1/ Thread on landscape level (across administrative boundaries & sectoral jurisdictions) #OneHealth approach could ↑ socio-ecological solutions; our new paper analyses Emerging infectious disease (EID) risk in high altitude mountains/plateaus of Asia
2/ 75% of EIDs are zoonotic i.e, transmitted to us from animals: SARS, COVID19, HIV/AIDS, Avian Flu, Plague etc. they've always had pandemic potential, but increase in frequency linked to globalisation & increasing anthropogenic resource extraction & macroeconomic demands;
3/ In a supplementary file, estimates of human fatalities from known pandemics are tabulated (with links to sources); see for eg estimates from plague & Spanish Flu static-content.springer.com/esm/art%3A10.1…
4/ accelerating land-use change, mining, deforestation ESPECIALLY those that're driven on industrial scale rather than those by indigenous/small farmers are heavily implicated; (1) economies of scale → trans-national/regional flows of people, animals & goods → pathogen flow
5/ (2) fragmentation of landscapes → greater contact of people, domestic & wildlife; (3) homogenisation of reduces/disrupts native/organic flows of pathogens/processes linked to resilience of ecosystems;
6/ use of antibiotics, pesticides etc create unknown/unstudied changes in human & ecological systems; wherever wildlife trade, hunting/trade/consumption of wildlife & traditional medicine use acquire large-scale those too contribute to the problem
7/ As our ongoing work on Kyasanur Forest Disease shows (see journals.plos.org/plosntds/artic…) rapid/recent land-use change implicated in spillover events; wider socio-ecological & macroeconomic context can pandemicise/epidemicise such events that would've normally petered out
8/ Forecast modeling with heat maps of zoonoses risk can be used to categorise high-risk hotspots; areas considered low-risk too in fact can easily change given rapid changes occurring; see for eg. the case of High Asia, comprising high-altitude 45 eco-regions;
9/ High Asia spans multiple countries in the region & is the distribution range of the Snow Leopard; these 45 mountain/plateau semi-arid high-altitude eco-regions also have been undergoing dramatic changes & have socio-ecological complex human-livestock-wildlife interfaces
10/ I cherry-pick the more health/social components in my thread, but the paper is rich in characterisation of ecological features of the landscape thanks to ongoing long-term social & ecological work that several authors are involved in;
11/ cold, dry & high-alt not necessarily unfavourable to zoonotic pathogens; so little work on OneHealth so we dont know enough; potentially low rates of pathogen exposure or lesser scope for co-evolution of pathogen-host relationships could render region more vulnerable
12/ Snow leopards, the top predator in this landscape has low density, but is known to travel large distances & its interface with domestic livestock is increasing; its wild prey too gregarious & sesonally vulnerable to disease;
13/ wild rodents & lagomorphs (also prey) are additional spp with enzootic cycling of pathogens; High Asia is also hosts 2 of 2 of 8 flyways (aerial highways of bird migrations!);
14/ indeed these flyways are visited by birds that winter/summer in west Africa & southern India & make pitstops in the region's large waterbodies where they interface with people, livestock & wildlife;
15/ human density is comparatively low but hugely productive for livestock with large grazing areas for the largely agro-pastoral communities; macroeconomic development in the region brings in new populations & resources; creates new niches for exchange;
16/ illegal demand for wildlife globally creates pressure on poor local communities for hunting/trading also contributing to spillover possibilities;
17/ we discuss potential pathways through which disruption of native hosts of some pathogens can drive spillovers (we cite Trypanosomiasis & West Nile studies);
18/ some potential "solutions" like eradication programs of rodents/"pests" could have unintended consequences of driving spillovers by disruptions of natural cycling;
19/ As with many other rural/remote communities, changing agricultural practices, mechanisation, homogenisation also drive rapid land-use change; new croplands opening up too rapidly can pass on new pathogens from livestock to wildlife that can travel long-distance;
20/ "Development", among other things, brings feral dogs, a major threat to widllife in multiple eco-regions & also aid exchange of pathogens between wild, livestock and human populations;
21/ Finally, their remote/marginal locations make them atypical; hence national/regional health systems design often not adapted to the unique socio-ecological realities;
22/ most countries in the region have limited community engagement participation in health services creating vulnerabilities & possible missing of spillover events, poor preparedness;
23/ Main zoonoses in High Asia sorted by type of disease (viral, bacterial, and parasitic) and main hosts involved have been listed; we also review possible list of diseases/pathogens for major taxa in the region;
So what you ask?
24/ (1) large macro-economic initiatives in the region (also linked to geopolitics & countries flexing economic muscles) could increase risks of spillover; see for eg. Belt & Road initiative;
25/ (2) strong investments in strengthening health systems esp OneHealth based approaches that involve intersectoral work across human, animal & wildlife health; not only biomedical epi-risk based, but also community engagement given remote & marginalised communities;
26/ this for me is the greatest limitation of OneHealth which has tended to have too heavily a "risk"-based focus with limited social science engagement, but that's largely a function of who's doing the OneHealth work and hopefully will change;
27/ Thanks to my Charudutt Mishra and colleagues for steering this; @snowleopards @snowleopard_ncf @ncfindia @gsamelius @munibkhanyari @iphindia @india_alliance @_SLU @JohanssOrjan
28/ beyond my paycheck to suggest more humane & sustainable models of economic shifts, but wthN, so here goes </end>

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More from @prashanthns

10 Jul
1/ Thread on our paper reporting unfair accumulation of malnutrition in particular intersectional social gps & geographies in India; we id 4 clusters of dts (hotspots); instead of separately for stunting, wasting & underweight, we use CIAF; > comprehensive Image
2/ Paper co-authored with @SabujosephK & @yogishcb & Sangeetha Joice; equityhealthj.biomedcentral.com/articles/10.11…
3/ High stunting (>46 m children) & wasting (>25 m) in India; 5th highest prevalence of u-weight & 3rd highest prevalence of wasting; unfair patterning of child malnutrition by caste, sex, religion, location and socio-economic position already well characterised;
Read 61 tweets
27 Jun
1/ Thread on High Level Expert Committee for Prevention & Management of COVID 3rd wave chaired by #DeviShetty & nearly #allmale & clinician led committee with hardly any diverse expertise needed (covered in my earlier thread which fell on deaf ears @BSYBJP @mla_sudhakar);
2/ My view based on my training in medicine & #PublicHealth & what I have learned through several years of #CommunityEngagement & #PrimaryHealthCare in rural Karnataka #Chamarajanagar;
3/ While the original notification was all men, 2 women seem to have been added; the summary of the report is about 30 pages while the "detailed recommendations" are 60 pages; rather poor attempt at summarising IMO
Read 38 tweets
9 Jun
1/ #Vaccination #Adivasi #COVID thread; day begins with an orientation meeting to #Solega #Adivasi leadership on #vaccination at a hamlet; we address doubts and misconceptions; leaders criticise the stereotype of #Tribal Community as being hesitant and "running away";
2/ ask that officials & NGOs engage meaningfully and respectfully with their leadership at multiple levels; refuse the idea that they are ALL hesitant which often prevails among "others"; they explain what is the best way of engaging #Adivasi communities
3/ They offer to identify #COVID volunteers in each podu (hamlet); volunteers can be oriented in small groups & shall help with obtaining proper consent and participation of their elders;
Read 11 tweets
8 Jun
1/ Shared few insights emerging from community-based #COVID care that some communities have begun in #Adivasi populations in #Chamarajanagar with support from #ZillaPanchayat in live video interaction with #Karnataka #GramPanchayats thanks to @gokRDPR
2/ #COVID19 care needs to be rational & #evidence-based but also respectful & dignified; these are not aspects we have done well with in our #HealthSystem & hence need special attention;
3/ Dignified & respectful care requires an awareness of diverse socio-economic & cultural contexts at individual, household, neighbourhood & societal levels; we haven't substantively engaged with (#caste #gender #disability #sexuality #privacy )-aware care at systemic level
Read 7 tweets
4 Jun
#COVIDSecondWave care requires local #CommunityEngagement for it to be meaningful, respectful and dignified; at one of #chamarajanagar #solega #adivasi settlements yesterday was a humbling experience learning together with the people how to organise care in a culturally safe way
A remote forest settlement; sudden spurt of cases; testing hesitancy and immediate referral to far away #covidcare centres driving anxiety for testing and failing trust in ASHAs; #Panchayat president on location, NGOs, health workers, tribal welfare officers on site
Hours of respectful dialogue follows; various modalities discussed; an amazingly enthusiastic #Panchayat president convenes impromptu consultation at local tribal residential school; CEO and Zilla panchayat admin patiently listen to local proposals
Read 8 tweets
2 Jun
1/ Joining some wonderful people from what I am seeing as a diverse group of researchers at the #EditorialBoard of @PLOSGPH; journal has given itself the tall order of “addresses inequities in public health and makes impactful research accessible to all… (1/n) #Threads
2/ In words of @paimadhu "the journal will amplify the voices of underrepresented and historically excluded communities and prioritize equity, diversity, and inclusion at all levels"; I am highly skeptical of this,
3/ yet I am thrilled that a #PublicHealth journal would give itself such a vision; #Knowledge #Science #Evidence all reproduce the same kind of social hierarchies that drive unfair accumulation of resources in our society
Read 12 tweets

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