Applying the Cost Effectiveness of a ‘One Health’ Approach to Disease Prevention, from Design to Implementation - A Case Study of Rabies Using the Context of Kerala, India

Abstract:

The One Health approach is a collaborative, interdisciplinary strategy that recognises the interconnectedness between human, animal, and environmental health. The cost effectiveness of this approach has been the subject of much debate, with some arguing that it is too expensive, and others contending that it is a cost-effective strategy in the long run. Careful design of a One Health approach, though challenging, is crucial to achieving this. A focus on equity is also essential while weaving together cross-cutting interventions so that we respect the interspecies perspective along with the human.

We take the case of rabies to design a One Health approach for countries targetting disease elimination. Through an evidence synthesis of economic evaluations, we put together the most cost-effective strategies in a One Health model. Data synthesis is done using the dominance ranking matrix. Certainty, transferability, and generalisability of the findings are looked into. An existing individual-based stochastic simulation model for rabies prevention is adapted to incorporate the components of the One Health approach designed. Cost-effectiveness, in general, and specifically for a tribal population, is attempted. The plan for taking the work forward into an implementation research in the form of a pragmatic cluster RCT with an economic evaluation alongside will be discussed.

Bio

Dr Zinia Nujum is an Additional Professor at the Department of Community Medicine at Government Medical College, Kollam, Kerala, India and a faculty at the School of Public Health, Kerala University of Health Sciences (KUHS). She has 18 years of experience of mentoring undergraduate and postgraduates in research. Dr Zinia’s expertise is in infectious diseases research, particularly neglected tropical diseases. She started off working on Filariasis and later Dengue. Besides these, she has worked on Tuberculosis and Rabies. She has vast experience in the field of rabies prevention. Currently she has been sent by the Indian Government as part of a scheme from the Indian Council of Medical Research, Department of Health research (Short term International Fellowship for Senior Indian Biomedical Scientist- 2023) for collaborating with LSE on doing a cost-effectiveness analysis of “One Health” as an intervention for rabies prevention. She is a Global Assessor for the Royal Society of Tropical Medicine and Hygiene, London, National Assessor for Effective Vaccine Management, member of several state-level committees, including Kerala State Planning Board, Working group on Medicine and Public Health (14th Five Year Plan),  the States rapid response team and HIV State Sentinel Surveillance team. Dr Zinia has received the World Health Organisation Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Post Graduate Training Grants in implementation Research 2014; A Special Appreciation Award for research in dengue from IMA Kerala State in 2019, and the Dr N.R. Roy award from the Indian Public Health Association in 2021. 

A list of Zinia’s publications can be viewed at 

https://scholar.google.co.in/citations?user=p-MOUvUAAAAJ&hl=en