COVID-19: the need for the strategic "ONE HEALTH" approach
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Human health is increasingly interconnected with that of the animals in the environment they share, while the threat of emerging diseases arising at that interface increases as a result of the multiple and growing driving forces which propitiate that greater human-animalenvironmental interrelationship COVID-19 is an emerging zoonosis caused by SARS-CoV-2, a new coronavirus whose primary source is associated with bats Its rapid global expansion led the World Organization (WHO) to consider the disease as a Public Emergency of International Concern (PHEIC), for which the cross-sectoral approach is necessary The One Health strategy, promoted by the international organizations FAO, OIE and WHO, promotes collaborative efforts at all levels across multiple disciplines and sectors to achieve optimal health for people, animals and the environment, thus providing a conceptual framework for the development of cross-sectoral and multidisciplinary solutions to global health challenges This approach reviews the latest research reports on crucial aspects in the epidemiology of this new zoonosis, such as the characteristics of coronaviruses, their hosts, factors after crossing the interspecies barrier, and the undefined aspects of SARS-CoV-2 with potential implications for its prevention and control, as well as the lack of knowledge of the intermediate host of the virus, an important link in the epidemiological chain and the role that wild and domestic animal species, including pets, can have in the persistence of the virus in the environment and its potential re-emergence It also addresses the necessary cooperation between human and animal health services in activities to face COVID-19, while pointing out its negative economic impact on the entire food production and distribution chain This is an example of the importance of the holistic vision proposed by the One Health approach in the prevention and control of zoonoses, benefiting the achievement of the Sustainable Development Goals by all countries, by proposing that healthy people and animals live in a healthy planet There is a need of strengthening capacity building and cooperation between the human and animal health sectors, as well as their preparedness to face future health emergenciesKeywords:
Zoonosis
One Health
Pandemic
Global Health
Coronavirus
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To formulate health development policy and strategies aimed at the Sustainable Development Goal 3, which seeks to ensuring health and well-being for all, it is indispensable to revisit the issue of global health governance in the wake of the Ebola virus disease outbreak in West Africa. The issue of global health governance is also relevant in the Asia-Pacific region, where Severe Acute Respiratory Syndrome (SARS), influenza A (H1N1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) were health security threats. The failure to respond timely and effectively to the health crisis was derived from a few factors that are relevant to the means of implementation necessary to achieve the Sustainable Development Goals. During ordinary times, efforts to enhance health systems should include building the core capacities of the International Health Regulations (IHR), which should be supported not only by the World Health Organization (WHO), but also through coordination among diverse multilateral and bilateral organizations as part of their health development cooperation programmes associated with achieving the Sustainable Development Goals. To enhance preparedness for handling health crises, the organizational capacities of WHO and its regional offices need to be strengthened. In addition, coordination among WHO and other actors should be facilitated in accordance with the situational categories based on the combination of (a) the capacity of the country where an outbreak of an infectious disease is occurring and (b) the severity and magnitude of that infectious disease.
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Recently, the term “One Health” has been widely used in many different contexts and by people with different professional backgrounds, resulting in confusion among clinicians and scientists. Although defining the boundaries of One Health is difficult, One Health promotes health through interdisciplinary studies and actions, across all animal species. The One Health Initiative proposed the One Health concept as a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for people, animals and the environment. For examples, the West African Ebola outbreaks of 2013~2015, which started in Guinea and became pandemic spread, as well as the global action plans to control the antibiotic resistance provide some useful insights how to analyze the One Health. So far, it seems that significant gaps are present in disease awareness and management, which can be addressed in responses to future outbreaks of emerging diseases. These gaps include (i) insufficient monitoring and ecological modelling of zoonotic diseases, (ii) insufficient systems for community education about the ecological aspects of disease outbreak and management, and (iii) insufficient resources committed to enhancing food security to limit environmental encroachment and exposure to zoonotic disease in the wild. To fill these gaps, it might be needed to generate the data required to create computational models that will be accurately predict outbreaks as well as seasonal monitoring of natural reservoirs for zoonotic diseases. In addition, a coordinated response is required in both human and veterinary sectors and resources must be committed to ensure that unstable food security does not increase opportunities for human to encounter viral reservoirs. Most importantly, professionals in environmental sciences, veterinary medicine, and human medicine need to help each other in the stewardship to achieve the One Health paradigm.
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The emerging public health issues of 21st century have clearly warned us that the efficient tackling of these threats need to be done in collaborative manner between relevant public health professionals under the umbrella of One Health. The concept of One Health is longstanding; however, it is gaining due momentum across the globe, especially in context of tackling emerging zoonoses. India remains vulnerable to many of emerging health threats due to demographic, socio-economic and other factors related with globalization, climate change and related biodiversity losses. In India, the various public health agencies which includes human, animal and environmental health professionals have contributed joint efforts in recent past to confront the One Health related issues. However, the bridging of professional silos to act more synergistically need further sustained efforts from all the stakeholders, including policy makers.
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The last months have left no-one in doubt that the COVID-19 pandemic is exerting enormous pressure on health systems around the world, bringing to light the sub-optimal resilience of even those classified as high-performing. This makes us re-think the extent to which we are using the appropriate metrics in evaluating health systems which, in the case of this pandemic, might have masked how unprepared some countries were. It also makes us reflect on the strength of our solidarity as a global community, as we observe that global health protection remains, as this pandemic shows, focused on protecting high income countries from public health threats originating in low and middle income countries. To change this course, and in times like this, all nations should come together under one umbrella to respond to the pandemic by sharing intellectual, human, and material resources. In order to work towards stronger and better prepared health systems, improved and resilience-relevant metrics are needed. Further, a new model of development assistance for health, one that is focused on stronger and more resilient health systems, should be the world's top priority.
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As COVID-19 pandemic emergence progresses and overwhelming healthcare systems, countries are reviewing their policies to protect those at increased risk of severe disease. These can be policies aimed at suppressing transmission in the wider population, vaccination (if vaccine becomes available) as the world anxiously awaits an effective COVID-19 vaccine that can be readily distributed. Until then, the priority is to reenergize countries to act rather than react. Even as the uncertainties of the COVID-19 crisis multiply, the aim must be to rebuild for the longer term protection i.e., explicit measures to protect people at increased risk by reducing interactions amongst people in danger, etc. The spread of SARS-CoV-2 pandemic has forced us to realize the fact that progress towards Sustainable Development Goals is threatened and fragile, as the numbers of people heading into poverty are now at increased risk of setbacks. It also stresses the need to strengthen the relationship between scientific evidence to protect the environment and public health. This requires an understanding of the importance of the interventions to address structural inequity, global health care and coverage, and comprehensive social protection schemes as part of the response. It is time to recognize that not all of us are at equal risk of severe outcomes from COVID-19 and to work with stakeholders to formulate an effective response. This study presents evidence from studies informing policymakers about the number of individuals that might be at increased risk or high risk of severe COVID-19 in different nations. Therefore, there is need to develop scientific evidence for rapid assessments of environmental and public health action in the era of coronavirus diseases, which should focus on different policies guidelines to prevent those at increased risk. Estimating the number of people at high risk of severe COVID-19 is important to help countries to design more effective interventions to protect vulnerable individuals and reduce strain on health systems. This information can provide and inform a comprehensive assessment of the health, social, and economic consequences of shielding different groups, suggesting the need to develop a longer term Covid-19 management strategy and given the unprecedented scale of decision-makers’, evidence needs large-scale collaboration and shared learning within the evidence synthesis community.
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Merge (version control)
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Globally, the threat of infectious diseases, particularly emerging infectious diseases, originating at the human-animal-environment interface, has caught health systems off guard. With forecasts that future pathogen emergence will be centred in hotspots in Asia, Africa, and Latin America, the need to prepare policy frameworks that can combat this threat is urgent.
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One Health is an integrated approach for preventing and mitigating health threats at the animal-human-plant-environment interfaces with the objective of achieving public health, food and nutrition security, sustainable ecosystems and fair-trade facilitation. Health threats have become more complex due to globalisation, increasing population, climate change, deforestation, and intensive livestock production practices. Majority (75%) of emerging and re-emerging infectious diseases are of animal origin and diseases such as rabies and zoonotic influenza continue to pose threat to human and animal health. Foodborne diseases and Antimicrobial Resistance (AMR) are increasingly emerging at the human-animal interface thus requiring a One Health multi-sectoral collaboration to address these emerging threats.
Since 2010, the tripartite, consisting of the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and the World Health Organization (WHO) have come together to synergise their efforts and in coordinating their efforts in addressing the One Health threats including Rabies, Zoonotic Influenza, AMR and other emerging zoonoses at the animal-human-ecosystem interface. The tripartite has come up with several global strategic plans, frameworks, guidelines, strategies, tools and mechanisms to support countries in addressing these threats. The tripartite has been organising the multisectoral workshop on zoonoses biennially since 2010 to keep the momentum on multisectoral coordination and collaboration in countries to address health threats and the most recent workshop was held in Bangkok this year.
The OIE, as the global inter-governmental organisation spearheading issues related to animal health and welfare, has been at the forefront in conceptualising and undertaking several activities such as organising workshops, seminars, conferences on zoonoses including diseases such as Rabies, Zoonotic Influenza, Zoonotic Tuberculosis, Brucellosis, Neglected Parasitic Zoonoses and other threats such as AMR. As the global standard setting body, the OIE publishes latest scientific information on animal diseases including zoonoses that countries can use for their disease prevention and control programs. The OIE through its rabies vaccine bank provides a platform for countries to access high quality animal rabies vaccines at affordable cost to prevent and control rabies in countries and support global target of eliminating dog-mediated human rabies by 2030. To address the threat of AMR, the OIE supports countries in the prudent and responsible use of antimicrobials through workshops to monitor the use of antimicrobials in animals; seminars for the livestock and aquaculture industries, veterinary schools, veterinarians, associations; and laboratory trainings on AMR surveillance.
Given the diversity in terms of animal production systems, animal and human population, developmental stages of countries in the Asia Pacific Region, there are still many challenges faced by countries in addressing the threats posed by zoonoses and emerging diseases. These challenges include weak political support, lack of adequate resources (human, infrastructure and funds), competing priorities amongst the One Health stakeholders, and weak coordination amongst the key stakeholders. In order to address the emerging threats posed by zoonoses and AMR, it is important to strengthen One Health initiatives at all levels through continuous advocacy for political support, institutionalisation of national and sub-national multisectoral coordination mechanisms, application of multisectoral tools, and joint prioritisation of One Health needs.
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Objective: This study identified the importance and the benefits of one health approach for strengthening public health system during the Covid-19 pandemic era. Method: This research was done by doing literature review from Google Scholar and PubMed. The journals chosen was recruited based on inclusion criteria with keywords “One Health” AND “Covid-19”. Results: The journals emphasized the importance of cross-sector collaboration. Disease transmission was triggered by human activities that resulted in environmental changes such as deforestation and land use shifts, forcing wildlife and their microorganisms to seek new hosts. This process could result in zoonoses disease, which is a disease that spreads from animal to humans. However, because the corona virus is known for its ability to easily mutate, there have been reports of disease transmission from human to animal as well. The first case was in the Bronx Zoo in New York, where two tigers and lions were tested positive for SARS CoV-2. Transmission was traced back to their zookeeper, according to investigations. Months later, the Ragunan Zoo in Jakarta reported the first human-to-animal transmission in two tigers. The virus appears to be susceptible to the tiger and its family (Felidae). However, there had been no reports of transmission from cats and their relatives (Felidae) to humans until this paper was completed. Therefore, coordination and communications are needed to tackle and acknowledge the disease. These disease transmissions from animal to human, human to human, and human to animal (zoonotic) underlined the importance of surveillance between sectors under the same roof to strenghten public health system. Moreover, One Health approach regained its recognition especially during the G-20 summit 2021 for Ministry of Health meeting as a resilience strategy in overcoming the next pandemic. One Health approach considered suitable preventing and combating the pandemic since the expert from human, animal and environmental health work together. Conclusions: One strategy to strengthen the public health system is to establish trust and collaborate across sectors for better public health outcomes. Since its integrity could manage developing public health challenges, one health is considered to be a great method overcoming the pandemic.
Pandemic
Zoonosis
Animal health
One Health
Disease Transmission
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