ÃÞ»¨ÌÇÖ±²¥

As an organization with an extensive global health program, and scientists and public health workers on the front lines in countries all over the world, ÃÞ»¨ÌÇÖ±²¥ understands firsthand the importance of addressing both natural and intentional biological threats. Although biosafety/biosecurity awareness and expertise has improved greatly in the past few decades, it remains among Member States, according to the World Health Organization (WHO). Addressing biothreats begins with proper training. Laboratorians need to follow strict protocols to ensure accidents don't happen, and if accidents do occur, to know how to effectively and rapidly respond. ÃÞ»¨ÌÇÖ±²¥’s Global Public Health Programs (GPHP) worked with ambassadors in Pakistan to enhance their knowledge of biosafety and equip them with tools and resources needed to train their colleagues and communities.

Biosafety includes the careful handling, transport and storage of contagious organisms. As the number of individuals working in high biocontainment laboratories increases, so does the need for behavioral and technical best practices to reduce potential for human error. Comprehensive biosafety training is critical to ensure safe handling and containment of hazardous biological materials. ÃÞ»¨ÌÇÖ±²¥'s GPHP programs implemented a specialized program called 52 Weeks of One Health Biosafety to promote the safe and secure handling of biological materials and mitigate the risk of biological incidents.

52 Weeks of Biosafety

“Continuous training on biosafety and biosecurity is needed to address the public health-related issues in Pakistan,” said program participant Dr. Muhammad Usman Qamar, a medical microbiologist at Government College University Faisalabad. He noted that the ÃÞ»¨ÌÇÖ±²¥ training—which covered One Health-related biosafety and biosecurity issues, biological and human risk factors, zoonotic disease, public health and preparedness for public health emergencies—not only improved his skillset, but also increased his appreciation for biosafety and biosecurity measures. He has since developed a 6-month curriculum to share this knowledge with his own trainees, so far reaching more than 1,400 students.

Rather than a traditional lecture or workshop, the 52 Weeks program combined both theory and practical skills to help participants adopt regular best-practice behaviors. The yearlong program also utilized monthly webinars, virtual office hours and capacity-building assignments to establish biosafety knowledge and behavioral practices at the worker level and containment measures at the institutional level.

Guided by mentors, participants built their confidence in demonstrating proper use of personal protective equipment (PPE), including safe donning (putting on) and doffing (removing) procedures, becoming experts who then could return to their home labs and share these behavioral competencies with the rest of their lab colleagues. The 52 Weeks program also helped participants develop customized and innovative solutions for their institutions—thereby increasing professional resilience and sustainable behavioral competencies in biosafety.

Controlling AMR

Implementing proper handling and disposal procedures can also help to combat the ongoing battle against antimicrobial resistance (AMR). Resistant organisms can be found in human, plant or animal hosts, and likewise, can escape into the environment through horizontal or vertical gene transfer. AMR is a serious concern for Pakistan, according to Dr. Afreenish Amir, AMR technical officer at the National Institute of Health, Pakistan (NIH). . In 2016, Pakistan established the One Health Hub at NIH’s Field Epidemiology and Disease Surveillance Division to build multi-sectoral collaboration between human, animal and environmental health departments. “AMR containment requires a holistic [One Health] approach. Containment plans [must] include human, animal, environment, food and agriculture sectors,” said Amir.

As antibiotic resistant microorganisms emerge, evolve and spread, the need for One Health multidisciplinary action is imperative. However, as Amir pointed out, implementing One Health in Pakistan has considerable challenges. “One of the key challenges is the inadequate health budget to address the needs of growing populations. The country’s decentralized health system results in each provincial government being responsible for its own finances and health-related decisions. NIH provides support to provinces, but there is still a scarcity of zoonotic and vector laboratories in country to accomplish testing needs, [and] testing methods need to be standardized,” she said. One consequence of these interrelated factors is an increase in zoonotic infections; increases in AMR organisms is another.

Qamar, who is currently researching the troubling occurrence of multidrug-resistant (MDR) and among pediatric patients with sepsis, agreed. He attributed the problem, in part, to inadequate sewer systems resulting in contaminated water and food that lead to increases in Salmonella, E. coli and other gut microbes transmitted via the fecal-oral route. Qamar also noted the importance of educating communities about health threats, in part because antimicrobial misuse has increased in Pakistan amid the pandemic as people turn to antibiotics as a potential treatment for COVID-19 or other ailments. “We have vaccines, we have masks, we have resources, and we were able to provide them [to the public] for free during COVID-19. But the problem is social behavior,” he said, adding that microbiologists are in a powerful position to positively influence such behaviors.

Controlling Community Spread Through Education

To educate the community, Pakistan’s NIH established a National One Health Strategic Framework, aimed at prioritizing the top 6 zoonotic diseases in the country: anthrax, influenza, rabies, brucellosis, salmonellosis and Crimean Congo hemorrhagic fever. Together, ÃÞ»¨ÌÇÖ±²¥ and NIH jointly conducted 2 virtual workshops in 2021 and created posters in Urdu and English to create and enhance awareness about these zoonotic diseases at both the community and professional levels. Amir worked with collaborators to design illustrated materials that depicted the full One Health spectrum of disease control—and destigmatize the prevalence of zoonotic disease. Her posters were shared at the community, subnational and national levels and disseminated widely through different channels, including relevant ministries and public health institutions. On a broader scale, Amir also works with community pharmacists and veterinarians to assess their knowledge, attitudes and practices toward priority zoonotic diseases and to identify region-specific biosafety training needs. Educating stakeholders informs future policies to further strengthen Pakistan’s One Health strategy.

GPHP’s efforts empower participants like Qamar and Amir to build on their knowledge and passions to become expert resources in their home countries. “ÃÞ»¨ÌÇÖ±²¥ has its name in the scientific world, and its contributions to the technical field [are] enormous,” said Amir. “With the support of ÃÞ»¨ÌÇÖ±²¥, NIH has been able to conduct certain essential steps towards [implementing] One Health. The long-term impact of these key initiatives is immeasurable.”