Integrative Methods and Models for Emerging Zoonotic Diseases: Linking Clinic, Laboratory, Community, and Field
Many globally significant infectious diseases remain persistent, though eliminated in some regions and populations (e.g., Malaria and Schistosomiasis). Some, like dengue, have dramatically re-emerged while others are newly emerging from wildlife sources (avian influenza-H5N1, Nipa, SARS, etc). This recalcitrance and emergence result from the multi-factorial and systemic character of diseases whose pathogenic agents originate from, or spill-over to humans and domestic animals often from host-parasite complexes and shared ecosystems. The above diseases are the most prominent, yet the list of persistent diseases includes many among neglected tropical diseases. Most of these are zoonotic and are of shared concern to human, veterinary and conservation medicine and public health.
It is becoming increasingly recognized that successful control of these diseases depends not only on laboratory and clinical science and practice but working in a field and communities setting– the “transmission arena” – applying ecological and social sciences. Moreover, methods for combining these knowledge and skill sets by multi-disciplinary teams, and in consultation if not collaboratively with community and policy stakeholders is essential. A “systems biology” perspective, from molecules-cells-organisms to whole ecosystems including their human communities, is most helpful. This is very apparent considering three of the diseases of focus at this meeting, Melioidiosis, Leptospirosis and Opisthorchiasis, all of which share a common transmission arena: the rice agroecosystems of Southeast Asia. Especially high incidences are documented for Northeast Thailand and adjoining areas of Lao PDR and Cambodia that share similar natural and human ecologies and socioeconomic conditions.
Global health, and the more recent “one health” and “ecohealth” movements, identify this need more integrative (interdisciplinary and Transdisciplinary) research that is simultaneously more holistic, ecological, inclusive, and ethics-based. Tropical disease research with its roots tropical medicine has traditionally linked clinical medicine, epidemiology and natural history (today called ecology). Yet this tradition has waned with the growing emphasis on lab and molecular-oriented research, reductionism, increased specialization, top-down disease control strategies, and de-emphasis on natural history. Nonetheless, new, powerful computer-aided molecular genetic and epidemiological modeling benefiting from evolutionary-ecological theory (a modern natural history), as well as developments in models, theory and practice for community and policy maker participation, including behavioral change, now exist. More deliberate efforts for their integration within medicine and public are needed.
Goals, Objectives, Outputs and Structure
This 4-day workshop aims to help strengthen this integrative research capacity and multidisciplinary collaboration to contribute to reducing disease burden in the Asia-Pacific region. The objectives of the meeting are to facilitate: (1) a better understanding concepts and methods for bridging disciplinary knowledge and carrying out integrative team disease research and intervention strategies, 2) mentor-mentee relationship-building among senior and junior researchers, and (3) international and interdisciplinary research collaborations, (4) “set the stage” for a subsequent in approximately 6 months.
The tangible objectives and outputs planned are three-fold: (1) Establishment of working groups for different diseases and themes with specific output goals and timelines. (2) Development by working groups of collaborative research plans, outlines and drafts of grant proposals and research papers. (3) A concrete plan for facilitating working group progress and achievement of goals. Day 1 (Monday) will be devoted to what we here refer to as integrative methods and models: theory, concepts, and methods linking clinic-lab-field-community research and practice. This is relatively new material, at least in terms of not being covered in depth in most graduate, medical, veterinary or public health training. Day 2 is devoted to presentations and discussion, incorporating concepts discussed Monday. Day 3 is predominantly “breakout” sessions for group work, including plenary session reporting on progress and discussion of cross-cutting themes. Day 4 is a field trip focused on practical applications/contextualization of previous days’ knowledge acquisition.