Research is vital to understand the relative
importance of disease alongside other priorities
for individual households, perceptions of ability
to effect change, and the situations required for
action to be taken. Even in the midst of epidemics,
attitudes toward disease risk and management, for
instance, may not be focused around one pathogen,
or even on avoiding disease at all, but on providing
food, income, education, or investment for the future. Local understanding of disease, relationships
to government officials and the state, and past
experiences with development projects play important mediating roles in community engagement
with disease control and capacity-strengthening
programs (18, 29). The causes of social difference
are complex. It is not always possible to address
these through individual behavior change and, instead, wider social, economic, and political processes
must be understood. One Health approaches offer
an advantage here because they can offer a broader
understanding of the interdependencies of human,
animal, environmental, and socioeconomic health
in the decision-making of households, in addition
to the likely effects of disease control interventions.
However, interventions are unlikely to be adopted
if individuals perceive that they lack the agency
to enact change. Focusing on tangible and tractable current problems can help to empower
Maximizing synergies and sustainability
By focusing on detecting and reporting rare EID
events independently of other disease problems,
we miss important opportunities for broader-
reaching benefits and synergies. Appropriately
targeted improvements in surveillance capacity
can be viewed as investments in a country’s “in-
clusive wealth,” argued to be a key factor in deter-
mining a country’s ability to achieve sustained
improvements in well-being (30). Our proposed
strategy reflects a growing global interest in opti-
mizing interactions across the SDGs (31). Progress
toward the SDG3.d target relating to EIDs—to
strengthen capacity of all countries, in particular
developing countries, for early warning, risk reduc-
tion, and management of national and global
health risks—depends on several other SDG3
targets, including access to good-quality essential
health-care services. Efforts to manage a locally
relevant disease can also contribute to ending
neglected tropical diseases (SDG3.3) and achieving
universal health coverage (SDG3.8). Interventions
that support targets for sustainable cities and com-
munities (SDG11) could be designed with a view to
detecting and mitigating emerging vector-borne
threats, such as Zika, chikungunya, and yellow
fever viruses, which are all transmitted by urban-
adapted species of Aedes mosquito vectors. Inter-
ventions to support sustainable and resilient
agricultural practices that help maintain diverse
ecosystems (SDG2) could be developed to miti-
gate against the land-use changes that have been
linked with spillover transmission and disease
emergence from wildlife reservoirs.
The components and requirements of effective global EID surveillance are known, but
there has been less
focus on the mechanisms that can be employed to strengthen
the capacities needed.
This is particularly
true in LMICs with
the weakest human
and animal health systems, where many diseases have emerged
and where the consequences of EID events
are likely to be most
serious. Many of the
capacities required for
EID surveillance are
identical to those required to tackle existing diseases of ongoing
local importance. We
argue for an approach
whereby gaps in EID
are filled by responding to existing local health
challenges rather than through a focus on EIDs
exclusively. The investments required to achieve
comparable capacity gains through an EID-only
strategy are likely to be greater and ultimately
unsustainable. In contrast, approaches to EID
capacity strenghthening that address locally relevant disease problems can capitalize on positive
reinforcement processes that will sustain the capacities and collaborative networks that make up
a functional surveillance system. By addressing
ongoing disease problems, greater understanding of the social determinants and context of
disease response capability in low-resource settings
can be built, generating insights that apply far
beyond the initial target disease. This approach
provides a mechanism for achieving the necessary
improvements in global EID surveillance capacity while also contributing to broader global
goals for development.
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This work was supported by the UK Biotechnology and Biological
Sciences Research Council (BBSRC) BB/J010367/1 (J.E.B.H.,
J.P.S., D. T.H., and S.C.), the UK Zoonoses and Emerging Livestock
Systems Initiative grants BB/L018845/1 (J.E.B.H. and D. T.H.)
and BB/L018926/1 (J.P.S. and S.C.), the Wellcome Trust 095787/
Z/11/Z (K.H.), the Economic and Social Research Council (ESRC)
RES-070-27-0039 (J.P.S.), and a Leverhulme-Royal Society
Africa Award (AA130131). J.E.B.H., D. T.H., and S.C. conceptualized
the project. J.E.B.H., N.H., J.P.S., and SC wrote the original draft.
J.E.B.H., K.H., N.H., T.L., J.P.S., D. T.H., and S.C wrote, reviewed
and edited the manuscript. The authors declare that they
have no competing interests. All data needed to evaluate the
conclusions in the paper are present in the paper and/or
the supplementary materials.
148 14 JULY 2017 • VOL 357 ISSUE 6347 sciencemag.org SCIENCE
Canine rabies vaccination campaigns achieve community engagement
to improve disease control and surveillance in Siaya County, Kenya.
EMERGING INFECTIOUS DISEASES