Investing in Regional Health Security through Wastewater & Environmental Surveillance

[00:00:00]This experience has shown us that wastewater and environmental surveillance can provide valuable information not only during a pandemic but also as a part of a broader preparedness system.

[00:00:18]A key factor behind this progress has been coordination.

[00:00:24]Different technical, institutional and operational capacities have been brought together around a common objective to deduct risks earlier, interpret them correctly and support timely action.

[00:00:42]Our experience has also taugh taught us a clear lesson.

[00:00:48]Successful surveillance requires more than laboratory capacity or technology alone.

[00:00:56]It requires strong infra infrastructure, trained professionals, institutional ownership, trust, effective coordination and sustained investment.

[00:01:14]Today, Turkey's vision in this field extends beyond infectious diseases. It also includes antimicrobial resistance, emerging contaminants and the broader one water, one health agenda.

[00:01:32]Turkey's experience has also shown that the future of wastewater and environmental surveillance cannot be shaped by national efforts alone.

[00:01:44]No single institution, sector or country can advance this agenda on its own. This is why international cooperation has been central to Turkeykey's approach from the beginning. In recent years, Turkey has supported efforts to bring waste water and environmental surveillance into broader global discussions on water, health, finance, and development.

[00:02:16]From the world water forms to the UN 2023 water conference and the glo process, the objective has been clear to move this from a technical discussion to a practical preparedness and investment agenda.

[00:02:36]In this regard, the west founders forum that hosted by our minister in IstAnul in November 2025 was an important milestone.

[00:02:49]It brought together development banks, philanthropic organizations, and international partners to align priorities and explore ways to scale wastewater and environmental surveillance at national and regional levels.

[00:03:10]Most recently, the fifth stumble water form further elevated this agenda by bringing west into a broader policy discussion among the water, health, agriculture, finance and development communities.

[00:03:31]Today this agenda has reached a point where the focus must shift from proving the value of V to scaling it in a sustainable way. The question is no longer whether waste works.

[00:03:49]The evidence and country experiences are clear.

[00:03:54]The real question is how we can move from successful pilot projects to sustainable national and regional programs.

[00:04:08]This requires institutional ownership, sustainable financing, effective governance, trusted partnerships, and regional cooperation.

[00:04:24]It also requires west to become an integral part of national surveillance systems rather than a project dependent on short-term funding cycles.

[00:04:39]In this respect, today's meeting in Baku is an important opportunity to translate share ambition into practical next steps to deepen cooperation and to identify new opportunities for implementation across the region.

[00:05:02]Building on this p perspective, Turkey remains fully committed to supporting regional cooperation on wastewater and environmental surveillance.

[00:05:15]We stand ready to share our experience, contribute technical expertise, support capacity building and facilitate knowledge exchange with partner countries and institutions.

[00:05:35]As the co-lead of gloon training and capacity building working group, Turkey attaches particular importance to the development of practical and sustainable capacity across regions.

[00:05:52]In this context, Turkey is well positioned to serve as a regional hub for training and knowledge exchange, especially across the Turkish states, the Middle East, and the Western Balkans.

[00:06:08]Through the Turkish Water Institute, Suen Academy, more than 2,000 professionals from 53 countries have participated in international training programs in different areas of water management.

[00:06:27]Today we are extending this experience to wastewater and environmental surveillance.

[00:06:36]Last November in Istanbul, we hosted a regional capacity building program on four representatives from Islamic Development Bank member countries. This program strengthened technical capacity, promoted knowledge, exchange and supported discussions on how west can be better integrated into national systems.

[00:07:07]Building on this experience, Turkey stands ready to work closely with the Islamic Development Bank, member countries, and all partners to support the development of a regional west support platform based on training, technical assistance, and mentorship because no country should have to start from zero. It's important for us.

[00:07:37]Through cooperation, we can help countries move faster, avoid duplication, and build systems that are technically sound, institutionally owned, and financially sustainable.

[00:07:54]Our commitment will also continue through major international platforms in the years ahead.

[00:08:02]as the lead country for the water for people and ecosystems sub team of the 11th world water forum in Saudi Arabia in 2027.

[00:08:14]Turkey will continue to support dialogue, partnership and action on water, health and sustainable development.

[00:08:29]I would also like to take this opportunity to announce that Turkey will host the 28th IRA World Water Congress in IstAnul on 4 to 8 October 2027.

[00:08:46]We see this congress as an important opportunity to continue this dialogue and to bring together the water, health, agriculture, environment, finance and development communities around practical solutions.

[00:09:06]Ladies and gentlemen, wastewater and environmental surveillance is more than a technical issue. It's about preparedness. It's about resilience. And it's about protecting our people, our environment, and our shared future.

[00:09:28]Together through the one water, one health approach, strong partnerships and sustained investment, we can transform preparedness into action, build stronger health security systems, and create a safer and more resilient future for generations to come.

[00:09:50]Thank you all.

[00:09:53][applause] Thank you very much, Mr. Deputy Minister, for sharing Turkey's available experience and vision for the future of the wastewater and environmental surveillance. Uh to continue setting the stage for today's discussion, it is now my pleasure to invite you to watch a special recorded message from Dr. Chris Elas, president of global development division at Gates Foundation.

[00:10:26]the Gates Foundation. Thank you for the opportunity to join this conversation and I'm sorry I can't be with you in person in Baku. I want to begin by thanking all of the distinguished speakers on the panel today as well as Dr. Isa Feay, director general for global practices and partnerships at the Islamic Development Bank for his leadership in bringing this agenda to the annual meetings. I also want to recognize Adrisia and Nizar Zed for serving as the Islamic Development Bank leads for this event, but also like to express our appreciation to the leadership of the Islamic Development Bank for our long-standing partnership and commitment to advancing health and development priorities across member states. The Gates Foundation has valued our collaboration over many years and look forward to continuing to build on that partnership. We are only six years past the onset of the CO 19 pandemic and since then the pace of public health emergencies has not slowed. Africa has borne the brunt of the recent Empox and Bundabuio Ebola epidemics while also continuing to face the daily burden of pathogens that rarely make international headlines. Measles, chalera, typhoid, hepatitis and polio continues to circulate with recent detections in Zambia and South Africa.

[00:11:53]This is why we are committed to multipathogen disease surveillance as a foundationwide priority because early detection is the difference between preventable deaths and epidemics that don't happen. Wastewater and environmental surveillance is an important area of strategic engagement for us. This is not a new technology.

[00:12:15]We've used it to detect polio virus since the 1990s.

[00:12:20]What has changed dramatically, accelerated by CO 19, is our capacity to detect a much wider range of pathogens, potentially offering us a head start of days or even weeks before clinical surveillance might catch the same signal. Working closely with the World Health Organization and other partners, the Gates Foundation has invested in multipathogen wastewater and environmental detection implementation across Nigeria, Ghana, South Africa, India, and the Democratic Republic of the Congo.

[00:12:53]Countries are building directly on the polio infrastructure, expanding its reach to track measles and other pathogens that are national priorities.

[00:13:03]Our partnership with the Islamic Development Bank has evolved over many years, including through the Lives and Lihoods Fund, which has demonstrated the potential to mobilize additional resources for health and human development across member countries while piloting innovations such as resultsbased management. We are encouraged to see lessons from the LLF increasingly informing broader Islamic Development Bank operations and the development of the new Islamic Development Bank concessional financing platform.

[00:13:35]What the Islamic Development Bank brings to this space that philanthropy and overseas development assistance alone cannot is the ability to move concessional financing at the scale and duration that national systems require.

[00:13:50]With the Islamic Development Bank, we have been proud to co-convene the wastewater environmental surveillance funders forum as well as the wastewater and environmental surveillance capacity strengthening conference for its member states last fall. Now, we are looking toward the Islamic Development Bank's concessional fund as an important and timely opportunity to bring concessional financing to health security in ways that can outlast donor cycles. Investing in surveillance and response systems that work across disease programs rather than in silos saves money and lives.

[00:14:26]Last month in Geneva at the World Health Assembly, we had a side event called Epidemics that didn't happen where we had the chance to share stories from El Salvador, Gabon, and Thailand. Countries that detected outbreaks early and stopped them before they caused preventable deaths.

[00:14:44]These were proof points that it is possible to get ahead of a crisis rather than simply respond to one. That is the world we are working toward. One with more and more of those stories to tell.

[00:14:55]Countries with the tools they need to see disease coming, make timely datainformed decisions and act before an outbreak becomes an emergency. Thank you.

[00:15:07][applause] >> Okay. We thank to Dr. alias for sharing his valuable perspectives. We will now move to our panel discussion. Before we begin, I would like to invite our distinguished panelists to the stage and briefly introduce them to you. Uh okay.

[00:15:24]I will I I would like to start with Dr. Hanan Balk. Yes, please. Please may I kind of ask to sit to reserve seats, please? [applause] Okay. Dr. Dr. Hanaman Balki was appointed a World Health Organization regional director for the Eastern Mediterranean by the World Health Organization executive board in 2024.

[00:15:45]She was previously assistant director general for antimicrobial resistance at WHO headquarters. Prior to this, she was executive director for infection prevention and control, ministry of national guard, Saudi Arabia. She led the Gulf cooperation council center for the infection control and the who collaborating center for infection prevention and control and antimicrobial resistance Saudi Arabia. Okay. Thank you being with us. Okay. Um our next panelist is Mr. Riyad Akunada.

[00:16:16]He is the he is the head of the strategy international cooperation and science department Azarban state water resource agency. He began his professional career in 2013 at a private company. After that he served as a member of international patent research working group in Milan, Italy. Then in 20 in 2019 2021 he worked as a chemical engineer in Azarban's water sector and after 2021 he worked as an engineer at Azaru open joint stock company. After 2022, he held positions as a chief adviser and later sector head as Azarbjan Ailioration and water management open joint stock company as the head of the strategy international cooperation and science department Azarban state water resource agency. He has played leading roles in projects focused on studying international best practices and improving water infrastructure in Azarban in cooperation with international organizations. Thank you being with us.

[00:17:20]Okay. Uh our next panelist is Mr. James Carti.

[00:17:26]He's Yes. He is the deputy director for the Middle East Gates Foundation. James Carti sets the strategic direction for the Gates Foundation's government relations, advocacy, communications, and partnerships across the Middle East.

[00:17:40]Previously, James worked extensively in the Middle East on policy and strategy at the executive branch level. He also worked with the former United Kingdom Prime Minister Tony Blair supporting his work on government reforms and key priorities around the world. And our next uh and last panelist is the Dr. Ismani Elfim.

[00:18:01]Uh she she is the she is the executive managing director of consultant group for international agriculture research known as CGI since 2023. She previously held the position of chief scientist at the food and agriculture organization of the United Nations. Prior to that she was a director general at the international center for bioeline agriculture based in United Arab Emirates. Dr. Adopi has extensive leadership experience in agriculture research and innovation having held senior positions at agriculture and agri food Canada and Canada food inspection agency. She has worked as a scientist with several international research organizations and has been a member of various strategy expert panels and advisory groups.

[00:18:49]Beyond her scientific achievements, Dr. Aloe has played role through her service on global advisory groups and the boards of leading organizations including global commission of adoption, harvest plus, IFPI and CABI. She was also member of scientific group in for the 2021 UN food systems summit and of the CGI system board. Okay. Thank you all of you being with us. Okay.

[00:19:28]Okay. I would like to open our panel discussion with Dr. Hanan Bali. Dr. Hanbali who has been playing a a critical role uh in supporting countries across uh the eastern Mediterranean region during a period marked by profound and overlapping challenges. The region faces a complex landscape of fragility, conflict, recurring health emergencies, the growing threat of antimicrobial resistance and increasing environmental risks. All of which place significant pressure on public health systems and communities. Many public health threats uh today do not respect national borders. Uh in that context, how do you see surveillance systems, especially wastewater and environmental surveillance supporting regional health security? Beyond helping us detect infectious disease outbreaks early, what role can these systems play in monitoring antimicrobial resistance across wastewater? soil, groundwater and agricultural environments.

[00:20:32]>> Thank you. Thank you very much and thank you for providing some of the context of the region that I actually lead. Um just to add to that, the eastern Mediterranean region which spans from Morocco all the way to Pakistan also includes two of the last uh member states that still have uh wild polio virus. And of course you heard Chris and we have uh also James with us here and also the ISBD lots of partners who are working on the final stages of eradicating polio. So I'll touch on that a little bit. Also in the reports on antimicrobial resistance which was my life for about 20 plus years. Um we still see that the eastern Mediterranean region also has uh large numbers and and trends of emerging what we call them multi-drugresistant pathogens which leads to the phenomena of antimicrobial resistance. Um what we also see just so that we understand the context very well um within those 22 member states we have the largest conflicts more than 50% of migrant population more than 42% of internally displaced population highest percentages of hospital destruction and and attacks u and also loss of infrastructure over and over again in countries such as Sudan, Gaza, Yemen and others. So when we talk about uh if we want to talk about human dignity that's another topic but if we talk about health in general these individuals that live in such contexts are facing some very dire challenges. Now when we come to why is this important to start with the uh on because your question was specific also on antimicrobial resistance. People can start looking at this phenomena of resistance as the solution is to create more antibiotics which is absolutely true. The pipeline for new antibiotics is dry for because I'm in a finance in um this type of platform and you know this very well to produce the investment needed to produce a new antibiotic is around 10 years$1 billion dollars and within two years of using this antibiotic it might become most likely resistant if there's no purpose stewardship. So on antimicrobial resistance we're facing a big problem.

[00:22:41]On the flip side, when dealing with our one health agenda and colleagues with within FAW and the ministries of agriculture, the need for economical sustainability on meat production and food production, fishery production, meat, poultry and whatnot, the use of antibiotics becomes critical to safeguard the economical output of such uh activities. However, because the antibiotics used in the agriculture are the exact same antibiotics that I need to use in the most difficult ICU patient, we created and that was my work for uh five years in Geneva working very close with the quadripart to figure out how do we create the frameworks to properly understand how do we produce stewardship and understanding between the different sectors. Now this becomes very complex in countries of conflict and that's why having newer modalities and building this capacity and maybe in the upcoming questions I can tackle more on why is this important for polio and we had maybe I can end with one or two critical examples the surveillance uh programs for polio in 360 sites in 18 out of 22 of the uh eastern Mediterranean countries is what's really saving the polio from also coming back from our region. There are other regions that also especially the Africa the rest of the African continent in 2025 when wild when polio resurged not what when polio resurged and was u detected in wastewater in Gaza despite the conflict we were able to vaccinate in three rounds close to 550,000 children below the age of 10 years and we saved in not we as who the partners the uh Palestinian Authority uh Gavi, UNICEF, uh, WHO, the funders and the partners that actually support this activity to mitigate, uh, because for 25 years there was no polio detected in Gaza. the destruction the of the infrastructure, the running sewage in the streets, the drop in imuni basic primary immunization within the middle of the war. We secured the capacity to do this type of of uh immunization plan to mitigate and stop the further spread of polio. Without that wastewater uh surveillance that was so robust and so well, you know, maintained, we would have been in a much much difficult situation. So I'm a big uh uh advocate for this work whether AMR polio or other uh pathogen mitigation and prevention and I'm very happy to be with you on this panel. So thank you.

[00:25:21]>> Okay. Thank you. You already talk about the crossber issues but following on from that what kind of crossber cooperation and information sharing mechanisms you recommend uh to make this work effectively while still respecting national sovereignity ownership and trust among the countries.

[00:25:42]>> Yeah, thank you. I did not address that.

[00:25:44]You're absolutely right and this is the whole essence of our work in WHO and the international health regulations. So the whole idea is to detect signals as fast as possible and early as possible. One thing that I would say which is maybe not so politically uh acceptable but I wish for one day that we're not ashamed of pathogens because there's no running away from outbreaks and what we see in the capacity for reporting to the international health regulations when a signal comes up and and it's not because it's shameful it's I think because it has economical consequences. But if we are super mindful that the earlier we detect, the earlier we intervene, we will mitigate bigger problems. So the collaboration is already happening. We have uh uh great collaboration between the uh countries of the Horn of Africa on polio for example. We communicate very well between us and UNICEF the member states. Um there's also some good communication now between another group of member states within the emerald region, Djibouti, Somalia, uh Yemen and Sudan. Uh they're working together also on certain areas. We are trying to support the the the advocacy for supporting public health authorities because if you have a strong public health authority and this will come into institutionalizing this work the collaboration between member states strengthening their IHR number one strengthening their capacity and their knowledge at the highest level of the relevance and importance to this and I'm I'm now a true believer we always have to link this to economies because unfort Unfortunately, health is not always a priority. Yeah. I So, I think we win more if we link this to economies and there's a huge link between economies.

[00:27:30]Uh, of course, sovereignty is very important. Uh, and we definitely respect that and work towards uh securing that as well in the middle of all of this work.

[00:27:39]>> Thank you. Thank you so much. Okay. Let me now turn to Mr. Akunada.

[00:27:44]Mr. The water and environmental authorities are increasingly recognized as key actors in public health surveillance due to their role in a critical infrastructure and oversight of water quality systems and effective wastewater and environmental surveillance requires close collaboration among water health and environmental sectors which is still not achievable uh in reality. uh from your perspective as being the head of strategy and agency responsible for water uh resources and wastewater systems of Azar Bejan, what are the most important enabling factors for build such partnership among uh the water health and environmental sectors.

[00:28:28]>> Thank you so much. From my experience, I would I would like to say the brief answer and the extended one. The brief brief answer is the cooperation. Uh successful wastewater and environmental programs depend first on strong cooperation. The platform from the platform the water sector collects very valuable datas but uh this data is a fragment of the big picture. Uh the there should be a platform where uh the various sectors the public and the private the health uh public service the local authorities water environmental every player of this field should uh be part of the big picture. the the data exchange, the experience exchange should build as a fragment of the big mosaic how I can say but the the the short answer will is definitely the platform but if I would like to uh I would like to add couple of more but the to extend the my answer the first one is the strong governmental support and political will definitely government needs to recognize uh water infrastructure or water waste water surveillance as a national priority. Uh luckily in this January still new uh new state program for development of the portable wastewater and storm water systems of Paco and Peninsula the capital. Uh the state program has been approved by Mr. president himself and in this state program uh we are aiming to bring all these decision makers regarding to the the infrastructure development the public health and environmental factor to the to one uh to uh to one table how we can say as I uh told the second answer is definitely that table the intergovernmental exchange platform uh because Because the the true partnership requires a a clear a a clear platform where everyone knows which data should they collect, which data should they share and how the decision-m procedures will be made because the reliable and timely exchange of the data in a critical uh periods will definitely affect the the results of the project, the effectiveness of the project in 2020.

[00:30:56]after the 2020 uh state water commission has a solution in Azarbaijan and the state water commission is a platform where uh back then we had three different water operators one for the portable one for the irrigation and one for the water reservers but uh regarding in the decision making procedures uh of course all these three operators organization has their own way of thinking for the f future perspectives their own budget digital locations, their own decision making and reporting procedures. State water commission was a was a platform to bring all the three but not just sim also uh the minister of health, minister of finance, minister of economy, ecology and others for the for making the decision making procedure much more easier. The final answer is definitely sustainable finance as madame mentioned the sustainable finance and technical capacity. You may be aware of yesterday at government of Azerbaijan signed an agreement with OPC fund regarding to uh the construction of the Sunite waste water treatment plant.

[00:32:05]uh because as the as we work harder on the to to solve the issues but everyone everything comes to the end in the financial sustainable and uh in general sustainable finance is a key uh also as the representative from the uh water sector uh the development of the wastewater infrastructure in general water infrastructure is not we we don't count it as a just infrastructure project because it will definitely leads to the positive environmental effects as the uh improvements in the quality of the Caspian Sea also the public health the social well-being of the population plus uh proper wastewater treatment plants proper seage systems means alternative water resources because as Azerbaijan's water resources is limited as Aaran is highly dependent from the transponder water waters which means that we need to We need to control whatever we have the properly. Uh in that case the proper wastewater treatment plants means uh better treatment which means alternative water resources.

[00:33:19]>> One more thing following on from that what is the major uh challenge as Azarban you are facing when developing your nationwide wastewater and environmental surveillance program if you have. Yes, >> I believe challenges are there for to change them to the opportunities for the future. The the definitely the the the the main challenge is fragmentation, institutional fragmentation in the decision making because uh as all countries has their own different agencies, ministries and uh in of course all these organizations has their own futuristic uh targets, their own budget allocations, their own capac and their own way of the reporting the results. Uh that's the main challenge but it's also opportunity for for for example as a platform like this is it kind of uh useful table for the everyone to come to come together to ex to do uh the experience exchange also to learn from others mistakes. The the second challenge is definitely the limited technical capacity.

[00:34:36]Not just I mean not of course I believe in every country uh some organizations has the difficulties in laboratory equipments monitoring systems also the uh number of the the capacity the number of engineers uh and in Azerbaijan uh we are newly established organization we we have or established it in 2023 but uh last year we had a chance uh to to establish any new master program master degree program in one of our governmental institutes for the it's like the uh master program for the water resource management uh engineers and the by building proper the how we change how we can change the challenge of the technical capacity uh to the opportunity for the future by investing the young generation the current generation for to to solve the uh the to make the better station for the future generations for the future of the countries and in general the ears.

[00:35:41]The the third one is definitely sustainable financing as I mentioned in the first as a answer of the first question. But uh by the solving this challenge I think there are very good opportunity as the international finance organizations as ADB as ISDB as the EBRD by sol because by the cooperation with these organizations we are not just solving the financing problem. We we can we also have a chance to learn from international experience. We can we also have a chance to build uh to build system monitoring system reporting system and others in international standards as well. The the the final one sorry it was a bit long. The final one the infrastructure gap. Infrastructure gap especially in the wastewater systems is uh the major challenge from many perspective from environmental from public health from the other perspectives but infrastructure gap means if we can solve the the this challenge properly we we because we are currently living in the technological center which means that we have very very uh advanced tools from AI from on the uh platforms where we can change our experiences, our mistakes, the the the the infrastructure gaps can lead the opportunities for building the most modern, the most advanced systems for the country.

[00:37:14]>> Okay. Thank you so much. Thank you so much for your contributions. And let me now turn to Mr. James Carti. Uh the Gates Foundation has been working for wastewater and environmental surveillance especially in low and middle income uh countries through investments in pandemic pre preparedness, polio eradication, entic disease control and antimicrobial resistance and today countries seek to move from pilot projects to sustainable national systems from the Gates Foundation perspective as a key driver for the innovation in the wastewater and environmental surveillance.

[00:37:52]What financing and partnership models uh do you believe are most effective for ensuring long-term adoption across countries with different governance structures, capacities, and priorities?

[00:38:06]>> Thank you, Professor Bila, for the uh for the question. It's a very important one. Um I'd also like to take this opportunity to thank the Islamic Development Bank for making time for this really important panel. Um, I've been telling everyone that I've met so far, um, about this really important panel on on wastewater surveillance. Uh, unfortunately, sewage doesn't have quite the same, uh, pulling power as as hot topics like AI or trade trade and infrastructure, but it really should because it really is the underpinnings of of preventing the next pandemic of of ensuring that we that we're able to to detect early and respond to potential pandemics.

[00:38:40]We have a long history with the ISTB as as Chris referred to earlier working on polio on water sanitation and hygiene working through the LLF with our partners the Abu Dhabi fund for development uh Katar fund for development and King Salman relief and humanitarian center and the Islamic um concessional financing fund to fund some of this work. Um and so it's sort of a natural progression from that to looking at wastewater and environmental surveillance. Um, so you we're grateful to the partnership with with the Islamic Development Bank. In in general, you know, pilots don't fail because of the science. They fail because there's no agreement on how to scale up and sustain financing for that in the long run. Um, you know, philanthropy is great at doing pilots. It's great at financing innovation and along with uh overseas development assistance, we can do these things really well, but it's not a sustainable solution for for long-term systemwide scale up and and uh support in the in the long run. Uh so that requires really three things. The first is it has to have country ownership, government ownership and commitment to doing this to make sure that it's fit international budgets that that countries are asking for the financing to support this. um you know that could be tailored to to the countries you know whatever is their their um particular pathogens that are most important for them in terms of their surveillance systems um obviously we've been working very closely with the WHO with Dr. Hanan and her colleagues um on normative guidance and standards um to make sure that this can be integrated into country um into country systems international systems but it really does require that country ownership first and foremost to make this a priority. The second piece is is coordinating bodies um so you We're grateful, hugely grateful to the the bank, to to HIA, the the um from the EU to the Hong Kong Institute of Philanthropy for bringing together the Funders Forum. You mentioned the wonderful meeting that happened in Istanbul. Um as well as the disease surveillance funders collaboration collaborative which was set up at the World Health Summit last year and that wider look at surveillance beyond just waste water. So these these bodies are really important to make sure that there is that coordination across the funders.

[00:40:49]Um but perhaps most importantly it's about having the scale up pathways. So how do you move beyond um these pilots to ensure that these are scaled um and sustained. It's not just about the finance but it's also about the technical assistance, the capacity building um the the ability to build implementation plans, create standards etc. and of course the financing and in terms of the financing in particularly in low and middle income settings making sure that that financing is concessional as possible. So instruments like the LLF um and uh the ICF are hugely important to enable that.

[00:41:25]>> Following on from that as Dr. Hannan uh mentioned there are many humanitarian settings conflict zones and the disaster affected areas. uh how do you envision the wastewater and environmental surveillance evolving as a tool for preparedness early warning and resilience in that zones disaster zones and the humanitarian settings refugee camps what is your opinion >> well I think it's it's vital to be able to adapt to to address environ uh sorry into violent to address fragile settings I mean these are the places where it's most important to have that surveillance you have a breakdown in the water sanitation and hygiene structures you have the loss of of clinics um and hospitals. So that normally when people would present that would be the first place that they would present but if that infrastructure doesn't exist you can't track uh through that. Um you Dr. Hanan talked about that the situation in Gaza where the water sanitation and hygiene uh infrastructure was completely destroyed. There was sewage running in the streets. Um the usual vaccination campaigns had broken down. So you had um numbers of people young babies and infants with zero dose infants. So it's critical the these are the places where where epidemics are bred where where where where these things can can can break out from. The advantage of um wastewater surveillance is that it can be done in these settings. You don't need to have the health infrastructure for people to present and it can actually give you a really early signal on things like cola, polio, hepatitis and other diseases before they show up in the population. and you can track them through the environmental surveillance. But it does require adaptation innovations in how to do this in much more simply um much more cheaply and at scale um you know you have to get around the challenges of lab access of cold chain etc. And so you investing in innovation to to enable that is really important. It's a significant opportunity um but it requires collaboration across funders um across humanitarian actors and so on helping to build these systems in the first place so that it's not just a reaction to an emergency but making sure that they're there. Dr. again referred to Gaza where luckily that that infrastructure was already in place and was able to survive um the the terrible crisis and um but you know that's the start but you also then need to prepare for emergencies and make sure that it's integrated into humanitarian plans and responses.

[00:43:44]>> Okay, thank you so much and let me now uh turn to uh Dr. Isman CGI are the world's largest agricultural research and innovation network working to transform food, land and the water systems in the face of climate change, food insecurity, water scarcity and emerging health challenges. And uh today agricultural and livestock systems face increasing risks from the emerging diseases and climate driven water scarcity is accelerating the use of treated waste water for the agricultural irrigation as the directive of the CGI long championed the connections between agriculture water food systems and health. How do you see wastewater and environmental surveillance contributing to one health approach that strengthens early warning safeguard food safety, monitors a antimicrobial resistance and supports the safe reuse of water especially treated waste water.

[00:44:50]>> Thank you very much. And definitely the one health approach is the right approach that we need to all invest in.

[00:44:57]And second, the wastewater environmental surveillance. It's the joint infrastructure that we need to use. The examples came from all colleagues. They were very important. We need really to make sure that we catch the resistance.

[00:45:13]We we secure the food safety and we recognize the risks. We have an early emerging diseases mechanism across animal, water, people and also the earth that we are all walking on and and and producing our our food on. So this is very important. It matters the most for the antimicrobial resistance. We know that we need to produce more proteins and there will be intensified livestock uh poultry fisheries in aquaculture. All of this going to happen. So if we want to make sure that we don't get to the 10 million people that gonna die by 2050 if we don't address AMR particularly we need to have those system in place and those system in place could be really um it has to be joined as towards the one health approach uh AMR it's not the only one we have also issues of aphletoxins aphlattoxins going to go beyond the tropical area because of climate change and we have already seen signals of that. Um and that's where for me really the work of the CGR centers uh Amy and the re rewaterina program uh it's working with national systems as James talked about the fact that they need to own it and be part of it and design it or co-design it. So in Lebanon for example uh EMI have been helping Libno to develop the country first water reuse national standards. In Jordan in the northern valley they facilitate dialogue that led the ministry of water and irrigation to publish regular water quality data to farmers. So in all of this really trust is very important and to build that trust you need data. You need data. You need independent institution that can bring this data to bear and maybe to to finalize CGR evidence base across the four strands the AMR the food safety the disease surveillance and the use governance can really feed directly in the wastewater environment surveillance and if we are looking at solutions because it is important to state the importance of data and and surveillance but also it's very important to look at the solutions I want I just end with one solution looking at the one health approach which is the integrated rice fish system. So by raising the fish in the rice fields, farmers not only improve their food production, their rice and nutrition, but also their incomes, but also in the same time, the fish is feeding on the mosquito larvas, helping reduce malaria vector population, which is a very simple but very powerful illustration of how agricultural innovation can both simultaneously increase income for farmers, increase nutrition for everybody but also reduce the hazard from certain diseases or lavas or insect or viruses. So looking for those nature positive solutions using the wild health approach is very important.

[00:48:30]>> Okay. Thank you so much. So uh you already answered my second part of question but I want to ask u the the specifically your recommendations on the mechanisms needed to ensure uh the uh uh to insights generated across those three different sectors agriculture water health and environmental are effectively shared and translated into the coordinated action. I think this is the major challenge of the one health approach. It looks very good in definition but in application it is not applied properly all around the world.

[00:49:09]So which mechanisms we should develop to achieve this? Hanan mentioned the quadr quadrilateral collaboration which actually it's between the four UN organization that work on one health and that's very important mechanism but I think what joined us up it's data could we really make sure that our data has all those aspect and I think that's where effort has to be uh given really the advance in AI the advance in digital solutions I think we need to make sure that information disease surveillance on livestock emission on pesticide use are really joined up together. Uh and we need to measure it. We need to have the right indexes, the right senders, the right measurement. H and maybe lastly what we need to do is our Codex Elementary for example, it's looking only at food safety. It's not enough. It has to have that one health approach. So it's about really our standards because the standards make country implement them because they trade between each other and unless you you measure it rightly you can't really address it in the right way. So I would push for data data data and the right standards that are really that are really taking the whole spectrum of one approach.

[00:50:30]>> Okay. Okay. Thank you so much Dr. Isman and thank you all of you for your valuable insights and before we conclude our panel discussion. I would like to pose one final question to you to take your uh closing reflections very shortly. Uh as environmental wastewater and environmental surveillance transform permanent pillar of the one health approach. uh that is what is the single most important action if I ask you one most important action needed to establish the minimum uh operational building blocks what is what is your recommendation >> thank you very much I think um there's a lot of course and I think it was in you know integrated in in many of our answers but I think having that joint platform for discussing the value of wastewater um surveillance uh very much agree with uh Asan on the issue of data and the reality that people in one sector for example people in the human sector do not understand fully the value of the need of use of antibiotics in preventing um in securing the the economical growth and I think that communication will create a common understanding and then that will push us to finding the solution and one of the solutions that we found here because of these discussions that we're having on the one health agenda is another topic that can have another session which is the health and all policy and integrating the health and all policy development for each of the sector into the financial cycles of the of the uh of the country so that the solutions can be integrated in each ministry line to be able to do what is needed to be done for mitigating disease outbreaks. if if that's uh one one outcome of of the surveillance but for me it's a long it's not one thing but it's it's it's one thing that leads to a whole lot of things. Thank you.

[00:52:31]>> Thank you Dr. Hana. Yes, please.

[00:52:35]I will push >> and I will push for the coordination because the the platforms like one health should be supported by uh public and private sector by the government international international organizations and uh the the digitalization the digital players of this sector as well because separately the governmental institutions the funding organizations technology ology. These are key factors but uh these key factors cannot solve the issue. The the coordination between the players, coordination between the organization is the the I believe the the most important action we should consider.

[00:53:20]>> Okay. Thank you Mr. Riyad. Yes.

[00:53:23]>> Thanks. I I think for us it's also about creating a financing pipeline. Um, it's a structured way to help countries bridge from the pilot to the sustained atscale funding. There's there's a a missing middle if you like. We're great at the pilots. We have the funding mechanisms such as the ICF and the NLF, but how do you bridge between the two and how do you um translate that pilot into a high quality finance ready investment?

[00:53:47]Identifying the pilots, the countries where this is happening. Um building the technical and economic case for that sustained financing at the estimating the incremental cost and then integrating into national plans. But it's not just the financing, it's also the common standards and approaches integrating that across countries and regions. We're able to do that through those that common approach through this this this um the pipeline approach uh that allows better coordination response to human animal and environmental data that enables a globally connected early warning system um serving one health as we've all been talking about remembering it's not just about the humans it's also the animal parts of it as well there is a some pressing nature to this there is some urgency I mean our financing for for the pilots runs out runs through 2027 but we need to sort of start building this pipeline to be able scale and finance. Beyond that, um, if we get it right, um, you know, we're measuring our success and and as Chris referred to, that the epidemics that the pandemics that didn't happen, being able to do that early warning, that detection and that response is is vital to stop that. Um, we're hugely grateful for our partnerships um, with the bank, with the CGI, with WHO, with her and others and country governments such as, you know, Turkey, Nigeria, Saudi Arabia and others um that enable this to happen.

[00:54:59]>> Okay. Thank you, James. Yes. So I'll go back to the integrated platform of data between health, agriculture, water, environment at the national level and the global level. But I think also I want to end up that nature it's interconnected.

[00:55:15]So if we we throw something bad somewhere, it comes back to us. It doesn't go anywhere else. It's not it's not disappearing. And hence I think it's very important to look for solutions for me that waste water shouldn't be waste.

[00:55:29]they should be treated and should be reused for agriculture. Uh and this is very much needed because water scarcity is one of the major issues and the major threat for human at large. So we need definitely to invest as well in technologies to make sure how do we reduce the cost of of treatment. Right now many countries don't have standards but don't have capacity and investment or finance to really treat it. So we need to focus on technologies for treatment. We use it for agriculture so we reduce the water scarcity and the food insecurity and and and malnutrition globally. Thank you. Okay. Thank you so much. Uh before handing over to the closing speaker I think to all of you for your insightful contributions and today discussion has shown that wastewater and environmental surveillance is no longer a surveillance tool only. It is becoming a platform for collaboration and it is becoming a platform for uh public health uh meets water management where agriculture meets with environment protection as your example is quite good. It's like an artificial symbioist. I call this as an artificial symbio in my mind. and where science meet with policy and where national priorities meet regional and global health security.

[00:56:55]And as we come to the end of session, I would like to express my uh deepest appreciation to the Islamic Development Bank for convening this discussion, providing us this opportunity to discuss this subject here. And I would like to invite the Nisar Zed, manager of agriculture, water resources and rural development for closing remarks. Yes, floor is yours, Nizar.

[00:57:22][applause] >> Well, thank you very much. First of all, I'd like really to ask you colleagues to give a second round of applause to our panel. Very rich panel, [applause] very diverse panel. You have research, you have philanthropies, you have UN agencies, you have uh uh uh academics.

[00:57:51]So, it's really quite what very good panel which we were able to assemble and I want really wanted to thank them all to be with us today.

[00:58:00]Second, I want to maybe tell you asking me to talk about after so imminent people about health and etc is given me really tough job actually but they will try to do my best actually to uh to try to summarize the discussion and started maybe with with a personal note you see long time ago I will not give you my age I did a PhD on waste water and I was at the lab doing COD chemical bod 5 etc and I have never thought one day I will be linking this to health and to environmental surveillance etc. For me it's just treating water to either to give it to farmers or to discharge it to the to the environment which is clean.

[00:58:40]So today it's really very very interesting opportunity and actually we we started with with hearing about hearing what the experience of Turkey how it started with COVID and it moved from emergency to something which is long term and and as one of our speakers mentioned that the earlier detect the better we can prevent and this is really one of the key messages you you have to remain here. Of course the the the annual meeting this this year the the theme of the annual meeting has been regional integration for sustainable prosperity but I would maybe phrase it differently for our session it could be maybe national integration for for sustainable cooperation because we heard from our colleagues about the challenges about the institutions not working together etc and it emerged from the discussion that cooperation within the country within the institutions is very very important for for for for waste water and environmental for wastewater and environmental surveillance.

[00:59:43]Uh, of course it uh maybe summarizing the the the discussion there was also a very very interesting remark Dr. data data and data this is very important to remember and especially when we had a session yesterday about environ AI etc with our colleagues so maybe it's the right time really to to to to bridge the gap actually in terms of data and information between different different institutions uh yes also maybe the the and and talking about the cooperation etc we we heard from our colleagues from so Gates Foundation how it is important to to to cooperate between the banks and and other partners because we heard clearly uh these philanthropies can give resources for pilots but to scale up you have to have bigger money and bigger resources this is what second I don't know whether you heard it very well you heard it well James was telling us the money will not be there after 27 so for those who have projects for member countries please do it as fast as we can and we are ready to work with you to work with WSU to work with our Turks Turkish uh uh partners to to try to to spread the west and use it in different member countries uh integration platforms etc. Yes. Last thing and I will conclude here in Singapore they don't use the word waste water they use the word used water >> yes >> because it's it's a water which can be used again and used and reused many many many times so this is really what we have to to to remember it's it's it's it's first of all it's a tool for public pol for public health for early detection but also it's a resource which we can use for agriculture for food security and for for for a livable planet. As simple as that. Thank you very much, >> Nisar. Thank you so much. Do we have time to take a few questions from the room? Of >> of course.

[01:01:51]>> Okay. Because we exceeded our time. I know. But uh yes, if we have any No, we >> still have we have >> we still have 13 minutes.

[01:01:59]>> Okay, perfect.

[01:02:00]>> We have 13 minutes. 13.

[01:02:01]>> Okay, then. Okay. Floor is yours. Dear audience, please ask your questions if any to our panelists. Yes.

[01:02:14]Yes, please.

[01:02:19]Asalamaikum. This is from Pakistan. Uh first of all I would like to appreciate uh the support of the Islamic Development Bank and the Gate Foundations while supporting the polio editation project in Pakistan. It's a really a very effective project which have been supported by the uh IDB and the gate foundations and it is supporting the local Pakistanis to eradicate the polio and contributing to the economic development of the country.

[01:02:49]Secondly, uh the uh the investing in the regional health security with the focusing on used water um and environmental servants. It's a very important and I suggest and I appreciate the uh the the the the bank and the panelists that they have provided us a very good information while one health platforms while focusing on integrating or mainstreaming these sectors into the pro uh agriculture sectors like it is also linked with agriculture food security livestock and also the private and public sectors and the other byan uh colleague has also mentioned the strengthening the coordinations which is very much important uh among all the stakeholders they are working on the health sectors agriculture sectors for the use water and environmental surveillance how uh I have one uh questions like how do you think while um integrating the localized institutions local community into these uh new um uh uh the the in you know into regional health security and environ environmental surveillance uh especially in context of the women empowerment and the youth engagements. Thank you to answer this question.

[01:04:17]>> Yeah, thank you. Um I think you're highlighting a critical issue and and uh one of our colleagues also the speakers talked about the youth. You you have mentioned the the the youth it's it's I think it's mainly about awareness at this point. The functions that need to be done specifically for this discussion is really one of the core public health functions and strengthening that core public health function becomes very important and engaging them could be through uh engaging the community on anything that we do in public health is important otherwise we face you know push back and conspiracy theories start coming up. So I think uh through education through understanding the relevance of this but it goes also to um the issues on on hygiene as well. Um so I think even the civil societies have had for example a major push for the meat industry and the um food industry on pro providing uh food that is not used that is not using antimicrobials and that's not using hormones for example that is camouflaged sometimes under the the word uh um food promotion or health no not food pro um growth promoters under the that I forgot that word we used to use it a lot in AMR so the word growth growth promoters is what? It's antibiotics, it's hormones, it's vitamins. It's a mixture of stuff that even the simple farm farm farmer does not know about. So the awareness of what they're eating and what they're drinking and what are they consuming, where do the disease come from can create a huge uh partnership between the civil societies, the communities on the ground and pushing governments and where they need to direct and put their investments and priorities because at the end it is their health and it is their well-being that we're talking about.

[01:06:07]>> Thank you. Thank you so much. Okay, is there any other question? Yes, please.

[01:06:16]>> Uh, thank you very much, Muhammad Duma.

[01:06:18]Uh, I'm the head of health in Egat secretariat.

[01:06:22]IGAT is in the horn of Africa where we have four countries from STP, Sudan and Djibouti, Somalia and Uganda.

[01:06:35]I uh it's very important uh topic and I'm very grateful to have this uh panelist. The question now of data sharing to make use of uh uh the information that we are getting from the uh uh from the other sectors all the how to utilize the one health sector into the health sectors and I think uh I would like the panelists maybe to reflect if there is any best practice that where we can use uh the information coming from like uh water uh waste water or even climate health very important to early predict the disease but still the human health the minister of health might not be benefiting or using this information. If there is any experience or any uh best practice that we can uh take a recommend thank you okay first maybe is and then toana okay because she okay and then I will give floor to you as well >> I mentioned the example in in Jordan and Lebanon and there are three colleagues here from EI from the international water management institute maybe colleague from EGAD connect with them they can give you the example and basically the the examples is really farmers would like to use partially treated water >> for agriculture but they don't trust it because the consumer does not trust it's its good so it's about how do you bring awareness how do you bring trust in the data and provide that data and be very transparent so it is used and it is not stopping those farmers from selling on the market and and providing that transparency. But uh the colleagues are here, they know it far better and they can give you the the aspect on the policy side, the aspects on the engagement of communities and engagement of other ministries like ministry of health or other ministries. Thank you.

[01:08:54]>> Yeah. and from thank you as Mahana and again we worked together in your previous role and and had some great discussions as chief scientist of FA and yes the the quadripartite and this is work that we've done from the governance part and again we're working again when I was ADG in in Geneva working at global level now at the regional level we have something called the national action plans for antimicrobial resistance and also for one health so what we're hoping to do and working with the member states is to make sure that they can take their national action plans which is a governance aspect and this is very crucial because the the integration of the different sectors to talk about data has to happen in a way that is uh supported by the highest level of the leadership. So when you have a multis sectoral national committee which we even have a tool on how to establish a multis sectoral national u committee on antimicrobial resistance I've been advocating that that those same committee members are the one health people right so they can talk about not just AMR they can talk about deni they can talk about um polio any other you know pathogen that or or chemical or whatever that that happens it's it's the planetary health or one health so that is a structure that needs to be further activated, integrated and supported at the highest level of the governments.

[01:10:18]And we're working through the different ministry lines to make sure that they don't forget because sometimes especially for us as UN agencies, we develop so many tools and guidelines and frameworks and and national action plans. We need to focus even more now on how to to utilize this these tools.

[01:10:36]There's tons of them and tons of them are extremely relevant and very helpful.

[01:10:41]I promise as a regional director I will continue as or who in general we will continue to support that at the country level and even those national action plans and the national action plan committee which is a multis sectoral committee led by the minister lines that are relevant they need to continue to invest in it and find the value because it mobilizes all of that and I go back to including because data is crucial and your your question was specifically about data and that is where the data platform platform should be shared and supported and developed and and identifying public health interventions to create the change that is needed uh in the different ministry lines ministry of finance has to be part of that committee and at least five six other ministry lines education social services uh ministries of interior and so on so I hope that answers the question and you're right we have to do more on that front >> thank you so much >> thank you much >> yes Hello, I'm Steven Fghazi from the International Water Management Institute and I actually have a question that's very linked to our colleague from IGAD but let's say from from the opposite end. So we know that um health issues often emerge, human health issues often emerge because of agriculture, landscape management and and urban settings and and in humanitarian settings. And so uh my question is how environmental health monitoring uh including um wastewater and environmental surveillance can actually and has uh linked back to those natural resource managers. So how can it inform the actions of the natural resource managers and and are there any particular examples that you can think of?

[01:12:28]>> Thank you.

[01:12:31]>> Can you can answer Mr. Roy?

[01:12:36]I think I think uh to to answer to this question uh we need to see the nature itself because in the nature uh the the the for example uh diseases also the for water resources the river they don't recognize any borders so they the flow from the source to the to the end naturally without any uh without any borders any also the it's the same for the disease So we need to implement we need to do the same holistic approach for our challenges as well if we bring that's why I I mentioned the integrated uh the the platforms to to bring everyone together because for example let taking uh the challenges of each sector sometimes we can solve the problems or the challenges of the multiple sectors by one action. For example, the public health could be the result of unproper uh seage systems. Also, the some environmental issues can be result of the unproper uh sewage systems. Uh also the water scarcity if we don't have the the the the local water resources or if we have limited amount of water resources that means that also that's also another challenge. But if we bring all these three two different challenge to the one one table the by solving the infrastructure problem for example the wastewater resource management waste water treatment uh will lead the the solutions to all these challenge. We will fix by by one investment we will fix the environmental issue. We will fix the health issue and we will fix the the water availability issue. Also the result of this for example let's take as a implementation or the investment and the or the some report in general the if the result of this report will support by not just one but multiple uh governmental organizations and if it's supported by international standards for example or inter international finance institutes that will be much more easier for the people to digest the result for example she mentioned in her speech that it's not easy for people for agriculture for farmers to accept that we can use the treated water without any problem. But if the results if our reports if our investments will be supported by multiple governmental organization with also and if if supported by international standards international organization that will be much more easier for the populations as well.

[01:15:21]Okay, I think it's it's time. I know that there's a lot of interest in the room, but it's about uh 12:15 exactly right on time and because we have to give them the space to to prepare for the next session. So, I would like again >> photo first. Okay. Before closing, okay, thank you so much to the audience for participating this important event and Okay.

[01:15:40]>> And let's have a group picture quickly.

[01:15:42]We can we can >> Yes. Yes. Yes. Please.

[01:17:39]Thank you very much.

[01:17:51]Thank you so much. Thank you.

[01:18:07]Merry Christmas.