Presentation on theme: "One Health: A Critical Pathway to Ensuring Global Food Safety"— Presentation transcript:
1 One Health: A Critical Pathway to Ensuring Global Food Safety Marguerite Pappaioanou, DVM, PhDCDC Liaison to FDA for Food SafetyThe findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Food and Drug Administration
2 Several Current Complex Health Problems Feeding 7 billion people (and growing numbers) with nutritious, accessible, affordable foodImpacts of climate changeFloods, droughtsChanges in reservoir hosts, vectors of diseaseNatural and human-made disastersUrbanization; Land Use and Agricultural Practice ChangesAccess to clean air and drinking waterNon-communicable diseasesPovertyBiodiversityRisk of emerging infectious diseases, pandemics
3 Why One Health?Health problems today are complex; caused by multiple drivers, factorsNo single discipline or sector can do it aloneOpportunities for prevention, mitigation along a continuum– multiple sectors and disciplines essential to solutions
4 One HealthIs the Collaborative Effort of Multiple Disciplines – working locally, nationally, and globally– to attain optimal health for people, animals, and our environment. AVMA-AMA One Health Task Force
5 Implementing One Health PoliciesImpacting on drivers, process, outcome, impact; resource allocation, communicationsMultisectoral /disciplinary health programsProviders/treatment/careDisease prevention, surveillance, response, control, treatmentMultisectoral/disciplinary ResearchMulti/Inter Professional Education
6 Why Implement One-Health ? Achieve improved health for humans, animals, and the environment– all interconnected-- more effectively and efficientlyMore efficient use of limited resourcesCost effectiveness of infrastructure to carry out preventionAchieve overall good for nation, region, world
7 Opportunities for One Health Emerging/ZoonoticDiseasesEmergencyResponseBio- Agro-TerrorismBiomedicalResearchFood SecurityFood SafetyDisabilityAntibioticResistanceMental HealthEnvironmentalHealthObesityPhysical ActivityInjuriesOccupationalHealthHealthEducation
8 Millenium Development Goals Goal 8: Develop a Global Partnership for DevelopmentSource:UNDP
9 Food SecurityExists “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life”.Includes both physical and economic access to food that meets people's dietary needs and food preferences.Three pillars:Food availability: sufficient quantities of food available consistently.Food access: having sufficient resources to obtain appropriate foods for a nutritious diet.Food use: appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation.
13 Imported Foods and Entry Lines to the US Imported food entry lines has doubled4.4 M in 20028.6 M in 2010As of 2011, ~ 15% of all food products consumed in the US were imported20% of fresh vegetables50% of fresh fruit80% of seafood
15 Food SafetyAssurance that food will not cause harm to the consumer when it is prepared and/or eaten according to its intended use (WHO).Causes of illness– contamination of food with bacteria, viruses, parasites toxins, metals, prionsSymptoms range from mild to severe and life threateningRange of food related activities with respect to foodborne illness -- from prevention and surveillance to detection and control
16 Ensuring Food Safety and Defense SurveillanceDetectionAssessing magnitude of the problemOutbreak investigationResponse/mitigationPreventionRegulatory SystemsCapacity Building
18 Estimates of Burden of Foodborne Illness (Morbidity, Mortality, Economic Costs 2011 Estimates) Canada (32.5 M people)1 in 8 Canadians (4 Million people) domestically acquired/yrCost ~ $12-14 B annuallyThe United States (300 M people)1 in 6 Americans (48 M people) with foodborne illness~ 128,000 hospitalized~3,000 people dieCost ~ $77.7 B (individual costs) annuallyGlobally (WHO) (7 B people)1/3 of global population (2 billion people)1.5 billion cases of diarrhea in children < 5 yrs/year,> 3 M premature deathsScallan, et al, EID 2011; Thomas et al, Foodborne pathogens and disease 2013
19 International Costs of Foodborne Illness Loss of trade (commodities– produce, livestock, etc.)Loss of foodLoss of tourismPublic Health Surveillance costsOutbreak investigationsClean-up
20 Global Food System – “Farm to Fork” Food production systems to feed growing human population at affordable cost (produce, nuts, meat, aquaculture, processed foods)Land, Water, Climate changeAnimal feed, fertilizers, pesticides, antibiotics?Markets – local, national, international, role of small holders, womenLivestock housing, animal welfare considerationsGenetics, genomics, seeds, animal and plant health, emerging food pathogensTransportation: To Processers, Distributers, Retailers, Food Stores, MarketingAgricultural investmentsEconomic crises, Rising Food Prices, Political turmoil and unrestSupply chain risks
22 How contamination of foods occurs Fields fertilized with untreated manure, watered with unclean waterAnimals fed contaminated feedMany bacteria– i.e., Salmonella spp., Campylobacter spp., Yersinia enterocolitica, E. coli STEC, can reside in healthy food animals showing no signs of illness.These animals can spread the bacteria to other healthy animals on the farm and during transportation to processing facilitiesDuring processing, the bacteria may cross-contaminate other foods being processed at the same location.Food is stored at too high a temperature and for too longMany different countries supply foods to other countries.Consumers should also be alert to the potential for cross-contamination in the home.
24 Challenges for Food Safety Authorities Increasing burden of foodborne illness and new emerging foodborne hazards (healthy animals)Rapidly changing technologies in food production, processing and marketingDeveloping science-based food control systems with a focus on consumer protectionInternational food trade and need for harmonization of food safety and quality standardsChanges in lifestyles, including rapid urbanizationGrowing consumer awareness of food safety and quality issues and increasing demand for better informationSource: Assuring Food Safety and Quality: Guidelines for strengthening national food control systems. FAO/WHO Publication
25 Food Safety Challenges of Developing Countries Differ by region-- differences in income level, diets, local conditions, and government infrastructures.Food producer and the consumer often have a close connection.Fewer processed and packaged foodsMost fresh food is traded in traditional markets; street vendors supply much of the food consumed outside the home.Perishable food often prepared and consumed immediatelyMinimal storage of prepared foods.
26 Food Safety Concerns - Developing Countries Inappropriate use of agricultural chemicalsUse of untreated or partially treated wastewaterUse of sewage or animal manure on cropsAbsence of food inspection, including meat inspectionLack of infrastructure, such as adequate refrigerationPoor hygiene, including a lack of clean water supplies
28 Food Safety Non-Regulatory Agencies (U.S.) HHS/Centers for Disease Control and PreventionFoodborne illness surveillance– PulseNet, FoodNET, FoodCORE, National Outbreak Reporting System (NORS), National Antimicrobial Resistance Monitoring System (NARMS), Foodborne Outbreak Online Database (FOOD)Epidemiologic outbreak investigations, special studies on attribution, outbreaksEHS-NET (food service establishments, NVEAIS)Integrated Food Safety Centers of ExcellenceUSDA/Animal and Plant Health Inspection Service, Veterinary ServicesOn the farm food animal disease surveillance, prevention, control
29 Food Safety-- Regulatory Agencies (U.S.) HHS/Food and Drug Administration (produce, dairy, eggs, seafood)Regulations, MFRPS, Food CodeCompliance and enforcementFacility / Food service inspections, investigationsTracebacks, trace-forwardsSampling and testing foodsEnvironmental assessmentsRoot cause analyses, industry relationsRegulatory scienceSubject matter experts, relationships with industryFood defenseRapid Response TeamsUSDA/Food Safety and Inspection Service (meat)
30 Tools to Stop Foodborne Outbreaks Trace back and trace forward– food vehiclesCommunications/sharing information/alerting consumersInspections, sampling, testingVoluntary RecallMandatory RecallFood DetentionSeizureAdministrative warning letterImport alertsInjunctionCriminal Prosecution
31 Preventing Foodborne Outbreaks Healthy animals and cropsSanitation, clean facilities, equipmentSafe agricultural/food production practices, safe food processingBest practices / Educating restaurant managers, food workers, grocers on food safety and sanitation measuresEducating consumers, proper food handling at home, hand washing, cookingPublic/private sector partnershipsEvidence-based, strong regulatory systemsCapacity Building
32 Farm-to-Table Prevention ProductionProcessingPreparation and CookingFarmers, Industry, Fishermen, University Extension, Engineers, Sanitarians, VeterinariansFood industry, Food Scientists, FSIS and FDA (SME, food inspectors, consumer safety officers, compliance officers), State agricultureGrocers, restaurant owners, food handlers/preparers, home cooks, preparers, FDA, City/County, State Government
33 Food Safety Legislation - US Federal Food, Drug, Cosmetic Act (1938)Food Safety Modernization Act (FSMA) (2011)Recognizes primary responsibility and capacity of food industry to make food safeWhat the food industry does every day– producers, distributors, suppliersHighlights need for gov’t collaboration with food industry in getting standards right and providing assurances that standards are metSpells out essential and complementary role of governmentGovernment, Industry Collaboration Key to Success
34 FDA’s International Food Safety Capacity Building Plan (FSMA- 305) Enhance efficiency across FDA/FVM ProgramIncrease effectiveness through evidence-based decision makingSupport exchange of information between FDA and foreign government agencies or other entitiesEnhance technical assistance and capacity building in food safety
35 International organization, organizations for food safety
37 International Organizations – Food Safety FAO, WHO, OIECodex AlimentariusWorld Trade OrganizationInternational Organization for Standardization (ISO)Alliance for Food Security and Nutrition (G8)Ministries of Health, Agriculture, CommerceAcademia/ Universities – Research, training, extensionParastatal organizations– NAS/IOM/NRC (US)Associations -- Not for profit and for profitPew Charitable Trust, Center for Science in the Public Interest, Institute for Food Technologists, International Association for Food ProtectionGlobal Food Safety InitiativeFood producers, processors, retail market
38 WHO Department of Food Safety and Zoonoses Provides evidence-based scientific options for policy development to protect consumer's health and managing food safetyDevelops mitigation strategies to prevent, control and contain risksSets international standards and promotes their implementationCoordinates international efforts to food-related outbreak surveillance, detection and responseEnsures clear risk communication in support of foodborne and zoonotic disease preventionProvides technical support to assist Member States building sustainable capacity.
39 WHO Global Foodborne Infections Network (GFN) Capacity-building programPromotes integrated, laboratory-based surveillancePromotes intersectoral collaboration among human health, veterinary and food-related disciplines184 Member States and territories; 1062 members
40 FAO Achieving food security for all Ensure regular access to high-quality food for active, healthy lives.Improve nutrition, increase agricultural productivity, raise the standard of living in rural populationsContribute to global economic growth.194 Member Nations, two associate members and one member organization, the European Union.Headquarters - Rome
41 Codex Alimentarius Commission Established by FAO and WHO in 1963Develops harmonized international food standards, guidelines and codes of practice to protect the health of the consumers and ensure fair practices in the food trade.Promotes coordination of all food standards work undertaken by international governmental and non-governmental organizations185 Member Countries and 1 Member Organization (EU)220 observers– 50 IGOs, 154 NGOs, 16 UNCommittees, Task Forces
42 CODEX Standards Codes of Practice (46) Guidelines (69) Maximum Residue Limits (MRLs)Standards (330)
43 OIE- World Organization for Animal Health Intergovernmental organization responsible for improving animal health worldwide (est. 1924).In total of 178 Member CountriesMaintains permanent relations with 45 other international & regional organizations; has Regional and sub-regional Offices on every continent.Reference organization of the WTOSanitary Phyto-Sanitary StandardsEstablishes standards (Terrestrial- ; Aquatic Animal Codes, Biological standards, etc.; veterinary services, competencies)Established permanent Working Group on Animal Production Food Safety (APFSWG)Membership includes internationally recognized experts from FAO, WHO, Codex Alimentarius Commission (CAC), reflects a broad geographical basis.
44 World Trade Organization Organization for trade openingForum for governments to negotiate trade agreementsOperates a system of trade rulesPlace for governments to settle trade disputes.Place where member governments try to sort out the trade problems they face with each other.Established 1995159 countriesWTO Agreements
45 Organization of International Foodborne/FoodSafety Surveillance
46 Looking to the FutureGlobalization -- Domestic IS Global; export and import of foods will only increaseFood Security, Food Safety, Food DefenseAntibiotic Resistance, Food producing animal – welfareImpacts of Climate ChangePublic-private sector collaborationNeed for Strong Regulatory Systems – all countriesCapacity Building – Applied epidemiology, laboratory methods (whole genome sequencing, culture independent methods), regulatory science/systemsOne Health!
47 Multi-Disciplinary Teams– Disciplines, Sectors Food ScientistsEnvironmental Health Specialists/EngineersPublic health nursesPhysiciansMicrobiologists, ToxicologistsEpidemiologistsVeterinariansConsumer Safety OfficersFood and Drug Investigators/inspectorsBiostatistitiansPublic Health EducatorsInformation/communication officersLegal/lawyersHealth sector;National reference laboratories;Agriculture, fisheries;Food/feed safety sectors;Local authorities;Sectors that liaise with industry, trade and academiaOther agencies
48 One Health Core Competencies Building on technical skills and knowledge of individual disciplines, sectorsSystems analysis/thinking (understanding bigger picture, determinants of illness/disease/health, how multiple sectors are involved)Strong leadership and management skillsUnderstanding self-limitations and need for experts from different fieldsTeams and teamwork- Understanding roles and responsibilitiesCommunication for collaborationConflict resolutionValues and ethicsCreating an enabling environment and advocating change
49 One Health Education for a One Health Workforce POLICIES that Create Enabling Environments and ResourcesRESEARCH AND EVALUATIONPractice/performanceWhat is Practicedin anySettingParticipantsMethodsTimingSettingsEducationWhat is LearnedandTaughtParticipantsMethodsTimingSettingsPreventionClinical-- clinical counseling; cross disciplinary educationPopulation based, disease transmission -- policies that reduce interactions between people, livestock, dogs, wildlife and human exposureEarly diagnosis, detectionClinical – early and accurate diagnosisPublic and animal health -- zoonotic diseases in wildlife, livestock, pets, peoplePeople who have close contact with animalsHealth care workersCommunitiesCorrect treatmentEffective disease and injury control measuresCost-effective use of limited resourcesPreventionEarly detection/DXEarly effective response/mitigationStop/control transmissionEffective treatment, careEfficient use of limited resourcesBetter Health and Well-BeingAdapted from D’Amour D. & Oandasan I J Interprofessional Care Suppl. 1:8-20.And further enhancements by Tufts University and DAI, Inc. of the USAID/Respond Project
50 Thank you Questions? Comments? Thank you very much, and I would be happy to entertain questions.The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention
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