A one health milestone in Southeast Asia: the Lawa model for liver fluke control

Background:

Liver fluke infection caused by Opisthorchis viverrini remains a major public health threat in the Lower Mekong Basin, particularly in northeastern Thailand. The parasite infects more than 10 million people and is closely linked to cholangiocarcinoma (CCA), a deadly form of bile duct cancer for which Thailand has the world’s highest incidence.

Conventional control strategies—such as mass drug administration—have seen limited success due to the complex life cycle of the parasite and entrenched cultural practices, including the widespread consumption of raw freshwater fish.

A One Health Innovation: The Lawa Model

This article introduces the Lawa model, an innovative, community-driven approach developed in the Lawa Lake region of Khon Kaen, Thailand. Based on the One Health framework, the model integrates:

• Human health interventions (e.g., deworming, education),

• Environmental engineering (e.g., habitat modification to reduce snail vectors),

• Animal reservoir management (e.g., treatment of cats and dogs),

• Culturally appropriate education using folk media, local language, and school programs.

The model adopts a systems thinking approach and prioritizes community engagement, working closely with village leaders, teachers, Buddhist monks, and health volunteers to co-design and implement tailored solutions.

Results and Impact:

Over 15 years of implementation, the Lawa model has led to remarkable improvements in public and environmental health:

• Human infection rates dropped from over 60% to below 5%.

• Infections in fish and snail intermediate hosts were eliminated.

• Infection in reservoir hosts (cats, dogs) was significantly reduced.

• Community awareness of disease risks and safe food practices increased.

• The Lawa region now serves as a model site for national and international liver fluke control efforts.

The success of the Lawa model has prompted its inclusion in Thailand’s national strategy, and efforts are underway to scale the model across other endemic areas in the Mekong region.

Broader Significance:

This study exemplifies how locally rooted, evidence-informed, and transdisciplinary initiatives can tackle complex public health issues in culturally and ecologically diverse settings. It demonstrates the power of One Health approaches in driving sustainable change by linking human, animal, and environmental health.

As the world seeks integrated solutions to persistent and emerging health challenges, the Lawa model offers a blueprint for effective community-based control of zoonotic diseases.