Raising the political profile of the neglected zoonotic diseases : three complementary European Commission-funded projects to streamline research, build capacity and advocate for control

The World Health Organisation identifies eight Neglected Zoonotic Diseases (NZDs) as major causes of ill health to both humans and domestic animals in many countries across the world [1–3]. Although largely controlled or eradicated in industrialised nations, these eight NZDs—anthrax, brucellosis, bovine tuberculosis (bTB), Taenia solium cysticercosis, cystic echinococcus, leishmaniasis, rabies, and human African trypanosomiasis (HAT)—still cause significant health problems in many low resource settings in developing nations [1–7]. The poor remain disproportionately affected by NZDs through a combination of close contact with domestic animals (particularly in rural settings), and the difficulties of accessibility, affordability, and capacity of local health centres. Aside from the significant human mortality and morbidity caused by NZDs, their added impact on livestock productivity—including decreased fecundity, poor growth rates, lowered draft power outputs, decreased carcass value, and deadly epidemics—further contribute to the burden of NZDs on poor livelihoods. NZD control offers a powerful opportunity to simultaneously save lives and secure livelihoods, contributing to poverty alleviation within affected communities [2]. History provides compelling evidence that the effect of zoonoses in humans can be mitigated through targeted interventions in animal reservoirs; the successful eradication of brucellosis, porcine cysticercosis, bTB, and rabies from a number of countries has all been done this way [8–10]. However, given the significant benefits of NZD control and prevention to the broader human health and development sectors, the financial and logistical responsibility for zoonoses control should not just fall on the shoulders of the veterinary sector alone. Confusion over roles and responsibilities, often resulting from the perception that the NZDs are beyond the mandate of either the human or animal health sectors, currently impede concerted efforts towards their control [11]. Vast underreporting, often as a result of poor advocacy, diagnostic difficulties and disease clustering that may be missed in broad-based epidemiological surveys, further compounds their political “neglect.” At the local level, primary healthcare workers and local veterinary officers faced with poor infrastructural investments in both health and veterinary services, lack the information, knowledge, and tools for NZD diagnosis and control. Moreover, the societal value of livestock and lack of compensation programmes render standard control methods utilised in industrialised nations, such as test and slaughter, unimplementable and unacceptable in much of Africa, Asia, and Latin America [12]. Despite the multiple benefits of control, coordinated efforts to collectively address the NZDs is generally lacking. With recent estimations that broader Neglected Tropical Disease (NTD) funding represents just 0.6% of total international development assistance [13], funding for the NZDs has been estimated at around one-tenth of this figure; a mere 0.06% of global assistance for health [3]. The need to identify and quantify the impact of endemic zoonoses in developing regions, evaluate and prioritise control approaches, and build national and local capacity and leadership is imperative. The European Commission, through their Seventh Framework Programme (FP7), has funded three complementary projects to address these issues on a large scale in Africa; i) Integrated Control of Neglected Zoonoses in Africa (ICONZ), ii) training of the One Health Next Scientific Generation in the Sahel and Maghreb (OH-NEXTGEN), and iii) Advocacy for Neglected Zoonotic Diseases (ADVANZ). Through simultaneously generating evidence, building capacity, and advocating for control, these three programmes promote coordination and collaboration for increasing the political visibility of this important, but underfunded, group of diseases (Table 1). The remainder of this article highlights the objectives and activities of these three projects, and discusses the policy implications for NZD control expected to arise from their outputs. Table 1 Major deliverable thematic areas highlighting complementary areas. ICONZ (www.iconzafrica.org) Concept and Objectives The ICONZ project has been specifically designed to generate an evidence base for the promotion of integrated control packages for the eight NZDs in seven African International Partner Cooperation Countries (ICPCs): Morocco, Mali, Nigeria, Uganda, Tanzania, Mozambique, and Zambia. Integrated control refers to interprogrammatic and intersectoral approaches based on stratification of risk to reach marginalized populations or geographic areas, rather than promoting vertical strategies that address each disease independently [14,15]. Scientific innovation and public engagement remain two important cornerstones to the ICONZ approach; locally-appropriate strategies are mindful of the wider existing policy frameworks of affected countries, with sustainability of these approaches ensured through the training of almost 70 postgraduate students (Masters and PhD) from both Africa and Europe to date. Whilst African countries have been the focus of ICONZ, given that it is the only continent affected by all eight zoonoses targeted by the FP7 call, it is anticipated that the strategies and experience resulting from ICONZ research can help form recommendations and advise other countries suffering similar burdens of disease, particularly in Asia and Latin America. The overall strategic objective of ICONZ is to mitigate the human and animal health impacts of NZDs, whilst contributing to poverty alleviation and the Millennium Development Goals. In order to achieve this, twelve Work Packages (WPs) incorporating 21 European and African partners have joined forces to determine the current disease burdens on communities, and subsequently identify innovative approaches for NZD identification and control tailored to different settings (Fig. 1). The ICONZ approach has emphasised the need to communicate research evidence to the highest possible number of beneficiaries and decision makers within each ICPC, to maximise impact on the local and national scale. Fig 1 Overview of ICONZ WPs. Overview of ICONZ WPs ICONZ WPs 1–4: Project management and gap analyses These four WPs align to ensure the effective management of interactions between the project partners, donors, and beneficiaries (WP1), create a database of concurrent NZD research in other parts of the world (WP2), cost and standardise methodologies for evaluating disease burden (WP3), and validate currently available diagnostic tools (WP4). Through fulfilling the deliverables of each of these WPs, it is anticipated that a clear analysis of the evidence gaps, and appropriate methodologies to address these, will be available to guide the activities of the remaining eight WPs.