Prioritization of Zoonotic Diseases in Malawi Using a Multisectoral One Health Approach: Outcomes and Future Directions

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Recognizing the increasing risks of emerging and re-emerging zoonoses, Malawi conducted its first multisectoral One Health Zoonotic Disease Prioritization (OHZDP) workshop utilizing the OHZDP tool developed by the United States Centres for Disease Control and Prevention (US CDC). Prioritizing zoonotic diseases of national importance is essential for strengthening prevention, early detection, and control efforts, particularly in resource-limited settings like Malawi. This workshop aimed to prioritize zoonotic diseases of greatest concern to Malawi using a One Health approach and to develop corresponding action plans to enhance multisectoral preparedness and response. Methods Using the OHZDP tool, stakeholders from the environment, public health, and animal health sectors jointly identified 23 zoonotic diseases of national relevance. Participants at the OHZDP workshop collectively developed ranking criteria, which included disease severity, epidemic potential, presence and extent of disease spread in the country, environmental and socio-economic impact, and availability of capacity for prevention. Associated questions were developed for each criterion and weighted accordingly. A decision-tree analysis and normalized scoring system were used to generate the final list of ranked priority zoonotic diseases. Results Of the 23 zoonotic diseases evaluated, ten were selected as top priorities for Malawi. These include rabies, salmonellosis, zoonotic tuberculosis, anthrax, viral haemorrhagic fevers, schistosomiasis (haematobium), African trypanosomiasis, cysticercosis, zoonotic avian influenza and Mpox. Rabies received the highest weight, making it the disease with the highest priority. Key recommendations included strengthening One Health governance structures, enhancing zoonotic disease surveillance systems, expanding laboratory diagnostic capacity, improving outbreak preparedness and response mechanisms, and advancing workforce development and risk communication strategies across sectors. Conclusions This exercise represents the first nationally endorsed prioritization of zoonotic diseases in Malawi using a One Health, semi-quantitative, and participatory methodology. The outcomes provide a strategic framework to guide policymakers, relevant stakeholders, and development partners in formulating, implementing, and monitoring coordinated interventions for zoonotic disease control, thereby improving health security at the human-animal-environment interface in Malawi. Zoonotic Diseases One Health Prioritization Malawi Workshop Report Public Health Rabies Anthrax Tuberculosis Figures Figure 1 Figure 2 Introduction Zoonotic diseases represent one of the most significant threats to global health security, with an estimated six out of ten known infectious diseases in humans being zoonotic in origin, while over 70% of newly emerging pathogens originate from animal reservoirs, including wildlife [ 1 , 2 ]. These diseases not only pose serious threats to human health but also affect animal health through illness and mortality, undermine food security and livelihoods, and can trigger major socio-economic disruptions, particularly in low- and middle-income countries (LMICs) [ 3 , 4 ]. Malawi, like many other sub-Saharan African nations, experiences a high level of interaction at the human-animal-environment interface due to its reliance on agriculture, livestock production, and close community proximity to wildlife ecosystems. These interactions significantly heighten the risk of zoonotic spillover events, especially within vulnerable rural populations where approximately 80% of the country’s population resides and depends on agriculture for their livelihoods. Furthermore, climatic shocks, such as the recurrent tropical cyclones and floods experienced in recent years, have exacerbated these risks by increasing human and animal exposure to contaminated water and environments, further intensifying the transmission of waterborne zoonotic pathogens such as Leptospira spp. , already endemic in parts of Southern Africa [ 5 , 6 , 7 ] Despite these realities, Malawi's routine surveillance systems have historically focused on endemic communicable diseases, including HIV, tuberculosis, and malaria, with zoonotic diseases often under-reported or undetected at endemic levels [ 8 ]. This surveillance gap is clearly exemplified by rabies, which remains a major public health concern despite being entirely preventable through vaccination. Between 2018 and 2023, Malawi recorded hundreds of dog bite cases annually, with rabies-related deaths still occurring despite the availability of post-exposure prophylaxis (PEP) [ 9 ]. Similarly, other zoonotic diseases such as anthrax, brucellosis, and zoonotic tuberculosis continue to affect both human and animal populations, yet their true burden remains poorly quantified due to limited surveillance and diagnostic capacity. The economic burden of neglected zoonotic diseases like anthrax, brucellosis, and zoonotic tuberculosis remains poorly quantified, representing a substantial gap in health sector planning and resource allocation [ 10 ]. This lack of systematic prioritization has hindered effective resource allocation and coordinated response planning across sectors, limiting the country’s ability to implement targeted interventions where they are most needed. Addressing these gaps requires strengthening multisectoral coordination and building consensus on national priorities. Prior to 2024, Malawi faced significant challenges in aligning human, animal, and environmental health responses due to sectoral silos and limited coordination mechanisms. These challenges were also highlighted in the country’s 2019 Joint External Evaluation (JEE), which underscored the need for an integrated One Health approach to enhance preparedness and response capacities for zoonotic diseases [ 11 ]. The JEE specifically recommended the development of multisectoral coordination mechanisms and the establishment of priority-setting processes to guide resource allocation and intervention planning. In direct response to these identified gaps and JEE recommendations, Malawi convened a One Health Zoonotic Disease Prioritization (OHZDP) workshop from August 27–30, 2024, in Lilongwe. This landmark workshop brought together key stakeholders and experts representing the human health, animal health (livestock and wildlife), and environmental health sectors, along with other relevant partner organizations. The primary goal was to prioritize the zoonotic diseases posing the greatest concern to Malawi, utilizing a structured, transparent, multisectoral One Health approach that ensured equitable input from all participating sectors. The specific objectives of this prioritization exercise were threefold: 1) to establish a consensus list of priority zoonotic diseases for Malawi based on scientific evidence and expert judgment; 2) to develop initial next steps and action plans for collaborative interventions targeting these priority diseases; and 3) to build in-country capacity by training local partners from key One Health sectors on the standardized OHZDP methodology for potential future use. This exercise represents the first systematic, nationally endorsed effort to prioritize zoonotic diseases in Malawi and provides a foundation for evidence-based resource allocation and coordinated multisectoral response planning. Materials and Methods This paper reports the process and outcomes of a One Health Zoonotic Disease Prioritization (OHZDP) workshop conducted in Lilongwe, Malawi, from August 27–29, 2024. The methodology employed the OHZDP tool, a semi-quantitative, mixed-methods approach developed by the U.S. Centres for Disease Control and Prevention (CDC) One Health Office to assist countries in prioritizing endemic and emerging zoonotic diseases for surveillance, research, and control efforts using a multisectoral perspective. Workshop Objectives and Stakeholder Engagement The workshop's primary objective was to prioritize zoonotic diseases of greatest national significance using a standardized, transparent multisectoral One Health approach with equal contributions from representatives of human, animal (livestock and wildlife), and environmental health sectors, as well as other relevant stakeholders. Participants included representatives from key government ministries and departments: Ministry of Health (MOH), Department of Animal Health and Livestock Development (DAHLD), Department of National Parks and Wildlife (DNPW), Public Health Institute of Malawi (PHIM), Environmental Affairs Department (EAD), Department of Forestry, and Ministry of Water and Sanitation. Academic institutions, non-governmental organizations, and international partners including FAO, WHO, Africa CDC, and the U.S. CDC also participated to ensure comprehensive expertise and perspective. Refer to Appendix A for the full list of participating institutions Participation in the workshop was strategically designed to be diverse and inclusive, ensuring representation from all key One Health sectors. Figure 1 illustrates the comprehensive stakeholder composition achieved during the workshop, demonstrating balanced participation across all relevant sectors. The stakeholder composition included NGOs and development partners (FAO, WHO, Africa CDC, Fleming Fund, LWT, African Parks, Trustees), human health sector (PHIM, Clinical, IHR, US CDC, AMRNCC), animal health sector (DAHLD), environmental sector (Environmental Affairs, Forestry, Wildlife, Water), and academia (LUANAR, MUST, KUHeS). This inclusive stakeholder representation promoted balanced multisectoral contributions, enhancing the legitimacy and collective ownership of the disease prioritization outcomes while ensuring that all relevant perspectives were incorporated into the decision-making process. OHZDP Methodology Implementation The workshop implemented the CDC's Five-Step One Health Zoonotic Disease Prioritization Process, a systematic approach that encompasses: (1) preparation and stakeholder engagement, (2) development of prioritization criteria, (3) formulation of categorical questions for scoring, (4) ranking of criteria by voting members, and (5) prioritization of zoonotic diseases based on weighted scoring. Figure 2 provides a graphical representation of this systematic five-step process as implemented in Malawi. This structured framework facilitated transparent, evidence-based multisectoral deliberations to identify and rank Malawi’s priority zoonotic diseases. The approach ensured equal input from human, animal, and environmental health sectors was integrated into consensus-driven decision making and action planning for zoonotic disease threats. The process resulted in consensus building and the development of multisectoral action plans, demonstrating the practical application of One Health principles in national priority-setting exercises. Workshop Preparation and Disease Selection Preparations involved extensive collaboration between Malawian government ministries (Health, Agriculture, Natural Resources/Climate Change, Water/Sanitation), international partners (including FAO, WHO, Africa CDC, US CDC), and local organizations. Participants included senior government officials as voting members at director-level from the key ministries/departments, advisors/observers from relevant technical organizations and academic institutions, and trained local and external facilitators. Six local facilitators were trained by Africa CDC with support from FAO to ensure effective facilitation across all sectors. As part of the preparatory phase, a comprehensive literature review was conducted to identify zoonotic diseases previously recognized in Malawi or reported in the region. This review drew on national notifiable disease lists, peer-reviewed publications, and regional and global reports. Based on their known or potential occurrence in Malawi, a total of 23 zoonotic diseases were shortlisted for prioritization during the workshop. Over 50 references were compiled and shared with participants before the workshop to ensure evidence-based scoring and decision-making during the workshop. Criteria Development and Scoring Methodology During the workshop, participants collaboratively developed five criteria for prioritizing diseases through structured group discussions: disease severity, epidemic potential, presence and coverage of the disease in Malawi, environmental and socio-economic impact, and ability to prevent and control the disease. For each criterion, a corresponding categorical question was formulated with ordinal, binomial, or multinomial answer choices, each assigned a score based on perceived importance and impact. Voting members individually ranked the relative importance of each criterion through a structured voting process. Their rankings were entered into the OHZDP tool, and a group weight for each criterion was calculated based on multicriteria decision analysis using the Analytical Hierarchical Process (AHP). This ensured that the final prioritization reflected the collective judgment of all participating sectors. Drawing from the evidence gathered during the pre-workshop comprehensive literature review, which included data from national and regional sources, facilitators and participants systematically answered the prioritization questions for each of the 23 zoonotic diseases. Where Malawi-specific data were unavailable, regional or global data were used as proxies. After answering all questions for each disease, the OHZDP decision tree analysis was applied. The weighted scores from each criterion were summed and normalized to a maximum score of 1.0, allowing for direct comparison across all diseases. The zoonotic diseases were then ranked based on these normalized scores, providing an initial technical ranking for further discussion. Consensus Building and Final Selection Following the technical scoring, participants engaged in structured group discussions to review the raw and normalized scores and reach consensus on the final list of prioritized zoonotic diseases. This consensus process allowed for the integration of contextual factors, implementation feasibility, and local expertise that may not have been fully captured in the technical scoring. The final prioritization balanced technical scores with practical considerations such as existing surveillance capacity, available interventions, and resource requirements. After finalizing the priority disease list, participants developed multisectoral next steps and action plans for addressing the top-ranked zoonotic diseases through collaborative One Health approaches, ensuring that the prioritization exercise would translate into actionable interventions. Results Prioritization Criteria and Weighting The workshop participants identified and ranked five criteria for prioritizing zoonotic diseases of national significance in Malawi. Table 1 presents these criteria in order of importance, along with their assigned weights and corresponding evaluation questions. Table 1 One Health Zoonotic Disease Prioritization Criteria Developed for Malawi Rank Criteria Weight Question and Description Answer Options Scores 1 Disease severity 0.385 What is the clinical impact of the disease in both animals and humans? Assessed using case fatality, Case Fatality Rate (CFR), hospitalization duration (> 3 days), unavailability of treatment, and presence of complications. A. All 4 assumptions (CFR > 30% in animals or > 10% in humans) B. 3 of the assumptions C. 2 of the assumptions D. 1 A. 4 B. 3 C. 2 D. 1 2 Epidemic potential 0.19 Has the disease caused an outbreak in humans and/or animals in Malawi or the region in the past 5 years? A. Both in animals and humans B. In humans only C. In animals only D. None A. 4 B. 3 C. 2 D. 1 3 Presence and coverage of disease 0.18 Has the disease been reported in humans and/or animals in Malawi or the region in the past 5 years? A. Yes, in Malawi and the region B. Yes, in Malawi only C. Yes, in the region only D. None A. 4 B. 3 C. 2 D. 1 4 Environmental and socio-economic impact 0.16 Does the disease have an impact on the environment and socio-economy of the country? A. Impact on all elements (environmental and socio-economic) B. Impact on two elements C. Impact on one element D. No impact A. 4 B. 3 C. 2 D. 1 5 Ability to prevent 0.085 How many of the following prevention capabilities are not available for the zoonotic disease in humans or animals: Surveillance and laboratory capacity, control or interventions in humans, control or interventions in animals, capacity to respond to human outbreaks, capacity to respond to animal outbreaks A. All unavailable B. 4 of the above unavailable C. 1–2 unavailable D. None unavailable A. 4 B. 3 C. 2 D. 1 These criteria guided the systematic scoring of all 23 zoonotic diseases during the prioritization process, ensuring that decisions were evidence-based, transparent, and context-specific to Malawi's One Health priorities. Technical Scoring Results All 23 zoonotic diseases were systematically evaluated using the prioritization criteria and scoring methodology. Table 2 presents the preliminary technical scoring results, showing raw scores and normalized final scores for all diseases considered during the workshop. Table 2 Preliminary Technical Scoring Results for All 23 Zoonotic Diseases Rank Disease Etiologic Agent Raw Score Normalized Score 1 Rabies Rabies Virus 1.223 1.000 2 COVID-19 SARS-CoV-2 1.211 0.990 3 Salmonellosis Salmonella enteritidis 1.094 0.895 4 African trypanosomiasis Trypanosoma brucei rhodesiense 1.094 0.895 5 Ebola hemorrhagic fever Ebola virus 1.072 0.876 6 Zoonotic Tuberculosis Mycobacterium bovis 1.047 0.856 7 Anthrax Bacillus anthracis 1.017 0.832 8 Yellow fever Yellow Fever Virus 1.012 0.827 9 Plague Yersinia pestis 1.002 0.819 10 Leptospirosis Leptospira spp. 0.977 0.799 11 Zoonotic Avian Influenza Influenza A viruses 0.971 0.794 12 Mpox Mpox virus 0.965 0.789 13 Crimean-Congo Hemorrhagic Fever Crimean-Congo Hemorrhagic Fever Virus 0.906 0.741 14 Rift Valley fever Rift Valley Fever Virus 0.854 0.698 15 Schistosomiasis Schistosoma haematobium 0.772 0.631 16 Toxoplasmosis Toxoplasma gondii 0.629 0.515 17 Cysticercosis Taenia solium 0.590 0.482 18 Q fever Coxiella burnetii 0.562 0.460 19 Brucellosis Brucella abortus 0.548 0.448 20 Zoonotic Swine Influenza Influenza A viruses 0.548 0.448 21 Zika Zika Virus 0.543 0.444 22 Echinococcosis Echinococcus granulosus 0.526 0.430 23 Cysticercosis Taenia saginata 0.473 0.387 Consensus-Based Final Prioritization Following the technical scoring, workshop participants engaged in structured discussions to develop the final consensus-based priority list. While the technical scores provided an important foundation, the consensus process allowed for integration of additional factors including existing surveillance and response capacity, availability of interventions, resource requirements, and strategic alignment with national health priorities. Notably, while COVID-19 received the second-highest technical score, it was excluded from the final priority list due to existing robust surveillance and response systems already established in Malawi, as well as substantial ongoing international support for COVID-19 preparedness and response activities. This decision reflects the workshop’s focus on identifying diseases requiring enhanced attention and resource allocation. The final prioritized list resulting from this consensus process is presented in Table 3 . Table 3 Final Consensus Priority List of Zoonotic Diseases for Malawi Rank Zoonotic Disease Key Rationale for Prioritization 1 Rabies • Highest technical score • High human and animal burden • Endemic with preventable deaths • Effective vaccines available but access limited 2 Salmonellosis • High technical score • Common foodborne illness • Endemic in poultry and humans • Significant economic impact 3 Zoonotic Tuberculosis • High technical score • Prevalent in cattle • Emerging cases in humans • Limited surveillance capacity 4 Anthrax • High technical score • Wildlife and livestock outbreaks reported • Zoonotic risk to humans 5 Viral Haemorrhagic Fevers • High technical score • Regional threat (Ebola, Yellow Fever) • Pandemic potential • Vaccines exist for some 6 Schistosomiasis • Moderate technical score • High burden in humans and livestock (Cattle) • Preventive chemotherapy available 7 African Trypanosomiasis • Moderate technical score • High burden in humans and livestock Moderate technical score • Moderate livestock prevalence• • Endemic in Malawi 8 Cysticercosis • Moderate technical score • Moderate livestock prevalence • Potential for severe human disease (neurocysticercosis) 9 Zoonotic Avian Influenza • High technical score • Regional presence • Global pandemic potential • Limited surveillance 10 Mpox • Moderate technical score • 27 human cases reported thus far. This final list of ten priority zoonotic diseases represents a balanced approach that considers both technical scoring results and practical implementation factors, providing a strategic foundation for Malawi's One Health interventions and resource allocation decisions. Refer to Appendix B for the epidemiological profiles of the diseases in both animals and humans Multisectoral Action Planning To translate the prioritization results into actionable interventions, workshop participants developed comprehensive recommendations organized around six key thematic areas. Table 4 presents the proposed multisectoral actions to address the priority zoonotic diseases in Malawi [ 12 ]. Table 4 Proposed Multisectoral Actions for Priority Zoonotic Disease Management in Malawi Strategic Action Thematic Area Responsible Sectors Timeline Establish and institutionalize a functional One Health governance structure with a national strategy One Health Coordination MOH, MOA, MNR&CC 6–12 months Develop a centralized national surveillance platform for zoonotic diseases Surveillance Capacity MOH, MOA, MNR&CC, MoWS, DNPW 12–18 months Enhance laboratory diagnostic capacity, recruit qualified technicians, and upgrade laboratory infrastructure Laboratory Capacity MOH, MOA, MNR&CC 12–24 months Strengthen outbreak response mechanisms and conduct joint multisectoral investigations Outbreak Response One Health Platform, MOH, MOA, MNR&CC 6–12 months Conduct multisectoral preparedness planning, including simulation exercises Preparedness and Planning One Health Platform 6–18 months Build the One Health workforce through accredited training programs and curriculum integration Workforce Development MOH, MOA, MNR&CC 12–36 months Improve community engagement, awareness, and risk communication Risk Communication MOH, DAHLD, DNPW, MNR&CC Ongoing Promote operational and implementation research to address zoonotic disease risks Research MOH, MOA, MNR&CC, MoWS 12–24 months MOH = Ministry of Health; MOA = Ministry of Agriculture; MNR&CC = Ministry of Natural Resources and Climate Change; MoWS = Ministry of Water and Sanitation; DNPW = Department of National Parks and Wildlife; DAHLD = Department of Animal Health and Livestock Development These action plans provide a roadmap for implementing coordinated, multisectoral interventions to address the prioritized zoonotic diseases and strengthen Malawi's overall One Health capacity for disease prevention, detection, and response. Discussion The implementation of the One Health Zoonotic Disease Prioritization (OHZDP) process in Malawi represents a significant milestone in the country's efforts to strengthen national capacities for the prevention, detection, and control of zoonotic diseases. By engaging stakeholders from environmental, human, and animal health sectors in a structured, evidence-based process, Malawi succeeded in establishing a transparent, participatory approach to prioritize zoonotic diseases of greatest national concern. This inclusive methodology resulted in the identification of ten priority zoonotic diseases and the development of strategic action plans to strengthen multisectoral coordination, surveillance systems, laboratory capacity, and outbreak response mechanisms. Alignment with Regional and Global Experiences Malawi's OHZDP experience aligns closely with similar exercises conducted across Africa and other regions, while also reflecting unique national priorities and contexts. Like experiences in Kenya and Ethiopia, where OHZDP processes facilitated greater integration between health and veterinary sectors [ 13 ], Malawi's workshop emphasized the critical need for institutionalized One Health frameworks that ensure sustainable multisectoral collaboration beyond individual projects or initiatives. The prioritization of rabies as the top concern mirrors findings from several other African countries, reflecting the continent-wide burden of this preventable disease. Nigeria's regional OHZDP efforts under the Economic Community of West African States (ECOWAS) similarly highlighted rabies as a priority and emphasized the importance of establishing real-time data sharing platforms and joint outbreak investigation teams [ 14 ]. These lessons directly informed Malawi's proposed surveillance and response strategies, particularly the emphasis on integrated reporting systems and coordinated response mechanisms. Mozambique's OHZDP experience demonstrated the transformative impact of workforce development and laboratory strengthening in improving zoonotic disease detection and management [ 15 ]. Malawi's action plans place significant emphasis on building technical capacity through targeted training programs and upgrading laboratory infrastructure, reflecting these regional lessons learned. The inclusion of academic institutions in Malawi's stakeholder engagement also mirrors successful approaches in Mozambique, where university partnerships proved crucial for sustainable capacity building. Jordan's prioritization experience in the Middle East underscored the importance of standardized data sharing mechanisms and event-based surveillance systems to enable faster detection and control of zoonotic events [ 16 ]. These principles are embedded throughout Malawi’s next steps, particularly in the proposed development of centralized surveillance platforms and standardized case definitions for priority diseases. Unique Aspects of Malawi's Approach Several aspects of Malawi’s OHZDP process distinguish it from other country experiences and reflect specific national contexts and priorities. The explicit inclusion of environmental factors in the prioritization criteria reflects Malawi’s recognition of climate change impacts on disease transmission, particularly relevant given the country’s vulnerability to extreme weather events and their effects on waterborne diseases like leptospirosis and vector-borne diseases. The decision to exclude COVID-19 from the final priority list, despite its high technical score was based on the existence of robust, dedicated national surveillance and response systems. This pragmatic approach allowed the focus to remain on identifying neglected zoonotic diseases that require additional resources and coordination, rather than ranking all diseases by their current burden. The process also recognized the opportunity to leverage substantial investments made during the pandemic such as molecular diagnostic equipment, surveillance networks, and trained personnel to strengthen the detection and control of other priority zoonotic diseases, including avian influenza and viral haemorrhagic fevers. Adapting these existing capacities through coordinated efforts will be key to the efficient and cost-effective implementation of One Health action plans. The strong emphasis on community engagement and risk communication in Malawi’s action plans reflects the country’s experience with community-based health interventions and recognition of the critical role of community participation in zoonotic disease prevention and control, particularly in rural areas where human-animal interactions are most intensive. Implementation Challenges and Considerations Despite the significant achievements of the prioritization process, several challenges must be acknowledged in interpreting and implementing these results. Data availability varied considerably across sectors, with environmental health data being particularly limited compared to human and animal health information. This data gap may have influenced scoring for diseases with significant environmental components and highlights the need for strengthened environmental surveillance and monitoring systems. The scoring process, while systematic and transparent, necessarily involved subjective expert judgment that may reflect current knowledge gaps rather than actual disease burden or transmission risk. For diseases with limited surveillance data, such as some viral haemorrhagic fevers, the prioritization may reflect perceived rather than documented risk, emphasizing the importance of enhanced surveillance to validate these assessments. Resource constraints represent a persistent challenge for implementation of the proposed action plans. While the prioritization provides strategic direction, successful implementation will require sustained political commitment, adequate funding, and continued multisectoral coordination. The workshop's emphasis on developing an investment case and resource mobilization strategy reflects recognition of these challenges. The technical focus of the prioritization process, while scientifically rigorous, may not fully capture community perspectives or cultural factors that influence disease transmission and control effectiveness. Future prioritization exercises should consider incorporating community-based participatory approaches to complement technical assessments. A further consideration is the potential for regional variations in disease prevalence and risk within Malawi. The prioritization exercise produced a national-level list, which may not fully capture the diverse local contexts shaped by climatic, sociological, and economic differences across the country. Future implementation of the strategic action plans should incorporate regional-level assessments to tailor interventions to local needs and priorities, ensuring that resources are allocated effectively to address the specific zoonotic disease threats in different parts of the country. Strategic Implications and Future Directions The outcomes of Malawi's OHZDP process have several important strategic implications for national health security and regional One Health initiatives. The establishment of a nationally endorsed priority list provides a foundation for evidence-based resource allocation and policy development, enabling more targeted and coordinated interventions across sectors. The emphasis on governance and coordination mechanisms addresses fundamental structural challenges that have historically limited effective multisectoral collaboration in Malawi. The proposed One Health governance structure, if successfully implemented, could serve as a model for other countries facing similar coordination challenges. The integration of workforce development and capacity building into the action plans recognizes that sustainable improvements in zoonotic disease management require long-term investments in human resources and institutional capacity. The proposed partnerships with academic institutions provide a foundation for sustainable capacity development beyond short-term project cycles. Looking forward, successful implementation of the proposed actions will require regular monitoring and evaluation to assess progress and adapt strategies based on emerging evidence and changing circumstances. The prioritization should be viewed as a living document that can be updated as surveillance capacity improves, and new data become available. The regional implications of Malawi's experience are significant, as the country’s approach and lessons learned can inform similar exercises in neighbouring countries and contribute to regional harmonization of One Health approaches. The emphasis on standardized methodologies and evidence-based decision-making provides a foundation for regional coordination and mutual support. Conclusion Using the CDC One Health Zoonotic Disease Prioritization (OHZDP) tool, Malawi successfully conducted its first systematic, nationally endorsed prioritization of zoonotic diseases through a transparent and multisectoral One Health approach. This landmark exercise facilitated unprecedented collaboration among environmental, human, and animal health sectors, establishing a foundation for enhanced surveillance, outbreak preparedness, and coordinated response to zoonotic disease threats. The identification of ten priority zoonotic diseases led by rabies, salmonellosis, and zoonotic tuberculosis provides strategic direction for resource allocation and intervention planning. The comprehensive action plans developed through this process address critical gaps in One Health governance, surveillance capacity, laboratory diagnostics, outbreak response, workforce development, and risk communication. This prioritization exercise represents more than a technical ranking of diseases; it embodies a paradigm shift toward evidence-based, multisectoral decision-making for health security in Malawi. The process has strengthened relationships across sectors, built local capacity in One Health methodologies, and established a framework for ongoing collaboration and coordination. Moving forward, the success of this initiative will depend on sustained political commitment, adequate resource mobilization, and continued multisectoral collaboration. The foundation established through this prioritization process provides an unprecedented opportunity to transform Malawi's approach to zoonotic disease management and enhance health security at the human-animal-environment interface. Abbreviations Africa CDC Africa Centres for Disease Control and Prevention AHP Analytical Hierarchical Process AMRNCC Antimicrobial Resistance National Coordinating Centre CDC Centers for Disease Control and Prevention DAHLD Department of Animal Health and Livestock Development DNPW Department of National Parks and Wildlife DoF Department of Forestry DoS Department of Sanitation EAD Environmental Affairs Department FAO Food and Agriculture Organization of the United Nations IHR International Health Regulations JEE Joint External Evaluation KUHeS Kamuzu University of Health Sciences LMICs Low- and Middle-Income Countries LUANAR Lilongwe University of Agriculture and Natural Resources MOH Ministry of Health MUST Malawi University of Science and Technology NHSRC National Health Sciences Research Committee NRCM National Research Council of Malawi OHZDP One Health Zoonotic Disease Prioritization PEP Post-Exposure Prophylaxis PHIM Public Health Institute of Malawi US CDC United States Centers for Disease Control and Prevention WHO World Health Organization Declarations Compliance with Ethical Standards This study did not involve human participants, patient data, or experimental interventions, and therefore, was conducted in accordance with the ethical principles of the Declaration of Helsinki. It was based entirely on expert consultations and a consensus-building workshop methodology. Institutional oversight and approval for the conduct of the workshop and associated data collection were provided by the National Health Sciences Research Committee (NHSRC) and the National Research Council of Malawi (NRCM) through the One Health Platform in Malawi, coordinated by the Public Health Institute of Malawi (PHIM), the Department of Animal Health and Livestock Development (DAHLD), and the Environmental Affairs Department (EAD). As the study did not constitute a clinical trial, a clinical trial number is not applicable. Availability of Data and Materials The database generated and analysed during the prioritization process, including detailed scoring matrices and supporting documentation, is available from the Public Health Institute of Malawi (PHIM) and can be requested through the One Health coordinating mechanisms. Workshop materials, including the adapted prioritization tool and stakeholder engagement protocols, are available to support similar exercises in other countries upon request to the corresponding author. Funding This workshop and related activities were supported by in-kind contributions from participating organizations, with technical and logistical support provided by the U.S. Centers for Disease Control and Prevention (CDC), the Food and Agriculture Organization of the United Nations (FAO), and Africa Centres for Disease Control and Prevention (Africa CDC). No specific grant funding was awarded for this work. The views expressed in this publication are those of the authors and do not necessarily reflect the official policies or positions of the supporting organizations. Declaration of Competing Interests The authors and contributors declare that there are no competing financial or non-financial interests related to this prioritization exercise. All participants contributed their expertise in their professional capacities to support national public health objectives without personal financial benefit. Consent to Publish Declaration Consent to publish was formally obtained from the National Health Sciences Research Committee (NHSRC) where PHIM assumes secretariat role. The NHSRC reviewed the manuscript and provided written authorization for publication of the findings arising from the national One Health Zoonotic Disease Prioritization workshop. This consent covers the use of anonymized workshop data and expert consultations collected during the exercise, as well as the dissemination of disease prioritization findings, system performance assessments, and recommendations at national. Acknowledgments The organizing team acknowledges the invaluable contributions of the Public Health Institute of Malawi (PHIM), Department of Animal Health and Livestock Development (DAHLD), Environmental Affairs Department (EAD), Department of National Parks and Wildlife (DNPW), the Ministry of Water and Sanitation, and all One Health stakeholders who participated in this landmark exercise. Special recognition goes to the US CDC, FAO, and Africa CDC for their technical expertise and methodological support. We thank the local facilitators who underwent training to support this process and the international experts who provided guidance throughout the workshop. The commitment and expertise of all participants made this first national zoonotic disease prioritization exercise in Malawi a success. 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Lilongwe: MoH-Epidemiology Unit; 2025. Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Feb, 2026 Submission checks completed at journal 23 Oct, 2025 First submitted to journal 22 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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13:56:03","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20152,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-6864950/v1/7fb62e98dcd572794bb9976c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prioritization of Zoonotic Diseases in Malawi Using a Multisectoral One Health Approach: Outcomes and Future Directions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eZoonotic diseases represent one of the most significant threats to global health security, with an estimated six out of ten known infectious diseases in humans being zoonotic in origin, while over 70% of newly emerging pathogens originate from animal reservoirs, including wildlife [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These diseases not only pose serious threats to human health but also affect animal health through illness and mortality, undermine food security and livelihoods, and can trigger major socio-economic disruptions, particularly in low- and middle-income countries (LMICs) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMalawi, like many other sub-Saharan African nations, experiences a high level of interaction at the human-animal-environment interface due to its reliance on agriculture, livestock production, and close community proximity to wildlife ecosystems. These interactions significantly heighten the risk of zoonotic spillover events, especially within vulnerable rural populations where approximately 80% of the country\u0026rsquo;s population resides and depends on agriculture for their livelihoods. Furthermore, climatic shocks, such as the recurrent tropical cyclones and floods experienced in recent years, have exacerbated these risks by increasing human and animal exposure to contaminated water and environments, further intensifying the transmission of waterborne zoonotic pathogens such as \u003cem\u003eLeptospira spp.\u003c/em\u003e, already endemic in parts of Southern Africa [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eDespite these realities, Malawi's routine surveillance systems have historically focused on endemic communicable diseases, including HIV, tuberculosis, and malaria, with zoonotic diseases often under-reported or undetected at endemic levels [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This surveillance gap is clearly exemplified by rabies, which remains a major public health concern despite being entirely preventable through vaccination. Between 2018 and 2023, Malawi recorded hundreds of dog bite cases annually, with rabies-related deaths still occurring despite the availability of post-exposure prophylaxis (PEP) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Similarly, other zoonotic diseases such as anthrax, brucellosis, and zoonotic tuberculosis continue to affect both human and animal populations, yet their true burden remains poorly quantified due to limited surveillance and diagnostic capacity.\u003c/p\u003e\u003cp\u003eThe economic burden of neglected zoonotic diseases like anthrax, brucellosis, and zoonotic tuberculosis remains poorly quantified, representing a substantial gap in health sector planning and resource allocation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This lack of systematic prioritization has hindered effective resource allocation and coordinated response planning across sectors, limiting the country\u0026rsquo;s ability to implement targeted interventions where they are most needed.\u003c/p\u003e\u003cp\u003eAddressing these gaps requires strengthening multisectoral coordination and building consensus on national priorities. Prior to 2024, Malawi faced significant challenges in aligning human, animal, and environmental health responses due to sectoral silos and limited coordination mechanisms. These challenges were also highlighted in the country\u0026rsquo;s 2019 Joint External Evaluation (JEE), which underscored the need for an integrated One Health approach to enhance preparedness and response capacities for zoonotic diseases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The JEE specifically recommended the development of multisectoral coordination mechanisms and the establishment of priority-setting processes to guide resource allocation and intervention planning.\u003c/p\u003e\u003cp\u003eIn direct response to these identified gaps and JEE recommendations, Malawi convened a One Health Zoonotic Disease Prioritization (OHZDP) workshop from August 27\u0026ndash;30, 2024, in Lilongwe. This landmark workshop brought together key stakeholders and experts representing the human health, animal health (livestock and wildlife), and environmental health sectors, along with other relevant partner organizations. The primary goal was to prioritize the zoonotic diseases posing the greatest concern to Malawi, utilizing a structured, transparent, multisectoral One Health approach that ensured equitable input from all participating sectors.\u003c/p\u003e\u003cp\u003eThe specific objectives of this prioritization exercise were threefold: 1) to establish a consensus list of priority zoonotic diseases for Malawi based on scientific evidence and expert judgment; 2) to develop initial next steps and action plans for collaborative interventions targeting these priority diseases; and 3) to build in-country capacity by training local partners from key One Health sectors on the standardized OHZDP methodology for potential future use. This exercise represents the first systematic, nationally endorsed effort to prioritize zoonotic diseases in Malawi and provides a foundation for evidence-based resource allocation and coordinated multisectoral response planning.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis paper reports the process and outcomes of a One Health Zoonotic Disease Prioritization (OHZDP) workshop conducted in Lilongwe, Malawi, from August 27\u0026ndash;29, 2024. The methodology employed the OHZDP tool, a semi-quantitative, mixed-methods approach developed by the U.S. Centres for Disease Control and Prevention (CDC) One Health Office to assist countries in prioritizing endemic and emerging zoonotic diseases for surveillance, research, and control efforts using a multisectoral perspective.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eWorkshop Objectives and Stakeholder Engagement\u003c/h2\u003e\u003cp\u003eThe workshop's primary objective was to prioritize zoonotic diseases of greatest national significance using a standardized, transparent multisectoral One Health approach with equal contributions from representatives of human, animal (livestock and wildlife), and environmental health sectors, as well as other relevant stakeholders.\u003c/p\u003e\u003cp\u003eParticipants included representatives from key government ministries and departments: Ministry of Health (MOH), Department of Animal Health and Livestock Development (DAHLD), Department of National Parks and Wildlife (DNPW), Public Health Institute of Malawi (PHIM), Environmental Affairs Department (EAD), Department of Forestry, and Ministry of Water and Sanitation. Academic institutions, non-governmental organizations, and international partners including FAO, WHO, Africa CDC, and the U.S. CDC also participated to ensure comprehensive expertise and perspective. Refer to Appendix A for the full list of participating institutions\u003c/p\u003e\u003cp\u003eParticipation in the workshop was strategically designed to be diverse and inclusive, ensuring representation from all key One Health sectors. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the comprehensive stakeholder composition achieved during the workshop, demonstrating balanced participation across all relevant sectors.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe stakeholder composition included NGOs and development partners (FAO, WHO, Africa CDC, Fleming Fund, LWT, African Parks, Trustees), human health sector (PHIM, Clinical, IHR, US CDC, AMRNCC), animal health sector (DAHLD), environmental sector (Environmental Affairs, Forestry, Wildlife, Water), and academia (LUANAR, MUST, KUHeS). This inclusive stakeholder representation promoted balanced multisectoral contributions, enhancing the legitimacy and collective ownership of the disease prioritization outcomes while ensuring that all relevant perspectives were incorporated into the decision-making process.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOHZDP Methodology Implementation\u003c/h3\u003e\n\u003cp\u003eThe workshop implemented the CDC's Five-Step One Health Zoonotic Disease Prioritization Process, a systematic approach that encompasses: (1) preparation and stakeholder engagement, (2) development of prioritization criteria, (3) formulation of categorical questions for scoring, (4) ranking of criteria by voting members, and (5) prioritization of zoonotic diseases based on weighted scoring. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides a graphical representation of this systematic five-step process as implemented in Malawi.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThis structured framework facilitated transparent, evidence-based multisectoral deliberations to identify and rank Malawi\u0026rsquo;s priority zoonotic diseases. The approach ensured equal input from human, animal, and environmental health sectors was integrated into consensus-driven decision making and action planning for zoonotic disease threats. The process resulted in consensus building and the development of multisectoral action plans, demonstrating the practical application of One Health principles in national priority-setting exercises.\u003c/p\u003e\n\u003ch3\u003eWorkshop Preparation and Disease Selection\u003c/h3\u003e\n\u003cp\u003ePreparations involved extensive collaboration between Malawian government ministries (Health, Agriculture, Natural Resources/Climate Change, Water/Sanitation), international partners (including FAO, WHO, Africa CDC, US CDC), and local organizations. Participants included senior government officials as voting members at director-level from the key ministries/departments, advisors/observers from relevant technical organizations and academic institutions, and trained local and external facilitators. Six local facilitators were trained by Africa CDC with support from FAO to ensure effective facilitation across all sectors.\u003c/p\u003e\u003cp\u003eAs part of the preparatory phase, a comprehensive literature review was conducted to identify zoonotic diseases previously recognized in Malawi or reported in the region. This review drew on national notifiable disease lists, peer-reviewed publications, and regional and global reports. Based on their known or potential occurrence in Malawi, a total of 23 zoonotic diseases were shortlisted for prioritization during the workshop. Over 50 references were compiled and shared with participants before the workshop to ensure evidence-based scoring and decision-making during the workshop.\u003c/p\u003e\n\u003ch3\u003eCriteria Development and Scoring Methodology\u003c/h3\u003e\n\u003cp\u003eDuring the workshop, participants collaboratively developed five criteria for prioritizing diseases through structured group discussions: disease severity, epidemic potential, presence and coverage of the disease in Malawi, environmental and socio-economic impact, and ability to prevent and control the disease. For each criterion, a corresponding categorical question was formulated with ordinal, binomial, or multinomial answer choices, each assigned a score based on perceived importance and impact.\u003c/p\u003e\u003cp\u003eVoting members individually ranked the relative importance of each criterion through a structured voting process. Their rankings were entered into the OHZDP tool, and a group weight for each criterion was calculated based on multicriteria decision analysis using the Analytical Hierarchical Process (AHP). This ensured that the final prioritization reflected the collective judgment of all participating sectors.\u003c/p\u003e\u003cp\u003eDrawing from the evidence gathered during the pre-workshop comprehensive literature review, which included data from national and regional sources, facilitators and participants systematically answered the prioritization questions for each of the 23 zoonotic diseases. Where Malawi-specific data were unavailable, regional or global data were used as proxies.\u003c/p\u003e\u003cp\u003eAfter answering all questions for each disease, the OHZDP decision tree analysis was applied. The weighted scores from each criterion were summed and normalized to a maximum score of 1.0, allowing for direct comparison across all diseases. The zoonotic diseases were then ranked based on these normalized scores, providing an initial technical ranking for further discussion.\u003c/p\u003e\n\u003ch3\u003eConsensus Building and Final Selection\u003c/h3\u003e\n\u003cp\u003eFollowing the technical scoring, participants engaged in structured group discussions to review the raw and normalized scores and reach consensus on the final list of prioritized zoonotic diseases. This consensus process allowed for the integration of contextual factors, implementation feasibility, and local expertise that may not have been fully captured in the technical scoring. The final prioritization balanced technical scores with practical considerations such as existing surveillance capacity, available interventions, and resource requirements.\u003c/p\u003e\u003cp\u003eAfter finalizing the priority disease list, participants developed multisectoral next steps and action plans for addressing the top-ranked zoonotic diseases through collaborative One Health approaches, ensuring that the prioritization exercise would translate into actionable interventions.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003ePrioritization Criteria and Weighting\u003c/h2\u003e\u003cp\u003eThe workshop participants identified and ranked five criteria for prioritizing zoonotic diseases of national significance in Malawi. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents these criteria in order of importance, along with their assigned weights and corresponding evaluation questions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOne Health Zoonotic Disease Prioritization Criteria Developed for Malawi\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCriteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQuestion and Description\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAnswer Options\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eScores\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisease severity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.385\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWhat is the clinical impact of the disease in both animals and humans? Assessed using case fatality, Case Fatality Rate (CFR), hospitalization duration (\u0026gt;\u0026thinsp;3 days), unavailability of treatment, and presence of complications.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA. All 4 assumptions (CFR\u0026thinsp;\u0026gt;\u0026thinsp;30% in animals or \u0026gt;\u0026thinsp;10% in humans) B. 3 of the assumptions C. 2 of the assumptions D. 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA. 4 B. 3 C. 2 D. 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEpidemic potential\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHas the disease caused an outbreak in humans and/or animals in Malawi or the region in the past 5 years?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA. Both in animals and humans B. In humans only C. In animals only D. None\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA. 4 B. 3 C. 2 D. 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresence and coverage of disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHas the disease been reported in humans and/or animals in Malawi or the region in the past 5 years?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA. Yes, in Malawi and the region B. Yes, in Malawi only C. Yes, in the region only D. None\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA. 4 B. 3 C. 2 D. 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnvironmental and socio-economic impact\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDoes the disease have an impact on the environment and socio-economy of the country?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA. Impact on all elements (environmental and socio-economic) B. Impact on two elements C. Impact on one element D. No impact\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA. 4 B. 3 C. 2 D. 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbility to prevent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHow many of the following prevention capabilities are not available for the zoonotic disease in humans or animals: Surveillance and laboratory capacity, control or interventions in humans, control or interventions in animals, capacity to respond to human outbreaks, capacity to respond to animal outbreaks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA. All unavailable B. 4 of the above unavailable C. 1\u0026ndash;2 unavailable D. None unavailable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA. 4 B. 3 C. 2 D. 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese criteria guided the systematic scoring of all 23 zoonotic diseases during the prioritization process, ensuring that decisions were evidence-based, transparent, and context-specific to Malawi's One Health priorities.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTechnical Scoring Results\u003c/h3\u003e\n\u003cp\u003eAll 23 zoonotic diseases were systematically evaluated using the prioritization criteria and scoring methodology. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the preliminary technical scoring results, showing raw scores and normalized final scores for all diseases considered during the workshop.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePreliminary Technical Scoring Results for All 23 Zoonotic Diseases\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisease\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEtiologic Agent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRaw Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNormalized Score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRabies Virus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.223\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCOVID-19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSARS-CoV-2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.990\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSalmonellosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSalmonella enteritidis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.895\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfrican trypanosomiasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrypanosoma brucei rhodesiense\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.895\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEbola hemorrhagic fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEbola virus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.072\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.876\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZoonotic Tuberculosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMycobacterium bovis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.856\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnthrax\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBacillus anthracis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.832\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYellow fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYellow Fever Virus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePlague\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYersinia pestis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.819\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeptospirosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLeptospira spp.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.977\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.799\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZoonotic Avian Influenza\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInfluenza A viruses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.971\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.794\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMpox\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMpox virus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.965\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.789\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCrimean-Congo Hemorrhagic Fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCrimean-Congo Hemorrhagic Fever Virus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.906\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.741\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRift Valley fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRift Valley Fever Virus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.854\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchistosomiasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSchistosoma haematobium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.772\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.631\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eToxoplasmosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eToxoplasma gondii\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.629\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.515\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCysticercosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTaenia solium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.590\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.482\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCoxiella burnetii\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.562\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.460\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrucellosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBrucella abortus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.548\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.448\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZoonotic Swine Influenza\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInfluenza A viruses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.548\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.448\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZika\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eZika Virus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.543\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEchinococcosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEchinococcus granulosus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.430\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCysticercosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTaenia saginata\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.473\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.387\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eConsensus-Based Final Prioritization\u003c/h2\u003e\u003cp\u003eFollowing the technical scoring, workshop participants engaged in structured discussions to develop the final consensus-based priority list. While the technical scores provided an important foundation, the consensus process allowed for integration of additional factors including existing surveillance and response capacity, availability of interventions, resource requirements, and strategic alignment with national health priorities.\u003c/p\u003e\u003cp\u003eNotably, while COVID-19 received the second-highest technical score, it was excluded from the final priority list due to existing robust surveillance and response systems already established in Malawi, as well as substantial ongoing international support for COVID-19 preparedness and response activities. This decision reflects the workshop\u0026rsquo;s focus on identifying diseases requiring enhanced attention and resource allocation. The final prioritized list resulting from this consensus process is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFinal Consensus Priority List of Zoonotic Diseases for Malawi\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZoonotic Disease\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKey Rationale for Prioritization\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Highest technical score\u003c/p\u003e\u003cp\u003e\u0026bull; High human and animal burden\u003c/p\u003e\u003cp\u003e\u0026bull; Endemic with preventable deaths\u003c/p\u003e\u003cp\u003e\u0026bull; Effective vaccines available but access limited\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSalmonellosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; High technical score\u003c/p\u003e\u003cp\u003e\u0026bull; Common foodborne illness\u003c/p\u003e\u003cp\u003e\u0026bull; Endemic in poultry and humans\u003c/p\u003e\u003cp\u003e\u0026bull; Significant economic impact\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZoonotic Tuberculosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; High technical score\u003c/p\u003e\u003cp\u003e\u0026bull; Prevalent in cattle\u003c/p\u003e\u003cp\u003e\u0026bull; Emerging cases in humans\u003c/p\u003e\u003cp\u003e\u0026bull; Limited surveillance capacity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnthrax\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; High technical score\u003c/p\u003e\u003cp\u003e\u0026bull; Wildlife and livestock outbreaks reported\u003c/p\u003e\u003cp\u003e\u0026bull; Zoonotic risk to humans\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eViral Haemorrhagic Fevers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; High technical score\u003c/p\u003e\u003cp\u003e\u0026bull; Regional threat (Ebola, Yellow Fever)\u003c/p\u003e\u003cp\u003e\u0026bull; Pandemic potential\u003c/p\u003e\u003cp\u003e\u0026bull; Vaccines exist for some\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchistosomiasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Moderate technical score\u003c/p\u003e\u003cp\u003e\u0026bull; High burden in humans and livestock (Cattle)\u003c/p\u003e\u003cp\u003e\u0026bull; Preventive chemotherapy available\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfrican Trypanosomiasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Moderate technical score\u003c/p\u003e\u003cp\u003e\u0026bull; High burden in humans and livestock Moderate technical score\u003c/p\u003e\u003cp\u003e\u0026bull; Moderate livestock prevalence\u0026bull;\u003c/p\u003e \u003cp\u003e\u0026bull; Endemic in Malawi\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCysticercosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Moderate technical score\u003c/p\u003e\u003cp\u003e\u0026bull; Moderate livestock prevalence\u003c/p\u003e\u003cp\u003e\u0026bull; Potential for severe human disease (neurocysticercosis)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZoonotic Avian Influenza\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; High technical score\u003c/p\u003e\u003cp\u003e\u0026bull; Regional presence\u003c/p\u003e\u003cp\u003e\u0026bull; Global pandemic potential\u003c/p\u003e\u003cp\u003e\u0026bull; Limited surveillance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMpox\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Moderate technical score\u003c/p\u003e\u003cp\u003e\u0026bull; 27 human cases reported thus far.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis final list of ten priority zoonotic diseases represents a balanced approach that considers both technical scoring results and practical implementation factors, providing a strategic foundation for Malawi's One Health interventions and resource allocation decisions. Refer to \u003cb\u003eAppendix B\u003c/b\u003e for the epidemiological profiles of the diseases in both animals and humans\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMultisectoral Action Planning\u003c/h2\u003e\u003cp\u003eTo translate the prioritization results into actionable interventions, workshop participants developed comprehensive recommendations organized around six key thematic areas. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the proposed multisectoral actions to address the priority zoonotic diseases in Malawi [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eProposed Multisectoral Actions for Priority Zoonotic Disease Management in Malawi\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrategic Action\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThematic Area\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResponsible Sectors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTimeline\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEstablish and institutionalize a functional One Health governance structure with a national strategy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne Health Coordination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMOH, MOA, MNR\u0026amp;CC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevelop a centralized national surveillance platform for zoonotic diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurveillance Capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMOH, MOA, MNR\u0026amp;CC, MoWS, DNPW\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u0026ndash;18 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnhance laboratory diagnostic capacity, recruit qualified technicians, and upgrade laboratory infrastructure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLaboratory Capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMOH, MOA, MNR\u0026amp;CC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u0026ndash;24 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrengthen outbreak response mechanisms and conduct joint multisectoral investigations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOutbreak Response\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOne Health Platform, MOH, MOA, MNR\u0026amp;CC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConduct multisectoral preparedness planning, including simulation exercises\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePreparedness and Planning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOne Health Platform\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u0026ndash;18 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBuild the One Health workforce through accredited training programs and curriculum integration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorkforce Development\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMOH, MOA, MNR\u0026amp;CC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u0026ndash;36 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImprove community engagement, awareness, and risk communication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRisk Communication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMOH, DAHLD, DNPW, MNR\u0026amp;CC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOngoing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePromote operational and implementation research to address zoonotic disease risks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMOH, MOA, MNR\u0026amp;CC, MoWS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u0026ndash;24 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eMOH\u0026thinsp;=\u0026thinsp;Ministry of Health; MOA\u0026thinsp;=\u0026thinsp;Ministry of Agriculture; MNR\u0026amp;CC\u0026thinsp;=\u0026thinsp;Ministry of Natural Resources and Climate Change; MoWS\u0026thinsp;=\u0026thinsp;Ministry of Water and Sanitation; DNPW\u0026thinsp;=\u0026thinsp;Department of National Parks and Wildlife; DAHLD\u0026thinsp;=\u0026thinsp;Department of Animal Health and Livestock Development\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThese action plans provide a roadmap for implementing coordinated, multisectoral interventions to address the prioritized zoonotic diseases and strengthen Malawi's overall One Health capacity for disease prevention, detection, and response.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe implementation of the One Health Zoonotic Disease Prioritization (OHZDP) process in Malawi represents a significant milestone in the country's efforts to strengthen national capacities for the prevention, detection, and control of zoonotic diseases. By engaging stakeholders from environmental, human, and animal health sectors in a structured, evidence-based process, Malawi succeeded in establishing a transparent, participatory approach to prioritize zoonotic diseases of greatest national concern. This inclusive methodology resulted in the identification of ten priority zoonotic diseases and the development of strategic action plans to strengthen multisectoral coordination, surveillance systems, laboratory capacity, and outbreak response mechanisms.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eAlignment with Regional and Global Experiences\u003c/h2\u003e\u003cp\u003eMalawi's OHZDP experience aligns closely with similar exercises conducted across Africa and other regions, while also reflecting unique national priorities and contexts. Like experiences in Kenya and Ethiopia, where OHZDP processes facilitated greater integration between health and veterinary sectors [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], Malawi's workshop emphasized the critical need for institutionalized One Health frameworks that ensure sustainable multisectoral collaboration beyond individual projects or initiatives.\u003c/p\u003e\u003cp\u003eThe prioritization of rabies as the top concern mirrors findings from several other African countries, reflecting the continent-wide burden of this preventable disease. Nigeria's regional OHZDP efforts under the Economic Community of West African States (ECOWAS) similarly highlighted rabies as a priority and emphasized the importance of establishing real-time data sharing platforms and joint outbreak investigation teams [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These lessons directly informed Malawi's proposed surveillance and response strategies, particularly the emphasis on integrated reporting systems and coordinated response mechanisms.\u003c/p\u003e\u003cp\u003eMozambique's OHZDP experience demonstrated the transformative impact of workforce development and laboratory strengthening in improving zoonotic disease detection and management [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Malawi's action plans place significant emphasis on building technical capacity through targeted training programs and upgrading laboratory infrastructure, reflecting these regional lessons learned. The inclusion of academic institutions in Malawi's stakeholder engagement also mirrors successful approaches in Mozambique, where university partnerships proved crucial for sustainable capacity building.\u003c/p\u003e\u003cp\u003eJordan's prioritization experience in the Middle East underscored the importance of standardized data sharing mechanisms and event-based surveillance systems to enable faster detection and control of zoonotic events [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These principles are embedded throughout Malawi\u0026rsquo;s next steps, particularly in the proposed development of centralized surveillance platforms and standardized case definitions for priority diseases.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eUnique Aspects of Malawi's Approach\u003c/h2\u003e\u003cp\u003eSeveral aspects of Malawi\u0026rsquo;s OHZDP process distinguish it from other country experiences and reflect specific national contexts and priorities. The explicit inclusion of environmental factors in the prioritization criteria reflects Malawi\u0026rsquo;s recognition of climate change impacts on disease transmission, particularly relevant given the country\u0026rsquo;s vulnerability to extreme weather events and their effects on waterborne diseases like leptospirosis and vector-borne diseases.\u003c/p\u003e\u003cp\u003eThe decision to exclude COVID-19 from the final priority list, despite its high technical score was based on the existence of robust, dedicated national surveillance and response systems. This pragmatic approach allowed the focus to remain on identifying neglected zoonotic diseases that require additional resources and coordination, rather than ranking all diseases by their current burden. The process also recognized the opportunity to leverage substantial investments made during the pandemic such as molecular diagnostic equipment, surveillance networks, and trained personnel to strengthen the detection and control of other priority zoonotic diseases, including avian influenza and viral haemorrhagic fevers. Adapting these existing capacities through coordinated efforts will be key to the efficient and cost-effective implementation of One Health action plans.\u003c/p\u003e\u003cp\u003eThe strong emphasis on community engagement and risk communication in Malawi\u0026rsquo;s action plans reflects the country\u0026rsquo;s experience with community-based health interventions and recognition of the critical role of community participation in zoonotic disease prevention and control, particularly in rural areas where human-animal interactions are most intensive.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eImplementation Challenges and Considerations\u003c/h2\u003e\u003cp\u003eDespite the significant achievements of the prioritization process, several challenges must be acknowledged in interpreting and implementing these results. Data availability varied considerably across sectors, with environmental health data being particularly limited compared to human and animal health information. This data gap may have influenced scoring for diseases with significant environmental components and highlights the need for strengthened environmental surveillance and monitoring systems.\u003c/p\u003e\u003cp\u003eThe scoring process, while systematic and transparent, necessarily involved subjective expert judgment that may reflect current knowledge gaps rather than actual disease burden or transmission risk. For diseases with limited surveillance data, such as some viral haemorrhagic fevers, the prioritization may reflect perceived rather than documented risk, emphasizing the importance of enhanced surveillance to validate these assessments.\u003c/p\u003e\u003cp\u003eResource constraints represent a persistent challenge for implementation of the proposed action plans. While the prioritization provides strategic direction, successful implementation will require sustained political commitment, adequate funding, and continued multisectoral coordination. The workshop's emphasis on developing an investment case and resource mobilization strategy reflects recognition of these challenges.\u003c/p\u003e\u003cp\u003eThe technical focus of the prioritization process, while scientifically rigorous, may not fully capture community perspectives or cultural factors that influence disease transmission and control effectiveness. Future prioritization exercises should consider incorporating community-based participatory approaches to complement technical assessments.\u003c/p\u003e\u003cp\u003eA further consideration is the potential for regional variations in disease prevalence and risk within Malawi. The prioritization exercise produced a national-level list, which may not fully capture the diverse local contexts shaped by climatic, sociological, and economic differences across the country. Future implementation of the strategic action plans should incorporate regional-level assessments to tailor interventions to local needs and priorities, ensuring that resources are allocated effectively to address the specific zoonotic disease threats in different parts of the country.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eStrategic Implications and Future Directions\u003c/h2\u003e\u003cp\u003e The outcomes of Malawi's OHZDP process have several important strategic implications for national health security and regional One Health initiatives. The establishment of a nationally endorsed priority list provides a foundation for evidence-based resource allocation and policy development, enabling more targeted and coordinated interventions across sectors.\u003c/p\u003e\u003cp\u003eThe emphasis on governance and coordination mechanisms addresses fundamental structural challenges that have historically limited effective multisectoral collaboration in Malawi. The proposed One Health governance structure, if successfully implemented, could serve as a model for other countries facing similar coordination challenges.\u003c/p\u003e\u003cp\u003eThe integration of workforce development and capacity building into the action plans recognizes that sustainable improvements in zoonotic disease management require long-term investments in human resources and institutional capacity. The proposed partnerships with academic institutions provide a foundation for sustainable capacity development beyond short-term project cycles.\u003c/p\u003e\u003cp\u003eLooking forward, successful implementation of the proposed actions will require regular monitoring and evaluation to assess progress and adapt strategies based on emerging evidence and changing circumstances. The prioritization should be viewed as a living document that can be updated as surveillance capacity improves, and new data become available.\u003c/p\u003e\u003cp\u003eThe regional implications of Malawi's experience are significant, as the country\u0026rsquo;s approach and lessons learned can inform similar exercises in neighbouring countries and contribute to regional harmonization of One Health approaches. The emphasis on standardized methodologies and evidence-based decision-making provides a foundation for regional coordination and mutual support.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUsing the CDC One Health Zoonotic Disease Prioritization (OHZDP) tool, Malawi successfully conducted its first systematic, nationally endorsed prioritization of zoonotic diseases through a transparent and multisectoral One Health approach. This landmark exercise facilitated unprecedented collaboration among environmental, human, and animal health sectors, establishing a foundation for enhanced surveillance, outbreak preparedness, and coordinated response to zoonotic disease threats.\u003c/p\u003e\u003cp\u003eThe identification of ten priority zoonotic diseases led by rabies, salmonellosis, and zoonotic tuberculosis provides strategic direction for resource allocation and intervention planning. The comprehensive action plans developed through this process address critical gaps in One Health governance, surveillance capacity, laboratory diagnostics, outbreak response, workforce development, and risk communication.\u003c/p\u003e\u003cp\u003eThis prioritization exercise represents more than a technical ranking of diseases; it embodies a paradigm shift toward evidence-based, multisectoral decision-making for health security in Malawi. The process has strengthened relationships across sectors, built local capacity in One Health methodologies, and established a framework for ongoing collaboration and coordination.\u003c/p\u003e\u003cp\u003eMoving forward, the success of this initiative will depend on sustained political commitment, adequate resource mobilization, and continued multisectoral collaboration. The foundation established through this prioritization process provides an unprecedented opportunity to transform Malawi's approach to zoonotic disease management and enhance health security at the human-animal-environment interface.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAfrica CDC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAfrica Centres for Disease Control and Prevention\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAHP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAnalytical Hierarchical Process\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAMRNCC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAntimicrobial Resistance National Coordinating Centre\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCDC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCenters for Disease Control and Prevention\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDAHLD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDepartment of Animal Health and Livestock Development\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDNPW\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDepartment of National Parks and Wildlife\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDoF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDepartment of Forestry\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDoS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDepartment of Sanitation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEAD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEnvironmental Affairs Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFAO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFood and Agriculture Organization of the United Nations\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIHR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Health Regulations\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eJEE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eJoint External Evaluation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKUHeS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKamuzu University of Health Sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLUANAR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLilongwe University of Agriculture and Natural Resources\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMOH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMinistry of Health\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMUST\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMalawi University of Science and Technology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNHSRC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Health Sciences Research Committee\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNRCM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Research Council of Malawi\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOHZDP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOne Health Zoonotic Disease Prioritization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePEP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePost-Exposure Prophylaxis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePHIM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePublic Health Institute of Malawi\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUS CDC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited States Centers for Disease Control and Prevention\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not involve human participants, patient data, or experimental interventions, and therefore, was conducted in accordance with the ethical principles of the Declaration of Helsinki. It was based entirely on expert consultations and a consensus-building workshop methodology. Institutional oversight and approval for the conduct of the workshop and associated data collection were provided by the National Health Sciences Research Committee (NHSRC) and the National Research Council of Malawi (NRCM) through the One Health Platform in Malawi, coordinated by the Public Health Institute of Malawi (PHIM), the Department of Animal Health and Livestock Development (DAHLD), and the Environmental Affairs Department (EAD). As the study did not constitute a clinical trial, a clinical trial number is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe database generated and analysed during the prioritization process, including detailed scoring matrices and supporting documentation, is available from the Public Health Institute of Malawi (PHIM) and can be requested through the One Health coordinating mechanisms. Workshop materials, including the adapted prioritization tool and stakeholder engagement protocols, are available to support similar exercises in other countries upon request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis workshop and related activities were supported by in-kind contributions from participating organizations, with technical and logistical support provided by the U.S. Centers for Disease Control and Prevention (CDC), the Food and Agriculture Organization of the United Nations (FAO), and Africa Centres for Disease Control and Prevention (Africa CDC). No specific grant funding was awarded for this work. The views expressed in this publication are those of the authors and do not necessarily reflect the official policies or positions of the supporting organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors and contributors declare that there are no competing financial or non-financial interests related to this prioritization exercise. All participants contributed their expertise in their professional capacities to support national public health objectives without personal financial benefit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent to publish was formally obtained from the National Health Sciences Research Committee (NHSRC) where PHIM assumes secretariat role. The NHSRC reviewed the manuscript and provided written authorization for publication of the findings arising from the national One Health Zoonotic Disease Prioritization workshop. This consent covers the use of anonymized workshop data and expert consultations collected during the exercise, as well as the dissemination of disease prioritization findings, system performance assessments, and recommendations at national.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe organizing team acknowledges the invaluable contributions of the Public Health Institute of Malawi (PHIM), Department of Animal Health and Livestock Development (DAHLD), Environmental Affairs Department (EAD), Department of National Parks and Wildlife (DNPW), the Ministry of Water and Sanitation, and all One Health stakeholders who participated in this landmark exercise.\u003c/p\u003e\n\u003cp\u003eSpecial recognition goes to the US CDC, FAO, and Africa CDC for their technical expertise and methodological support. We thank the local facilitators who underwent training to support this process and the international experts who provided guidance throughout the workshop. The commitment and expertise of all participants made this first national zoonotic disease prioritization exercise in Malawi a success.\u003c/p\u003e\n\u003cp\u003eWe also acknowledge the broader One Health community in Malawi and the region for their ongoing efforts to strengthen multisectoral collaboration and improve health security at the human-animal-environment interface.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTaylor LH, Latham SM, Woolhouse ME. Risk factors for human disease emergence. \u003cem\u003ePhilos Trans R Soc B\u003c/em\u003e. 2001;356(1411):983\u0026ndash;9. https://doi.org/10.1098/rstb.2001.0888\u003c/li\u003e\n\u003cli\u003eJones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, Daszak P. 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One Health. 19. 100761. 10.1016/j.onehlt.2024.100761.\u003c/li\u003e\n\u003cli\u003eNambala P, Mulindwa J, Chammudzi P, Senga E, Lemelani M, Zgambo D, Matovu E, MacLeod A and Musaya J (2022) Persistently High Incidences of Trypanosoma brucei rhodesiense Sleeping Sickness With Contrasting Focus-Dependent Clinical Phenotypes in Malawi. Front. Trop. Dis. 3:824484. doi: 10.3389/fitd.2022.824484\u003c/li\u003e\n\u003cli\u003eMarsela M, Hayashida K, Nakao R, Chatanga E, Gaithuma AK, Naoko K, Musaya J, Sugimoto C, Yamagishi J. Molecular identification of trypanosomes in cattle in Malawi using PCR methods and nanopore sequencing: epidemiological implications for the control of human and animal trypanosomiases. Parasite. 2020;27:46. doi: 10.1051/parasite/2020043. Epub 2020 Jul 20. PMID: 32686644; PMCID: PMC7370688.\u003c/li\u003e\n\u003cli\u003eKeller L, Stelzle D, Schmidt V, Carabin H, Reinhold A-K, Keller C, et al. (2022) Community-level prevalence of epilepsy and of neurocysticercosis among people with epilepsy in the Balaka district of Malawi: A cross-sectional study. PLoS Negl Trop Dis 16(9): e0010675. https://doi.org/10.1371/journal.pntd.0010675\u003c/li\u003e\n\u003cli\u003eBandi V, Ngowi B, Mpolya E, Kilale AM, Vianney JM. Prevalence of \u003cem\u003eTaenia solium\u003c/em\u003e cysticercosis in domestic pigs following albendazole deworming intervention in rural communities of Mbulu district, Tanzania. Food Waterborne Parasitol. 2024 Jul 2;36:e00234. doi: 10.1016/j.fawpar.2024.e00234. PMID: 39109170; PMCID: PMC11299552.\u003c/li\u003e\n\u003cli\u003eMalawi Ministry of Health. Mpox situation report: April\u0026ndash;May 2025. Lilongwe: MoH-Epidemiology Unit; 2025.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Zoonotic Diseases, One Health, Prioritization, Malawi, Workshop Report, Public Health, Rabies, Anthrax, Tuberculosis","lastPublishedDoi":"10.21203/rs.3.rs-6864950/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6864950/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEmerging and re-emerging zoonotic diseases pose significant public health, agricultural, and environmental threats in Malawi, a country characterized by extensive livestock production, human-wildlife interactions, and environmental changes. Recognizing the increasing risks of emerging and re-emerging zoonoses, Malawi conducted its first multisectoral One Health Zoonotic Disease Prioritization (OHZDP) workshop utilizing the OHZDP tool developed by the United States Centres for Disease Control and Prevention (US CDC). Prioritizing zoonotic diseases of national importance is essential for strengthening prevention, early detection, and control efforts, particularly in resource-limited settings like Malawi. This workshop aimed to prioritize zoonotic diseases of greatest concern to Malawi using a One Health approach and to develop corresponding action plans to enhance multisectoral preparedness and response.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eUsing the OHZDP tool, stakeholders from the environment, public health, and animal health sectors jointly identified 23 zoonotic diseases of national relevance. Participants at the OHZDP workshop collectively developed ranking criteria, which included disease severity, epidemic potential, presence and extent of disease spread in the country, environmental and socio-economic impact, and availability of capacity for prevention. Associated questions were developed for each criterion and weighted accordingly. A decision-tree analysis and normalized scoring system were used to generate the final list of ranked priority zoonotic diseases.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the 23 zoonotic diseases evaluated, ten were selected as top priorities for Malawi. These include rabies, salmonellosis, zoonotic tuberculosis, anthrax, viral haemorrhagic fevers, schistosomiasis (haematobium), African trypanosomiasis, cysticercosis, zoonotic avian influenza and Mpox. Rabies received the highest weight, making it the disease with the highest priority. Key recommendations included strengthening One Health governance structures, enhancing zoonotic disease surveillance systems, expanding laboratory diagnostic capacity, improving outbreak preparedness and response mechanisms, and advancing workforce development and risk communication strategies across sectors.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis exercise represents the first nationally endorsed prioritization of zoonotic diseases in Malawi using a One Health, semi-quantitative, and participatory methodology. The outcomes provide a strategic framework to guide policymakers, relevant stakeholders, and development partners in formulating, implementing, and monitoring coordinated interventions for zoonotic disease control, thereby improving health security at the human-animal-environment interface in Malawi.\u003c/p\u003e","manuscriptTitle":"Prioritization of Zoonotic Diseases in Malawi Using a Multisectoral One Health Approach: Outcomes and Future Directions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-26 00:27:36","doi":"10.21203/rs.3.rs-6864950/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-03T05:46:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-24T02:09:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-10-22T08:21:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c6594739-a0fc-41ec-a404-b36a903da9d1","owner":[],"postedDate":"October 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-04T22:53:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-26 00:27:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6864950","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6864950","identity":"rs-6864950","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}