During the final workshop discussion session, Dr. Aðalheiður Inga Þorsteinsdóttir, Ministry for Foreign Affairs of Iceland, shared information about the Arctic Council and the role it may play in considerations of Arctic microbial threats. The Arctic Council is the leading intergovernmental forum promoting cooperation, coordination and interaction among the Arctic States, indigenous communities and other Arctic inhabitants, on common Arctic issues. In particular, the Council focuses on issues of sustainable development and environmental protection in the Arctic. The Ottawa Declaration lists the following countries as Members of the Arctic Council: Canada, the Kingdom of Denmark, Finland, Iceland, Norway, the Russian Federation, Sweden and the United States. In addition, six organizations representing Arctic indigenous peoples have status as Permanent Participants. The category of Permanent Participant was created to provide for active participation and full consultation with the Arctic indigenous peoples within the Council. Observer status in the Arctic Council is open to non-Arctic states, along with inter-governmental, inter-parliamentary, global, regional and non-governmental organizations that the Council determines can contribute to its work. Arctic Council Observers primarily contribute through their engagement at the level of the Council’s Working Groups:
- The Arctic Contaminants Action Program acts as a strengthening and supporting mechanism to encourage national actions to reduce emissions and other releases of pollutants.
- The Arctic Monitoring and Assessment Programme monitors the Arctic environment, ecosystems and human populations, and provides scientific advice to support governments as they tackle pollution and adverse effects of climate change.
- The Conservation of Arctic Flora and Fauna Working Group addresses the conservation of Arctic biodiversity, working to ensure the sustainability of the Arctic’s living resources.
- The Emergency Prevention, Preparedness and Response Working Group works to protect the Arctic environment from the threat or impact of an accidental release of pollutants.
- The Protection of the Arctic Marine Environment Working Group is the focal point of the Arctic Council’s activities related to the protection and sustainable use of the Arctic marine environment.
- The Sustainable Development Working Group works to advance sustainable development in the Arctic and to improve the conditions of Arctic communities as a whole.
The Council may also establish Task Forces or Expert Groups to carry out specific work. Dr. Þorsteinsdóttir noted that at any given time, the Arctic Council is likely running close to a hundred projects. Arctic Council assessments and recommendations are the result of analysis and efforts undertaken by the Working Groups. Decisions of the Arctic Council are taken by consensus among the eight Arctic Council States, with consultation and involvement of the Permanent Participants. The Chairmanship of the Arctic Council rotates every two years among the Arctic States. Iceland assumed the Chairmanship from Finland in May 2019. The next Chair will be Russia in 2021. Icelandic Chairmanship priority areas include the Arctic marine environment, climate and green energy solutions, people and communities, and a stronger Arctic Council. It is important to note that the Arctic Council is a forum; it is not an international organization and it has no programming budget. All projects or initiatives are sponsored by one or more Arctic States. Some projects also receive support from other entities. The Arctic Council cannot implement or enforce its guidelines, assessments or recommendations. That responsibility belongs to each individual Arctic State. Last and not least, the Arctic Council’s mandate, as articulated in the Ottawa Declaration, explicitly excludes military security.
In 2010, the Arctic Council’s Sustainable Development Working Group (SDWG) created the Arctic Human Health Expert Group (AHHEG). Dr. Þorsteinsdóttir noted that it is responsible for framing the SDWG human health agenda, proposing priorities and projects, and assessing proposals for actions that will contribute to the advancement of a knowledge base on circumpolar human health. AHHEG is also a resource to the Council’s Working Groups on broader crosscutting health research and activities. It may provide advice to the Council’s Senior Arctic Officials, on current issues of relevance to the circumpolar human health community. The first phase of SDWG’s One Arctic, One Health project was initiated under the US Chairmanship in 2015. The project has continued under the Chairmanship of Finland and now Iceland.
Mr. Joshua Glasser, US Department of State, reflected on workshop discussions and emphasized the value of circumpolar cooperation. Following Dr. Þorsteinsdóttir’s remarks, Mr. Glasser noted that the activities of the One Arctic, One Health project include three pillars: information sharing, tabletop exercises, and collaborative investigations (which may be operational or research in nature). Two tabletop exercises have been held, one in Ottawa and one in Anchorage, that addressed gap analysis and partnership development after a simulated threat has been identified. The goal of the project is to establish points of contact throughout the Arctic to sustain networks of collaboration on One Health issues. Mr. Glasser noted the timeliness of these discussions, given the expectation that the trends driving emerging microbial risks will continue—due in part to rapid environmental and social change, but also due to increased travel and tourism to, from, and through the region.
The Arctic Council includes permanent participant organizations representing indigenous communities, and Mr. Glasser noted that many Working Group meetings take place above the Arctic Circle. It may be useful to conduct subsequent workshops in
northern communities, to increase indigenous engagement. He also acknowledged the enterprise of sustainable development and the need to balance similarities and differences between public health perspective, a wildlife health perspective, and an environmental management perspective, as well as the need for both short-term emergency management and long-term research enterprises. In addition, he noted that it is critical to be aware of the region’s bioinfrastructure context and to remain sensitized to biosafety and biosecurity concerns while this work progresses.
Additional reflections were shared by Ms. Christina Chappell, US Agency for International Development (USAID), who noted that the Office of Infectious Diseases collaborates with developing countries to increase their capacity to address infectious disease threats (particularly malaria and tuberculosis). Programming is done for global health security1 with a One Health perspective to examine emerging pandemic threats as well as neglected tropical diseases and outbreaks of unusual nature. Most of the USAID current program is outside of the Arctic, but that work could potentially benefit from ongoing partnerships developed across disciplines. There are parallels to other USAID development work for health sector initiatives, particularly the focus on local capacity and best practices, which is vital to ensure interventions are targeted and effective. Ms. Chappell noted that collective systems are needed to ensure early alerts to proactively address emergent threats. There is also an interest in applying research for decision-making and action at state and community levels.
Ms. Chappell reiterated that a One Health lens is vital for programming at the confluence of human, animal, and ecosystem health. Cultural context is vital to ensure engagement of communities, tailored interventions to create behaviors that are effective in protecting communities and wildlife, cultivated and built in partnership. She asked if there is an implication of gender-based risk within communities, depending on who is placed at risk due to behaviors and expectations around burial practices, food preparation, and other activities. Innovative use of technologies, such as data platforms and data mining, communications for quick alerts, satellite technology, and micro-mapping can help accelerate accumulation of data sets and help to gather strategic expertise needed for a tailored response effort. She noted that partnership was a key theme of workshop discussions, and asked participants to also consider effective examples of collaborating with private sector enterprises. This may be an option for future exploration, especially with extractive industries and tourism. This is also related to global health security and potential interest in collectively building sustainable enterprises and capacity that can be retained long-term. Ms. Chappell concluded her remarks by noting that USAID seeks to help countries and communities assess risk, understand current and projected threats, and build resilience. Together with USAID's Office of Foreign Disaster Assistance, risk factors are identified that may be useful for international response efforts.
1 “Global health security is the existence of strong and resilient public health systems that can prevent, detect, and respond to infectious disease threats, wherever they occur in the world.” Source: https://www.cdc.gov/globalhealth/security/index.htm.
Dr. Bert Rima, Wellcome-Wolfson Institute for Experimental Medicine, expressed his interest in risk assessments for genetically modified organisms and the relationship to gain of function experiments. Reflecting on workshop discussions, he pointed out that the Arctic research community is well connected in some ways, but research gaps remain. He felt that the workshop’s emphasis on trying to improve health care for communities in the Arctic is an important element in assessing risk of emerging organisms. Tropical microorganisms have evolved to thrive in temperatures that are similar to human body temperatures, where as microorganisms in permafrost have evolved to live in very different temperatures. This difference may have an impact on the likelihood of emerging infections for humans. Animal carcasses are a potential source of pathogens, and people in the Arctic may interact with these for economic and also for personal reasons, especially where it concerns human remains. Scavengers are attracted to these and animal remains as well, and this can lead to a situation where it is likely that they will be exposed to pathogens and might become an amplifying host.
Surveillance for known pathogens may be difficult in Arctic regions due to complex geography, but the process is well known. Dr. Rima concluded from workshop discussions that the anthrax outbreak in Russia was an exceptional case, and it is not clear how long anthrax had been in the environment. It likely is a relatively recent reintroduction and this could not be considered to be a prior event to use as a baseline in Bayesian statistics. For known pathogens, there may not be much cause for concern, except for issues associated with challenging logistics of the Arctic environment. He emphasized that the likelihood of emergence of unknown or eradicated pathogens is extremely difficult to establish. Dr. Rima estimates that the likelihood of an RNA virus surviving in the Arctic environment for long periods of time is very low as RNA as a molecule is not very stable. Metagenomics do not always produce a useful result. He wondered what could be detected by sequencing DNA, what would be viable, what could be cultured, and what would be found to be pathogenic. Finding an unknown virus is likely a very difficult task due to the fact that much of the so-called “dark sequence material” in metagenomic studies is probably derived from viruses of animal, plant, and bacterial organisms. It would require much more research before that technology could be used to find viable organisms as most of the nucleic acids are degraded. Using relatively simple, structured experiments of spiking microbes into permafrost (that goes through freeze and thaw cycles) could be helpful research to understand survivability and stability of the organisms and their nucleic acids.
Reflecting on workshop discussions and presentations, participants engaged in an open discussion session to share thoughts on what is known about microbial risks, what is unknown, and potential paths forward. Mr. Bob Reiss, an author and journalist, started the discussion by noting the importance of the intersection of science, policy, and language especially in communicating about difficult issues. One participant proposed a thought exercise: if Arctic countries agreed to initiate a new global health
security initiative and committed significant new funding sources, how should the funding be spent? For example, it could be spent on early warning for global health security threats, capabilities for human and animal surveillance, gathering additional data, and a number of other priorities. Participants considered what mechanisms would help to improve understanding of global health security threats around the Arctic, and noting that it ultimately depends on the source of funding, made several suggestions including:
- Capacity building in communities, including education;
- Improved access to remote regions;
- Harmonization of data;
- Mechanisms to encourage international global collaboration;
- Introduction of the One Health concept into reporting systems;
- Training for One Health in every rural community;
- Support for basic research to identify environmental triggers and improve mechanistic understanding;
- Mechanisms for networks to inform each other effectively and tools to facilitate communication;
- Sentinel health systems to pick up severe health disturbances in people and animals in the Arctic;
- Definitive rapid diagnoses when there are unusual disturbances; and
- Systems that are of routine value for people in local communities.
Participants noted that it would be helpful to understand relative risks specifically in the Arctic compared to health security across the globe. What is the potential reduction in the global disease burden associated with research investments in the Arctic and where could that spending be maximized? Are there opportunities for bioprospecting or exploration of potentially beneficial biochemical or genetic materials in the permafrost? Given the uncertainties and gaps in research to date, it is challenging to understand the potential benefits and real risks posed by the Arctic regions in this context. A participant noted that continued research and resources are warranted, especially considering the sheer pace of environmental and social change in the Arctic as well as commonalities between Arctic and non-Arctic communities. Given that there is the potential to achieve relatively high impact with comparatively straightforward interventions built on robust health systems, there are important benefits to continuing engagement in the Arctic region. There may also be broad benefits associated with scientific information acquired about the permafrost microbiome. Significant changes in the Arctic associated with increased tourism and increased travel may indicate the need and value of understanding the potential for harmful microorganisms in the region. However, it is not clear that the Arctic should be considered a “hot spot” for disease emergence, especially compared to areas that are known to be high risk.
Importantly, global health security threats do exist in regions of the Arctic. Participants noted that there are areas of the Arctic in which a large disparity exists
between the health of northern people and non-Arctic people. Hot spot maps may have detection bias, and population density in the Arctic is much smaller than other places under study. However, the potential impacts on those small communities could be catastrophic and there are different ways of weighing the risks. The Arctic is changing and could become a bigger risk as it thaws. In this context, participants considered the value of stopping an outbreak before it starts versus waiting until it is out of control. In terms of biodiversity, plants and animals are more diverse around the equator, but that does not apply for microorganisms, where diversity is perhaps uniform (albeit different) throughout the globe. New diseases are appearing in the Arctic and certain species of wildlife are disappearing. That may imply that the Arctic is a hot spot for bioconservation efforts, and a One Health approach could be utilized to ensure well-being of humans and animals in the region. Technology being developed for emerging diseases elsewhere in the world could be leveraged and tailored specifically for Arctic needs (i.e., education and sampling). Participants noted that, in much of the world, indigenous people are land stewards and they face activities (industrial and otherwise) that may be damaging to local and downstream health effects.
Discussion turned to the types of data that could be collected to counteract skepticism about the Arctic as a potential hot spot for emerging infectious disease. Beyond risks associated with permafrost thaw and ice melt, other risks were not explored in this workshop. In many Arctic countries, “hidden” populations may not be represented in research on risk. The associated health differences and disparities are important factors to consider. Many people live in lower socio-economic conditions and may have reduced access to care, contributing to higher disease rates. It is estimated that 70 percent of Canadian Inuit youth are food insecure. Because the Arctic is rich in resources, it is also under a large amount of pressure from outside sources (e.g., shipping, climate change, etc.). Given the extent of change occurring in the Arctic system, there may be valuable lessons learned that could be applied throughout the rest of the world. A participant noted that although the discussions have been focused on pathogenic microbes, cryosphere change might lead to the loss of entire microbial ecosystems, with uncertain implications for the rest of the biosphere. Most of the microbiology of the north remains unknown, and it can be difficult to communicate the crucial need for local capacity building and augmentation to those unfamiliar with the region. Many participants stressed the importance of a common vocabulary and communication within a One Health framework.
Concluding the workshop, Dr. Volker Ter Meulen, InterAcademy Partnership and Planning Committee Vice Chair, noted that increased engagement with Arctic research colleagues across disciplines will be useful for continued exploration of this topic. Arctic countries have a responsibility to understand what is needed to care for Arctic people and environments. He encouraged participants to consider continued exploration of these topics, collaborations with social scientists, and ensuring broader societal engagement. Although there may currently be more questions than answers, researching the risks associated with pathogen emergence is a crucial way forward.