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In addressing pandemics, science has never seemed more needed and useful, while at the same time limited and powerless. The existing contract between science and society is falling apart. A new covenant is urgently needed to navigate the days ahead.

Objectives: The burden of disease associated with acute gastrointestinal illness (AGI) in Canada is estimated to be ~ 20 million cases/year. One known risk factor for developing AGI is recreation in freshwater bodies such as lakes. The proportion of cases attributable to freshwater recreation in Canada, however, is currently unknown. The study objective was to estimate the risk of developing AGI from exposure to Giardia, Cryptosporidium, Campylobacter, Escherichia coli O157:H7, norovirus, and Salmonella during freshwater recreation in Ontario, Canada., Methods: A quantitative microbial risk assessment (QMRA) was conducted to estimate the number of AGI cases per 1000 recreational events associated with freshwater recreation. QMRA utilizes four steps: hazard identification, exposure assessment, dose-response modelling, and risk characterization. A probabilistic model was developed using the following inputs accounting for uncertainty and variability: published data on pathogen prevalence and concentration in freshwaters in Ontario (hazard identification), recreator water ingestion volumes (exposure), pathogen-specific dose-response models, and ratios between numbers of infections and symptomatic disease cases to estimate illness risks (risk characterization)., Results: The mean estimated AGI risk associated with recreation ranged from 0.8 to 36.7 cases per 1000 swimmers (5th-95th probability interval: 0-226.3 cases/1000) which is in line with previous studies conducted in Lake Ontario, as well as prior QMRAs of freshwater recreation. Upper range predicted values exceeded the Health Canada guideline of less than 20 cases per 1000 recreators., Conclusion: This study shows that QMRA can be used to estimate disease risk in the absence of large-scale epidemiological studies. The results demonstrate a range of risk that is in line with exposure to pristine (low risk estimates) and more contaminated waters (high risk estimates) and capture the potential risk to vulnerable populations., Competing Interests: Declarations. Ethics approval: N/A. Consent to participate: N/A. Consent for publication: N/A. Conflict of interest: Murphy is a member of the Health Professionals Advisory Board for the International Joint Commission that advises the Canadian and US governments on transboundary water issues related to health. She has also received funding from Drexel University’s Academy of Natural Science through the William Penn Foundation to conduct a risk assessment of recreational waterborne disease in the City of Philadelphia (Grant # ANS Award # DWRF-19–01). Her Canada Research Chair program also includes an area on studying recreational waterborne disease in Canada (Grant #950–232787). Parmley is engaged in research funded by the Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council, the Public Health Agency of Canada, and the Canadian Safety and Security Program. She is currently President of the Board of Directors of the Centre for Coastal Health, past president of the Canadian Association of Veterinary Epidemiology and Preventive Medicine, treasurer and member of the Board of Directors of the McEachran Institute, and a member of the Advisory Council for Research Directions: One Health. Prior to February 2019, she was employed by the Public Health Agency of Canada., (© 2024. The Author(s) under exclusive license to The Canadian Public Health Association.)

This paper focusses on biological hazards at the global level and considers the challenges to risk assessment (RA) from a One Health perspective. Two topics - vector-borne diseases (VBD) and antimicrobial resistance (AMR) - are used to illustrate the challenges ahead and to explore the opportunities that new methodologies such as next-generation sequencing can offer. Globalisation brings complexity and introduces drivers for infectious diseases. Cooperation and the application of an integrated RA approach - one that takes into consideration food farming and production systems including social and environmental factors - are recommended. Also needed are methodologies to identify emerging risks at a global level and propose prevention strategies. AMR is one of the biggest threats to human health in the infectious disease environment. Whereas new genomic typing techniques such as whole genome sequencing (WGS) provide further insights into the mechanisms of spread of resistance, the role of the environment is not fully elucidated, nor is the role of plants as potential vehicles for spread of resistance. Historical trends and recent experience indicate that (re)-emergence and/or further spread of VBD within the EU is a matter of when rather than if. Standardised and validated vector monitoring programs are required to be implemented at an international level for continuous surveillance and assessment of potential threats. There are benefits to using WGS - such as a quicker and better response to outbreaks and additional evidence for source attribution. However, significant challenges need to be addressed, including method standardisation and validation to fully realise these benefits; barriers to data sharing; and establishing epidemiological capacity for cluster triage and response., (© 2019 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.)

Since the 1960s, global trade in food and feed has increased rapidly, and the number of countries at least partially reliant on this trade has sprouted into complex International Agrifood Trade Networks (IATN). IATNs have obscured the already-labyrinthine causal webs of food-borne diseases, and the usual methods for demonstrating causal links between IATNs and food-borne diseases yield results that are, at best, inconclusive. At the same time, responses are being offered which will, if implemented, likely to have unintended negative consequences. In this context, risk analysis (RA) is being used in situations for which it was not designed, in which facts are uncertain, values are in dispute and assessments are embedded in contested power arrangements, with heterogeneous consequences for diverse stakeholders around the world. To characterise and manage the most serious unintended food-borne disease consequences of globalisation, the most effective way forward will require reframing of RA as a post-normal science., (© 2019 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.)

Ecosystem approaches recognize the complexity of many contemporary public health challenges and offer an alternative for dealing with problems that have proven intractable and unresponsive to conventional public health strategies. Infectious disease outbreaks are among the most dramatic aspects of systems failure, and the Canadian cases of SARS (Severe Acute Respiratory Syndrome) in Toronto, and the E. coli outbreak in Walkerton, serve as useful illustrative examples. This paper examines some of the limitations of current public health approaches, the fundamental tenets of an alternative, transdisciplinary ecosystem approach, and changes necessary for implementation, including those in philosophical approach, communications and education, and, finally, institutions and governance. [ABSTRACT FROM AUTHOR]

THE LATE 19th and early 20th centuries drew pictures of health and disease in the broad strokes of the public hygiene movement, which brought us the miraculous successes of clean […]

Infectious zoonoses emerge from complex interactions among social and ecological systems. Understanding this complexity requires the accommodation of multiple, often conflicting, perspectives and narratives, rooted in different value systems and temporal-spatial scales. Therefore, to be adaptive, successful and sustainable, One Health approaches necessarily entail conflicts among observers, practitioners and scholars. Nevertheless, these integrative approaches have, both implicitly and explicitly, tended to marginalize some perspectives and prioritize others, resulting in a kind of technocratic tyranny. An important function of One Health approaches should be to facilitate and manage those conflicts, rather than to impose solutions.This article is part of the themed issue 'One Health for a changing world: zoonoses, ecosystems and human well-being'., (© 2017 The Authors.)

Zoonotic diseases will maintain a high level of public policy attention in the coming decades. From the spectre of a global pandemic to anxieties over agricultural change, urbanization, social inequality and threats to natural ecosystems, effectively preparing and responding to endemic and emerging diseases will require technological, institutional and social innovation. Much current discussion emphasizes the need for a 'One Health' approach: bridging disciplines and sectors to tackle these complex dynamics. However, as attention has increased, so too has an appreciation of the practical challenges in linking multi-disciplinary, multi-sectoral research with policy, action and impact. In this commentary paper, we reflect on these issues with particular reference to the African sub-continent. We structure the themes of our analysis on the existing literature, expert opinion and 11 interviews with leading One Health scholars and practitioners, conducted at an international symposium in 2016. We highlight a variety of challenges in research and knowledge production, in the difficult terrain of implementation and outreach, and in the politicized nature of decision-making and priority setting. We then turn our attention to a number of strategies that might help reconfigure current pathways and accepted norms of practice. These include: (i) challenging scientific expertise; (ii) strengthening national multi-sectoral coordination; (iii) building on what works; and (iv) re-framing policy narratives. We argue that bridging the research-policy-action interface in Africa, and better connecting zoonoses, ecosystems and well-being in the twenty-first century, will ultimately require greater attention to the democratization of science and public policy.This article is part of the themed issue 'One Health for a changing world: zoonoses, ecosystems and human well-being'., (© 2017 The Authors.)

Background: Enteric diseases affect thousands of Canadians annually and several large outbreaks have occurred due to infection with enteric pathogens. The objectives of this study were to describe the spatial and temporal distributions of reportable Campylobacter, Escherichia coli, Giardia, Salmonella and Shigella from 1994 to 2002 in New Brunswick, Canada. By examining the spatial and temporal distributions of disease incidence, hypotheses as to potential disease risk factors were formulated., Methods: Time series plots of monthly disease incidence were examined for seasonal and secular trends. Seasonality of disease incidence was evaluated using the temporal scan statistic and seasonal-trend loess (STL) decomposition methods. Secular trends were evaluated using negative binomial regression modeling. The spatial distribution of disease incidence was examined using maps of empirical Bayes smoothed estimates of disease incidence. Spatial clustering was examined by multiple methods, which included Moran's I and the spatial scan statistic., Results: The peak incidence of Giardia infections occurred in the spring months. Salmonella incidence exhibited two peaks, one small peak in the spring and a main peak in the summer. Campylobacter and Escherichia coli O157 disease incidence peaked in the summer months. Moran's I indicated that there was significant positive spatial autocorrelation for the incidence of Campylobacter, Giardia and Salmonella. The spatial scan statistic identified clusters of high disease incidence in the northern areas of the province for Campylobacter, Giardia and Salmonella infections. The incidence of Escherichia coli infections clustered in the south-east and north-east areas of the province, based on the spatial scan statistic results. Shigella infections had the lowest incidence rate and no discernable spatial or temporal patterns were observed., Conclusions: By using several different spatial and temporal methods a robust picture of the spatial and temporal distributions of enteric disease in New Brunswick was produced. Disease incidence for several reportable enteric pathogens displayed significant geographic clustering indicating that a spatially distributed risk factor may be contributing to disease incidence. Temporal analysis indicated peaks in disease incidence, including previously un-reported peaks.

Recent outbreaks of Escherichia coli O157:H7, Campylobacter, and Cryptosporidium have heightened awareness of risks associated with contaminated water supply. The objectives of this research were to describe the incidence and distribution of waterborne disease outbreaks in Canada in relation to preceding weather conditions and to test the association between high impact weather events and waterborne disease outbreaks. We examined extreme rainfall and spring snowmelt in association with 92 Canadian waterborne disease outbreaks between 1975 and 2001, using case-crossover methodology. Explanatory variables including accumulated rainfall, air temperature, and peak stream flow were used to determine the relationship between high impact weather events and the occurrence of waterborne disease outbreaks. Total maximum degree-days above 0 degrees C and accumulated rainfall percentile were associated with outbreak risk. For each degree-day above 0 degrees C the relative odds of an outbreak increased by a factor of 1.007 (95% confidence interval [CI] = 1.002 - 1.012). Accumulated rainfall percentile was dichotomized at the 93rd percentile. For rainfall events greater than the 93rd percentile the relative odds of an outbreak increased by a factor of 2.283 (95% [CI] = 1.216 - 4.285). These results suggest that warmer temperatures and extreme rainfall are contributing factors to waterborne disease outbreaks in Canada. This could have implications for water management and public health initiatives. [ABSTRACT FROM AUTHOR]

The emerging risks facing humanity have highlighted the need to address and prevent challenges through multilateral preventive strategies. The Mexico-United States (US) border is a region with great biological biodiversity and both countries shared a similar history and intense socioeconomic, and cultural interrelationships. Also, it has an extraordinary ecological contrast, resulting in an enormous biological diversity in a broad Nearctic-Neotropical transition zone. This dynamic region has important disparities due to the lack of bilateral strategies to face emerging issues (e.g., infectious diseases) in an integrated and holistic approach. In this context, we describe the various socio-ecosystemic contexts of the shared border and present different diseases transmitted, and different zoonoses that affect ecosystemic public health that must be addressed under collaborative schemes that can develop preventive policies under the One Health approach with emphasis on the Mexican zone. We describe the social determinants of health issues for the border, but we add ecological contexts infrequently studied in classical epidemiological approaches. Strategies towards One Health require international and multidisciplinary approaches that strengthen diagnostic capabilities, recognizing social, and environmental challenges. Recognizing these aspects will allow the establishment of joint monitoring, prevention, and mitigation strategies with benefits for both countries. [ABSTRACT FROM AUTHOR]

Introduction: Inter- and transdisciplinary research (ITDR) is increasingly promoted to address "wicked problems", particularly in health sectors adopting approaches like Ecohealth. Our Ecohealth-inspired project on rodent-borne diseases, initiated just before the COVID-19 pandemic, provided an opportunity to evaluate ITDR implementation. Methods: We employed a recently developed semi-quantitative evaluation method to measure our project's success in achieving ITDR and analyzed factors influencing this achievement. Results: The project showed strengths in system description, team task allocation, and data sharing, but had lower scores in engaging societal actors throughout the project cycle. Discussion: We identified the underexplored influence of problem wickedness as a critical determinant of ITDR success. Addressing rodent-borne diseases, a less wicked problem, limited engagement potential but enabled constructive dialog with local actors. These insights are vital for addressing variably wicked problems in a polycrisis era. We propose recommendations to strengthen researchers' capacities, particularly in Ecohealth. [ABSTRACT FROM AUTHOR]

One quarter of the population of Pennsylvania relies on private domestic well water: two-fold greater than the US average. Private well owners are responsible for the maintenance and treatment of their water supply. Targeted interventions are needed to support these well owners to ensure they have access to safe drinking water, free of contaminants. To develop appropriate interventions, an understanding of the characteristics and social vulnerability of communities with high well water use is needed. The purpose of this study was to determine the spatial patterning of social vulnerability in Pennsylvania and assess the association between social vulnerability and private domestic wells using profile regression. Census data and water supply information were used to estimate the proportion of the population using domestic wells. Ten area-level measures of social vulnerability at the census-tract level were investigated, using Bayesian profile regression to link clustering of social vulnerability profiles with prevalence of private domestic wells. Profile regression results indicated 15 distinct profiles of social vulnerability that differ significantly according to the area-level prevalence of domestic well use frequency. Out of these, two profiles of census tracts were identified as socially vulnerable and had a high proportion of well-water users, representing approximately 1.1 million Pennsylvanians or a third of all well water users in the State. High area-level social vulnerability profiles coincide with a high frequency of private well-water use in PA. This study presents a data-driven approach to supporting public health programs aimed at reducing exposure and health risks of chemical and infectious agents in household water supplies by targeting vulnerable populations. [ABSTRACT FROM AUTHOR]