Contain This: The Latest in Global Health Security

Wet Markets with Mark Schipp and Anna Okello

June 30, 2020 Indo-Pacific Centre for Health Security: Department of Foreign Affairs and Trade Season 1 Episode 10
Contain This: The Latest in Global Health Security
Wet Markets with Mark Schipp and Anna Okello
Show Notes Transcript

Welcome to Episode #9 of Contain This, brought to you by the Indo-Pacific Centre for Health Security and hosted by Adam Craig.

On the episode we have Dr Mark Schipp and Dr Anna Okello.

In 2011 Mark was appointed Chief Veterinary Officer of Australia. He was also appointed as Australia’s Delegate at the World Organisation for Animal Health (OIE) where he is also the elected President of the OIE World Assembly. Mark leads Australia’s national responses to emergency animal disease incursions. He works to strengthen the veterinary services of countries in our region so they are able to detect and respond to emerging infectious diseases of concern to both human and animal health. He has been active in leading Australian agriculture’s response to the global threat of antimicrobial resistance.

Anna is the Research Program Manager of Livestock Systems at Australian Centre for International Agricultural Research (ACIAR), providing Animal Health and One Health expertise to the portfolio. Since graduating with a veterinary degree from Melbourne University in 2002, the majority of Anna’s career has been spent working in the veterinary public health and livestock development sectors, including 10 years researching zoonotic Neglected Tropical Disease control in sub-Saharan Africa and Southeast Asia. Anna completed a PhD in political science (public health policy) at the University of Edinburgh’s Centre for African Studies in 2012, and has worked in various project management and technical advisory roles for international NGOs, the Australian government, the World Health Organization and the University of Edinburgh.

In this episode, Adam, Mark and Anna discuss biosecurity, wet markets and their respective roles in Australia's response to disease risk.

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Contain This Team 

 Contain This Podcast Episode 9:  Wet Markets

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The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.

Welcome to Episode #9 of Contain This, brought to you by the Indo-Pacific Centre for Health Security and hosted by Adam Craig.

On the episode we have Dr Mark Schipp and Dr Anna Okello.

In 2011 Mark was appointed Chief Veterinary Officer of Australia. He was also appointed as Australia’s Delegate at the World Organisation for Animal Health (OIE) where he is also the elected President of the OIE World Assembly. Mark leads Australia’s national responses to emergency animal disease incursions. He works to strengthen the veterinary services of countries in our region so they are able to detect and respond to emerging infectious diseases of concern to both human and animal health. He has been active in leading Australian agriculture’s response to the global threat of antimicrobial resistance.

Anna is the Research Program Manager of Livestock Systems at Australian Centre for International Agricultural Research (ACIAR), providing Animal Health and One Health expertise to the portfolio. Since graduating with a veterinary degree from Melbourne University in 2002, the majority of Anna’s career has been spent working in the veterinary public health and livestock development sectors, including 10 years researching zoonotic Neglected Tropical Disease control in sub-Saharan Africa and Southeast Asia. Anna completed a PhD in political science (public health policy) at the University of Edinburgh’s Centre for African Studies in 2012, and has worked in various project management and technical advisory roles for international NGOs, the Australian government, the World Health Organization and the University of Edinburgh.

In this episode, Adam, Mark and Anna discuss biosecurity, wet markets and their respective roles in Australia's response to disease risk.

Adam Craig (01.40)

Mark, thanks for making time in your busy schedule to talk to us on Contain This. Could I start by asking you want led you to take up the position as Australia’s Chief Veterinary Officer?

Mark Schipp

I trained as a veterinarian in Western Australia and I have always worked for governments. Initially in the WA Department of Agriculture. Then I joined the Commonwealth working with abattoirs and the meat export program. I had two terms overseas in agriculture posts in Beijing and Seoul. When I returned I was eventually asked to act as the Chief Veterinary Officer in 2011 and was later confirmed in that role.

Adam Craig

For those who don’t know, could you tell us what the role of Chief Veterinary Officer entails?

Mark Schipp

I have responsibility and oversight of Australia’s animal health status. To report on our status internationally and represent Australia internationally. To lead responses and preparedness on emergency animal disease. Also I work with the Chief Medical Officer to lead Australia’s response to antimicrobial resistance. Just last month we released the second national strategic plan on antimicrobial resistance.

Adam Craig (03.20)

You mentioned you are involved in responding to biosecurity threats. What are the major challenges that Australia faces domestically and from a regional perspective?

Mark Schipp

African Swine Fever is very much on our minds at the moment. We’ve seen a global loss of 25% of the world’s pigs. It has a huge impact on small holders. They are important, not only economically but culturally and on food security. In Thailand it is the first time African Horse Sickness has occurred in our region. The disease is spread by midges. We have a large racing and eventing pleasure horse industry in Australia. It would be conceivable the disease would spread in our direction.

Foot and Mouth Disease is something we are always exercising against. If we had a large outbreak it is estimated we could spend $50 billion and a decade to recover from it. Then a number of zoonotic diseases that we have our eyes on in the region.

Rabies is moving across the Indonesian archipelago and towards East Timor and Papua New Guinea and northern Australia where there is a large number of dogs in the communities.

Avian influenza is an ever present threat with migrant birds and infect poultry or create a spill over event into humans. Australians are great travellers and it occurs that they bring back antimicrobial resistance.

Adam Craig (05.05)

Can you talk about how antimicrobial resistance develops and the relationship between the human and animal sectors?

Mark Schipp

Antimicrobial resistance develops when bacteria are exposed to antibiotics and some of those bacteria survive and reproduce and eventually the majority of the bacteria that remain are resist to the antibiotic. It is the bacteria that become resist, not the host, not the human or the animal. And any exposure of bacteria to the antibiotic can trigger the development of resistance.

The largest users of antibiotics are the agriculture sector, particularly the livestock sector. Somewhere between two thirds and three quarters of all the antibiotics used in the world are in the livestock sector. So vets and farmers have a great responsibility to use antibiotics responsibly and minimize inappropriate use because any of that use is contributing to resistance we are seeing in humans.

We could see that in food or manure discarded into water bodies then people pick up a bacterial infection but find that infection is resistant. It can have a significant impact and we could face a post-antibiotic future where routine surgeries like hip operations might not be possible because we don’t have effective antibiotics.

Adam Craig (06.00)

I understand the human side of things. From an animal and agriculture perspective I presume antimicrobial resistance also is a threat to that industry, both in Australia and in our region.

Mark Schipp

We are seeing emerging antimicrobial resistance in livestock and in small animals and companion animals. We're also seeing increasing market drivers coming through so that our markets are now asking for antibiotic free products, so animals and animal products raised without the routine use of antibiotics. And we're starting to see some of that in labelling, even here in Australia.

Adam Craig (06.30)

You're also the president of the World Organization for Animal Health. Can you tell us about what the mandate of that organization is and what your vision for your term as president

Mark Schipp

The World Organization for Animal Health, the OIE, is the body responsible for setting international standards for animal health and welfare for the safe trade of animals and animal products. I was elected to be president for the three year period between 2018 and 2021. So I'm in the middle of my three year term. And my role there is, is to represent the members and to lead the members in the work of that organization to chair the annual general assembly of that organization, which normally takes place in May of each year.

In this three year period, I've been very fortunate to be a president and chaired during the development of the seventh strategic plan the next five years. So working with the Director General to develop the work program for the OIE over the next five years, but coming into the role, I make clear to the members that I had three objectives as president.

Firstly, it was to increase the transparency and global good governance of the organization. It's an organization that relies on the income through subscription of its members, and it's important that it be seen to be spending that money well and being efficient and transparent in decision-making so that was one plank.

The second plank was around increasing member participation in the standard settings. So the OIE establish standards for trade, for the animal welfare and for animal health. But what we find is that only a very few countries participate in that standard setting. And even as a smaller number, actually implement the standards. Although a hundred percent of members might vote for the standards, only a small percentage actually implement them. And so I wanted to understand that and get better participation in the standard setting process.

And then the third aspect was to try and amplify the veterinary voice and ensure veterinarians are heard and respected for the professional contribution. And that was particularly important around antimicrobial resistance, but also in all of the One Health spheres where veterinarians are involved, but often not heard and not respected for what they're able to contribute.

Adam Craig (08.25)

You mentioned One Health. Could you tell the audience what the One Health concept is? And it's obviously been around for quite a while now. So how important is it that we take a One Health approach when addressing animal health and the interface with human health issues?

Mark Schipp

So One Health is the recognition that diseases arise spontaneously arise at the intersection between a susceptible host, such as a human, a source which might be an animal and in an environment which allows that, that pathogen and that interaction to take place. So you really need the three elements to be present an animal, a human and an environment which supports that. And an example might be that the COVID pandemic that we're experiencing at the moment. This disease did not arise spontaneously in humans. It spilled over from bats, it's believed to be that.

And what is it that occurred in the environment that allowed that spill over to occur? And it might've been that that was wet markets that bringing together stressed wildlife together with domestic animals, created an environment where the virus could survive and spread further into humans. So a One Health approach then demands that where you have that occur and that could be rabies, or it could be influenza, or it could be antimicrobial resistance, any of these One Health type issues that you, you bring all those aspects together when you study the disease and what its solution might be.

One way to do that is to ensure that we take a holistic approach, the difficulty with a One Health approach is that because it brings together so many different disciplines, it's difficult to teach it to medical students or to veterinary students, or even to environment students. And because it needs to include other aspects as well as such as ecology, economics and psychology, social sciences.

Adam Craig (10.05)

I see the challenge. You mentioned wet markets. Could you describe for me what a wet market actually is and why it seems to be a persistent factor in the emergence of zoonotic diseases, such as avian influenza, obviously COVID-19 and others.

Mark Schipp

So a wet market is a market where animals are bought for slaughter and sale. It's argued that we have wet markets here in Australia. So we have farmer's markets. We have seafood markets. What is concerning us in response to the COVID situation is the existence of wildlife wet markets, where wildlife are brought into market environments. So these are animals that are captured in the wild, or that have been captured in the wild and then bred and then I brought into a market. So they're stressed. They're not used to being confined. They're combined in an environment where they are close to other domestic animals and humans.

So markets are busy congested places and another characteristic of wet markets is that they are wet. And that the reason they are wet is because they're washed down certainly daily, if not more frequently. And that conjunction of stressed animals in a congested environment, that is damp allows the transfer, the spill over of viruses from wildlife into other species, and from other species into humans. These markets pose a significant risk in terms of animal welfare, food safety, human health biodiversity and conservation efforts.

So there are many reasons to try and address the issue of wildlife wet markets. But to do that Australia cannot do it alone. We can't say to another country we think you should dismantle or shut down your wildlife wet markets. It needs to be led by global multilateral organizations, such as the FAO, the OIE, and the WHO. And so we've been working with those multilateral organizations to try and establish alternatives to look at setting standards and to assist with legislation and enforcement. It's important to establish alternatives in many places. There are alternatives available but they are not being accessed because of regulatory burden or lack of support. We know that in some countries farmers have gone into wildlife because they were formerly poultry farmers and lost their flocks due to avian Influenza. They weren't compensated so they started farming wildlife. And now if they're going to be taken out of wildlife, they need to be supported.

However, in some countries we know that wildlife wet markets are important for food security. They're important, culturally, in which case, what standards should apply to those markets, how can we try and minimize and manage the risk in that environment? And that might mean separating wildlife from other species, creating a hygienic environment and one that supports, biodiversity, conservation and animal welfare. And it's not enough to simply have legislation. You also must be able to enforce it. And so we're hoping that if we get the multilateral organizations on board, that they develop standards countries pick up and adopt those standards in their legislation, and then receive support to enforce and change policy.

Adam Craig (13.20)

You're painting a picture that it's a very complex space to be working in. Could you talk a little bit about what Australia is doing through the FAO and OIE and even WHO to address some of these issues and comment a little on how the socioeconomic status of a country might influence the success of action to control wet market transmission risk?

Mark Schipp

The wet market issue is a traditional wicked problem in that it is one that requires a One Health solution because there's no single clear policy or regulatory lead in any country that has wildlife wet markets. We can speak to the health department and they say, yes, we recognize there's a health issue here, but we're not responsible for livestock. That's the agriculture department. If we talked to the agriculture department, they say yes, but we're not responsible for wildlife. That requires the forestry or the conservation department and likewise, when you start to talk about commerce and regulation of markets, so it's a very good example of a wicked problem and one that requires a One Health solution.

Further there are also many people that are reliant on markets either for their own livelihood and for the role that they play in terms of culture or food security, and, you know, one of the great attractions of these markets is that they're cheap and they're colourful and they're cheerful, and you don't want to come through and demolish something that has cultural value. I think what Australia can do is to try and provide technical resources, try and provide financial assistance where that's appropriate, try and provide leadership in terms of setting international standards and support for multilateral approaches. I think we've got a number of examples where we have already done that in the region on other One Health issues whether that's rabies, influenza, malaria and antimicrobial resistance. There are a number of examples where Australia has applied a very useful role in the region in addressing these types of challenging issues.

Adam Craig (14.30)

You mentioned that the One Health concept or the need to take this holistic approach can sometimes fall between the cracks between the different organizations and the technical specialties. In your experience, what has worked in the past to overcome those gaps?

Mark Schipp

What works is bringing everybody together, all of the stakeholders together. Often that's a role that Australia, or Australia with these multilateral organizations, has played very well, to bring together all of the agencies in the country together. So in many cases, it's the first time those agencies, those government officials have seen each other and spoken to each other, and it took an outside body to bring them together, but it also needs the involvement of the private sector and recognition that they have a legitimate role. This is something that Australia does well that there's a good public private partnership. And recognizing that the private sector interests are legitimate and need to be supported. I think we've got some good models of that here in Australia, that export quite well into other settings.

Adam Craig (15.15)

Can you give some examples?

Mark Schipp

So a very good example of a public private partnership in Australia is Animal Health Australia. This is a body that was set up between the Commonwealth government, state governments and all of the livestock industries in order to develop a forum where we could have discussions and we could also respond to emerging animal diseases, and we could carry out surveillance and undertake control of endemic diseases.

This is a model that has been recognized globally and has been picked up by a number of other countries now. And it's quite unique in that we created a not for profit company. It has a clear mandate, and that has the support of all of the partners. And if there's ever a dispute or an issue that we need to discuss were able to come together under the umbrella of Animal Health Australia, and have that discussion and reach a very constructive outcome.

Adam Craig (16.00)

That's excellent, wonderful to see Australian models potentially scaled and used in other settings. Much of Australia's work has been in the Asian region. Does the Pacific also face risks, posed by zoonotic diseases? How are they different and what can we do to support?

Mark Schipp

The Pacific region is particularly vulnerable. They have very limited resources and are reliant often on tourism for their source of income. So agriculture itself is not a significant industry in many Pacific Island countries. they have very weak veterinary services in the main. I think Australia and New Zealand have provided good levels of support into that region.

Some examples have been in response to malaria, tuberculosis in the region. And in terms of the animal health, we're seeing the spread of African Swine Fever into Timor and Papua New Guinea. We are watching very closely to see if it spreads further. And likewise the fall armyworm is a horticultural agriculture pest. Again it has spread across the Pacific region and poses a great threat there. So they are very vulnerable populations and populations that Australia has provided support in the past and continues to do so.

Adam Craig (17.15)

To finish, in a post COVID world aid and development is likely going to look very different. How do you see the COVID situation affecting the way Australia supports animal health, antimicrobial resistance and general disease prevention more broadly?

Mark Schipp

We are facing that challenge at the moment. We're trying to assist to Papua New Guinea in its response to African Swine Fever and due to COVID travel restrictions we are not able to be on the ground. So that's required us to liaise very closely with our counterparts in PNG and asked them what it is we can provide, what support we might be able to usefully provide them with. They've responded that they would like our training materials, and we've been able to provide that. They've asked for some IT support, we've been able to do that. And we provided financial support so they can get out in the field and do the surveillance and the controls themselves.

I think that is going to be a model into the future where we rather than arriving in country and telling the country what it is that we might do. Rather [we will] sit back and ask them how they would like to be supported and what we might be able to do from a distance. And these are very challenging environments and very different from the Australian situation.

If we're looking at African Swine Fever in Timor Leste or Papua New Guinea, there are environments where every person has one or two pigs, largely free roaming, scavenging and very low levels of biosecurity. In Australia, we would take an approach where we would cull animals, completely depopulate, decontaminate, and then restock and impose higher levels of biosecurity. These countries that are unable to adequately control their borders, have low levels of quarantine and poor veterinary resources. And so the solution that we might offer in the first place might not be very appropriate. So it's better to hang back and ask for their advice on how we might assist them. And then see how we might provide them the assistance they're actually looking for rather than what we would initially offer.

Adam Craig

Mark, thank you for making the time to speak with me today.

Mark Schipp

Thank you.


Adam Craig (18.20)

Thanks for making time to speak to me on Contain This.

Anna Okello

Thanks Adam. Thanks for having me. It's great to be here.

Adam Craig (18.25)

I'll start by asking you to tell us a little bit about your background.

Anna Okello

I'm a veterinarian. I graduated about 18 years ago now, which sounds longer... it sounds longer than it feels. That's for sure. It was at Melbourne university here in Australia. I spent a couple of years in practice and then started working in livestock development as a veterinary volunteer in North Africa. So I was working over there and just, it really hit me in a sort of low income country context. Morocco was a very different country 15 years ago but it hit me how important animals are not just as a food source for people, but in terms of their livelihoods. They're a tractor, they're a car, they're a bank, they're an asset, they're insurance, all that sort of thing. And it really got me interested in this interaction between humans and animals and the broader environment.

So I worked in the NGO, non-government organization sector for a couple of years. I ended up doing a Masters and then a PhD at the University of Edinburgh. And they was very much in this One Health space. I started it just at the tail end of the avian influenza outbreaks in much of Asia and in parts of Africa, sort of the mid-2000s. And One Health was a buzzword back then. Everyone was saying, "Oh, you know, human and animal health need to work together to address the big sort of emerging infectious disease issues".

And my PhD ended up being in, at the School of Social and Political Science at Edinburgh Uni. And I was very much looking at how these sectors need to work together to address some of these issues around disease transmission from, from animals into humans. But also really what does that policy space look like and how do we make policies that go across sectors and how do we fund interventions on the ground that need to have different pots of money coming from different areas? So that was very much my Phd.

And from that, I moved into almost 10 years of neglected zoonotic disease research. So looking at, working on the ground, how do we control a lot of these diseases that are affecting people in poor, predominantly rural areas day in day out, things like rabies, which I'm sure a lot of people have heard of this disease, brucellosis, tuberculosis, that you can get from all these types of sort of diseases that don't have a huge amount of visibility compared to the big emerging infectious diseases.

So this is where I come from, I guess. And about three years ago, we moved back to Australia and I've been working at the Australian Centre for International Agricultural Research since then.

Adam Craig (20.50)

So you work at ACIAR, can you tell us a little bit about what ACIAR does. Specifically, what is its role in regional health security?

Anna Okello

The Australian Centre for International Agricultural Research is Australia's leading international agricultural research agency. We have been around for almost 40 years now. We had our 38th birthday this week and our mandate is food security. So we fund research programs and projects between Australian researchers and Australian institutions and in our partner countries overseas. So in government agencies or in universities in the Indo-Pacific region. We're part of the Australian government's foreign aid program. We're wholly funded from official development assistance money but we're a statutory authority. So we have programs that work very much in this research for development space. We work in a broad range of areas, as I said, food security is our mandate. So we work very much in the AgriFood systems, but for example, I mentioned the livestock systems research program, and we've been funding research in zoonotic diseases and animal disease for almost 40 years. Now, looking very much at how these diseases impact both people's livelihoods on the ground, but also how it impacts their health.

Adam Craig (22.15)

We've heard a lot about wet markets recently with the COVID-19 outbreak, but previously wet markets seem to feature or be synonymous with outbreaks or pathogens of outbreak potential. Could you describe for us what a wet market actually is?

Anna Okello

Yes, it's interesting. I mean, if you look back in history, here is a bit of trivia for you. Wet markets have existed for a long time. The term wet market actually came to prominence, we think, during about the 19th century to describe this sort of semi or semi-open or open markets, where people came to sell their fruit, salad, vegetables, livestock. And, and the term wet market we think actually originated because people were using lots and lots of water to keep them clean.

And the term wet markets have emerged from this to contrast with the dry markets, which meant cereal grains, you know, your rice and all that sort of stuff. So today the terminology wet market is, can be a mix. You know, it's a broader term that often lumps together, various different types of markets. It's a little bit synonymous with things like traditional markets, farmer's markets, local markets. All these wet markets, all these different versions of this, have differing food safety standards, right? And different levels of certification and different rules and regulations within their own countries. So you're right. It's really quite a broad term, but it can encompass a lot of different things and mean different things to different people and also different countries.

Adam Craig (23.40)

If you take a stereotypical, if there is such a thing, the village environment in say Southeast Asia, what role does the wet market play in the broader society of the community in which it's placed?

Anna Okello

Wet markets are central to any sort of local economy, local community. It's where people go and buy and sell their food on a daily basis. It's where people congregate. It's where they socialize. Wet markets, this sort of traditional markets where people bring their produce straight from the farm to sell. If they have excess, there's a sort of a way that lots of people, particularly for vulnerable people. If they don't have land to grow animals on or grow vegetables on, they can go and buy these products fairly cheaply because they don't have these long sort of value chains they're quite localized, all that sort of thing. So it's a really, really important, integral economic social economic system.

The other thing to sort of highlight is that again, markets can be anything from the sort of open air space where we've all seen in countries, in Asia and Africa, for example, where hawkers are sort of selling their products on the ground there. But wet markets also include, the more sort of markets that are undercover, they've got electricity, they've got refrigeration, all these types of things. So the term covers a long spectrum of different spectrum of typologies and scenarios, but essentially it all plays a role in this sort of social, cultural fabric of these communities, including in Australia.

Adam Craig (25.05)

You articulated very clearly the socio cultural importance of wet markets, that's a nice segue into the next question, which is about the biosecurity and what risks do wet markets play in biosecurity for emerging infectious diseases?

Anna Okello

Good question. I think I might start back a little bit by sort of talking a bit about what do we actually mean by risk. So it's a little bit like the market, you know, we all think we know what it means but it actually, when you come to describe it, it's quite hard to articulate. So I think a lot of the work that ACIAR does in our research in food safety and in these wet markets in countries like Vietnam, for example, it's very much what the risk actually is. When you think of disease circulating round a place where there's lots of humans and lots of animals congregating, for example, you need to make the differentiation between a hazard, which is something that can cause harm and a risk, which is the probability or the likelihood that that harm is actually going to cause a problem. Right?

So when we think about risks in wet markets, I mean, there's lots of documented risks. There's been a lot of research around a lot of diseases. So for example, the diseases I used to do research in, the sort of neglected tropical diseases we know there's food safety issues from, you know, handling of food, handling of animals, treating sick animals, cutting up veggies on the same board that you just cut your chicken up, all these sorts of things. So they're all very much defined risks that we know.

And that's just to make the point that if we don't just say what's in markets, for example, we're really just looking for sometimes hazards. What are the things that are occurring but the next step in that research is to know, okay, what are the practices that we're doing? Or what are the conditions, I guess, in these environments that would lead to actually those diseases causing a problem either in other species or in us as a species, as humans. So that's sort of, so I've talked about some of the risks in wet markets around handling animals, the hygienic preparation of food, washing your hands. All these sorts of things are fairly well known. Wet markets in particular. So for example, there's a lot of research done around the time of avian influenza when that was circulating around. In some countries in Asia there was a lot of research done on what other risk factors in a wet market situation.

So there's live bird markets, for example, and, and a lot of the research points to, yes, there's the handling and the washing and the equipment used for slaughtering, feeding these animals, watering them, handling them, all that stuff. But even risks can be upstream such as how many animals were traded that day, how many birds came new from different farms and put in the cages of birds from other farms that might not have been sold the day before.

For example, mixing species where you're getting some of these animals from even down to movement poultry through these wet markets and how quickly they're circulating through and how much of a risk is associated with that. I guess the long answer to the question is there is not sort of one type of risk. All these markets are so different and if we don't really pinpoint what the risks actually are, it's very hard for us to make recommendations that are actually going to cause an impact on that risk itself and improve human and animal health by doing so.

Adam Craig (28.35)

In your experience, what are some of the levers that actually create that process or behaviour change that's required to improve biosecurity risk or reduce biosecurity risk?

Anna Okello

That's a really important question. And you've brought up a really important point. You know, when we talk about risk, it's not just the risk actually is. It's how people that are dealing and living and working in that situation actually perceive what that risk is as well. And that has often very strong cultural and social, social backgrounds, and gender. There's quite strong gender differences between how particularly for food safety, which is area I've worked in, you know, how women perceive risks compared to how men perceive risk. You know, this is the same as what we have for health, public health issues. Like smoking, some people say the risk or perceive it to be a really bad thing to do and others smoke their whole life. So same sort of thing when we identify what these are, the next step is to really understand how people are perceiving these risks, because this is what can cause the behaviour change and improve the systems and upgrade the systems in a way that decreases the likelihood that that risk is going to be caused. So things like we do a lot of anthropological research, for example.

So I lived in Laos for three years in Southeast Asia, and I was working on a project an ACIAR funded project actually at the time around this disease that people get from pigs. It's a parasite causes epilepsy, right? It's called taenia solium, the disease that this parasite causes spread between humans and pigs. You have to address the transmission cycle at two places. There's no point just addressing it in the pigs because the people who still have it circulating in the human population and you can't just address it with the people and get rid of it that way, because the pigs still carry it. So there were really high levels of this disease in this part of Lao that we were working in. And if you visited that village, a lot of people I'm sure have been in villages in Southeast Asia, there's lots of animals around people and you know, on the surface, this village, any other village that I would have been in. But for some reason in this particular village, the, the incident, the prevalence of this parasite was really, really high. So, you know, the question not what is the prevalence, but why is it so high in this village compared to other places where we've been testing for this parasite, right? And after, you know, did all their epidemiological research looked at the risk factors? There was nothing really standing out that this group of people was doing any different in either their pigs or the way that rearing pigs or in their own behaviours until we brought a medical anthropology team in and they did a lot of sit-down sort of interviews and talked to people.

We lived in this village for like a week trying to really understand what what's causing such a high incidence. And it turned out that this was a homogenous group of a particular ethnic group in Laos. They had very, very strong tradition around the consumption of raw pork more than other groups in the same area, for example. So, you know, they were, they were eating a lot more raw pork and we know it's a factor for example, but it's just an example of how the social and the economic and the cultural perspectives and, and gender, as I mentioned before, is really important to understand, if we are actually going to address these risks. Otherwise you could just go in and get all sorts of intervention going. We worm the pigs, we get rid of the parasite in the pigs. We get rid of the parasite and the people job done. But if we can identify practice change and make the disease make sense to people or make the practice changes that we know are going to decrease the risk of that disease, make it acceptable, affordable, applicable, all these sorts of things from a whole host of sort of perspectives, then we're never going to address the disease. That goes across the board for lots of these diseases that people get from animals.

Adam Craig (32.20)

I think your example is a wonderful one, and it really highlights the need to take, in the broader sense, a One Health approach. We're not going to solve a problem, obviously by looking at it straight from a veterinarian animal health perspective, it's going to take a whole host of proponents to come together, to find solutions to these big questions. Can you tell us a little bit more about what the Australian government's doing and the response to these risks in both Southeast Asia and also the Pacific?

Anna Okello

I work for the ACIAR. So from an ACIAR perspective, we've been working in this space for almost 40 years. Looking at zoonotic diseases, looking at not just the epidemiologic perspective, how much of their diseases are circulating, but what can you do about it? As I said before, with the differentiation, I've worked a lot in this neglected zoonotic diseases. So in endemic diseases that are there day in, day out, they predominantly affect rural people, poor people. And so ACIAR has been working in that space.

We've also been doing a lot over the years in avian influenza, for example, when the epidemic was happening in Asia, we've worked a lot in rabies. So, so this Australian government, at least through ACIAR, which, which is what my direct experience of working in Australian government has been, has been spending a lot of money trying to improve, not just our knowledge of what these diseases are and how we can work with our partners in these countries to mitigate these diseases and these risks, but also understanding what are the long term sort of opportunities that we've got for working at this partnership level. Because if we think about particularly these pandemic diseases, right. They're fast moving diseases of pandemic potential. They're not just a problem in one country but can potentially affect other countries. So we all need to work together at sort of a higher level to it to address these diseases. That's what the partnership model has been doing for many years.

More recently, I see the great partnership with the Department of Foreign Affairs and Trade Indo-Pacific Centre for Health Security. We're doing a One Health program. That's a co-funded program between ACIAR and DFAT as part of the centre to really look at some of these other questions around health. Yes, there's disease surveillance and epidemiology and really good technical questions that are being answered by this research program. But then we've also got projects looking at governance and policy process analysis and legislation, and some of these other less tangible sort of things that you can see. You can see the disease circulating a lot of the time, but we can't often see the policy processes that happen behind the decision making or that sort of thing in some of these countries. So, so from a One Health perspective, all this sort of other type of social policy economic research are also really important as is the social research. So this program that we've got with DFAT at the moment under the Centre for Health Security is really looking at a lot of these questions in the region, and that's a really great program.

Adam Craig (35.10)

Wonderful. It's great to hear that there's work happening across the spectrum from policy right through to on the ground risk management work. Back to your area in food security, what sort of impact would closing a wet market if a wet market was closed in response to a biosecurity issue, what impact would that have on the livelihoods, but also the food security of local communities?

Anna Okello

I think the short answer is quite a significant impact. I suppose security and the definition of food security, which is part of ACIAR's mandate and that the Food and Agriculture Organization of the United Nations defines it is that food security is the production of sufficient, safe and nutritious food. So if you take those wet markets, you're really having a huge impact on this sort of package that we deem to be food security. You're taking away the sufficiency of the food if people are getting a lot of their food there. So a lot of small holder farmers will grow food, what we call subsistence farmers, for example, they grow rice and that's for the family to eat, but how do you get these other micro nutrients and other protein sources and these types of things they often come from wet markets or markets. For example, families who don't have the land to grow these animals or these protein products themselves. They have to kill animals because it's a bank for their kids' school fees or there's lots of reasons people keep animals.

So often these wet markets are the source of these other micro nutrients and protein and all these things that people need to have this really secure, safe and nutritious version of food. So I think there's that there's a whole food security angle, but as you mentioned before a lot of people make their daily money off selling something at the market every day. And we see it all over the countries that I've worked in.

Particularly you also have to think about the gender aspects of closing some of these wet markets. For many people informal markets is the way that women, for example, can have a little bit of economic sort of independence, for example, often women have small stock, so the pigs and the chickens. That's the thing, they can take their chickens to the market and sell them. And that money is often there to use for how they want. So I think in closing wet markets and I think everyone agrees that it's really not an option to just shut down wet markets, but that's a conversation and it's a really great conversation to be having. How do we sort of improve these markets to a point that they're still got all the good stuff about them? You know, the livelihoods contributions, food security, all these things whilst at the same time, decreasing what we know as some of these risks of, you know, some of the practices that occur in some countries.

Adam Craig (38.20)

Interesting. Thanks for bringing up the issue of gender. I think that's an interesting angle to look at. You talked about the economic empowerment and presumably there's some social empowerment that comes with being a wage earner. Is there any other gender related aspects of food security, wet markets, zoonotic diseases?

Anna Okello

Zoonotic diseases in general is really interesting to look at from a gender perspective. So I mentioned previously that around this sort of perception of risk men and women often perceive risk in quite different ways. But what we also know, from a lot of the research that's been done over the years is that women or men are affected differently by particularly foodborne disease. And I think this stems back to, if we look at a lot of practices in many countries, it's often the women that are cutting up the animals, preparing the food, all these sorts of things. So they are predominantly exposed for diseases. We know risk factors are higher if you're a woman compared to, if you're a man, for example. So I think it's important to look at the gender thing from not just a social cultural perspective, but also in terms of exposure and the practices that men do and the roles that men have compared to some of the roles that women have in some societies and what actually increases the likelihood that they are going to being exposed to these diseases and getting them more than the other gender.

Adam Craig (39.40)

The whole COVID-19 pandemic is likely going to bring a lot more focus and review of bio-preparedness globally. How do you see that playing out and what are ACIAR's medium term goals in a post-COVID world?

Anna Okello

Really interesting question. I guess the last few months have been quite hectic at ACIAR working out short term contingency plans for how we are going to manage a lot of that. We've got 250 something projects. The great thing about the partnership model is that we have people in place so that the model is Australian researchers, Australian government agencies are working with researchers and governments in country. So the great thing is that a lot of the work can continue and has been continuing.

Now that countries are starting to open a little bit, even if it isn't for travel. So I think at least till the end of this year, we've been building that into our contingency plans and thinking about how we can adapt at the agency level for that. Longer term, absolutely we've been doing a lot of thinking around what it's going to mean for food systems. ACIAR's mandate is food security. Yes, we've got a health security crisis. We don't want that health security crisis to turn into a food security crisis as the next stage, right? So there's been a lot of thinking, a lot of talking.

At ACIAR we've recently released a really rapid assessment of some of the hot spots of potential food security issues in the region. That work's going to be built on in the next couple of months. Take a bit more time to look at what are going to be the food security hotspots that not just ACIAR, but obviously a lot of international agencies are going to be thinking about and seeing if we can do things to support, making sure that people are still able to produce food, get their food to those markets, buy and sell food all that sort of thing. Whilst at the same time, keep ensuring we don't increase other disease risks by, by changing the practices that may need to be changed a little bit as a result of COVID-19. So that's very much where ACIAR has been thinking.

I think it's a really good example of again, how health security is inherently linked to food security and the agrifood systems where we grow and produce and sell that food. Because as we've seen with COVID-19 that there are this sub-questions emerging around how people are going to make sure that they keep being able to produce food and feed themselves as some of these lockdowns could go on.

Adam Craig

Anna Okello. Thank you for speaking with me.

Anna Okello

No problem, Adam. Thanks for the chat.