Asian Development Bank Manilla July 12

A vision of an ASEAN at the forefront of anticipation, containment and control of

zoonoses and emerging infectious diseases

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Disclaimer: The views expressed in this paper/presentation do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

PRESENTATION

« One Health » paradigm to confront EID in SEA Institut Pasteur International Network at the forefront of EID Institut Pasteur in Cambodia : missions and flagship projects to APSED Presentation of CNRS activities CNRS in SEA: networking on biodiversity and ecosystems towards EID Vision of CNRS-IPC on « One Health » approach to APSED

Creation of a regional platform for research on communicable infectious diseases and emerging pathogens in Southeast Asia

Conclusion/discussion

Intermediate hosts/Reservoirs/

Vectors

A multitude of major factors of

emergence

Environment

Susceptibility: Genetics,

Immune status Behavior

Cultural performances

Virulence Recombinaison

Mutations Drug resistance

More than half of emerging epidemics are caused by pathogens

which originated in animals

« One Health » Paradigm

Southeast Asia

Southeast Asia: a region endemic for emerging pathogens

A multitude of major factors of emergence

• Poverty: Regions with low incomes • Increasing human population • Frequent contacts with domestic

and wild animals • Migrating population • Tourism

• Important pig and poultry production • Bats and rodents reservoirs of diseases • Numerous hematophagous insects infected • Illegal animal trade

• Deforestation • Climatic disasters • New intensive agriculture (manioc, hevea…)

IPIN: A global Network with 32 Institutes worldwide

In countries with high Incidence and endemic infectious diseases

The IPIN (Asia-Pacific) & focus on the Mekong Region

4 Mekong countries

What we have in common Scientific culture

Pathogens

Populations

Environment

What differs Cambodia : French + national

Vietnam, Laos: national PHL

China: national academies

Various levels of development

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• Participate to the national and regional surveillance activities for a better prevention, outbreak management and response under IHR

• Strive for innovative and competitive research projects that are adapted to local needs in an international context

• Contribute to sustainable local and regional capacity and capability building, and partnerships to control emergence and spread of emerging infectious diseases under APSED requirements

Missions of IPIN in SEA

Public Health Research Training

The Institut Pasteur in Cambodia

The Institut Pasteur in Cambodia is a for-not- profit private foundation of public utility .

The missions of IPC are excellence in research for public health application and training

By its history (60 years in Cambodia) and its missions, it has a vital role to play in the fight against infectious diseases and emerging pathogens as well as in the support to public health in Cambodia and in Southeast Asia.

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• 171 staff:

- 150 Cambodians

- 9 French Expats

- 12 students/fellows

• 3 NRC

• 4 Research Units

• Technical platforms

• BSL-3/ASL-3

Flagship projects in IPC (major collaborations)

• Seasonal and Avian Flu (WHO/FAO/NaVRI/DHHS/CIRAD)

• Dengue and other arboviroses (EU/IPIN)

• Impact of the Environment on EID (AFD/CNRS/IPIN)

• Infectious Encephalitis (IRD/CIRAD/INSERM/IPIN)

• Zoonoses and Pathogen Discovery (WCS/CNRS/CIRAD)

• Malaria drug resistance (WHO/GF/NIH/NAMRU2/ITMA/IPIN…)

• Tuberculosis and HIV (ANRS)

• Rabies (IPIN)

• Antimicrobial Drug Resistance (WHO, FAO) 9

(In close partnership with MoH and WHO; Large participation of hospitals and communities)

Network building on emerging diseases

Main sponsors

CNRS, brief institutional presentation of activities in ASIA

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● I CNRS operates under the French Ministry of Education and Research

● I The largest fundamental research organization in Europe, CNRS directs over 1100 research teams , regrouped in 10 domains :

I mathematics I computer sciences I physics I nuclear and particle physics I chemistry I ecology and the environment I biology I earth sciences and astronomy I systems & engineering sciences I human and social sciences

● I Almost 34,000 people including 11,400 researchers and 14,200 engineers, technicians and administrative staff

● I 90% of CNRS research is performed within joint research units, partnerships with universities, or international research institutes or companies

● I 25,500 publications each year in high-caliber international magazines

● I Founded in 1939, CNRS hosted 18 Nobel and 11 Fields Medal laureates

CNRS, an essential contributor of scientific research

CNRS institutional activities

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Beij

ing

8 joint research units (UMI) in ASIA ( 30 worldwide ) 4 representative offices in Asia ( 11 worldwide )

New Delhi China

Mongolia

Japan

India

Taiwan

Korea

Indonesia

Malaysia

Nepal Pakistan

Myanmar

Bangladesh Vietnam

Laos

Thailand

Cambodia

Brunei

Singapore

Philippines

JAPAN : 3 UMI :

Tokyo

UMI LIMMS Laboratory of

Integrated Micro-Mechatromic

Systems, Tokyo-U

UMI JFLI Jp-Fce Laboratory in Informatics Paris6., Keio-U., Tokyo-U., NII.

UMI JRL Japanese Robotics

Laboratory,

UMI E2P2L : Eco-Efficient

Products & Processes Laboratory

RHODIA

CHINA : 1 UMI :

INDIA : 1 UMI :

UMI IFCAM : Indo French

Center for Applied Mathematics

DST

SINGAPORE : 2 UMI :

UMI IPAL : Image & Pervasive

Access Laboratory

I2R (A*STAR), NUS

UMI CINTRA : CNRS

International THALES NTU

Research Alliance

Hanoi

UMI MICA : Multimedia

Information Communication and

Applications Gr-INP, H.U.S.T.

VIETNAM : 1 UMI :

AIST

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33 LIA ( virtual labs )

LIA CPN Center for Photonics

and Nanostructures

KOREA: 2 LIA :

LIA FK-PPL France Korea

Particle Physics Laboratory

TAIWAN : 1 GDRI

LIA ADEPT : Active deformation

& environt’l hazard assessment

VIETNAM : 6 LIA

LIA VIIC Petrochemical research

LIA PhytoChemistry

LIA FV-PPL

LIA CSA-CSAE

LIA ForMATH

LIA Corrosion

INDIA : 5 LIA

LIA Immunology n Genetics

LIA Nuclear Sciences

LIA IF Formal Methods Lab.

LIA CATalysis for

Sustainable … chemistry

LIA Solid State Chemistry

JAPAN : 6 LIA

LIA ElytLAB

LIA CASSH

LIA ReaDiLab

LIA FJPPL

LIA FJ-NSP

LIA FJ-MFL

LIA ORIGINS

CHINA : 11 LIA

LIA BioMNSL

LIA FC-PPL

LIA 2MCIS

LIA LAS2M

LIA LFCC

LIA LSE

LIA FOM

LIA XiamENS NanoBioChem

LIA PMC

LIA LMTM

SINGAPORE : 2 LIA

LIA FSQL : Quantun physics LIA CAFS : MechanoBiology

INSHS

INP

INC

INSIS

IN2P3

INS2I

INEE

INSMI

INSU

INSB

Southeast Asia

Environmental diversity Biological diversity Cultural diversity Historical diversity Socio-economic diversity

Southeast Asia: a region of high diversity

Southeast Asia: a hotspot of biodiversity at threat with an increasing number of ID outbreaks’ events

(Wilcove et al., 2013)

(Morand et al., 2013)

(Schipper et al., 2008)

Threatened mammals

Higher number of zoonotic outbreaks is linked with increasing biodiversity at threat

Higher number of vector-borne disease outbreaks is linked with low forest cover

Southeast Asia: ID outbreaks are related to biodiversity loss

(Morand et al., 2013)

2008

1999

1988

7 HR Land covers developed Rodents & RoBo acquired

7 HR Land covers in development Rodents & RoBo acquired

6 HR Land covers to develop Rodents & RoBo acquired in early 2014

Temporal change

Spatial change

Remote Sensing and Geographic Information Systems : reconstructing land use changes to infer risks

Administrative boundaries

Conceptual maps

Land covers

Epidemiological maps

Landscape genetics

Towards mapping of ecosystem services

Representing landscapes as a tool for community-based management and planning

Capacity building and research expert network in biodiversity and ecosystem services

• French teams

– CNRS-IRD-ISEM PathoDivSEA (AFD-CNRS)

– CIRAD-AGIRs GREASE-CIRAD (network)

– INRA-CBGP PathoID-INRA (metaprogram)

– IRD-BIOMECO PPR SELTA-IRD (network)

– IRD-CIRAD-InterTryp Platform BioZoonoSEA

– Institut Pasteur Cambodia One Health (FP7-EU)

• SE Asian teams

– Mahidol University, Dpt Medecine, TropMed, Bangkok

– Kasesart University, Dpt Veterinary, Bangkok

– Thammasat University, Dpt Anthropology, Bangkok

– Chulalongkorn University, Dpt Biology Bangkok

– AFRIMS (US Army), Bangkok

– Maha Sarakham University

– NAFRI, Agricuture & Forestry, Vientiane

– National Institute of Health, Vientiane

– Centre Christophe Mérieux, Vientiane

– University of Health Sciences, Phnom Penh

– IP Cambodia

– OUCRU, Ho Chi Minh City

– Veterinary University, Ipoh, Malaysia

– National University of Singapore

Network building

Vision of CNRS-IPC on Ecohealth approach

The One Health paradigm aims to strengthen human and animal health by acting at the Animal-Human-Ecosystems interface

Building capacity by implementing an Ecohealth approach:

1) To understand the patterns/processes of emerging diseases (from syndrome, transmission to ecology) and the interactions between environment and human health

2) To take into account the cultural/traditional/scientific knowledge in order to develop a scientifically and acceptable Ecosystem Services for Diseases Regulation

3) To develop risk maps and map scenarios based on Geographic Information Systems as a tool for science/decision interface (surveillance, land planning, etc.)

See more at www.ceropath.org

Rodents and rodent-borne diseases : - Biodiversity changes - Rodent-borne diseases - Agricultural pests - Local perception: hunting, health, environment

Project CERoPath 2008-2012 - Tools (barcoding), database, maps - Trainings - Research network in SE Asia Project BiodivHealthSEA 2012-2015

www.biodivhealthsea.org

Interdisciplinary research & stakeholder involvement - hospitals, departments Agriculture, Health, Livestock

Vision of CNRS-IPC on « One Health » approach

Mobilize and coordinate forces present in ASEAN to :

– develop our knowledge, particularly in the anticipation, early detection, containment and control of zoonoses, and in emerging diseases;

– understand the causes and the mechanisms behind emergences, resistance to antimicrobials, and the crossing of the inter-species barrier;

– analyze the consequences of the emergences on the ecological, social, political and economic outcomes.

New viruses identified in rats in SEA causing SARI in humans (IPC-CNRS)

Creation of a regional platform for research on communicable infectious diseases and emerging

pathogens in Southeast Asia

PROJECT OF INFRASTRUCTURE IMPLEMENTED IN

INSTITUT PASTEUR IN CAMBODIA

PR-ASIA

11 March 2013

Completed: end 2013

• To develop a competitive technical platform for the surveillance of emerging infectious diseases in Cambodia and in the SEA region

• To develop an integrated approach of new problematics in human and animal health within the « One Health » paradigm

• To increase the competitivity, efficacy, and innovation by fostering a multidisciplinary research (microbiology, clinic, ecology, environment, socio-economic, epidemiology) with external partners, and by offering an attracting scientific environment

• To develop the training capacity in all domains of infectious diseases

Missions of the PR-ASIA

• Laboratoires (including a BSL-2) for molecular biology, cell biology, immunology, microbiology for more than 40 researchers and technicians

• A biobank equiped with freezers and liquid nitrogen

Laboratory modules connected to IPC facilities

• Offices for researches in silico, modelization, anthropology, social and environmental sciences, data analysis

• Additional rooms in IPC (epidemiology Unit, Virology, Immunology)

420 m2, evolutionary

• Access to platforms of IPC (BSL-3, Animal facility, insectarium…)

A regional initiative on a major public health issue

SOUTHEAST ASIA ENCEPHALITIS PROJECT

A multidisciplinary and inter-organizational project

Encephalitis in Asia:

• Among the most frequent and severe causes of pediatric hospitalization

• Significant biodiversity hotspot particularly at risk for pathogen emergence (high interaction between humans and animals)

29 • SouthEast Asia encephalitis project BAD, July 2013

First pilot sites: Subsequently expanded to:

• Cambodia • Thailand • Laos • Indonesia • Vietnam • Other sites (China, Myanmar…)

Main and specific objectives

Improve clinical/microbiological diagnosis and medical care of children suffering from acute encephalitis syndrome

Identify unknown pathogens responsible for encephalitis cases

Document and analyze risk factors related to clusters of encephalitis cases through the “One Health” approach (human, animal and environment health)

Promote increased preparedness for emerging diseases by providing information to clinicians and public health stakeholders

The SEAe project aims to reduce

the morbidity and mortality associated to

infectious encephalitis in Southeast Asia

by improving diagnosis and medical care

for children

SOUTHEAST ASIA ENCEPHALITIS PROJECT

30 • SouthEast Asia encephalitis project BAD, July 2013

Conclusion/Discussion

Structure a cross-sectoral and multidisciplinary academic and applied research on zoonoses and EID to foster a regional strategic framework to build sustainable local and regional capacities and expertise to ensure public health security through surveillance, risk assessment, early detection and rapid response in SEA

Networking with local health, agriculture and environment authorities and international organizations in a coordinated fashion

Collaborate with clinical, institutional and academic partners

Offer a scientific and technological platform for hosting and connecting researchers and developing innovative, competitive and expert task force in the region

Complement existing networks on surveillance of, and response to EID (Focal IHR, WHOCC, GOARN etc.)