Fit to fight infectious disease

Training tomorrow’s global health workforce

BY FRANK JOSSI

When local fishermen reported a massive die-off of more than 10,000 migratory birds in several districts along the shores of Uganda’s Lake Victoria region in 2017, alarmed officials quickly determined the outbreak’s cause to be pathogenic avian influenza H5N8 and went to work informing communities on risk factors they faced.

Uganda’s Public Health Emergency Operations Centre jump-started a campaign to combat the potential spread of the virus in Kalangala, Masaka, and Wakiso. Part of the response included students from a Ugandan university trained in an approach called “One Health,” which brings together experts from different disciplines to respond to pandemic threats. Many of the students who responded were taught by professors who received training from Innocent Rwego, PhD, an assistant professor in the University of Minnesota College of Veterinary Medicine (CVM).

The training was available under the One Health Workforce (OHW) Project, which is funded by the United States Agency for International Development (USAID) and led by the University of Minnesota in collaboration with Tufts University. As they prepare to enter the workplace at the front lines of where these diseases emerge, students in the program build skills in coordinating and collaborating to effectively combat infectious disease threats.

The program’s primary mission is to help the multi-sector workforce of health professionals prevent, detect, and respond to infectious disease threats through a collaborative approach that synthesizes animal, human, and environmental health. The project promotes skills among students and professionals working in veterinary medicine, human medicine, nursing, environmental sciences, and public health. To support a multidisciplinary approach, the CVM convened experts from six U of M colleges to develop training and curricula for managing antimicrobial-resistant and animal-to-human infectious diseases.

outbreak response team in ugandaIn 2017, One Health students joined Uganda’s Ministry of Health’s investigation into the Highly Pathogenic Avian Influenza H5N8 outbreak along the shores of Lake Victoria. The One Health Central and Eastern Africa (OHCEA) university network’s Uganda Office has trained the students in infectious disease management and other soft skills needed on a response team.

Worldwide impact

“The One Health Workforce Project has had a major impact in the countries where we have worked,” says Rwego. The program puts students into multidisciplinary teams at One Health Demonstration sites. Curricula from different disciplines are designed to improve teaching methodologies, incorporate current disease management concepts, and send students into the field with better skills.

According to associate professor Katey Pelican, DVM, PhD, who oversees the OHW project, the workforce is a global effort to think about health in a systems-based approach while being more holistic in tackling challenges to the health of human and animal populations.

USAID named the University the primary grantee for OHW in 2014 and, based on project performance, recently raised their funding ceiling another $13.7 million, bringing the total to $63.7 million. The U of M and Tufts University collaborative works with One Health University Networks involving 79 universities in eight central, western, and eastern African countries and five countries in Southeast Asia.

Using new tools

The growing resistance of pathogens to antibiotic treatment creates vulnerability to once treatable diseases. The process can be slowed by careful and conservative use of antibiotics in human and animal health. This requires building capacity to ensure that best practices in antibiotic use are executed by all health workers globally. In Africa, for example, OHW member universities held training workshops on antimicrobial resistance in 2017 in Cameroon, Kenya, Tanzania, Senegal, and the Democratic Republic of Congo, as well as in Thailand.

Among the initiatives Pelican and her colleagues led was creating a tool for government agencies to review how well they work together on planning and preparedness for infectious disease threats, natural disasters, and antimicrobial-resistant disease. Nineteen countries have used the tool.

Most recently, the One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) was used to synthesize and define national infectious disease workforce needs in seven countries in Africa and Asia and create national plans for workforce development. These plans are among the first truly pan-national plans involving multiple sectors for strengthening the workforce at the front lines of managing global threats of public health importance.

What develops out of the OHW is led from the field, with partner universities in disease hotspot regions defining their needs with guidance from Minnesota and Tufts experts. Now, these countries’ plans can align with known workforce needs in all key sectors.

ecosystem health training in ThailandEach year, students in Thailand attend a field training course to prepare them for outbreak response needs. Faculty with the Thailand One Health University Network (THOHUN) enhance the students’ learning experience and soft skills through multidisciplinary teamwork and field work using the One Health approach.

Building a nexus

Although much of the emphasis is on university students and training government workers, the program pays significant attention to faculty development and what is called “institutional strengthening.” The network of schools within colleges and within countries continues to grow, creating a robust international network to prevent, detect, and respond to disease.

When Rwego first brought together faculty members, he discovered the deans of different schools had never sat in the same meeting together. Now, they and their faculties are familiar with one another and have collaborated to prepare students and government officials for potential disease outbreaks.

Working with faculty from 17 Vietnamese universities spanning human, animal, and environmental health programs, CVM instructor Kaylee Myhre Errecaborde, DVM, heard from many participants that they wouldn’t know each other, let alone be building shared curriculum and field experiences spanning student and professional training, without the help of the program. Nursing, medical, veterinary, and public health students testify that the OHW university network in Vietnam has provided a host of common skills to prevent and treat infectious diseases.

Universities and their faculty play a preeminent role in the societies of developing countries, Pelican says. “I have a saying that in working with universities, the bad thing is they’re hard to change and the good thing is they’re hard to change.” While universities can be bureaucratic, rule-based, and resistant to new ideas, they are among the most stable of institutions in many countries.

“They have maintained their place much more than their governments, industries, or other institutions in their countries,” Pelican says. “They have a power in that, and if you can change them, there is a true sustainability in that change that you don’t see in other sectors.”

As for faculty, they have an important power when working with government officials because they have educated many of them. Using these connections and a rapt audience, faculty can often convince government officials to introduce new systems, skills, and approaches to combat disease that can fundamentally change societies for decades.

Photos courtesy of the One Health Workforce Project