Session 3: Research and Operational Paths Forward
During the final workshop session, participants and speakers reflected on some of the key opportunities to facilitate multidisciplinary, interagency, and international cooperation and collaboration. Building upon existing research and observational programs and platforms, participants discussed best practices as well as ethical dimensions to be considered for working with indigenous communities. Lessons learned from research in other regions (e.g., Antarctic research) were highlighted as well.
Local Environmental Observer Network
Mr. Michael Brubaker, Local Environmental Observer (LEO) Network,1 shared information about this online platform to collect local observations of environmental change. This network is made specifically for people that are familiar with their local environments and are thus able to detect and report changes over time. He noted that some of the challenges faced by Arctic populations may include isolation and reduced access to resources. One benefit of this online resource is the ability to share information and knowledge regardless of location. Mr. Brubaker used examples from local communities to illustrate the intimate knowledge that community members possess about their environment and the related ability to perceive small changes. The goal is to collect and track “symptoms” of how the environment is changing, some of which can be identified through observations, and some of which require scientific research or remote sensing methods (i.e., structured monitoring). If local experts are able to provide information or “symptoms” of local change, this can be added to a database that can be tracked and compared over time and geographic range.
Using these methods, thousands of observations have been collected in Alaska revealing potential vulnerabilities to climate change (e.g., ice hazards, reduced food security, increased allergies, and others). The LEO Network was developed by the Alaska Tribal Health System beginning in 2012 as a strategy for gathering and sharing information about climate and other drivers of environmental change. Mr. Brubaker noted that the primary goal is to share knowledge with a secondary goal to help answer questions and connect local communities with resources. The content is observational (not structured monitoring) and takes holistic rather than topic specific approach. It is based on a social media (member owner) model and welcomes different knowledge systems, is multi-lingual (including indigenous languages), and is user driven and user friendly. Different groups of individuals use the network in different ways. For example, community members use the platform to share observations about significant environmental change, as witnessed through specific events, as a way to raise
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awareness about pressing concerns and to connect with topic experts to receive technical support. Public health experts use it as a communication tool for engaging with communities, staying informed about emerging priorities, and providing environmental health consultations. Finally, researchers and agencies use this network as a surveillance system for receiving local updates on emerging issues, for identifying experts and research partners, for learning about local change and vulnerabilities, and for providing event specific consultations.
Mr. Brubaker outlined the network in detail, and noted that a future goal is to incorporate additional users and partners from Canada and Russia. The content of the network consists mostly of observations about specific events or articles about specific events from local newspapers. Observations primarily come from local residents, who can provide specifics on problem statements, background, hypotheses, photos, geographic information, and other crucial information. The system will ask users to identify aspects of the natural environment that are relevant to the observation, why it is unusual or unexpected, and how the human environment has been impacted. Observations are then forwarded to partner organizations or experts that can provide detailed topical consultations on the event and may be able to provide additional information or context. Previously added information is available for searches using specific filters such as date range, region, or type of observation.
An example of the effect of thawing permafrost on a mass burial site was outlined by Mr. Brubaker. Subsidence and erosion of the permafrost in the area of Brevig Mission caused gravesites to be disturbed (Figure 17). The issue was reported by local community members, and engagements with permafrost experts and relevant consultants may be able to provide ideas to preserve these sites. Using information collected by the network database, satellite and aerial images can be added along with weather data to indicate potential extreme events and historical data for context. As this issue becomes more prevalent with thawing permafrost, examples can be collected, categorized, and mapped within the LEO system.
Zoonotic Diseases of Importance to Subsistence Communities
Zoonoses and issues related to subsistence food handling and consumption was discussed by Mr. Eduard Zdor, University of Alaska Fairbanks. Indigenous peoples are facing and adapting, not only to social and cultural changes, but also to climatic changes. Food obtained from traditional subsistence hunting, fishing, and gathering is widespread in the remote villages of the Bering Strait region. For example, in 2012, 198.7 kilograms of meat, fish, birds, berries, and so on per capita were harvested on the Alaskan side of the Bering Strait (Fall, 2016). On the other side of the Bering Strait, in Chukotka, for part of 2012, 399 kilograms per family were stored, and a year earlier, 737 kilograms per family were consumed (Kochnev and Zdor, 2014). The amounts of food harvested, stored, and consumed are similar on both sides of the Bering Strait because the people living in these regions have similar lifestyles and food sources from the sea and tundra. Fishing, a crucial food source, provided 122 kilograms of food for Chukotkan households
in 2011, and 76 kilograms per capita in Alaskan rural communities in 2012 (Kochnev and Zdor, 2014). On the other hand, reindeer meat consumption is declining; in Chukotka in 2019, 23 kilograms of reindeer meat was consumed per capita, and 30.4 kilograms of caribou meat were harvested per capita in Alaskan rural communities in 2012 (Fall, 2016). Traditional processing and drying methods are still used for these foods, but salt is frequently used due to increasing temperatures above freezing.
Mr. Zdor noted that the efficiency of marine mammal hunters is high compared to 20-30 years ago due to the involvement of high-tech equipment and transportation. However, innovation is also contributing to a shift in traditional approaches to wildlife and thereby changing the sociocultural pattern of communities in the region. The Chukotkan annual average harvest includes 120 gray whales, 1 bowhead whale, 1,000 walruses and 3,000 seals of different species per year. In Alaska, on average, villages annually harvest several thousand seals, from 200 to 400 belugas (Hovelsrud et al. 2008), and 1,200 walrus. In 2017, 11 Alaskan villages landed 50 bowhead whales. In the past few decades, methods such as smoking, pickling, and salting have been increasingly used for processing and safe storage (versus more traditional methods such as ice cellars). Given ongoing changes to climate, subsistence consumers are forced to look for other ways to store traditional food. Villagers must limit meat consumption in the summer, postponing the hunt for autumn. Another example highlighted by Mr. Zdor
was walrus meat, the most desirable traditional food on the Chukotka coastal settlements side; the cooking and preparation methods (boiling and fermentation) are of particular interest to epidemiologists. Initially, the decline in traditional processing and storage methods was attributed to sociocultural changes in the settlements. Over time, it emerged that the thawing of the permafrost also contributed to shifts in traditional food consumption.
Dr. Cheryl Rosa, US Arctic Research Commission, shared information on the “indigenous protocol” (as termed by co-presenter Mr. Zdor) when diseased or abnormal animals are discovered. Following indications of unusual animal behavior and organoleptic examination (i.e., assessment of flavor, odor, and appearance of a food product), appropriate processing measures are taken. For example, animals that appear abnormal or diseased are generally avoided or discarded. Animals are cut up and processed as quickly as possible, and only the processed meat is eaten. Low temperatures, and to some extent, dry weather, during processing and storage are crucial to ensure safety. As noted earlier, drying and fermentation are additional ways of processing products. Dr. Rosa mentioned that there are other ways to provide safe consumption, and examples of preventive measures may include sharing knowledge of these protocols amongst communities and generations as well as partitioning into small settlements along the coast. These measures may not always work, however, and entire communities have fallen ill with infectious diseases in the past.
A case study on “stinky whales” was discussed by Dr. Rosa. In 1998, Chukotka Native hunters began reporting an increase in the number of hunted eastern North Pacific gray whales that exhibited a strong medicinal odor. Tissues from these whales are deemed inedible (not palatable) by people and not consumed by sled dogs. People have tasted the blubber or meat and have noted numbness of the oral cavity and reported skin rashes or stomachaches. Samples were collected in the early 2000s, though it can be challenging to get marine mammal samples out of Russia into the US. Sample quality declined due to cycles of freezing and thawing. Additional samples were collected between 2008 and 2014, and the plan was to submit samples to several labs for analysis of the following: persistent organochlorines (OCs), polyaromatic hydrocarbons (PAHs), heavy metals (HM), stable isotopes (SI), and volatile organic compounds (VOCs) and HABs. Unfortunately, researchers still do not have access to these samples, highlighting the issues associated with policy and politics making this type of work more difficult.
At the end of her remarks, Dr. Rosa noted that it is critically important to take into consideration the benefits that come from eating a subsistence diet, and that culturally appropriate messaging is imperative when communicating risks. Mr. Zdor concluded by sharing that a high level of concern exists surrounding efforts to “ensure food safety”—specifically that these efforts could restrict subsistence hunting, handling, and consumption abilities. With changing environmental conditions (and recognizing the importance of food safety as a part of food security), the solution may be a compromise in the protocols that provide a safe way to process and store traditional foods while
avoiding disruption to Indigenous lifestyles, which is a key factor in preserving cultural identity.
Using Indigenous Knowledge to Detect Emerging Pathogens
The use of community-based wildlife health surveillance for the detection of emerging pathogens in the Arctic was outlined by Dr. Susan Kutz, University of Calgary. If pathogens emerge from thawing permafrost, ice patches, glaciers, or graves, wildlife may be the first to be affected. Therefore, wildlife may be important sentinels and amplifying hosts as well as a food safety concern. Current wildlife health surveillance in the Arctic is often not adequately sensitive to detect emerging concerns, nor are current surveillance methods particularly effective. Population density is low in remote areas of the Canadian Arctic, and thus surveillance is hampered by the lack of local expertise as well as fear of diseases, costs and logistics, shipping of samples, time delays and sample quality, unknown existing pathogen diversity, and the lack of policies, reportable diseases, political will, and priorities. Dr. Kutz noted that there are many examples of unexplained wildlife mortalities and diseases across the Arctic region.
Dr. Kutz suggested that a possible solution is to bring knowledge systems together for wildlife health surveillance. The complexity of the Arctic forces researchers to draw on all sources of knowledge, including local and indigenous knowledge (Schoolmeester et al., 2019). Indigenous wildlife health knowledge is accumulated over generations. This knowledge is applicable in all seasons, across many species (Tomaselli et al., 2018), and includes information about what is normal and what is abnormal. A challenge is ensuring that knowledge and experience are respected, documented, and implemented. Dr. Kutz shared case studies on muskox and caribou health research. In 2008, a lungworm parasite (Umingmakstrongylus pallikuukensis) emerged further north into areas that it had not appeared before, indicating changing environmental conditions. Unusual muskox mortality events were reported between 2009 and 2013. In 2012, a sample was retrieved that showed septicemia caused by the bacteria Erysipelothrix rhusiopathiae. Whole genome sequencing revealed that there were no differences in the strain across multiple animals and across the entire area. A human infection was also recorded, but genome sequencing was unable to identify a source (Groeschel et al., 2019). Dr. Kutz and her colleagues began thinking about monitoring in a community-based wildlife health surveillance approach, including individual interviews, small group interviews, hunter-based sampling, and targeted sample collection. Fundamental to this program is building capacity within the local communities (including workshops, training, and science in the classroom).
Following the group interviews, areas of observation were highlighted from residents and pilots familiar with the territory. Dr. Kutz showed how estimated muskox population trends indicate a dramatic recent decline following a peak in population, and aerial surveys show similar results (Figure 18, Tomaselli et al., 2018). Understanding this decline involves comparing health indicators during peak and decline periods. This is
accomplished through “proportional piling”2 exercises used to quantify people’s perceptions (i.e., participatory epidemiology). The exercise showed declines in the proportion of juveniles, body condition, and health status. The cause of death post-decline ranged from predation to acute death, and the exercise revealed that the number of cases between 2009 and 2014 was higher than anticipated. Dr. Kutz indicated that the epidemic was missed by standard scientific methods, and provides an example of the challenge of tracking emerging diseases in the Arctic when indigenous and local knowledge is not included (Tomaselli et al., 2018).
A hunter-based sampling program provides hunters with kits to gather important indicators of health over time (e.g., blood samples, skin and hair, and bones). Dr. Kutz noted that interviews revealed observations about animals becoming thinner over time, developing scabs on their mouths, overgrown hooves, tooth abnormalities, fewer calves, and limping. Brucellosis was cultured from some of the hunter sampling kits and, combined with archive data, is shown to be increasing on Victoria Island (Tomaselli et al., 2019). This emerging condition was first identified through interviews with local residents and the research was improved using the hunter-based samples.
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2 “Proportional piling is a semi-quantitative method for determining community priorities. For example, circles can be drawn on the ground or pictures can be drawn on cards, which represent the problems mentioned. The respondents are then asked to pile pebbles or beans in proportion to the importance of the problem. A fixed number of beans can be used to make the technique more reproducible. The appraisal team then counts the number of beans placed on the symbol for each problem.” Source: http://www.fao.org/3/X8833E/x8833e03.htm.
There is an intimate connection between Northern peoples and wildlife, and indigenous knowledge provides a contextual understanding and experiential knowledge on a temporal and spatial scale that cannot be accomplished through western science. In addition, Dr. Kutz highlighted the ability of indigenous knowledge and hunter-based sampling to inform science, generate research hypotheses, and serve as an early detection of change. At the conclusion of her remarks, Dr. Kutz suggested that effective wildlife health surveillance requires bridging knowledge systems. She highlighted the importance of communication with indigenous communities, understanding that sensitivities are crucial when researchers are interested in discussing food sources and traditional ways of life.
Panel on International and Multidisciplinary Research Examples
Dr. Kutz moderated a discussion to explore examples of international and multidisciplinary research projects from microbial discovery to surveillance and response. During the panel discussions, Dr. Michael Bruce, US Centers for Disease Control and Prevention, spoke about the International Circumpolar Surveillance (ICS) System for Invasive Bacterial Diseases and collaborative One Health research in the Arctic. Started in 1999, ICS is an infectious disease surveillance network of hospitals and public health laboratories across the Arctic. Current members include Alaska, Northern Canada, Greenland, Iceland, Norway, Northern Sweden, and Finland, and all members submit laboratory, clinical, and demographic data on invasive bacterial diseases to ICS. Testing and laboratory capabilities are not uniform across the Arctic, so the system conducts quality control. An example of data illustrated by Dr. Bruce includes rates of invasive disease in children under five, in a pre-vaccine period and post-vaccine period. With the introduction of pneumococcal vaccine, there was a dramatic decline of invasive pneumococcal disease in Native and non-Native children, though the rates of infection are still currently higher for Alaska Native children compared with non-Native children (Bruce et al., 2015). Additional data on Haemophilus influenzae serotype b also show significant decreases in the rates of infection in indigenous and non-indigenous children post-vaccine (Singleton et al., 2000). However, through this network, rates of Haemophilus influenzae serotype a have been identified and are highest in this region compared with the rest of the world. Approximately 11 percent of cases are fatal, 32 percent require hospital transfer, 78 percent require air transport, and 36 percent required intensive care or died before admission. Disease complications were identified in 14 percent of patients a year or more after the clinical episode (Bruce et al., 2013 and Plumb et al., 2018). Dr. Bruce also outlined how the network identified an outbreak in 2018, including four cases in one village (Nolen et al., 2020). A vaccine underway in Canada could avert considerable morbidity and mortality in affected populations (Barreto et al., 2017 and Cox et al., 2017).
Dr. Bruce outlined examples of collaborative One Health research projects in the Arctic. The Circumpolar Climate Change and Infectious Diseases Workgroup performed a survey of 11 climate-sensitive, reportable infectious diseases in the Arctic (arboviral
disease, brucellosis, Q-fever (Coxiella burnetti), cryptosporidiosis, echinococcus, giardiasis, hepatitis E, rabies, toxoplasmosis, trichinellosis, and tularemia). A serosurvey was completed in Alaska (Miernyk et al., 2019) and a serosurvey is planned in Greenland and Sweden. During a 2019 Alaska Zoonotic Prioritization Workshop, a five-step prioritization process was developed using quantitative and qualitative steps (Figure 19). The process starts with a list of zoonotic diseases for prioritization, specific criterion are applied to each (e.g., clinical outcome, prevalence and modes of transmission, social or economic effects, response capacity, and climate change), and after ranking numerically, a list of top priority diseases are developed. Dr. Bruce noted that the following diseases emerged as priorities for Alaska: amnesic shellfish poisoning, zoonotic influenza, rabies, cryptosporidiosis, toxoplasmosis, brucellosis, and Q fever. Landscape reviews are planned for the existing literature, surveillance, and testing to create a baseline level of knowledge in Alaska for each disease.
Sharing an Antarctic perspective, Dr. Trista Vick-Majors, Michigan Technological University, discussed subglacial lakes and tackling interdisciplinary problems of international interest. She noted that ice covers approximately 98 percent of the Antarctic continent. The ice sheets contain about 60 percent of Earth’s freshwater. In addition to ice cover, water is widespread under Antarctic ice. Since the mid-1990s, nearly 400 lakes have been discovered, and many areas are thought to be underlain by water-saturated sediments and crossed by streams. Scientific interests in
this area include microbial life, subglacial geology and sedimentology, and hydrology. In 1998, completion of the Vostok ice core (3623 m) provided climate records and information on microbiology of ice accreted from the lake. Between 2000 and 2009, multinational committees worked to determine the importance of subglacial work and ensure that the environments remain pristine after work commences. In 2011, the Scientific Committee on Antarctic Research developed a Code of Conduct for subglacial drilling presented at the Antarctic Treaty Consultative Meeting and following that, national programs pursued subglacial lake access plans.
Dr. Vick-Majors noted that the United States, United Kingdom, and Russia have been working in earnest to understand subglacial lakes, but the question of keeping the environment pristine remains. Clean access to subglacial lake environments (and controlling the potential for contamination) involves wearing protective clothing, precleaning and bagging borehole instruments, and drilling with hot water. To provide an example, Dr. Vick-Majors discussed the steps associated with hot water drilling at Lake Whillans; the process involves melting snow from surrounding area, pumping high-pressure hot water to melt a hole, continually recirculating water through filters and UV light banks to destroy microbial cells, removing the drill at 700 m to sample borehole water, reducing borehole water level by 30 m before breakthrough, and at 801 m, the drill load cell is unloaded and borehole water level then increases by 30 m, indicating lake water movement into the borehole. The process prevents contamination associated with the drill water and produces a 7-log cumulative reduction in microbial cell numbers in drilling water and on surfaces using a combination of: filtration, UV radiation, pasteurization, and surface disinfection with H2O2 (Achberger et al., 2016; Christner et al., 2012; Priscu, et al., 2012).
Continuing the panel discussion, Dr. Arja Rautio, University of Oulu, highlighted the challenges associated with climate change, thawing permafrost, and related environmental and socioeconomic impacts, adaptation, and mitigation strategies. Progress depends on multiple disciplines working together. For example, physical science (e.g., terrestrial, subsea, and coastal permafrost and coastal waters), together with social science (e.g., health and pollution, coastal infrastructure, natural resources, and economy) and integration through modeling, adaptation, and mitigation, contributes to greater understanding of the issues in the region. Recently, discussions have centered on risk of contaminants and infectious diseases for local communities. Important considerations in these discussions include ethics, community-based participatory approaches, and involvement of the indigenous advisory boards. The foremost goal of the work discussed by Dr. Rautio is to determine the impacts of thawing permafrost on global climate and on humans in the Arctic and to develop targeted and co-designed adaptation and mitigation strategies. This includes assessing the vulnerability of coastal and subsea permafrost systems; determining the contribution of greenhouse gases released from organic matter along Arctic coasts; determining the impact of permafrost thaw on the health of Arctic coastal communities;
and assessing risks to local infrastructure, as well as the state of local societies, economies and cultures.
Focusing on the health and pollution aspects of the research, Dr. Rautio shared examples including mapping the state of human health in Arctic coastal communities (Abass et al., 2018; Waits et al., 2018), risk assessments of pollutants found in permafrost, modeling of anthrax, mental health aspects, and risks associated with permafrost thaw for human health (Rautio, 2009). She discussed a collection of papers from across the Arctic, illustrating examples of health effects (Figure 20), and highlighted a One Health approach to understanding risks.
Dr. Warwick Vincent, Université Laval, concluded the panel discussion with thoughts on multidisciplinarity and international perspectives to mobilize networks that are available for disease surveillance. The Arctic has seen many changes within the last decade. He discussed changes in lakes, in particular, which are the lowest points of the landscape and thus water and microbes often find their way into the lakes. Additional research could be undertaken to monitor for microbial threats in these waters. He also described recent research on airborne virome sampling associated with rapid glacier and permafrost change. Knowing that there are many research efforts occurring throughout the Arctic, Dr. Vincent noted that the Center for Northern Studies has developed the CEN Network3 to understand how the environment is changing in a global perspective. The network includes 9 field stations and 110 climate stations, covering 30 degrees of latitude and 3500 kilometers. Aircraft must be used to travel from station to station, but automated instrumentation is increasingly used as well, especially in the winter months.
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The network of stations is included in a circumpolar network called INTERACT, funded through the European Union. Dr. Vincent noted that there are 86 northern field stations, and highlighted the work package on managing risks, which is intended to develop a rapid response approach by mobilizing the stations around the circumpolar north in case of an emerging microbial risk. Data can be obtained through these remote sites using the infrastructure already in place. An ongoing test case examines mosquito-borne diseases in the Arctic and asks station managers to provide samples that can be analyzed for viruses. Dr. Vincent noted the importance of working across disciplines and among nations, and specifically mentioned the Multidisciplinary drifting Observatory for the Study of Arctic Climate (MOSAiC)4 project as an example of this type of collaborative research with partnerships across 20 countries. He noted that there are additional projects occurring in parallel, namely a terrestrial counterpart (T-MOSAiC)5 that examines associated impacts on landscapes and ecosystems. Two action groups of particular interest include the Arctic microbiomes group and the northern community issues group.
Discussion on Harmonization of Surveillance Data
Workshop participants shared ideas on surveillance approaches, international standards, and microbiologic or diagnostic approaches in breakout group discussions.
Understanding the Need for Surveillance
One group discussed potential special surveillance approaches that could be taken in at-risk communities. They noted that subclinical and clinical symptoms could arise, and a good baseline (or background surveillance) may help illustrate best approaches. A One Health approach would be ideal and could be an opportunity to expand surveillance to humans and animals. Group members debated the ultimate goal, whether it is to increase local capacity or if it is primarily related to increased research. They noted that every community has a location-specific, individual risk profile that can help determine the distinct approaches that might be needed. In discussing syndromic surveillance systems, the group noted that this approach lends itself to working directly with communities and health care providers to ensure real-time surveillance in specific locations, with limited resources. The group also considered existing networks such as the LEO Network as a platform for this type of community engagement. Other large sources of data (e.g., from Google and Amazon) could be used as a resource in understanding flu trends, for example, and other epidemiological information. Use of military liaisons may be another method of connecting with local communities, though concerns about maintaining relationships and communication with indigenous people requires sensitivity. The group shared that co-production of research with local
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communities would ideally be planned from the beginning with robust community participation.
In thinking about a sentinel disease surveillance system, the group noted that a One Health approach is relevant for people and animals as well. The Arctic fox, for example, is circumpolar, crosses large distances, and scavenges for food sources and thus may be an interesting sentinel species to consider. Having case definitions for wildlife surveillance would be useful, and surveys could help establish baselines. A system may be needed to rapidly collect and analyze samples in local communities, for their health as well as the broader global health response network. If diagnostic testing is unavailable for individual diseases, whole genome sequencing, for example, could be used to identify outbreak clusters. Standardized approaches and informatics output around the purpose of surveillance will be key, but the groups emphasized the crucial need to build relationships and trust with communities.
Current Surveillance Approaches in the Arctic
Current surveillance approaches vary across Arctic countries, states, and territories. Most countries in the Arctic have state or countrywide surveillance programs looking for infectious diseases. In the US and some Canadian territories, states select their own reportable diseases. The breakout group noted that Finland has good system for coordination between both humans and wildlife; there are fewer transport issues and fewer issues related food quality surveillance. Most countries do not have wildlife surveillance networks. There are very isolated and closed networks, and veterinarians need to decide what tests to order and where to send information. The group emphasized that funding is a main concern. Currently, research projects are funded for a specific purpose, and wildlife surveillance programs might be able to utilize some of those resources, but there is no designated, funded, long-term, routine, and systematic program available. Different programs exist for different pathogens, and some must go through government labs for testing. Large geographic distances are problematic for sample transport. For example, in Canada, where there are concerns about brucellosis, the samples travel great distances, and the meat must be frozen until the lab tests are returned. However, this is unlikely to happen, and the meat is shared widely so may be hard to track. The group debated the ability of current systems to detect emergence of new human pathogens. They noted that research programs at universities may be able to test for emerging pathogens, but connections and partnerships with other laboratories would be useful. Improved animal/human interface surveillance programs may be able to detect new human pathogens, and unusual presentation in particular could be detected quickly in some areas. Despite progress in surveillance systems in some countries, cases of influenza-like illnesses and foodborne illnesses remain underdiagnosed and underreported in many Arctic areas.
Examining the Benefits of International Surveillance Standards
Small groups also discussed the need for international standards around surveillance. Existing procedures could be harmonized on an international level, together with harmonization of the types of diseases are reportable from labs. Diagnostic laboratories could be a good way to accomplish this. The group posed a number of questions such as: Why not report all diseases? How can standard methods for selecting reportable diseases be achieved? At issue are emerging infections that rely on surveillance systems, and the need to monitor geographically (including the Russian Arctic) and with wildlife to prepare for these events. This group also emphasized a One Health approach for looking at trends, especially given that the biggest driver for human health is global environmental change. The group underscored again that human data could be harmonized with wildlife surveillance and landscape surveillance.
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