The 21st century has seen an upsurge in health threats which are complex both in their origins and how they play out in the world. Better understanding of these threats and who they effect, when and why, is essential if people and governments are to be best prepared for them, responses are to be proportionate and socially just, and harmful impacts minimised, with the most vulnerable protected.
Researchers at IDS have long been at the forefront of contributing new evidence, analysis and knowledge brokering related to the social, political, economic and cultural aspects of health issues. Applying their work to the challenge of these complex health threats has increasingly meant working with new partners and in new ways.
Antimicrobial resistance
Antimicrobial resistance (AMR) is what happens when microorganisms that cause disease, such as bacteria, become resistant to the drugs (‘antimicrobials’) used to kill them, or prevent their growth. It has its roots in the overuse and misuse of antimicrobials, such as antibiotics, in human and animal health although the drivers and dynamics are complex, making this a difficult challenge to address. A world without antibiotics is hard to think about and the World Health Organization has named AMR among the top 10 global health threats.
Close to five million deaths in 2019 were associated with AMR and it is forecast that from 2025 to 2050 there will be more than 39 million deaths directly attributable to it, with 169 million deaths associated with it.
As well as the grave impact to human health, AMR has serious implications for animal and environmental health. Together these bring associated risks to food security, food safety, environmental wellbeing, and social and economic development – all with serious equity consequences. The World Bank has estimated that by 2050 AMR could knock 3.8% off global gross domestic product each year, pushing 28 million people into poverty. Low and middle-income countries will be hardest hit by the productivity losses and healthcare costs of AMR – and the poorest and most marginalised people within all societies are the most vulnerable to its impacts.
The challenge is to find ways to stem the development and spread of AMR and its inequitable impacts, as well as to find new ways to replace the antimicrobial drugs healthcare has long relied on and ensure they are available to all. Researchers and knowledge intermediaries at IDS are doing this in many ways – from exploring the socioeconomic barriers to safer livestock practices, to supporting policy work to promote investment in antibiotic drug discovery and ensure equitable distribution of drug innovations and health care, to finding ways to work with communities confronting AMR.
One Health
Much of this work has been undertaken in One Health projects. One Health is an approach which understands the links between human, animal, environmental and ecosystem health. As such, it seeks solutions to complex health challenges such as AMR which are collaborative, interdisciplinary and integrated.
IDS works with experts in many and diverse disciplines and sectors, as well as people in affected communities (interdisciplinary and transdisciplinary work). Our AMR research is in partnership with local, national and regional policy and decision makers, civil society organisations and researchers from other disciplines including veterinarians, microbiologists, public health experts, mathematical modellers and more.
IDS researchers have also been at the forefront of developing One Health thinking, including methodological work to better understand the challenges such collaborative working presents in practice to further One Health in action.
Zoonotic diseases
IDS researchers also bring their One Health evidence and analysis to infectious diseases which transmit from animals to people (‘zoonoses’) – another growing health threat with inequitable impacts. Seventy-five per cent of recent emerging diseases, such as Covid-19, have their origins in animals. A holistic understanding of the links between people, animals and the ecosystems in which they live is essential to fully understand the many and varied drivers of zoonoses, as well as how the diseases can be prevented and their transmission managed.
This is as important for headline-making zoonoses such as mpox, Ebola and bird flu (avian influenza), which have the potential to create localised epidemics and global pandemics, as it is for ‘endemic’ diseases, such as Rift Valley fever and sleeping sickness (trypanosomiasis), that persist at low level in communities. The impact of endemic zoonoses, as well as of zoonoses such as the Salmonella virus which cause food poisoning, tends to lie beneath the news radar. However, they can be just as devastating to people’s health and livelihoods. Again, it is the most vulnerable countries and people who are most affected.
IDS zoonoses research has ranged from explorations of the drivers of these diseases and the health and livelihood risks they present, to building platforms and networks to inform responses to disease outbreaks, as well (as other humanitarian emergencies) that are effective, adaptive and, importantly, context-informed.
Covid-19 and pandemic preparedness
Covid-19 was the big wake-up to the dangers presented by infectious diseases and zoonoses in particular. IDS contributed significant evidence and insight to the response, and continues to work with partners across the world to generate new thinking and knowledge related to the social and cultural factors that supported responses to outbreaks and build resilience for future challenges (whilst at the same time questioning assumptions about ‘community resilience’ in low resource settings).
IDS innovative thinking on how people and governments can prepare for the next pandemic in ways that are not only effective but also locally sensitive and socially just continues, as does IDS work on meanings and practices of preparedness. It has put this concept under the spotlight and posed questions such as ‘preparedness for what and for whom’. This becomes an important consideration in contexts with competing disease burdens and structural inequalities, where systems strengthening needs to be an essential part of preparing for health and other shocks.
