ONE HEALTH APPROACH: THE NEED OF THE HOUR
Neelam Kushwaha
Hospital Registrar (Clinical Veterinary Medicine, Ethics and Jurisprudence),
Teaching Veterinary Clinical Complex, College of Veterinary and Animal Sciences,
Udgir – 413 517, Dist. Latur (Maharashtra)
The recent COVID-19 pandemic in human and outbreak of lumpy skin disease in animals have necessitated the relevance of One Health approach. One Health is a collaborative, multisectoral, and transdisciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment (One health basics, CDC). With the time, forests have encroached by the human due to increases in the population. With the advancement of human civilization, industrialization as well as global changes are hastening. These changes led to damage to the biodiversity and ecosystems. Human actions have altered 75% of terrestrial environments and 66% of marine environments. Because of the speedy changes in the environmental and climatic conditions, there is emergence and reemergence of diseases including zoonoses occurring. Zoonotic diseases are the infections that are transmitted between animals and humans and are a major source of emerging infectious diseases.
Animal diseases pose a direct threat to the livelihood of the people whose income depends on livestock production. More than 75% of the billion people all around the world rearing on livestock as source of income for their survival. As per the World organisation for animal health (WOAH) 60% of pathogens that cause human diseases originate from domestic animals or wildlife, 75% of emerging human pathogens are of animal origin and 80% of pathogens that are of bioterrorism concern originate in animals. As far as food safety is concerned, at each night, some 811 million people go to bed hungry. More than 70% additional animal protein will be needed to feed the world by 2050. Meanwhile, more than 20% of global animal production losses are linked to animal diseases. Humans and livestock are more likely to encounter wildlife. Some of these contacts may increase the chances of disease transmission.
As far as challenges for the public health is concerned, multi-disciplinary approaches along with coordination and mutual understanding between different sectors are required. The main aim of working together is to fill the communication gap between various institutions and stakeholders to improve the health of people and animals including pets, farm animals, and wildlife.
Journey towards One health approach and establishment of One health office
Although the term “One Health” seems quite new for the people but its concept has been recognized long back. Till 20th century the veterinary and human medicine were being practiced separately, although the similarities between animals and human diseases processes were noted by scientists and researchers in 1800s. There were so many events occurred before the concept of One health approach but only some important events are mentioned here.
Dr. Rudolf Virchow, a German pathologist, recognizes the link between human and animal health. He was one of the most prominent physicians in 19th century. While studying Trichinella spiralis (a roundworm) in swine, he developed interested in the linkages between human and veterinary medicine. He emphasized, “Between animal and human medicine there are no dividing lines—nor should there be. The object is different but the experience obtained constitutes the basis of all medicine.” He coined the term “zoonosis” to indicate an infectious disease that is passed between humans and animals. He promoted the upgradation of veterinary education. After him, Dr. William Osler (father of veterinary pathology in North America) was a Canadian physician who had a deep interest in the linkages between human and veterinary medicine. “The Relation of Animals to Man” was one of his first publications was titled,
Before 1947, there was no existence of concept of Veterinary public health. It was Dr James H. Steele who understood that the good health of animal is important for the good health of public. He recognized that the animals play important role in the epidemiology of zoonotic diseases and in the year 1947, he founded the Veterinary Public Health Division at Centres for Disease Control and Prevention (CDC). The Division played an important role in the public health response to diseases such as rabies, brucellosis, salmonellosis, Q fever, bovine tuberculosis, and leptospirosis.
The term “One Medicine” is coined by Dr Calvin Schwabe in his textbook, “Veterinary Medicine and Human Health”. He had many significant contributions to veterinary epidemiology and had supported one health. In the 1964 edition of his monograph, he called for unified approach including both veterinary and human health professionals collaborate against zoonoses.
In 2008, October 25-26, an International Ministerial Conference weld held on Avian and Pandemic Influenza in Sharm el-Sheikh, Egypt and “Contributing to One World, One Health™-A Strategic Framework for Reducing Risks of Infectious Diseases at the Animal-Human-Ecosystems Interface” was officially released in this meeting. Representatives from more than 120 countries and 26 international and regional organizations attended this conference. Based on the framework, One Health becomes a recommended approach for fighting against avian influenza and other infectious diseases.
In 2009, Lonnie King (then director of CDC’s National Center for Zoonotic, Vector borne, and Enteric Diseases) proposed the One Health Office. The One Health office was established and is located within the National Center for Emerging and Zoonotic Infectious Diseases at CDC in Atlanta, GA. Since that time, the role of the One Health Office has expanded to includes supporting public health research that furthers the One Health concept, facilitating the exchange of data and information among researchers across various disciplines and sectors.
In 2009, March 16-19, the Public Health Agency of Canada hosted “One World, One Health™: From Ideas to Action expert consultation” in Winnipeg, Manitoba. It was held to further discuss the One World, One Health™ strategy and the objectives in “Contributing to One World, One Health™-A Strategic Framework for Reducing Risks of Infectious Diseases at the Animal-Human-Ecosystems Interface”, which was first released at the 2008 International Ministerial Conference on Avian and Pandemic Influenza in Sharm el-Sheikh. Experts attended from 23 countries.
In 2010, May 4-6, CDC, in collaboration with the WOAH, FAO and WHO, hosted a meeting in Stone Mountain, GA, entitled, “Operationalizing ‘One Health’: A Policy Perspective—Taking Stock and Shaping an Implementation Roadmap.” The meeting, which came to be known as the “Stone Mountain Meeting,” was designed to define specific action steps to move the concept of One Health forward. Participants identified seven key activities to advance the One Health agenda. These activities formed the basis of which focused on:
- Cataloguing and developing One Health trainings and curricula
- Establishing a global network
- Developing a country-level needs assessment
- Building capacity at the country level
- Developing a business case to promote donor support
- Gathering evidence for proof of concept through literature reviews and prospective studies
In 2010, April 19-21, a total of 71 countries and regional bodies, along with representatives from international organizations, development banks and other stakeholders, attended the 2010 International Ministerial Conference on Avian and Pandemic Influenza in Hanoi, Vietnam. With the experience of the H1N1 pandemic and highly pathogenic H5N1 avian influenza, participants confirmed the need to bring greater attention to the links between human and animal health to address threats that happen when animals, humans, and the ecosystem interface. At the conclusion of the meeting, participants unanimously adopted the declaration, which called for focused action at the animal-human-ecosystem interface and recommended broad implementation of One Health.
A high-level technical meeting was held in Mexico City November 15-17, 2011. The focus of this meeting was to address health risks that occur in different geographic regions by highlighting three priority One Health topics—rabies, influenza, and antimicrobial resistance.
In 2012, February 19-22, the first One Health Summit was held in Davos, Switzerland. The Summit presented the One Health concept as a way to manage health threats, focusing on food safety and security. The conference ended by approving the “Davos One Health Action Plan,” which pinpointed ways to improve public health through multi-sectoral and multi-stakeholder cooperation.
Why the need of One Health approach?
Health of humans, animals and environment is interdependent. One Health is an approach which recognizes that the health of people is related to the health of animals and environment. One Health concept is not new, but it has become more important in recent years. As the human populations are growing and expanding into new geographic areas. As a result of this the natural habitat of the animals are encroached by the humans. The livelihood of the rural communities depends on the livestock. More people keeping pets for companionship. Therefore, close contact of people with animals and disruptions in environmental conditions can provides new opportunities for diseases to transmit between animals and people. As the movement of people, animals, and animal products has increased from international travel and trade, resulting in quick spread of across borders and around the globe.
Damage to the biodiversity, ecosystem due to deforestation and intensive farming practices and migratory movement of human and animals including birds have led to the spread of existing and emerging zoonotic diseases. OIE has listed numbers of zoonotic diseases, some examples of zoonotic diseases are Rabies, Salmonella infection, West Nile virus infection, Q Fever (Coxiella burnetii), Anthrax, Brucellosis, Tuberculosis, Lyme disease, Ringworm, Ebola etc. Every year, millions of people and animals around the world are affected by zoonotic diseases. Some diseases are transmitted to animals from humans. Because of this, animals can serve as early warning signs of some human diseases e.g. birds often die of West Nile virus before people in the same area get sick with West Nile virus infection.
No single person, organization, or sector can address issues at the animal-human-environment interface alone. Cooperation of professionals in human health (doctors, nurses, public health practitioners, epidemiologists), animal health (veterinarians, paraprofessionals, agricultural workers), environment (ecologists, wildlife experts) and other areas of expertise (law enforcement, policymakers, communities and pet owners) is needed to communicate, collaborate and coordinate activities for managing public health. The common issues include zoonotic diseases, antimicrobial resistance, food safety and food security, vector-borne diseases, environmental contamination as well as other health threats shared by people, animals, and the environment like contamination of water lead to illness of people and animals. The One Health approach can prevent outbreaks of zoonotic disease in animals and people, improve food safety and security, reduce antibiotic-resistant infections and improve human and animal health and protect global health security.
How does a One Health approach work?
First formal office dedicated to One Health was established in 2009. It is located within the National Center for Emerging and Zoonotic Infectious Diseases at CDC in Atlanta, GA. The One Health Office works to promote the One Health approach and increase awareness of CDC’s role in One Health.
Source:- https://www.cdc.gov/onehealth/index.html
One Health approach works on communication, coordination and collaboration among human, animal, environmental health, and other relevant partners. The One Health Office serves as the head of the World Organisation for Animal Health (WOAH) Collaborating Center for Emerging and Reemerging Zoonotic Diseases. One Health Office staff also serve as agency liaisons to the Food and Agriculture Organization of the United Nations (FAO) and WOAH.
One Health is as an effective way to fight health issues such as antimicrobial resistance and zoonotic diseases such as rabies, avian flu and tuberculosis. CDC uses a One Health approach by involving experts in human, animal, environmental health, and other relevant disciplines and sectors in monitoring and controlling public health threats and to learn about how diseases spread among people, animals, plants, and the environment. The focus areas and priorities of One Health Office listed below-
Focus Areas
- Zoonotic and emerging infectious diseases
- Pandemic preparedness and response
- One Health emergencies at the human-animal-environment interface
- One Health pan-respiratory disease surveillance
- Global health security and capacity building
- Strengthen One Health coordination in the United States
- Strategic One Health partnerships
- Prevent zoonoses shared between people and pets
Priorities
- Lead CDC’s One Health strategy in the United States and around the world
- Coordinate partners to operationalize and strengthen One Health in the United States
- Advance One Health globally through development of tools and trainings for capacity building for global health security
- Leverage CDC’s expertise and engage partners to tackle One Health issues
- Provide technical expertise at the human-animal-environment interface, including during public health emergencies
- Fill the national void on control and prevention of pet-associated zoonoses through the healthy pets, healthy people program.
Status of One Health in India
The highest load of zoonotic disease with widespread illness and death, is prevalent in Ethiopia, Nigeria, Tanzania, and India (Jones et al., 2008). According to a study carried out by the International Livestock Research, India, 13 zoonoses are the cause of 2.4 billion cases of human diseases and 2.2 million deaths per year (Jones et al., 2008). India ranks high globally in terms of the burden and diversity of endemic and emerging zoonotic diseases (Chatterjee et al., 2017; Grace et al., 2012). With increasing population, a greater number of people are in contact with livestock and pets, making the country a hotspot for emerging zoonotic diseases. The animal health sector lacks proper surveillance and reporting of animal diseases and laboratory diagnosis. There is a lack of awareness among public and the proper attention is not paid to the wild zoonosis.
After the emergence of avian influenza and Ebola virus disease in India, the need of intersectoral coordination was felt for the effective prevention and control of diseases. The emergence of avian influenza H5N1 helped to hypothesize the collaboration of human health, animal health, and wildlife sectors to combat the problem. In the Indian context, the One Health approach is gaining importance from all stakeholders such as public health professionals, veterinarians, health‑care providers, policymakers, and researchers. Animal‑to‑human transmission is a major threat in the India such as avian flu, rabies, tuberculosis.
A National Standing Committee on Zoonoses (NSCZ) was formed for the public health importance of zoonotic diseases in 2007. The Food Safety and Standard Act, instructs the limits for contaminants, naturally occurring toxic materials, antibiotic residues, pesticides, heavy metals, veterinary drug residues, etc.. Government initiated the control programs for rabies, brucellosis, and food‑and‑mouth disease. A manual for handling zoonotic diseases has published by the Centre of Zoonosis, National Centre for Disease Control, India. National Standing Committee on Zoonoses collaborates with the Food Safety and Standard Authority of India and the National Centre for Disease Control. National Action Plan on antimicrobial resistance taking a One Health approach including human, animal and environmental sectors was prepared in India in 2017. National Expert Group on One Health (multi-sectoral transdisciplinary collaborative group), National Institute of One Health at Nagpur, Maharashtra and Integrated Public Health Laboratories have taken the initiative for mainstreaming One Health plan in India. The Department of Biotechnology (BDT), Government of India launched the First ‘One Health’ project of DBT through video conferencing post COVID. This programme envisages carrying out surveillance of important bacterial, viral and parasitic infections of zoonotic as well as transboundary pathogens in India, including the North-eastern part of the country. Use of existing diagnostic tests and the development of additional methodologies when required are mandated for the surveillance and for understanding the spread of emerging diseases. DBT-National Institute of Animal Biotechnology, Hyderabad, is one of the biggest one health programs launched by Govt of India in post-COVID times.
The collaboration and coordination among the stakeholders are not sufficient to adopt a standard One Health protocol. The successful implementation of the One Health approach requires coordination and collaboration between multiple sectors of agriculture, animal health, and human health. To make the One Health policy initiatives functional in India, there should be constitution of One Health Committees (OHCs) at State and district levels with representation from district administration, public health including clinical medicine, veterinary and wildlife institutions as well as environmental health and private stakeholders. However, the main challenge in the implementation of various One Health activities is the availability of funds.
Central as well as state governments follows the One Health approach to tackle the rapidly emerging issues of antimicrobial resistance, Zoonoses and food safety in India. Vaccination plays an important role in reducing disease. Under the National Animal Disease Control Programme, animals are vaccinated for FMD, Brucellosis, PPR and CSF. Awareness programmes are initiated regarding antimicrobial resistance for different stakeholders. As a One Health initiative we are look for the Good Animal Husbandry Practices both at farm as well as field level to reduce the direct and indirect burden caused by diseases in animals. In this regard antimicrobial resistance is a very important aspect as it is one of the most serious issues for health of livestock and human globally as we entered in 21st century.
The sharing of data in Indian context is not up to the mark. The Indian government is working towards creating One Health platform for sharing of knowledge on health of human and animal as well. For infectious diseases in animal, a nationwide surveillance programmes are going on by National Institute of Veterinary Epidemiology and Disease Informatics (NIVEDI), under Indian Council of Agricultural Research. This surveillance data is available on website of NIVEDI. But if we talk about the sharing of data, it is still scanty as we don’t have streamlined Data sharing systems with built-in mechanisms. Therefore, the data are not easily accessible by various sectors.
Conclusions
The One Health approach is adopted as the standard approach globally to combat the emerging and reemerging infectious diseases including zoonoses. The COVID-19 pandemic caused public health crisis and necessitated the understanding of one health concept for the health of public. In future the health risks of human as well as animals will increase with changes in climate and in human behaviour. Damage to the biodiversity and alteration in terrestrial as well as marine environment, provide suitable and multiple chances for existing pathogens to colonise new territories and evolve into new forms. The challenges and risks are not limited to humans only. The health of animal is also at risk because some diseases are transmitted to animals from human. Managing the global health risk is not possible alone. People must understand that the health of animal, human and environment is interdependent. Health of animals and the environment depend on behaviour and action of human, and the health of animals and the environment determine the health of human. Therefore, managing the global health risks including health of public, animal (pet, domestic, and wild) and environment is very crucial and needs the collaboration and coordination of the animal, human, and environmental health sectors.
For one health, surveillance of animal health is strictly advised. The surveillance and monitoring have to be improved by joint interdisciplinary network of different sectors. In addition to this, public, farmers, livestock owners and environmentalists should increase their awareness regarding zoonotic diseases and one health approach. Practices as well as national disease registry of zoonotic diseases need to be developed and adopted globally. We are living in the era of advance technology in each field, use of which should be increased for the improvement of environment as well as monitoring and treatment of diseases globally.
References
One Health Basics. Available from: https://www.cdc.gov/onehealth/basics/index.html
One health. Available from: https://www.woah.org/en/what-we-do/global-initiatives/one-health/
One health. Available from: https://www.cdc.gov/onehealth/basics/history/index.html
One health. Available from: https://www.cdc.gov/onehealth/who-we-are/index.html#:~:text=CDC’s%20One%20Health%20Office%20is,in%20a%20US%20federal%20agency.
Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, et al. 2008. Global trends in emerging infectious diseases. Nature, 451:990‑3.
Chatterjee P, Bhaumik S, Chauhan AS, Kakkar M. Protocol for developing a database of zoonotic disease research in India (DoZooRI). BMJ Open. 2017;7(12):e017825.
Grace D, Mutua F, Ochungo P, Kruska RL, Jones K, Brierley L, Lapar M, Said MY, Herrero MT, Phuc PM, Thao NB. Mapping of poverty and likely zoonoses hotspots. 2012. Available from: https://cgspace.cgiar.org/bitstream/handle/10568/21161/ZooMap_July2012_final.pdf? sequence=4&embedded=true
Ministry of Science & Technology. Available from: https://www.pib.gov.in/PressReleasePage.aspx?PRID=1763772#:~:text=of%20launched%20the%20First%20’One,eastern%20part%20of%20the%20country.
***
