1. One Health: A Critical Pathway to Ensuring Global Food Safety
Marguerite Pappaioanou, DVM, PhD
CDC Liaison to FDA for Food Safety
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 or the Food and Drug Administration

2. Several Current Complex Health Problems
Feeding 7 billion people (and growing numbers) with nutritious, accessible, affordable food
Impacts of climate change
Floods, droughts
Changes in reservoir hosts, vectors of disease
Natural and human-made disasters
Urbanization; Land Use and Agricultural Practice Changes
Access to clean air and drinking water
Non-communicable diseases
Poverty
Biodiversity
Risk of emerging infectious diseases, pandemics

3. Why One Health?
Health problems today are complex; caused by multiple drivers, factors
No single discipline or sector can do it alone
Opportunities for prevention, mitigation along a continuum– multiple sectors and disciplines essential to solutions

4. One Health
Is 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
Policies
Impacting on drivers, process, outcome, impact; resource allocation, communications
Multisectoral /disciplinary health programs
Providers/treatment/care
Disease prevention, surveillance, response, control, treatment
Multisectoral/disciplinary Research
Multi/Inter Professional Education

6. Why Implement One-Health ?
Achieve improved health for humans, animals, and the environment– all interconnected-- more effectively and efficiently
More efficient use of limited resources
Cost effectiveness of infrastructure to carry out prevention
Achieve overall good for nation, region, world

7. Opportunities for One Health
Emerging/
Zoonotic
Diseases
Emergency
Response
Bio- Agro-
Terrorism
Biomedical
Research
Food Security
Food Safety
Disability
Antibiotic
Resistance
Mental Health
Environmental
Health
Obesity
Physical Activity
Injuries
Occupational
Health
Health
Education

8. Millenium Development Goals
Goal 8: Develop a Global Partnership for Development
Source:
UNDP

9. Food Security
Exists “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.

10. Food Security

11. Globalization of the Food Supply
Global Poultry Exports
Air Routes

13. Imported Foods and Entry Lines to the US
Imported food entry lines has doubled
4.4 M in 2002
8.6 M in 2010
As of 2011, ~ 15% of all food products consumed in the US were imported
20% of fresh vegetables
50% of fresh fruit
80% of seafood

14. Food Supply and Globalization

15. Food Safety
Assurance 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, prions
Symptoms range from mild to severe and life threatening
Range of food related activities with respect to foodborne illness -- from prevention and surveillance to detection and control

16. Ensuring Food Safety and Defense
Surveillance
Detection
Assessing magnitude of the problem
Outbreak investigation
Response/mitigation
Prevention
Regulatory Systems
Capacity 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/yr
Cost ~ $12-14 B annually
The United States (300 M people)
1 in 6 Americans (48 M people) with foodborne illness
~ 128,000 hospitalized
~3,000 people die
Cost ~ $77.7 B (individual costs) annually
Globally (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 deaths
Scallan, 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 food
Loss of tourism
Public Health Surveillance costs
Outbreak investigations
Clean-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 change
Animal feed, fertilizers, pesticides, antibiotics?
Markets – local, national, international, role of small holders, women
Livestock housing, animal welfare considerations
Genetics, genomics, seeds, animal and plant health, emerging food pathogens
Transportation: To Processers, Distributers, Retailers, Food Stores, Marketing
Agricultural investments
Economic crises, Rising Food Prices, Political turmoil and unrest
Supply chain risks

22. How contamination of foods occurs
Fields fertilized with untreated manure, watered with unclean water
Animals fed contaminated feed
Many 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 facilities
During 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 long
Many 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 marketing
Developing science-based food control systems with a focus on consumer protection
International food trade and need for harmonization of food safety and quality standards
Changes in lifestyles, including rapid urbanization
Growing consumer awareness of food safety and quality issues and increasing demand for better information
Source: 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 foods
Most fresh food is traded in traditional markets; street vendors supply much of the food consumed outside the home.
Perishable food often prepared and consumed immediately
Minimal storage of prepared foods.

26. Food Safety Concerns - Developing Countries
Inappropriate use of agricultural chemicals
Use of untreated or partially treated wastewater
Use of sewage or animal manure on crops
Absence of food inspection, including meat inspection
Lack of infrastructure, such as adequate refrigeration
Poor hygiene, including a lack of clean water supplies

27. Roles and Responsibilities-- Surveillance, Outbreak Investigation, Mitigation/Response, Regulatory Systems, Prevention

28. Food Safety Non-Regulatory Agencies (U.S.)
HHS/Centers for Disease Control and Prevention
Foodborne 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, outbreaks
EHS-NET (food service establishments, NVEAIS)
Integrated Food Safety Centers of Excellence
USDA/Animal and Plant Health Inspection Service, Veterinary Services
On 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 Code
Compliance and enforcement
Facility / Food service inspections, investigations
Tracebacks, trace-forwards
Sampling and testing foods
Environmental assessments
Root cause analyses, industry relations
Regulatory science
Subject matter experts, relationships with industry
Food defense
Rapid Response Teams
USDA/Food Safety and Inspection Service (meat)

30. Tools to Stop Foodborne Outbreaks
Trace back and trace forward– food vehicles
Communications/sharing information/alerting consumers
Inspections, sampling, testing
Voluntary Recall
Mandatory Recall
Food Detention
Seizure
Administrative warning letter
Import alerts
Injunction
Criminal Prosecution

31. Preventing Foodborne Outbreaks
Healthy animals and crops
Sanitation, clean facilities, equipment
Safe agricultural/food production practices, safe food processing
Best practices / Educating restaurant managers, food workers, grocers on food safety and sanitation measures
Educating consumers, proper food handling at home, hand washing, cooking
Public/private sector partnerships
Evidence-based, strong regulatory systems
Capacity Building

32. Farm-to-Table Prevention
Production
Processing
Preparation and Cooking
Farmers, Industry, Fishermen, University Extension, Engineers, Sanitarians, Veterinarians
Food industry, Food Scientists, FSIS and FDA (SME, food inspectors, consumer safety officers, compliance officers), State agriculture
Grocers, 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 safe
What the food industry does every day– producers, distributors, suppliers
Highlights need for gov’t collaboration with food industry in getting standards right and providing assurances that standards are met
Spells out essential and complementary role of government
Government, Industry Collaboration Key to Success

34. FDA’s International Food Safety Capacity Building Plan (FSMA- 305)
Enhance efficiency across FDA/FVM Program
Increase effectiveness through evidence-based decision making
Support exchange of information between FDA and foreign government agencies or other entities
Enhance technical assistance and capacity building in food safety

35. International organization, organizations for food safety

37. International Organizations – Food Safety
FAO, WHO, OIE
Codex Alimentarius
World Trade Organization
International Organization for Standardization (ISO)
Alliance for Food Security and Nutrition (G8)
Ministries of Health, Agriculture, Commerce
Academia/ Universities – Research, training, extension
Parastatal organizations– NAS/IOM/NRC (US)
Associations -- Not for profit and for profit
Pew Charitable Trust, Center for Science in the Public Interest, Institute for Food Technologists, International Association for Food Protection
Global Food Safety Initiative
Food 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 safety
Develops mitigation strategies to prevent, control and contain risks
Sets international standards and promotes their implementation
Coordinates international efforts to food-related outbreak surveillance, detection and response
Ensures clear risk communication in support of foodborne and zoonotic disease prevention
Provides technical support to assist Member States building sustainable capacity.

39. WHO Global Foodborne Infections Network (GFN)
Capacity-building program
Promotes integrated, laboratory-based surveillance
Promotes intersectoral collaboration among human health, veterinary and food-related disciplines
184 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 populations
Contribute 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 1963
Develops 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 organizations
185 Member Countries and 1 Member Organization (EU)
220 observers– 50 IGOs, 154 NGOs, 16 UN
Committees, 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 Countries
Maintains permanent relations with 45 other international & regional organizations; has Regional and sub-regional Offices on every continent.
Reference organization of the WTO
Sanitary Phyto-Sanitary Standards
Establishes 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 opening
Forum for governments to negotiate trade agreements
Operates a system of trade rules
Place for governments to settle trade disputes.
Place where member governments try to sort out the trade problems they face with each other.
Established 1995
159 countries
WTO Agreements

45. Organization of International Foodborne/FoodSafety Surveillance

46. Looking to the Future
Globalization -- Domestic IS Global; export and import of foods will only increase
Food Security, Food Safety, Food Defense
Antibiotic Resistance, Food producing animal – welfare
Impacts of Climate Change
Public-private sector collaboration
Need for Strong Regulatory Systems – all countries
Capacity Building – Applied epidemiology, laboratory methods (whole genome sequencing, culture independent methods), regulatory science/systems
One Health!

47. Multi-Disciplinary Teams– Disciplines, Sectors
Food Scientists
Environmental Health Specialists/Engineers
Public health nurses
Physicians
Microbiologists, Toxicologists
Epidemiologists
Veterinarians
Consumer Safety Officers
Food and Drug Investigators/inspectors
Biostatistitians
Public Health Educators
Information/communication officers
Legal/lawyers
Health sector;
National reference laboratories;
Agriculture, fisheries;
Food/feed safety sectors;
Local authorities;
Sectors that liaise with industry, trade and academia
Other agencies

48. One Health Core Competencies
Building on technical skills and knowledge of individual disciplines, sectors
Systems analysis/thinking (understanding bigger picture, determinants of illness/disease/health, how multiple sectors are involved)
Strong leadership and management skills
Understanding self-limitations and need for experts from different fields
Teams and teamwork- Understanding roles and responsibilities
Communication for collaboration
Conflict resolution
Values and ethics
Creating an enabling environment and advocating change

49. One Health Education for a One Health Workforce
POLICIES that Create Enabling Environments and Resources
RESEARCH AND EVALUATION
Practice/performance
What is Practiced
in any
Setting
Participants
Methods
Timing
Settings
Education
What is Learned
and
Taught
Participants
Methods
Timing
Settings
Prevention
Clinical-- clinical counseling; cross disciplinary education
Population based, disease transmission -- policies that reduce interactions between people, livestock, dogs, wildlife and human exposure
Early diagnosis, detection
Clinical – early and accurate diagnosis
Public and animal health -- zoonotic diseases in wildlife, livestock, pets, people
People who have close contact with animals
Health care workers
Communities
Correct treatment
Effective disease and injury control measures
Cost-effective use of limited resources
Prevention
Early detection/DX
Early effective response/mitigation
Stop/control transmission
Effective treatment, care
Efficient use of limited resources
Better Health and Well-Being
Adapted 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