COVID-19 Pandemic Has Highlighted the Importance of ‘One Health’ Collaborations
Selena Ruto, community health volunteer visits the Kibet family in Narok County, Kenya to discuss the risk of anthrax.

The COVID-19 pandemic has pushed the scientific community to start to implement a  ‘One Health’ approach – encompassing people, animals, plants and the environment – to ensure the early identification of infectious diseases and make the world a healthier place.

The issues that “One Health” may tackle are diverse. They can range from curbing deforestation to prevent new pathogens from being released from the wild to targeted efforts to improve sanitation and food safety in slaughterhouses, to vaccination as an alternative to the overuse of antibiotics in both humans and animals.

‘One Health’ is a key theme at the upcoming Geneva Health Forum, but it is often difficult for many people to fully understand what it means.

Until the pandemic, ‘One Health’ was often consigned to the margins of health agendas. But the importance of a holistic approach to health across species became evident when it emerged that the SARS-CoV2 virus was likely to have originated in a bat and could have been transmitted to humans via infected mammals that were housed and slaughtered in unsanitary conditions at a marketplace in Wuhan, China.

Freshly slaughtered animals in a market in Wuhan, Hubei, China

Suddenly, the once-obscure ‘One Health’ approach has become a broad international movement supported by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and, most recently, the United Nations Environment Program (UNEP).

There has been some heated debate about the definition of One Health, Dr Rafael Ruiz De Castañeda, a researcher and lecturer in the Institute of Global Health at the University of Geneva, told Health Policy Watch.

Only in December 2021, did an inter-agency One Health High-Level Expert Panel (OHHLEP) roll out a formal definition. This definition states: “One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.”

According to OHHLEP, One Health collaborations will contribute to protecting health and addressing the full spectrum of disease control challenges, while improving and promoting health and environmental sustainability.

“One Health is the added value of a close cooperation between human and animal health experts and those working in related disciplines,” Dr Jakob Zinsstag-Klopfenstein, deputy head of the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, told Health Policy Watch.

Ruiz de Castañeda describes the approach as “transdisciplinary”, encompassing veterinary health, human health disciplines, natural and environmental sciences, and even social sciences and the humanities. It also engages non-academic actors, including civil society and communities affected by the health problem that can become active players in the One Health approach.

“One Health has sometimes been criticized for remaining too high level and we need to make it more operational and implementable at the national and subnational levels,” Ruiz de Castañeda said.

Geneva Health Forum

At the next month’s Geneva Health Forum (GHF) from 3 to 5 May, One Health is a key point of focus, within the broader theme of the conference, which is the COVID pandemic and the environmental health emergency.

The event will kick off with a high-level discussion on why One Health is a “paradigm shift” requiring much closer cooperation between health and the environment sectors as well as between human health and animal health sectors.

Addressing the link between health and environment is critical because climate change, deforestation, biodiversity loss and unsustainable urbanization have increased the risks of human infection from pathogens once harbored mainly in the wild – from insect-borne diseases like dengue to pathogens carried by birds and mammals, including Ebola virus, coronaviruses, influenza viruses and more.

At the same time, the overuse and misuse of many drugs in both animal health, as well as human health, is increasing the threat of antimicrobial resistance – which also increases future pandemic risks.

Among the One Health sessions, Ruiz de Castañeda will take part in a panel entitled “Science and Global Health Diplomacy to Preventing and Tackling Pandemics: Opportunities and Challenges for One Health.” He and other speakers will address how diplomacy and international cooperation can further contribute to One Health research and action, and how systemic, integrated and cross-sectoral approaches in science and global health practice can support cooperation.

Other sessions will include: a look at achieving more sustainable antibiotic access using a One Health approach, how the private sector could be a key player in the operationalization of the One Health concept and what training might be needed to move One Health forward.

Finally, Zinsstag-Klopfenstein will run a workshop on the One Health model as it pertains to the health of nomadic pastoralists, of which there are an estimated 50 million to 200 million globally. Pastoralists have frequent exposure to animal reservoirs of pathogens with emerging epidemic potential.

An integrated approach to surveillance

Selena Ruto, community health volunteer visits the Kibet family in Narok County, Kenya to discuss the risk of anthrax. Droughts in the area often push herders to seek greener pastures in areas where wild game mingle, and this can put herders’ families at risk too.

As the COVID-19 pandemic continues to surge in countries worldwide, the discussion will focus on how to implement an integrated approach to epidemiological surveillance in humans and animals.

“Studies have shown that two-thirds of emerging infectious diseases emerge from animals,” Ruiz de Castañeda said – usually wild animals, but sometimes livestock. This phenomenon is expected to grow due to anthropogenic pressure on the environment. But he said that we often fail to catch these pathogens on time, detecting them when they are already in humans, which “puts up behind an epidemic and potential pandemic.”

An integrated approach to epidemiological surveillance in humans and animals could detect these pathogens in animals before they reach humans or when only a few humans are infected, which would save time, money and improve public health outcomes.

This is already working in Italy, for example, Zinsstag-Klopfenstein explained. Since 2012, the country’s health services have managed an integrated approach to surveillance of West Nile virus. This is an arbovirus first identified in Africa that is transmitted by mosquitoes, infecting wild birds, horses and humans. With warmer temperatures it has been found in Europe and the United States, after being first discovered in New York state in 1999. That programme has shown evidence of cost-effectiveness.

“The earlier a zoonotic pathogen can be detected in the environment, in wildlife or in domestic animals – and the better human, animal and environmental surveillance communicate with each other to prevent an outbreak – the lower are the cumulative costs,” wrote Zinsstag-Klopfenstein and his colleagues in a paper titled “Why One Health?”, published by CAB International in 2021.

In contrast, a lack of integration and collaboration can have detrimental effects, according to Zinsstag-Klopfenstein. In a recent outbreak in the Netherlands of Q-fever, a disease caused by the bacteria Coxiella burnetii, public health authorities were not informed by veterinary authorities about a wave of abortions in goats. Likewise, outbreaks of Rift Valley fever in humans in Mauritania were misidentified as yellow fever until public health services contacted livestock services and learned about the occurrence of abortions in cattle.

One Health: the human and livestock nexus

Another area where One Health could have an impact is in terms of food security and nutrition, Zinsstag-Klopfenstein told Health Policy Watch. That’s because, for a large portion of the developing world, animals directly provide physical and financial sustenance.

“Animals play a very important role in most semi-arid areas, such as Mongolia or among the Bedouin community in Israel’s Negev,” Zinsstag-Klopfenstein said, adding that even in the Swiss Alps “if you do not want to survive on tourism, you need a cow. A cow can convert grass into milk. If a drought comes and there is no grass, you have nothing.”

While a farmer can grow fruits and vegetables, the harvest is usually only once or twice a year. A chicken, in contrast, can lay an egg a day and a goat can provide a litre of milk, providing a family with daily income.

Around 800 million small-scale farmers rely on livestock production to keep themselves out of extreme poverty, so maintaining the health of livestock is essential, added Zinsstag-Klopfenstein.

Ways need to be found to improve animal health while controlling the overuse of antibiotics, which also are critical to human health,and can lead to antimicrobial resistance.

Ugandan dairy farmer Tony Kidega has taken a keen interest in turning the tide of antimicrobial resistance (AMR) in his country.

Sometimes there are unexpected benefits. Zinsstag-Klopfenstein highlighted an example in Chad, where a team of doctors and veterinarians discovered that more cattle were vaccinated than children against childhood diseases.

“Recognition of this fact enabled subsequent joint human and animal vaccination campaigns, providing preventive vaccination to children who would otherwise not have had access to health services,” he wrote. “This is one of the rare and first examples of One Health in healthcare provision, where you can save money from working together to provide health services.”

He said it could work for the eradication of rabies, too. Today, humans are vaccinated against rabies if they are bitten by a dog, in what is a painful and prolonged series of shots. But if you want to eliminate the disease, you really have to vaccinate the dogs once or twice.

Case study: Snakebite envenoming

While better infectious disease surveillance and prevention is the major value of a One Health approach, improved diagnosis and treatment are important as well. This is particularly true for neglected tropical diseases (NTDs), which by their nature often lack high-quality medicines and vaccines and because many of these diseases involve animals, Ruiz de Castañeda told Health Policy Watch.

“If you look at the problem only with a human perspective, you are often missing a big part of the problem. You need a broader systemic One Health approach to understand, prevent and better control NTDs,” he said.

One example is snakebite envenoming, in which Ruiz de Castañeda has done extensive research.

Snakebites kill between 81,000 to 138,000 people every year, according to the latest research. And most victims are among the world’s poorest, living in rural Africa, Asia and South America. It was only in 2017, that WHO included snakebite envenoming on its list of neglected tropical diseases.

Because anti-venom treatments are often hard to access, snakebite is often fatal. In Nepal, for instance, snakebite impacts 252 out of 100,000 people with a 7.8% fatality rate. They injure both domestic livestock and people which cause a significant loss of livelihoods.

Ruiz de Castañeda and team assessed the effect of snakebite in the Terai region of Nepal using a One Health perspective that encompasses health and socioeconomic losses associated with snakebites of people and domestic animals. They used primary data from a large-scale household survey to produce estimates for disease burden, out-of-pocket healthcare expenditure, productivity losses for people who had been bitten and their families and losses associated with cases in domestic animals.

“Our results confirm that snakebite is an important problem in the Terai region that affects livelihood and DALYs [disability-adjusted life years], which are mostly associated with envenoming in women, high pediatric mortality and losses in domestic animals,” the report said.

Households whose domestic animals were impacted by snakebite experienced a median loss of $90.80 out of average monthly earnings of $250.36, meaning that snakebite can lead to an economic crisis and feed the vicious cycle of poverty.

What’s next?

Ruiz de Castañeda said that One Health has gained a lot of momentum due to COVID-19 and “we see a very interesting discussion among countries trying to see how One Health can be part of their national strategies and their international relations”.

“Pandemics often emerge far away from the Western world – Ebola in West Africa and COVID-19 in China, for example – but they are quickly on our doorstep,” he said. “One Health needs to become part of the international strategy for countries: Science for diplomacy and diplomacy for science.”

See the full GHF 2022 programme. Register here: Rates are tiered and early-bird fees range from CHF 300-100 for the in-person event, and CHF 200-70 for digital participation. Daily rates are also available.

Part of a Health Policy Watch series of stories on feature themes at the 2022 Geneva Health Forum.

Image Credits: International Federation of Red Cross and Red Crescent Societies / The Kenya Red Cross Society, Arend Kuester/Flickr, Tony Kidega, Geneva Health Forum.

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