Presentation by Hung Nguyen-Viet, Sinh Dang-Xuan and Rortana Chea at a seminar on 'Food Safety and Antimicrobial Resistance: One Health Perspectives', Battambang, Cambodia, 12 August 2019.

1. Photo Credit Goes Here
Hung Nguyen-Viet , Sinh Dang, Rortana Chea
International Livestock Research Institute (ILRI), HUPH (Vietnam), and NAHPRI (Cambodia)
UBB, August 12, 2019 – Battambang, Cambodia
ONE HEALTH AND FOOD SAFETY
RESEARCH IN DEVELOPING COUNTRIES

2. OUTLINE
• One Health and Ecohealth approach
• Food safety in developing countries
and approach
• Capacity building and policy
translation
• Conclusions

3. CGIAR Research Centers
CGIAR research is carried out by the 15 Centers, members of the
CGIAR Consortium, in close collaboration with hundreds of
partners, including national and regional research institutes, civil
society organizations, academia, development organizations and
the private sector.
REDUCED
POVERTY
IMPROVED FOOD AND
NUTRITION SECURITY FOR
HEALTH
IMPROVED NATURAL
RESOURCE SYSTEMS AND
ECOSYSTEM SERVICES
EQUITY, CAPACITY
AND ENABLING
ENVIRONMENT

4. Improved food and
nutrition security for
health
Improved natural
resource systems and
ecosystem services
Reduced poverty
International Livestock Research Institute
(www.ilri.org)
ILRI’s mission is
to improve food and nutritional security
and to reduce poverty in developing countries through
research for
efficient, safe and sustainable
use of livestock —
ensuring better lives through livestock.

5. • Food & nutrition
security
• Poverty
eradication
• Environment &
human health
Policies,
institutions and
livelihoods
Sustainable
livestock
systems
Feed and
forage
resources
development Livestock
genetics
Animal &
human
health
Impact at scale BecA-ILRI hub
ILRI programs

6. HLPE 2017 Food Systems and Nutrition Report
Food systems for diets and nutrition

7. One Health and Ecohealth

8. Challenges in Asia
• Population and economic growth,
environmental issues, intensive agriculture
and livestock, food security, nutrition,
politics…
• Complex health issues (EID, AMR, NCD…)
need innovative, integrated approaches.
• Strengthening the capacity of professionals
working in the human, animal and
environmental health sectors to respond to,
control and prevent outbreaks of EID is vital.
• Need to widen scope: Looking beyond
HPAI, “Systems” approach vs. focus on
specific diseases, animal health / human
health

9. Ecohealth

10. Introduction to Ecohealth
EcoHealth: a comprehensive concept to look at health as an
integrative component of the complex relation of human,
animal and environment in socio-ecological contexts
• Systems thinking
• Transdisciplinarity
• Participation
• Sustainability
• Gender & social equity
• Knowledge to action
Six Ecohealth
Principles

11. What is One Health?
Veterinary
medicine
Environmental
science
Human
medicine
• Understanding the linkages
• Adding value
• More knowledge
• Better health (human or animal)
• Economical benefits

12. One Health Research -
show added value
• Added value in
terms of better
health and well-
being for humans
and animals,
financial savings and
improved
environmental
services
•  incremental value
Example: OH added value
Cost effective zoonosese control
Proposed cost-sharing scheme
Zinsstag et al., 2009, PNAS
http://www.onehealthinitiative.com/publications/OHOW_Compendium_Case_Studies.pdf
Veterinarians without Borders Canada, 2010
0
5'000
10'000
15'000
20'000
25'000
30'000
35'000
40'000
45'000
50'000
1 2 3 4 5 6
Time in years
Cumulatednetpresentcostor
rabies(US$)
Cumulative net present
costs without rabies dog vaccination
Cumulative et present costs
with PET and dog vaccination

14. • INDOHUN
• THOHUN
• VOHUN
• MYOHUN
EcoEID
Emerging Pandemic Threats Program
PREDICT • RESPOND • PREVENT • IDENTIFY
EHRCs
GHI
One Health and Ecohealth
programs in SEA

15. Food Safety in LMICs

16. Food safety is integral to the SDGs
Traditional Image of Food Safety
• Food safety is integral to:
• Food safety (practice) contributes to:
Food Safety critical to ACHIEVING the SDGs

17. 17Havelaar et al., 2015
• 31 hazards
• Worldwide
• 5 years period, various experts
WHO – Global estimates of food borne
diseases burden
• Helminthes
• Microbes
• Toxins
• Aflatoxins
?¿: Most important among these 4?

18. FBD- a new priority – most probably from ASF
Millions DALYs lost per year (global)
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
18,000,000
20,000,000
Asia Africa Other
developing
Developed
Other toxins
Aflatoxins
Helminths
Microbial
Havelaar et al., 2015
31 hazards
• 600 mio illnesses
• 420,000 deaths
• 33 million DALYszoonoses
non zoonoses
Burden LMIC

19. Foods implicated in FBD
Painter et al., 2013, Sudershan et al., 2014, Mangan et al., 2014; Tam et al., 2014;
Sang et al., 2014 ; ILRI, 2016

20. GLOBAL ESTIMATES OF FBD
BURDEN
(IN DALY’S)
Hazard
group
Foodborne
illnesses
(millions)
Foodborne
deaths
(thousands)
Foodborne
DALYs
(millions)
All 600 420 33
Diarrheal 549 230 18
Invasive 36 117 8
Helminths 13 45 6
Chemicals 0.2 19 0.9
Havelaar et al., 2018

21. GLOBAL BURDEN OF FBD BURDEN,
REGIONAL DIFFERENCES
Africa America
Eastern
Mediterranean Europe
Southeast
Asia
Western
Pacific
Havelaar et al., 2018

22. FBD burden is a significant (and growing)
public health problem in emerging Asia
China Indonesia Laos Malaysia Myanmar Philippines Thailand Vietnam
Tuberculosis
(2016)
148 1514 1820 146 1716 1063 299 414
HIV/AIDS
(2016)
67 900 337 1080 904 25 1205 440
Malaria
(2016)
1 50 36 1 31 3 3 1
Food-borne
disease
(2010)
272 693 933 293 711 293 685 390
WHO Statistics
Comparative Public Health Burden:
Disability Adjusted Life Years Lost Per 100,000
Jaffee, 2018, World Bank

23. Domestic costs may be 20 times
trade costs
Cost estimates for 2016 (US$ billion)
Productivity loss 95
Illness treatment 15
Trade loss or cost 5 to 7
‘Productivity Loss’ =
Foodborne Disease DALYs x Per Capita GNI
Based on WHO/FERG & WDI Indicators Database
Illness treatment =
US$27 x # of Estimated foodborne illnesses
Trade loss or costs =
2% of developing country high value food exports
Download here

24. FERG key results
• Demonstrated that almost 1 in 10 people fall ill every
year from eating contaminated
• Children less than 5 years of age represent only 9% of
the global population but 43% of disease burden was
subjected to this group.
• Highest burden observed for Africa (East and Central
Sub-Saharan Region) followed by South East Asian
region
• Cosiderable regional difference on specific FBD burden
• FBD are of a similar burden in order of magnitude as
the “big three” infectious diseases

25. FERG limitations
Due to its limitations the provided estimates are
expected to be conservative which may result in
underestimates rather than overestimates
– E.g. In USA alone each year, 1 in 6 Americans get sick
from eating contaminated food (CDC, 2016)
– Vietnam, 1 reported FBD versus 100 unreported
– Underestimates for Europe for Salmonella
• Germany, approx. factor 7 for Salmonella
• Europe, average approximately factor 42
• Poland, approx. factor 62

26. MORE INFORMATION
• WHO website
http://www.who.int/foodsafety/areas_work/foodborne-
diseases/ferg/en/
• PLOS collection
http://collections.plos.org/ferg2015
• Interactive tool
https://extranet.who.int/sree/Reports?op=vs&path=/WHO_H
Q_Reports/G36/PROD/EXT/FoodborneDiseaseBurden
Havelaar et al., 2018

27. Research approach: what do we do to
understand and improve food safety?
• Situational analyses of food safety
• Capacity building on risk-based approaches
• Proof of concept: participatory risk assessment
• Pilot testing interventions

28. 1. Actionable evidence on FBD burden associated with animal
source foods (ASF)
2. Pilot incentive-based approach to improving food safety
among ASF traders
3. Cambodian-led Theory of Change for improving food safety
4. Gender and equity research
5. Building capacity in food safety risk assessment, management,
communication
Safe Food Fair Food for Cambodia
Project objectives

29. 1. Risk profiling
1. Scoping visits
2. Systematic literature
review
3. Risk profiles
4. Training in risk ranking
5. Stakeholder prioritisation
2. Generate
evidence on FBD
Five Urban Survey
Study
QMRA
Markets
Cost of
Illness
Household
Nutrition
3. Develop & test solutions for wet
markets
RCT intervention
Taskforce
Gender TOC
NutritionImpact
QMRA
Markets
Cost of
Illness

30. Multi-pathogen survey in Cambodian
traditional market
• Pork and poultry
• Salmonella &
Staphylococcus aureus
• Traditional markets in 25
provinces of Cambodia
• Urban focus: Phnom
Penh municipal and Siem
Reap province

31. Pork
Animal sourced food Chicken
In traditional
Market

32. PREMILINARY RESULTS
• All samples of the first round was collected for the multi-
pathogen survey in Cambodian markets in 25 provinces. In
total 416 samples (pork = 156, pork cutting board=52)
chicken (chicken meat = 156, cutting board = 52) were
collected. 312 shop owners were interviewed during the
sampling.
• In total of 184 samples positive to Salmonella (36%) and
133 to S. aureus (32%).
• Isolates are being kept for further analysis on antimicrobial
resistance.

33. Cost of Illness in Phnom Penh and Siem Reap
• 200 cases of
foodborne diseases
• Direct and indirect
cost
• Siem Reap: completed
data collection
• 100 more cases in
health centers in
Phnom Penh: ongoing

34. Capacity building and policy translation

36. Taskforce of Risk assessment for
food safety in Vietnam
• Linking research to policy
• Taskforce: composed by
experts from universities,
research institutes, policy
makers from the ministries
(health, agriculture)
• Risk analysis capacity
development for researchers
and policy makers
• Taskforce now
institutionalized and
sustainable

37. Capacity building impact: curriculum
development & trainings
• Guidelines on FS risk assessment:
more accessible and understandable
in use in 17 universities, 7 cities
• Curriculum developed to teach 200
students per year: majority of future
food safety human resources
• Trainings for veterinary and public
health staff at ministry level
• Hand-on training on risk assessment
for researchers, students

38. Policy impact: translational research for
interventions in modernizing food
system
• CGIAR/ILRI niche - risk assessment
and policy / regulatory analysis for
fresh foods in domestic markets
• World Bank convenes overall
support to government: ILRI led
technical works
• Upcoming projects based on WB
report we led will improve food
safety for 20 million people in
major cities of Vietnam

39. • Stakeholder consultation
• Risk assessment training

40. Savanakhet, Laos
Foodborne parasitic disease research
October 2017
Decision makers
Public
health
(MD,
army
health)
Scientists
Vets

41. Research into use: Risk
communication and management
• Risk communication and management problem
• Cysticercosis in schools in Bac Ninh
• African swine fever and food safety

42. CONCLUSIONS1. One Heath and Ecohealth are good approach to address
complex health issues
2. Food safety: huge health and economic burden of
foodborne diseases in LMIC
3. Capacity to develop food safety research in LMIC is
important, risk communication need
4. Research translation to actions and policy: timely and
opportunistic
5. Food safety investment and interventions in long term,
wide-reaching impacts likely require: training &
technology, incentives, and enabling environment

43. Acknowledgement
• Fred Unger, Sinh Dang, Delia Grace, Kristina Roesel, Silvia Alonso,
Johanna Lindahl: ILRI
• PigRISK and SafePORK team
• Sothyra Tum, Chhay Ty, Rortana Chea, Melissa Youth and SFFF
Cambodia team
• BMZ project team
• Vietnam Food Safety report team
• ComAcross project in Laos: Vannaphone Phouthana
• Funding: ACIAR, CGIAR A4NH, World Bank, BMZ, USAID through
LSIL, IAFP

44. Bibliography
• Hung Nguyen-Viet, Tran Thi Tuyet-Hanh, Unger, F., Sinh Dang-Xuan and Grace, D. 2017. Food safety in
Vietnam: where we are at and what we can learn from international experiences. Infectious Diseases
of Poverty 6: 39. http://hdl.handle.net/10568/79981
• Sinh Dang-Xuan, Hung Nguyen-Viet, Meeyam, T., Fries, R., Huong Nguyen-Thanh, Phuc Pham-Duc,
Lam, S., Grace, D. and Unger, F. 2016. Food safety perceptions and practices among smallholder pork
value chain actors in Hung Yen province, Vietnam. Journal of Food Protection 79(9): 1490–1497.
http://hdl.handle.net/10568/77065
• Sinh Dang-Xuan, Hung Nguyen-Viet, Unger, F., Phuc Pham-Duc, Grace, D., Ngan Tran-Thi, Barot, M.,
Ngoc Pham-Thi and Makita, K. 2017. Quantitative risk assessment of human salmonellosis in the
smallholder pig value chains in urban of Vietnam. International Journal of Public Health
62(Supplement 1): 93–102. http://hdl.handle.net/10568/77739
• Tran Thi Tuyet-Hanh, Dang Xuan Sinh, Pham Duc Phuc, Tran Thi Ngan, Chu Van Tuat, Grace, D., Unger,
F. and Hung Nguyen-Viet. 2017. Exposure assessment of chemical hazards in pork meat, liver, and
kidney, and health impact implication in Hung Yen and Nghe An provinces, Vietnam. International
Journal of Public Health 62(Supplement 1): 75–82. http://hdl.handle.net/10568/77702
• Nguyen-Viet, H. et al (2018). Research and training partnership to assist policy and capacity building in
improving food safety in Vietnam. Global Food Security