‘Communities need to be at the heart of it all’

A World Health Summit panel calls for a paradigm shift in the implementation of One Health

One Health has traditionally focused on collaboration between human and animal doctors. Panellists at the World Health Summit argued for a paradigm shift to put communities and their natural environments at the center. Four concrete One Health projects show what this can look like in practice.

‘One Health is a bit like world peace,’ quipped Dr Eckart von Hirschhausen, opening a workshop entitled One Health: Good Practices and Challenges at the 2021 World Health Summit in Berlin. ‘Everybody thinks it’s a good idea, but nobody knows exactly how to get there.’ 

Where we are on the journey towards realising the One Health concept in practice – and whether, indeed, we are going in the right direction – was the focus of the workshop hosted by the German Federal Ministry for Economic Cooperation and Development (BMZ) on the first day of the annual global health gathering. Four short films about the implementation of projects following a One Health approach offered a jumping off point for discussion of opportunities and challenges among a diverse group of experts.

From talk to action: One Health in the time of COVID-19

Dr Maria Flachsbarth, Parliamentary State Secretary and Commissioner for Global Health and One Health at BMZ, kicked off the session by noting that German development cooperation has been working for some time to anchor the One Health concept in its policies and programmes. Since the advent of COVID-19, however, the focus is squarely on realising it in practice. The task is complex, not least because One Health implementing approaches remains fragmented in silos.

Dr Maria Flachsbarth
Dr Maria Flachsbarth

Nevertheless, the urgency is clear: ‘Everybody now realises that a small virus can cause huge damage, not only to health systems, but to the whole economy and to social and cultural systems.’ If before no one was ready to believe this, ‘now we are in a situation where we can make systems more resilient and better prepared – and we have to.’

‘We need to think differently’

Indeed, a cross-cutting theme which emerged from the session is that One Health is needed more than ever, but that conventional ways of thinking about it may not suffice. The overlapping public health, climate change and biodiversity crises are so severe – and the current global economic system so incompatible with a One Health approach – that a fundamental re-think is in order. 

According to Dr John Amuasi, co-chair of the The Lancet One Health Commission and lecturer at the Kwame Nkrumah University of Science and Technology, COVID-19 has challenged the members of the Commission to question certain assumptions: ‘While the traditional thinking has been about human doctors and animal doctors working together for good, we now think it goes far beyond that,’ he says. Among others, this means thinking differently about who needs to be engaged in a One Health approach and how. Effective disease surveillance, for example, is more complicated than just having doctors and veterinarians as ‘eyes on the ground’ to pick up signals of rare events. It requires approaches to be much more embedded in communities – and more participatory in both design and execution.

Bring in ‘non-academic’ knowledge

The first featured project, which applies a transdisciplinary focus to zoonotic disease surveillance in rural areas of Guatemala, is an example of what can happen when cooperation in the realm of One Health involves the local community, as well as academic experts. 

Professor Jakob Zinsstag heads a research group at the Swiss Tropical and Public Health Institute which has helped to support this project. He sees it as one case of how doctors and veterinarians, working together, can help more humans and animals than they could if they continued to work in separate ‘corners.’ According to Zinsstag, this cooperation offers a starting point for expanding outwards to include other specialists, such as environmentalists, anthropologists and food scientists, as well as government officials and community members. In the case of the project in Guatemala, for example, traditional healers are a key constituency.

Professor Jakob Zinsstag
Professor Jakob Zinsstag

‘If you are able to co-produce a new transformational knowledge by joining together practical knowledge held by people, the authorities and scientists, then you can find societally-acceptable solutions that could never be found only coming from the top-down,’ Zinsstag explains.

‘If you are able to co-produce a new transformational knowledge by joining together practical knowledge held by people, the authorities and scientists, then you can find societally-acceptable solutions that could never be found only coming from the top-down,’ Zinsstag explains.

Involve the people who are most at risk 

Disease surveillance is fundamentally about sharing information, but too often the people who are first aware of rare events are not accounted for in surveillance systems, according to Dr Marisa Peyre, deputy director of ASTRE, the integrated health research unit at the French Agricultural Research Center for International Development (CIRAD). 

Dr Marisa Peyre
Dr Marisa Peyre

 ‘There needs to be a shift in paradigm so that solutions are developed together with people who are facing the risk every day,’ she argued. Participatory disease surveillance systems that engage hunters, herders, community health workers and animal health workers, and community members have a greater chance of detecting rare events early and enabling immediate protective measures to be put in place. They are both more sustainable and ultimately ‘a lot cheaper than responding to a pandemic,’ she pointed out.

A project in Kenya, implemented by the International Livestock Research Institute (ILRI) and amplified by the BMZ-supported One Health Research and Education Center, undertakes mapping and surveillance of Rift Valley Fever, Brucellosis and Q Fever in pastoral communities. 

Commenting on the approach, Dr Peyre underscored that disease surveillance and detection is ‘not only about health, it’s about livelihoods of people in the poorest communities.’ Recurrent outbreaks of Rift Valley Fever in the Horn of Africa result in the closure of markets and have, in extreme cases, led to the collapse of national economies. This is another reason why it is critical to invest in surveillance systems in communities which stand to lose the most when disease outbreaks occur.

Address the reasons why spillovers occur

Professor Wanda Markotter, Director of the Centre for Viral Zoonoses at the University of Pretoria, appealed for greater attention to the factors that are fuelling human-animal interactions. ‘A pathogen is not going to spill over if the interface is not there,’ she explained. ‘Human-animal contact happens for specific reasons and we need to start addressing those reasons.’ 

Professor Wanda Markotter
Professor Wanda Markotter

She offered these reflections in reponse to the third short film, which described a German-supported project in India that aims mitigate the risks of human-wildlife contact. It does this, among others, by raising awareness among community members, deploying veterinary rapid response teams, and establishing guidelines on the safe handling of dead animals.

Cases like this are where the One Health concept becomes very practical, says Professor Markotter. The ministries and other stakeholders involved are addressing the underlying reasons for human-animal interactions: ‘In this case it’s encroachment. There’s just not enough space for everybody and not enough resources.’ If we are serious about pandemic prevention, these are the things we need to be talking about and addressing. 

One Health requires political collaboration, too

One Health cannot be realised without collaboration between disciplines, but it also requires political cooperation, including at the regional level. The fourth film described how a German-supported project in West Africa is helping to strengthen coordination among stakeholders in different countries and to facilitate communication about health risks that could affect the region as a whole. One element is support for SORMAS, an open source software which is used in Ghana and Nigeria to link and coordinate outbreak data and responses in real time between community, health facility and national levels.

From HSS to OHSS: A call for One Health Systems Strengthening

In recent years, much attention has been paid to health systems strengthening (HSS). This approach recognises that a resilient, well-functioning health system is one in which its different elements – workforce, infrastructure, supplies and technology, policies and resources – work in harmony with one another.  

In his closing remarks, Dr John Amuasi questioned whether it is not time to introduce the concept of ‘One Health Systems Strengthening’ (OHSS), with community-based research and disease surveillance as one of its building blocks. One Health will not be realised unless the approach is broadened to engage more and more of us in initiatives which aim to protect our families, our communities and our societies. ‘The message coming out of this session is clear,’ he said. ‘Communities need to be at the heart of it all.’

Karen Birdsall
October 2021

© World Health Summit
© World Health Summit
© World Health Summit
© World Health Summit

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