One Health Approach: The Need for An Hour
Das T
Scientist, ICAR-DFMD, Bhubaneswar
Over the last decades, many infectious agents are emerged and reemerged at human, animal and environmental interface posing threats to global health security. Emerging diseases include outbreak of previously unknown diseases or known diseases whose incidence has increased in recent past or threatens to increase in future which include previously unidentified disease or old disease with new features like affecting new population, development of antimicrobial resistance, disease with new clinical features etc. Re- emerging infectious diseases are known diseases which reappeared again after being fully controlled or eradicated. The main driving factors for such emergence and re-emergence of infectious agents are climate change, international travel and trade, alteration in human demography and behavior, pathogen adaptation, advances in technology, industry, land use, dense urbanization, development of megacities, human encroachment into habitant and interface with wild life, and collapse in public health system etc. These factors cause disease emergence by changing transmission dynamic of pathogens. Alternation genetic constitute/ mutation of pathogens helps in development of new pathogen. Changes in human behavior like imprudent use of antimicrobial, drugs and pesticides resulted in development of antimicrobial resistant microbes. About 60% of newly identified are zoonotic and about two third are wild life origin (Dikid et al., 2013). About 75% of emerging diseases are of animal origin. So, pathogens emerged and reemerged as a result of complex interaction of pathogen, human, animal and environment. These pathogens provide a serious challenge to economy, security and development by taking heavy toll of human and animal lives and by crossing borders quickly. Due to favorable environmental, demographic and socioeconomic condition, the developing and the second most populous country like India is at risk of epidemic/ pandemic and is also suffering from the burden of pathogens. Emerging pathogens like COVID-19, HIV, SARS, MERS, Ebola Virus, Zika virus, African swine fever, Rabies, avian influenza H5N6, E. coli (O157:H7), Chikungunya, monkey pox, brucellosis, West Nile fever etc. and increasing antimicrobial resistance are serious global health concern. During this covid-19 pandemic, SARS-COV-2 has likely to be emerged at intersection of horseshoe bat, pangolins and people at Wuhan market of China (Zhang et al., 2020). To address these health issues, a strident awareness programme is required at local, national and global level. “One health” is such a multidisciplinary approach at different levels to attain optimum health for the people, domestic animal, wild life, plants and our environment (Ryu et al., 2017). Co-operation, communication and co-ordination among multidiscipline is required to combat global health issues like zoonotic diseases, antimicrobial resistance, food safety, biodiversity loss, climate change, maintenance of healthy water ecosystem etc. Vicq d’ Azyr, an eighteenth-century physician linked human and animal epidemic with climatic and geographical factor through the study of Rinderpest and successfully managed cattle plague in southern part of France in 1774 (Parent et al., 2007). Dr. William H. Foege, an epidemiologist, is a strong proponent of disease eradication and control programme and had taken active role in eradication of small pox, Guinea worm, Polio, River blindness and measles and always given importance to human, animal and environmental health (http://www.oneworldonehealth.org/sept2004/presentations/eve_foege.html ). One health concept is based on the fact that human and animals are dependent on each other while sharing common environment and pathogens.
International ministerial conferences on avian and pandemic influenza (IMCAPI) have been a major driver of one health. In 2008, the major international organization like FAO, WHO, OIE, UNICEF (the United Nations children fund), world bank, the UN coordinator for avian and human influenza (UNSIC) collaborated to develop strategy against ongoing avian influenza (H5N1) and later extended to reduce the risk of infectious diseases at huma-animal-ecosystem interface and also to minimize the global impacts of emerging infectious disease pandemic or epidemic by enhancing disease surveillance, diagnosis, intelligence and emergency preparedness at national, international and global level through strong human and animal health care system and effective national communication (http://www.un-influenza.org/files/OWOH_14Oct08.pdf ).
The one health high level expert panel organized by WHO, FAO, OIE, United Nations Environment Programme (UNEP) recently formulated new operational definition of OH as “an integrated unifying approach that sustainably balance and optimize health of human, animal and ecosystem”. They work together to predict, prevent, detect and respond to global threats and to promote sustainable development. (https://www.genevaenvironmentnetwork.org/resources/updates/one-health ).
AMR is an ecological issue which involves strong interaction between microbes affecting human and animal health with the environment. AMR arises when microbes acquire and express AMR genes under environmental selection pressure due to use and overuse of antimicrobial at human sector, animal sector for growth promotion and mass medication and environmental sector (industrial pollution) and also by factors promoting spread of AMR microbes and their genes between these three sectors like environmental contamination, geographical movement of infected animals etc. Extended spectrum beta lactamase producing E. coli aroused due to overuse of third generation cephalosporins. These resistant bacterial genes spread both clonally and horizontally in different bacterial species present in human, animal and environment. Emergence of health care associated methicillin resistance Staphylococcus aureus (MRSA), multi drug resistance TB, extensive drug resistance TB etc. are also a global concern responsible for high mortality. There is also emergence of antimicrobial resistance Salmonella, Campylobacter jejuni. The microbial genome can be altered by various factors which may give rise to highly resistant superbugs. AMR is responsible for 700,000 deaths per year and may emerge as leading cause of death globally by 2050 (O Neill, 2016). The multidrug resistance TB and extensive drug resistance TB are responsible for 200,000 deaths annually. Therefore, a coordinated and multidisciplinary approach like one health is required to combat AMR. One health interconnected three domains like human, animal and environmental heath that helps in emergence, evolution and spread of AMR microbes at different level. Food and Agriculture organization (FAO), world health organization (WHO) and World organization of animal health (OIE) together formulated guideline to combat AMR (Aslam et al., 2021). WHO has banned the use of antimicrobial for growth promotion and in animals with good health and advised to reduce the use of antimicrobial of human importance in animals (McEwen and Collignon, 2018). World antimicrobial awareness week is celebrated from 18-24 November every year to increase awareness and to stop resistance.
As infectious diseases are found to affect mostly poor people who battle disease, debt, loss livelihood with poor economic wellbeing. So, one heath intervention is to reduce economic burden and alleviate poverty (Kakkar et al., 2019). One health and one biofilm concept were proposed as biofilms are required for bacterial persistence during infection, for persistence in the environment and for transmission between hosts (Jacques and Malouin, 2022).
Food security and safety is also one of important theme of one health (OH). Due to increase in global human population which is expected to increase to 9.7 billion by 2050, there is also increase in challenges to provide sufficient nutritious and healthy food to the people. To meet such demand, food production also need to be enhanced which strained our natural resources resulting in environmental pollution, soil erosion etc. Natural disasters and also transboundary diseases pose threats to food safety and security by causing high morbidity and mortality in animals and causing public health issues (Gracia et al., 2020).
Biodiversity supports human health and wellbeing by proving basic goods and services. About 1.5 billion people depend upon biodiversity for livelihood. There is a complex linkage between biodiversity and human health. High diversity of species has dilution effect as they decrease host pathogen density and also balance the population of vectors. Biodiversity loss affects host and vector population control by declining predator population and by increasing contagiousness of diseases. Land use change and wildlife hunting and trading are main causes of biodiversity loss. So, integrating biodiversity management with OH is helpful in better assessing risks of disease emergence and poor health outcome (https://www.genevaenvironmentnetwork.org/resources/updates/one-health/#scroll-nav ).
Climate change is a global problem. Climate change like increased global temperature, rising sea level, heat waves, droughts, floods, cyclone, increased emission of greenhouse gases, wildfires etc. have detrimental effect on social and environmental factors that determine human and animal health. Air, water and food qualities are affected along with emergence of vector borne and water borne infectious agents, rise of allergens and zoonoses (Viegas, 2021). The increase in global average temperature by 2-30 C will 3-5 % increase the population at risk of malaria by changing migration pattern of vector. Climate change may cause additional deaths of 250,000 per year between 2030 to 2050 due to viral diarrhea, malaria and childhood under nutrition (https://www.env-health.org/wp-content/uploads/2021/01/One-Health-Briefing.pdf ).
For generating increased world awareness on one health, 3rd November is celebrated as one health day. In India, death due to rabies occurs annually around 20, 000. Tamil Nadu state pioneered one health committee to address Rabies challenges in human and dogs by cost effective rabies vaccination of human and dog as well as canina sterilization (Sudarshan et al.,2013).
One health approach prevents future outbreak of zoonotic disease, decrease AMR, improves food security and protects global health (https://www.cdc.gov/onehealth/basics/index.html ). The potential outcome of one health approach is more interdisciplinary programmes, more sharing of information related disease diagnosis, detection, education and research, more prevention of chronic and infectious diseases and development of new therapeutics and treatments etc. In last few decades, animal and human health are challenged by complex disease, those are multifactorial, involving multi species and are transboundary. So transdisciplinary and multisector approach is required at different level to successfully control those diseases.
References
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