Presentation by Fred Unger, Sinh Dang-Xuan and Hung Nguyen-Viet at a webinar on One Health application in foodborne diseases, Gadjah Mada, Indonesia, 14 July 2022.

1. Better lives through livestock
Use of risk assessment for food safety management with
an integrated One Health approach
Webinar on One Health application in foodborne diseases
14 July 2022, One Health Collaborating Centre, Universitas Gadjah Mada, Indonesia
Fred Unger, Sinh Dang-Xuan, Hung Nguyen-Viet
International Livestock Research Institute (ILRI)

2. 2
Contents
• CGIAR and ILRI
• Food systems changes and food safety
• Basic concepts of risk analysis
• One Health case study on food safety management

3. www.cgiar.org
One CGIAR: New collaborative structure of CGIAR established
Aiming for: More synergies among centres, joint resources & higher impact
One voice with partners
Regional scope: 6 regions worldwide (as in the map)
ILRI: Remains as a legal entity but fully integrated into One CGIAR
ILRI is part of CGIAR
For 50 years, CGIAR has been a leader in agricultural
science and innovation for development
– currently transformed to One CGIAR

4. 4
• One Health
• Food safety, zoonoses, AMR, COVID
• Animal welfare
• Animal Health
• Livestock value chains
• Genetics
ILRI* priority research areas (Vietnam)
* Member of CGIAR
ONE CGIAR initiatives
o Focus on Vietnam
o E.g., One Health, Food
systems & SAPLING
Bilateral projects
• Safe PORK & ICT4HEALTH
• Chicken genetic gains
(regional)

5. 5
Food system changes
Population grow & livestock production
• World population was estimated at 6.8 billion in 2009, with
5.6 billion living in the less developed regions (UN, 2009)
• Will grow to 9.1 billion in 2050, with most of the growth
occurring in developing countries (UN, 2009)
• Jul 2022 we reached already 8 billion!
• More than 70% of livestock derived food in Asia and Africa
produced by small farms, often distributed in traditional
value chains – food safety mitigation can be challenging

6. Changing food systems
• Food systems are rapidly changing in many developing countries, e.g.,
including Vietnam, Cambodia 3-5 % grow of livestock sector
• These transitions are likely to be associated with more consumption of
risky food
• Milk, meat, aquatic products and crops
• Food safety is an emerging public health problem worldwide, SE Asia
region a known hotspot for disease emergence

7. 7
Some definitions
Health
“ The absence of diseases”
“ A state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity” WHO
Food borne disease (FBD)
is any illness resulting from the food spoilage of contaminated food, pathogens
(Bacteria, viruses, or parasites) that contaminate food, as well as chemical,
physical or natural toxins/particals.

8. 8
Some definitions
Health impact of diseases
Information on health impacts are expressed in disease burden
Burden of diseases
• Often quantified in terms of disability-adjusted life years (DALYs)
• Expressed in health statistics as the number of years lost due to ill-health, disability and early
dead, which quantify the number of years lost due to disease or one lost year of healthy live
• note that DALYs may not address sufficiently social impact of FBD e.g., trade impacts or losses in
agriculture and food sector

9. 9
Food safety and impact
Go to menti.com, and enter code PPT: 3341 2407
What do you think is the health burden of food borne diseases globally compared to
the “big three” infectious diseases (malaria, tuberculosis and HIV)?
(click only one but most valid option)
- About the same as each of the “big” three
- Much higher
- Much lower

10. • Almost 1 in 10 people fall ill every year from eating contaminated food,
with 420,000 fatalities
✓ Main contributor are diarrhoeal diseases caused by norovirus, Campylobacter,
non-typhoidal Salmonella and pathogenic E. coli
• Children under 5 years of age from low-income countries are at
particularly high risk
• Huge regional difference in disease burden
✓ E.g. liver flukes (O.V.) in SE Asia highest incidence
Evidence on food safety impacts (globally)
Laos Malaysia Myanmar Thailand Vietnam
Tuberculosis
(2016)
1820 146 1716 299 414
HIV/AIDS
(2016)
337 1080 904 1205 440
Malaria
(2016)
36 1 31 3 1
Food-borne
disease (2010)
933 293 711 685 390
• 31 hazards
• Worldwide
• 5 years period, various
experts

11. Perceived versus actual risks ???
Highest risk from microbiological hazards.
What people worry most does not always match actual risks.
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
>
=
<
Among the three presented food commodities which do you
rank as most important in health impact?
- Contaminated meat (Salmonella)
- Contaminated pork with Cysts
- Mycotoxin contaminated corn
>
=
<
Go to menti.com, and enter code PPT: 3341 2407

12. Better lives through livestock
Risk assessment principles

13. Risk Analysis
• Science-based approach to manage risks
• Estimate, evaluate and discuss risk of adverse events (e.g.,
Food borne disease, FBD) and their management
✓qualitative and/or quantitative (more data demanding) approach
• Driven by political consideration and managers
• Limited time scale & resources available but decisions are
needed

14. Hazards # Risk
Hazard
• Something that can cause adverse effects (harm)
(microbiological, chemical, physical…)
Risk
• Likelihood of occurrence of unwanted outcome AND
magnitude of consequences given its occurrence
• probability plus consequences

15. Current frameworks of Risk Assessment (RA)
RA frameworks:
✓ OIE is the standard setting organisation for animal health,
zoonoses and animal welfare in international trade
✓ OIE Animal Health Code contains guidelines for import risk
analysis/assessment. Structure equivalent to import-scenario
(release, exposure, consequence)
✓ CAC is the standard setting body for (microbiological) hazards in
international trade with foods
✓ CAC guidelines describe quantitative (microbiological) risk
assessment and the principles of risk analysis: Differentiation in
hazard-identification, hazard characterization, exposure
assessment, risk characterization
Example:
• Import risk assessment for introduction of emerging animal
diseases (ASF)
• Risk of disease spread within country e.g., farm to farm HPAI
Example:
• Health impact assessment of Salmonella in pork

16. The structure of risk analysis process of the OIE vs. CODEX
Sources: OIE handbook on import risk analysis; http://www.who.int/foodsafety/micro/ links/en/

17. Risk Analysis – CODEX framework
Risk
Assessment
Risk
Management
Risk
Communication
*Science based *Policy based
*Interactive exchange of
information and opinions
concerning risks

18. Hazard identification
• The identification of biological, chemical, and
physical agents
• capable of causing adverse health effects
• and which may be present in a particular food
or group of foods
Hazard
identification
Exposure
assessment
Hazard
characterization
Risk
characterization
Identification of characteristics of agents through:
✓literature review
✓public database or
✓expert opinion
Process of Hazard identification
Risk assessment framework CODEX

19. Dose-response assessment
Determination of the relationship between the
magnitude of exposure (dose) to a chemical, biological or
physical agent and the severity and/or frequency of
associated health effects (response)
Hazard
identification
Exposure
assessment
Hazard
characterization
Risk
characterization
Hazard characterization
• Qualitative or quantitative description of the
severity and duration of (health) effects that
may result from the ingestion of a
microorganisms or its toxin in food
• A dose-response assessment should be
performed if the data are obtainable

20. Uncertainty: Lack of knowledge
• Associated with the data themselves
✓ Data uncertainty might arise in the evaluation and extrapolation
of information obtained from epidemiological, microbiological
and laboratory animal studies
Variability: Variation in a system
• Biological variation: difference in virulence of hazard
✓ e.g., SARSCOV2 but also Salmonella
• Variability in susceptibility within the human population:
✓ e.g., SARSCOV2 but also Salmonella
✓ Malaria in humans
Hazard
identification
Exposure
assessment
Hazard
characterization
Risk
characterization
Hazard characterization – challenges

21. Éxposure assessment
• Humans/consumers health risk consequences
• Microbial hazards
• Foodborne pathogens (zoonoses)!
Food Safety Risk Assessment (CODEX)
• Dose-response model/relationship
• Exposure assessment
- Consumption (amount, type of food, culture…)
- Pathogen prevalence and concentration
- Growth and inactivation/cross-contamination,...
• Deterministic vs. stochastic RA
• Monte-Carlo simulation

22. Codes framework - Risk characterization
• An estimate of the likelihood and
severity of the “negative "effect which
could occur in a given population
• Estimate likelyhood of FBD in humans due
to Salmonella
Likelihoods: neglectable - extreme
• Degree of confidence in estimates:
• some uncertainty and variability occurs
Hazard
identification
Exposure
assessment
Hazard
characterization
Risk
characterization

23. PROBABILITY/CONSEQUENCE MATRIX
High Negligible Very low Low Moderate High Extreme
Moderate Negligible Very low Low Moderate High Extreme
Slight Negligible Very low Low Moderate High Extreme
Low Negligible Negligible Very low Low Moderate High
Very low Negligible Negligible Negligible Very low Low Moderate
Extremely low Negligible Negligible Negligible Negligible Very low Low
Negligible Negligible Negligible Negligible Negligible Negligible Very low
Negligible Very low Low Moderate High Extreme
CONSEQUENCE
PROBABILITY
Risk characterization
(qualitative risk assessment)

24. PROBABILITY/CONSEQUENCE MATRIX
High Negligible Very low Low Moderate High Extreme
Moderate Negligible Very low Low Moderate High Extreme
Slight Negligible Very low Low Moderate High Extreme
Low Negligible Negligible Very low Low Moderate High
Very low Negligible Negligible Negligible Very low Low Moderate
Extremely low Negligible Negligible Negligible Negligible Very low Low
Negligible Negligible Negligible Negligible Negligible Negligible Very low
Negligible Very low Low Moderate High Extreme
CONSEQUENCE
PROBABILITY
Risk characterization
(qualitative risk assessment)

25. PROBABILITY/CONSEQUENCE MATRIX
High Negligible Very low Low Moderate High Extreme
Moderate Negligible Very low Low Moderate High Extreme
Slight Negligible Very low Low Moderate High Extreme
Low Negligible Negligible Very low Low Moderate High
Very low Negligible Negligible Negligible Very low Low Moderate
Extremely low Negligible Negligible Negligible Negligible Very low Low
Negligible Negligible Negligible Negligible Negligible Negligible Very low
Negligible Very low Low Moderate High Extreme
CONSEQUENCE
PROBABILITY
Risk characterization
(qualitative risk assessment)
Risk: not wearing a
mask to avoid
pollution

26. PROBABILITY/CONSEQUENCE MATRIX
High Negligible Very low Low Moderate High Extreme
Moderate Negligible Very low Low Moderate High Extreme
Slight Negligible Very low Low Moderate High Extreme
Low Negligible Negligible Very low Low Moderate High
Very low Negligible Negligible Negligible Very low Low Moderate
Extremely low Negligible Negligible Negligible Negligible Very low Low
Negligible Negligible Negligible Negligible Negligible Negligible Very low
Negligible Very low Low Moderate High Extreme
CONSEQUENCE
PROBABILITY
Risk characterization
(qualitative risk assessment)
Risk: not wearing a
helmet

27. Risk management
Process of deciding and implementing mitigation methods for the appropriate level of safety.
NOTE there is usually no “0” risk.
Food security
Food safety

28. Risk management & communication
• What can be done to eliminate or reduce hazard?
• How effective and feasible are options?
• Can to options be scaled? (VIETGAP, only 5% uptake)
• What is cost-effectiveness of control options?
• What is the expected compliance of actors?
• What impacts do options have
• e.g. enforced closing of life bird markets during bird flu

29. Risk communication
What is best option?
Media to be used, trust, reach, accessibility, targeted
group, gender, ethnicity …

30. Picture source: Rahman et al (2020) https://doi.org/10.3390/microorganisms8091405
Requirements & Main steps of a risk assessment:
Main steps of RA
• Framing the risk question
• Identifying the hazard(s)
• Outlining the risk pathways
• Identifying data needs
• Collecting data
• Assessing the risk
Requirements:
• Clear definition of terms:
- Risk question
- Hazard identification
- Qualitative risk assessment: risk categories and combination
matrix
• Transparency:
- A risk assessment must be clearly set out, transparent and fully
referenced in the resulting report

31. Better lives through livestock
One Health food safety case study from Vietnam and Cambodia

32. One Health case studies
Case study 1: Safer Pork for Vietnamese consumers
Case study 2: Safe food fair food Cambodia SFFF

33. Case study 1: pork in Vietnam
Pork is an important component of the Vietnamese diet
• The most widely consumed meat: 28.1Kg/person
• About 80%
• comes from very small or small farms,
• processed in small slaughtering
• Retailed through traditional retail
• Preference for fresh “warm” pork supplied in traditional markets
Food safety among the most pressing issues for people in Vietnam, more
important than education or health care

34. Case study 1: Pork safety assessments and pathways towards safer pork
PigRISK (2012-2017) SAFE pork (2017 – 2022)
Research questions
Is pork safe in Vietnam?
Methods:
Quantitative and qualitative risk assessment
Assess cost of FBD illness (hospitalisation)
Cross-contamination Salmonella (household)
Risk based approach
Research questions
What are faesable options for safer Pork?
Methods:
Food safety (FS) performance of value chain
FS interventions (e.g. RCT)
Risk communication

35. Vietnam: Farm to fork approach
One Health Team (public health, vets, economic, gender& private sector)

36. Methodology – Codes framework risk analysis (Cambodia and Vietnam)
Hazard identification
• Lit review, expert opionon
Hazard characterisation
• Dose-response, from literature (clinical
studies)
Exposure assessment
• Prevalence studies, dose-response,
pork intake, gender/age aspects
Risk characterisation
• Magnitude of the risk
Risk management
Risk Communication

37. Hazard identification
Pork/Food-borne disease
Parasitic
• Cysticercus cellulosae
• Trichinella spiralis
• Toxoplasma gondii
• Fasciola spp.
Bacterial
• Bacillus cereus
• Brucella suis
• Campylobacter spp.
• Salmonella spp.
• Staphylococcus aurues
• Streptococcus suis
• Shiga toxin producing E. coli
• Yersinia enterocolitica
Virus
• Hepatitis E
• Norovirus Source: PigRISK
Salmonella spp.
Tape worms

38. Vietnam: Evidence of food safety risks in the pork value chain
Poor food safety outcomes (Salmonella) across all retail types (modern and traditional)
Evidence on:
• 1-2 out of 10 pork consumers estimated to suffer from foodborne disease (Salmonella) annually;
• Cost of hospitalization study due to FBD: 33US$/day, 107US$/episode; Estimate ~ US$200 M/year
Low risk from chemical hazards: grow promoters, antimicrobials (AM), heavy metals
Value chain actors incorrectly perceive chemical hazards as more important than microbiological
Low risk from pork parasitic zoonoses (Taenia, cysticercosis & trichinella)
Women more cautious about chemical residues in pork/food than men, while men more in favour of
purely technical interventions than woman (RISK COM ISSUE)
Traditional retail Street food Canteens „Boutique“ shops SuperMK/convenient stores Indigenous pigs

39. Vietnam: Food safety innovation/intervention to mitigate risks
Food safety risk communication
Manuals, poster
Introduction of food safety nudges & guidelines
Training > 600 trained (VC actors, school canteen,
media, academia and risk accessors)
& > 80 media representatives
Inox grid, separate clean/dirty zones, cleaning & disinfection,
and training, certification (as incentive)
Significant hygienic improvement (hygienic indicator)
Food Safety Interventions at slaughter (300-1000 USD)
Separate meat/intestines/cooked products, cleaning &
disinfection, scoring system for best retailers
Moderate hygienic improvement (hygienic indicator)
Food Safety Interventions at retail (40 USD)
Food auction/willingness to pay
Consumer tend to pay 16% more
for the intervened pork

40. Case study 2: Cambodia
Hazard surveys in pork & chicken
• Presence of Salmonella (moderate to high) in
chicken and pork across modern and traditional
retail (survey in all provinces)
• 1.5 out of 10 consumers of mixed chicken and
pork salad estimated to suffer from foodborne
disease (Salmonella) annually
• Cross-contamination at household also important
(using same cutting board and knife)
• Low risk from pork parasitic zoonoses (Taenia,
cysticercosis & trichinella)

41. Feasible risk mitigation options (Cambodia) Intervention package: Cost about 25.0 $
- Easy to clean surface
- Frequent washing and disinfection
- Separation (fresh/cooked/intestine)
- Training on FS knowledge and practices
- Hygienic cutting board
- Branding for upgraded shops
Intervention package tested across 6 provinces and 360 retailers using RCT design
- Reduced presence of food safety hazards in intervention group.

42. • FBD are a major health concern comparable to ‚big three‘ infectious
diseases
• Risk analysis – important tool to evaluate risk and make evidence-based
decisions to mitigate risks in a context with limited resources
✓ Focus on the few relevant and not many trivial
✓ Risk Communication limited or even often neglected
• Case study example
• Safer food can be achieved but technical solutions need to be:
• Evidence
• Feasible
• Incentivized
• Cost – beneficial
• Supported by risk communication
Overall conclusions
Take home messages

43. Thank You!
Including research team, value chain actors and authorities from Vietnam and Cambodia.
Food safety risk management report & recognised by high level (DPM) https://www.worldbank.org/en/country/vietnam/publication/food-safety-risk-management-in-vietnam-challenges-
and-opportunities
http://www.who.int/foodsafety/publications/foodborne_disease/fergreport/en/