessments within a community-based participatory research model. However, examples of community participation in problem formulation, capacity assessments, data report-back, and pathway mapping were limited. Additionally, the limited examples of community-initiated and community-driven risk assessments suggest a need for improving community involvement from the earliest stages of research priority setting through all phases of data collection, analysis, and interpretation. Further research is also needed on adapting participatory approaches for emerging infectious disease risk assessments.

When outbreaks of emerging and reemerging zoonotic diseases are discussed, little attention is paid to differential gender impacts, or to gender involvement and roles in different settings during the outbreak. Gender roles shape how individuals’ interactions with animals, wildlife, other people and the environment, which influences exposure to zoonotic pathogens. For example, in some rural communities, men may face risks of exposure to emerging pathogens during hunting whilst women who primarily take care of domestic animals may face prolonged exposure to other zoonotic diseases. In some settings, women (and men) lack access to health protection, education or communication with health officials (medical doctors or veterinarians). In some cultures, women are not allowed to speak directly with male service providers, further limiting their access to critical information and services. One Health is a holistic, inclusive approach which should be incorporating a gender lens when considering zoonoses. This includes thinking about the need to create appropriate gender sensitive policies that address disparities in surveillance, response, prevention, detection, and control of the disease (or health issue) being addressed. In this paper, we highlight these issues through several case studies that demonstrate the importance of including gender in zoonotic disease response and, ideally, when implementing prevention measures.