After decades of depleting natural resources and healthy ecosystems, the bill is now coming due – and pressure is mounting. We must act swiftly and coherently if we want prevent ever more catastrophes emerging at the interface of human, animal and environmental health.

This was the message delivered by a group of One Health practitioners and experts during a panel discussion on ‘One Health in Action’ on the second day of the 2022 World Health Summit in Berlin. Jointly organised by the German Federal Ministry for Economic Cooperation and Development (BMZ) and the German Federal Ministry of Health (BMG), the session provided an opportunity to reflect on the progress being made in advancing the One Health agenda, as well as the stumbling blocks which still stand in the way of practical implementation.  Dr Francesco Branca, Director of the Department of Nutrition and Food Safety at the World Health Organization (WHO), moderated the discussion.

The ecological destruction we have wrought has come back to haunt us. What now?

In his opening remarks, Jochen Flasbarth, the Parliamentary State Secretary at BMZ, spoke from the perspective of someone who has spent his professional life working on issues of biodiversity and the environment: 

What an illusion we had that we could destroy biodiversity and ecosystems, in a more or less endless way, without this eventually backfiring on us.

Jochen Flasbarth

Now that it has – now that we are being forced to reckon with the costs of pandemics and unsustainable agricultural practices and the rising threat of antimicrobial resistance (AMR) – what can we do about it?

The key is a holistic approach which integrates human, animal, plant and environmental health into frameworks at the global level, as well into programming. ‘This is where BMZ comes in,’ said Flasbarth. 

Germany has been following a One Health approach in its development cooperation for some time. ‘The idea of bringing human, veterinary and environmental health together is already integrated into many projects on the ground, but we have to continue enhancing this.’ German efforts focus in particular on health system strengthening and pandemic prevention, preparedness and response, as well as combatting zoonotic diseases, neglected tropical diseases, and AMR. 

An important step forward in the high-level integration which Flasbarth mentioned happened earlier this year when the United Nations Environment Programme (UNEP) officially joined the Tripartite Alliance for One Health, which previously comprised the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (WOAH), and the WHO. The Quadripartite’s new One Health Joint Plan of Action, which was launched at a side event at the World Health Summit, sets out a framework for advocacy and action over the coming five years.

Reinvent food systems to tackle climate change, biodiversity and AMR challenges

 Dr Sunita Narain, an environmental activist and director of the Centre for Science and Environment in India, welcomed the formation of the Quadripartite and Joint Plan of Action as signs that the environment is no longer at the margins of the One Health debate, but squarely at its center, where it belongs. 

‘There has been movement in the past two years,’ she said, in comments delivered via video from New Delhi. ‘We are getting integrated, but not enough when it comes to action because it’s not yet clear what exactly needs to be done in different parts of the world.’

For Dr Narain, food systems are the core challenge for One Health because of their fundamental links with climate change, biodiversity and the growing threat of AMR. She argued that countries in the Global South need to find ways to reinvent their food systems so that they provide nutrition and livelihoods without contaminating the environment. ‘In my country and in Africa we have still not built intensive food systems,’ she noted. 

‘We still have the chance to leapfrog ahead and do things differently than in the Global North, so that we do not first contaminate and then have to clean up.’  

Addressing the issue of AMR, she noted that there is not enough understanding of the lack of capacity and financing available in many countries to clean up pollution or to set up expensive surveillance systems. ‘This is why we need to keep the focus on prevention,’ she says. This includes investing in water, sanitation and hygiene (WASH) measures which help to prevent disease outbreaks, and in systems which allow for reusing and recycling waste without worrying about antibiotic residue.   

An opportunity to put One Health at the center of government

 ‘The COVID pandemic has shown what happens if you don’t get health right,’ said Dr Ebere Okereke, an advisor on health systems strengthening with the Tony Blair Institute for Global Change in the United Kingdom. Governments often do not see health as a priority, and consider expenditure on health as a cost, rather than an investment. Now that everyone can see how expensive the alternative is, ‘there is a chance to put health as a core business for government – and that health should be One Health,’ she said. 

This would also lead to changes that could aid implementation. Vertical programming and compartmentalised mindsets still hinder action when it comes to tackling complex One Health-related challenges. She argued:

We need to disrupt the existing system. We need to stop thinking in siloes, start thinking about the issues and the solutions that need to be implemented, and then work collectively to realise those, regardless of department or specialty, with a single dataset, and towards a common purpose.

Dr Ebere Okereke

Get the ‘bottom’ and the ‘top’ to work together to overcome policy disconnects  

Dr Janetrix Hellen Amuguni, who is an Associate Professor in the Department of Infectious Disease and Global Health at Tufts University in the United States, spends three-quarters of her time in Africa as a One Health practitioner. ‘We talk a lot about human-animal-environmental health issues way up here,’ she said, gesturing with her hands, ‘but too often we forget the people who are the “actors in our One Health movie.’” 

Dr Amuguni shared a typical example to illustrate her point: a woman purchases antibiotics at her local market, gives some to her sick child and saves the rest for later. When her chickens are unwell, she adds the remaining antibiotics to their water. Later, she collects the chicken manure and puts it on her crops. ‘Just like that, we have antibiotics in humans, animals and on the farm, too.’ 

She fears that there is often a disconnect between One Health policies at the national level and the needs of community members.

Usually what communities do is food security or livelihood-related. Banning certain practices means taking away someone’s livelihood. How do you work to address the needs people have today in order to solve tomorrow’s problem?

Dr Janetrix Hellen Amuguni

Communities know what they want and are the ones who will ultimately make changes. Engagement needs to improve so that stakeholders from the bottom up have more of a voice, and so that they get feedback from above about what is happening.

Dr Amuguni noted that there are many One Health platforms, training programmes and initiatives springing up across Africa which provide positive examples of how One Health can be implemented in practice. ‘Most people working in One Health are veterinarians, doctors and nurses,’ she said. ‘One Health masters programmes are good, but the people already on the ground need training and skills to practice One Health where they are.’ 

She cited the positive example currently unfolding in Uganda, where an Ebola outbreak is underway. Linked to the national One Health platform, the country’s Emergency Operations Center sends out interdisciplinary teams of doctors, veterinarians and environmental scientists who meet every evening to brief one another and coordinate actions. Another example is the Africa One Health University Network, which encourages interdisciplinary teams of medical, veterinary and environmental studies students to conduct joint projects to give them practical experience in collaboration before graduation. 

Implementation needs to be our common mantra

‘We’ve talked a lot about concepts. What we need now is impact generation,’ said Prof Dr Andrea Winkler, the co-director of the Center for Global Health at the Technical University of Munich. ‘Implementation needs to be our common mantra.’

From her vantage point as the co-chair of the Lancet One Health Commission, Dr Winkler reflected on some areas that urgently require more attention. ‘We can learn from countries of the Global South which have established One Health offices and coordination mechanisms which work across ministries and implementing agencies,’ she said, with reference to some of the examples which Dr Amuguni shared. 

We need to have One Health structures of some kind that are monitoring what’s happening and also evaluating.

Prof Dr Andrea Winkler

Evaluation metrics are still not well developed, she noted.

Equitable financing is another concern. Dr Winkler welcomed the World Bank’s move to integrate One Health into the Financial Intermediary Fund as a positive first step, while underscoring that many more such mechanisms are needed. She also noted that it is necessary to be able to calculate the return on investment for One Health, so that one can go to decision makers with clear evidence in hand to use as leverage. ‘We need to be able to say, “Look, this can work.” But we aren’t quite there yet.’ A joint project by the World Bank and UN organisations is currently examining this.

Prevention, prevention, prevention

Jochen Flasbarth summed up the spirit of the session in his final comments, with reference to the German virologist Christian Drosten’s observation that ‘There is no glory in prevention.’ This is a political obstacle, said Flasbarth: ‘In a situation of a disaster, people understand that there is a need to act, but they might forget it the next day.’ We need to act preventively on many levels, from biodiversity loss to sanitation and access to clean water, said Flasbarth. ‘People need to understand that prevention is much cheaper than paying the bill afterwards.’

October 2022