The Next Threat: Listen to All the Data
The current public health crisis has taught us that the United States is not immune to dangerous pathogens and viruses. Gone are the days when travel from Asia to the U.S. took weeks, giving diseases time to run their course. As we are keenly aware, a disease outbreak occurring across the globe yesterday has the potential of affecting the U.S. today. In previous articles we have discussed the need to get ahead of disease threats, especially considering the white paper written by Dr. Oyewale Tomori where he states that “the greatest enemy of disaster response is time.” Since time is a commodity that you never have enough of, especially during a crisis, we need mechanisms in place to rapidly make informed public health decisions. We must also recognize that public health is closely connected to the health of animals and our shared environment. This concept is not new and is referred to as a “One Health” approach. While the U.S. is rightfully focused on the human aspect of the current public health crisis, we must not ignore contributing factors such as animal and environmental health. We must also recognize that health security requires a whole-of-government approach with leaders making evidence-based decisions with readily accessible One Health data that is properly integrated.
One Health takes into consideration the effects that the environment, animals and humans have on each other. It is a multidisciplinary approach to public health that encourages the collaboration of professionals in human health (medical doctors, epidemiologists), animal health (veterinarians) and the environment (ecologists, wildlife experts). The strongest example that highlights the importance of this approach is the current COVID-19 pandemic. There are many views on how SARs-CoV-2 made the jump from animals to humans. But the prevailing theories note that humans came into contact with the virus either in the animal’s natural environment, through animals migrating to human areas because of deforestation, and/or humans bringing bats or other species into live markets.
Closer to home, we see a slightly different environmental effect with ticks and Lyme disease, which is the most common vector-borne zoonosis in the United States. Due to warming weather, ticks that have traditionally thrived in forests in the Northeast are emerging from winter hibernation earlier and are spreading farther south and west. Similarly, the warmer weather has helped mosquitoes carrying the Zika virus spread into the U.S., causing a crisis in 2016. In addition to COVID-19, the One Health approach can illuminate these other significant public health concerns.
While One Health brings together the overall public health community, it is important to include law enforcement professionals into the approach to adequately account for overall health security. While many of these zoonotic diseases are natural threats, we must also recognize that several bioterrorism agents, such as anthrax for example, are zoonotic in origin. Because of this, integrating law enforcement with veterinary and human public health surveillance efforts is essential. Likewise, terrorist organizations could attempt to target the U.S. food supply. Diseases such as the African Swine Fever, while not dangerous to humans, would severely impact the U.S. economy, much like it did in China. Considering what we have seen in the U.S. with chaos caused merely by news of potential food shortages, one can reasonably assume that an actual food shortage in a sector as big as the pork industry would have significant ramifications. Much like the public health sector, law enforcement needs readily available One Health data, such as suspected disease outbreaks in other countries, so that it can make timely decisions to get ahead of any threats.
An example of using One Health data to get ahead of disease outbreaks occurred in 2006 when observation of satellite data accurately predicted the outbreak of Rift Valley fever in East Africa. Rift Valley fever is a viral disease that can affect both humans and animals and is initially spread through mosquitoes, although exposure to the blood of an infected animal can also make a person sick. A correlation was discovered between the El Nino weather system, the prevalence of mosquitos, and outbreaks of the disease. This allowed for early warning (2–4 months), giving governments and communities time to prepare for the disease and limit the spread. Getting this data, however, was not a simple task and required the close collaboration of multiple organizations to include U.S. Department of Agriculture (USDA), that received satellite data from the National Aeronautics and Space Administration (NASA), and the Centers for Disease Control and Prevention (CDC), that provided access to epidemiological data.
The CDC and USDA both have disease reporting and monitoring systems in place for their respective sectors, namely human health and animal health. However, even though there are organizations that look at both animal and health issues globally, the data remains mostly siloed and not properly integrated for a variety of reasons. This includes the professional segregation of human health and animal health care providers, and a national lack of emphasis on prevention as funding is largely focused on disease emergencies. Similarly, the U.S. Geological Survey (USGS) leads the U.S. in examining environmental health through mapping and conservation science. And while USGS offers near real-time data on current conditions and earth observations, the information could be better integrated with human and animal health surveillance data. Inquiries can be made but predictive analysis is limited as the emphasis is on response. What is required is a mechanism that incorporates this disparate data to increase overall health security.
There are numerous organizations both domestic and international that are attempting to utilize data better to get ahead of public health threats. Unfortunately, and as mentioned previously, most of these are focused on response and mapping current outbreaks. As an example, the Global Outbreak Alert and Response Network (GOARN) is a World Health Organization partnership designed to provide technical support to countries experiencing a human health emergency. It has also encouraged partner nations to utilize data information systems such as ArcGIS to enhance response capacity. While this is useful for after an outbreak, this still does not allow the ability to predict and get ahead of the threat.
What the U.S. needs is a mechanism to aggregate the One Health information from different data sources to enhance predictive, evidence-based decision making. As discussed above, this tool should be available to a wide cohort of public health and law enforcement agencies. The challenge we face to realize this approach to overall Health Security generally falls into three categories: namely data availability, data interoperability and mission-driven alerts and warnings. Although all the data exists, we need to have it readily available, accessible, and searchable for decision makers. The datasets that do exist are not built with each other in mind and blending them together to be interoperable will take resources in both time and funding. Finally, we must continue to holistically study the drivers of health security problems so that we can correctly build the logic for systems to trigger alerts and warnings. Only through the proper integration of data that allows for the rapid visualization of information can leaders make informed decisions that provide overall health security and truly allow us to get ahead of public health threats.
