Mission 'One Health'
The epidemiologist Jakob Zinsstag conducts his research in the poor countries of the Global South and is an advocate of 'One Health'. With its view to improving health care, this approach aims to promote synergies across human and veterinary medicine and the nutritional and environmental sciences. By Irène Dietschi
(From "Horizons" no. 110 September 2016)
Since early childhood, Jakob Zinsstag – the second-youngest of eight children – knew exactly what he wanted to become in life: a missionary or an aid worker. His desire was so strong that when he was just 11 years old, he invited a missionary to his Sunday school in his home town of Visp. She had to explain all about her activities in poor countries. Later, he went to work regularly on the farms of his mother's family in the Jura, helping out in the fields and the cowsheds. His love of animals led him to study veterinary medicine. At the age of 25, fresh from qualifying, Zinsstag went to work at a veterinary clinic for large animals in Porrentruy, where his wife began her first job as a Reformed pastor. Their future seemed mapped out: secure, lucrative and free of worries. But Zinsstag was bored.
Today, Zinsstag is a titular professor for epidemiology at the Swiss Tropical and Public Health Institute in Basel (Swiss TPH) – and his life could hardly be more exciting. He has just returned from a two-day oncology symposium of the Collegium Helveticum. Before that he and his team were in Ethiopia, where, together with local partners, he is aiming to document and improve the health provision of the nomads in the Ogaden, the ethnic Somali region in the south of the country. "Right from the start we've been out and about with mixed teams – physicians and veterinarians, but also specialists in pasture farming, ethnologists and other experts from the human sciences", he explains. "We want to find out: what is the nutritional situation of the children? Do pregnant women have access to midwives? What's the condition of the soil? And of the animals?" The results of these surveys will enable them to develop ideas as to how they could adapt the health services on the spot to suit the needs of the local people.
"The biggest kick of all: change"
One Health is the name of this approach that encompasses human and veterinary medicine, food production and environmental conditions. Zinsstag is one of the most important representatives of this research field. He has published innumerable articles and a book about it, and above all he has initiated many projects in very different regions of the world – in Africa, Asia and Central America. All these projects are committed to the idea of One Health. He spends almost a third of his work-time travelling. "There are a lot of projects, but we always find a way somehow", he says earnestly as we march to the nearest café. His rolling gait reminds one a bit of the farmer he could well have become. Besides One Health, his projects have another common denominator: they're all transdisciplinary. In other words, the people on the ground are just as involved in the research as the Swiss scientists who've launched the projects. "For me, the academic world is a means to an end: it's not publishing that gives you the biggest kick of all: it's the change that I can bring about", he says.
Zinsstag left the veterinary practice in Porrentruy back then to sign up as a postdoc at Swiss TPH. Afterwards, he and his wife lived in West Africa with their four daughters – born between 1989 and 1996. Zinsstag was the project head at an international research centre for sleeping sickness in Gambia, then Director of the Centre Suisse de Recherches Scientifiques in Abidjan in Côte d'Ivoire.
It was Marcel Tanner who fetched Zinsstag back to Switzerland. "I suggested he could set up a research programme for the nomadic population of Chad, focussing on the perspective of veterinary medicine. This was because the nomads live so close to their animals, and because zoonotic diseases are a huge global challenge. These are diseases that occur in both humans and animals". Tanner is the long-serving Director of Swiss TPH, and he's clearly still delighted at having won over Zinsstag back in 1998. "The idea behind it was to bring veterinary and human medicine together and to implement the concept of One Health".
An ounce of prevention ...
The idea caught on. Working with funding from the SNSF, Zinsstag and his team discovered in their field studies that the cows in these nomadic communities had been inoculated, but the same was rarely true of their children. "So it was a natural solution to set up inoculation services for people and animals alike, using the same refrigeration chain and the same transport". The data collected by the Basel researchers also helped to combat rabies in Chad. This disease threatens millions of people in Africa and is primarily carried by dogs. The problem is at its worst in the towns. "We developed a mathematical model that shows how proactively inoculating all dogs is more effective and cheaper than treating people after they've been bitten", explains Zinsstag.
In 2012 and 2013 he and his team carried out a mass inoculation of 20,000 dogs in the capital city of N'Djamena. As a result, the rabies transmission rate in the city plummeted. They had their proof: "Rabies can indeed be eradicated – and this is a goal that Africa aims to reach by the year 2030". The commitment of the authorities in Chad was decisive, insists Zinsstag. They participated in the campaign by providing personnel and logistics.
In parallel with his activities out in the field, Zinsstag has continued with his academic career. In 2004 he was appointed assistant professor at the University of Basel, and in 2008 he was made two tempting offers: one from the University of Munich to take up a professorship in tropical veterinary medicine, and one from the University of Zurich as Professor of Epidemiology. He refused both, out of loyalty to Swiss TPH. "The working conditions here are unique", he says. Zinsstag goes into raptures as he speaks, his eyes glistening as he describes his 'epiphany' when he realised that, as a vet, he could have access to the knowledge of 20 or 30 different disciplines and could use it to help the developing world.
It seems he did become a kind of missionary after all.
Irène Dietschi is a freelance science journalist in Zurich.
One doctor for all
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