How is One Health being approached in the Pacific? A conversation with Dr Salanieta Saketa

This week we continue our analysis of One Health, bringing you a discussion about how One Health approaches are being advanced in the Pacific with Dr Salanieta Taka Saketa. Dr Sala is a Senior Epidemiologist in the public health division of the Pacific community (SPC).

We discuss how priorities vary in different Pacific country contexts, the application of One Health to noncommunicable diseases, the intersection between One Health and gender and what needs to be done to strengthen the One Health approach in the region.

Dr Sala also speaks about the history of One Health in the region, and how whole of government responses to climate change-driven disasters such as cyclones have laid the foundation for using multi-sectoral approaches for disease prevention activities. 

This episode comes to you from the World One Health congress which was sponsored by the Indo Pacific Centre for Health Security. Find out more at: https://worldonehealthcongress2022.miceapps.com/client/sites/view/WOH2022

For more information on Dr Sala’s work, visit: 

• The Pacific Community Public Health website: https://php.spc.int/
• Pacific Public Health Surveillance Network: https://www.pphsn.net/

We encourage you to join the conversation at @CentreHealthSec and @WOHCongress.

Transcript

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

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. 

Dr Francette Dusan 00:17

Hello, and welcome to Contain This. I'm Dr. Francette Dusan, Senior One Health Advisor at the Indo Pacific Centre for Health Security. This week, we continue our analysis of One Health, bringing you another discussion from the World One Health Congress in Singapore. Dr. Salanieta Saketa, Senior Epidemiologist in the Public Health Division of the Pacific Community, or SPC, discusses how One Health approaches are being advanced in the Pacific. We explore how approaches vary in different Pacific country contexts, the importance of the application of a One Health approach to non-communicable diseases, and what needs to be done to strengthen One Health in the region. We hope you enjoy the conversation.  

Good morning, Dr. Sala, and I really appreciate you joining us here today at the World One Health Congress. If we'd like just to start off, I think it's great if you could introduce yourself for the audience.

Dr Salanieta Saketa 01:16

Bula Vinaka. I'm Dr. Sala Saketa, a public health physician, and also medical epidemiologist and currently working with the surveillance preparedness and response programme with the Public Health Division of the Pacific Community.

Dr Francette Dusan 01:32

Thank you so much. And Dr. Sala, why does the One Health approach resonate with you? 

Dr Salanieta Saketa 01:40

As we all know, almost 75% of newly emerging infections, are from animal to men, or zoonotics, and so we need to engage animal health people, and also environmental health people. And so if we in the public health sector are just handling those issues and those emerging problems. I think we won't be able to effectively tackle them, if we were engaging other important sectors, as I've alluded to. 

Dr Francette Dusan 02:26

So it's all about really partnerships and collaboration, utilising each other's knowledge bases to make it easier for everyone, and and have a more successful outcome?

Dr Salanieta Saketa 02:37

Indeed, indeed. When we're talking about the One Health approach really it’s just about that. It's about collaboration, coordination, and communication. I think those are the three important C's when we talk about using the One Health approach. 

Dr Francette Dusan 02:53

How do you see the One Health approach or One Health priorities differing in different country contexts? You’re yourself are working in the Pacific Community office at the moment, and you have your own country, context, and background. But what factors do you think affect the different priorities in different countries?

Dr Salanieta Saketa 03:19

Just to backtrack a bit and just to give you our background, and a context to how we are enhancing or advancing the One Health approach within the region. So way back in 2018, we held our first consultative meeting on One Health. And one of the important objective of this meeting was not only bringing the different sectors together onto the same table and into the same room, but also asking the countries to come in with their priorities of what issues or diseases that they wish to address using the One Health. So there was differing priorities identified by countries, but one that seems to be common across most countries was vector borne diseases, you know, addressing Dengue fever, Chikungunya, and Zika. Many of the countries have suffered from Dengue fever for many, many years. But Chikungunya and Zika were really newly emerging diseases or arboviral diseases within within the region. So yeah, so many, that was quite common across all countries. But then other countries particularly like Fiji, for example, prioritise the antimicrobial resistance, you know, they considered antimicrobial resistance as a really an important issue that they wish to tackle. And they think that you know, using the One Health approach because they need to engage with animal health sector, with the private sector and also with the environment sector, and academia, in terms of how best they can address antimicrobial resistance. One country, particularly in our recent work is with Samoa is that they are addressing zoonotic diseases amongst animals. And so zoonotic disease surveillance is an issue or something that they wish to strengthen, going forward in the use of One Health approach. So countries came up with their priorities, we use some tools to to identify what their priorities were, and how then we would advance that. And so subsequently, we've had other meetings, particularly the Pacific public health surveillance network meetings in 2019, and now, this year in 2022, we, of course, with our support through the phase two of COVID-19 pandemic response with the Pacific JIMT (Joint Incident Management Team), we have been able to change some funding from the EU, and work with five countries targeting their priorities, using the One Health approach. So Fiji is now advancing the work around antimicrobial resistance, while stronger with vector borne disease, surveillance using an integrated approach. And of course, Samoa is using zoonosis surveillance amongst the animal health sector. 

Dr Francette Dusan 06:31

Thank you so much, Dr. Sala. And I really like how you've sort of outlined how important it is for countries to have their own priorities and drivers and motivations to make that coming together collaboration work for them. Do you see any particular differences in what say the Pacific wants to work on with some of the other regions that have been represented at the World One Health Congress today? Do you see any differences? Or do you feel it's all quite similar in terms of how people are coming together, and what priority diseases make sense for them to work on, or issues such as antimicrobial resistance?

Dr Salanieta Saketa 07:09

One of the key takeaways which I have is the need to raise capacity. People are what they term is, One Health practitioners, I like that term. One Health practitioners within a country. And I think that's one of the things that is quite lacking in the Pacific. In the way we've been taught for human health, we've gone to medical school, and we've been taught what we have been taught. Same also for vets and also for environmental health. So they've been taught in their own siloed training institutions. And so what I would wish to see from the experiences that I've heard from other countries, to see all the different sectors coming together. Or, if they you know, even if they're being trained, that they bring in the One Health lens into their training, and to ensure that as they come out, and I think the ideal thing would be bring it down into primary school, into secondary school, even the idea around One Health as the new generation of Pacific Island people coming out, they have a fair understanding of what that means. One Health. And I think that's something that's yeah, we need to raise within not only the professional sectors and animal health, human health, environment, but also even within the community, as we saw, also, in many of the presentations that were made, generally it is the women or the children in the coalface upfront, who are facing daily, the risks that are associated with spillover events, and other being exposed to agents, microbial agents that could harm them. And so we need to engage them in all this discourse. And so I guess that's my second point about the importance of community engagement. So this is really key also in in the way we want to advance One Health. So not just with professionals, with technical people, but it's also important to engage the community. So they should understand what means what if we ask someone on the street or someone in the village, we're talking about One Health, they really should have some understanding of what that means.

Dr Francette Dusan 09:33

In an Australian indigenous context, we have a very strong, it's called connection to country, um does that exist within the Pacific Island countries? You know, this sort of ancient approach, if you like, to understanding that we're all interconnected with our land and spaces? I think this is one of the issues that's coming with climate change as well, impacting people's homes and that sense of we live in a safe place. Is that that idea, I guess, of care for country or connection to country, do you see that in the Pacific Island countries as a basis for some of these community discussions on One Health? 

Dr Salanieta Saketa 10:12

Yeah, I think it is the same, I think what happens in the indigenous population in Australia, I think it's similar to what is also in the Pacific. You know, many of the landowners are still indigenous people, within the Pacific. At least for Fiji, we have 90% are still traditionally owned land. And so the, our ancestors and our mothers and grandfathers, and grandmothers, you know, they understood what it means to be good stewards of this land, and what the trees and also the forest and what's in the sea, or what's in the river, they understand how important it is to be good stewards of that. And I think we have a lot to learn. The scientific community has a lot to learn from, from our community, maybe we're saying One Health, but you know, they already have that understanding that it's important that we live in harmony with nature, with the animals that we, that live around us. And maybe they don't fully understand that you know, some of these animals could be, you know, the vectors for for some of the microbial agents that could be harmful to them. But I think they've come a long way. For example, in Fiji, we've had cycles of outbreaks of typhoid fever, and that those have been mainly occurring, you know, post cyclones, tropical cyclones, flash flooding events, or adverse weather events, when everyone relates that to you know, climate change and what's happening around us now. So many of them, you know, have been taught and same also for leptospirosis have been taught, that these are caused by microbial agents. And often it's because of the interaction with contaminated water or with contaminated food, or inadequate sanitation or hygiene, that often can lead to transmission of this infection. So they already understand that I think, I want to think that, that the community have some understanding that your risk of getting leptospirosis, for example, would be if you're interacting with, with either with animals directly, or you're swimming in flood waters, that may be contaminated with infected urine of animals. So yeah, so that understanding that that animals, of course, you know, we just be careful with our interaction with animals and with water and all that because they could also be vehicles for transmission of diseases.

Dr Francette Dusan 12:53

That's a really great example to give of, you know, particular country contexts, I think that's very helpful. Since COVID-19, there's been a much greater acceptance, I think, of the One Health approach to particularly infectious diseases and pandemic prevention, preparedness, and response. But how do you see application as an approach to other issues such as non-communicable diseases?

Dr Salanieta Saketa 13:20

One Health is just as it is quite applicable for infectious disease, it is the same also in when we want to address common non communicable disease. And, you know, that's a still is the major burden of disease in Pacific Island population. The fact that we know we have a high prevalence of diabetes and obesity and other non-communicable diseases, One Health approach resonates and is quite applicable in addressing or tackling non communicable disease, because it’s basically a multisectoral approach, or transdisciplinary approach in trying to address a problem. Yeah, and we know that for non-communicable disease, we in the health sector cannot handle that alone, because many of the risk factors associated with non-communicable diseases in the region are associated with food, you know, with the kind of food that we are consuming. And we know that more and more of our population are consuming processed food and less, you know, the more healthier food. And so, which means we have to engage with people who are manufacturing this food and who produce food, and also in terms of trade, and all those other aspects of food systems. And so we need to engage with other sectors in how best we can address non communicable disease risk. So, yeah, so it's I think it's it's quite relevant for for not only for infectious disease, control, and response, but also for non-communicable diseases.

Dr Francette Dusan 15:02

Thank you so much, that was a really good example again. I was struck by when doing some work in Fiji about the the government's strategy for not just health, but the health and wellness concept. Would you like to talk a little bit more about how, I guess, Fiji sees wellness as being just as important as health?

Dr Salanieta Saketa 15:27

Yes, I think that's one of the, you know, the key things about wellness, I guess it goes back then to about, you know, prevention. And we've heard a lot of that too, in this One Health Congress, the importance of investing in prevention. So again, prevention is better than cure. And I think that's why the Fiji government and also the Fiji Ministry of Health, you know, is going that way in trying to encourage wellness, rather than, you know, addressing the diseases that that people are having. And so when, so there's a bit more investment in terms of, for example, we talked about a non-communicable disease. So when we talk about wellness, it means, you know, making sure that those who don't have the disease, you know, don't have, maintain that, and live a more healthy lifestyle. And so, you know, making sure looking at the kind of food that they use they’re consuming, making sure that they have access to healthy food. And the same also in terms of, you know, maintaining their weight, and making sure they have access to exercise. And so, you know, a lot of things in terms of policy, and also in terms of infrastructure that needs to be put in place to ensure that, you know, it's an enabling environment, that people can have to be able to maintain that wellbeing. So it'll be the same also, I guess, for other any other, whether it be infectious disease or any other issue that they are address, or, they think is a priority, with that notion of wellbeing, I think that's the way it is.

Dr Francette Dusan 17:05

You've mentioned already a little bit of what you've taken home from conference, but I might just ask: something that struck you as a little bit concerning in the conference? And something that gave you hope?

Dr Salanieta Saketa 17:16

Here we're talking about a One Health and multisectoral collaboration, I thought what was concerning to me, was the sort of lack of participation from the private sector, I didn't see that quite come out. There was a bit around environmental health from the Ecohealth movement, but I think also that maybe there's an area that we need to get more evidence around in terms of how environment and maintaining the environment really helps in addressing issues that countries grapple with. So I think, and for the Pacific, that's, that's really important, you know, because our environment is still you know, we still have a lot of issues in terms of our environment, in our risks, to many of the, you know, the things that we we're tackling with, both for infectious disease, and also for non-communicable disease. So we'd really like to see, you know, some of the best practices, or some of the, you know, evidence that's out there that really helps in terms of how we can address some of these issues, you know, with environmental interventions. But what really, also is quite encouraging to me, you know, just that to see, you know, that there is a will to engage from from those various sectors, in addressing issues in whether it be at country level, or regional or at a global level. So, I think the will is there, so there's a will there's a way. And so, also, apart from that, I can see also that, you know, in terms of financing, because that's also one of the things that's coming out quite clearly, the need to invest. And so, you know, it was pleasing to see, you know, how World Bank is, is, has been really quite actively engaged in the space of One Health. Others, including DFAT, the Australian Government, is quite, you know, very much investing in this area as well. Hope there'll be more philanthropics also in the Pacific who will be willing to support, you know, our issues in the Pacific region. So, yeah, that was encouraging to me. 

Dr Francette Dusan 19:45

There's certainly a global push, a regional push. Within Fiji itself, do you think that you have the national support and that, to go forward in the One Health area? And there'll be national investment in this as well?

Dr Salanieta Saketa 20:01

Yes, I think so. Even though that's kind of, you know, One Health, you know, coming out explicit in the policies, or even in the, in the regulation or the action plans of various sectors. Well, I think it's already there. Because, you know, like, for example, when when we respond to the disasters, natural disasters that have, we've suffered through, you know, tropical cyclones and floods and, and all that, it's always been multisectoral in response, so that they are familiar with that, they know that in order to be able to address that, we need every sector to come on board and be able to do their bit. So it's really just saying, you know, that's that's how it is for One Health. So if you wish to address, whether it be leptospirosis or non-communicable disease, the setup is already there, it’s just a matter of just, you know, maybe using the term One Health and so it's this is it, this is a One Health approach, being multisectoral. But of course, you need to have, make sure that you know, the policies, the goals, you know, we have to have a common goal, a common objective, and also the funding that needs to support that, that work. Just being able to have access, you know, for every sector to have access to the funding is also key. 

Dr Francette Dusan 21:24

Fantastic. Thank you so much. You've been listening to a conversation with Dr. Salanieta Saketa on how One Health approaches are being implemented in the Pacific. Contain This aims to bring you fresh insights, analysis, and updates on what is shaping the future of global health in our region. I'm Dr. Francette Dusan, and we look forward to having your company on the next episode.

Contain This is produced by the Indo Pacific Centre for Health Security. We acknowledge the Traditional Owners and Custodians of country throughout Australia and the Indo Pacific region. We recognise their continuing connection to land, waters, and community, and pay our respects to Elders past and present. You can follow us on Twitter @centrehealthsec.