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A call for a coherent One Health strategy for the surveillance of climate-sensitive infectious diseases in the Canadian Arctic and subarctic regions

One Health Outlook volume 6, Article number: 25 (2024) Cite this article

Abstract

Introduction

The increased burden of climate-sensitive infectious diseases (CSIDs) within the circumpolar region, one of the many impacts of climate change, is impacting human, animal and ecosystem health. An integrated One Health approach to surveillance of CSIDs has been promoted by the scientific community as a prerequisite to enhance preparedness and response. Up to now, little is known about how the One Health approach has been implemented in surveillance systems for CSIDs in the Arctic and surrounding regions.

Objectives

The objectives of this study were to map surveillance activities currently implemented in the Canadian Arctic and subarctic for the 16 CSID identified by the Arctic Council, to describe how One Health has been operationalized in these activities, and to explore the integration and leadership of Indigenous partners in current surveillance systems.

Method

We performed the mapping in three steps: a rapid review of the scientific literature, a review of the grey literature and an online questionnaire sent to key stakeholders involved in CSID surveillance in the Canadian Arctic and subarctic regions.

Results and conclusions

We identified 37 scientific peer-reviewed and 58 grey literature records. We mapped (1) surveillance of mandatory notifiable diseases at the federal, provincial or territorial levels not specific to the Arctic and subarctic regions, and (2) non-mandatory surveillance programs specific to the Arctic and subarctic regions. We described programs targeting either a single disease, human populations or wildlife. In most programs, there was no explicit mention of the integration of the One Health approach, and little information was available on collaboration efforts between sectors. Programs involved Indigenous communities at various levels, ranging from very low communication to community members, to high involvement and leadership in program management. Improvement in current CSID surveillance activities in Canada should include enhancing information accessibility, ensuring geographic representation, fostering sustainability in implementation of One Health strategies, and stronger involvement of Indigenous communities in the leadership of surveillance systems. An internationally harmonised approach across the Arctic and subarctic regions for all CSIDs has the potential to unify circumpolar surveillance efforts, save resources, and ultimately better inform public health authorities on the actions to prioritize in the context of climate change.

Introduction

The Arctic is inhabited by over 7 million people, including many Indigenous communities [1] from more than 40 nations [2]. In the Americas, the Inuit, Cree and Innu peoples, and in Eurasia, the Saami, Nenets and Evenk peoples, are amongst the main Indigenous peoples living in the Arctic and subarctic regions. In these regions, global warming is occurring nearly four times faster when compared to the rest of the world [3] which raises concerns for human, animal, plant and ecosystem health; one of these concern is the emergence of diseases [4, 5]. Indeed, climate change is modifying the ecology and spread of several infectious diseases, referred to as climate-sensitive infectious diseases (CSIDs) [6, 7]. The climate, along with its associated weather patterns, influence pathogens – namely, viruses, bacteria, fungi and parasites – whose transmission cycles involve animals, vectors or environmental compartments. The mechanisms underlying these disturbances include changes in pathogen survival and development rates outside the host, shifts in geographic range and abundance of reservoir animal species and disease vectors, and changes in transmission due to more frequent extreme climate events such as drought and heavy precipitation events [8]. In northern regions, research also suggests that the thawing of permafrost may expose populations and wildlife to pathogens preserved in ice, some of which may have been eradicated or forgotten, posing a potential challenge to modern immune systems not previously exposed to these agents [9].

The Arctic Council, a leading intergovernmental forum on Arctic governance, established an International Circumpolar Working Group (ICWG) in 2011 “to assess the potential emergence and health impact of climate-sensitive infectious diseases in northern human and animal populations, and to identify activities that may minimize the risks of disease emergence” [10]. This group identified 16 CSIDs of concern for human and animal health, caused by pathogens including viruses (hantaviruses, rabies virus, tick-borne encephalitis viruses, West Nile virus), bacteria (Brucella spp., Leptospira spp., Clostridium botulinum, Francisella tularensis, Borrelia burgdorferi, Bacillus anthracis, Coxiella burnetti) and parasites (Toxoplasma gondii, Trichinella spp., Echinococcus spp., Giardia spp., Cryptosporidium spp.) [10]. Except for botulism, which can survive in the form of spores in the environment, all these diseases are zoonotic agents and have wildlife reservoirs [11]. Consequently, the development of integrated surveillance systems following a One Health (OH) approach has been considered essential to better understand changing risks for humans and animals, and strengthen preparedness and response [7, 10, 12].

The Quadripartite Alliance defines OH as an “integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems, […] recognizing [that] the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent” [13]. One Health surveillance systems thus require collaboration between at least two sectors (human health, animal health, plant health, environment) at different steps along the process, including planning, data collection, analysis, interpretation and communication phases [14]. The OH approach also embraces Indigenous Knowledge and ways of being regarding the intimate linkages between health, wellness and nature, and building upon this knowledge [15].

A growing number of research projects on CSIDs in the Arctic and subarctic regions have been developed and funded in recent years (see ArcticNet, 2021, amongst others) and apply the OH approach in partnership with Indigenous communities [16]. For example, the Nordic Centre of Excellence named CLINF is a research center, which is made up of an interdisciplinary research team collaborating with more than 150 local organizations in the Arctic region [17, 18]. The main objectives of this group are to identify and investigate the effects of climate change on human and animal infectious diseases from western Greenland to eastern Siberia in a One Health perspective, in order to provide accessible data and tools for communities and decision-makers. However, surveillance capacities for CSIDs in the Canadian Arctic and subarctic regions have never yet been formally assessed. It remains unclear to what extent the OH approach has been integrated into surveillance systems for CSIDs in these regions and whether Indigenous Knowledge is taken into consideration.

The objectives of this study were to map current surveillance activities and programs on CSIDs in the Canadian Arctic or subarctic regions, to characterize the actual implementation of the OH approach, and to explore the integration and the leadership of Indigenous partners in current surveillance systems. This article presents the main findings and lessons learned from this mapping, emphasizing the need for a coherent OH surveillance strategy for CSIDs led by the Indigenous communities affected by these diseases.

Method

Current surveillance activities were mapped using three steps: a rapid review of the scientific literature, a review of the grey literature and an online questionnaire sent to key stakeholders involved in CSID surveillance in the Canadian Arctic and subarctic regions. The CSIDs included were the 16 diseases identified by the ICWG, as listed above [10].

The selected study area covers lands acknowledged by the Arctic Council as part of the Canadian Arctic and subarctic regions and is presented in Fig. 1, including Yukon (YT), Northwest Territories (NT), Nunavut (NU), Nunavik (NK; Québec) and Newfoundland and Labrador (NFL), including Nunatsiavut.

Surveillance activities were defined as any multi-year activity or program involving systematic data collection, integration and analysis, and timely dissemination of information to inform public or animal health decisions [19].

Scientific and grey literature review

The rapid scientific literature review was conducted in PubMed and Web of Science (including Core Collection, Biological Abstracts, Medline), using keywords associated with four themes: CSID, Canadian Arctic and subarctic regions, surveillance and One Health (Table 1 and Appendix 1). A general framework for conducting rapid literature reviews as outlined by the 2020 Cochrane Rapid Reviews guidance document was followed with modifications [20]. The review included the following steps: (1) database search, (2) importation of the records into an Excel spreadsheet, (3) removal of duplicates, and (4) rapid screening of titles and abstracts for eligibility (one reviewer per record). The grey literature review included a search within all websites of Canadian government entities (federal, provincial and territorial) and of Indigenous communities, research compendiums and topic-focused grey literature databases (such as Arctic Science and Technology Information System (ASTIS) and Circumpolar Health Bibliographic Database (CHBD)). Google and Google Scholar search engines broadened the scope of the review. For the grey literature, we adapted the search strategy to the constraints of each database, sometimes resorting to single-word or manual search when necessary. An initial search was conducted between May and December 2021, followed by a final search between April and November 2023 to identify new, relevant papers, reports and information on websites. The eligibility of both grey and scientific evidence was assessed independently by three reviewers (LDe, CN and LDa). Records were selected based on the following inclusion criteria: English or French languages, reliability of the source of information for grey literature (websites, reports or online documents from governments or research organizations), online accessibility, relevance to the subject, geographic range limited to Arctic and subarctic regions of Canada and activities ongoing since 2000 or that have lasted at least one year. Records were excluded according to the following exclusion criteria: not a multi-year project, no mention of a surveillance program, wrong geographic area and does not include any of the 16 targeted CSIDs.

Stakeholder questionnaire

To complete information on surveillance activities identified in the scientific and grey literature, and to collect information on other surveillance activities that we may have missed, we contacted key stakeholders involved in infectious disease surveillance within the Canadian Arctic and subarctic regions and asked them to complete a short questionnaire about these surveillance systems. We used two means of recruitment: (1) we contacted key stakeholders identified by consulting websites of Arctic research networks, Indigenous institutions and government organizations through the scientific and grey literature (i.e. project or program leaders and corresponding authors); (2) at the end of the questionnaire, participants were invited to name other stakeholders involved in surveillance activities in the Canadian Arctic and subarctic regions. This resulted in the identification of 49 stakeholders who were invited by email to participate in an online questionnaire designed using the LimeSurvey Professional software [21]. The questionnaire was composed of five questions (available in Appendix 2) to collect additional information about ongoing or past surveillance activities or programs. It was conducted between May and December 2021.

Data collection and analysis

We systematically extracted information on the CSID surveillance systems in the Canadian Arctic and subarctic regions identified with the three steps described above (additional details are available in Appendix 3). This included: program name, lead organization, targeted diseases and pathogens, type of data collection (opportunistic, i.e., identified through other activities, active or passive), geographic areas covered, stakeholders involved, targeted OH sectors (human health, animal health, plant health, food safety, wildlife and environmental health) and Indigenous participation. To characterize the implementation of OH in surveillance activities based on the extracted information, we used the following definition of OH integration into disease surveillance: “the collaborative efforts […] between at least two sectors (amongst human health, animal health, plant health, food safety, wildlife and environmental health) at any stage of the surveillance process […]” [14]. To explore the involvement of Indigenous partners in current surveillance systems, we searched for evidence of participation and/or leadership from Indigenous organizations. We characterized the participation as follow: (1) the program was explicitly managed by an Indigenous group or organization (characterized as “lead”), (2) specific participation was mentioned (characterized as “collaborators”), and (3) there was not enough information on the type of involvement (characterized as “unclear”). The information from the three steps detailed above was combined to map the state of current CSID surveillance in the Canadian Arctic and subarctic regions.

Results

Search results

A flow diagram synthesizing search results from both the grey and scientific literature is presented in Fig. 2. In total, 37 scientific peer-reviewed and 58 grey literature records were identified (n, total = 95). Record exclusion was mainly due to not being a multi-year project (n = 11), having no mention of a surveillance program (n = 11), lacking reference to CSIDs from the ICWG list (n = 9), and being in the wrong geographic area (n = 2). Out of the 49 key stakeholders invited to complete the online questionnaire, only 10 responded with enough information to be included in our mapping results. All of the respondents were representatives from federal or provincial government or were part of academic research groups.

All Arctic and subarctic regions targeted in this study were covered by at least one surveillance program. This coverage included nationwide passive surveillance activities for mandatory reportable diseases and non-mandatory surveillance programs. The Northwest Territories and Nunavut were the regions with the highest coverage from CSID surveillance programs, followed by the Nunavik region (Québec). Yukon and Newfoundland and Labrador were the least covered regions.

The surveillance activities included in the analysis can be divided into two main sections, that are (1) surveillance of mandatory notifiable diseases at the federal, provincial or territorial levels that are not specific to the Arctic and subarctic regions, and (2) non-mandatory surveillance programs specific to the Arctic and subarctic regions. Both sections are described below.

Mandatory notifiable diseases at the federal, provincial or territorial levels that are not specific to the Arctic and subarctic regions

The term “notifiable disease” encompasses all diseases that require immediate and/or annual notification. Cases of these diseases in humans or animals are reported by physicians, laboratories and/or veterinarians in each province and to the federal authorities, contributing to the surveillance system. Amongst the CSIDs included in this study, six out of 16 were notifiable to public health authorities in Canada at the time of publication, for both humans and animals: anthrax, botulism, brucellosis, rabies, tularemia, and West Nile fever [22,23,24]. Four out of 16 CSIDs were notifiable for animals only (echinococcosis, Q fever, toxoplasmosis, and trichinellosis), and four were notifiable for humans only (cryptosporidiosis, giardiasis, hantavirus pulmonary syndrome, and Lyme disease). Leptospirosis and tick-borne encephalitis were the only two CSIDs without obligation of notification to the federal authorities. Table 2 summarizes the different categories related to federal reportable diseases.

Each province and territory also maintains its own notifiable or reportable disease list, indicating additional diseases for surveillance in addition to federally reportable diseases. These lists change over time, depending on the priorities of provinces and territories. For example, leptospirosis, which is not a reportable disease at the federal level, was notifiable in Newfoundland and Labrador, Ontario, and Québec at the time of the study [22].

All these surveillance activities are led by provincial, territorial, and federal public authorities. Professionals practicing in the Arctic and subarctic regions at local institutions are required to report these diseases as in other Canadian regions, but we found no clear documented evidence of participation of local Indigenous communities in the leadership of these programs.

Non-mandatory surveillance programs specific to the Arctic and subarctic regions

In addition to the notifiable reporting systems of CSIDs within federal, provincial, or territorial programs, surveillance programs led by other organizations and targeting one or more CSIDs were identified. These surveillance programs can be further classified into three sub-categories: (A) programs targeting a single disease (including screening programs), (B) surveillance programs targeting human populations, or (C) surveillance programs targeting wildlife (monitoring one animal species or overall wildlife health). The first two categories are presented in Table 3.

  1. A)

    Programs targeting a single disease. Three programs were identified in this category and targeted two CSIDs: trichinella and West Nile virus. The two programs targeting trichinella are programs led by Indigenous communities to screen walrus meat submitted by Indigenous hunters for the presence of pathogens [25,26,27,28]. The Nunavik Trichinellosis Prevention Program has been ongoing for over 20 years, while the Nunavut Trichinella Detection Program is a more recent initiative (2017). The third program targeted West Nile virus across Canada through a combination of active and passive surveillance activities. This program is led by the Canadian Wildlife Health Cooperative (CWHC), an organization focused on wildlife conservation and management in Canada. In this monitoring strategy, data were collected through human blood and organ donations, testing birds or horses that were sick or dead, examining mosquito pools, and screening humans exhibiting symptoms compatible with West Nile fever [29, 30]. With this program, we found no clear evidence of active involvement of Indigenous communities.

  2. B)

    Surveillance programs targeting human populations. Two programs were classified in this category (Table 3, B) [27, 31]. The National Inuit Health Surveys (Qanuippitaa?) are conducted through partnerships by academic researchers and Inuit organizations. Since 2018, it has been fully led by Inuit communities. This program collects data on exposure to toxoplasmosis, rabies, trichinellosis, and cryptosporidiosis. The program’s objective is to collect data to improve the health and well-being of Inuit, including health data on disease prevalence [32]. The Nunavik Toxoplasmosis Screening Program for pregnant women was implemented by academic researchers, local government, and Inuit organizations in response to cases reported in Nunavik in the 90s. Since 2004, this program has been part of the National Inuit Health Surveys.

  3. C)

    Surveillance programs targeting wildlife. Programs included in category C were more complex and intertwined, often mergers of existing monitoring programs targeting wildlife species. Different organizations (e.g. academics, federal or provincial/territorial governments, local groups, non-governmental organizations, etc.) were responsible for various surveillance functions, including funding, data collection, laboratory analysis, data analysis, interpretation and integration, and results dissemination. Additionally, some of these activities are embedded within broader research programs. Therefore, it was challenging to distinguish between different surveillance activities and the involved groups and institutions. The main characteristics are described below.

At least thirteen CSIDs were covered in these different programs (13/16): anthrax, brucellosis, cryptosporidiosis, echinococcosis, giardiasis, hantavirus pulmonary syndrome, leptospirosis, Lyme disease, rabies, toxoplasmosis, trichinellosis, tularemia, and West Nile fever. Based on the information available on these programs, they involved Indigenous communities at various levels, either mostly collaborators or leads of certain activities.

The most frequently monitored species in this category were Caribou [33,34,35,36,37,38,39,40,41,42,43,44], Wood bison [34, 40,41,42,43, 45,46,47,48,49,50,51,52,53,54,55,56,57], Beluga [34, 40,41,42,43, 58,59,60], Polar bear [61,62,63,64,65], Ringed and bearded seal [34, 41,42,43, 53, 66,67,68,69,70] and Muskox [71,72,73,74,75,76,77,78]. Some of those species were classified, at the time of publication, as species of concern or priority species. Indeed, in Canada, Barren-ground Caribou, Boreal Caribou, Peary Caribou, and Wood Bison are amongst the six federally, provincially, and territorially shared priority species identified, and they are located in Arctic and subarctic regions. For those species, federal, provincial, and territorial governments are collaborating to develop recovery strategies, either following the Pan-Canadian Approach or focusing on Priority Species. With this approach, the government is funding surveillance activities intending to protect these species.

Other surveillance activities in this category targeted more than one animal species [34, 40, 42, 49, 52, 53, 56, 66, 70, 79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94]. One example is the “Community-based monitoring program of wildlife health”, coordinated by a research group based at the University of Calgary, Canada [43, 77, 89, 93, 95,96,97,98]. This ongoing program started in 2003 in the Northwest Territories and was later extended to Nunavut. As a community-based program, it evolved over time to incorporate Indigenous Knowledge, and some monitoring activities were led by local Indigenous groups. It also includes many organizations and groups, such as academia, regional and local groups, non-governmental organizations and government. Over the years, many CSIDs were covered at various levels of investigation in this program, including brucellosis, echinococcosis, toxoplasmosis, and West Nile fever. Other suspected CSIDs not included in the list were also investigated, as orf and erysipelas.

Implementation of One Health

We found no explicit mention of the integration of the OH approach in the retrieved activities, except for one example which can be included in category C, namely The Canadian Arctic One Health Network [16]. It is a network of researchers and community partners focused on monitoring, modeling, and mitigating various One Health threats across the changing Canadian North. Still, some programs can be considered as implementing OH surveillance, as per Bordier et al.’s definition. Surveillance activities integrating two to four sectors were identified, with most programs involving collaborating efforts, at some level, between two sectors. The nationwide surveillance of West Nile virus (in mosquito pools, wild birds, horses, and people) serves as an example of data integration across various sectors, although this surveillance system was not specific to the Arctic and subarctic regions. This monitoring program is the result of a close collaboration between multiple provinces, territories and federal agencies, as well as non-governmental organizations (NGOs), to actively track cases of West Nile virus in wildlife (birds), domestic animals (horses), the environment (mosquito pools), and humans (hospital-reported cases) each summer.

The two OH sectors most frequently involved in CSID surveillance were ‘wildlife & environmental health’ and ‘food safety’. Category A (targeting one disease) was the category with the best coverage of OH sectors, including wildlife health, food safety, human health and domestic animal health. Programs in Category B (targeting human populations) included only the human health and food safety sectors. Programs in Category C (targeting wildlife) covered mostly wildlife health and food safety. The CWHC programs in this category also had a certain orientation towards human health. Little information was available on how collaboration efforts between sectors took place. For example, it was not possible to determine whether collaboration was limited to the joint interpretation of surveillance data from multiple sources (e.g., animals and food products) or involved co-development or co-management by multiple institutions.

Discussion

This study is the first to systematically map and characterize the implementation of OH and the integration of Indigenous Knowledge and leadership in surveillance systems for CSIDs in the Canadian Arctic and subarctic regions. Results reveal that although some surveillance activities were found for almost all CSIDs prioritized by the Arctic Council, major gaps were identified regarding the equitable inclusion of regions across the Canadian Arctic and subarctic regions that are the most strongly affected by climate change, the implementation of a sustainable One Health approach, and the integration of a strong Indigenous leadership in existing initiatives.

Geographic representation

Surveillance activities appeared to be unevenly distributed across the Northern region, with some territories and/or communities better represented than others. Indeed, the majority of the surveillance programs were located in the Northwest Territories and Nunavut, whereas Yukon and Newfoundland-Labrador were the least-covered areas. Other northern Indigenous communities in Canada, especially those in subarctic regions, are also suffering from climate change and emerging diseases and could benefit from a more inclusive CSID surveillance network.

One Health implementation and sustainability

OH implementation was not explicitly mentioned in any surveillance documentation retrieved in this study. There was also no available information on the collaboration efforts between sectors, including co-planning, data collection, management and sharing, dissemination of findings, and communication of positive cases between agencies. Nevertheless, a partnership amongst academics, governments, NGOs and local groups is crucial for complex surveillance programs, and most of the programs included at least some representation of these groups. A more indepth evaluation of OH integration into CSID surveillance programs currently taking place in the Canadian Arctic and subarctic regions would be beneficial to obtain more accurate and comprehensive information before identifying and addressing gaps [14, 99].

Another important finding was that most of the non-mandatory surveillance activities were not long-term formal surveillance programs, but rather multi-year activities conducted by a research network or team, which can impede the sustainability of current CSID surveillance. This can be mainly observed in Category C (targeting wildlife), which includes programs that involved many organizations and various sources of funding. Although the inclusion of multiple partners in the surveillance of CSIDs can create synergies between surveillance and research, this approach can also be a threat to surveillance programs if their activities rely on research funds. Long-term surveillance programs are essential for the continuous monitoring and evaluation of CSIDs affecting humans, animals, and their shared environments and could provide the information needed to detect, prevent, and control these diseases [100]. The lack of adequate surveillance systems for CSIDs in the North has been noted by other authors [7, 101], as is the need for the development and implementation of sustainable CSID surveillance systems in the Arctic and subarctic regions [102]. Awuor and collaborators (2019) propose that this gap is partly due to the availability of sufficient data on the risks of a disease justifying stopping a program, or to a lack of financial resources [103]. However, as they pointed out, sustainable and continuous surveillance activities are critically needed to assess risks, fully understand the situation, and prepare for future emergences.

Leadership of Indigenous communities

The findings of this study also underline an apparent lack of involvement from Indigenous communities in certain programs, despite all of these activities taking place on native lands. Detailed reporting of participatory processes is crucial for the co-production of knowledge in the Arctic [104]. It is also essential that Indigenous people be at the core of the management and design of CSID surveillance programs in the future [7, 101]. Equitable inclusion of diverse knowledge systems achieves better outcomes than a sectoral framework, particularly in the circumpolar region where the majority of the population is Indigenous [105, 106]. Integration of Indigenous Knowledge in research and surveillance of health threats for humans, animals, and ecosystems is also known to contribute meaningfully to adaptation to climate change [107, 108].

Despite these remaining challenges, some examples suggest positive changes over time toward stronger Indigenous leadership. For example, Inuit Tapiriit Kanatami (ITK) became the lead and developed the Qanuippitaa? National Inuit Health Survey (QNIHS) from 2021 onwards [31]. Before 2021, similar Indigenous health surveys were conducted through partnerships between researchers, Inuit organizations and local health authorities, but not led by Indigenous communities. Another example identified in this study is the “Community-based monitoring program of wildlife health”, which integrates local and Indigenous Knowledge with western ecological knowledge [95, 109]. Other existing good examples of Indigenous Knowledge integration in research and practices could serve as models to enhance current practices in CSID surveillance. A mapping of all community-based monitoring activities in the Arctic by the Sustaining Arctic Observing Networks led to the publication of the web Atlas Nunaliit in 2015 (http://www.arcticcbm.org) [110]. While not specifically targeting CSIDs, this work highlighted good practices for conducting monitoring activities in partnership with Indigenous communities. These practices include capacity building, co-production of knowledge, support for the construction of sustainable networks, development of accessible data management protocols, use of the collected data to inform decision-making, and ensuring the sustainability of the programs [110].

The need for a coherent, Arctic- and subarctic-wide, One Health surveillance strategy for CSIDs, co-managed by the Indigenous communities

A key priority for future developments in CSID surveillance in the Canadian Arctic and subarctic regions is to identify and prioritize CSIDs of interest for the various regions and communities involved. To achieve this, we propose employing a participatory research approach involving Indigenous community representatives.

To ensure that information on surveillance activities is more comprehensible and accessible, there are existing examples of mapping activities related to climate change. For instance, Canada in a Changing Climate: Advancing our Knowledge for Action produced a geographical map documenting case stories related to adaptations and resilience for addressing climate change in Canada [111]. Another example is The Northern Caribou Canada project, which aims to track changes in Canadian Arctic and subarctic caribou populations, incorporating both traditional and scientific knowledge [112]. The Wekʼèezhìi Renewable Resources Board, led by the Tłı̨chǫ Nation and supported by the federal and territorial government, created this project. These are examples of tools used for CSID surveillance activities that make the information more accessible to all organizations and groups, and to the public, including Indigenous Peoples.

Limitations of the study

This study has limitations. Firstly, during our research, we excluded surveillance programs for infectious diseases in the Arctic and subarctic regions that were not listed in the International Circumpolar Working Group, but which could also be considered as CSIDs. For instance, the International Circumpolar Surveillance system collects data on invasive bacterial diseases, but none are pathogens prioritized by the Arctic council [113,114,115,116]. Numerous authors have emphasized a possible increased burden for several infectious diseases not included in this study, including enteric infections [117], helminthic zoonoses [101, 118], Erysipelothrix rhusiopathiae [119], rickettsial diseases and mosquito-borne viruses, including California serogroup viruses [120, 121] in the Northern regions within the context of changing climate. Also, since the study, several other infectious agents that could be of concern have emerged, but were not included.

Secondly, we encountered considerable difficulty in accessing information on existing surveillance activities. Only a few formal surveillance programs were described in the grey and scientific literature, and their descriptions lacked detail. Since many of them involved diverse organizations (i.e. academia, federal and/or regional governments, non-governmental organizations, local groups, etc.), it was challenging to delineate their frontiers, due to the lack of information provided. This is why we decided not to list and count programs in Category C, as done with Categories A and B which were less challenging on this matter. The lack of geographic representation in certain Canadian Arctic and subarctic regions could be partly due to a representation bias, as some provinces maintain better records of activities (research compendium available at the NT and NU) compared to other provinces or territories, for which information on activities was more difficult to obtain. Information on CSID surveillance activities needs to become available and more accessible for Indigenous Peoples, decision-makers, and researchers to inform the development of a coherent OH surveillance strategy for CSIDs across the Canadian Arctic and subarctic regions. There is a crucial need for guidelines for better describing surveillance programs.

Lastly, the stakeholders questionnaire had a very low response proportion, and most respondents from provincial or federal authorities were not directly involved in surveillance programs. This led to limited access to information and a limited depth of understanding of the programs. Therefore, due to the limited access to information about programs, the classification of monitoring activities in Table 3 may not be the most adequate representation. Moreover, surveillance activities were challenging to characterize: there was no official name or topic mentioned, pathogens searched were sometimes not clearly defined, and roles and parties involved in the surveillance were often not clearly identified, varying over time in longitudinal projects.

Table 1 Key concepts and keywords for this systematic map
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Fig. 1
figure 1

Map of the selected study area. Legend: The selected study area covers lands acknowledged by the Arctic Council as part of the Canadian Arctic and subarctic regions. It includes the following territories and provinces, in blue: Yukon (YT), Northwest Territories (NT), Nunavut (NU), a part of the Québec (Nunavik; NK) and Newfoundland and Labrador (NFL), including Nunatsiavut (hatched area)

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Fig. 2
figure 2

Flow diagram of the mapping for current CSID surveillance activities. Legend: This flow diagram presents the number of results obtained at each step of the search. Excluded articles did not meet the inclusion criteria. A record does not necessarily refer to a surveillance program or network (e.g. one program may ask for multiple research permits over the years, hence generating multiple records in a compendium). Once extracted, records were analyzed and grouped together by stakeholders and targeted diseases to have an accurate view of the current surveillance programs

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Table 2 CSIDs that are notifiable at the federal level, for terrestrial animals [22, 23] and humans [24].a
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Table 3 Overview of programs for CSIDs in the Canadian Arctic and subarctic regions
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Conclusion

The scientific community widely acknowledges the importance of implementing and maintaining CSID surveillance in the Arctic and subarctic. Substantial investments in surveillance programs aimed at detecting disease emergence events are urgently needed, distinguishing newly detected diseases from emerging diseases, establishing baseline rates for endemic diseases susceptible to transmission in a warming North, and assessing the effectiveness of awareness and control programs in reducing transmission and enhancing biosecurity. Our study highlights the need for improved access to information about ongoing surveillance activities in the circumpolar region. In evaluating the gaps in the current surveillance activities on CSIDs in the Canadian Arctic and subarctic regions, there is a critical need for a coherent, Arctic- and subarctic-wide, One Health surveillance strategy for CSIDs, co-managed by Indigenous communities. This strategy requires a renewed effort in prioritizing needs and risks associated with CSIDs in the Canadian Arctic and subarctic regions. It aims to ensure more equitable distribution of surveillance activities across all parts of the Canadian Arctic and subarctic regions, establish sustainable programs over time, foster OH collaboration amongst the involved sectors, and, last but not least, ensure that Indigenous people are at the core of the management and design of these CSID surveillance programs. An internationally harmonised approach across the Arctic and subarctic regions for all CSIDs has the potential to unify circumpolar surveillance efforts and ultimately better inform public health authorities on the actions to prioritize in the context of climate change [18].

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

ASTIS:

Arctic Science and Technology Information System

CHBD:

Circumpolar Health Bibliographic Database

CSID:

Climate-sensitive infectious disease

CWHC:

Canadian Wildlife Health Cooperative

ICWG:

International Circumpolar Working Group

ITK:

Inuit Tapiriit Kanatami

NFL:

Newfoundland and Labrador

NGO:

Non-governmental organization

NK:

Nunavik

NT:

Northwest Territories

NU:

Nunavut

OH:

One Health

QNIHS:

Qanuippitaa? National Inuit Health Survey

WNV:

West Nile virus

YT:

Yukon

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Acknowledgements

We would like to thank Dr. Emilie Bouchard, Dr. Susan Kutz and her team, Géraldine-Guy Gouin, and other collaborators who completed the questionnaire for their valuable assistance in understanding some surveillance programs.

Funding

This study was funded by the Canadian Institutes of Health Research (CIHR) (Grant nu. 167542). The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.

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Author notes

  1. Laurence Daigle and Charlotte Nury contributed equally.

Authors and Affiliations

  1. Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada

    Laurence Daigle, Charlotte Nury, Léa Delesalle, Carol-Anne Villeneuve, Patrick A. Leighton, Hélène Carabin, Kate Zinszer & Cécile Aenishaenslin

  2. Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada

    Laurence Daigle, Léa Delesalle, Carol-Anne Villeneuve, Patrick A. Leighton, Hélène Carabin, Kate Zinszer & Cécile Aenishaenslin

  3. Centre de recherche en santé publique de l’Université de Montréal et du CIUSSS du Centre-Sud-de-l’île-de-Montréal, Montréal, Québec, Canada

    Laurence Daigle, Léa Delesalle, Carol-Anne Villeneuve, Patrick A. Leighton, Hélène Carabin, Kate Zinszer & Cécile Aenishaenslin

  4. Université de Montréal, Montréal, Québec, Canada

    Juliette Colinas

  5. École de santé publique, Université de Montréal, Montréal, Québec, Canada

    Kate Zinszer

  6. School of Health Policy & Management, York University, Toronto, Ontario, Canada

    Sean Hillier

  7. Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatoon, Saskatoon, Saskatchewan, Canada

    Emily Jenkins

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  1. Laurence Daigle
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  2. Charlotte Nury
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  11. Cécile Aenishaenslin
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Contributions

The study was designed by CA, HC, KZ and SH. The rapid literature review was done by LDa, CN, and LDe. The questionnaire was administrated by CN and CV. LDa, CN, LDe and CA wrote the first version of the manuscript. All authors, either LDa, CN, LDe, CV, JC, PL, HC, KZ, SH, EJ and CA, then contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Laurence Daigle.

Ethics declarations

Ethics approval and consent to participate

Experts and professionals were asked for complementary information regarding existing monitoring programs run by their organizations. The respondents were not asked about their opinion of the program and we did not gather any personal information. Collecting this type of information does not require ethical approval in Canada, as these programs are in the public domain and the individuals who participated have no reasonable expectation of privacy (see Article 2.2: https://ethics.gc.ca/eng/tcps2-eptc2_2018_chapter2-chapitre2.html).

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Daigle, L., Nury, C., Delesalle, L. et al. A call for a coherent One Health strategy for the surveillance of climate-sensitive infectious diseases in the Canadian Arctic and subarctic regions. One Health Outlook 6, 25 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s42522-024-00117-5

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Keywords

One Health Outlook

ISSN: 2524-4655