One Health: Understanding the critical need for it in global health security
By Jane Fieldhouse
In February of 2021, I was thrilled to learn that my field of research had made it to late-night television. Last Week Tonight by John Oliver tackled the threat of the ‘next’ pandemic, with Oliver describing the One Health perspective as it relates to infectious diseases and human behaviors that put humans in closer proximity to wildlife and livestock, thus increasing the risk of outbreaks.
Despite making it to late night television, I feel One Health remains under-discussed outside of scientific and policy circles. Though as a buzzword One Health is doing its circles at the moment, I believe a more comprehensive understanding of the concept and approach can help us as a global community to address global health security threats.
As Zoonotic diseases jump from animals to humans (e.g. bats), it is important to learn more about the animal-human interaction and vector (e.g. mosquitoes, ticks) control.
So what is One Health? In a sentence, One Health is a multi-sectoral, transdisciplinary approach which recognizes that the health of humans, animals, plants, and the environment are all interdependent. To achieve optimal health for any one of those sectors, we must work collaboratively across all sectors at the local, national, regional, and global levels. Hence, One Health is essentially about the future of humans but also the future of this planet, with the recognition that our actions, which affect the balance of nature and its eco-systems, have consequences. Some of these consequences we observe today in challenges such as antimicrobial resistance, food and water safety and security, vector-borne diseases, and emerging zoonotic disease threats. Researchers in the field of One Health are trying to find ways to address these challenges while expanding our understanding of the interconnected health impacts of human actions on the natural environment. The COVID-19 pandemic has served as a stark reminder of just how interconnected human, animal and plant health is, and the rapid and devastating impact an outbreak can have in our globalized world.
While it may be immediately obvious that a One Health approach is relevant to addressing pandemic threats, I think it is valuable to consider concrete examples of how, exactly, the One Health approach can contribute to pandemic preparedness and prevention.
The G20 High-Level Independent Panel 2021 report, Financing the Global Commons for Pandemic Preparedness and Response, proposed investments to plug four major gaps in 1) globally networked surveillance and research; 2) resilient national systems; 3) supplies of medical countermeasures and tools; and 4) global governance.
One Health has a role to play in addressing each of these gaps:
Surveillance and research for emerging infectious diseases have clearly defined role for One Health in pandemic prevention and preparedness, including the development of early warning systems and integrated genomic and epidemiological surveillance programs that can serve as global common goods for health. An excellent example of such a tool spanning multiple sectors is the Food and Agriculture Organization’s Rift Valley fever Early Warning Decision Support Tool, an innovative climate-based model that allows for near real-time forecasting, modeling, mapping, and risk assessment of the vector-borne disease.
Other tools include outbreak reporting systems such as ProMED or HealthMap, which integrate animal, human, and plant health surveillance systems to report on infectious disease outbreaks using a One Health approach. It is also vital to note that community members with experience and knowledge of their local environments, animals, and ecosystems are essential to successful event-based surveillance. The One Health approach therefore prioritizes community engagement and communication, both of which have been demonstrated essential during the COVID-19 pandemic response. An approach that builds capacities within communities by empowering them to understand and tackle impending global health security challenges will be more sustainable.
Efforts to strengthen resilient national systems also need to consider the One Health approach when investing in infrastructure, information systems, and importantly, workforces of professionals from diverse fields. Ideally, multidisciplinary training and education for young professionals should prioritize One Health competencies such as effective communication, epidemiologic principles, and research and evaluation methods. Such training will allow trainees enter careers with the technical knowledge and interpersonal skills to effectively engage across sectors in collaborative efforts to achieve global health security. Existing examples of networks promoting accessible training and education to future leaders include the Africa One Health University Network and the Southeast Asia One Health University Network, which are working to build and strengthen a workforce with expertise in outbreaks preparedness and response.
Given the current climate, vaccines are perhaps the first thing that comes to mind when thinking of medical countermeasures in a pandemic response. However, there are a host of other tools, pharmaceutical and non-pharmaceutical alike, that can also shorten response times during a pandemic using a One Health approach. For instance, in 2019, a group of Salzburg Global Fellows convened a multidisciplinary team of experts from around the globe to develop a set of One Health timeliness metrics for epidemic preparedness to serve as standardized measures of timeliness during outbreaks involving the animal, environmental, human, or plant sectors. By broadening metrics such as these which have historically focused on human outbreaks to encompass all One Health sectors, we are better poised to measure and monitor performance during multisectoral outbreaks such that we make progress toward detecting and responding to outbreaks faster.
The One Health approach needs to be grounded in the governance systems as well. The inclusion of One Health principles such as collaboration and communication - not just across disciplines, but also across public, private, and philanthropic sectors at national and global levels – will be essential to not only facing but also assessing the future global health and climate change related threats. Therefore, the One Health approach and the champions of this approach are also well placed to facilitate coordination and cross-sectoral advocacy for pandemic prevention, preparedness, and response. The fact that One Health is already recognized as a component of the Global Health Security Agenda and similar mechanisms speaks to its growing role in not only addressing infectious disease threats but also building or re-orienting systems to be able to address future threats. In May of 2021, a One Health High-Level Expert Panel was launched to operationalize One Health to address diseases with epidemic or pandemic potential. The panel, led by 26 experts from diverse scientific disciplines, advises the Food and Agriculture Organization of the United Nations, the World Organisation for Animal Health, the United Nations Environment Programme, and the World Health Organization in developing innovative research agendas and policy measures from local to global levels.
These examples of how we can leverage One Health for pandemic prevention and preparedness, though illustrative, are by no means exhaustive. We must also acknowledge that, as most interventions or strategies in global health, One Health is not a one size fits all solution. The strategy must be leveraged alongside other approaches to reduce the risk of epidemic and pandemic threats, including continued strides toward universal health coverage. Furthermore, ensuring collaboration across disciplines and sectors requires an intense commitment to equity, inclusion, and communication. Therefore, a One Health approach can be quite challenging to achieve in practice.
A first step in addressing some of these practical challenges is making One Health approach a commonly understood concept within the global community. While the adoption and inclusion of this approach at the global level is encouraging, more work remain in the areas of strengthening local, national, regional level One Health approaches. Thus, I hope that One Health will not die out as a mere buzzword post-pandemic but will be an approach that is commonly taught and understood. Increased awareness about One Health will help strengthen global health security and build global solidarity, starting from actions within local communities.
About the Author
Jane Fieldhouse is a Global Health Sciences Ph.D. candidate at the University of California, San Francisco and a graduate student researcher with the One Health Institute at the University of California, Davis. She holds a master’s in global health from Duke University where she worked with the Duke One Health Research Laboratory.
The thumbnail image for this article on the homepage is from Wikimedia and is being used under the Creative Commons License 4.0.
