Protecting Food Systems, Preventing Future Pandemics The Case for a Central Asia One Health Program © 2023 The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved. This work is a product of the staff of The World Bank. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. The World Bank encourages dissemination of its knowledge, therefore, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. All queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. Typesetting: Circle Graphics, Inc. Images: World Bank, Ospan Ali, Canva Cover image: Chorsu market in Tashkent city, Uzbekistan Source: Canva Used with permission; reuse requires additional permission. Protecting Food Systems, Preventing Future Pandemics The Case for a Central Asia One Health Program Meat market in Astana, Kazakhstan. Source: World Bank Contents Acknowledgment v Preface vii Abbreviations ix Executive Summary 1 1. Introduction 7 1.1. Objectives 12 1.2. Approach and sources of information 13 2. Main issues 15 2.1. Human population, mobility, and urbanization 16 2.2. Livestock production systems and livestock trade 17 2.3. Climate change, wildlife and ecosystem transformations 25 2.4. Public health 29 2.5. Priority zoonoses in Central Asia 31 2.6. Food safety 38 2.7. Antimicrobial resistance (AMR) 42 3. One Health in Central Asia 49 3.1. Institutional capacity 53 3.2. Epidemiological surveillance 56 3.3. Prevention and control of zoonoses, anti-microbial resistance and food hazards 59 3.4. Regional cooperation 62 4. One Health: lessons learned from implementation 71 4.1. Strengthen national and regional capacity 76 4.2. Regional cooperation 77 Conclusion and recommendations for a regional 5.  One Health program in Central Asia 79 5.1. Regional issues require a regional response 79 5.2. Now is the right time 80 5.3. A Regional One Health program in Central Asia 81 References 85 iii P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S List of boxes Box 1. A One Health (OH) approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Box 2. Key investment needs to improve animal productivity and trade, with a focus on animal health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Box 3. Key investment needs to improve the preservation of wildlife and ecosystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Box 4. Key investment needs to improve pandemic preparedness, prevention and response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Box 5. Key investment needs to improve the prevention and control of zoonoses and non-zoonotic animal diseases . . . . . . . . . . . . . . . . . . . . . . 36 Box 6. Key investment needs to improve food safety . . . . . . . . . . . . . . . . . . . . 40 Box 7. Key investment needs to control antimicrobial resistance . . . . . . . . . . . . 46 Box 8. Key investment needs for a strategic and regulatory framework . . . . . . . 52 Box 9. Key investment needs to support institutional capacity building . . . . . . 55 Box 10. Key investment needs to improve epidemiological surveillance . . . . . . . 57 Box 11. Key investment needs for One Health prevention and control programs . . 60 Box 12. Key investment needs for regional cooperation . . . . . . . . . . . . . . . . . . . 69 Box 13. The regional disease surveillance system engagement (REDISSE) in Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 List of tables Table 1. Central Asia key socio-economic indicators . . . . . . . . . . . . . . . . . . . . . . 16 Table 2. Agriculture and livestock production in the national economies of the five Central Asian countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 3. Livestock numbers in Central Asia 2020 vs 2010 . . . . . . . . . . . . . . . . . . . 19 Table 4. National livestock exports/imports, Central Asia 2019 . . . . . . . . . . . . . . 21 Table 5. Central Asia key health indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 6. Central Asia anti-microbial resistance progress indicators . . . . . . . . . . . . 44 Table 7. Central Asia One Health-relevant strategies and policies . . . . . . . . . . . . 51 Table 8. Infectious disease prevention and control objectives . . . . . . . . . . . . . . . 72 List of figures Figure 1. Central Asia livestock units by country . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Figure 2. Intra-regional trade: Total export value (left) and trade flows of live animals (right) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Figure 3. The global burden of foodborne disease (DALYS per 100,000 population) by hazard groups and by subregion for 2010 . . . . . 39 Figure 4. Main drivers of AMR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Figure 5. Central Asia Regional Economic Cooperation transport corridors . . . . . 64 iv Acknowledgment This report was prepared by a World Bank Khakimov (Agricultural Specialist); team co-led by Pierre Gerber (Senior the Turkmenistan Country office Oraz Agriculture Economist) and Anna- Sultanov (Senior Operations Officer); Elisabeth Larsen (Junior Professional and from the Uzbekistan country Officer), with contributions from Joana office Dilshod Khidirov (Senior Agri­ Godinho (World Bank Consultant), cultural Specialist), Teklu Tesfaye Francois Gary (World Bank Consultant, (Senior Agricultural Specialist), Nodira Phylum), Katinka de Balogh (Senior Akhmedkhodjaeva (Environment Animal Health and Production Officer/ Specialist), and Iqboljon Ahadjonov One Health focal point, Food and (Health Consultant). Agriculture Organization of the UN, Investment Center) and Aashima Auplish Valuable guidance was provided by (One Health Veterinary Consultant, Food the Peer Reviewers David Wilson and Agriculture Organization, Investment (Program Director, Health Nutrition Center), and Dariga Chukmaitova and and Popula­ tion, Global Engagement), Gulsumkhanum Bayazitova (World Bank Franck Berthe (Senior Health Specialist, Consultants) and Colm Foy (Editor). The One Health lead, The Pandemic Fund), team is grateful for the contributions of Sergiy Zorya (Lead Agricultural Specialist, World Bank staff members Asferachew Agriculture and Food, Europe and Abebe (Senior Environment Specialist), Central Asia); as well as by World Bank Baktybek Zhumadil (Senior Operations management: Tatiana Proskuryakova Officer), Dmitry Petrin (Senior Operations (Country Director, Europe and Central Officer, Europe and Central Asia), Asia), Naveed Hassan (Country Serge Mandiefe Piabuo (Consultant) Manager, Kyrgyz Republic), Marco and from the Kazakhstan country office Mantovanelli, (Country Manager, Azat Alkeyev (Program Assistant), Kanat Uzbekistan), Jean-Francois Marteau Kaiyrberli (Country Officer), and Talimjan (former Country Manager, Kazakhstan), Urazov (Senior Agricultural Specialist); Ozan Sevimli, (Country Manager, the Kyrgyz Republic country office Tajikistan and Turkmenistan), Tania Jyldyz Turgunbaeva (Health Specialist), Dmytraczenko (Practice Manager, Aidai Bayalieva (Environmental Specialist), Health, Nutrition and Population, Europe and Talaibek Torokulovich Koshmatov and Central Asia), Frauke Jungbluth (Senior Agricultural Specialist); the (Practice Manager, Agriculture and Tajikistan country office Julia Komagaeva Food, Europe and Central Asia), Paola (Senior Operations Officer), Mutriba Agostini (Lead Natural Resources Latypova (Health Specialist), and Parviz Management Specialist, Environment, v P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S Natural Resources and Blue Economy), and data provided by Government Jane Ebinger (Sector Leader, Sustainable counterparts in Central Asia facilitated Development, Europe and Central Asia), by the World Bank One Health National and Tazeen Fasih (Program Leader, Human Focal Points: Development, Europe and Central Asia). The Republic of Kazakhstan: Repre- The preparation of this report benefited sentatives from the National Center of from the findings of national case Public Health, Ministry of Healthcare. studies led by Mariela Varas (Livestock Specialist, Agriculture and Food, Global The Kyrgyz Republic: Representatives Engagement), Francois Gary (World from the Ministry of Health, Ministry of Bank Consultant, Phylum), and Dariga Agriculture; and the Ministry of Natural Chukmaitova (World Bank Consultant), Resources, Ecology, and Technical with contributions of the following World Supervision. Bank Consultants: Meruyert Saduakassova The Republic of Tajikistan: Represen- (Kazakhstan), Chynara Aalieva (Kyrgyz tatives from the Ministry of Health Republic), Manuchehr Goibov (Tajikistan), and Social Protection; the Ministry of Selbi Myradova (Turkmenistan) and Mayya Agriculture; and the Committee on Makhmudova (Uzbekistan). Food Safety; and the Committee for The team is also grateful for the review Environmental Protection. and advice from the One Health Turkmenistan: Representatives of Quadripartite Alliance in Europe and the Ministry of Health and Medical Central Asia; Daniel Beltran-Alcrudo Industry, the State Veterinary Service Animal Health Officer and Eran Raizman, of the Ministry of Agriculture and Senior Animal Health & Production Environmental Protection, the Ministry Officer from the Food and Agricultural of Agriculture and Environmental Organization of the UN; Peter Sousa Protection, the Ministry of Finance and Hoejskov, Technical Officer—Food Safety Economy and other relevant ministries & Zoonotic Diseases, Danilo Lo Fo Wong, and departments. Programme Manager Control of Antimi- crobial Resistance, and Sinaia Netanyahu, The Republic of Uzbekistan: Represen- Program Manager for the Regional tatives from the Ministry of Health, the Office for Europe from the World Health State Committee for Veterinary and Organization; and Mario Latini, Technical Livestock Development; and the State Assistant, and Mereke Taitubayev, Sub- Committee for Ecology and Environ- regional Representative from the World mental Protection. Organisation for Animal Health. The preparation of the report was funded Finally, the team would like to acknowl- by the World Bank’s Food Systems 2030 edge with gratitude, the information, Multi-Donor Trust Fund program. vi Preface The world economy is still recovering Prevention and preparedness based in from the COVID-19 crisis. Yet, as the pace strong and resilient health systems will of emerging infectious disease outbreaks be key. In Central Asia, countries are continues to accelerate, the next pan- coming together to put this approach demic may be closer than we think. into practice. Human activity is the main driving force behind new, emerging, and re-emerging diseases. Most pathogens that are infec- Central Asia presents tious to humans cross over from animals to people. The World Organisation for a unique opportunity Animal Health estimates that about Central Asia is particularly vulnerable to 75% of all human emerging infectious emerging infectious disease outbreaks diseases have an animal origin. Their as it is located at an intersection of emergence is linked to our interference global value chains with countries that in animals’ natural habitats, farming rely heavily on labor migration. Across practices that harm water resources and the region, animal diseases, such as biodiversity, and the intensive farming brucellosis, anthrax, and Lumpy Skin of a few domesticated animal breeds. Disease – combined with relatively Climate change will only exacerbate poor animal husbandry practices and these risks. Today, many countries rely genetics – have a detrimental impact on on short-term solutions that involve the productivity, regional food supply, and use of antimicrobials – medicines such as agricultural competitiveness. However, antibiotics, antivirals, and antifungals – it has, together with the broader region, to prevent and combat infectious a unique advantage to prevent and diseases, preserve food, and promote tackle future disease outbreaks due to animal growth. But this leads to one the shared epidemiological past of the of the world’s top global public health countries of the former Soviet Union, threats facing humanity—antimicrobial which once boasted an elaborate resistance, where bacteria, viruses, and network of antiplaque centers, research parasites adapt and no longer respond institutes, and laboratories with trained to medicines. personnel. This is why prevention, rather than Some parts of this legacy remain and cure, needs to be the global focus were further developed in Central Asian for emerging infectious diseases. countries, notably with the support of the vii P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S World Bank, the Food and Agricultural and the trade of animals and animal Organization of the United Nation, products, enhance the region’s pre- the World Organisation for Animal paredness and response to disease Health, the United Nations Environment outbreaks, and generate savings from Programme, the World Health Orga- sharing crucial information on animal nization, and the Centers for Disease and human health. Control and Prevention. As a result, the region already has a strong foundation We may be on the precipice of another for implementing One Health – a health pandemic, but the case for collaborative approach that brings ani- prevention is clear and the adoption of mal, environmental, and public health One Health is paramount. Central Asia sectors together to prevent, detect, is taking on the challenge and setting respond to, and recover from infectious an example for other regions and diseases. Central Asian countries also countries to follow. share animal species, farming systems, movement and trade patterns, and existing mechanisms for cooperation, which will help in developing a coher- ent regional response. Tatiana Proskuryakova Regional Director for Central Asia, World Bank Regional collaboration is key This report sets the tone for Central Martien van Nieuwkoop Asian countries to work together to Global Director, Agriculture and proactively prevent emerging infectious Food Global Practice, World Bank disease outbreaks. The countries in the region share three high-level objectives: stronger and more resilient health systems for pandemic prevention, food system resilience, and trade and competitiveness. Juan Pablo Uribe Adopting a One Health approach in Global Director, Health, Nutrition and Central Asia could improve productivity Population Global Practice, World Bank viii Abbreviations AAR After Action Review ADB Asian Development Bank AMC Antimicrobials Consumption AMR Antimicrobial Resistance AMU Antimicrobials Use BRI Belt and Road Initiative CAAHN Central Asia Animal Health Network CAAP Central Asia Aids Control Project CAC Codex Alimentarius Commission CAESAR Central Asian and European Surveillance of AMR CAREC Central Asia Regional Economic Cooperation CCHF Crimean-Congo Haemorrhagic Fever CDC Centers for Disease Control (United States) COVID-19 Coronavirus Disease identified in December 2019 CSOs Civil Society Organizations DALYs Disability Adjusted Life Years DTRA Defense Threat Reduction Agency EAEU Eurasian Economic Union EC European Commission ECOWAS Economic Community of West African States EID Emerging Infectious Disease EQA External Quality Assistance EU European Union EU-ECDC European Centre for Disease Prevention and Control FAO Food and Agricultural Organization of the United Nations FETP Field Epidemiology Training Program of the US CDC FMD Foot and Mouth Disease GDP Gross Domestic Product GIS Geographic Information System ix P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S GLASS Global AMR Surveillance System GPAI Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response HPAI Highly Pathogenic Avian Influenza IBCM Integrated Bite Case Management IDPIP Integrated Dairy Productivity Improvement Project (Kyrgyz Republic) IFAD International Fund for Agricultural Development IHR International Health Regulations ILM Integrated Land Management JEE Joint External Evaluation JRA Joint Risk Assessment JROA Joint Rapid Outbreak Assessments JRRT Joint Rapid Response Team KAP Knowledge Attitudes and Practice KAZ Kazakhstan KYG Kyrgyz Republic LMICs Low- and Middle-Income Countries LSD Lumpy Skin Disease MDRTB Multi-Drug Resistant Tuberculosis MERS-CoV Middle East Respiratory Syndrome—CoronaVirus MRL Maximum Residues Limit NAPHS National Action Plan for Health Security NBW National Bridging Workshop OECD Organisation for Economic Co-operation and Development OFFLU Joint OIE-FAO Scientific Network on Animal Influenza OH One Health OHHLEP One Health High Level Expert Panel WOAH World Organisation for Animal Health (founded as the OIE) PLDCA Network on Priority Livestock Diseases in Central Asia PPR Peste des Petits Ruminants PVS Performance of Veterinary Services RASSF Rapid Alert and Surveillance of Food and Feed x P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S REDISSE Regional Disease Surveillance System Enhancement program SARS Severe Acute Respiratory Syndrome SDGs United Nations Sustainable Development Goals SPS Sanitary and Phytosanitary TAD Transboundary Animal Disease(s) TAJ Tajikistan TB Tuberculosis TUR Turkmenistan UNEP United Nations Environment Programme UNSIC United Nations System Influenza Coordination UZB Uzbekistan VEE Veterinary Education Establishment VSB Voluntary Statutory Body WHO World Health Organization WTO World Trade Organisation xi Pasture in Kyrgyz Republic Source: Canva P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S xii Executive Summary Central Asian countries face major erosion and degradation of land and regional challenges: preventing and water resources. The purpose of this preparing for future pandemics; document is to assess the basis for improving food-system resilience; and supporting regional and cross-sectoral addressing new opportunities and cooperation towards a One Health threats associated with increasing approach in Kazakhstan, the Kyrgyz animal production and transborder Republic, Tajikistan, Turkmenistan and movements of animals and animal Uzbekistan. It reviewed: products. These common challenges i. Gaps in knowledge and capacity are high on governments’ agendas hampering national and regional and demand regional collaboration cross-sector cooperation activities to develop prevention and control for pandemic prevention and systems on a scale that single-country preparedness, prevention and strategies are unable to achieve. control of zoonoses and AMR, The signing of the Joint Communique and promotion of food safety, ‘Protecting food systems, preventing while ensuring ecosystem health; future pandemics in Central Asia’ ii. Areas of potential national confirms the Central Asian countries and regional cross-sector recognition of One Health as a cooperation; and potential approach to addressing iii. The relevance of developing a regional challenges through increased Regional One Health program in Central Asia. collaboration across sectors including agriculture, environment, health, and The assessment of the prospects for veterinary services. The signing of the further implementation of a One Joint Communique on November 14, Health approach in the region iden- 2022, affirmed the commitment of the tified interest and advanced levels governments of Kazakhstan, Kyrgyz of readiness to further implement a Republic, Tajikistan, Turkmenistan, and One Health approach in the region. Uzbekistan to continue to adopt a The assessment involved literature technically and economically justifiable reviews, country case studies and One Health approach to prevent, dialogue with national stakeholders, prepare for and respond to regional including high-level meetings with vulnerabilities to pandemics, zoonoses, Ministers and Deputy Ministers from food hazards, antimicrobial resistance the Agriculture, Health and Environ- (AMR), climate change, biodiversity ment sectors, and representatives 1 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S from international partner organiza- Livestock-sector productivity is still tions. Counterparts expressed great low in the region and the region as interest in engaging in a dialogue a whole is a net importer of animal about implementing a One Health products and live animals. This is approach at national and regional levels. despite the net positive trade balances The assessment also verified that of Kazakhstan and the Kyrgyz Republic elements of the One Health approach in the sector and the potential for are already in place, although imple- production growth, given the natural mented unevenly across countries and resource endowment of the region. sectors, and in need of further support Animal diseases, such as brucellosis, to reach full effectiveness. echinococcosis, foot and mouth disease (FMD), and lumpy skin disease (LSD) – COVID-19 emphasized the urgent combined with relatively poor animal need for pandemic preparedness and husbandry practices and genetics – have the prevention and control of infec- a detrimental impact on productivity tious diseases and drug resistance. and, thus, on regional food supply and The economic impact of the pandemic production costs. They also negatively will continue, compounded by a affect human health and the efficiency relatively high prevalence of zoonoses of the use of natural resources in animal in livestock, domestic animals, and production, which aggravates land the human population. Central Asian degradation and increases greenhouse countries’ food safety controls and gas emissions. Disease prevalence compliance with the main food safety further limits the capacity of animals and principles and mechanisms vary across livestock systems, in general, to cope the region. Antimicrobial drugs are with the effects of climate change. widely used to treat people and in livestock and plant production, including Central Asia’s future as a supplier for animal disease prevention and of agri-products and livestock will growth promotion and to prevent and depend on how food producers and cure crop diseases, while regulations processors in the region respond vary across the region. This is likely to the increased quality and safety to lead to drug resistance and to fuel demands of consumers, and on how future epidemics and pandemics well countries coordinate with each affecting the region. In addition, land other to improve standards. The degradation and water scarcity are development of regional networks, and widespread and will be aggravated the proximity of demanding markets, by climate change, with consequent opens opportunities for the trade in live effects on agricultural production and animals and animal products. However, risk of spillovers to animal and human the international trade of food products health. from Central Asian countries to countries 2 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S with efficient rapid alert systems is still includes Central Asia, underlining the limited. Trade costs are high due to need for concerted action. In 2019, complex topography, long distances, low six pathogens were each responsible economic density, and fragmented trade for more than 250,000 deaths asso­ regimes. In addition, the prevalence ciated with AMR: E coli, S aureus, of internationally reportable diseases K pneumoniae, S pneumoniae, (zoonoses and other transboundary A. baumannii, and P aeruginosa. diseases) and AMR, poses significant barriers to competitive trade in livestock These challenges take place against and animal products. This adds to the a backdrop of renewed attention to already limited competitiveness of the persistent poverty and a renewed sector because of poor biosecurity, focus on inclusion, on resilience and the indiscriminate use of antibiotics, lack on addressing food insecurities. Since of coordination between border control 2020, the Central Asian regional economy services, non-compliance with sanitary has suffered from two major adverse and phytosanitary (SPS) standards, shocks—the COVID-19 pandemic and outdated knowledge and legislation, the war in Ukraine. Long-term growth and poor laboratory capacity. and investment prospects could be dampened by persisting geopolitical The AMR burden of disease in Central tensions and political instability in the Asia is being driven by the misuse of wider region of Europe and Central antimicrobials, including for growth Asia. The triggered imposition of wide enhancement in the livestock sector, sanctions on Russia, due to the inva- poor biosafety and animal health stan- sion of Ukraine, is expected to have a dards, and substandard food hygiene, sizeable impact on economic activity all of which contribute to the spread that could eventually impact migrant of new infectious agents and AMR. workers from Central Asia in Russia, The 2019 Global Burden of Disease whose remittances are a substantial study estimates that in Central Europe, source of income in the region. While Eastern Europe and Central Asia, an the impacts of war on the livelihoods expected annual average of 17.6 deaths of migrant workers and thus remit- per 100,000 (11.7–25.3) can be directly tances have so far been less severe attributed to AMR, while an average than anticipated, they add to regional of 67.7 deaths per 100,000 (45.4–96.6) increases in food prices with reported can be indirectly linked to AMR per food insecurity being currently largely year. Data from the Central Asian and linked to affordability concerns. Food European Surveillance of AMR (CAESAR) security and the competitiveness of network shows that resistance to priority the agriculture and livestock sectors AMR pathogens is widespread in the are likely to be further impacted by WHO’s entire Europe Region, which increasing prices for inputs. 3 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S Managing global health risks requires and coordinating policies, regulations full cooperation nationally, regionally and information relating to trade and and globally between the animal, to animal, environmental and public environmental and public health health, as well as co-investing in infra- sectors. One Health is a collaborative structure, among other actions. approach that brings these sectors together to prevent, detect, respond Regional collaboration forums exist to, and recover from infectious and can serve as bases to develop diseases, aiming at improving global mechanisms for addressing the chal- health security and achieving gains in lenges faced by regional food systems, development. This approach addresses health, and economic infrastructures. the root causes of the issues and is thus Regional cooperation platforms include critical for achieving targets under the the Central Asia Presidential meetings, UN 2030 Agenda for Sustainable the Commonwealth of Independent Development and the related Sustain- States (CIS), the Eurasian Economic able Development Goals (SDGs). One Union (EAEU), and the Central Asia Health has been a useful approach in Regional Economic Cooperation Pro- other regions that have adopted it and gram (CAREC). None of these platforms where it has proved to be cost-effective. has yet developed sufficient One Health approaches to enable the region to Cross-country and national inter- significantly confront the challenges of sectoral collaboration are already pandemic preparedness and building underway, for example, to harmonize resilience to the threats associated with legislation on food safety, on control­ increased regional movement and trade ling wildlife migration or in relation in animals and animal products, and to to the livestock trade. Achieving the impacts of climate change and other further health and economic improve- environmental challenges. ments would require, (i) studying the economic and health constraints The economic case for investing in One to livestock productivity and trade in Health is compelling. Refocusing on Central Asian countries, (ii) reducing curative and reactive approaches to internal trade barriers and synchronizing investment in One Health systems and procedures for moving commodities the prevention of zoonotic diseases, food and products across Central Asian safety, AMR, and future pandemics, countries’ regional borders into China, can offer significant economic returns. the Middle East and the European Union A World Bank cost-benefit analysis (EU), (iii) facilitating the cross-border flow showed that investments by the of goods and services to increase market international community of US$1.9 to size and make the region more attractive US$3.4 billion per year (depending on to foreign investors, and (iv) harmonizing whether disease prevalence is low or 4 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S high) in One Health systems will result a risk to national, regional, and global in an annual expected rate of return health security. Policy development between 44–71% and prevent half and harmonization, epidemiological or all mild pandemics. The baseline and environmental surveillance, and annual expected loss in global national building institutional and professional income from viral zoonotic disease out- capacity for adequate prevention and breaks is US$212 billion, suggesting that control of zoonoses, avoiding food primary prevention could cost a fraction hazards and reducing AMR are further of the cost of response. Additional areas that would benefit from improved added value can be expected from a cooperation. A key requirement for a regional collaboration between animal, One Health approach is capacity devel- human and environmental sectors. For opment at all levels and within all skill example, 50% of AMR costs are avoided sets. There is a clear need for manage- by vigorous containment efforts across ment expertise, but also for technical different sectors, and investment costs development and education, among of US$0.2 trillion would reap between health and veterinary professionals and US$10 trillion and US$27 trillion in specialists. Funding is needed for animal expected cumulative global benefits identification and traceability, effective by 2050. The infrastructure put in place information management systems and in Central Asian countries to address knowledge distribution throughout the Highly Pathogenic Avian Influenza offers region, as well as the establishment of a further example of significant oppor- modern laboratories and training. tunities for economies of scale when A comprehensive response to imple- focusing on other species or health menting a One Health approach will issues; support services for human and only be possible through regional laboratory capacity can often be shared. high-level commitment and coordi- Lessons learned from the operation- nated action, in collaboration with alization of One Health approaches in international public and private part- other regions show that investments ners. The successful implementation of in dialogue and institutional capacity a One Health approach will depend on at the regional level need to be the commitment of the Central Asian complemented by building national countries and coordinated support resources. The exchange of knowl- from international organizations, multi- edge, information, and lessons learned lateral and bilateral donors, and other from action at the national and regional development partners. While Central levels condition how Central Asian Asian governments would ensure countries will be able to come together national ownership and technical and to address environmental, public financial sustainability of a One Health health and veterinary issues that pose regional initiative, international partner 5 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S organizations, including The World of decision makers and technical staff Bank, the Quadripartite (FAO, WOAH, (e.g., epidemiologists, veterinarians, UNEP, and WHO), and other partners and environmental specialists) from the may be asked to consider providing three operational sectors. coordinated support. Defining One Health governance A Central Asia One Health Framework structures for the implementation of Action will provide the direction of national and regional activities is and coordination mechanisms for envisaged to drive the implementa- regional cooperation to address needs tion of the Central Asia One Health for pandemic prevention and pre- Framework of Action forward. The paredness, prevention, and control of governance arrangements will be zoonoses and AMR, and food safety. formalized in a regional platform for With the signing of the Joint Commu- coordination of animal health, public nique “Protecting food systems and health, and environmental health preventing pandemics in Central Asia” in Central Asia; defining national on November 14, 2022, the five Central and regional mechanisms for col- Asia countries affirmed their commit- laboration, including (i) convening ment to a regional response to shared and coordination activities between current and emerging threats to public sectors and countries and with global health, food security and competitive­ and regional international partner ness. The Central Asia One Health organizations active on One Health; Framework for Action, which is under (ii) development and harmonization preparation, will be a practical tool for of policies and legal frameworks; supporting cooperation and invest- (iii) development of knowledge through ment in the region. The framework joint research; and (iv) capacity build- will identify key work areas, potential ing, including modern infrastructure coordination mechanisms and a moni- and training. It will develop and toring framework. The development of operate a harmonized monitoring the Central Asia One Health Framework and evaluation mechanism, including for Action is expected to support targets, indicators and evaluation and regional dialogue between networks reporting processes. 6 1. Introduction Central Asia has made much prog- the countries’ natural resources with ress in public health and animal significant impacts on biodiversity, health in the last 20 years but was as livestock production, and animal and unprepared as other regions in the public health through the spread of world to respond to the COVID-19 zoonoses. Climatic and environmental pandemic. The region also faces changes have accelerated the rate challenges from other emerging of emergency of controlling zoonotic diseases, re-emerging diseases1, and diseases because rising temperatures climate change. COVID-19, which is increase the risk of transfer of vectors likely to have had an animal origin, of human and non-human pathogens has caused over 18,000 deaths and and reservoirs. Vectors and reservoirs about two million cases in Central can be dispersed through trade Asian countries. Zoonoses2 are still and migration. Deforestation results very prevalent in the region, especially in movement of animals closer to brucellosis and echinococcosis, which human populated areas as well as an indicates active interfaces between increased interaction with livestock, humans, animals, and ecosystems. which also increases the risks of Livestock represent between 26% and disease transmission through novel 54% of agricultural GDP in most of the microbial pathogens (Mishra, Mishra countries (Robinson 2020). According and Aurora 2021). to the International Union for Con­ser­ vation of Nature (IUCN) drylands in Since 2020, the Central Asian Central Asia are among the most rapidly regional economies, as the rest of degrading and climate-vulnerable the world, have faced two shocks— areas in the world (2019). The region the COVID-19 pandemic and the is increasingly exposed to intense war in Ukraine. Despite these shocks, weather events and natural disasters Central Asia seems to experience only that further degrade the lands a relatively small slowdown of growth (Bosquet 2019). Climate change is forecast to increase moderately from expected to worsen the conditions of 3.7 percent in 2022 to 3.9 percent in 1 Emerging and reemerging diseases are infectious diseases that are newly recognized in humans, newly appearing in a different population or geographic area, affecting many more people and/or that have developed new attributes (e.g., resistance or virulence). 2 Zoonoses are communicable diseases that are transmitted from animals to humans. Most endemic and infectious diseases in humans have an animal origin, and can be transmitted directly or indirectly, through vectors, water, or food. 7 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 1. A One Health (OH) approach One Health is an integrated, unifying approach that aims sustainably to balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent. The approach mobilizes multiple sectors, disciplines, and communities at varying levels of society to work together to foster well- being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, acting on climate change, and contributing to sustainable development (OHHLEP 2021). 2023 and further to 4.3 percent in 2024 linked to affordability concerns (World Bank 2022a). Long-term growth (UK Aid Direct and World Bank 2022). and investment prospects could be Food security and the competitiveness dampened by persisting geopolitical of the agriculture and livestock sectors tensions and political instability in the are likely to be further impacted by wider region of Europe and Central increasing prices for inputs (World Asia. The triggered imposition of Bank 2022b). wide sanctions on Russia, due to the invasion of Ukraine, is expected to have Animal diseases do not respect a sizeable impact on economic activity borders and remain a public health that could impact migrant workers concern because of the possible from Central Asia in Russia, whose transmission of pathogens to humans. remittances are a substantial source of They can spread quickly from one income in Tajikistan, the Kyrgyz Republic country to another, with impact on and, to a lesser extend Uzbekistan. animal health, trade, food security, While the impacts of war on the live- food safety and possibly creating lihoods of migrant workers and thus public health emergencies. The World remittances have been less severe Organisation for Animal Health (WOAH) than anticipated, they add to regional estimates that about 75 % of all human increases in food prices with reported EIDs have an animal origin, and are food insecurity being currently largely thus zoonoses, and that out of the 8 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S five new human diseases that emerge have become infected after contact each year, at least three are of animal with infected humans. Before COVID-19, origin (Jones, et al. 2008).3 The pace which may have killed between 5 million of emergence of infectious diseases of and 19 million people worldwide, animal origin has accelerated over the some of the largest outbreaks in past 70 years, driven by conversion of the 21st century included the 2003 natural habitats into land for agriculture, SARS pandemic, the 2009 Swine Flu urbanization, increased loss of bio­ H1N1 pandemic, the 2014 Ebola diversity; and climate change. This has epidemic, and the 2015 Zika epidemic. increased interactions between animals Every year, 2.5 billion people in devel- and humans, and hence offered more oping countries are infected by diseases opportunities for infectious diseases with origins in animals (zoonotic) and to emerge. Trade, free movement of 2.7 million die as a result (Gebreyes, people, and environmental changes et al. 2014). These diseases had caused by agricultural and urban staggering socio- economic costs, expansion lead to greater human-to- estimated to range from US$7 billion human and human-to-animal contact for Zika, US$10 billion for Ebola, and increasing the likelihood of diseases $30 billion for the H5N1 Avian Influenza spreading. pandemic to over US$10 trillion for COVID-19 (Morand 2020). As with other emerging and re-emerging diseases and pandemics Central Asia is at a crossroads for of animal origin, the COVID-19 pan- humans and animals through regional demic has brought into sharp relief trade and migration routes that facili- the urgent need for increasing epi- tate the emergence and transmission demic prevention and preparedness, of new pathogens, which raises the improving health and food safety and urgent need for improving pandemic socio-economic impacts. COVID-19, prevention and preparedness. The which is an EID with a likely animal origin, livestock population is increasing in is now considered a reverse zoonosis, the region. Central Asian countries as animal species (dogs, cats, zoo share regional vulnerabilities, especially animals, farmed mink, wild deer, etc.) intense cross-border movements 3 A zoonotic agent may be a bacterium, a virus, a fungus or other disease agent. Old zoonoses are epidemic and endemic human infections with a temporally distant non-human source (e.g., common cold and measles); established zoonoses are non-human infectious diseases occasionally transmitted to humans (e.g., rabies, monkeypox); recent zoonoses are new infections with a recent non-human source (e.g., HIV); new and emerging zoonoses are infectious diseases with a non-human reservoir host that have only recently spread, or been observed to spread, to humans (e.g., hantaviruses and Ebola); and parazoonoses are epidemic or endemic infectious diseases in humans that change in virulence after an input of genes from non-human pathogens (e.g., antibiotic resistance transferred from animal to human bacteria or genomic reassortment in influenza A virus or rotavirus). 9 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S of people and animals, and have to management, with negative economic deal with the impact on human and impacts from endemic and emerging animal health of international transport zoonoses, unsafe food, and AMR. corridors, wild bird migratory flyways, SPS standards to protect humans, climate change and land degradation. animals, and plants from diseases, Transboundary corridors between pests, or contaminants are unevenly Central Asian countries are land deployed, and are poorly coordinated. degradation hotspots, with regional Pooling resources in a targeted manner impacts on deforestation and low would lead to economies of scale and land productivity, increased risk of would enable countries to address animal-human diseases, poor livestock common problems across systems in a productivity, and increased poverty. As targeted manner without unnecessary a result, these countries share common duplication. The World Bank’s Global issues, such as pandemics and other Program for Avian Influenza (GPAI) transboundary diseases4, zoonoses and supported countries in their efforts to antimicrobial resistance (AMR), which deal with avian influenza in animals pose barriers to trade of livestock and and to prepare for a possible human animal products and competitiveness. flu pandemic through a global funding Zoonoses are still very prevalent in program. Investments were made in the Central Asia and are expected to Kyrgyz Republic (2006–2011), Tajikistan increase due to climate change. (2006–2010), Turkmenistan (2007–2010) Very little is known about the role of and Uzbekistan (2007–2009) to improve wildlife in the spread of some of these veterinary services made in the response diseases and more research is needed to Highly Pathogenic Avian Influenza for outbreak investigation in the region. (HPAI) as well as interagency responses Kazakhstan and the Kyrgyz Republic and coordination mechanisms to insure have the capacity and the ambition to effective collaboration among the export live animals and animal products. health, environment and agriculture However, animal productivity and animal sectors. The infrastructure put in place health management capacity are low. to address HPAI in poultry has offered significant opportunities for economies Central Asian countries are faced of scale when focusing on other livestock with poor animal, human, and envi- species. The GPAI has offered countries ronmental health, and public sector a method for intersectoral collaboration 4 While the terms transboundary animal diseases and zoonoses are often used interchangeably, they are not mutually inclusive. Transboundary animal diseases (TADs) are livestock and wildlife diseases that have the capacity to expand over large geographical areas and country borders, with significant economic impact. This is due to virus characteristics and environmental conditions, and occurs through animal movement across territories, by land or air. African swine fever, avian influenza and foot and mouth disease are classical examples of transboundary diseases. Avian influenza and, to some extent, brucellosis, are also transboundary diseases, but not all zoonoses are transboundary by nature. 10 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S to better coordinate a response in case appropriately into financed projects. of zoonotic disease outbreaks. It outlines activities and interventions to target disease threats and highlights One Health is an approach that allows mechanisms for institutional and tech- for addressing human, animal, and nical implementation to build more col- ecosystem health issues through laborative veterinary and public health intersectoral action, to prevent, systems (Berthe, et al. 2018). This has detect, respond to, and recover from been strengthened by continuous infectious diseases, with an endpoint global operational experience address- of improving global health security ing successive crises of the HPAI, the and achieving gains in development. Ebola Virus Disease and most recently Some Central Asian countries have the COVID-19 pandemic. In 2020, adopted a One Health approach, with the World Bank adopted a Regional some of them offering field epidemio- Engagement Framework for Central logical training programs that explicitly Asia as a first step to increasing efforts include animal health professionals, and to support a locally driven process of having mechanisms for sharing data deeper economic cooperation within among relevant ministries for human, Central Asia and across Eurasia animal, and wildlife surveillance. (Burunciuc 2020). Emergency operations in response to COVID-19 have proven The World Bank has been actively useful in establishing regional networks engaged in Central Asia for over two to coordinate risk management in decades and is well-placed to act as the event of transboundary disease a convener able to provide regional outbreaks. In livestock and agriculture, program-design expertise and imple- Central Asian countries and the World mentation support for a One Health Bank can build on initiatives such as the program. The World Bank has worked Integrated Dairy Productivity Improve- for over a decade to promote and ment Project in the Kyrgyz Republic operationalize One Health approaches and the Livestock Sector Development supported by country partners, technical Project in Uzbekistan. Both address institutions, international organizations, weaknesses in public and private veter- and donors. In 2018, the World Bank inary services to improve animal health, adopted a One Health: Operational which can provide a better understand- Framework for Strengthening Public ing of emerging infectious diseases and Health Systems at the Human-Animal- address the root causes of how these Environment Interface to offer guidance spread and support platforms for One to apply a One Health approach to Health implementation. The current ensure sector- and country-specific World Bank portfolio in Central Asia action targeted to address the specific of nine One Health-relevant projects One Health issues and is integrated amounts to US$886 million, including 11 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S livestock and agriculture projects that through the increased collaboration include One Health approaches, and across sectors, including agriculture, One Health-oriented projects that focus environment, health, and veterinary entirely on reducing the risk of emerging services. The assessment includes: health threats (Burunciuc 2020). i. Areas of potential regional The signing of the Joint Communique cross-sector cooperation on ‘Protecting food systems, preventing prevention and control at future pandemics in Central Asia’ the source of public health confirms the Central Asian countries issues of zoonotic nature recognition of One Health as a (e.g., endemic and emerging potential approach to addressing infectious diseases, AMR, regional challenges through increased foodborne diseases); collaboration across sectors including ii. Gaps in knowledge and agriculture, environment, health, and institutional capacity; and veterinary services. The signing of the iii. The relevance of developing Joint Communique on November 14, a Regional One Health 2022, confirmed the commitment of program in Central Asia. the Governments of Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan and The findings of this report will support Uzbekistan to continue to adopt a the preparation of the Central Asia technically and economically justifiable One Health Framework for Action One Health approach to prevent, by providing recommendations prepare for and respond to regional for activities which can be further vulnerabilities to pandemics, zoonoses, supported through public spending, food hazards, AMR, climate change, private investments, and other biodiversity erosion and degradation financial resources. The governments of land and water resources. A Central of Central Asian countries, the Quad- Asia One Health Framework for Action ripartite Alliance for One Health (the will guide and support this process. Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO), 1.1. Objectives the World Organisation for Animal Health (WOAH), the United Nations In close cooperation with national Environment Programme (UNEP), and regional stakeholders, this work international financial institutions and assesses One Health as a potential development banks have been working approach to addressing emerging to mainstream One Health approaches food, health, and environmental in national policies and investments so issues in the Central Asia Region that the region is better prepared to 12 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S prevent, predict, detect, and respond Tashkent, identified the need for further to global health threats and promote investments to strengthen national and sustainable development. This effort regional cooperation to prevent and takes place in the context of the global control outbreaks and epidemics of dialogue on One Health facilitated by animal origin, identify and reduce the the G7 and G20 leaders’ group, the incidence of AMR, and to improve food preparation of the International Treaty safety. In-country consultations with for Pandemic Prevention, Preparedness, stakeholders—Ministries of Agriculture/ and Response, as well as the launch of Veterinary Services, Environment/Natural the Quadripartite Alliance for the One Resources, Public Health, and Finance, Health Joint Plan of Action to address as well as, academia, private sector health threats to humans, animals, representatives, civil society organiza- plants, and the environment. tions (CSOs), and international organi- zations working on OH at the country and regional level—have informed the analyses through information on: 1.2. Approach and ◾ The current situation of zoonoses, sources of emerging infectious diseases, AMR, information food safety, land degradation and biodiversity issues. This note incorporates information on ◾ Communication and collaboration livestock production and productivity, mechanisms between stakeholders zoonoses and food-borne diseases, at national and regional level. and AMR in Central Asian countries ◾ The benefits and challenges asso­ collated from country case studies ciated with the development of a and country consultations with stake- One Health approach to address holders. Initial country case studies, health threats at the animal-human- carried out in 2022 and discussed at environment interface in the regional a regional workshop in July 2022 in context. 13 Flatbread sold on a market in Bishkek, Kyrgyz Republic. Source: Canva 2. Main issues Central Asian countries face similar urbanization. As increased oppor- vulnerabilities, drivers, and risks tunities for agriculture and livestock of outbreaks of zoonotic diseases, exports will bring many benefits for transboundary diseases, foodborne regional countries, they also pose an hazards and AMR that pose barriers increased risk of infectious diseases. to trade of livestock and animal Weather conditions and climate change products and to regional competitive- in the region influence the region’s ness. Human and animal mobility across agriculture and limit livestock produc- borders and regional transport corridors tivity. Land degradation, which also and urbanization, together with changes increases the likelihood of zoonoses, is in climate and the ecosystem, make particularly prevalent in border areas. these countries more vulnerable to Transboundary corridors between circulating pathogens and more at risk Central Asian countries are land degra- of outbreaks of infectious diseases. dation hotspots, with regional impact Intensified livestock production and on deforestation and low land and trade, and increased proximity of animal productivity, increased risk of humans, livestock, and domestic animals animal-human diseases, and increased to wildlife, coupled with limited inter­ poverty. sectoral action between animal, environmental and health management These countries thus share similar systems are some of the regional risks of pandemics and transboundary drivers of zoonoses, food hazards and animal diseases, zoonoses, food AMR. Factors such as economic and hazards and AMR. Zoonoses are still social inequalities and gender disparities very prevalent in Central Asia and are further compound these risks. expected to increase due to climate change. However, there is limited data About half of the population live on cases among animals and no infor- in close contact with livestock and, mation on the spread of these diseases as urbanization grows, there is an from animals to humans. Assessing increased risk of disease outbreaks. the magnitude of AMR in the region Services, such as water and sanitation also remains a challenge due to a lack and energy, have not kept pace with of adequate animal and public health the rates of population growth and surveillance systems. 15 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S 2.1. Human less than $6.85 per day for 2021 is: 16.70 % in Kazakhstan; 66.35 % in the population, Kyrgyz Republic; 51.10% in Tajikistan; mobility, and and 21.49% in Uzbekistan5. There is limited information about Turkmenistan. urbanization Table 1 summarizes key socio-economic indicators for Central Asia. Central Asia’s population of almost 76 million is young, with a median About half of the Central Asian age of 27.6 years. The Central Asian population live in rural areas and are population has continued to grow, but in close contact with livestock, from density is still low at about 19 inhabitants which they depend economically, and per km2. According to World Bank staff are therefore exposed to zoonoses— estimates using 2021 official survey data, including emerging and reemerging the percentage of people living under diseases—and pandemics, as well the international poverty line of lower- as to food contamination and AMR. and middle-income countries living for Politically and socially, the region is TABLE 1. Central Asia key socio-economic indicators Poverty ratio (estimated % of 2021 Unemployment, Official population total (% of total Human Capital development living on labor force) Population GDP per capita Index (scale 0 assistance less than (national Country 2021 (current US$) to 1) 2020 as % of GNI US$3.65/day)6 estimate) KAZ 19,000,988 10,373.8 (2021) 0.63 0.0 (2021) 0.4 4.9 (2020) KYG 6,691,800 1,276.7 (2021) 0.60 6.0 (2021) 17.7 4.1 (2021) TAJ 9,750,064 897.0 (2021) 0.50 5.2 (2021) 14.6 6.9 (2016) TUR 6,341,855 7,344.6 (2019) NA 0.1 (2019) NA 4.0 (2010) UZB 34,915,100 1,983.1 (2021) 0.60 1.6 (2021) 5.37 5.3 (2020) Sources: The World Bank Open Data: https://data.worldbank.org/ Accessed 25 May 2023 5 World Bank estimates based on 2021 official survey data. 6 World Bank estimates based on 2021 official survey data. 16 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S fragile. Although rapid economic is one of the main drivers for EIDs. At growth over the last two decades has the same time, urban areas are expe- lifted millions of people out of poverty, riencing very high levels of pollution uneven prosperity, restricted mobility, with substantial health impacts, lower and degraded land resources have productivity, an impact on the wider created yawning gaps between thriving economy and the decline of biodiversity and struggling areas. The region is (Center for Economic Research 2013). also vulnerable environmentally and climatically, inducing a vicious cycle of land degradation, water scarcity, pollu- 2.2. Livestock tion, and sedimentation, and increased production natural disasters. The resulting loss of arable land particularly affects the rural systems and poor and their livelihoods. livestock trade As urbanization grows there is an The region is sparsely populated with increased risk of disease outbreaks. large areas that are either too arid The region has relatively low rates of or at elevations too high to support urban density with more than 50% of human life. For most of the Central Central Asia’s population living in rural Asian population, livestock is econo­ and often remote areas (Table 2). How- mically and socially important and the ever, current trends of demographic urban population remains connected growth, migration and industrialization to its rural origins for leisure, securing in Central Asia will result in continued traditional foods and participating in population growth in urban areas and social and religious events organized cities, especially the small and medium- around animals in the countryside. sized ones. Greater concentration of Although Tajikistan has the highest pro- population, production and cultural portion of the population (72.5%) living life is expected in large cities (Center in rural areas and has the highest level for Economic Research 2013). Services of employment in agriculture (43%), have not kept pace with the rates of livestock appears to have the lowest population growth and urbanization. share of GDP (26%) compared to the As water supply and sanitation systems other Central Asian countries. Access and services are generally poor in to veterinarians varies in the region with Central Asia, especially for the most Kazakhstan having the highest number vulnerable, this can be a critical deter- of veterinarians per 100,000 people with minant of infectious disease susceptibil- a score of 223.26 compared to 40.09 in ity. The resulting increased interactions Uzbekistan and 44.63 in Turkmenistan, between livestock, wild and domestic numbers are not available in the Kyrgyz animals, people, and the environment Republic and in Tajikistan (Table 2). 17 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S TABLE 2. Agriculture and livestock production in the national economies of the five Central Asian countries % livestock in total value of Number of Rural population % employment in % GDP from agricultural veterinarians per (% of total agriculture of total agriculture, forestry production 2016 100,000 people 2020 Country population) 2021 employment 2021 and fisheries 2021 (Robinson 2020) (Bell and Nuzzo 2021) KAZ 42 15 5 (2021) 38 223.26 KYG 63 17 14.7 (2021) 48 N/A TAJ 72 43 24 (2020) 26 N/A TUR 47 22 10.8 (2019) 54 44.63 UZB 50 24 25 (2021) 37 40.09 Sources: The World Bank Open Data: https://data.worldbank.org/ Accessed 25 May 2023; Robinson 2020; Bell and Nuzzo 2021 The Central Asian livestock popula- feed insufficiency, snow and/or cold, tion is increasing but agriculture’s and to take advantage of natural contribution to GDP varies. In 2020, forage surpluses in other areas. Later, Uzbekistan had the highest contribution under collectivization, livestock move- (25,1%) and Kazakhstan had the lowest ment was restricted, cultivated forage (5,4%), while the shares in Kyrgyzstan, substituted for the natural pastures Tajikistan and Turkmenistan were 13.5%, previously captured through migratory 23.8% and 10,8%, respectively. Over the movements, and winter settlements last 10 years, the populations of cattle were imposed. National statistics do and sheep have significantly increased in not fully account for animal movements all five countries of Central Asia (Table 3, in the region, especially transboundary Figure 1). movements such as traditional move- ments for grazing, where pastures are Nomadic pastoralism is practiced scarce. on the steppes, with transhumance from lowland pastures in the winter The Central Asian livestock sector to highland meadows in the summer. used to supply meat, dairy products, Before Soviet collectivization, animals and animal fiber to the rest of the migrated to avoid areas of temporary Soviet Union. Economic collapse 18 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S TABLE 3. Livestock numbers in Central Asia 2020 vs 2010 Item Year KAZ KYG TAJ TUR UZB 2020 7 850 045 1 715 776 2 335 580 2 278 876 13 154 200 Cattle 2010 6 095 200 1 298 825 1 829 997 2 174 600 8 510 800 2020 17 749 598 5 508 032 3 818 750 13 969 559 18 829 200 Sheep 2010 14 660 800 4 095 231 2 617 373 13 600 000 12 081 900 2020 2 307 969 770 704 1 950 635 2 327 988 3 629 600 Goats 2010 2 708 900 942 484 1 582 811 2 800 000 2 350 700 2020 816 736 29 465 87 7 726 52 430 Pigs 2010 1 326 300 59 791 418 13 900 96 500 2020 227 703 256 57 123 025 20 447 Camels 2010 155 500 338 45 122 400 17 600 2020 3 139 831 539 644 81 646 26 044 253 625 Horses 2010 1 438 700 378 448 75 796 24 600 180 600 Source: FAOSTAT: https://www.fao.org/faostat/en/#home Accessed 29 October 2022 FIGURE 1. Central Asia livestock units by country Livestock numbers (as livestock units) in Central Asia 1992–2020 as % of 1992 gure 300 Turkmenistan Livestock units (% of 1992 gure) 250 Uzbekistan 200 Tajikistan 150 Kyrgyzstan 100 Kazakhstan 50 0 1992 1996 2000 2004 2008 2012 2016 2020 Source: FAOSTAT: https://www.fao.org/faostat/en/#home Accessed 29 October 2022 19 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S following the dissolution of the Soviet net importers of animal products and Union, combined with the breakdown live animals, despite their production of feed supply chains, long-distance potential. Suboptimal production grazing management, and veterinary practices and relatively poor genetics systems led to plummeting productivity and animal health management are and, in some former Soviet Central the main constraints to productivity in Asian republics, loss of a large pro- the region. They are mostly explained portion of the national herd. With the by limited investment in research and disappearance of inter-republic trading training, extension services, and ill- links within the Soviet Union, marketing directed public support. The prevalence became a domestic and even local affair. of internationally reportable diseases Yet the livestock sector is an area with and subsequent trade restrictions and growth potential. high trade costs related to transport infrastructure and administrative The livestock sector has a large protocols further limit Central Asian potential for growth in the region. countries’ trade in livestock and Increasing urban incomes have livestock products outside the region. stimulated domestic demand for meat- Countries in the region face significant based products and Kazakhstan and issues related to implementing harmo- the Kyrgyz Republic are already net nized national SPS measures consistent exporters of cattle and sheep (Table 4). with international standards, guidelines Based on their extensive land and and recommendations. Outdated water resources, Kazakhstan and the legislation, poor laboratory capacity, Kyrgyz Republic could become major and lack of coordination between exporters of meat and dairy products border controls create vulnerability (Robinson 2020). Apart from livestock, to transboundary pests and diseases Kazakhstan is already the world’s which constrain the potential of Central ninth-largest wheat exporter, selling over Asian countries to expand their agricul- nine million tons annually, and has the tural food trade (Figure 2). potential to become a significant global beef and mutton exporter. Uzbekistan Agriculture in Central Asia is also also is a large crop producer and has vulnerable to climate change. Con- steadily increased its agricultural exports. tinued pressure on pastures, especially The Kyrgyz Republic and Tajikistan are those surrounding villages, and a boosting their dairy and beef sectors, stagnant, low-productivity animal which increasingly target export markets husbandry sector add to inefficiency. within and outside the region. Fodder, particularly winter fodder, which is both scarce and of poor quality, However, animal productivity is still animal diseases and poor operational low and Central Asian countries are management have been the main 20 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S TABLE 4. National livestock exports/imports, Central Asia 2019 KAZ KYG TAJ TUR UZB 2019 Export Import Export Import Export Import Export Import Export Import Cattle Head 125 593 36 414 981 616 1 1 769 — 6 453 — 145 592 Thousand 81 100 74 005 994 476 — 2 298 — 9 691 — 122 407 USD Sheep Head 272 471 238 4 672 14 300 458 — 1 087 253 928 Thousand 24 247 241 576 2 64 53 — 216 21 327 USD Goats Head 3 947 841 — 1 204 88 59 — 709 4 401 Thousand 276 486 — 133 6 — 52 852 USD Camels Head 1 358 — 1 7 20 1 113 Thousand 1 901 — n/a n/a n/a n/a USD Source: FAOSTAT: https://www.fao.org/faostat/en/#home Accessed 29 October 2022 FIGURE 2. Intra-regional trade: Total export value (left) and trade flows of live animals (right) 35 Total exported value (million USD) 30 25 20 15 10 5 In thousand USD <50 50–500 0 500–5000 >5000 1995 2000 2005 2010 2015 2020 Source: UN Comtrade database: https://comtradeplus.un.org/ Accessed 6 July 2022 21 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S factors responsible for low productivity producers able to supply retail chains and levels. Given the number of small-scale created significant difficulties for small farms and the dominance of animal producers used to selling their products husbandry in the countryside, for directly to consumers. The war in Ukraine example, combating animal diseases has created market volatility and high and improving range management and food prices, in particular in the Kyrgyz folder production would be the quickest Republic, Tajikistan and Uzbekistan (FAO, and most effective ways to improve the IFAD, UNICEF, United Nations, WFP, incomes and food security of many rural WHO and WMO 2023). communities. Initiatives to support rural Before the pandemic and the war, dwellers, like the Kyrgyz Integrated Dairy global international trade in animal Productivity Improvement Project (IDPIP) products rose from €56 billion in 2000 exist to bolster the rural economy by, to €152 billion in 2018, with acceler- for example, providing micro-loans and ation since 2009, dominated by a few promoting quality investment in the dairy large private multinational companies sector by small-scale producers, as well or very large cooperatives (Chatellier as longer-term investment financing for 2021). The trade is increasingly oriented herd improvement and dairy productivity. towards processed, transformed, and The persistence of COVID-19 and assembled products (finished products or the war in Ukraine, which is having ingredients for the agro-food industry). a negative impact on global food In 2018, the value of international trade security, have produced an increased in animal products was composed of sense of urgency in Central Asia to 52% meat, 32% dairy products, 5% live animals and 11% other animal products mitigate intersectoral, cross-country (Chatellier 2021). World trade in animal food security risks and prepare for products is geographically concentrated. pandemics. The impact of the COVID-19 Trade in live animals is frequent between pandemic on food security has gen- neighboring countries, as it remains erally not been significant. However, in more complex over long distances. some places, local food markets were closed, which made it difficult to access Rising incomes and more demanding necessary inputs or financing. For consumer preferences in target example, the spring sale of livestock is export markets are making product a traditional way for livestock breeders quality and safety a key determinant to finance their spring fieldwork. Some of export success. This is the case external borders were completely for OECD markets, and the markets closed and temporary restrictions on in emerging Asian economies such open-air markets led to a shift in food as China, Vietnam, and Thailand. In sales from markets to retail chains. This these countries, the number of quality- created advantages for large agricultural conscious and increasingly wealthy 22 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S middle-class consumers is growing. to local consumers’ needs for healthy In addition, the Central Asian countries livestock and safe food, reducing the are lagging behind jurisdictions, such dependence on imports. as the EU countries, in creating an Agriculture and livestock exports to enabling business legislation for agri- markets such as China and the Middle culture, infrastructure and information East present many opportunities for technology. The quality and capacity of Central Asian countries but also the countries’ phytosanitary and food enhanced needs for SPS control. safety certification systems, customs The development of the Eurasian control, and inspection bodies typically Economic Union, and the proximity of do not meet the requirements of demanding markets open trade oppor- higher-end export market destinations. tunities but also reinforce the need for This puts the Central Asian exporters SPS controls. Reducing internal trade at a disadvantage vis-a-vis other major barriers and facilitating the cross-border suppliers of those more lucrative, flow of goods and services would destinations (FAO, IFAD, UNICEF, increase market size and make the United Nations, WFP, WHO and WMO region more attractive to foreign 2023). Considering this, countries investors which would also help Central around the world are investing in Asian countries improve product infrastructure that assures better quality variety and enhance export-market and safety of their agricultural products. penetration. The trade in live For example, investments made by animals and animal products calls for Uruguay to improve animal health to the regional coordination of specific comply with EU requirements led it to trade policies. Central Asian countries significantly increase its share of China’s are well-placed to become a source beef imports in just eight years. of sheep and goat meat for Middle Eastern markets. Co-investing in Central Asia’s future as a supplier this infrastructure would save time of agri-products and livestock will and money, as would synchronizing depend on how food producers and procedures for moving commodities processors in the region respond and products across Central Asian to the increased quality and safety countries’ regional borders into China demands of consumers, and on and the Middle East. how well countries coordinate with each other to improve standards, to A One Health approach encourages boost economic growth and to raise coordination between public health, citizens’ standards of living. Increasing veterinary services, and environ- the capacity for processing animal mental agencies as a prerequisite products in compliance with interna- for ensuring access to new markets tional standards would also respond through harmonized and coordinated 23 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 2. Key investment needs to improve animal productivity and trade, with a focus on animal health Convening ◾ Regional cooperation and communication to improve animal productivity and trade, including addressing policy bottlenecks to trade. Knowledge development and addressing gaps ◾ Routine monitoring of animal movements in the region, especially transboundary movements. ◾ Estimates of the impact of zoonoses on animal productivity. Policy development and harmonization ◾ Cross-border and regional cooperation between veterinary services to address transboundary animal diseases such as foot and mouth disease, lumpy skin disease, highly pathogenic avian influenza, brucellosis and rabies. ◾ Border control coordination to address vulnerabilities to transboundary pests and diseases. ◾ Legislation development, including on disease notification and regulations (e.g., on prescription of antibiotics) and its implementation. Capacity building ◾ Veterinary epidemiological surveillance, diagnosis, disease control, rapid response, and inspection, especially of endemic/emerging zoonoses and transboundary diseases. ◾ Veterinary laboratory capacity and technology; biosecurity, nutrition and husbandry practices; and use of antibiotics. ◾ Inspection and quarantine capacity. ◾ Access to inputs and supplies, e.g., quality vaccines and veterinary drugs. ◾ Resources and methods available to extension services. ◾ Capacity for processing animal products in compliance with international standards. ◾ Implementation of SPS measures to improve trade opportunities. ◾ Animal identification and traceability of movements. 24 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S regulations to prevent and control environmental disasters the world has zoonoses, reduce food safety risks seen. Desertification has devastated and facilitate the safe movement of many areas, and the booming mining, animals. The readiness of the region oil and gas industry has created addi- to increase exports and access new tional environmental problems. Many markets is currently challenged by the of these challenges occur due to a unsatisfactory level of compliance of lack of regulatory policies for curbing national regulations with international deforestation and regulations for standards. While the ambition of environmental management in mining increasing the export of live animals areas. Due to the lack of regulation and and animal products is common for enforcement in the Kyrgyz Republic, the region, the trade situation differs important freshwater resources have between the countries. Kazakhstan been contaminated by foreign mining and the Kyrgyz Republic have both the companies. The increasing livestock capacity and the ambition to export live population in the region has also led animals and animal products, whereas to intensive grazing, which has exacer­ Tajikistan, Turkmenistan, and Uzbekistan bated deforestation, degradation of need to import animals and animal pastureland, alluviums and soil drift into products but face the challenge of river and lake ecosystems, creating an unsafe import of live animals and animal additional burden on the already vulner- products. Both challenges require a able environment. This puts animals and harmonization and coordination of humans at increased risk as it lowers regulations to prevent and control the quality of drinking water. Efforts zoonoses, reduce food safety risk and, to contain desertification are under especially, facilitate the safe move- way in some regions. For example, the ments of animals through increased World Bank’s Resiland CA+ program coordination between public health, financed by IDA, PROGREEN, Korea veterinary services and environmental Green Growth Trust Fund and The agencies in the region. Korea-World Bank Partnership Facility seeks to help affected rural communities 2.3. Climate change, in restoring landscapes, protecting lives wildlife and hoods, and increasing resilience and liveli­ to desertification, landscape degradation ecosystem and climate change. The program transformations includes projects in all five Central Asian countries working under a regional Among other issues, environmental umbrella, seeking to build resilience degradation has brought global through regional knowledge sharing attention to Central Asia. The destruc- and institutional capacity building tion of the Aral Sea is one of the worst (KGGTF 2021). 25 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S Land degradation is particularly prev- of extreme climate events, such as those alent in rangelands and border areas7, occurring in the region, impacts animal causing acute regional damages such health and productivity. For example, as low land productivity, poor livestock warmer weather causes heat stress and productivity, accelerating deforestation, increases the spread of vector-borne increased poverty, and increased risk of diseases transmitted by ticks and animal-human diseases (Quillerou, et al. mosquitos to areas of livestock and 2016). Transboundary corridors between human population. Most of Central Asia Central Asian countries are land degrada- falls within arid and semiarid zones and tion hotspots. With the breakdown of the is covered by grassland, rangeland, Soviet Union, transboundary pastoralism desert, and woodland, with a dramatic slowed down, leading to overgrazing of physical landscape, ranging from grassy pasture resources around the borders. steppes and high mountains, to deserts These hotspots are also home to rural and large rivers, to lakes and seas. There­ communities and livestock. Thus, regional fore, the degradation of biodiversity, collaboration is critical in enhancing land natural habitats, and ecosystems due restoration and animal-human health. to climate stressors will increase the Environmental degradation contributes vulnerability of poor rural areas, which to air pollution and enhances the use largely lack the financial and political of chemical inputs to reduce nutrient capacity to overcome these challenges. loss, coupled with higher irrigation and Climate-change induced transforma- precipitation, leading to the leaching of tions are already being observed in chemicals into groundwater sources and the region. The predator-prey balance surfaces with serious animal and human in nature is being modified, with a higher health impacts. risk of contact between humans and/or Climate change will induce a further domestic animals with wild animals increase in average temperature and (wolves, foxes, and non-domesticated temperature extremes. Changes in pre- ruminants), which increases the risk of cipitation patterns are also anticipated diseases such as rabies and brucellosis. which is predicted to impact agriculture Other prevalent infectious diseases, par- and livestock production – and increas- ticularly vector-borne, such as Crimean- ing food security risks. The evidence of Congo Haemorrhagic Fever (CCHF), the impact of climate change on animal continue to spread among livestock in health and produc­ tion in the region some countries in the region. Meanwhile, remains limited. However, international drought and flooding push predators research has outlined how the frequency closer to inhabited areas, while drought 7 This could be explained, inter-alia, by the slowdown of transboundary pastoralism after the breakdown of the Soviet Union, which has restricted the mobility of livestock between pastures to this day. This restriction of seasonal pastures results in overuse of pasture resources along the borders. 26 BOX 3. Key investment needs to improve the preservation of wildlife and ecosystems Convening and coordination ◾ Cooperation and communication to integrate climate change adaptation and mitigation in wildlife and preservation efforts. Knowledge development and addressing gaps ◾ Wildlife status and ecosystem monitoring data. ◾ Role of wildlife in the presence and spread of zoonoses and related surveillance needs. Policy development and harmonization ◾ Integrated land management (ILM) in development plans to achieve large-scale outcomes in complex and highly vulnerable landscapes. ◾ Harmonized policies and strategies for landscape restoration and improvement of land management sustainability, animal safety standards, and trade. ◾ Regional and transboundary approaches for landscapes shared by more than one country. ◾ Pooling of national technical and financial resources towards shared landscape management; attraction of external investors. ◾ Implement a systematic program of surveillance and analysis of drinking- water between water agencies and health sectors so as to ensure water quality according to a national drinking water quality standard. Capacity building ◾ Knowledge-sharing platforms on successful strategies to improve the technology of keeping farm animals and pasture management and pasture monitoring system. ◾ Educational and scientific support of crop production and animal husbandry, setting up training on land, animal and human health monitoring and evaluation systems. ◾ Restoration of degraded landscapes such as forests and rangelands; water management at farm and landscape level. ◾ Strengthen disease monitoring and surveillance systems to detect and control desertification, land degradation and drought related diseases with the integration of approaches among key sectors. ◾ Monitoring of ecosystems and ecosystem services, including wildlife populations and movement and carbon sequestration, biodiversity, and other ecosystem services related to climate resilience. ◾ Organic farming and resource-saving technologies for tillage and sowing, such as Zero (no-till) and minimum (mini-till) tillage, and bed- sowing and precision-farming. 27 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S reduces the availability of grassland, Responding to challenges posed both for livestock and for wild ruminants, by land degradation and improving as pest patterns change, and disease water management will contribute outbreaks increase (Guglielmi 2022). to restoring productive landscapes and ecosystem services, with positive The melting of permafrost and glaciers impacts on climate change mitigation, reduces water storage and availability human health and livestock produc- during hot months which can cause tivity. Poor grazing practices combined disease spores to come to the surface with climate change have led to land and spread into new areas. Anthrax degradation and desertification issues, is an example of a global zoonotic and and to reduced animal productivity, epizootic disease, with a high case-fatality thus increasing food systems reliance ratio in infected animals, whose trans- on cultivated fodder and irrigation mission is mediated by environmental water. Poor grazing practices also contamination through highly resistant resulted in increased livestock-wildlife spores that can persist in the soil for several decades. The temporal variability contacts. The restoration of rangelands of grazing and active layer thawing and other forms of natural vegetation may influence the dynamics of anthrax would improve the availability of disease and, specifically, favor sustained quality feed for cattle and small rumi- pathogen transmission. Particularly warm nants, which would in turn reduce years are shown to be associated with an the carbon footprint per kilogram of increased risk of anthrax outbreaks and animal protein produced and contribute may also foster infections in the following to carbon sequestration. Restored years (Stella, et al. 2020). Extending landscapes would also allow to reduce pasture to new places without memory of biodiversity losses and livestock- their sanitary status will increase the risk wildlife contacts, thus reducing the of telluric (soil-based) diseases such as risk of zoonoses, water- and food- anthrax. Scarcity of water and pastures borne diseases, as well as respiratory can lead to local disputes and small-scale diseases caused by atmospheric (cross border) conflicts over the use of dust from wind erosion and other scarce resources. Regionally, land degra­ air pollutants. Addressing these dation, soil erosion, water extraction challenges requires increased cooper- and sedimentation disrupt river connec- ation among key sectors to strengthen tivity for migratory fish (especially the the management of pasturelands, iconic sturgeon) and pose water supply water and feed quality, and disease and water quality problems. Such land monitoring and surveillance systems degradation can destroy infrastructure to guide interventions for addressing and disrupt connectivity, trade and environmental challenges (Sena and value chains in the region. Ebi 2021). 28 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S 2.4. Public health with increasing dominance of non- communicable diseases over the last Central Asian countries have made three decades, but with a persistent progress in public health. Key health communicable disease burden as well indicators have improved in all of them, (Table 5). The burden of disease due though at different paces. In the three to communicable, neonatal, maternal decades since the dissolution of the and nutritional causes, measured in Soviet Union, the health indicators have Disability-adjusted life years (DALYs)9 significantly improved in Kazakhstan, the losses per 100,000 population, is three Kyrgyz Republic and Tajikistan, while to six times higher than in the EU. slower progress has been made in Chronic infectious diseases such as Turkmenistan8 and Uzbekistan. Tajikistan, hepatitis B and C, HIV/AIDS and multi­ which had the highest under-5 and drug resistant tuberculosis (MDRTB) maternal mortality rates, has shown continue to represent an important most progress in these indicators, partly part of the burden of disease and of due to external assistance. The Kyrgyz health care utilization and expenditures Republic has the highest maternal in the region. Meanwhile, emerging mortality ratio, while Turkmenistan has the diseases, such as COVID-19 and other highest under-5 mortality rate (Table 5). zoonoses continue to make inroads in Central Asian countries allocated the region. between 3.79% and 8.18% of GDP to health in 2020 (Table 5). This compares to Equity, cost-effectiveness, and quality the 5.32% that middle-income countries of health services continue to be allocated to health on average in the issues in Central Asia, despite these same year, while high-income countries countries’ maintaining more health allocated 12.5%. External aid provides professionals than other middle- a relatively small contribution to income countries. In the health sector, national budgets, but it continues to improving information and evidence, be a major influence on health sector tackling the burden of chronic diseases reform in the region. and further developing public health, The double burden of disease is primary health care and the quality of present in all these countries, care, are the main policy priorities. 8 The Ministry of Health and Medical Industry of Turkmenistan has informed the World Bank that since the country adopted the international definition of live births and stillbirths in 2007 and adopted strategies aiming at improving the survival of children and mothers, including integrated management of childhood diseases, the level of morbidity and mortality from infectious diseases has significantly decreased and, with some fluctuations, there has been a steady downward trend in infant and child mortality indicators. 9 One DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population. 29 TABLE 5. Central Asia key health indicators Burden- of-disease Burden-of- communicable disease10 non- neonatal, Under-five Maternal communicable maternal and mortality rate mortality diseases (NCDs) nutritional (per 1,000 live ratio Medical doctors Life expectancy at 2019 diseases 2019 births) 2021 (per 100,000 Health expenditure per 10,000 birth 2019 (Roser, Ritchie and (Roser, Ritchie and (UN IGME live births) as a % of GDP population Country (WHOa) Spooner 2021) Spooner 2021) 2021) 2020 2020 (WHOb) KAZ 73.95 24916.93 3133.80 10.27 13 3.79 40.28 (2020) KYG 74.18 22541.78 4160.66 17.4 50 5.26 21.68 (2019) 30 TAJ 69.50 27901.25 6552.81 31.42 17 8.18 17.08 (2014) TUR 69.75 26726.68 5399.55 41.43 5 5.68 21.47 (2014) UZB 73.01 31275.16 5633.95 14.07 30 6.75 23.73 (2014) Sources: The World Bank Open Data: https://data.worldbank.org/ Accessed 25 May 2023; WHOa The Global Health Observatory: https://www.who.int/data/gho/data/indicators/ indicator-details/GHO/life-expectancy-at-birth-(years) Accessed 25 May 2023; WHOb The Global Health Observatory: https://www.who.int/data/gho/data/indicators/indicator- details/GHO/medical-doctors-(per-10-000-population) Accessed 25 May 2023; Roser, Ritchie and Spooner 2021; UN IGME 2021 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S 10 Burden of disease is a measure of population health that aims to quantify the gap between the ideal of living to old age in good health, and the current situation where healthy life is shortened by illness, injury, disability and premature death. P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 4. Key investment needs to improve pandemic preparedness, prevention and response Convening and coordination ◾ Coordination and cooperation between the animal health, human health and environmental health services, to avoid duplications and gaps in diagnosis and responses. Knowledge development and addressing gaps ◾ National One Health priorities for which a coordinated approach will improve animal, environmental and public health: priority zoonoses and transboundary diseases, food safety, and prudent use of antibiotics and AMR. Policy development and harmonization ◾ Coordinated communication with policymakers and the public about risks, outbreaks, responses, and the respective reviews to strengthen community outreach. ◾ Coordinated and integrated management of risks in animal health, environmental health and public health, involving national authorities. ◾ One Health legislation on pandemic preparedness, prevention, and response, zoonoses, food safety and AMR. Capacity building ◾ Coordinated epidemiological surveillance and prevention and control of zoonoses, including the development of early warning and response systems. ◾ Intersectoral database communication and integration. ◾ Public health laboratory capacity: HR and equipment. ◾ Disease prevention and control activities based on integrated risk assessment and response plans. ◾ Simulation exercises to improve coordination and intersectoral cooperation. ◾ Coordinated investigation of epidemic outbreaks and after-action reviews. ◾ Capacity building for joint response and field investigation of priority zoonoses. ◾ Expand the reach of the primary healthcare networks and quality of primary healthcare. 31 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S The COVID-19 pandemic has so far rather than the real extent of the dissemi- caused over 18,000 reported deaths nation of the virus. The number of cases and about 2 million cases in Central is closely linked to diagnosis capacity Asia (Worldometer 2022), but the share (tests per million population), rather of population fully vaccinated remains than the real extent of the dissemina- below 50%11. By December 2022, tion of the virus. Kazakhstan had reported almost 1.4 million COVID-19 cases12 and The probability of zoonoses and 13,693 deaths (713/million); the Kyrgyz reverse zoonoses manifesting and Republic reported over 200,000 cases spreading is growing, posing risks for and almost 3,000 deaths (445/million); environmental conservation, public Tajikistan reported over 17,000 cases health, and national economies. and 125 deaths (13/million); and Central Asian countries would increase Uzbekistan had over 240,000 cases and their ability to detect, prevent, and 1,637 deaths (48/million) (Worldometer respond to this challenge by adopting 2022). The share of population partly an OH approach to zoonoses at the vaccinated according to the country human-animal-environment interface. protocol varies from about 25% in the Multidisciplinary teams and collabora- Kyrgyz Republic, 56% in Kazakhstan, and tion across sectors are fundamental to 61% in Uzbekistan (Our World in Data building capacity and creating solutions 2022), to 99% with at least one dose in for challenges at the human-animal- Tajikistan13. The global average was ecosystem interface. 69% of people at least partly vaccinated by December 2022 (Our World in Data 2022). Overall, there have been lower 2.5. Priority zoonoses COVID-19 numbers in Central Asia com- in Central Asia pared to Europe and the United States. These relatively low numbers may be Many transboundary diseases are due to the pandemic’s not having spread endemic in Central Asia, and the as efficiently in the region as it did in prevalence of zoonoses in human other parts of the world, but it may also and domestic animals is higher in be due to poor health surveillance and this region than in other parts of testing, and to transparency in reporting, the world. Zoonoses such as anthrax, since obtaining accurate data remains brucellosis, echinococcosis, HPAI and an issue across the region. The number rabies are still very prevalent among of cases is closely linked to diagnosis animals in Central Asia and, in the cases capacity (tests per million population), of brucellosis and echinococcosis, 11 Share of people vaccinated against COVID-19 according to a complete initial protocol. 12 COVID-19 confirmed cases include hospitalized patients and people on ambulatory care with mild symptoms or asymptomatic. 13 Dose 1 of the target group (18+) COVID-19 vaccination as reported by the Ministry of Health and Social Protection 32 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S among humans as well. Other animal in parts of Central Asia and is a major diseases that have also been reported veterinary and public health concern. among humans in the region are zoonotic In 2021, Kazakhstan reported 27 human tuberculosis, CCHF, and foodborne cases14, and the Kyrgyz Republic zoonoses such as salmonellosis, lepto- reported 22 (National Statistical Com- spirosis, leishmaniasis, and orthohanta­ mittee of the Kyrgyz Republic 2022). virus infections (WOAH 2022). Some Infections annually cause sporadic out- of the major transboundary animal breaks in domestic livestock and wild diseases that are circulating in the region, animals, which could be a sign of a loss although not zoonoses, are foot-and- of awareness of infected pastures or the mouth disease (FMD), peste des petits emergence of cases in new areas. The ruminants (PPR), or lumpy skin disease pathogen can be spread by scavengers (LSD), requiring capacity to develop or vultures feeding on animal corpses. contingency plans in case of outbreaks. Drought can increase outbreaks, The circulation of animal diseases may because low grass cover leads to soil jeopardize trade and movement of live consumption by ruminants and due ruminants between countries, and repre- to the extension of pastures into new sent a food security issue through their impact on animal production and trade. areas not previously known to carry the disease. Heavy rains and floods can There is limited data on zoonosis bring spores to the surface and affect cases among animals and even more areas that had not reported any cases limited data on the spread of these for some time. Anthrax presence in diseases from animals to humans. animals and humans can be controlled In 2019—2022, 137 animal outbreaks by improving the surveillance system of anthrax, brucellosis, echinococcus, (including investigation of all human HPAI and rabies in Central Asia were cases), increasing the biosecurity in the reported to WOAH in Kazakhstan (24), field, and vaccination, which would be Kyrgyz Republic (25), Tajikistan (83), a more effective strategy for countries. Turkmenistan (3) and Uzbekistan (2) Mapping the risk of disease is necessary (WOAH 2022). However, the number of for targeted surveillance and routine zoonosis outbreaks notified yearly varies vaccination. In Kazakhstan, modelling significantly due to inconsistencies in the of anthrax burial-site data for the period collection of case information and the 1933–2014 indicated elevated risks poor quality of surveillance of zoonotic along the northern and southeastern diseases (WOAH 2022). borders, which follows the distribution Anthrax, caused by a bacterium of historic disease cases and accounts persisting in soil (telluric), is present for potentially suitable environmental 14 Data provided by the Ministry of Healthcare of the Republic of Kazakhstan to the World Bank 33 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S conditions (Abdrakhmanov, et al. based prevention and control policies 2020). In the Kyrgyz Republic, ongoing and programs is lacking, which is a serious anthrax outbreaks have also been problem, since brucellosis is an endemic reported in humans associated with zoonosis. A 2015 study in Kazakhstan handling infected livestock and con- indicated that about US$24 million was taminated animal by-products such as spent on testing animals, and about meat or hides. Mapping based on data US$21 million compensated for animals of anthrax in livestock reported from that were slaughtered due to brucellosis 1932 to 2006, identified four areas (Charupkhan et al. 2019). People can con- most at risk of outbreaks in animals and tract brucellosis when they are in contact humans: the plateaux near Talas and with infected animals or animal products, Bishkek, the western Fergana Valley and consumption of unpasteurized/ region, and the low-lying areas along raw dairy products. Farmers and their the shore of Lake Isyk-Kul (Blackburn, families may also be contaminated et al. 2017). Cattle were the most during breeding events (abortions, affected in the period, with the greatest calving, lambing, etc.) if animals are not number of cases in late summer handled following proper biosecurity months. In areas where domestic measures. With increased recourse to animals have had anthrax in the past, summer pastures and increased com- routine vaccination and high-quality petition for pastures between wild and inspection of food animals prior to domestic animals from climate change slaughter helps preventing outbreaks effects, the circulation of brucellosis (CDC 2020). in wild ruminants will contribute to its circulation in domestic ruminants. Vacci- Brucellosis causes considerable nation before transhumance to mountain economic losses due to reduced repro- pastures or grasslands is indispensable duction in livestock. The number of and, in most cases, mass vaccination is reported cases of brucellosis in humans the best option. has decreased in Kazakhstan and the Kyrgyz Republic. In 2021, Kazakhstan Echinococcosis, a parasitic disease reported 412 cases15 and the Kyrgyz caused by infection with tiny tape- Republic 796 (National Statistical worms of the genus echinococcus, Committee of the Kyrgyz Republic 2022). causes a substantial health and eco- However, the quality of epidemiological nomic burden due to costs related to data is uneven across the region, and treating cases and losses to the live- accurate epidemiological data allowing stock industry. The two most important for the design of cost-effective risk- forms, which are of medical and public 15 Data provided by the Ministry of Healthcare of the Republic of Kazakhstan to the World Bank 34 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S health relevance in humans, are cystic vaccination of dogs and puppies, staying echinococcosis and alveolar echinococ- away from wildlife, and seeking medical cosis. Both cystic echinococcosis and care after potential exposure before alveolar echinococcosis in humans are symptoms start. People are usually often expensive and complicated to infected following a bite or scratch from treat, sometimes requiring extensive an animal with rabies, which is, in most surgery and/or prolonged drug therapy. cases, a dog. Once clinical symptoms Prevalence rates range from under 1 per appear, rabies is usually fatal (CDC 2022a). 100,000 to more than 200 per 100,000 Rabies continues to be present in all in rural populations in close contact with Central Asian countries, but cases are domestic dogs. The annual prevalence rarely reported, and registered numbers of the disease has decreased in the differ greatly from the estimated burden. Kyrgyz Republic, but it still reported Current diagnostic tools are not suitable 888 cases in 2021 (National Statistical for detecting rabies infection before Committee of the Kyrgyz Republic 2022); the onset of clinical disease. Unless the while Kazakhstan had almost 600 human rabies-specific signs of hydrophobia or cases in 202116. In most countries, a aerophobia are present, diagnostic tools limited number of animal outbreaks may fail in detecting rabies infection before be due to limited symptoms in animals the onset of clinical disease. To support and lack of surveillance and reporting countries in improving their national in slaughterhouses. Dogs are mainly rabies elimination plans, it is important responsible for cases in humans. The to engage with local communities to handling and preparation of fur from strengthen disease surveillance, data foxes, mostly involving women, is also reporting and monitoring of rabies. a high-risk practice. Considering the long incubation period before the first Highly Pathogenic Avian Influenza symptoms, epidemiological surveillance (HPAI) continues to be a risk for in animals should be strengthened in Central Asia, as the first cases of slaughterhouses and for wild animals the current H5N8 strain have been with the assistance of hunters trained to identified in the region. In 2020, FAO identify the effects. alerted the countries of Central Asia of the risk of re-introduction of HPAI, Rabies is still prevalent in Central Asia as the genetic characteristics of the among domestic and wild animals latest H5N8 HPAI virus were identified as well as in humans. Rabies is a viral in Kazakhstan (FAO 2022).These out- disease affecting the central nervous breaks were probably linked to high system that can be prevented by density and frequent movement of 16 Data provided by the Ministry of Healthcare of the Republic of Kazakhstan to the World Bank 35 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 5. Key investment needs to improve the prevention and control of zoonoses and non-zoonotic animal diseases Convening and coordination ◾ Cross-sector and regional coordination of risk assessments as the basis for decision-making. ◾ Cross-sector coordination of risk-based decision-making between local, national and regional authorities. Knowledge development and addressing gaps ◾ Risk factors and underlying drivers associated with emerging zoonoses and reverse zoonoses and non-zoonotic animal diseases to identify pathogens and transmission routes. ◾ Risk-based identification of priority zoonoses and interventions based on evidence. Policy development and harmonization ◾ Coordination and mobilization of technical resources (e.g., epidemiological surveillance, diagnosis capacity, vaccine production) and human resources from animal health services, environmental agencies, and public health services. ◾ Allocation of adequate and sustainable resources for vaccination programs. ◾ Establishment of compensation systems in case of need to cull animals. ◾ Risk communication to prevent contamination by zoonotic pathogens. Capacity building ◾ Zoning and compartmentalization to control transboundary diseases, and to ensure free zones or compartments. ◾ Veterinary and public health laboratory capacity, including staff training to identify priority zoonotic pathogens. ◾ Coordination of epidemiological surveillance ◾ between the animal, environmental and public health systems, and integrating surveillance of wild animals. ◾ focusing on relevant pathogens and risk factors which provide early warnings and allow for planning appropriate responses. 36 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 5. Key investment needs to improve the prevention and control of zoonoses and non-zoonotic animal diseases (continued) ◾ to facilitate evidence-based decisions based on risk assessment and monitoring and evaluation of prevention and control programs. ◾ Training of farm biosecurity for farmers. ◾ Epidemiology training of program managers and field veterinarians to correctly implement disease prevention and control programs, especially during outbreaks. ◾ Implementation of biosecurity measures to control priority zoonoses. ◾ Outbreak investigation in regions (oblasts). ◾ Simulation exercises to test the capacity of the different authorities to develop a coordinated and efficient response. flocks from intensive poultry production, agencies in the region were responsible the disease is now considered a priority for monitoring the concentration of zoonosis in Kazakhstan, and a roadmap wild birds and mapping their migration to prevent and control avian influenza to identify the location of AI and risks (AI) is under implementation. Central of transmission, and intersectoral Asia is situated at an important migratory training on sample collection and crossroads for waterfowl and other laboratory diagnosis took place. species of birds that bridge regions However, inter-sectoral collaboration where avian flu is prevalent. Direct has been limited since the closure of transmission of the virus from wild the 2011 Regional One Health project birds to humans is rare or non-existent, financed by the Bank-managed Avian but transmission from domestic species Flu TF and the Kyrgyz Republic Avian to humans does occur and hundreds Influenza Control and Human Pandemic of cases have been reported globally. Preparedness and Response (GPAI) Therefore, controlling the disease project. The 2011 Regional One Health in birds is critical to decrease risk to grant of US$ 3 million to prevent humans. During the 2005–2006 outbreak and control zoonoses and improve emergency response, environmental food safety, developed and applied a 37 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S detailed gap analysis tool, as well as 49–52 per 100 000 people in the economic analyses of the impact of region versus 41 in Europe (Havelaar, zoonoses; and developed action plans et al. 2015). The difference is mainly for veterinary and public health services due to zoonoses (Havelaar, et al. in Kazakhstan, the Kyrgyz Republic, 2015). Local populations are exposed Tajikistan and Uzbekistan. to significant food-safety risks, due to limited capacity in food and water safety management and control. Prog- ress on reducing food safety risks has 2.6.  Food safety mainly been driven by private food In all Central Asian countries, the companies’ voluntary implementation strengthened implementation of of food-safety standards. However, a One Health approach could sup- only larger food companies and global exporting companies have developed port better control of foodborne food-safety management systems zoonoses and reduce food safety according to the Eurasian Economic risks along the food chain. The data Union (EAEU) international standards on food-borne illnesses and inter- and technical regulations. national notification of food safety events coming from these countries Meeting the countries’ ambitions of is limited and does not allow for an exporting animal food products to accurate description of the food safety external markets can be supported situation. Their international trade through compliance with international of food products with countries with standards, animal identification efficient rapid alert systems is limited: systems, farm-to-fork surveillance from January 2020 to March 2023, plans and strengthening the capacity 36 notifications have been recorded for the enforcement of food safety on RASSF17 by EU countries on their regulations. The International Health products (mainly ochratoxins and Regulations (IHR) 2005 agreement chemical contaminants on fruits and states that all countries are required vegetables). Central Asian countries to build the capability to detect and have made no recent notifications to report potential public health emer- INFOSAN and only Kazakhstan has gencies worldwide and the ability to been audited by the EU Food and detect, assess, report, and respond Veterinary Organization for fish prod- to public health events. According to ucts. The burden of food-borne dis- Joint External Evaluation (JEE) and eases in the region is not much higher Performance of Veterinary Services than it is in Western Europe (Figure 3): (PVS) assessments, the food-safety 17 RASSF: Rapid Alert and Surveillance of Food and Feed https://webgate.ec.europa.eu/rasff-window/screen/search 38 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S FIGURE 3. The global burden of foodborne disease (DALYS per 100,000 population) by hazard groups and by subregion for 2010 1200 Foodborne DALYs per 100,000 inhabitants 800 400 0 AFR D AFR E AMR A AMR B AMR D EMR B EMR D EUR A EUR B EUR C SEAR B SEAR D WPR A WPR B Diarrheal disease agents Helminths Invasive infectious disease agents Chemicals and toxins Source: WHO Global Estimates and Regional Comparisons of the Burden of Foodborne Disease in 2010 (Havelaar, et al., 2015). Note: The Central Asian countries belong to subregion EUR B (Albania; Armenia; Azerbaijan; Bosnia and Herzegovina; Bulgaria; Georgia; Kyrgyzstan; Montenegro; Poland; Romania; Serbia; Slovakia; Tajikistan; North Macedonia; Turkey; Turkmenistan; Uzbekistan) and EUR C (Belarus; Estonia; Hungary; Kazakhstan; Latvia; Lithuania; Republic of Moldova; Russian Federation; Ukraine).18 procedures in both the animal and issues. Food-safety inspections of public health services do not currently domestically produced products are comply with the international standards. shared by (i) veterinary services, that Addressing the region’s food-safety inspect primary products (pre- and gaps is important for ensuring access post-mortem, raw milk), (ii) the Ministry to safe and nutritious domestically pro- of Health, that inspects food processing duced or imported food. Controlling units, and (iii) local authorities, that are the safety of imported food products responsible for inspecting slaughter­ is currently restricted by limited border houses and distribution chains in infrastructure and a lack of resources local communities. In systems with to detect and respond to food-safety shared responsibilities, multisectoral 18 The subregions are defined on the basis of child and adult mortality. Stratum A: very low child and adult mortality, Stratum B: low child mortality and very low adult mortality, Stratum C: low child mortality and high adult mortality, Stratum D: high child and adult mortality, and Stratum E: high child mortality and very high adult mortality. The use of the term ‘subregion’ here and throughout the text does not identify an official grouping of WHO Member States, and the “subregions” are not related to the six official regions. AFR = African Region; AMR = Region of the Americas; EMR = Eastern Mediterranean Region; EUR = European Region; SEAR = South-East Asia Region; WPR = Western Pacific Region (Havelaar, et al. 2015). 39 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 6. Key investment needs to improve food safety Convening and coordination ◾ Develop and adopt national food-safety strategies from farm-to-fork based on international best practice and guidelines using the One Health approach. Knowledge development and addressing gaps ◾ Develop a joint database accessible for all food control agencies for registration of food inspection results (ante- and post-mortem inspections and food inspections). ◾ Develop a database registration of food-business operators to categorize food business according to risk and plan risk-based inspection activities. Policy development and harmonization ◾ Strengthen institutional frameworks and multisectoral coordination for effective food control. ◾ Strengthen compliance and risk-based food inspection and enforcement capacity. ◾ Cooperation to ◾ Strengthen evidence-based policy and legal frameworks complying with international guidelines. ◾ Adopt quality and safety standards for food-business operators. ◾ Strengthen food safety laboratories and implement consistent testing and analysis, based on international best practices. ◾ Adopt a risk-based preventive approach to food safety, including consumer campaigns on how to prepare food safely. ◾ Establish certification systems based on food-safety standards, such as the Codex Alimentarius Commission (CAC) and other international risk-assessment approaches. Capacity building ◾ Enhance capacity to detect, assess, investigate and respond to food safety events. ◾ Joint investigation and response to foodborne and zoonotic disease outbreaks. ◾ Strengthen the network of reference laboratories (national and/or regional) with specialization in specific food-safety hazards. 40 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 6. Key investment needs to improve food safety (continued) ◾ Improve national laboratory capacity to test residues and contaminants and carry out priority food pathogens surveillance. ◾ Strengthen risk-based food inspection systems. ◾ Strengthen food-business operators’ capacity to implement food safety management systems, including full traceability with capacity of recalling and withdrawal of unsafe and non-compliant products. ◾ Build risk management capacity, including training-of-trainers programs for (i) farmers and agri-food producers to follow international food- safety requirements, (ii) epidemiological surveillance and laboratory information systems, and (iii) lab technicians, food-safety regulators and inspectors, and relevant personal in food-business operators. coordination of surveillance and Safety Strategic Plan has been prepared monitoring systems, inspection and but not yet approved. Kazakhstan and enforcement plans, and food safety Turkmenistan are current beneficiaries emergency response is of utmost to the Codex Trust Fund and recipients importance. While all countries have of technical and financial support to intersectoral committees in place for strengthen their participation in Codex coordinating food-safety efforts, the Alimentarius. Kyrgyzstan completed its countries are facing different challenges Codex Trust Fund supported project in ensuring efficiency. The Kyrgyz in 2020. Uzbekistan will soon start Republic and Kazakhstan have animal implementation of a Codex Trust Fund identification systems in place but, in the supported project and Tajikistan is former, there is a lack of IT specialists eligible for applying. Overall, food- and resources to develop the traceability safety efforts in the region are being systems further. In Uzbekistan, a Food prioritized, however, management Safety Council has been established, of food-safety crises is limited by and a draft law prepared as part of a lack of animal identification and the preparation for WTO accession. traceability in the supply chain. While In Tajikistan food-safety regulations work on addressing these issues is are being updated to comply with ongoing, the lack of surveillance plans the CODEX Alimentarius, and a Food and limited collection and analysis 41 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S of food-safety data from inspections Over the last decade, research has reduces most of the countries’ ability to demonstrated a range of drivers assess food-safety risks and implement contributing to AMR emergence and efficient and cost-effective policies spread, ranging from environmental based on risk assessment. dissemination of antimicrobial residues, resistant pathogens, and resistant genes to inappropriate use of anti­ 2.7. Antimicrobial microbials in health-care settings and animal production, and low public resistance (AMR) awareness about prudent use (Figure 4) (WHO 2019). AMR requires enforce- Progress on controlling AMR, which in ment of legislation, public education, 2019 caused 1.2 million deaths world- and infection prevention and control wide, is a significant development measures. Detecting and respond- challenge, with a substantial economic ing to AMR relies on strengthened impact on developing countries, and and coordinated surveillance and posing a substantial threat to global laboratory capacity and coordinated health security. AMR’s disproportionate responses across sectors of human impact on poverty reduction, food secu- and animal health, environment, rity, health, and well-being, and inequality and trade. reduction in low- and middle-income countries (LMICs) makes it a priority for The AMR burden of disease in Central development strategies. Unaddressed, Asia is being driven by increasing AMR is expected to cause 10 million livestock production, poor biosecurity deaths per year by 2050 (Wellcome and animal health standards, misuse Trust 2016, 2020). In 2017, the World of antimicrobials and growth hormones, Bank estimated that the impact of AMR and substandard food hygiene, all could account for as much as 3.8% of of which contribute to the spread of annual GDP by 2050, with much of the new infectious agents and AMR. The burden of this impact falling on LMICs 2019 Global Burden of Disease (GBD) (Jonas, et al. 2017). study estimates that in Central Europe, While AMR may be devastating for Eastern Europe and Central Asia, an human health, the driving forces of expected average of 17.6 deaths per resistance go well beyond the health 100,000 (11.7–25.3) can be directly sector and are shaped by actions in attributed to AMR, while an average multiple sectors with consequences of 67.7 deaths per 100,000 (45.4–96.6) that threaten human, animal, and can be associated with AMR per year environmental health, collectively. (Murray, et al. 2022). Data from the The key driver of AMR remains the Central Asian and European Surveillance overuse and misuse of antimicrobials. of AMR (CAESAR) network shows that 42 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S FIGURE 4. Main drivers of AMR a Aquat Hum ns ial & ic Misuse and overuse of r Misuse and overuse of Terrest An antimicrobials; poor access antimicrobials; poor access to imals to quality, affordable medicines, vaccines and quality, affordable medicines, diagnostics; lack of vaccines and diagnostics; lack of awareness and knowledge; awareness and knowledge; population movement movement of animals IMPACT OF ANTIMICROBIAL RESISTANCE itation & od & Fee Poor infection and Lack of access to an Fo disease prevention and S d Hy clean water, Water, control; transmission of giene sanitation and resistant pathogens in hygiene; poor Risks to food Increased Economic food production, infection and disease and feed morbidity and damage, loss of production, mortality in productivity storage, distribution prevention and businesses and humans and and increased and preparation control in health care trade; animals health care facilities and farms interaction with expenditures climate change Discharge of waste from Misuse and overuse of health care facilities, antimicrobials; poor pharmaceutical infection and disease manufacturing and prevention and control En la p s P farms v ir o n m e n nts o t & Cr Source: WHO 2019. No Time to Wait: Securing the future from drug-resistant infections. resistance to priority AMR pathogens a lack of adequate animal and public is widespread in the WHO’s Europe health surveillance systems. Although Region that includes all five Central Kazakhstan, the Kyrgyz Republic and Asian countries, underlining the need Tajikistan have satisfactory AMR surveil- for concerted action. In 2019, six patho- lance in humans and participate in the gens were each responsible for more regional External Quality Assistance than 250,000 deaths associated with (EQA) scheme (WHO 2020), the region AMR: E coli, S aureus, K pneumoniae, generally lacks accurate information S pneumoniae, Acinetobacter baumannii, on the AMR situation. All the countries and P aeruginosa, by order of number have been taking steps to address of deaths (WHO 2020). AMR and are making some progress on antimicrobial consumption (AMC)19 Assessing the magnitude of AMR in (Table 6). All of them have developed the region remains a challenge due to AMR action plans. The countries have 19 Antimicrobial consumption (AMC) is defined as the quantity of antimicrobials used in a specific setting (total, community, hospital) during a specific period of time (e.g. days, months, and year). 43 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S TABLE 6. Central Asia anti-microbial resistance progress indicators KAZ KYG TAJ TUR UZB Focal point appointed No Yes Yes Yes Yes Action Plan developed Yes Yes Yes Yes Yes Data submitted to CAESAR, regional No No No No No surveillance network Regional external quality assistance Yes Yes Yes Yes Yes (EQA) scheme participation Enrolled in GLASS No No No No No Sources: WHO 2020, Central Asian and European Surveillance of AMR—CAESAR appointed AMR focal points; and they Legislation for use of antibiotics is in have established some multisector place to varying degrees across the cooperation to tackle the issue. region, but all countries suffer from gaps in enforcement. In Uzbekistan, While there is a strong commitment the national legislation requires a to addressing AMR in the region, prescription for antibiotic use in the high-level endorsement and both animals and humans, including implementation of action plans have all veterinary medicines and feed been stalled due to the prioritization additives. In Kazakhstan, the national of issues related to COVID-19 and legislation requires prescriptions for lack of resources and capacity to antibiotic use for animals and imposes detect AMR in humans, animals, a withdrawal period of 21 days for and in the environment. In Uzbekistan, antibiotics before an animal is slaugh- an AMR legislative framework is tered and animal-based products are being updated, and a draft presi­ produced; and the sale of antibiotics dential resolution is under review to people in the retail network is not by the Cabinet of Ministers, while in carried out without a prescription. The Tajikistan a new National Action Plan use of antibiotics in medicine is also for AMR is under preparation to follow regulated through nationally approved up on the action plan from 2018–2022 clinical protocols. The Kyrgyz Republic (Table 6). and Tajikistan have legislation banning 44 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S the sale of antimicrobials for humans professionals, and establishing integrated without prescription (Bell and Nuzzo systems for public health, animals, 2021). In addition, the Kyrgyz Republic and food surveillance systems in their also prohibits the improper addition of national strategy for AMR. In Uzbekistan, antibiotics to animal feed and imposes the national laboratory system tests for fines on the free sale of antibiotics. nine AMR pathogens, including four In Turkmenistan, there is currently WHO priority pathogens: Escherichia no legislation in place requiring pre- coli, Klebsiella pneumoniae, Salmonella scriptions for antibiotic use in animals spp., and Streptococcus pneumoniae (Bell and Nuzzo 2021). For all Central (WHO 2020) with one accredited AMR Asian countries, there are gaps in laboratory. In Turkmenistan, a few enforcement of the legislation due to designated laboratories are capable of the lack of training of doctors, nurses, detecting and reporting on seven pri- veterinarians, and para-veterinarians, ority AMR pathogens Escherichia coli, as well as animal and human health Klebsiella pneumoniae, Staphylococcus pharmacists on the prudent use of aureus, Streptococcus pneumoniae, antibiotics (ICARS 2021). Surveillance Salmonella spp., Neisseria gonorrhoeae, and monitoring of both sales and Mycobacterium tuberculosis (Bell and the use of antimicrobials is unevenly Nuzzo 2021). In Tajikistan, the National carried out in the region (Bell and Reference Laboratory and four hospital- Nuzzo 2021). based laboratories have initiated AMR susceptibility testing, but a laboratory Addressing the gaps in enforcement quality assurance system should be will require capacity building in established; AMC and AMR surveillance laboratory systems to implement should be expanded across the animal surveillance and monitoring systems health, food safety and environment of antimicrobial use (AMU)20 in both sectors, and data should be published humans and animals efficiently. For all and used to inform public policy (Bell countries, there is currently no system- and Nuzzo 2021). Both Kazakhstan atic reporting of AMR data, although (WHO 2020) and the Kyrgyz Republic surveillance, detection, and reporting (Bell and Nuzzo 2021) are in the pro- of priority AMR pathogens is a priority. cess of appointing an entity to coordi- Tajikistan, Turkmenistan, and Uzbekistan nate the AMR surveillance network to have included the development of develop a national multisectoral plan new surveillance tools, training of for AMR surveillance. 20 Antimicrobial use (AMU) means the volume of antimicrobials delivered. Depending on the data source, this may not reflect the actual amount administered. 45 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 7. Key investment needs to control antimicrobial resistance Convening and coordination ◾ Action plan on AMR setting goals for the reduction of antibiotic use and the prevention of resistance among humans and animals and for cross- border cooperation. Knowledge development and addressing gaps ◾ Biosafety and the quality of veterinary drugs, including to tackle the risk of fraudulent drugs, and their use under supervision by veterinarians. ◾ Public awareness and behavior change campaigns ◾ for farmers, veterinarians and other health professionals on AMR risks in livestock and the environment (rivers, wastewater).; and alternatives to antimicrobials in animal feed. ◾ for policymakers and the public on AMR risks, prevention, and control. Policy development and harmonization ◾ Animal husbandry and animal health practice guidelines, including biosecurity measures and vaccination strategies at farm level, according to international guidelines and standards. ◾ Regulation on prudent use of antibiotics and bans on their use for growth. ◾ Legislation/guidelines on prudent use of antimicrobial drugs in animal production and healthcare, in compliance with AMR international standards. ◾ Regulation/guidelines on over-the-counter sales of antimicrobials. ◾ Prescription guidelines and stewardship for healthcare workers. ◾ Antibiotic residue surveillance and control plans, including according to Limit Maximum residues limit (MRL)21 on food. 21 Maximum residues limit (MRL) is the maximum concentration of residue legally tolerated in a food product obtained from an animal that has received a veterinary medicine. 46 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 7. Key investment needs to control antimicrobial resistance (continued) Capacity building ◾ Surveillance of: ◾ AMR and AMU among animals and humans. ◾ AMR genes in main pathogens (E. coli, salmonella). ◾ AMU and AMR bacteria in water and sanitation systems. ◾ Public health and veterinary laboratory capacity, including training of lab workers to identify priority zoonoses, carry out quality control of antimicrobial drugs, and test their use in animals and humans. ◾ Safe disposal of unused antimicrobials. ◾ Detection and deterrence of substandard and falsified antimicrobials. ◾ Infection prevention and control in health care settings. ◾ Waste management practices in pharmaceutical manufacturing and agricultural production/processing. ◾ Treatment and disposal of sewage and wastewater. ◾ Field inspection systems to monitor and control the use and sales of antibiotics in animals and humans. Goats on a mountain bridge, Tajikistan. Photo credit: Canva 47 A woman selling artisanal dairy products at a free market in the outskirts of Almaty, Kazakhstan. Photo: Ospan Ali 3. One Health in Central Asia Central Asian countries have been services responsible for prevention working on One Health-related and control of epidemic outbreaks, issues, such as strategy develop- and transmission of diseases between ment, epidemiological surveillance, species, used to work in highly special­ and laboratory capacity, with ized silos with rules and functions international partner organizations; well-defined by law, but without and on specific prevention and incentives for cooperation and coordi- control plans, such as those against nation of preparedness and responses. brucellosis and echinococcosis, and While veterinary services notify public AMR. Significant progress has been health services of zoonoses, many observed when there have been clear other prevention and control actions objectives at national level and good are still taken by each sector without involvement of the different local consultation or common planning and authorities and other stakeholders in reviews. A One Health approach would program implementation. However, bring veterinary, public health and there are many gaps in One Health environmental health services together implementation, the most significant to assess risks, prepare for epidemics, of which is limited intersectoral coop- plan and implement timely responses eration between the animal, environ­ to outbreaks, and carry out joint mental and public health sectors, at reviews of those responses, among the national and regional level, in other joint activities. relevant aspects such as regional epidemiological surveillance. Country consultations with senior representatives from the Ministries Animal diseases know no boundaries of Agriculture, Environment, and or borders, and, therefore, their Health of the five Central Asian prevention and control require coop- countries, demonstrated a high level eration and coordination between of engagement, and willingness to animal health, environmental health initiate regional collaboration on and human health services. Imple- a One Health approach with the menting a One Health approach in the World Bank and other international region currently faces challenges of partners. These country consultations poor-quality health specialist training have confirmed two pressing high- and the lack of integrated animal and level issues shared at the regional public health surveillance systems. The level: pandemic preparedness and 49 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S new trade-related opportunities Veterinary Services, Environment/ and threats associated with regional Natural Resources, Public Health, the transport infrastructure. One Health is Quadripartite and other partners— considered an appropriate approach will continue to be carried out in to address these high-level issues the context of this activity to establish through the control of zoonoses, food communication and collaboration safety, and AMR. All Central Asian mechanisms between them; identify countries have developed interagency priority issues in the prevention and programs and have been implement- control of zoonotic and non-zoonotic ing joint activities. Ad hoc cross- animal diseases, AMR and food safety; country collaboration is already taking discuss the benefits and challenges place, for example, in the control of associated with the development of wildlife migration or on issues related a One Health approach to address to the livestock trade. More support those issues; and provide govern- for cross-sectoral cooperation to ments with an overview of financing address urgent health security risks options for ongoing, planned and across animals, human and environ- future activities. mental health would be welcome. The need for a regional approach has been National strategies, plans and highlighted by most counterparts and policies mention One Health none expressed doubts about the approaches and prioritize key One feasibility of regional collaboration. Health activities under different The nature and the magnitude of areas, such as improvement of the the two common challenges require prevention and management of main regional collaboration to develop communicable diseases, moderniza­ prevention and control systems on a tion of sanitary-epidemiological scale that single-country strategies services, public health laboratories, will not be able to achieve. Platforms and veterinary services (Table 7). for regional collaboration, such as the The Quadripartite One Health Joint Central Asia Presidential meetings, Plan of Action (JPA) provides guidance Commonwealth of Independent for countries to implement the One States (CIS), the Eurasian Economic Health approach to address food Union (EAEU), the Central Asia Animal safety, zoonotic diseases, AMR and Health Network (CAAHN) and Central pandemic preparedness. Most coun- Asia Regional Economic Cooperation tries have drafted national strategic (CAREC) do exist and can be vectors plans to address the impact of climate for One Health strategic initiatives. change, and have also developed strategies against transboundary Country consultations with zoonoses, according to their available stakeholders—Ministries of Agriculture/ resources. 50 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S TABLE 7. Central Asia One Health-relevant strategies and policies Kazakhstan ◾ Roadmap for implementation of the International Health Regulations (IHR) and Global Health Protection (GHP) Program 2019–2023 Interdepartmental Internal Evaluation of the Republic of Kazakhstan for IHR and GHSA, ◾  based on the JEE tool in 2016 PVS 2011—and follow-up in 2018 ◾  National Bridging Workshop—Roadmap for implementation of IHR and the OIE PVS ◾  Pathway 2018 ◾  WOAH PVS Gap Analysis mission 2021 Kyrgyz Program on Public Health Protection and Health Care System Development 2019–2030 ◾  Republic Healthy Person—Prosperous Country PVS Evaluation Follow-up mission in 2016 ◾  JEE in 2016 ◾  National Bridging Workshop—Roadmap for implementation of IHR and OIE PVS ◾  Pathway 2018 Tajikistan National Health Strategy 2021–2030 ◾  Health Codex 2017 ◾  ◾ JEE 2019 PVS GAP analysis Mission 2017 ◾  Turkmenistan National Health Strategy 2021–2025 ◾  National Program 2021–2025 for strengthening the capacity of the population to fight ◾  infectious diseases Plan for Preparedness for Counteraction and Response to Acute Infectious Diseases ◾  National Strategy for containment of AMR 2017–2025 ◾  ◾ JEE 2016 PVS mission in 2017 ◾  Uzbekistan Public Health Strategy 2010–2020 ◾  Healthcare system development concept 2019–2025 ◾  PVS mission in 2017 ◾  OIE PVS Gap Analysis mission 2018 ◾  51 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 8. Key investment needs for a strategic and regulatory framework Convening and coordination ◾ Effective intersectoral cooperation frameworks between the animal, environmental and public health sectors, at national and regional levels, including the private sector, to agree on strategy, policy, and regulation for coordinated management of risks. Knowledge development and addressing gaps ◾ Identification of national and regional platforms for increased cooperation, coordination and harmonization of One Health strategies, policies, regulations, and activities. Policy development and harmonization ◾ Establishment and resourcing of a multisector coordination mechanism, and technical working groups on pandemic prevention, preparedness and response, prevention and control of zoonoses, food safety, and AMR, at national and regional level. ◾ Harmonized policies and regulations on those areas, at national and regional level. ◾ Development and implementation of One Health Action Plans. ◾ Harmonized and coordinated legislation that complies with international standards, to (i) provide incentives, and define mechanisms, for increased intersectoral cooperation between animal health services, environmental health services and public health services to avoid duplications and gaps on diagnosis and responses; (ii) control diseases to facilitate safe movement of animals and products; and (iii) identify epidemiologic units and regulate the movements of animals. ◾ Coordinated communication with policymakers and the public about risks, outbreaks, responses and the respective reviews. ◾ Compensation systems for farmers in response to animal culling as part of specific disease prevention and control programs. Capacity building ◾ Development and implementation of One Health Action Plans, in line with The Quadripartite One Health Joint Plan of Action. ◾ National and regional management capacity for increased cooperation at both levels. 52 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S 3.1. Institutional competence due to declining training quality in the absence of continuing capacity education. Successful implementation of a One PVS assessments22 and One Health Health approach in the region is workshops, carried out by FAO, WHO threatened by limited capacity to and WOAH, have identified the need implement intersectoral collaboration to define priority diseases and improve on epidemiological surveillance, surveillance programs, laboratory prevention and control of zoonoses capacity, and vaccination programs and AMR, and food safety. The Public as prerequisites for successful imple- Health and Veterinary, Phytosanitary mentation of a OH approach. The Services supervise and control the safety assessment of the need to strengthen and health of people, animals, and plants. coordination between public health and While these services have the capacity veterinary services through Joint External to perform epidemiological surveillance Evaluations (JEE)23 and National in both humans and animals, there is Bridging Workshops (NBW)24 on IHR25 limited coordination between them, has been delayed in the region due to which compromises efforts to imple- the COVID-19 pandemic. The capacity ment infection prevention and control building workshops on One Health interventions as well as to ensure com- in both Kazakhstan and the Kyrgyz pliance with sanitary and phytosanitary Republic identified anthrax and HPAI (SPS) standards. The veterinary sector as priority diseases, and were advised has sufficient staff, but service quality to limit the number of priority diseases is poor because of a lack of critical to avoid dilution of resources. The PVS 22 The Performance of Veterinary Services (PVS) pathway exercises are performed to strengthen the capacities of the veterinary services in countries by doing a situation assessment, a gap analysis, and developing an action plan with a budget estimate; WOAH provides support to the development of legislation and of the veterinary laboratory network. 23 The JEE is a voluntary, collaborative, multisectoral process comprehensively to assess country capacity to prevent, detect and rapidly respond to public health risks in the framework of the IHR, and inform the development of the national action plans. It validates and adapts a country’s self-evaluation, helping to identify the most critical gaps in IHR core capacity implementation, and prioritize actions to improve preparedness and response capacities. 24 NBW workshops are designed to bring together veterinary and public health country specialists to harmonize frameworks and prepare plans to increase collaboration and develop a joint roadmap for improved management of infectious diseases, particularly zoonoses. Joint use of the IHR Monitoring and Evaluation Framework (IHR MEF), developed by WHO and the OIE Performance of Veterinary Services (PVS) pathway, result in better alignment of animal and public health strategies, and facilitate capacity building. 25 IHR is an international legal instrument under which countries commit to reporting public health emergencies of international concern and to strengthening national preparedness and response systems. Countries are required to provide self-evaluations of core capacities for emergency preparedness and response annually. The State Party Self-Assessment Annual Reporting (SPAR) tool collects data using 24 indicators across 13 capacities: (i) legislation and financing; (ii) IHR coordination and National IHR Focal Point functions; (iii) zoonotic events and the human–animal interface; (iv) food safety; (v) laboratory; (vi) surveillance; (vii) human resources; (viii) National Health Emergency Framework; (ix) health service provision; (x) risk communication; (xi) points of entry; (xii) chemical events; and (xiii) radiation emergencies. 53 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S assessments carried out in Kazakhstan, highlighted. In Tajikistan, multisectoral Kyrgyz Republic. Tajikistan, Turkmenistan, collaboration and communication and Uzbekistan informed the need between public health, animal health, for improving veterinary institutional food safety and other relevant sectors capacity related to surveillance, labora- need to be further strengthened. tories and vaccination programs as part This can be achieved through the of One Health programs. implementation of join action plans for the prevention and control of Modern public health and veterinary priority zoonoses as well as supporting sciences—epidemiology, risk analysis, data sharing or implementing an veterinary governance—required integrated animal and public health for the implementation of the OH surveillance system. In Turkmenistan, approach should be further devel- the One Health strategy needs to oped in Central Asia (WOAH 2012). ensure a better coordination of stan- This should entail a significant training dard operating procedures (SOPs) effort of local staff, to upgrade their and that coordination mechanisms are knowledge and capacity to take the in place. right decisions in case of outbreaks. Improvements in veterinary education Environmental public administrations require curricula to comply with in the region have been included in WOAH standards and guidelines, national One Health initiatives only professional and social expectations to a limited degree, despite having to be met and innovative teaching the capacity to predict transmission methods and educational best of zoonoses and prevent their emer- practices to be adopted. It is also gence and spread, as long as budgets necessary to improve the dialogue for surveillance and monitoring of between Veterinary Statutory Bodies wildlife and pasture protection are (VSBs) and enhance regional coop- available. These services are respon- eration and harmonization between sible for waste management and Veterinary Education Establishments control; supervision of the rational use (VEEs) (WOAH 2018). Improvement of of natural resources; study of the soils continuing education will enable the and resource bases; use and protec- veterinary workforce to remain skilled tion of water, including sanitation; and and updated with new developments protection, reproduction, and use of (WOAH 2016). In the Kyrgyz Republic, wildlife in protected areas, including the need for specialist training in hunting, forest management, and epidemiology, laboratory diagnosis, control of pasture lands. Stronger inte- chemical and nuclear/radiation gration of the environmental services safety, and primary health care was in One Health activities can support 54 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 9. Key investment needs to support institutional capacity building Convening and coordination ◾ Interdisciplinary network of strategic animal, environmental and public health managers to ◾ improve surveillance and monitoring, with a strong focus on outbreak prevention and control. ◾ increase transparency, openness and willingness to share information and resources. ◾ supervise the surveillance system and monitor a One Health Dashboard. Knowledge development and addressing gaps ◾ Development of a dashboard to monitor and evaluate progress on One Health implementation at country and regional level. ◾ Mapping activities of the stakeholders to avoid duplication of efforts. Policy development and harmonization ◾ Development of a Central Asia One Health Framework for Action for pandemic prevention and preparedness, prevention and control of zoonoses and AMR, and food safety. ◾ Regulation of the chain of command and coordination mechanism needed for sharing information, and decision making on planning, implementation, and M&E. ◾ Harmonize One Health case definitions, tools, methods, and operational procedures to address animal and human health threats. Capacity building ◾ Quality training and simulation exercises in ◾ epidemiology, laboratory diagnosis, chemical and nuclear/radiation safety, and primary health care related to infectious diseases, especially zoonoses, AMR, and food hazards. ◾ Training of veterinarians and veterinary paraprofessionals with a curriculum aligned with WOAH recommendations. The number of graduated veterinarians should be based on the country’s real needs. ◾ Data management and operational M&E, with formal procedures for the development of the information system and harmonized development and implementation of disease-prevention and control plans. 55 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S institutional capacity for disease to address health threats. While there prevention and control across human, is an increased focus on the prediction animal, and environmental sectors and prevention of diseases in public at both national and regional levels health, the animal health sector lacks through surveillance of wildlife move- proper surveillance and reporting ments. Through their engagement with of animal diseases and laboratory hunters and forests workers, who can diagnosis. National regulations do locate and remove carcasses safely, not define epidemiological units in they can collect samples to determine compliance with the WOAH definition. the cause of death. In general, these Kazakhstan has recently updated its authorities have been underfunded, regulations, but the definition does which has left a knowledge gap, in not cover all situations (e.g., “village terms of monitoring and surveillance with common pasture”, “farmers”, of wildlife, on how best to maintain “settlements”), which may lead to and protect pastureland, forests, and misunderstandings. In the absence biodiversity to limit the interaction of the definition of epidemiological between wildlife and livestock and units, the epidemiological indicators ensure the productivity of livestock are not entirely useful. It is often through healthy feeding. better to use prevalence or incidence in epidemiological units, and not prevalence and incidence in individual animals. The lack or low quality of 3.2. Epidemiological epidemiological data does not allow surveillance for risk assessment and design of appropriate and efficient prevention Although Central Asian countries and disease-control programs. Active, have made some progress in animal surveillance is essential to guide effective and public health epidemiological disease prevention and control programs surveillance and reporting, data programs, and to demonstrate when quality is insufficient to ensure good countries become free of diseases; and information and decision-making it will result from, and further promote, around prevention and control of collaboration between the relevant zoonoses, AMR and food safety. public sectors, between the public and Controlling contagious diseases starts private sector, and between large by building the capacity to detect companies and smallholder farmers. them. However, the animal health and human health sectors do not use Effective animal and human health harmonized case definitions, tools, surveillance systems require a methods, and operational procedures mechanism for data sharing and 56 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 10. Key investment needs to improve epidemiological surveillance Convening and coordination ◾ Coordinated and integrated network of animal health, environment and public health managers to collect and share epidemiological data across all relevant sectors, stakeholders, and countries. ◾ Interdisciplinary network of strategic stakeholders to improve surveillance and monitoring, with a strong focus on outbreak prevention and control. ◾ Notification of nationally- and internationally notifiable diseases. ◾ Notification of suspected cases to ensure effective field surveillance, including of wild animals. Knowledge development and addressing gaps ◾ Mapping the risk and spread of priority zoonotic and non-zoonotic diseases among humans and animals (wildlife, livestock, domestic animals). ◾ Incorporation of climatic/meteorological data into epidemiologic surveillance. Policy development and harmonization ◾ Cross-country information-sharing on priority diseases across veterinary, environmental and public health services. ◾ Development of animal (domestic, livestock and wildlife), environmental and public health epidemiological surveillance networks. ◾ Network of National Reference Laboratories for animal health, environmental health and public health to ensure the surveillance of circulating strains. ◾ Coordination of public health and veterinary laboratory activities to ensure better coverage and more flexibility in case of emergency management. (continues) 57 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 10. Key investment needs to improve epidemiological surveillance (continued) Capacity building ◾ Capacity for detection, reporting and immediate notification of public health events, including through improved coordination among animal, environmental and public health services. ◾ Early warning and response systems, with intersectoral communication of early warning signals and surveillance results. ◾ Integrated electronic system to gather animal, environmental and public health data, allowing for routine sharing of data on priority zoonoses and monitoring epidemiological indicators and programs. ◾ Coordination of capacities of health and veterinary laboratories, including data-sharing mechanisms. ◾ Field surveillance capacity and reporting to national databases. ◾ Laboratory quality control management to ensure the quality of the tests performed. transparency to ensure reliable, systems in Kazakhstan and the Kyrgyz high-quality, and timely data for Republic can be assessed, with the decision making. The animal health objective of sharing the experience surveillance systems in the region still with the other countries of the region. rely on a few data sources, and delayed Mobilization and support of national and chronic under-reporting, while research institutes would enable the the costs of data collection and trans- development of research on country mission are high. The integration of challenges to adapt international data from multiple sources can enhance practices to the Central Asian context. early detection and response to animal This also facilitates the transfer of diseases and zoonoses and facilitate know-how from international expertise the early control of outbreaks. The to national and regional research strengths and limits, for example, of the institutes. The collection of accurate development of animal identification and transparent epidemiological data, and traceability of animal movement to assess the situation and define the 58 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S best risk-based prevention and control report suspected zoonoses and food strategy is essential, and an area that hazards, is limited. Epidemiologists, needs improvement across the region. public health, environmental health and veterinary specialists, as well as labora- tory technicians, have few opportunities 3.3. Prevention for common training streams. The curriculums of the veterinary faculties and control and the schools for veterinary para­ of zoonoses, professionals do not comply with international standards defined by anti-microbial WOAH. Modern and evidence-based resistance and knowledge in epidemiology, a risk- based food safety system, animal wel- food hazards fare, cost-benefit analysis and impact studies are not well-developed and A coordinated approach to manage- understood, especially to the extent ment of zoonoses and food safety that they would be required to develop risks across ministries to prevent the One Health approach. Clinical and control zoonoses is not yet fully skills to provide high-value animal care established in the countries of the services for farmers are not sufficiently region. It would need to include developed by veterinary faculties. joint early and effective detection, Quality and safety standards for food prevention and control of endemic, producers and processors in the region emerging and re-emerging diseases, need to be updated and harmonized. and of antimicrobial use (AMU) and Joint operational risk communication resistance (AMR); and food safety does not exist. When infected animals risks. There are lists of priority zoonoses are culled, farmers’ compensation is not by country, but the criteria for prioriti- guaranteed. zation are not clear. One Health Action Plans have been developed, with WHO Most countries have given priority assistance, and are at different stages to the control of zoonoses in humans of implementation in each country. IHR and livestock but, among other core capacities are being developed. aspects, have underestimated the However, the animal health and human role of wild animals in the transmis- health sectors do not use harmonized sion of new viruses. Countries are case definitions, tools, methods and involved in the global strategy to operational procedures to address control FMD and PPR. The Kyrgyz animal and human health threats. Republic and Uzbekistan have been The inspection capacity of animals, implementing a control program of ante- and post-mortem, to detect and echinococcosis, and all Central Asian 59 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 11. Key investment needs for One Health prevention and control programs Convening and coordination ◾ Network of animal health, environmental health and public health services and professionals to agree on risk-based prevention and control actions and programs based on surveillance data and other evidence. ◾ One Health workshops would contribute to further strengthening intersectoral cooperation, as well as to raising awareness among the rural population about animal infectious diseases, vaccination and the need for their notification. Knowledge development and addressing gaps ◾ Asses and address: (i) wildlife reservoirs of foxes and wolves; (ii) The dynamics of the stray dog population, to limit rapid renewal and growth of an uncontrolled population, at the time of vaccination. ◾ M&E of national disease prevention and control action plans, based on international best practice, to increase effectiveness and efficiency. Policy development and harmonization ◾ Development of a One Health managerial culture to manage zoonoses, including by early and effective detection, prevention and control of endemic, emerging and re-emerging infectious diseases; to mitigate AMU and AMR; and to improve food safety. ◾ Intersectoral One Health Action Plans for risk assessment, prevention, preparedness, and response to pandemics, zoonoses, AMR and food safety events. ◾ Contingency plans for response to outbreaks of priority zoonoses and other biological threats, and to prevent food contamination and food- borne diseases. ◾ Routine and outbreak intersectoral operational risk communication. ◾ Long-term, adequate resources to facilitate successful implementation of the One Health programs. ◾ Food quality and safety standards for food producers and processors. 60 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 11. Key investment needs for One Health prevention and control programs (continued) Capacity building ◾ Routine and outbreak intersectoral operational risk communication to develop awareness among decision-makers and the population, targeting the most exposed people, such as animal handlers and hunters. ◾ Raise awareness among rural population, and further intersectoral cooperation on the prevention and control of animal infectious diseases, vaccination, and the need for their notification. ◾ One Health field activities involving community stakeholders: farmers, veterinarians, environmental specialists, and public health specialists. ◾ Joint Rapid Outbreak Assessments (JROA), simulation exercises and After-Action Reviews (AARs) to improve coordination and networking across sectors, strengthen the recovery phase and build resilience. ◾ Simulation exercises by Joint Rapid Response teams (JRRT) at local level to ensure effective capacity to manage emergency situations. ◾ Joint prevention and control programs for zoonoses, especially in highly vulnerable regions (oblasts), (i) for rabies, better coordination between human and animal health services for the management of biting dogs and bitten humans, following integrated bite-case management (IBCM); (ii) for brucellosis, vaccination campaigns of young females in cattle and small ruminants, and for rabies, of the dog population; (iii) simultaneous deworming to prevent echinococcosis and vaccination against rabies. ◾ Zoning and compartmentalization to control some diseases and to ensure free zones. ◾ Risk-based food inspection capacity, including developing inspection capacity, ante- and post-mortem, to detect and report suspected zoonoses and food safety issues. ◾ HR capacity for joint response and field investigation of priority zoonoses and foodborne diseases, and establish joint continuous education for epidemiologists, public health and vet specialists, and lab technicians. 61 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S countries have expressed interest in implementing a One Health approach. developing joint control strategies for Partners include: the Central Asia echinococcosis, in line with the One Regional Economic Cooperation Health approach, to strengthen their (CAREC) Program, the Eurasian Eco- efforts to carry out dog deworming and nomic Union (EAEU), the Central Asian to control offal from slaughtered ani- and European Surveillance of AMR mals better. The One Health approach (CAESAR), the World Health Organiza- should be developed through specific tion (WHO), the Food and Agriculture prevention and control programs, Organization (FAO), the World Organi­ demonstrating the added value of a sation for Animal Health (WOAH), coordinated approach, and illustrating and the United Nations Environment internationally recognized concepts Programme (UNEP), the Asian Devel­ and practices, to improve public opment Bank (ADB), the World Bank, health and animal health indicators, EU countries and the European while increasing understanding and Commission (EC). The Quadripartite capacities of international One Health (FAO, WOAH, WHO, and UNEP) have practices. been carrying out sector evaluations and developing capacity building activities on zoonoses, AMR, food 3.4. Regional safety and biosecurity, biodiversity loss and climate change. EU countries cooperation such as Austria, France, and Germany; the European Commission; the US Regional infrastructure developments Center for Disease Control (CDC), open significant economic opportu- US Defense Department and others nities for Central Asian countries but have also carried out studies and bring an increased risk for the trans- provided technical and financial mission and spread of transboundary assistance to the development of diseases along regional transport One Health activities in Central Asia. corridors, as has been observed in other parts of the world. Regional Regional cooperation in Central Asia cooperation on One Health will con­ has significant potential; the region tribute to unlocking the countries’ is well placed to prevent and tackle potential even more, enhancing future zoonoses and other disease efficiency and lowering costs. Regional outbreaks. As viruses flow freely across and international organizations have borders, knowledge, information, and been helping Central Asian countries action at the national and regional level to improve public health and veteri- are important first steps to identify nary services and take initial steps in how Central Asian countries can come 62 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S together to address environmental, a COVID-19 project. In the Kyrgyz public health and veterinary issues Republic, World Bank-financed projects posing a risk to national, regional, and are under implementation: Integrated global health security. Dairy Productivity Improvement, Emergency COVID-19, and Integrated The World Bank and other inter­ Forest Ecosystem Management. Others national partner organizations have under preparation: Climate-Smart been supporting the development of Investment for Food Security; Resilient One Health Initiatives in Central Asia Landscape Restoration, and Air Quality in the last decade. A World Bank- Improvement. In Tajikistan, the World funded Regional One Health Project Bank is currently preparing a new was implemented in Central Asia in health project: Milati Solim—Healthy 2011, in the context of the Central Nation—including a US$4.75 million Asia Regional Public Health Platform, component to strengthen Health Emer- initiated under the Central Asia AIDS gency Preparedness and Response, Control Project (CAAP), both financed and is assisting in the preparation of by World Bank grants and implemented the National Agriculture Strategy, and by the Eurasian Economic Community the implementation of four OH-related (World Bank 2012a). The 2011 World projects: Strengthening Resilience of Bank US$3 million One Health grant the Agriculture Sector; Resiland CA+; to prevent and control zoonoses and Emergency COVID-19; and Rural Water improve food safety, developed and Supply and Sanitation. In Uzbekistan, applied a detailed gap analysis tool, the One Health-related World Bank- as well as economic analyses of the financed project—First Livestock Sector impact of zoonoses; and developed Development—has been completed; action plans for veterinary and public the Emergency COVID-19 Response is health services in Kazakhstan, the Kyrgyz being implemented; and the Second Republic, Tajikistan and Uzbekistan. Livestock Sector Development is under The World Bank is currently (end-2022) preparation. assisting the Kazakh government with the development of its Health Since its inception in 2001, CAREC26 Strategy, and the Bank has financed has mobilized US$40 billion of funding and assisted the implementation of to establish multimodal transportation 26 CAREC is a partnership of 11 countries and development partners working together to promote development through cooperation, leading to accelerated economic growth and poverty reduction. A vision of Good Neighbors, Good Partners, and Good Prospects guides members: Azerbaijan, Georgia, Kazakhstan, the Kyrgyz Republic, Mongolia, Pakistan, People’s Republic of China, Tajikistan, Turkmenistan and Uzbekistan. 63 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S networks (Figure 5), increased energy countries through a regional approach, trade and security, facilitated free while safeguarding the needs of the movement of people and freight, most vulnerable segments of the and laid the groundwork for the population. The Strategy has five development of an economic corridor. pillars: leadership, coordination, human About 75% of these investments were resource capacity building; improved in transport, 22% in energy and 3% in surveillance and laboratory infrastructure; trade. About US$15 billion have been emergency demands and access to financed by ADB, US$16 billion by supplies; border health and services other develop­ ment partners, and for migrants, border communities and US$9 billion by CAREC governments. vulnerable groups; and cross-cutting CAREC 2030 provides the new long- issues: gender, digital health/innovation. term strategic framework for the It aims at addressing pandemic risks program. It is anchored on a broader and controlling communicable diseases, mission to connect people, policies, including through the development of and projects for shared and sustainable early warning and response systems development, serving as the premier and regional surveillance centers; and economic and social cooperation facilitate common approaches and platform for the region. cross-learning in prevention and treatment protocols for non-communicable diseases. In November 2021 CAREC adopted a A Regional Investment Framework for Health Strategy 2030, which addresses implementa­ tion of the CAREC Health public health threats in member Strategy is being developed in 2022. FIGURE 5. Central Asia Regional Economic Cooperation transport corridors CAREC Transport Corridor 1 CAREC Transport Corridor 2 RUSSIAN FEDERATION MONGOLIA CA KAZAKHSTAN RE ASTANA C 2 AZERBAIJAN MONGOLIA UZBEKISTAN KAZAKHSTAN KYRGZ REPUBLIC PEOPLE’S REPUBLIC TURKMENISTAN TASHMENT OF CHINA UZBEKISTAN IRAN XINJIANG UYGUR BISHKEK TAJIKSTAN AUTOMOUS REGION TASHKENT KYRGYZ REPUBLIC PEOPLE’S REPUBLIC OF CHINA TAJIKSTAN XINJIANG UYGUR OU SHANBE AUTONOMOUS REGION Source: CAREC 2017 64 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S ADB has been assisting CAREC to associated with climate change; it develop and implement the 2030 provided a US$200 million to finance Strategy, which includes a Health women’s businesses, and the Entrepre- Strategy. ADB supports the develop- neurship Development Fund (“Damu”) ment of the Almaty-Bishkek economic financing mechanism to support corridor as part of the China Silk Road adoption of green investments by initiative. The Belt and Road Initiative micro, small and medium enterprises (BRI) was announced by China’s Pres- (MSMEs). In the Kyrgyz Republic, ident Xi Jinping in 2013. Countries ADB focuses on supporting inclusive along the BRI are expected to improve growth and economic diversification, infrastructure connectivity to form a improving access to public and social network that will bring together Asia, services. It provided US$25 million Europe and Africa. Key transportation for COVID-19 vaccines, and plans to passageways are being improved to assist school education reform, regional facilitate international transport for the health security, and assistance with countries through railways and high- the development of the Issyk-Kul Lake ways, and on seaports and airports, environmental management and tourism energy-oil and gas pipelines, power development. In Tajikistan, ADB assists supply grids and communications- diversifying the economic base and optical networks. Four of the six improving the investment climate to CAREC corridors pass through create jobs with higher incomes. It has Kazakhstan, reinforcing its critical role approved a US$30 million grant to in regional transport. The most vital modernize the Yovon irrigation and are the CAREC Corridor 1, an impor­ drainage system in the lower Vakhsh tant cargo-transit route from China, river basin, and it plans to provide through the Kyrgyz Republic and US$345.54 million from 2022 to 2024, Kazakhstan, to the Russian Federation to fund food security and water- and Europe; and the CAREC Corridor 2, resource management, develop urban an east-west conduit linking Uzbekistan infrastructure and the energy sector. with China and the Russian Federa­ ADB has been assisting Turkmenistan to tion, the Caucasus and beyond reposition itself as a regional trade and (CAREC 2017) . transit hub and to diversify its overseas markets. ADB plans to support SME In addition, ADB has provided exporters, the development of renew- support to regional countries. In able energy and a gas pipeline and is Kazakhstan, the ADB has helped to supporting improved nursing quality ensure COVID-19 pandemic recovery, and capacity. In Uzbekistan, ADB is and to minimize the country’s depen- assisting reforms to transition to a more dence on commodity exports, reduce inclusive and market-driven economy inequalities, and address vulnerabilities by developing the private sector and 65 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S reducing the state’s footprint. It plans to to be updated by taking a risk-based invest in the gas transmission network’s approach to food safety based on the modernization and efficiency, urban Hazard Analysis Critical Control Point development, infrastructure for rural (HACCP) principles adopted according productivity, wind power, and water to country-specific circumstances resources management in the Aral (ADB 2019) Sea Basin. The Central Asian and European The Eurasian Economic Union (EAEU) Surveillance of AMR (CAESAR) is is an international organization for a network of national surveillance regional economic integration. It systems. It includes European countries has an international legal personality that are not part of EARS-Net, the and is established by the Treaty on European AMR Surveillance Network, the Eurasian Economic Union. The which is coordinated by the EU ECDC— EAEU provides for free movement of European Centre for Disease Prevention goods, services, capital, and labor, and and Control. CAESAR is a joint initiative pursues coordinated, harmonized and of WHO-Europe, ESCMID—the Euro- single policy in the sectors determined pean Society of Clinical Microbiology by the Treaty and Union international and Infectious Diseases, and RIVM— agreements. The Union was created the Dutch National Institute for Public to upgrade, raise the competitiveness Health and the Environment. CAESAR of and increase cooperation between is part of the GLASS—the Global AMR the national economies involved, and Surveillance System. Participating to promote stable development to countries are (October 2022) Albania, raise the living standards of its member Armenia, Azerbaijan, Belarus, Bosnia states: Armenia, Belarus, Kazakhstan, and Herzegovina, Georgia, Kazakhstan, Kyrgyz Republic, the Russian Federa- Kyrgyz Republic, Kosovo, Montenegro, tion, and Moldova (as an observer). To Moldova, Russian Federation, Serbia, allow for free trade between country Switzerland, Tajikistan, North Macedonia, members, common standards and Turkey, Turkmenistan, Ukraine and regulations on food safety and animal Uzbekistan. health have been developed in compli- ance with international specifications In Central Asia, the US CDC has (CAREC 2019). However, despite been working on global health amendments to veterinary legislation, security activities, including sup- Central Asian countries lag behind and porting implementation of a One are not providing appropriate levels of Health approach and strengthening protection from animal diseases and emergency preparedness. The CDC zoonoses. The same applies to food supports cross-sectoral collaboration, safety, where national legislation needs development of guidelines, and 66 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S training of key government staff on tracking diseases, improving testing epidemiological surveillance, dis- and standardizing clinical practice ease outbreak response, laboratory guidelines. A One Health 5-year systems and workforce development strategic plan was completed, and the (CDC 2022b). CDC’s Field Epidemiology national One Health Program used Training Programs (FETP) in Kazakhstan, a CDC tool to prioritize zoonoses the Kyrgyz Republic, Uzbekistan, and (CDC 2022b): anthrax, brucellosis, Tajikistan have trained 176 health CCHF, echinococcosis, plague, rabies, professionals since 2003. FETP trains zoonotic influenza, and tuberculosis. field epidemiologists who work to CDC assisted the establishment of improve global health security by the National Centre for AMR, which is strengthening their country’s capacity responsible for diagnosing and identify- to prevent, detect and respond to ing drug-resistant bacteria, conducting disease threats before they become surveillance and antimicrobial suscepti- larger epidemics. FETP residents have bility testing. conducted outbreak investigation and surveillance evaluations of zoonoses FAO, WOAH, and WHO have focused such as anthrax, CCHF, leptospirosis on global and regional health-security and tularemia. issues such as AMR, rabies and zoonotic influenza, zoonotic tuber- In Kazakhstan, CDC has conducted culosis, and Middle East Respiratory five-week workshops on surveillance Syndrome—Coronavirus (MERS CoV). evaluation, Geographic Information These organizations have been provid- Systems (GIS) and scientific commu­ ing tools and capacity building to nication for epidemiologists and strengthen cooperation between public veterinarians. It has helped enhance health and animal health systems and CCHF surveillance and control (CDC synergize the capacity development 2022b). With CDC support, Kazakhstani of health services. The WHO Global public health and veterinary officials Action Plan on AMR, which was devel- conducted a serosurvey (of people, oped in close collaboration with FAO and sheep and cows) and a knowledge, WOAH and was endorsed by member attitudes and practice (KAP) study on countries of all three organizations, CCHF in the Zhambyl region (CDC committed countries to implement action 2022b); as well as a study on the distri- plans at national level. The Global frame- bution of tick-borne pathogens among work for the elimination of dog-mediated hospitalized patients and ticks in the human rabies aims to reduce the number Pavlodar region. In Uzbekistan, CDC, of human deaths to zero by 2030. The the Defense Threat Reduction Agency WOAH-FAO Network of Expertise on (DTRA) and FAO have worked with the Animal Influenza (OFFLU), addressing government on new approaches to zoonotic influenza, has improved 67 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S global surveillance and information High Level Expert Panel (OHHLEP), sharing with WHO experts to adapt flu a multidisciplinary group of 26 inter­ vaccines to the current animal strains nationally recognized experts, collects, in circulation. FAO, WOAH and WHO distributes, and publicizes reliable are participating in the implementation scientific information on the links of the Multi-Partner Trust Fund (MPTF) between human, animal, and environ- project to combat AMR in Tajikistan. mental health to assist public officials The project aims to use multisectoral in making appropriate decisions to approaches to implement the National avoid future crises and to inform Action Plan (NAP) on AMR in the citizens (OHHLEP 2021). country. The Regional One Health Coordination International organizations are Mechanism for Europe consolidates taking steps to strengthen the multi­ cooperation between the FAO, the lateral health architecture. In 2017, WOAH, the WHO and the UNEP FAO, WOAH and WHO established Regional Offices for Europe and the One Health Tripartite with the Central Asia to address the wide range objective of addressing priority areas of activities related to this approach, requiring a multi-sectoral collaborative within the human-animal-environment leadership through joint planning, interface. This was established in April monitoring, and reporting. This 2021, and when the Regional UNEP Office joined the mechanism in August partnership was recently enlarged 2022, the regional directors of the four by partnering with UNEP and is now organizations signed a new Joint State- referred to as the Quadripartite, to ment of Intent establishing the Regional include the environment sector and Quadripartite Mechanism for Europe. ensure optimal animal, environmental A Regional Operational Plan of Action and public health levels. Tools have on One Health is under preparation for been developed to assist countries in consideration by the WHO Regional enhancing One Health collaboration, Committee for Europe in 2024. WHO coordination, and communication, and FAO have approved Global Food including by strengthening early Safety Strategies, and WHO EURO has warning and surveillance and monitor- recently established a Technical Advisory ing systems, implementing risk-based Group on One Health. approaches to address emerging, re-emerging and neglected infectious To promote the One Health approach diseases and pandemics, and address- with national partners, FAO and ing food-safety issues. The partners WOAH have been supporting the encourage and support collaboration development of the Central Asian through regional, national and local Animal Health Network (CAAHN), networks. Since 2021, the One Health which acts as an umbrella organization 68 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S to coordinate initiatives and projects control zoonoses and AMR, protect the by countries and international agencies hoods of farmers from the impacts liveli­ related to animal health in the region. of plant and animal diseases, and Other FAO initiatives in the region increase the sustainability of agricul- are the Network on Priority Livestock tural practices. To anticipate, prevent, Diseases in Central Asia (PLDCA) and the detect and respond to plant, animal project on reducing the advance of and food-borne disease outbreaks and AMR in food and agriculture in the AMR, FAO encourages the sharing of region. Globally, FAO works with epidemiological data and laboratory partners to promote global health, information across sectors and borders, eliminate hunger, promote food which can result in more effective safety and healthy diets, prevent and coordinated planning and response. BOX 12. Key investment needs for regional cooperation Convening and coordination ◾ Areas of potential regional cross-sector cooperation are livestock productivity and trade, the prevention and control of zoonoses, emerging diseases and pandemics, AMR and biodiversity losses. Exchange of information about a regional harmonization of national SPS ◾ requirements consistent with international standards, guidelines and recommendations as stated in the WTO agreement on the application of SPS measures. ◾ Regional coordination of food oversight programs on quality and safety to reduce costs. Knowledge development and addressing gaps ◾ Technical, environmental, sanitary and regulatory constraints to livestock productivity and trade in Central Asian countries. Policy development and harmonization ◾ Investment, leadership, and engagement on a coordinated approach to One Health in Central Asia. (continues) 69 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 12. Key investment needs for regional cooperation (continued) ◾ Coordination of management of animal health, environmental and public health risks, involving all national and local competent authorities, would increase regional well-being and add value to the regional economies. ◾ World-class plant- and animal-product safety standards to grow agricultural and meat exports. Capacity building ◾ Capacity to rapidly share information during food safety emergency situations using the FAO/WHO International Food Safety Authorities Network (INFOSAN). ◾ IHR core capacities, including a regional epidemiological surveillance network. Stockfish in the Issyk-Kul market, Kyrgyz Republic. Photo credit: Canva 70 4. One Health: lessons learned from implementation In the past decade, the World Bank to allow each partner to make regula- has worked globally at both national tory adjustments based on shared data. and regional levels to promote To support countries reaching infec- and operationalize One Health tious disease prevention and control approaches supported by govern- objectives, the World Bank has ments, technical institutions, and developed a considerable knowledge international partner organizations. base on how to address One Health The One Health approach is used dimensions at both national and to design and implement programs, regional levels. The World Bank One policies and legislation impacting Health: Operational Framework for sustainable agriculture, food safety Strengthening Public Health Systems at and security, AMR, nutrition, animal and the Human-Animal-Environment Inter- plant health, fisheries, and livelihoods. face offers guidance to apply a One In the context of the global avian influ- Health approach to ensure sector- and enza crisis, FAO, WOAH (OIE at the country-specific action is targeted to time) and WHO, in collaboration with address the specific One Health issues UNICEF, UNSIC, and the World Bank, and is integrated appropriately into have also developed a joint strategic financed projects. It outlines activities framework (FAO, et al. 2008) to address and interventions to target disease risks associated with emerging and threats and highlights mechanisms for re-emerging diseases and pandemics. institutional and technical implementa- The joint report set out six specific tion to build more collaborative veter­ objectives for countries to consider in inary and public health systems (Berthe, their approach to infectious disease et al. 2018). Lessons learned from control at the human-animal-environment country-based operations, such as the interfaces, which can be applied to One Global Program for Avian Influenza and Health issues such as zoonoses, AMR, Human Pandemic Preparedness and and food safety and security. Table 8 Response (GPAI), and ongoing regional summarizes the specific objectives for operations, such as the Regional Disease infectious disease prevention and control Surveillance System Enhancement whose success depends on countries’ Program (REDISSE), and Africa Center ability to strengthen collaboration among for Disease Control and Prevention existing institutions and its effectiveness (Africa CDC), have been considered. 71 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S TABLE 8. Infectious disease prevention and control objectives Component Approach Risk Assessment Identify and take sensible and proportionate measures to control the risks. Surveillance Develop international, regional, and national capacity in surveillance using international standards, tools, and monitoring processes. Prevent, detect, and Ensure adequate international, regional, and national capacity in public and animal respond health including communication strategies. Rapid response Ensure functioning national emergency response capacity as well as global rapid system response capacity. Collaboration Promote interagency and cross-sector collaboration and partnerships. Control Control existing and reemerging infectious diseases. Training and capacity Infectious disease prevention and control of health care staff and biosecurity measures building of farmers and veterinarians. Research Conduct strategic research. Source: World Bank BOX 13. The Regional Disease Surveillance System Engagement (REDISSE) in Nigeria The REDISSE project aims at strengthening countries in the Economic Community of West African States (ECOWAS) sub-region following the 2014 West African Ebola crisis. It is designed as a multi-sectoral One Health project incorporating an interdependent series of projects to be implemented across the human and animal health sectors in four phases across West Africa. Project structure. In Nigeria, the project is being implemented under regular government structures by the Federal Ministry of Health, represented by the Nigeria Centre for Disease Control (NCDC), and the Federal Ministry of Agriculture and Rural Development, represented by the Department of Veterinary Services. The NCDC hosts the project coordination unit (PCU), which is staffed by civil servants. 72 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S BOX 13. The Regional Disease Surveillance System Engagement (REDISSE) in Nigeria (continued) Regional component. The project’s regional component is anchored by the West African Health Organization (WAHO), which provides oversight and technical guidance through the coordination of the Regional Technical Committee and technical support to countries. WAHO provides technical support for regional laboratories, funding for regional training of residents on the advanced field epidemiology program, establishment of centers for epidemiological surveillance in some countries and capacity building for regional rapid response teams. National level. The PCUs of the participating countries would be responsible for collecting and compiling all national level data with the assistance of external partners through external evaluations, including the US Centers for Disease Control (US CDC), and World Health Organization (WHO) for the human health sector, and OIE for the animal health sector. Project Components, Sectors and Units. The REDISSE project provides access to flexible and easily deployable resources through five components. ◾ Surveillance and health information ◾ Capacity building of laboratories ◾ Emergency preparedness and response ◾ Human resources management for effective disease surveillance and epidemics preparedness ◾ Institutional capacity building, project management, coordination and advocacy Project governance. Governance for the project is provided by the National Steering Committee (NSC) which is chaired by the Minister of Health with the Federal Minister of Agriculture and Rural Development (FMARD) as co-Chair. oversight is provided by the National Technical Committee (NTC) which is led by the Director General of the NCDC, and cochaired by the Chief Veterinary Officer of Nigeria (Director, Department of Veterinary and Pest Control Services, FMARD). Source: REDISSE Project Nigeria, Annual Report 2020 73 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S The World Bank is now supporting significant economic returns. A World around 45 projects incorporating a Bank cost-benefit analysis showed One Health approach at a value of that investments by the international US$1.5 billion in commitments. This community of US$1.9 to US$3.4 billion includes REDISSE in West & Central per year (depending on whether Africa, an interdependent Series disease prevalence is low or high) in of Projects (ISOP, US$657 million) One Health systems will result in an supporting surveillance in human and annual expected rate of return between animal populations and epidemic 44–71% and prevent half or all mild preparedness. pandemics (World Bank 2012b). The baseline annual expected loss in global Aligning priorities across different national income from viral zoonotic sectors and across borders can be disease outbreaks is $212 billion (Berstein, challenging, adding to One Health et al. 2022) suggesting that primary pre- project complexity, but it is crucial vention could cost a fraction of the cost for investing in preparedness and risk of response. Additional added value can reduction, as demonstrated by the be expected from regional collaboration REDISSE project (Box 13). The main between animal, human and environ- obstacles for countries to embrace One mental sectors. For example, 50% of Health at national level include the AMR costs are avoided by vigorous con- lack of coordination between public tainment efforts across different sectors, entities, the absence of communication and investment costs of US$0.2 trillion and coordination across the public would reap between US$10 trillion and and private spheres, the reorientation US$27 trillion in expected cumulative of investments from prevention to global benefits by 2050 (Jonas, et al. response, and a tendency to focus on 2017). In addition, the total productivity one sector, which may divert attention loss associated with foodborne disease from other One Health components. in low- and middle-income countries is estimated to cost US$ 95.2 billion per One Health strategies have proven to year, and the annual cost of treating be highly cost-effective for reducing foodborne illnesses is estimated at pandemic impacts, AMR risks and US$ 15 billion (Jaffee, et al. 2019). zoonotic and endemic diseases, while enhancing food safety and The infrastructure put in place in providing benefits of economies of Central Asian countries to address scale. Refocusing from curative and Highly Pathogenic Avian Influenza reactive approaches to investment in offers an example of significant One Health systems and the prevention opportunities for economies of scale of zoonotic diseases, food safety, when focusing on other species or AMR, and future pandemics, can offer health issues; support services for 74 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S human and laboratory capacity can zoonoses will not only attenuate human often be shared. Pooling resources in a health costs but reduce livestock sector targeted manner will lead to economies losses in the region. Classic examples of scale and enable countries to address from brucellosis and rabies demonstrate common problems across systems ratio- that zoonosis control can save money in nally, avoiding duplication. For example, resource-limited countries and is likely investments in improving veterinary to reduce their occurrence worldwide. services in the response to HPAI were Multiple cost-effect analyses have shown focused mostly on poultry, however, the that the control of canine-mediated resulting infrastructure offers significant rabies through vaccinating of dogs is a opportunities to address additional highly cost-effective One Health interven- species and AMR, as support services tion by WHO definitions (Baltussen, et al. for human and laboratory capacity can 2003) compared to human post-exposure often be shared. Harmonization can prophylaxis alone (Borse, et al. 2018). bring coherence to communication The per-unit cost of post-exposure approaches and unify communication prophylaxis in humans is about 500 times messages. Importantly it can also higher than the vaccination of dogs. Live- support faster and better coordination stock vaccination for brucellosis (Roth, in crisis (World Bank 2019). Vietnam et al. 2003) (Coelho and Pinto 2011) Avian and Human Influenza Control and control of cystic echinococcosis through Preparedness Project (VAHIP, under the drug administration and improved Framework of the Global Program for management practices also offer positive Avian Influenza) clearly demonstrated cost-benefit ratios for society (Robertson, the high rates of return on investment in Torgerson and van der Giessen 2018). enhancing government effectiveness in Brucellosis control in Central Asia—and veterinary and public health services, by in Mongolia, as part of the 10-year annual controlling avian influenza at the source livestock mass vaccination campaign— in poultry, thereby reducing the risk of has proven to be one of the most cost- pandemic influenza. The preparedness effective interventions at US$ 25 per under VAHIP would have saved Vietnam’s DALY averted, which is comparable to economy US$1 billion if a pandemic had the cost-effectiveness of vaccinating started (World Bank 2015) and continues women and children, or treating tuber­ to strengthen existing systems, multi- culosis (Zinsstag, et al. 2007). sectoral collaboration and the country’s preparedness for future pandemics. Control of zoonotic food-borne infections at the animal source also Substantial evidence exists of the eco- presents a strong case for investment nomic value of investing in the control in One Health, because of the sub- of endemic zoonotic diseases at the stantial co-benefits, such as for food source, the animal reservoir. Control of safety. Prevention of salmonellosis, 75 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S campylobacteriosis, toxoplasmosis, investments and planning for collabora- cysticercosis and Escherichia coli within tive implementation at an early stage. livestock underscore the case for public and private investment by illustrating a One country’s experience in posi- cost-effective means of reducing the risk tively addressing a key One Health of exposure and subsequent incidence issue can serve as a good example for neighboring countries. Disease of human cases, in addition to industry control and public health functions losses. For instance, a cost-benefit are handled largely through national analysis of the food safety regulation institutions. Evidence from past public of poultry production (in New Zealand) health emergencies shows the impor- showed a remarkable cost-benefit ratio tance of supporting the client country’s with good returns from the combined own systems for prevention, emergency efforts of industry and the regulator preparedness, response, and recovery equal to US$32.7 million annually systems. However, while country (Duncan 2014). projects are at the core, coordinated responses across countries and sectors would strengthen performance. 4.1. Strengthen national and Investments in institutional capacity at the regional level must be comple- regional capacity mented by resourcing the national level. REDISSE has highlighted the At the national level, the success importance of developing a robust of One Health projects requires an regional management implementation understanding of the country context agency through recruitment and capacity and actions to prevent and manage building (Box 13). This needs to be emerging infectious diseases, includ- supported by national staff to strengthen ing zoonoses, as well as the institu- communication between regional tional and human resource capacity countries and build institutional capacity. to work across sectors. Several tools The capacity of this implementation can be useful in informing the country agency is key for project success. An diagnoses, including the IHR security experienced agency can overcome framework, which has already been emerging difficulties and speed up used in Central Asian countries. Where implementation. The institutional capacity there is appetite for a multisectoral of the implementation agency is equally approach, bringing the results of important to ensure well-prepared sub- the JEE and the PVS together in a projects and effective project oversight. National Bridging Workshop (NBW), as has already been done in Central Adoption of the One Health approach Asian countries, can help prioritize would have the advantage of 76 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S including: (i) pooling of expertise and and animal products can benefit from financial resources to address the sharing information and coordinating issues across the three health systems policies at the regional level. A regional of animal-human-environmental mechanism can support comple- health; (ii) synergies between dif­ ferent mentary and joint actions among institutional perspectives and expe- implementation agencies for greater riences; and (iii) a strong focus on efficacy and efficiency. Such a regional constructive partnerships. The experi- service could also save money, which ences of the HPAI campaign underline is particularly important when regional the importance of a productive activities are funded by grants or loans. institutional partnership between the Stakeholder and donor alignment traditional public, animal, and wildlife needs to be a priority early in project health sectors, and between social preparation, especially for a novel and public financing sectors, including reform, while ensuring that sufficient government departments, industry, the time is given to tailor design to the private sector, research institutions, and local context is another key to project CSOs. At the regional level, potential success. Striking a balance between partners would include organizations donor involvement and government that promote collaboration among ownership is also necessary. Alignment governments. Internationally, they of donors funding a national program would include both international helps improve efficiency and focus on organizations, such as the Quadri­ a country’s own priorities. The World partite, and a wide network of actors. Bank has been bringing stakeholders The institutional partnership should to a shared understanding of devel- be focused on prevention, contingency opment priorities, and harmonizing planning, and action against emerging donors around the objectives, design, and reemerging infectious diseases and and implementation of a reform such not be limited to addressing one or few as One Health. Some OH activities infectious diseases or other health threats that benefit from regional cooperation such as AMR (Berthe, et al. 2018). are: (i) networking decision makers to respond to multi-jurisdictional outbreaks; (ii) connecting epidemiologists to share 4.2. Regional information and efficiently integrate cooperation new knowledge; (iii) creating common high-level infrastructures; and (iv) sharing Both REDISSE and Africa CDC show of laboratory capacity. the value of working with a regional institution. Central Asian countries Lessons learned from FAO, WHO, shared economic interest in improving WOAH, and UNEP suggest that productivity and the trade of animals implementing a standing coordination 77 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S mechanism to help ensure continuity themselves, and engagement with other of joint operations and encourage stakeholders through joint agreements One Health implementation could be and coordination mechanisms, e.g., secured by either creating a forum Global Early Warning System (GLEWS), or partnership between govern­ the global network on animal influenza ments or through joint agreements (OFFLU), and Global Framework for the and coordination mechanisms. Progressive Control of Transboundary A forum or partnership between Animal Diseases (GF-TADs)27 to encour- governments would be advised to age collaboration with more stakeholders focus on the implementation of a and strengthen a country focus (FAO, et al. Strategic Framework from a political 2008). Indeed, the OH Quadripartite is perspective and providing advice and planning to initiate a stock-taking exer- guidance to the specialized international cise of existing cross-sectoral global and agencies. Another approach would regional initiatives around OH to identify be to strengthen formal collaboration and advise on synergies and overlaps, between the specialized agencies, and to support coordination. 27 GF-TADs is a facilitating mechanism that will endeavor to empower regional alliances in the fight against transboundary animal diseases (TADs), to provide for capacity building and to assist in establishing programs for the specific control of certain TADs based on regional priorities. 78 5. Conclusion and recommendations for a Regional One Health program in Central Asia 5.1. Regional issues and regional level; data availability and data sharing are very limited, and so require a regional are human capacities and cross-sectoral response collaboration. Central Asian countries face similar The continuing development of regional transport infrastructure animal, ecosystem and human health brings major opportunities for challenges: the need to prepare for exports of livestock and animal future pandemics; and to seize new products, but also brings increased opportunities and address threats asso- risk of the transmission and spread of ciated with food insecurity and land and transboundary diseases and unsafe water resource degradation. The nature food. The prospects of these countries and the magnitude of these common as suppliers of agri-products and challenges are high on governments’ livestock will depend on how their food agendas and call for regional collabora- producers and processors respond tion to develop prevention and control to the quality and safety demands systems on a scale that single-country of consumers, and on how well they strategies are not able to achieve. coordinate on quality standards and expanding agricultural food trade In addition to the COVID-19 pan- to boost economic growth and raise demic, Central Asian countries con- standards of living. front regional and global issues such as zoonoses, food safety and AMR. Managing health risks from pandemics Many zoonoses are endemic in the and climate change requires full region, including anthrax, brucellosis, cooperation and collaboration echinococcosis, HPAI, TB and rabies. between the animal, environmental Meanwhile, these countries continue and public health sectors at national to deal with food safety issues and and regional level; investments face the suspected increased threat of in environmental and agricultural AMR. Country strategies and policies sectors can contribute to preventing on prevention and control of such diseases at source. The One Health issues are not harmonized at national approach enables swift detection and 79 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S rapid response to infectious disease experience gained in other parts of the outbreaks. Regional infectious disease world, including those supported by surveillance networks can strengthen the World Bank. multi-sector coordination in participating countries by improving resource Central Asian governments and allocation, organize information flows sector services have taken initial and facilitate the implementation of steps to implement a OH approach IHR. This approach could be as useful and have expressed interest in further in Central Asia as it has been in other developing this. Cross-country and regions. It has proved to be highly cost- national intersectoral collaboration effective in strengthening animal and is already underway, for example, public health management systems, to harmonize legislation on food safety, contributing to improving global health, on controlling wildlife migration or supporting sustainable economic growth, related to the livestock trade. On and furthering poverty alleviation. 11 September 2022, ministers of health of Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan and Uzbekistan Now is the 5.2.  endorsed the Roadmap for Health and Well-being in Central Asia 2022–2025 right time fostering cooperative responses to Three factors suggest a conducive crises, including the COVID-19 pan- environment for Central Asia to demic, the climate crisis and political adopt a One Health approach. First, instability. At the national level, public the COVID-19 pandemic and the war health and veterinary services have in Ukraine have produced an increased identified neglected zoonoses as top sense of urgency in Central Asia to priorities, while the Central Asia Animal mitigate intersectoral and cross-country Health Network (CAAHN), a coordinating food security risks and prepare for pan- mechanism focused on zoonoses, has demics. Second, there is a high level been established. Numerous activities of awareness in the region around the strengthen the sectors that work risks and opportunities from increased together under One Health. Interna- production and trade of animal products. tional tools—such as JEE, PVS pathway, Third, readiness to adopt One Health National Action Plans for Health approaches is well advanced because Security (NAPHS) and National Bridging Central Asian countries have experi- Workshops (NBW)—have been used. ence of working with the World Bank National governments, the World Bank, and other international partner organi- and international partner organizations zations on OH. Indeed, initial elements such as ECDC and CDC, WHO, FAO, of OH are already in place, and the WOAH, and UNEP have been support- region can benefit from implementation ing initial OH efforts. In October 2022, 80 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S a new One Health Joint Plan of Action in Central Asia”, a Central Asia One was launched by the Quadripartite Health Framework for Action is being (WHO, OIE, WOAH, and UNEP) with prepared. An increased regional dia- the objective to create a framework logue between networks of decision to integrate systems and capacity to makers and networks of technical staff improve the health of humans, animals, (e.g., epidemiologists, environmental plants, and the environment, while con- specialists, and veterinarians) from the tributing to sustainable development. three operational sectors is supporting the development of the Framework for Regional collaboration forums exist Action, which will guide investments, and can serve as a starting point policy work and collaboration for One to develop effective mechanisms Health in Central Asia. to address the identified regional food system and health challenges. The Central Asia One Health Frame- Platforms for regional collaboration work for Action will address shared do exist – the Central Asia Presidential priority areas, establish a mechanism meetings, the Commonwealth of for coordination, monitoring and Independent States (CIS), the Eurasian evaluation as well as activities for Economic Union (EAEU), and the Central implementation. Broad regional objec- Asia Regional Economic Cooperation tives as well as concrete intervention (CAREC). Currently, none of these plat- areas will be identified and a dash- forms have emphasized One Health as a board designed to facilitate progress strategic approach to confront the dual monitoring by all countries will support challenge of pandemic preparedness progress in closing specific knowledge and building resilience to the threats gaps as well as supporting increased associated with increased regional regional cooperation to be able to movement and trade. track wildlife movements, zoonoses outbreaks and other transboundary diseases. The Framework will encourage A Regional One 5.3.  data and information sharing between Health program relevant stakeholders for a more active in Central Asia integration of new knowledge in deci- sion making. Further, the Central Asia A regional response to the threats One Health Framework for Action will exposed by pandemics and trans- include the identification of leadership border diseases can be coordinated opportunities for intersectoral action at with national intersectoral efforts. regional and national levels. High-level Following the signing of the regional leadership for transcending sectors is communiqué “Protecting food essential for successful implementation systems and preventing pandemics of a One Health approach but it can be 81 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S difficult to achieve as high-level initia- is needed for technical training, the tives risk becoming orphaned without establishment of modern laboratories, an effective home. Existing collabora- animal identification and traceability, tion mechanisms in Central Asia will be effective information management further reviewed, regional and national systems and knowledge distribution champions identified in collaboration throughout the region. with relevant authorities, and options will be considered. The findings of this report support the preparation of the Central Asia Country engagement in operation- One Health Framework for Action alization of One Health approaches by providing recommendations for should focus on core issues with a activities within four broad areas of strong economic rationale for invest- work, which can be further supported ment. Lessons learned from the opera- by public investments and through tionalization of One Health approaches future lending operations. Based in other regions show that investments on the findings of this report it is rec- in dialogue and institutional capacity ommended to focus activities on the at the regional level need to be com- following four broad areas of work: plemented by building resources at the national level. Knowledge, information, (i) Convening and coordination. and action at the national and regional A current challenge for One levels will condition how Central Asian Health implementation in countries will be able to come together Central Asia is the limited and to address environmental, public health fragmented links nationally and veterinary issues posing a risk to and regionally between the national, regional, and global health agriculture, environment security. Policy development and and health sectors, and the harmonization, epidemiological surveil- private livestock and animal lance, and building institutional capacity products sector. The limited for adequate prevention and control of collaboration between the zoonoses, food hazards and AMR are relevant sectors increases further areas that would benefit from the likelihood of regional improved cooperation. Another key epidemics of transboundary requirement for a One Health approach diseases, diminishes human is capacity development at all levels and animal productivity and and within all skill sets. There is a clear returns on public and private need for management expertise, but investments, duplicates efforts also for technical development and and promotes inefficient training among health and veterinary use of scarce resources. The professionals and specialists. Funding purpose of this work area is 82 P ROTECTI N G FOOD SY ST E M S , PR E VE N T I N G F U T U R E PA N D E M I C S to support the development livestock production, health of a One Health platform in implications of imports of live Central Asia and establish animals and animal products, a process for the adoption and losses due to animal of the Central Asia One diseases. Major benefits Health Framework for Action. include shared knowledge This will build on ongoing that can contribute to initiatives at the local and methods to ensure healthy regional level, including pasture management. those supported by the Institutional and social World Bank and international assessments can identify partners. It will also build institutional engagement and on the experience of inter- social awareness, to allow for sectoral collaboration that the design of communication, took place between 2006 and participation, and operational 2011, when the World Bank activities. An environmental carried out an One Health assessment of the impact of assessment in the region. climate changes on livestock (ii) Knowledge development is productivity, biodiversity, essential and needs to cover wildlife, AMR, and endemic a wide variety of topics that and emerging infectious affect animal health, their diseases can equip authorities identification and, therefore, with the tools to cope with their traceability, including such threats. records of wild animal (iii) Policy and regulatory movements, that can development and eventually be linked to harmonization is needed zoonosis. In addition, shared to provide a medium-term knowledge of transboundary strategy for OH development disease outbreaks, while at the national level, with a contributing to traceability clear division of roles and systems, can also identify responsibilities, and technical shortcomings in surveillance and financial support for systems that could compro­ intersectoral cooperation mise implementation of and coordination between international guidelines on the relevant sectors. Such food safety. This is particularly a strategy would include important for economic the development of analysis of issues such as the epidemiological surveillance opportunities and risks of systems at all levels, with data 83 P ROTECTI N G FOO D S Y S T E M S , PR E VE N T I N G F U T U R E PA N D E M I C S management and sharing region. There is an abiding to prevent and control need for standardization zoonoses and other animal and monitoring of animal diseases. Coordination of vaccination and veterinary public health and veterinary drugs to prevent and control laboratories will ensure better zoonoses and transboundary coverage and more flexibility diseases, while attacking in case of emergency the threat of AMR. SPS management. Policy changes standards in animals and will be needed to remove plants should be brought up bottlenecks and obstacles to international standards to trade and productivity and meet consumers’ as well as to improve expectations, while raising animal productivity, protect public awareness of zoonoses, pasturelands and provide the proper use of antibiotics, incentives for essential and the importance of workers—especially in the food-safety standards. For veterinary sector—to work in professionals and other rural areas. actors in the food chain there (iv) Capacity development is a need for continuing for implementing One professional development Health critical processes and training sensitive to the for zoonotic disease local and regional context, prevention and control, as well as for capacity AMR control, and food building in the relevant safety will be needed. Skills in biodiversity management areas of management. and wildlife monitoring, Cultural and behavioral as well as epidemiological challenges related to the surveillance systems of operationalization and animal and human health, implementation of the are necessary. Interoperable One Health approach in databases to manage Central Asia also needs epidemiological information to be better understood need to be created to and addressed. Soft skills analyze and share data on need to be developed zoonoses, AMR, and food together with a conducive safety. 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