This post was written by Melissa Marcia, ICF, with Derrick Mimbe, PATH.

A chicken is sick in Uganda. Left unaddressed, it could affect us all. A USAID project is working to prevent infectious disease outbreaks in Uganda by improving the ability to detect and respond to zoonotic diseases in the animal health sector.

Zoonotic Diseases: A Global Threat

A livestock farmer in Uganda notices one of his chickens is sick. Later, the chicken dies, but the farmer is not alarmed because the rest of the flock appears healthy. He takes the flock to market, unwittingly exposing vendors and shoppers, some of whom fall ill. The shoppers return home to their villages and spread the illness to their families and neighbors. One neighbor has a family member visiting from another country. The visitor becomes ill but needs to return home. At the airport, the visitor exposes travelers from other countries all over the world to the illness. The illness spreads. Suddenly, a single chicken in Uganda has infected enough people to lead to a worldwide pandemic.

This hypothetical example is not implausible. Chickens and many other animals are carriers of zoonoses (zoonotic diseases), which are caused by pathogens, such as viruses and bacteria, that can infect both humans and animals. These diseases can jump from animals to humans through “spillover events” when humans come into close contact with wild or domesticated animals. In recent years, global headlines have featured zoonotic diseases such as COVID-19, Ebola virus disease, avian influenza (bird flu), monkeypox and Zika virus disease. Three out of every four new, emerging or reemerging infectious diseases in people come from animals. On World Zoonoses Day, July 6, we recognize that human and animal health are inextricably linked.

To prevent a sick chicken from perpetuating an outbreak among humans, there must be a coordinated effort between human, animal (livestock and wildlife) and environmental professionals across all levels and sectors of a health system — an approach called One Health. Uganda’s One Health strategy to fight zoonotic diseases is complex and involves an integrated, multisectoral approach. Due to its complexity, implementation and coordination across sectors require additional support to optimize the country’s ability to detect and respond to zoonotic diseases. For the past two and a half years, USAID’s Infectious Disease Detection and Surveillance (IDDS) project has focused its efforts to build capacity in the animal health sector to better detect, report and respond to zoonotic diseases.

Accelerating Disease Detection

The first step to preventing the theoretical outbreak described above is to submit a specimen (such as a blood sample) from the sick chicken to an animal health laboratory for analysis. The laboratory can test the specimen for infectious bacteria or viruses and return the results to a local veterinarian. The veterinarian can provide the livestock farmer with an accurate diagnosis, and the farmer can take quick action to resolve the issue.

Prior to IDDS’ support, most animal specimens in Uganda were sent to a central laboratory for testing. This system experienced significant delays in specimen transport to the laboratory, low test request volumes and limited laboratory staff. These factors resulted in veterinarians and farmers having to wait for test results, thus delaying detection and outbreak response. To reduce turnaround times, IDDS focused on empowering regional laboratory staff to conduct testing at their facilities, which are located closer to potential disease hotspots where humans have close contact with animals. IDDS developed a toolkit for national trainers to use in mentoring regional laboratory staff on how to properly conduct diagnostic tests for zoonotic diseases. The project then trained a group of twelve national mentors who have been mentoring staff at four regional laboratories.

At the conclusion of the mentorship program, the regional laboratories will qualify for accreditation, indicating that the laboratories’ tests are conducted according to international standards and the results are accurate and reliable. For the communities served by these regional laboratories, this means that livestock owners, such as the hypothetical chicken farmer, will be able to test sick animals, quickly receive accurate results and, when necessary, take actions to prevent zoonotic diseases from spreading to humans. After observing quality improvements IDDS made at one of the regional laboratories, U.S. Ambassador to Uganda Natalie Brown commented, “We commend all the partners who have dedicated their time and resources to improving and monitoring the status of animal health. This is very important to both families and communities in which they live as it prevents future pandemics.”

Coordinating Outbreak Response

If a positive laboratory test leads to timely and accurate diagnosis of a sick chicken by a local veterinary health official, public health authorities can take action to alert the vendors and shoppers who were exposed at the market by the rest of the chickens. Veterinary health officials rely on aggregate testing data to determine the scale of an outbreak (how many animals are sick and where). Reports of positive cases are sent from regional testing sites to national authorities for monitoring and surveillance. In Uganda, data were compiled manually — a time-consuming, inefficient process that was prone to errors. IDDS developed an electronic data entry tool for four regional pilot sites that is easier to use and prevents mistakes. At the national level, the new tool helps officials to aggregate and analyze data, making it easier to spot outbreaks and mobilize resources.

To contain an identified outbreak, human and animal health officials must coordinate their response across national and local governments (vertical coordination) and across sectors (horizontal coordination). At the national level, IDDS worked with the National One Health Platform to develop a national strategy and plan for implementing a One Health approach to zoonotic disease surveillance. Musa Sekamatte, the national One Health coordinator said, “With this implementation plan in place, we can now move the One Health concept from national-level meetings to actual One Health practice at a community level.”

To support collaboration and implementation of a One Health approach at the community level, IDDS assembled and trained District One Health Teams (DOHTs) in Mbale and Kazo districts, which have experienced several outbreaks of zoonotic disease in the last five years. Prior to the launch of the DOHTs, many of the human health officials had never spoken to veterinary officials in the districts. Now, the DOHTs meet monthly to share data and strategize to prepare for a future outbreak. When there is an active outbreak, the DOHTs meet weekly to share new developments, coordinate their response and prevent the outbreak from spreading.

Though zoonotic diseases can be challenging to address, there are opportunities to intervene before local outbreaks become global pandemics. To contain outbreaks, the human and animal health sectors must be able to work together and act quickly based on the available evidence across all levels of government. If we employ a holistic One Health approach, we need not wait until the next catastrophe — or even the next local outbreak — to act. There are actions we can take now to prevent spillover events from animals to humans and ensure that when the next spillover event occurs, public health officials are ready to sound the alarm, isolate sick animals and humans to minimize the threat and save lives.

The IDDS project is funded by USAID. IDDS strengthens the ability of health systems in low- and middle-income countries to quickly detect, track and respond to infectious disease threats. The views expressed here are the authors’ and are not necessarily those of USAID or the U.S. government.