The ISOHR observed with a great concern that over the past five decades, the world has witnessed the emergence of about 40 new diseases including Legionnaires' disease, HIV/AIDS, hepatitis C, mad-cow disease, SARS, Middle East respiratory syndrome (MERS), Nipah and Ebola virus diseases. Twenty of these diseases were found in China alone.8 Many of these new diseases along with the existing climate-sensitive vector-borne diseases such as dengue, Zika and West Nile virus, remain ongoing threats to health security worldwide.9 Many emerging diseases, after a period of absence or being controlled, re-emerge as epidemic with devastating impacts. For example, dengue in Bangladesh in 201910, measles in the Pacific since 201711 and polio in the Philippines in 201912. Malaria, multidrug-resistant tuberculosis, HIV/AIDS, neglected tropical diseases and viral hepatitis affect billions of people worldwide, and are responsible for more than 4 million deaths annually, where the vast majority are in low- and middle-income countries (LMICs).13 The ISOHR noted that approximately 75% of emerging diseases originate in animals (zoonoses) with greater frequency of outbreaks and significantly higher burden in LMICs than high-income countries.14-17
The ISOHR acknowledged the role of economic globalization in the twenty-first century and the associated growth in tourism and trade. These and other developments have significantly increased the mobility of populations and trade in goods worldwide and increased the risk of infectious disease spread across regions and countries. In some areas this has resulted in a continuing epidemic and pandemic threat. The impact of global climate change, agricultural intensification, rapid economic growth combined with population growth and urbanization, further complicate public health challenges globally and more specifically in LMICs.18 Today, more than half of the world’s 7.7 billion population live in the South Asia and South-East Asia—a region which includes China, India, Indonesia, Bangladesh, Pakistan and Vietnam.19 This densely populated region hosts some of the fastest growing economies in the world, and faces a wide range of challenges including climate change, food safety and emerging infectious disease threats. Many of these countries are often dubbed as ‘emerging disease hotspots’.20
In the recent past, the region has experienced some of the deadliest epidemics resulting in formidable losses not only to health but also impacting heavily on their economies with substantial sociological and political repercussions.20 For example, after the 2002–03 SARS pandemic21, which caused enormous losses to health and economies of over 30 countries, the highly pathogenic avian influenza (H5N1) has become endemic in parts of China and other countries in the region including Bangladesh, Indonesia, and Vietnam, and in parts of Africa.22 The combination of avian and human strains in a favorable environment can result in a sustained spread from birds to human, and then human to human with a potential for a pandemic causing large-scale illnesses and deaths worldwide. There is an overwhelming body of evidence that infectious disease occurs at human-animal-environment interface and that their transmissions and the magnitude of impacts are influenced by many factors including behavioral, social, environmental, and cultural.20 These recognitions have been the catalyst to call for a broad-based, holistic approach, known as One Health (OH), which is defined as, “The collaborative effort of multiple health science professions, together with their related disciplines and institutions – working locally, nationally, and globally – to attain optimal health for people, domestic animals, wildlife, plants, and our environment”.23
Countries increasingly recognize the value of working collaboratively and sharing knowledge, expertise and resources for the protection of their own country and to address the collective vulnerability in today’s globalized world. This recognition is evidenced by the Australian Government’s regional health security initiative known as ‘Indo-Pacific Centre for Health Security’ established in 2017.24 The initiative is focused on a holistic, transdisciplinary and multisectoral approach, known as “One Health” (OH), to strengthen the health security capacity across the Indo-Pacific region.24