A recommended first step for countries trying to prepare for future infectious disease scenarios is to understand how the local One Health publication landscape looks like. Here we make progress toward this end, describing the scientific output about infectious disease research from Panama in the last 30 years. Our evaluation strives to serve as a tool for local health authorities to determine the country’s research capability on specific aspects of zoonotic pathogens within the One Health umbrella [48, 50].
Overall, publication output for One Health related research has grown significantly in Panama since 1990. Although the country’s research agenda has not explicitly focused on One Health, almost 60% of the entire country’s research productivity is interconnected with this concept. We revealed a significant pattern of temporal growth in publication records associated with the One Health model, with noticeable differences in the number of peer-reviewed articles and the range of scientific areas tackled by different institutions. Institutional variation in research focus and publication output related to One Health might be due to differences in the task, budget, number of scientists and/or operation time in the country (Supplementary Figure S3). For instance, STRI is the only unit of the Smithsonian located outside the USA, and researchers have conducted pioneering studies on plant and animal ecology in Panama for more than 100 years. STRI has 15 research facilities scattered across the country, 40 staff scientists and more than 1,400 scientific visitors every year , which may explain its larger input to One Health related studies compared to other institutions (Table 2). Similarly, the ICGES, the oldest public health institute in Panama (formerly, Gorgas Memorial Laboratory) , dating back to the heroic efforts of the USA to combat mosquito-borne diseases during the construction of the inter-oceanic Canal; and the UP, the firstborn Panamanian University, have more publications about One Health subjects than INDICASAT . This may be explained by the significantly lower resources, fewer personnel, and less time in operation (16 years) at INDICASAT, which represents 55% of the total time range used in this study (Supplementary Figure S3). Notwithstanding the differences about One Health associated publication output and areas of concentration among research institutions, jointly STRI, ICGES, and INDICASAT house the necessary equipment, human resources, areas of expertise and infrastructure to implement a One Health research program, and are well positioned to rapidly apply effective actions against pandemic pathogens through a close working relationship with the UP and the Panamanian Health authorities at MINSA.
Infectious disease research in Panama has concentrated on arthropod-borne zoonotic infections, with a strong inclination for protozoan pathogens transmitted by mosquitoes (i.e., Anophelinae - Plasmodium), sandflies (i.e., Phlebotominae - Leishmania) and kissing bugs (i.e., Triatominae – Trypanosoma). Malaria, Chagas disease, and leishmaniasis have been equally and greatly investigated in the country, reflecting the persistence of these neglected tropical diseases in poor rural settings and isolated indigenous communities [6, 32-37, 44, 54, 55], but also SENACYT’s steady motivation to sponsor research projects about vector-borne infectious diseases . The Ministries of Health and Agriculture from LAC have recognized some of these zoonoses as endemic or emerging priorities, including Chagas disease and leishmaniasis . However, other zoonoses with spillover potential have received relatively less attention by the Panamanian scientific community thus far . This is the case of influenza, Hantavirus, tuberculosis and leptospirosis, plus rare animal diseases such as rabies, brucellosis, salmonellosis, and also recent pandemic infections like West Nile, Chikungunya and Zika arboviruses (Fig. 3). In fact, 60% of the infectious diseases classified as priorities for LAC, have not been studied in Panama whatsoever [15, 16]. Generally, these outcomes mirror the low publication record seeing in this study by MINSA, MIDA and the Agriculture Research Institute (IDIAP), which are the governmental agencies in charge of investigating these topics, or they may just be due to the recent emergence time of some of these pathogens. Our findings underline the limited inter-sectoral research between academia and MINSA/MIDA in Panama during the last three decades. Future efforts will have to align the needs among local academic and governmental institutions, and between them and those from the Ministries of Health and Agriculture in LAC [15, 57, 58].
Targets and benefits from implementing a One Health research program in Panama and LAC
A cooperative research approach for bioscience and health has been advocated for Panama before, echoing the need for a connection of research priorities among the social, environmental, agricultural and health sectors . To be successful though, this proposal needs to involve a synergistic collaboration among SENACYT, MINSA, MIDA and researchers from various Panamanian institutions with strongly complementary research traditions and strengths [26, 59]. However, the rates of multidisciplinary, inter-institutional and inter-sectoral research in Panama are moderate to low, and very low, respectively, which means that the links among academic institutions and between them and stakeholders, are still limited making the implementation of the One Health model challenging. To overcome these problems, the government of Panama needs to create funding instruments that favor inter-institutional and inter-sectoral collaborations, particularly between those institutions that have published little about One Health related subjects (i.e., UTP, IDIAP, private universities, MINSA and MIDA), over single institutional research plans, which do not include the participation of MINSA or MIDA. In addition to local funding instruments, international collaborations, including partnerships among the Ministries of Health and Agriculture along with prominent academic institutions from LAC, need to be considered and sponsored to increase local competitiveness while building the necessary technological capacity to compete for extra funding overseas (Table 2). Historical and recent examples of successful inter-institutional and inter-sectoral research on Hanta virus and Zika virus, respectively, have been conducted in Panama in the past [7, 8, 16, 17, 29-31, 38, 45, 47 60-69].
The government of Panama needs to allocate extra funding to improve the research infrastructure nationwide, create additional scholarship programs to continue training undergraduate and graduate students, and to build competitive leadership by increasing manpower and job opportunities in interdisciplinary areas across the country (Table 2). Non-Governmental Organizations (NGOs), both local and international, also need to be part of the One Health agenda, as they may provide in-kind support to strengthen research opportunities during training, response, and post-pandemic activities. Moreover, Panama needs to invest resources to create the first One health research Centre in Central America in order to coordinate the best available resources to solve complex infectious disease events through building new competencies in bioinformatics, genomics, and vaccine development, while promoting inter-sectoral studies and joint governmental efforts across LAC (Table 2). Since Panama is historically important in terms of disease research with the institutional infrastructure in place, and a Center of commerce and trade, the country is perfectly located to continue carrying out research about infectious diseases. Given Panama’s position as a global logistical hub, and major airline center between North and South America, the research and intellectual knowledge generated by a collaborative One Health research program will position the country to respond quickly to newly emerging pathogens of pandemic potential. This has the advantage of stopping or at least slowing the spread of an epidemic regionally and provides a sophisticated research infrastructure for monitoring new pandemic foci (Table 2). While research institutions in Panama differ in various degrees of expertise and scientific interest, each of them brings a unique visualization of the disease spillover process, which can effectively supplement joint research efforts about pandemic zoonotic pathogens (Fig. 2). Panama has one of the most species-rich and best-characterized faunas of the world, and researchers from STRI, ICGES, INDICASAT and UP bring expertise in tropical ecology, public health, disease epidemiology, and the population and evolutionary dynamics of pathogens, vectors and hosts relationships, which could be easily integrated into a solid research plan under the One Health framework. The high level of research complementarity among Panamanian institutions can be used to enable an information system for the prediction and mitigation of future zoonotic spillover events, including enhanced voucher collections of wildlife, domestic animal and human tissues plus associated pathogens and vectors .
Panama’s One Health research program will need to cover research efforts oriented towards field monitoring and ecological understanding of highly pathogenic disease agents, and the animal hosts that act as reservoirs or vectors in both natural and anthropogenic environments [20, 21]. Nevertheless, the focus should also be extended to experimental research, basic epidemiology, mathematical modeling, molecular ecology, clinical trials and social sciences  (Table 2). Furthermore, One health’s research efforts in Panama need to tackle not only diseases that are transmitted by arthropods, but also sexual, respiratory, and fecal-oral parasitic infections plus chronic and non-infectious health-related issues such as cardiovascular disease, diabetes, cancer, hypertension, obesity, and neurodegenerative illnesses, which have not been studied comprehensively in the country thus far . The country needs to establish an innovative and broad research, education, and training Curricula on One Health by incorporating areas other than infectious diseases, including more recent development within this framework such as food safety, biodiversity, chronic diseases, animal companionship, and antimicrobial resistant, among many others (Table 2). Finally, the private sector, pharmaceutical and biotechnological companies, need to play a role in developing partnerships with academic and governmental agencies to increase research activities towards appropriate medical technologies and therapeutic products, ensuring their availability to, and affordability for the populations in need.