Contain This: The Latest in Global Health Security

WISH Fiji: Building resilient watersheds and healthy communities in the Pacific, Part 2.

November 18, 2021 Indo-Pacific Centre for Health Security: Department of Foreign Affairs and Trade Season 2 Episode 9
Contain This: The Latest in Global Health Security
WISH Fiji: Building resilient watersheds and healthy communities in the Pacific, Part 2.
Show Notes Transcript

Welcome to Contain This, brought to you by the Indo-Pacific Centre for Health Security, an initiative of the Australian Government's Department of Foreign Affairs and Trade.

This episode is hosted by Francette Dusan, Senior Advisor at the Centre. In today's episode, Francette speaks to members of the WISH Fiji Project Team. She is joined by the Chief Investigator for the project, Dr. Aaron Jenkins, Senior Research Fellow in Planetary Health at the University of Sydney and Edith Cowan University; Dr Donald Wilson, the Associate Dean for Research and Director of the new Fiji Institute of Pacific Health Research at Fiji National University; and Dr Stacey Jupiter, the Melanesia Regional Director for the Wildlife Conservation Society.

If you missed our first episode on WISH Fiji in July 2021, you may like to pause now and scroll back to listen to the previous podcast. You can find more information on WISH Fiji here:

Additionally, you can find information on the RISE Program here:

You can join the conversation on Twitter via @CentreHealthSec and @AusAmbRHS. Enjoy the episode.

Stacy: What the science is showing is that ecological degradation increases the overall risk of the emergence of these infectious diseases, and large-scale studies have supported the conclusions that large disturbances are associated with increased risk of spillover. The number of vectorborne disease outbreaks that we're seeing is negatively correlated with forest cover. So, what that means is that more forest cover, if you have more forests, it translates to fewer vectorborne disease outbreaks when you look kind of macro scale across a number of countries.

Francette  00:33

Welcome to Contain This brought to you by the Indo-Pacific Center for Health Security, an initiative of the Australian Government’s Department of Foreign Affairs and Trade. I'm your host for this episode, Francette Dusan, Senior Advisor at the Centre. 

In today's episode, I'm back talking with members of the WISH Fiji project team. I'm joined by the Chief Investigator for the project Dr. Aaron Jenkins, Senior Research Fellow in Planetary Health at the University of Sydney and Edith Cowan University, Dr. Donald Wilson, the Associate Dean for Research and Director of the new Fiji Institute of Pacific Health Research at Fiji National University, and Stacy Jupiter, the Melanesia Regional Director for the Wildlife Conservation Society. 

If you missed our first discussion with WISH team members in July 2021, you may like to pause now and scroll back to listen to the previous podcast. You can find more information on WISH Fiji and join the conversation via the links in our show notes. And if you are interested, you can also follow up on RISE Fiji, which is another DFAT-supported project mentioned in our discussion. The WISH project has succeeded in addressing water, sanitation and health issues using holistic and multi-sectoral approaches in the face of cyclones and a global pandemic. It's bringing together environmental and health sectors with communities to change behavior, reduce disease, and increase resilience. I do hope you enjoy the episode. 

Aaron, last time we spoke was about three months ago and since then the COVID-19 situation in Fiji has escalated significantly. How has it impacted your work with the watershed interventions for systems health or wish Fiji project?

Aaron  02:18

Well, thank you, Francette for again allowing us to talk a bit about our project on this podcast. Certainly, COVID has reduced our mobility significantly in country and during these periods where mobility has been restricted, obviously, we are a field work, our data collection has been somewhat curtailed. However, we have switched over for our midline for some of our midline data collection, we've switched over to phone interviews. So where possible, we're doing phone interviews with community members. And some of the questions on our surveys have also changed to deal with you know, what are the impacts of COVID on practices within the village and within communities. So there's, there's those changes. One of the things about WISH is that because we have established very good partnerships with many of the government sectors that are still active and moving around, such as the Water Authority of Fiji for example, we're still able to get some of our interventions done for our work so, so particularly like installation of new water collection and water and sanitation in the villages can still be advanced because of our partnerships with Government. 

Also, nurseries we're starting to collect seedlings, for reforestation work in the catchments that we're working in, the watersheds that we're working in. We've offered assistance to the lab for COVID testing and where possible, we've been delivering, working with the WASH cluster to deliver relief packages to the villages that we can get into or have partners that are going into the villages and then we put the packs together and make sure that they get them. Those are a few things just off the top of my head that have changed as a result of COVID.

Francette  05:07

We've really seen the importance globally of frontline health workers this year. But we know that the health workforce consists of many, many different disciplines, including the environmental health workers or WASH teams, as you discussed, and laboratory specialists. As discussed in the last podcast also, we know for cyclone responses, that it's not just health workers that need to ensure people's health and well-being are provided for. How important Aaron, is it for different disciplines to be able to work together.

Aaron 05:40

Oh, it's absolutely imperative. I think one thing that we see, and I may have mentioned this before, but one thing we see is that, that in a responsive situation where you've got a disaster, in particular, you tend to get different sectors coming together and working together more around particular problems. But then in non-disaster times, people and organizations tend to drift back into their disciplinary silos or their sectoral silos. So, I think that there are some processes that are designed for cross sectoral dialogue and problem solving, that are built around disasters. In particular, in the Fijian setting, we've seen the WASH cluster being a great example of that, and in that does provide an opportunity for cross sectoral dialogue, and it does provide us an opportunity for you know, many sectors trying to solve problems. But those particular forums, or those particular places in which cross sectoral dialogue can occur, are limited in non-disaster times. And so, what would be good is if we can  into systems at various levels of government, at provincial level at community level, that we can build these forums for, for cross sectoral dialogue and problem solving, which often don't exist,

Francette  07:40

Donald and Stacy, what's you're experiencing with this type of collaboration and encouragement of cross sectoral work?

Stacy 07:50

Sure. Hi, Francette, thanks very much for having me. I've been involved in many multisectoral committees in Fiji over the past decade or longer. One of the best examples would have been the Integrated Coastal Management Committee, which is supposed to be looking at management from the top of the mountains, all the way down through the rivers to sea, which is also what we're looking at under WISH Fiji.  And so, it brought in people from forestry, environment, waterways, health, the development and transport sectors, all coming together. And we were able to develop a framework for how to effectively do integrated coastal management in Fiji to inform how this would go out. But, the problem has been over the past decade or so is that committee really has very, met very few times. And it hasn't moved forward, because there isn't any agency with a legal mandate and the budget to actually coordinate across all of these multiple sectors, and to pull them together and make sure that they're coordinating with each other, and that their annual work plans are complimentary, as opposed to negatively impacting on outcomes from the other sectors. And I think that's what really needs to happen for us to achieve this sort of systems approach to management of the environment and for public health is that there needs to be a single agency tasked with mandate and budget to pull things together. 

Donald 09:27

I'll just follow on from what Aaron and Stacy have shared. And that is, you know, looking at your question about, for instance, Cyclone responses, and for COVID. We've experienced that again, with this pandemic. And I think it's the same picture all around the world that frontline health care workers can't do that on their own, you know. And when we went into mitigation phase of the COVID response, it needed, in addition to the frontliners, you know, the military, the police. It came to a stage where in addition to volunteers where government had to bring in just other government workers, other public servants to assist with things like just awareness about the infection, about the testing, about the vaccine, so people had to go from so these people, for instance, who worked in the Ministry of Agriculture, the Ministry of, of the Civil Service, for instance, who worked behind computers, those people had to go and do door to door, take pamphlets and do this awareness, just to support the activities of the Ministry of Health as far as trying to get to people about the pandemic. 

But then in addition to that, I think when we're looking at other emergency situations, such as cyclones, I think we've had our fair share of cyclones in the past. And the bigger one was probably, so we've had one at the beginning of 2020, that was Harold. But, even the bigger one in 2016 was Cyclone Winston. And, and again, with all the damage that we, the country sustained, obviously, you know, there needed to be a coordinating mechanism. So, the National Disaster Management Office took center t NDMO. And then all the government ministries needed to pitch in. But without this sort of a mechanism, if you know, where a government does not invest in these structures and mechanisms, I think it always spells disaster or it worsens the outcomes. So, it's only in the best interest of the populations and the communities that there is a centralized mechanism. And also, indeed for a project like the WISH project.

Francette  11:47

Thanks so much for that, Donald. We know that one of the key issues also of importance for Fiji and the Pacific and and in fact, globally, is climate change. And we also know that there's a relationship between this and expected rise in certain disease conditions. How do you work at the intersection of climate change and disease prevention at the Fiji National University?

Donald 12:14

Well, one is I think the Fiji National Development Plan puts environmental protection, climate change adaptation and resilience at the heart of our vision, the country's vision for a cleaner, greener and more sustainable future. And this is also looking at protecting our pristine natural environment, and also that our economy will be made more climate resilient. So, the Fiji National University in aligning with that, and also realizing the UN SDGs, you know, with the many components of it, our revised strategic plan of 2021 to 2026 tries to embed as one of its pillars, environmental sustainability. So that's in everything. And as an academic institution or as the National University, we’ve from 2019, developed a degree, a postgraduate diploma and a master's degree in Interdisciplinary Climate Studies. 

So that builds in the different facets, so looking at climate change as a science, but also looking at the health impacts of climate change, which is, which is a slightly difficult angle. But for the health, you know, the health angle or the health component of climate change, we're very happy that we've got these two projects, one being the WISH project, and there is another one the RISE project, but you know, they're looking at similar environmental factors. They're looking at the focus being water sensitive diseases, because these are endemic again to Fiji. These continue to burden our, you know, our health costs. And so, these are really critical for us, as a university to ensure that we are promoting, we are pushing for that agenda to ensure that we are training the health professionals so the Fiji National University, is the National University, but it also trains health professionals from the Pacific region. So, we are trying to ensure that the training that we're giving, you know, that we're providing, our programs are current, and that we are aligning to the needs and also to the global instruments and agreements. And also what we're trying to do now is, is create linkages between the research projects that happen and connect those back to the Learning and Teaching so that we are informing the training programs so that when students graduate or when they come out of the training programs, they are aware of evidence that is locally generated. So, this is from research projects that are conducted locally.

Francette  14:47

That's great. Donald, I can see that the WISH Fiji Project is an active case study for your transdisciplinary learners. And that's a very unique situation. It'd be great to see some more examples, as you said, it's really important to have those local examples and within the region. I'd like to ask you now Stacy, how you see in your regional role, thesetypes of case studies. What lessons can be learned or how could they be rolled out? Or what can the world learn from Fiji's management of these waterborne diseases alongside regular cyclones and COVID-19 as well as climate change?

Stacy 15:36

I think Fiji as a country has been both quite proactive and innovative in dealing with these kinds of triple threats of the water related diseases, the cyclones and COVID over the past couple of years. In terms of being proactive, you know, we've seen this with COVID-19, that the Ministry of Health and Medical Services launched a very rapid effort as soon as vaccinations were available to be able to roll out very quickly across the target population, and it's up over 96% of the target population has received the first dose so far. So it's, I think, one of the quickest rollouts in the world, as far as I can see, in terms of being innovative, you know, that the government has endorsed and Fiji National University has endorsed and embraced these projects, like WISH Fiji and RISE that Donald mentioned, that is really trying to work at the interface of the environment, and people, in terms of how do we look at the interactions between people and the environment when we're trying to address these public health challenges, which relate to waterborne diseases, but they're also affected by climate change.  

And so, we're trialing out these different approaches, the system's approach through WISH, where we're looking within a watershed unit, and we're undertaking different interventions at different scales, where we know both from the literature and from our own observations and practice in Fiji, that there are different either activities or human behaviors that affect disease risk. And we're trying to reduce those by taking actions at the landscape scale, at the village scale, at the individual household, and then human behavioral scale. And then with the RISE project, what they're doing is they're making some investment in new technologies through artificial wetlands, in peri-urban environments, and trying to track that over time, and see how that reduces risk. So, I think these are models and approaches that can certainly be scaled to the rest of the world.

Donald 17:49

Francette, my other hat is, you know, as in addition to the Associate Dean for Research, is Director of what's called the Institute of Health Research. And one of the things we're realizing in, you know, in this structure, as Stacy mentioned, one is, so we were happy, we established because we identified that one of the gaps for us as an academic institution, as a health training institution for the Pacific was a deficiency or a weakness in communicable disease research, infectious disease research. 

So, with that, we also identified that the infrastructure and the facilities, the resources that we had, were not able to support the Ministry of Health when it needed support, for instance, for COVID testing. You know, if we had maybe additional one or two GeneXpert machines, for instance, we could have provided that support, but we didn't. And as a National University, and indeed, as a training institution that provides training for the larger Pacific region in the South, I think we have that opportunity. But also, being able to see that we also have the capacity to be able to ensure that when such a big, you know, whether it's a natural disaster, or whether it's a pandemic, that we have the capacity to be able to respond, just like any other country would, and with our own people and with our own resources.

Francette  19:13

Thanks so much, Donald. We've touched quite a lot now on the incredible response and the analysis that's gone on to look for the gaps and key challenges that were there. Certainly, the capacity building in terms of laboratory capacity and the health workforce, as well, would very much assist with pandemic preparedness if we were to be faced with this again. I'm interested now also in taking us back to a step to how the management of the natural environment and these nature-based systems, interact you feel with pandemic prevention.

Stacy 19:55

So, I think the first thing to realize is that people have substantially altered the earth's ecosystem. So over 80% of the terrestrial marine regions on the planet are substantially altered by people and globally, only about 40% of forest areas still are reasonably intact. And what that means is that as people transform the environment, we are increasingly transgressing these catastrophic environmental boundaries where we're going to see system shifts into unfavorable states, pandemics being one of those, right? At the same time globally, we're seeing increasing outbreaks of emerging infectious diseases. Among these emerging infectious diseases, and among zoonoses 72% of those outbreaks originate in wildlife, the rest are from domestic animals and the frequency of these outbreaks, originating in wildlife, are increasing. 

What the science is showing is that ecological degradation increases the overall risk of the emergence of these infectious diseases and large-scale studies have supported conclusions that large disturbances are associated with increased risk of spillover.  The number of vector-borne disease outbreaks that we're seeing is negatively correlated with forest cover, so what that means is that more forest cover, if you have more forests, it translates to fewer vector-borne disease outbreaks, when you look kind of macro scale across a number of countries. And we've seen studies that show that following biodiversity loss, there's an increase in numbers of weedy species like rats, which are significant carriers of diseases, for example, like leptospirosis, which is particularly prevalent in Fiji. So, those are the main issues in terms of when we think about the Earth is transforming, it's coupled with this emerging infectious disease, we know there are links between transformation in the environment, and emerging infectious disease. So, this points to; we need to be looking at better environmental management in order to stem these outbreaks into the future.

Francette  22:07

Thanks so much, Stacy and I might just bring us back to Aaron now because Stacy's really summarized where the WISH program began from and many of the interventions that you're doing, Aaron. Really, it's a prevention of future pandemics, but also prevention of ongoing disease issues within the environment, such as leptospirosis, dengue and typhoid. Do you want to touch now on how you're hoping the interventions that are occurring, will bring down these three diseases in Fiji, just to wrap us up?

Aaron 22:52

So, as you know, the water related diseases that are kind of a primary target of our project are leptospirosis, typhoid, and dengue, which are known as collectively as the three plagues in the Pacific Islands, because they're so prevalent. And so, you know, there's a combination of water related and landscape related factors and environment and climate that are all driving incidents of these diseases. So, you know, in the span of our work, we’re trying to make these interventions at all those different levels and document whether or not over time, we can have an effect on the prevalence of diseases within people, but also, importantly, downstream ecosystem services. So, by acting within a watershed context, but by working to restore environments in a watershed, we can also have impact on downstream ecosystem services such as the quality of the water, such as the numbers of fishes available for people to eat, and, you know, access to things like cultural services that they may have not had access to because of degraded ecosystems. I think one of the things that just kind of continuing from what Stacy was saying, there's a whole bunch of studies, recent studies that come out that have shown that the act of protecting protected areas, and firstly conservation practice at a community level is documented as good for well-being and is good for community cohesion, and so forth.

But then, that your proximity to protected areas can actually decrease the amount of diarrhea, acute respiratory infection, and kids that tend to live in proximity to protected areas have higher weight for age, they're less likely to be stunted and there are effects of protected areas on typhoid, fever, trichinosis, echinococcosis, anthrax. So, I think there's a compelling narrative here to be managing systems as wholes and all the subcomponents within that for the multiple co-benefits that it can provide for society, including health. And so, our wish, for WISH, is to be able to have impact on both human and ecosystem health, particularly with reference to water related climate sensitive diseases, and downstream ecosystem health within the catchments, the watersheds that we’re working. Thank you.

Francette  26:13

Stacy, Donald and Aaron, thank you so much for your time. Our discussion on the WISH Fiji Program covered COVID concerns, cyclones, climate change, and most importantly, collaboration. The Indo-Pacific Center for Health Security continues to support the project alongside Bloomberg Philanthropies. 

In this episode, we have been joined by Senior Research Fellow in Planetary Health at the University of Sydney Dr. Aaron Jenkins, Melanesia Regional Director for the Wildlife Conservation Society Stacy Jupiter, and Associate Dean for Research and Director of Fiji's Institute for Pacific Health Research at Fiji National University Dr. Donald Wilson. Catch us in another fortnight for the next episode of Contain This.