Is One Health really an agenda of only the Global North?  Panelists at an event last week, hosted by the Geneva Graduate Institute’s Global Health Center, think otherwise. They talked about how developing countries are putting One Health principles into practice to head off future disease outbreaks.

One Health is critical to future prevention of outbreaks and pandemics, and wider application of One Health principles should be a common agenda of both the global North and South – even if negotiators continue to wrangle over its inclusion in the still-unfinished World Health Organization (WHO) pandemic agreement. 

Those were key messages emerging from a dialogue co-sponsored by the Global Health Center (GHC) together with the Geneva Health Forum on the sidelines of last week’s World Health Assembly. At WHA, negotiators received a new mandate from member states to continue talks to conclude a pandemic accord by the 2025 WHA at the latest. The talks are set to resume in July.

The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors.

During the last frenzied weeks of negotiations just before WHA, the inclusion of references to One Health principles in Article 5 of the draft text spurred opposition from some low- and middle income countries (LMICs) as well as some civil society organizations. 

In late May, 68 CSOs called on negotiators to ‘Reject One Health Instrument’ in the pandemic agreement. They argued that One Health provisions intended to boost pathogen surveillance and pandemic prevention could also enable developed countries to erect new trade barriers and data demands on developing countries, and impose more costly pandemic preventive measures which poorer countries could not afford to implement. 

Over 120 experts and civil society proponents shot back with an open letter of their own. They asserted that better recognition of One Health principles and practices is critical to prevent more deadly spillover of zoonotic diseases into human populations, which could cause the next pandemic, as well as more locally disease outbreaks that typically kill people in LMICs first of all. 

Many One Health projects already taking place in Africa, South-East Asia 

“Is One Health really a global North agenda?” asked moderator Nina Jamal, International Head of Pandemics and Campaign Strategies at Four Paws International, which also co-sponsored the event.  

The soft-spoken Jamal, a Lebanese-Austrian with a wealth of experience straddling such ‘North’ and ‘South’ polarities, has become one of the leading advocates One Health in the pandemic agreement, patiently sitting through countless late-night sessions, and speaking one-on-one with delegates about their views and concerns over more than two years of negotiations.   

“The perception is that One Health involves a set of obligations imposed by high income countries on low-income ones. But is all the knowledge and expertise on One Health in the global North?” asked Jamal.  

At the GHC event, researchers working in countries as diverse as the Cote d’Ivoire, Guinea, Mexico, China and the Democratic Republic of Congo, described how they they are putting One Health principles into practice to promote better animal surveillance, reduced deforestation, and improved practices around wildlife management in food markets and trade – and document related health benefits. 

Most recent outbreaks linked to lack of ‘One Health’ measures

Most recent outbreaks of disease that have hit developing countries harder than developed ones are somehow related to an overall dearth of One Health measures that needs to be addressed, the experts asserted. 

Examples range from Ebola, Lassa fever and mpox in Africa, to SARS and Nipa virus in Asia, and expanding circles of dengue virus, Chagas disease, in Latin America. 

Countries in the global North are not immune either. That was evident in the 2009 H1N1 [swine flu] pandemic, that first appeared in Mexico and the United States, and ultimately infected up to 80 million people.

More recently the US has seen a surge in H5N1 cases among dairy herds, as well as infections in some farm workers; in the case of the latter, poor sanitation around milking machines has been named as a key transmission factor.

In fact, some 75% of recent disease outbreaks and epidemics can largely be traced to zoonotic spillovers to human populations – related to deforestation, poor regulation of domestic animal production, as well as poorly regulated wildlife markets and consumption, Jamal points out citing a widely held view amongst public health experts.

Aims and practices of One Health 

The overarching aim of One Health, according to WHO, is to “balance and optimize the health of people, animals and the environment… It involves veterinary, public health and environmental sectors.”  One Health approaches most commonly involve practical efforts to improve:

• Animal and ecosystem surveillance for pathogens of risk to humans and not only for species protection;
• Community water, waste and sewage  management to improve human hygiene and prevent the breeding of vector-borne diseases, from dengue to zika and malaria.  
• Sustainable milk and meat production, including sanitation and management of waste. Poor waste management in concentrated pig farming was, for instance,  named as one possible source for the 2009 eruption H1N1 (Swine flu).
• Animal use of antibiotics and other antimicrobial agents whose efficacy has been eroded by rampant veterinary overuse, leading to growing threats to human health from antimicrobial resistance (AMR).  
• Forests: preventing rampant deforestation that drives rodents, insects and other wild animals and their pathogens into human communities – driving spread of dengue, Chagas, and more recently nipa virus;

  

• Wild animal breeding, trade, and consumption. The spread of the first SARS virus from bats to palm civets and then to humans via wild animal markets is well documented.  A number of prominent scientists attribute the emergence of SARS-CoV2 to similar pathways – although others disagree. In Africa, the hunting and consumption of bushmeat (from reptiles to mammals) has been linked to the emergence of major diseases such as HIV and Ebola, as well as mpox – although bushmeat is also valued as an important protein source.   

Health and wildlife surveillance disconnect 

Despite much debate in WHO pandemic talks about improving disease surveillance to identify emerging pathogen risks earlier – the very first link in the surveillance chain remains broken, noted Arlette Dinde a research associate at the Swiss Centre for Scientific Research in Côte d’Ivoire. 

Dinde recently led a 10-year, multi-country review of research of studies on wildlife in Côte d’Ivoire covering 2012-2022, including both the period of the West African Ebola epidemic (2014-2016) as well as COVID-19. 

The study identified a trend towards more wildlife research over that decade – but still little attention to the public health threats. 

 “Research is still much more focused on biodiversity and conservation, and much less about the health and food security aspects,” Dinde said, noting that zoonoses and public health risks were mentioned in only about 22% of the research on wildlife and biodiversity identified. 

Conversely, “only about 5% of [public-health focused] research addressed aspects of wildlife disease surveillance,” she said. 

Not surprisingly then, government wildlife or farm sector planning doesn’t typically include the health sector, she found. 

She lamented the “lack of collaboration between the different sectors in the government, when we could have a great opportunity to  push the wildlife sector into the public health system, and have a national One Health plan, around which we could coordinate.”  

A dangerous pathogen found in Mexico could ‘be in Geneva’ next 

PREZODE, an international One Health network is working with governments in 25 countries around the world, including projects to curb dangerous deforestation patterns, which drive more wild animals, rodents and insects into villages, towns and cities every year. 

Efforts include a pilot effort in Thailand for “reforestation by communities that can actually try to reduce diseases, and especially rodent borne diseases, which is generally a group of diseases that don’t receive enough attention,” said Benjamin Roche, co-founder of the international NGO. 

Similarly the group is trying to develop a “win-win strategy” in Mexico’s Yucatan province, a sensitive tropical area that is also one of the most deforested in the world, to improve biodiversity protection in ways that also reduce human exposure to zoonotic diseases. 

“I’s not just about biodiversity protection,” Roche underlined. “It’s also about education in some very remote rural communities, working closely with local NGOs in order to try to fit together real integrative prevention strategies in place.”

It’s also about global health security, he underlined, in light of the speed at which emerging pathogens and outbreaks can travel: 

”The Yucatan Penninsula is connected with Mexico by 10 flights a day, and Mexico City is 25 million people.  So you can imagine that when you have a pathogen jumping from Yucatan to Mexico City – it is almost already in Geneva.”   

Changing norms around wildlife markets

Nowhere was that principle demonstrated better than in China during the SARS-CoV 2 pandemic and the rapid international transmission of COVID-19. 

Since that time, China has cracked down on wildlife markets, which were often patronized by more affluent groups which considered wild animal meat as a kind of “prestige” cuisine, noted Chloe Clifford Astbury, a researcher at the York University School of Public Health.  

China has also rolled back its former support for the commercial breeding of certain wildlife species, which may have played a role as intermediary hosts of  SARS-CoV2, transmitting the virus to humans, particularly in the early days of the outbreak in Wuhan.  

“But wildlife is still used and traded for other uses, just not necessarily for consumption,” she added.  

In comparison, in central African countries like the DRC, wildlife, or bushmeat consumption is more widely a practice of lower income and rural communities “who depend on it as a source of protein, or as a source of income, for example,  selling in the markets.”  While there are laws on the books preventing hunting of certain species, on-the-ground convictions are relatively rare.

Community involvement is key 

But Dinde, like Roche, stressed the importance of community involvement in development of government regulations  – if One Health-related measures are to succeed. 

For instance, she said that she doesn’t support blanket bans on bushmeat consumption – noting that such decrees are widely ignored. And many African communities still rely on bushmeat as a “vital source of protein, she said.

Following Côte d’Ivoire’s banning of bushmeat consumption during the 2014-16 West African Ebola epidemic, she led a paper evaluating its impacts, which found: “While fish and edible mushrooms seem to have filled related protein deficits in the households assessed… constraints in availability and utilization of these alternative sources build an inconsistent basis to fulfill the nutritional needs [of rural populations].

Such bans, therefore, needed to be accompanied by a stronger development of fish farming and livestock production to improve access to vital protein sources and insure that nutrition is not undermined. 

At the same time, communities need to be more sensitized to the risks that some bushmeat poses and how to minimize those – for instance by avoiding consumption of animals found dead in a forest  – which may have perished due to disease.  

“Most of the time, communities will eat those animals [found dead in the forest] now,” she says, noting that there is little awareness of the risks involved.  

One Health: why should we tackle it in the pandemic agreement? 

Paradoxically, a clause regarding the “involvement of communities” in One Health remains a key disputed clause in the pandemic text, noted Jamal. 

And despite animal-borne diseases pose the leading pandemic risks of the future, some member states continue to argue that One Health doesn’t belong in the pandemic treaty at all, she added. 

“They ask ‘why should we tackle this in the Pandemic Instrument,” she said. “They say, why not just give pieces of One Health to WHO, to the WOAH [World Organization for Animal Health] to UNEP, to FAO, and , etc.. and on the national level, just leave them in their boxes?”

Historically, activities at country level, and globally, have “been quite siloed,” Astbury notes.  

“Both at the national and global level, there’s so much to be gained from intersectoral collaboration and so much loss when there’s really siloed ways of working,” she said. “Take  surveillance, for example, there’s so much potential additional knowledge so much sharing is good practice that you can get through an integrated surveillance system – compared to a siloed one.

“I know a lot of countries are struggling with implementing something like that. Historically, things have been quite siloed, and they are now trying to bring them together.

“So coming together and thinking about trade offs and co-benefits is really important. And to do that, you can’t work in that kind of a siloed way.”

Adds Roche: “An outbreak somewhere, even quite remote, can be a pandemic very quickly. So the vertical approach is not working any more. 

“Look at COVID-19, which was just a couple of cases in December, and it was a worldwide pandemic just four months later. It’s just an illustration of how quick and viral these things can be. It’s not like 20 years ago, we have a lot of small threats emerging all of the time. It means we have to change our approach.”

Concluded Eric Comte, director of the Global Health Forum,  which co-sponsored the event: “One Health is a bridge, a bridge between different scientific disciplines and a bridge between science and policy.   There is no one single One Health solution, but stage by stage we can make progress.”

Image Credits: Arend Kuester/Flickr, Flickr/M M, Josh Kelahan, PREZODE, PREZODE , PREZODE , WHA .