‘One Health’ may prevent the next pandemic

The concept of One Health

  • The Emerging Pandemic Threats-2 program by USAID, together with FAO, is conducting novel pathogen surveillance in “hotspot” countries where infectious diseases are most likely to emerge.
  • ‘Our Planet, Our Health’, an initiative by the Wellcome Trust, provides strategic funding for transdisciplinary research that connects environment and health.
  • Bill and Melinda Gates Foundation has funded One Health projects under the initiative ‘The One Health Concept: Bringing Together Human and Animal Health for New Solutions’.
  • The Network for Evaluation of One Health (NEOH) (http://neoh.onehealthglobal.net) is an initiative by the European Cooperation in Science and Technology that brings together over 250 scientists and One Health practitioners from more than 30 countries globally.
  • The WHO OneHealth Costing Tool (http://www.who.int/choice/onehealthtool/en/) is designed to inform national health planning in low- and middle-income countries and seeks to align disease control objectives and targets with needed investments.

Why is it challenging?

  • We don’t have harmonised definitions of health across disciplines and sectors. This creates challenges with assessing outcomes, demarcating their geographical scope (national, regional) and choosing appropriate time scales of assessment. Quality-adjusted life years (QALY) or disability-adjusted life years (DALY) are commonly used to assess disease burden for humans. Animal health issues are usually reduced to monetary terms and interventions are modelled with a cost-benefit analysis. Some contest that not all aspects of livestock and domesticated animals can be monetised, yet economics used methods to place prices on outputs that have no markets. Plant and aquatic animal health is also reduced to monetary terms and it is rarely included in health assessments.
  • We lack some fundamental cross-disciplinary knowledge. For example, assessing the risk of the emergence of zoonoses in human populations requires a more comprehensive understanding of the interaction networks between infectious agents, their hosts, and the environment in which they evolve and how these are affected by human activities, climate change and other factors.
  • Most efforts to prevent future disease are limited, given the challenges in addressing their root causes. The drivers of zoonotic disease transmission are land use and habitat change, biodiversity loss, deforestation, extractive industries, agricultural practice changes, wildlife trade and hunting, climate change, international trade and travel among others. These drivers are typically outside of the control of the health sector and require multi-sectoral stakeholder engagement to facilitate comprehensive assessments and strategies.
  • It’s difficult to coordinate between sectors and agencies. Health authorities have different priorities, data and information systems and resources and their risk management role may vary greatly by disease.

Why adopt a One Health Approach

  • One Health may result in more information sharing between those working in disease detection, diagnosis, education and research.
  • It may lead to highly interdisciplinary programs in education, research, and policy which in turn may create new comparative knowledge spaces (see the concept of zoobiquity).
  • One Health can create more intervention levers. Let’s take for example the case of Lassa fever prevention. A successful prevention strategy may target environmental factors such as improving household sanitation, animal factors such as removing rodents and human-related factors such as educating the healthcare personnel about safely disposing of contaminated materials. The ultimate goal of One Health is to identify opportunities for health improvement and risk mitigation across all three domains.
  • We may develop new eco-inspired therapies and approaches to treatments. Nature can provide innovative solutions that use the properties of natural ecosystems and services. For example, phages are natural predators of bacteria, controlling bacterial behaviour and can inspire the development of new anti-infectious strategies. New methods of fighting vector-borne transmission can also be based on microbial symbiosis. For example, it has been found that symbiotic interactions between Wolbachia and insect species can be harnessed to control mosquito-borne pathogens, by manipulating insect reproduction and interfering with human pathogens.

Towards implementing One Health

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Eirini Malliaraki

Eirini Malliaraki

http://emalliaraki.com/

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