Prioritization of zoonotic diseases in Bhutan through a One Health framework

Zoonotic diseases pose an increasing threat to human, animal and environmental health, and identifying the zoonoses of greatest public health concern is key to address them effectively. Despite high ongoing risks from zoonotic diseases, Bhutan has never conducted a zoonotic disease prioritization exercise. Therefore, the present study aimed to prioritize the top 10 zoonotic diseases in Bhutan and develop action plans to support targeted resource allocation, coordinated surveillance, and strategic planning through the One Health framework. The current study used a literature review of peer-reviewed publications and grey literature, expert knowledge, followed by a workshop to prioritize zoonoses in Bhutan. The workshop was convened in April 2024, and 42 participants from 20 different organizations from human, animal, wildlife, environmental, and food safety sectors participated in the workshop. Zoonotic disease prioritization was conducted using a mixed-method approach that combined an expert consensus approach with the U.S. Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization (OHZDP) tool. The initial literature review listed 55 zoonotic diseases for prioritization in the country. The workshop prioritized the top 10 zoonotic diseases viz., Rabies; Influenza A H5N1; Leptospirosis; Brucellosis; Escherichia coli infections; Dengue; Scrub Typhus; Bovine tuberculosis; Anthrax; and Salmonellosis. Joint action areas for the top five zoonotic diseases were developed to effectively address each disease through the One Health approach in the country. The prioritized zoonoses in Bhutan should be used for strengthening One Health coordination. Key recommendations from the OHZDP workshop emphasized strengthening disease surveillance, building laboratory diagnostic capacity, enhancing intersectoral collaboration, and developing a harmonized, interoperable system for information sharing and reporting. These measures aim to improve real-time data exchange, facilitate joint outbreak investigations, and support evidence-based decision-making for the prevention and control of zoonotic diseases.