Importance of food systems to public health

The Kenya Veterinary Association (Nairobi branch) organised a webinar to explored how sustainable food systems provide healthy food to people and animals and how they may have direct and indirect impacts on the environment, economy and social systems. The webinar was held on 15th July 2020 with 269 people registering for the webinar out of which 140 participants attended the live zoom webinar with average viewership time of 80.05 minutes.  130 participants were from Kenya, with 6 from the USA, 3 from Rwanda and 1 from Uganda. 96 of the participants were veterinary surgeons, 14 veterinary paraprofessionals, 12 students/interns, and 18 others.

KEY MESSAGES FROM THE DISCUSSIONS

• We need to critically re-evaluate the relationship between nature, food and health and start producing food in a manner that is sustainable with little negative impact on the environment to avert subsequent public health impact.
• As we progress as a continent we are slowly beginning to see the critical need to have a One Health or One Welfare approach, where we try to look at the intricate connection between the environment, animals and humans, including outcomes of their interaction such as negative health outcomes like zoonoses.
• There is a disconnect between the structure from the Directorate of Veterinary Services (DVS) to the County Directors of Veterinary Services. That link has been disconnected and the CDVS’s are more responsible to their bosses in the counties than the DVS. A huge number of counties do not allocate sufficient resources to agriculture, yet agriculture is huge in this country and hence do not have extension workers. Lack of extension workers is what makes farmers to go to agrovets to get products to administer themselves. Pharmaceutical companies also need to train people on the ground so as to pass correct knowledge to the farmers.
• The first challenge is that even the constitutional provisions have not been implemented as they are needed. In the section 4 of the Constitution of Kenya talks about roles of national government and county governments. Extension is part of what county governments should do and further talks about agriculture extension (crops and animals), and further mentions county veterinary services excluding the regulation of the profession. Those are things that need to thrive and the media need to highlight these gaps in implementation.
• Veterinarians have concentrated a lot on curative medicine and that is why we have raised medics to a certain level. We forget that you will never have a healthy population unless you have looked at preventive aspects of medical services e.g. is meat wholesome, is the production system (what we eat is what we are). if we eat maize with aflatoxins or milk with mycotoxins then we end up with a problem and that becomes very expensive to treat.
• The main dangers of growth promoters is the constant exposure of bugs to sub-therapeutic levels of antimicrobials resulting to resistance. Humans could, therefore, be potentially exposed to these low doses of the drugs through drug residues in food (milk, eggs and meat); hence constantly treating animals with sub-optimal doses impacts negatively in controlling the same pathogens in humans.
• Keeping off antimicrobials from the food chain is not only beneficial to the food chain, but also to the companies that develop these molecules as it is a resource-intensive investment to develop a new drug molecule; early resistance means that the companies are not able to re-coup their investments.
• To an untrained eye the COVID-19 pandemic will seem as novel and unprecedented but scientists predicted such scenarios in the past and this is because a perfect storm has been brewing for some time, this is because the world is more interconnected than before with an intricate interaction among humans, animals and the environment.
• In the past 100 years we have had a four-fold increase in human population. It is predicted that by 2030 there will be an extra 2 billion people on earth who will lead to an increased demand for animal protein e.g. beef, poultry, fish and wildlife and this will lead to unsustainable intensive poultry, pig farming and increased exploitation of wildlife because of protein and compounded by climate crisis. This will mean that COVID-19 may not be the last pandemic on planet earth because the world is becoming like a crucible for disease transmission and emergence.
• The solution lies in the problem and the problem is close interaction between people, animals and the environment and the solution is a One Health approach where the human, animal and environmental specialists come together to work to predict future pandemics, to stop, if possible, and mitigate their impact. Clearly, the currrent pandemic has shown that we are ill equipped to stop pandemics.
• Scientists should work as disease detectors and go ahead of the curve by working in pristine environments to understand how viruses, bacteria and other pathogens are evolving before the assortments and reassortment of their genetics to humans.
• The current COVID-19 outbreak may sound novel, but every year the world loses up-to 2 million people due to neglected disease that disproportionately affect the poor in low- and middle-income countries. We need to keenly rethink about these diseases since they affect humans and animals as well.
• In Kenya One Health has taken shape, there are structures, but they need to be strengthened. What is missing is mainly working with the environment sector.
• Ideally a farmer should not walk into a drug store and walk away with a prescription only medicine (POM). Any medicine inscribed as POM should not be in the hands of the farmer. Unfortunately, in our entire region, all countries neighbouring Kenya, a farmer will walk into the shop, buy a product and walk out; this is where the misuse starts. It is a task that calls for a regulator that has capacity. The only way to manage the situation is by making sure that agrovets are properly licensed and owned by technical people who are available all the time. There are cases where agrovets are owned by technical people but they are never there and people left are non-technical to attend to the farmers.
• It has been shown there is a benefit of tackling diseases holistically and not just at the pathogen level but also addressing the social and environmental drivers, since they also play a huge role in the spread of the disease.
• The challenge we have had as vets is that we have restricted ourselves to matters relating to just treatment. We need to broaden our role in human-wildlife conflicts.
• In Kiambu, farmers who used to keep poultry are finding it sensible to invest in real estate rather than a poultry investment. Another key question in the context of food systems is how will we ensure that the population is food secure when farmers are transitioning to other investments? As kenyans are we then justified to complain when food is coming from Uganda? It is therefore a complex issue.
• It is important to push for One Health and mainstream it as an approach of handling disease outbreaks.
• Using some of the products is not in itself a problem. The main problem, that is among farmers and also observed in humans, is that once farmers buy the drugs they do not use them correctly. They do not get the right advice on dosage and duration of usage.
• Pharmaceutical companies have an obligation to ensure that their pharmaceutical products are used properly. It is in their own interest that the products are used properly so that resistance doesn’t set in quickly. If pharmaceutical companies do not do that then the shelf life of veterinary products will be very short and soon resistance will set in.
• All pharmaceutical companies need to conduct regular training of farmers on the usage of their products and their withdrawal times.
• Other than the pharmaceutical industry and farmers out there, it is the responsibility of each veterinarian to safeguard and protect the usage of antimicrobial agents. It is also the duty of the pharmaceutical industry to engage professionals to bring out details of their products to colleagues who are part of the stakeholders who use the products in the marketplace. As a vet after using a product after making a diagnosis, it is you as a vet that should be the first to know which product has not worked.
• As professionals we are a reflection of our society. Our professional norms will revolve around our societal norms and for a long time it has been a man-eat-man society. Even some of the issues around wildlife encroachment, a lot may not be about population explosion, it is about greed. Where someone who has huge tracks of land somewhere grabs more pieces of land and wants to build. If you buy a product severally and find it doesn’t work then you should not buy it.
• Our market has become a dumping ground for veterinary products, we have a lot of rubbish products, it is my prayer that regulators on the ground including the feed industry will pay a little more attention to the usage of products and how products perform and naturally kill products that do not work.
• My plea to all of us is that if we are to use antimicrobials let us use them appropriately and above all let’s practice prevention and only use antimicrobials when the control mechanism breaks down. But we should not inject every animal for the sake of getting an income.
• Secondly, at the National government we should have developed a National policy which would have addressed issues raised on the connection between county and national government.
• In conclusion, the role of national government (under article 22 of the Constitution of Kenya) talks about protection of the environment and natural resources with a view of establishing a sustainable system of development including (a) fishing, hunting and gathering; b) protection of wildlife. The Constitution of Kenya already highlights the need to have sustainability. Unless we sustainably utilize the natural resources in development esp. fishing, hunting, gathering, protecting animals and wildlife we will end up with challenges. Politicians are hoodwinking us and we need to ask them why have the provisions in the Constitution in regard to veterinary sector not implemented.
• In as much as the veterinary policy is not yet gazetted, currently there are two pieces of legislation that are being developed that have taken into consideration the role of the county and national veterinary services i.e. the animal health bill and the veterinary public health bill.
• The UN FAO food security document dated 2010 defines sustainable diets as diets with low environmental impacts, which contribute to food and nutritional security, and that support healthy lives of present and future generations. Further, the document states that sustainable diets are protective and respective of biodiversity, ecosystems and cultural acceptable, economically fair and affordable, nutritional adequate, safe and healthy while protecting natural and human resources.
• When you look at schedule 4 of the Constitution of Kenya which talks about separation of duties and responsibilities between county and national government; part 2 which gives responsibilities of the county government, under county veterinary services (section, e) includes veterinary services. A question that I keep grappling with and which the 2 pieces of legislation will probably sort is veterinary services are part of county health services or are they under the traditional Ministry of Agriculture, Livestock and Fisheries. Constitutionally veterinary services at county level should be part of the County Health Services and not part of agriculture.
• The media should also try and help to pass a message from the profession to the public that farmers should not expect that a service will be delivered without any compensation in terms of payment. Animal health practitioners have spent a lot of time and money to get themselves in the position they are in and the public is dully expected to renumerate them accordingly. The public should learn to get value for their money many a times the public expecting that they should not be charged for a service rendered should be an idea that should be discarded.
• Every registered veterinarian has a registration card that shows his registration number and validity period. All veterinarians must be retained in a register and the register is closed by end of March of every year through a gazette notice.
• The key question is how do we mainstream our priority areas? Funding is not much since our priorities do not much the funders priorities. This is a challenge in neglected zoonotic diseases

Partners

This event was made possible through partnership with the Kenya Small Animal Veterinary Association