Rethinking One Health
World Zoonoses Day is celebrated on 6 July every year to highlight zoonotic diseases and measures to control them. It also offers an opportunity to take stock of policy debates around zoonoses and reflect on their development.
There have been considerable achievements in recent years in increasing the visibility of zoonotic disease on public policy agenda. Recent reporting on Ebola, nipah, and antimicrobial resistance (AMR) have all served to highlight the importance of zoonoses, their associations with poverty and the importance of building resilient health systems in mounting an effective response. The relatively rapid response to the recent Ebola outbreak, as well as the timely control of nipah in Kerala, India, have demonstrated that at least some of the lessons of 2014 have been learned.
A good portion of credit for promoting zoonoses discussions on public platforms must go to the One Health movement, whose proponents have been advocating close collaborations between animal, human and environment sectors.
But what explains the limited uptake of One Health where it matters most – within implementing agencies at international and national levels?
And, relatedly, what can we do to make the term relevant?
Most critiques of One Health appear to target the structural inadequacies of the One Health approach, focussing on institutional leadership and competing agendas. This though addresses only a part of the problem. The main challenges might actually lie in the following two ways in which the problems and solutions for zoonoses have been conceptualised by the approach itself.
Rethinking the pandemic focus
Firstly, from its initial days, One Health approach framed zoonotic diseases almost exclusively as (re)emerging and outbreak-prone diseases, resulting in infectious diseases being viewed as a threat to global health security. Unsurprisingly, the single-minded focus of One Health on emerging infections that ignored local health challenges meant that it was seen to be addressing problems of economically advanced nations with instrumental use of the approach for interventions in poorer countries. This is not helped by the fact that zoonoses researchers have consistently displayed a disconnect with policy realities.
(Incidentally, while on the topic of representation, an IDS colleague analysed the representativeness of a One Health Congress, finding it overwhelmingly male, elderly and white. While the One Health Congresses continue to be well attended despite their short history, might the fact that all the Congresses have been held in high-income countries, or been organised piggyback on another conference, be an indication of limited ownership of the approach in the global South?)
A large share of current One Health funding is allocated to research aiming to predict the emergence of pandemic strains. It is easy to overlook the fact that 'detecting pandemics' is logically just a first step towards preventing and controlling potential pandemics. Consequently, there is an emerging school of thought that advocates stepping away from studying novel pathogens among wildlife to strengthening surveillance at livestock-human interface.
In addition to arguments of reach and access, the fact remains that much of zoonoses globally is spread due to poor livestock hygiene and is found among the poorest populations. Given the recent advances in high-throughput genome sequencing, recent research shows that it is more practical, cost-efficient as well as effective to prevent rather than predict potential outbreaks by increased surveillance and diagnostic capacities. And you can be sure the country programme managers are also likely to be more welcoming for such an approach.
The second major challenge to One Health, I believe, comes from the instrumentalised nature of multisector collaboration envisaged in the approach. This vision calls for representatives from animal health, environment and public health to work towards reducing the risks of zoonotic diseases to human health populations without taking into account the contrasting perspectives and mandates of the engaged sectors.
For instance, the OIE-WHO as well as the World Bank have released 'framework' documents to facilitate institutional One Health collaborations at the country level. However, even a quick perusal of the documents demonstrates the prescriptive and checklist-like standardised methods to envision and force upon multisectorality upon country teams. To be fair, the myopic 'health first' approach to collaborations is not unique to One Health alone and has resulted in failure of other multisector approaches as well.
Even as public health practitioners advocated for multisectorality in the context of nutrition or social determinants, health needs are assumed to prioritise over the needs of other sectors. Surely, if such a self-centred attitude doesn't work in individual relationships, it is unlikely to succeed at level of multisector engagement where political sensitivities are high.
If we want One Health to be 'operationalised' beyond small pilots, we need to be more open-minded about our expectations from collaborations. Rather than starting out with a predefined set of rigid expectations, it might be more important to start with a shared vision for the problem and allow collaborators to work towards their organisational mandates. This is borne out by research in other disciplines as well.
Instead of coming together to fulfil a common goal, long-term partnerships are frequently drawn together by a complementarity of resources and high levels of mutual interdependence. Trust and empathy are other essential preconditions. Indeed, most formal collaborations are underpinned by informal networks and shared understandings. An accommodating attitude towards collaborators would necessarily mean that (within limits) we will have to learn to let go of control and be flexible for adapting the scope of collaborations to cope with changing requirements. Sustainable collaborations would be those that are adaptable to changes.
In such a scenario, the 'One Health' we start with, might not be the ‘One Health’ we end up with. But perhaps that will not be a bad thing after all.
Photo credit: Chris Smith [Public domain], via Wikimedia Commons