Rebranding Antibiotic Resistance As A Disaster Risk Problem – A Necessary Step Towards Integrated Health Risk Management
1The University of Sydney; 2University of Technology Sydney
To see the emergence of antibiotic resistance rebranded as a ‘disaster risk management’ problem. Antibiotic resistance presents as an increasingly global and multifaceted risk to human and animal life every bit as profound as other disaster risks such as climate change, natural disasters and global security. Antibiotic resistance is no longer a "business as usual problem". Rebranding the risk in this manner opens up new opportunities for engagement between management, community and diverse stakeholders allowing access to the skills and expertise of others such as disaster risk managers.
We use a mixed method approach including systematic literature reviews; questionnaire surveys and interviews to explore stakeholder (e.g., doctors, health care professionals, members of the public, farmers etc) understanding about the causes and consequences of antibiotic resistance and their role in facilitating or ameliorating the problem. From this empirical data, intervention strategies may be developed that reduce the unnecessary prescription of antibiotics.
(1) The issue is almost exclusively framed as a health and medical problem; (2) health practitioners have been the dominate focus of efforts to better control the use of antibiotics through antimicrobial stewardship programs; and (3) using psycho-social models of risk perception usually employed in natural disaster contexts provides useful alternatives for investigating stakeholder attitudes towards the problem of antibiotic resistance.
Given the current state of the antibiotic resistance problem and the likely near future of untreatable bacterial infections, including epidemics and pandemics, we propose an alternative and novel policy perspective. Governments and disaster policy makers across the world use the Emergency Risk Management process in the management of and preparation for natural disasters. This process is a systematic method that identifies, analyses, evaluates and treats risks and takes an iterative approach with well-defined activities that lead to implementation of risk-treatment strategies.
Comparison of Science-Based Frameworks for Risk-Informed Decision Support Across Life-Science and Engineering Disciplines
1Technical University of Denmark, Denmark; 2Technical University of Denmark, Denmark; 3Technical University of Denmark, Denmark
Most risk management strategies, regardless of the types of hazards considered, have been designed for individual hazards and risks as well as individual organizations responsible for managing them. In an increasingly inter-connected society, compartmentalizing the management of risk – and therefore also the underlying risk assessment - will result in major missed opportunities in relation to synergy in solutions as well as prioritization of risks. . Our study is in direct response to the challenge of building a holistic, cross-disciplinary risk assessment capability that can enable the synchronization of efforts of multiple stakeholders within one or multiple management frameworks.
We have conducted a study of six academic fields, which aim to provide risk-informed, evidence-based decision support with respect to risk and sustainability assessment: human and environmental health, civil engineering, transportation, management science and scientific computing. We describe major trends in the area of risk assessment and management and their drivers and discuss the implications for the above academic fields. We compare procedural risk frameworks and associated terminologies as well as scientific frameworks, together with underlying principles, methodologies and metrics. We highlight several theoretical principles as particularly suitable in the context of risk-informed decision making, which are applicable across academic domains: Bayesian decision analysis, Value of Information, Bayesian Probabilistic Nets, Multi-Criteria Decision Analysis, and a number of socio-economic models and indicators for risk acceptance criteria, including DALYs, HALYs and the Life Quality Index (LQI).
We propose a cross-disciplinary scientific effort , whose novel contribution is building a generic framework, which will enable a common development of metrics and models with respect to sustainability and risk assessment in a number of presently separately managed areas.
One Health Epidemic Risk Management in Kazakhstan with Open-Source EIDSS
1Committee on Consumer Rights Protection of the Ministry of National Economics of the Republic of Kazakhstan; 2Black & Veatch, United States of America; 3Kazakh Scientific Center of Quarantine and Zoonotic Diseases, Almaty, Kazakhstan
Epidemic risk management methodology development and approbation based on multivariate analysis per administrative areas of Kazakhstan using the Electronic Integrated Disease Surveillance System (EIDSS) capabilities.
Large territory and diverse natural climatic and landscape characteristics of Kazakhstan make epidemic risks assessment and prediction for the whole country challenging. In order to transition epidemic risks management to individual administrative areas the Committee for Consumer Rights Protection of Kazakhstan developed a concept for modernizing the existing national epidemiological surveillance system.
The sanitary-epidemiological and socio-economic current and retrospective data will be consolidated in a new tool for epidemic risk management called the Regional Sanitary-Epidemiological Passport (RSEP) for each of Kazakhstan’s districts, providing capabilities for short-term (2-3 years) and long-term (3-5 years) forecasting. RSEP will focus on plague, tularemia, anthrax, CCHF, brucellosis, cholera and other marker diseases. Since population sporadic morbidity hinders the ability to forecast, RSEP will include GIS maps of natural foci, their distribution and long-term observations epizootic activity.
The open-source EIDSS will serve as the main tool of the proposed methodology in addition to its functions of collecting, processing and analyzing data on 64 diseases in 269 organizations of the Committee as the national epidemiological e-surveillance system. In 2012-13 we tested the EIDSS capability to forecast the disease risk for the Kazakhstani population of contracting the Crimean-Congo hemorrhagic fever (CCHF). The forecast proved to be 81.3/88.9% accurate.
The epidemic risk management methodology was developed and approbated for CCHF. Next steps:
Methods development for the rest of marker diseases
Estimation methods adjustment (increasing of the number of factors, use of specific algorithms for individual nosologies) and calibration
Reach back data bank formation (15-20 years deep on 6 infections based on historical data)
Methodology introduction into neighbor countries for regional risk management.
Beyond Three Rings: An Enhanced One Health Model
World Organization for Animal Health, United States of America
One Health and One Medicine as concept models have traditionally been characterized by three intersecting rings of a Venn diagram representing Human, Animal, and Environment or Human, Domestic Animal and Wildlife. These intersections create a framework for addressing One Health issues such as emerging and zoonotic diseases at the human, animal, and environment interface, but fail to address broader concepts of One Health in a real world setting. An enhanced model of One Health would encompass the traditional three rings and also include the larger context in which the take place. The Enhanced One Health Model encompasses multiple lenses of One Health including: zoonosis, translational and comparative medicine, emerging diseases, human-animal bond, environmental focus, and sustainable agriculture. This Enhanced Model takes a holistic approach to One Health to include the political, social, cultural, economic, geographic, and religious aspects of One Health and the impacts they have on creating an effective and efficient One Health approach to global issues.
One Health Impacts on Clinical Decisions
University of Zürich, Switzerland
One health as a framework for human, animal and environmental health should provide a theoretical concept and standardised terms for transparent communication. System and chaos theory provide some grounding upon which a one health theory can build and have been applied in a variety of disciplines. Fundamentally, there is no clear delimitation of systems in regard to the flow of material, energy and information, and all systems need to be considered as open. It is up to the observer to define the limits of the system under observation. Furthermore, every system, including biological and socio-economical systems, is embedded in a hierarchy of systems which determines its function in space and time. For such complex adaptive systems, resilience is suggested as a useful proxy for health. Resilience is an emerging system property and is scale and time specific. This implies that short term resilience may paradoxically reduce a system’s long term resilience, but apparent instability today might build greater resilience for the future. Ideally, objectives of systems at different scales are synergistic, however, conflicts emerge when, for example, interests of an individual are opposing those of society. This emphasises what we already know: (1) human health has inextricable links to animal and ecosystem health and requires integrative thinking, (2) living organisms are complex adaptive systems characterized by hierarchies of interacting systems where small changes in any one element can alter the context of all other elements, (3) medical and public health decisions are made in complex environments including psychological, socio-economic, and biomedical parameters. Consequently, contradictions between curative medicine, population (herd) health management, public health and environmental policies are inevitable. Thus, for one health to be effective, it is imperative that clinical decisions include considerations across the whole scale of the hierarchy, and tools for weighing these interests must be developed.