ONE HEALTH APPROACH: THE NEED OF THE HOUR
Neha Parmar1 and Vinod V.K.2
1Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University Ludhiana, Punjab, India
2College of Veterinary and Animal Sciences, Pookode, Wayanad, Kerala, India
Email Ids: npvet36@gmail.com; vinodvk@kvasu.ac.in
The World Organization for Animal Health (OIE) has estimated that more than 60% of all infectious diseases, including more than 75% of all emerging and re-emerging human diseases, originate from animals. Humans and animals live in the same environment and share several pathogens. Zoonoses are diseases that are transmitted from animals to humans and vice versa. Since these infectious diseases can affect both man and animals and the environment plays the role of a mixing vessel, a multisectoral approach can help in minimising the transmission of these zoonoses. One such approach that is gaining popularity is the One Health concept. One Health (OH) is a cost-effective, sustainable and practical approach to achieve optimal health for people, animals and the environment. The OH approach can help in solving health problems that require a holistic and multidisciplinary approach, specifically in developing countries. It aims to form and create networks to enhance human, animal as well as environmental health outcomes and well-being along with encouraging environmental resilience through a collective approach. The approach helps to control traditional zoonotic diseases such as rabies and tuberculosis. The OIE, along with the World Health Organization and the Food and Agriculture Organization, has been sponsoring this concept since the early 2000s.
The incidence of global epidemics such as highly pathogenic avian influenza (HPAI), SARS, MERS and Ebola have provided a significant push for international advocacy and backing to fortify the OH concept and promote partnership among human, animal and environmental sectors. Given the complexity of these diseases, specialists from different health areas need to work together to prevent, control and avert potential epidemics.
The human population is growing and expanding into new geographic regions. As a result, an increasing number of population is living in close contact with wild and domesticated animals, including companion animals. Animals play an essential role in our day to day lives, whether for food, fibre, subsistence, travel, sports, education or companionship. Close association with animals and their environment enable the transmission of diseases between animals and humans. Many factors, like changes in climate and pattern of land use, deforestation and intensive agricultural practices, have changed the interactions between humans, animals, plants and nature providing new opportunities for disease transmission between animals and humans. The increased international travel and trade resulted in the rapid spread of diseases worldwide. Over the past 30 years, it has become evident that most of the emerging zoonotic infectious diseases originated in animals, especially wild animals. A collaborative and multidisciplinary approach that encompasses animal, human and environmental health is needed to know the ecology of emerging zoonotic diseases, which can commence a risk assessment programme and plans for disease response and control. Today’s problems in health sectors are complex, multifactorial and multispecies. Sustainable mitigation strategies are unlikely to be developed if tackled from a solely medical, veterinary or environmental viewpoint.
One Health concept recognises that human health is closely linked to the health of animals and our common environment. It is a scientifically based and validated concept of great social importance that emerged from integrated zoonoses research. This approach has gained prominence recently. It currently encompasses the interrelationships among human, animal and environmental health in a multidisciplinary approach represented by a complex biological and social system involving multiple factors and processes and their interactions over time at local, national and global scales. Multiple sectors work collectively to achieve improved public health outcomes. The complex interactions between people, animals and plants render this collaborative, multi-sectoral and transdisciplinary method critical in addressing future health risks and challenges.
The thought of One Health can be traced back at least two centuries. It was initially known as One Medicine, later as One World-One Health and ultimately as One Health. There is no internationally agreed definition of One Health, though quite a few have been proposed. The widely used definition of ‘One Health is a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional, national, and global levels—to achieve optimal health outcomes recognising the interconnection between man, animals, plants, and their shared environment’(CDC, USA AND One Health Commission). Another definition recommended by the One Health Global Network is: ‘It recognises the health of man, animals and ecosystems as interlinked and involves the application of a coordinated, collaborative, multidisciplinary and cross-sectoral approach to handling potential or existing health risks at the interface of animal-human ecosystems.
The term One Health was first used in 2003-2004 with the emergence of SARS in the year 2003 and then with the emergence of highly pathogenic H5N1 avian influenza. A set of goals known as the Manhattan Principles, consequent to a 2004 Wildlife Conservation Society conference, identified the relationship between human and animal health and the concerns and risks those diseases posed to the food supply chain and global economy. These principles were a critical step in acknowledging the importance of collaborative, interdisciplinary approaches in responding to emerging and resurgent diseases, particularly in incorporating wildlife health as an integral part of global disease surveillance, prevention, control and mitigation strategies.
The outbreak of SARS led to the realisation that (a) a previously unidentified pathogenic organism could erupt from a wildlife source at any time and place and may threaten the health, welfare and economy of all societies without warning; (b) There was a clear necessity for many countries to have the capabilities to sustain an efficient alert and response system to quickly detect and respond to outbreaks of international importance and to share information about such pandemics in a timely and transparent manner, and (c) Responding to outbreaks or pandemics in multiple countries requires global collaboration and global involvement using the core principles embodied in One Health. The appearance and spread of H5N1 influenza was another excellent example of global collaboration and a one-health approach, fuelled by widespread concern that it could be the next strain of the pandemic.
The interdisciplinary partnership is at the essence of the One Health concept. The One Health concept focuses on outcomes, efforts, and actions taken at the animal-human–ecosystems interfaces, particularly on 1) emerging and endemic zoonoses, being accountable for a much more significant burden of ailments in the developing world, with a significant impact on societies with poor financial backgrounds,2) antimicrobial resistance (AMR), as resistant pathogens can arise in human, animals, or the environment and lead to worldwide spread and 3). Food safety. However, the One Health concept also holds other disciplines like environmental ecology and social sciences, ecosystem health, wildlife, patterns of land use, and biodiversity.
An global estimate of 59,000 individuals, including over 20,000 in India, succumb to rabies every year, and most of them are children living in rural or underprivileged areas. Rabies is an endemic disease present worldwide except in Australia and Antarctica, where dog-mediated rabies has not been reported. Many Asian, European, North, and South American nations have been declared rabies-free. However, rabies is still a problem in many countries in Asian and African continents. Rabies is a classic one-health challenge and more than 99% of mortality is due to contact with a rabid dog. Vaccines to prevent rabies in dogs and humans are the main component of post-exposure prophylactic (PEP) therapies after a dog bite. However, lack of awareness, combined with the differential accessibility of PEP, is the cause of rabies-associated deaths in the human population. Although vaccinating dogs has the potential to control the transmission of rabies to humans, it was widely considered unaffordable in India.
For rabies control, surveillance needs to go beyond the clinics and vaccination of dogs and should be mobilized at the rural grassroots, recognizing the mutual benefits to human and livestock health. Rabies can contribute significantly to integrated capacity building by taking a whole-of-government approach outside the established health system and silos. Vaccination of dogs has been reported as the most disruptive rabies control measure, yet it is the pragmatic and most cost-effective measure that can be carried out. It is essential to prevent many zoonoses at the source and build preparedness for emerging diseases in healthy ecosystems. The effective management of rabies, typically endemic zoonosis, will create the most robust platform to strengthen universal health reporting and health security. Investment in OH through rabies eradication will save lives, build harmony, reduce health dissimilarities and reinforce core capacities to respond to future health emergencies.
