December 8, 2024 • 13 mins
In this episode of "Going Macro on Micro," host Dr. Julie Ann Lough explores the future of One Health with experts Dr. Elaine Cloutman-Green and Dr. Simon Doherty. The discussion focuses on the challenges of pandemic preparedness and the need to address global health inequities. The episode highlights the key lessons from the COVID-19 pandemic, underscoring the importance of preparedness, building resilience, and recognizing global health security as a shared responsibility.
2024-13527
Going Macro on Micro podcast (2024-13459) is sponsored by Beckman Coulter. 2024 Beckman Coulter, Inc. All rights reserved. Beckman Coulter, the stylized logo, and the Beckman Coulter product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the United States and other countries. For Beckman Coulter’s worldwide office locations and phone numbers, please visit www.beckmancoulter.com/contact or email: MicroScanEU@beckman.com
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hello, and welcome to Going Macro on Micro, the podcast where we explore emerging themes in microbiology brought to you by Beckman Coulter.
I am your host, Dr. Julie Ann Lough, a science communicator passionate about sharing stories, exploring the future of health and science.
(00:22):
This is the fifth episode in our series exploring One Health, an integrated approach that recognises the health of people, animals and ecosystems are all interconnected.
When we think about the challenges facing our health, from pandemics to antibiotic resistance, it's clear that no one exists in a vacuum.
We are all in this together.
(00:44):
In the last episode, we spoke about the benefits of storytelling in bringing stakeholders on the One Health journey with us.
For this episode, we will explore some of the challenges globally, including into the future and the considerations the world should make to be prepared for the next pandemic.
We continue our chat with our experts in human and animal health.
(01:06):
On the human side, we have Dr. Elaine Cloutman Green.
She is a consultant clinical scientist specialising in infection prevention and control, as well as the lead healthcare scientist at Great Ormond Street Hospital in London.
And on the animal side, we continue to have Dr. Simon Doherty, an associate fellow at Queen's University Belfast, and recently named the World Veterinary Association's World Vet of the Year.
(01:28):
Both of them are passionate about infection control and the principles of One Health.
Let's look into the future now to emerging threats.
Look, there is a growing concern that there's going to be a widespread treatment resistant bug or a new pandemic coming over the hill.
So what innovative tools and technologies or policies do you foresee as transforming infection control and One Health practises in the coming years, Elaine?
(01:52):
So I think we need to have a strategic national response.
And I feel like that was one of the things that had kind of been stepped down a little.
I think people got quite comfortable before the pandemic.
I think in the build up to swine flu, there were lots of protocols.
We'd had lots of meetings nationally.
And then because swine flu didn't go as badly as people thought it could, everyone was like, oh, well, you know, anything in the future will just be the same.
(02:20):
And of course, it wasn't the same.
And we have to really invest in that capacity building, all the stuff that Simon said, all of these things are challenges, because if you invest in them at the right level, a lot of the time, you won't be using them.
And so they look like a waste.
However, if you don't have them when you need them, it's a disaster.
(02:43):
And so you have to be able to design a system that can step up and step down.
And we have lost in infection control, at least so many people that had vast years worth of knowledge, because they've retired or sadly, actually being on the front line, you know, some of us didn't make it.
(03:04):
And that means that we have a whole new bunch of people coming through without that organisational kind of legacy of knowledge being passed through.
And we really have to find a way to correct that, because these things will always come from their field, we will never be as prepared for them as we'd like to be, but we need to have the surveillance programmes.
(03:26):
I'm involved in a programme in West Africa, where we're about to start mass dosing of azithromycin in order to try to reduce infant mortality, but that means we're giving out a lot more antibiotics.
That's great.
Like we're hoping to save 140,000 lives.
And that needs to happen.
But at the same point, you have to have the surveillance programme in place to make sure that you're not then creating a different challenge that is going to impact those people down the line.
(03:53):
And so we have to be having these brave conversations and saying, it costs money, it costs resource.
But if you want to be in a better position when this happens again, and it will happen again, it's not like this is a one off.
I think this is my fifth pandemic in my professional career, but some of them don't hit the media in the same kind of way.
(04:15):
But we have to actually be investing and having all of those surveillance programmes and that capacity and knowledge built in so that we can step it up, because otherwise, that's when you lose people.
And that's when things get out of control before you have time to step in.
And sadly, every time you manage it, and you stop it becoming a massive thing, people then use that as an excuse to then that you don't need the resource.
(04:39):
But if you didn't have the resource, you wouldn't have stopped it when you stopped it.
And so making people realise that I think is so key.
I have this great policy in life, you're better looking at it than looking for it, which is that future thinking and being prepared.
You mentioned that you're going off to Africa to deliver azithromycin.
And I guess that brings me on to something that we really saw during the COVID pandemic, and that was global health inequality and inequity in terms of access to vaccines and to treatments.
(05:10):
As we get new technologies, then how can we ensure that they're fairly distributed across the globe and not further exacerbate the disparities between the resource rich and the resource limited countries?
I think we have to stop using countries in Africa, countries that don't have the resource as our own little private testing labs.
(05:31):
Frankly, like they aren't there just so that we can run a clinical trial, take the data and go back and implement it in kind of developed Western healthcare.
That is not fair.
And we can't be doing it.
I'm going to say this, and this may be contentious, but I think it's a really colonial way of looking at healthcare and medicine.
And we have to be working with people and populations to address their healthcare needs, not just using it as a way of moving forward our healthcare needs.
(06:01):
So a lot of the stuff that we're trying to do in Mali right now and in places like West Africa is the research, the funding is owned within country by country.
So I'm there to give my expert advice, if I'm an expert in anything to have those conversations.
(06:22):
But my job is to create learning and teaching resources so that they train people within country, develop labs within country to be able to do these surveillance schemes and the isolates and the samples are staying in country.
We may get a sub aliquot out for us to do other things if we need them in the future, but they're there for that country as a resource for that country.
(06:47):
And I think that's the way that things need to change.
And we have to be looking at what we're bringing to the table and what we're taking away at the end.
So the Ebola outbreak was a really great example.
Yes, we went in and set up a whole bunch of labs and, you know, we did a whole load of healthcare and it was really, really great, except we left machines that could not be maintained.
(07:13):
We walked away, we did not leave any consumables that could be used on those machines.
There was no legacy for all of that work.
And so actually, did we really make the long term difference that we could have if we'd had conversations with people about what would work long term in order to leave that legacy of improved healthcare?
(07:35):
We didn't.
And I feel like that's a massive missed opportunity that if we're going to be going and doing these things, we actually have to just not be looking right in front of us.
We have to be looking at what that means for that health economy moving forward.
And I suppose, Simon, global disparity, you know, an animal gets sick up in the Western world and that animal might be insured or we saw with foot and mouth disease, the government would maybe give payouts to people.
(08:02):
Obviously, that doesn't exist in countries with limited resources.
So it's all well and good saying, oh, well, don't be giving your animals antibiotics, but those people need those animals to survive.
So how kind of going forward with this idea of One Health approach, can we ensure better equity?
Yeah.
And look it's really important that we get the One Health elements of sustainable development absolutely right.
(08:22):
Whether we're looking at contingency planning for, you know, episodic diseases that are going to transmit across the globe, like foot and mouth disease, you know, we have to get that contingency planning right from the start.
There's no point in funding contingency planning for the two years, three years after an outbreak of foot and mouth disease, which is what happened, you know, with the outbreak in 2001.
(08:46):
You could get unending funding available for, you know, for a few years, then Blue Tongue arrived and it was all about Blue Tongue, then it was Schmallenberg.
We have to be aware of climate change.
I think that's going to be certainly part of it.
We're now seeing transmission of a number of viruses of livestock, which we wouldn't have seen before because of vector competence.
(09:10):
So that's one element of it.
But in terms of that global parity piece, I mean, Elaine's absolutely right.
You know, any kind of technology, whether it's for human health or animal health, whether it is actually patient side or in the laboratory, needs to be appropriate and it needs to be serviceable.
OK, so, you know, there's no point in us trying to mechanise agriculture in sub-Saharan Africa if you haven't got a supply of parts for John Deere tractors, or you haven't got fuel available and you haven't got machinery and you haven't got mechanics.
(09:44):
There's no point.
OK, so anything that you do needs to be transferable and sustainable from that perspective and appropriate for the environment.
And I think, again, that comes back to one health.
It's about understanding the people, the plants, the animals in that particular environment that is going to be really critical.
(10:04):
However, there are things that have a global knock on.
So, you know, we're looking at things like vaccine and drug formulations, and this is where things like Bill and Melinda Gates Foundation and some of their spinoffs like GalvMed.
So GalvMed is an organisation funded largely by Bill and Melinda Gates Foundation, which is looking at novel vaccine designs for livestock.
(10:27):
And one of the things that we can do in that area is not only create more effective vaccines, but look at things like removal of cold chain. So if you can design a vaccine that remains stable at ambient temperatures and doesn't need to be kept refrigerated, then you're much more likely to be able to get doses of that into rural areas in sub-Saharan Africa or other developing countries.
(10:53):
OK, and that is a big game changer.
That's where we're really going to start, you know, getting on top.
There needs to be a level of coordination.
So there is some responsibility, and we are now seeing much greater working across what's called the quadripartite, so the World Health Organisation, the World Organisation of Animal Health, the Food and Agriculture Organisation of the United Nations and the UN Environment Programme.
(11:20):
We're seeing much better working across the quadripartite now, and they are taking one health approach is really, really seriously.
And that's where we're going to see the impact.
It's when you get that joined up working and that sort of parity where you're making some of these new technologies available.
In fairness, you know, there was a lot of work put in during COVID trying to make sure that we were getting doses of COVID vaccine to the areas to almost create that firebreak effect and get ahead of it.
(11:50):
But as always, it was once we'd looked after ourselves to a certain extent as well.
So there's more work to be done.
But preparedness will improve resilience a long way.
And isn't that a lesson for us all, I suppose?
Preparedness improves resilience.
And we need to make sure that we are prepared for the future, but hope that it's never needed.
(12:14):
We have to acknowledge that we have lost expertise over the pandemic, and we need to build up that resilience again.
But it's not just about us.
This is a global problem.
And the Global South should not just be a testing ground for the Global North.
We need to ensure equity globally in terms of surveillance and preparedness, as no one is safe until we are all safe.
(12:37):
In the next and final episode of this series, we are going to talk about the key elements of a robust One Health and Infection Control Framework to have in place.
Elaine and Simon, thank you so much again for joining me.
Going Macro and Micro is a podcast series supported by Beckman Coulter, exploring emerging themes in microbiology.
Subscribe to the podcast wherever you listen to stay up to date with each new episode as it's released.
(13:03):
You can also join our online professional community by searching Beckman Coulter Microbiology on LinkedIn.
There you'll find discussions on a variety of interesting microbiology topics.
Until next time, when we go Macro and Micro, goodbye.
Hello, and welcome to Going Macro on Micro, the podcast where we explore emerging themes in microbiology brought to you by Beckman Coulter.
I am your host, Dr. Julie Ann Lough, a science communicator passionate about sharing stories, exploring the future of health and science.
(00:22):
This is the fifth episode in our series exploring One Health, an integrated approach that recognises the health of people, animals and ecosystems are all interconnected.
When we think about the challenges facing our health, from pandemics to antibiotic resistance, it's clear that no one exists in a vacuum.
We are all in this together.
(00:44):
In the last episode, we spoke about the benefits of storytelling in bringing stakeholders on the One Health journey with us.
For this episode, we will explore some of the challenges globally, including into the future and the considerations the world should make to be prepared for the next pandemic.
We continue our chat with our experts in human and animal health.
(01:06):
On the human side, we have Dr. Elaine Cloutman Green.
She is a consultant clinical scientist specialising in infection prevention and control, as well as the lead healthcare scientist at Great Ormond Street Hospital in London.
And on the animal side, we continue to have Dr. Simon Doherty, an associate fellow at Queen's University Belfast, and recently named the World Veterinary Association's World Vet of the Year.
(01:28):
Both of them are passionate about infection control and the principles of One Health.
Let's look into the future now to emerging threats.
Look, there is a growing concern that there's going to be a widespread treatment resistant bug or a new pandemic coming over the hill.
So what innovative tools and technologies or policies do you foresee as transforming infection control and One Health practises in the coming years, Elaine?
(01:52):
So I think we need to have a strategic national response.
And I feel like that was one of the things that had kind of been stepped down a little.
I think people got quite comfortable before the pandemic.
I think in the build up to swine flu, there were lots of protocols.
We'd had lots of meetings nationally.
And then because swine flu didn't go as badly as people thought it could, everyone was like, oh, well, you know, anything in the future will just be the same.
(02:20):
And of course, it wasn't the same.
And we have to really invest in that capacity building, all the stuff that Simon said, all of these things are challenges, because if you invest in them at the right level, a lot of the time, you won't be using them.
And so they look like a waste.
However, if you don't have them when you need them, it's a disaster.
(02:43):
And so you have to be able to design a system that can step up and step down.
And we have lost in infection control, at least so many people that had vast years worth of knowledge, because they've retired or sadly, actually being on the front line, you know, some of us didn't make it.
(03:04):
And that means that we have a whole new bunch of people coming through without that organisational kind of legacy of knowledge being passed through.
And we really have to find a way to correct that, because these things will always come from their field, we will never be as prepared for them as we'd like to be, but we need to have the surveillance programmes.
(03:26):
I'm involved in a programme in West Africa, where we're about to start mass dosing of azithromycin in order to try to reduce infant mortality, but that means we're giving out a lot more antibiotics.
That's great.
Like we're hoping to save 140,000 lives.
And that needs to happen.
But at the same point, you have to have the surveillance programme in place to make sure that you're not then creating a different challenge that is going to impact those people down the line.
(03:53):
And so we have to be having these brave conversations and saying, it costs money, it costs resource.
But if you want to be in a better position when this happens again, and it will happen again, it's not like this is a one off.
I think this is my fifth pandemic in my professional career, but some of them don't hit the media in the same kind of way.
(04:15):
But we have to actually be investing and having all of those surveillance programmes and that capacity and knowledge built in so that we can step it up, because otherwise, that's when you lose people.
And that's when things get out of control before you have time to step in.
And sadly, every time you manage it, and you stop it becoming a massive thing, people then use that as an excuse to then that you don't need the resource.
(04:39):
But if you didn't have the resource, you wouldn't have stopped it when you stopped it.
And so making people realise that I think is so key.
I have this great policy in life, you're better looking at it than looking for it, which is that future thinking and being prepared.
You mentioned that you're going off to Africa to deliver azithromycin.
And I guess that brings me on to something that we really saw during the COVID pandemic, and that was global health inequality and inequity in terms of access to vaccines and to treatments.
(05:10):
As we get new technologies, then how can we ensure that they're fairly distributed across the globe and not further exacerbate the disparities between the resource rich and the resource limited countries?
I think we have to stop using countries in Africa, countries that don't have the resource as our own little private testing labs.
(05:31):
Frankly, like they aren't there just so that we can run a clinical trial, take the data and go back and implement it in kind of developed Western healthcare.
That is not fair.
And we can't be doing it.
I'm going to say this, and this may be contentious, but I think it's a really colonial way of looking at healthcare and medicine.
And we have to be working with people and populations to address their healthcare needs, not just using it as a way of moving forward our healthcare needs.
(06:01):
So a lot of the stuff that we're trying to do in Mali right now and in places like West Africa is the research, the funding is owned within country by country.
So I'm there to give my expert advice, if I'm an expert in anything to have those conversations.
(06:22):
But my job is to create learning and teaching resources so that they train people within country, develop labs within country to be able to do these surveillance schemes and the isolates and the samples are staying in country.
We may get a sub aliquot out for us to do other things if we need them in the future, but they're there for that country as a resource for that country.
(06:47):
And I think that's the way that things need to change.
And we have to be looking at what we're bringing to the table and what we're taking away at the end.
So the Ebola outbreak was a really great example.
Yes, we went in and set up a whole bunch of labs and, you know, we did a whole load of healthcare and it was really, really great, except we left machines that could not be maintained.
(07:13):
We walked away, we did not leave any consumables that could be used on those machines.
There was no legacy for all of that work.
And so actually, did we really make the long term difference that we could have if we'd had conversations with people about what would work long term in order to leave that legacy of improved healthcare?
(07:35):
We didn't.
And I feel like that's a massive missed opportunity that if we're going to be going and doing these things, we actually have to just not be looking right in front of us.
We have to be looking at what that means for that health economy moving forward.
And I suppose, Simon, global disparity, you know, an animal gets sick up in the Western world and that animal might be insured or we saw with foot and mouth disease, the government would maybe give payouts to people.
(08:02):
Obviously, that doesn't exist in countries with limited resources.
So it's all well and good saying, oh, well, don't be giving your animals antibiotics, but those people need those animals to survive.
So how kind of going forward with this idea of One Health approach, can we ensure better equity?
Yeah.
And look it's really important that we get the One Health elements of sustainable development absolutely right.
(08:22):
Whether we're looking at contingency planning for, you know, episodic diseases that are going to transmit across the globe, like foot and mouth disease, you know, we have to get that contingency planning right from the start.
There's no point in funding contingency planning for the two years, three years after an outbreak of foot and mouth disease, which is what happened, you know, with the outbreak in 2001.
(08:46):
You could get unending funding available for, you know, for a few years, then Blue Tongue arrived and it was all about Blue Tongue, then it was Schmallenberg.
We have to be aware of climate change.
I think that's going to be certainly part of it.
We're now seeing transmission of a number of viruses of livestock, which we wouldn't have seen before because of vector competence.
(09:10):
So that's one element of it.
But in terms of that global parity piece, I mean, Elaine's absolutely right.
You know, any kind of technology, whether it's for human health or animal health, whether it is actually patient side or in the laboratory, needs to be appropriate and it needs to be serviceable.
OK, so, you know, there's no point in us trying to mechanise agriculture in sub-Saharan Africa if you haven't got a supply of parts for John Deere tractors, or you haven't got fuel available and you haven't got machinery and you haven't got mechanics.
(09:44):
There's no point.
OK, so anything that you do needs to be transferable and sustainable from that perspective and appropriate for the environment.
And I think, again, that comes back to one health.
It's about understanding the people, the plants, the animals in that particular environment that is going to be really critical.
(10:04):
However, there are things that have a global knock on.
So, you know, we're looking at things like vaccine and drug formulations, and this is where things like Bill and Melinda Gates Foundation and some of their spinoffs like GalvMed.
So GalvMed is an organisation funded largely by Bill and Melinda Gates Foundation, which is looking at novel vaccine designs for livestock.
(10:27):
And one of the things that we can do in that area is not only create more effective vaccines, but look at things like removal of cold chain. So if you can design a vaccine that remains stable at ambient temperatures and doesn't need to be kept refrigerated, then you're much more likely to be able to get doses of that into rural areas in sub-Saharan Africa or other developing countries.
(10:53):
OK, and that is a big game changer.
That's where we're really going to start, you know, getting on top.
There needs to be a level of coordination.
So there is some responsibility, and we are now seeing much greater working across what's called the quadripartite, so the World Health Organisation, the World Organisation of Animal Health, the Food and Agriculture Organisation of the United Nations and the UN Environment Programme.
(11:20):
We're seeing much better working across the quadripartite now, and they are taking one health approach is really, really seriously.
And that's where we're going to see the impact.
It's when you get that joined up working and that sort of parity where you're making some of these new technologies available.
In fairness, you know, there was a lot of work put in during COVID trying to make sure that we were getting doses of COVID vaccine to the areas to almost create that firebreak effect and get ahead of it.
(11:50):
But as always, it was once we'd looked after ourselves to a certain extent as well.
So there's more work to be done.
But preparedness will improve resilience a long way.
And isn't that a lesson for us all, I suppose?
Preparedness improves resilience.
And we need to make sure that we are prepared for the future, but hope that it's never needed.
(12:14):
We have to acknowledge that we have lost expertise over the pandemic, and we need to build up that resilience again.
But it's not just about us.
This is a global problem.
And the Global South should not just be a testing ground for the Global North.
We need to ensure equity globally in terms of surveillance and preparedness, as no one is safe until we are all safe.
(12:37):
In the next and final episode of this series, we are going to talk about the key elements of a robust One Health and Infection Control Framework to have in place.
Elaine and Simon, thank you so much again for joining me.
Going Macro and Micro is a podcast series supported by Beckman Coulter, exploring emerging themes in microbiology.
Subscribe to the podcast wherever you listen to stay up to date with each new episode as it's released.
(13:03):
You can also join our online professional community by searching Beckman Coulter Microbiology on LinkedIn.
There you'll find discussions on a variety of interesting microbiology topics.
Until next time, when we go Macro and Micro, goodbye.
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