Over the past decade, a significant increase in the circulation of infectious agents was observed. With the spread and emergence of epizootics, zoonoses, and epidemics, the risks of pandemics became more and more critical. Human and animal health has also been threatened by antimicrobial resistance, environmental pollution, and the development of multifactorial and chronic diseases. This highlighted the increasing globalization of health risks and the importance of the human-animal-ecosystem interface in the evolution and emergence of pathogens. A better knowledge of causes and consequences of certain human activities, lifestyles, and behaviors in ecosystems is crucial for a rigorous interpretation of disease dynamics and to drive public policies. As a global good, health security must be understood on a global scale and from a global and crosscutting perspective, integrating human health, animal health, plant health, ecosystems health, and biodiversity. In this study, we discuss how crucial it is to consider ecological, evolutionary, and environmental sciences in understanding the emergence and re-emergence of infectious diseases and in facing the challenges of antimicrobial resistance. We also discuss the application of the "One Health" concept to non-communicable chronic diseases linked to exposure to multiple stresses, including toxic stress, and new lifestyles. Finally, we draw up a list of barriers that need removing and the ambitions that we must nurture for the effective application of the "One Health" concept. We conclude that the success of this One Health concept now requires breaking down the interdisciplinary barriers that still separate human and veterinary medicine from ecological, evolutionary, and environmental sciences. The development of integrative approaches should be promoted by linking the study of factors underlying stress responses to their consequences on ecosystem functioning and evolution. This knowledge is required for the development of novel control strategies inspired by environmental mechanisms leading to desired equilibrium and dynamics in healthy ecosystems and must provide in the near future a framework for more integrated operational initiatives.

/pdf/the-one-health-concept-10-years-old-and-a-long-road-ahead-3cw8v0vm79.pdf

The one health concept: 10 years old and a long road ahead

The United Nations (UN) launched the 2030 Agenda for Sustainable Development to address an ongoing crisis: human pressure leading to unprecedented environmental degradation, climatic change, social inequality, and other negative planet-wide consequences. This crisis stems from a dramatic increase in human appropriation of natural resources to keep pace with rapid population growth, dietary shifts toward higher consumption of animal products, and higher demand for energy (1, 2). There is an increased recognition that Sustainable Development Goals (SDGs) are linked to one another (3, 4), and priorities such as food production, biodiversity conservation, and climate change mitigation cannot be considered in isolation (5⇓⇓–8). Hence, understanding those dynamics is central to achieving the vision of the UN 2030 Agenda.



Infectious zoonotic diseases typically emerge as a result of complex interactions between humans and wild and/or domestic animals. Image credit: Pixabay/sasint.



But environmental change also has direct human health outcomes via infectious disease emergence, and this link is not customarily integrated into planning for sustainable development. Currently, 65 countries are engaged in the Global Health Security Agenda (GHSA) and are finalizing a strategic plan for the next five years (the GHSA 2024 Roadmap) to better prevent, detect, and respond to infectious disease outbreaks in alignment with SDGs 2 and 3 on food security and human health. Without an integrated approach to mitigating the disease emergence consequences of environmental change, countries’ abilities to achieve SDGs and GHSA targets will be compromised.

Emerging infectious diseases (EIDs) such as Ebola, influenza, SARS, MERS, and, most recently, coronavirus (2019-nCoV) cause large-scale mortality and morbidity, disrupt trade and travel networks, and stimulate civil unrest (9). When local emergence leads to regional outbreaks or global pandemics, the economic impacts can be devastating: The SARS outbreak in 2003, the H1N1 pandemic in 2009, and … 

[↵][1]1To whom correspondence may be addressed. Email: moreno.dimarco{at}uniroma1.it.

 [1]: #xref-corresp-1-1

https://www.pnas.org/content/pnas/117/8/3888.full.pdf

Opinion: Sustainable development must account for pandemic risk.

Global Biodiversity Outlook 2

Some aspects of research supply chains problems are proposed in this regular session.

http://ieeexplore.ieee.org/iel7/7368810/7380113/07380245.pdf

Supply chain

Antimicrobial resistance (AMR) is a complex, multifaceted problem that threatens human and animal health, the global economy, and national and global security. In the USA, an estimated 2 million drug-resistant infections occur annually, accounting for 8 million extra hospital days, 23,000 deaths, and $20 billion in direct healthcare costs (Hughes 2011; Centers for Disease Control and Prevention 2013). Worldwide, AMR is increasing (Klein et al. 2018); if current trends continue unabated, there could be as many as 10 million annual AMR-associated deaths from a wide array of infections by 2050 (Review on Antimicrobial Resistance 2016). The World Health Organization (WHO) has included AMR as one of the top ten threats to global health in 2019 (World Health Organization 2019). Two recent examples highlight the threat of emergence and rapid geographic dissemination of antibiotic resistance genes. An enzyme that confers resistance to a wide range of antibiotics, New Delhi metallo-beta-lactamase 1 (NDM-1), has emerged in the Indian subcontinent and spread to the UK as a result of medical tourism after first being detected in 2008 (Yong et al. 2009). The NDM-1 gene was subsequently detected in surface and tap water samples in India in 2010 and in the environment in Bangladesh, indicating the potential for environmental origin and worldwide spread of this gene and its variants (Walsh et al. 2011; Islam et al. 2017; Khan et al. 2017). The NDM-1 gene has recently been identified in nutrient-rich Arctic soil of a remote Norwegian archipelago, raising the possibility of spread by feces from migratory birds (McCann et al. 2019). The MCR-1 (mobilized colistin resistance-1) gene, a plasmidborne gene conferring colistin resistance, was identified in pigs in China in 2014 (Liu et al. 2016) and has subsequently spread to dozens of other countries (Marston et al. 2016; Wang et al. 2018). The purpose of this commentary is to highlight the importance of an integrated and holistic multisectoral One Health approach in combating AMR (Fig. 1) and in particular, the need for better integration of environmental, aquatic, and wildlife issues into current approaches (Andersson and Hughes 2014; Lammie and Hughes 2016; Robinson et al. 2016). Recent national and multinational strategies to address the urgency of AMR include the United States National Action Plan for combating antibiotic-resistant bacteria (White House 2015), World Health Organization (WHO) Global Action Plan on Antimicrobial Resistance (World Health Organization 2015), Declaration from the 2016 high-level meeting on antimicrobial resistance at the United Nations General Assembly (OPGA/ WHO/FAO/OIE 2016), and the FAO/OIE/WHO Tripartite Collaboration (FAO/OIE/WHO 2017)—all of which stress the importance of a multisectoral One Health response. WHO’s Global Antimicrobial Resistance Surveillance Correspondence to: Allison White, e-mail: white@ecohealthalliance.org

/pdf/critical-importance-of-a-one-health-approach-to-y8pmwo1t6r.pdf

Critical Importance of a One Health Approach to Antimicrobial Resistance.

Public health systems have critical and clear relevance to the World Bank’s twin goals of poverty eradication and boosting shared prosperity. In particular, they are impacted by, and must respond to, significant threats at the human-animal-environment interface. Most obvious are the diseases shared between humans and animals (“zoonotic” diseases), which comprise more than 60 percent of known human infectious pathogens, but also aspects of vector-borne disease, food and water safety and security, and antimicrobial resistance. Public health systems must therefore be resilient and prepared to face existing and future disease threats at the human-animal-environment interface. This Operational Framework provides a practical reference toward achieving that aim, with the following key objectives: i) Provide operational guidance to directly address the need for targeted investments that prevent, prepare, detect, respond to, and recover from issues like diseases with endemic, emerging, and pandemic potential, including antimicrobial resistance; ii) Showcase opportunities for targeting disease threats upstream (prevention at the source, or via early detection and effective response) to help reduce the frequency and impact of emergencies the system has to react to; ii) Jointly yield long-term gains (and consider trade-offs) in human health, animal production, and environmental management, ultimately improving overall health of the planet and the lives, livelihoods, and well-being of people; Outline activities and interventions with a starting point at the human-animal-environment interface, highlight proposed methods of institutional and technical implementation, and enable mechanisms of coordination and partnership to build more collaborative public health systems. In its entirety, the Operational Framework provides a strong orientation to One Health to assist users in understanding and implementing it, from rationale to concrete guidance for its application. Six core chapters are included, supported by annexes diving deeper into operational tools and recent World Bank alignment with One Health topics, and a glossary that explains key terms, including interpretations specific to the Operational Framework. Chapter one presents background on the need and scope for One Health, showing how it is inclusive of and can be useful in addressing a broad range of priorities for human and animal health and environment sectors. Chapter two reviews the economic argument for One Health for the global and local public good both through more effective disease prevention and control, as well as operational efficiencies at country and project levels. Chapter three showcases relevant tools and initiatives for One Health that support capacity for human, animal, and/or environmental health sectors, bringing them together and articulating possible connections as well as identifying priority areas for further development to aid in successful One Health operations, with additional examples provided in the Annex. Chapters four to six present specific applications of One Health. Examples of entry points for One Health thinking are shown in Chapter four, including determining relevance of different sectors for involvement based on the specific context. Chapter five outlines the building blocks for embedding One Health approaches to prepare for endemic, emerging, and pandemic threats, all the way from disease prevention to recovery. Finally, noting the challenge of monitoring progress across sectors, Chapter six outlines possible pathways for monitoring and upscaling, showcasing indicators from relevant Bank projects. Ideally, projects will be designed with One Health intent from the onset, allowing Task Team Leaders (TTLs) to align their tools, investments, and indicators to yield added value from One Health.

One health : operational framework for strengthening human, animal, and environmental public health systems at their interface

Emerging infectious diseases are economically, socially, medically, and environmentally costly, as evidenced by the H1N1 influenza pandemic. Their broad consequences demand interdisciplinary solutions. One such solution, known as the One Health approach, is a growing global strategy that is being adopted by health organizations and policy makers in response to this need. It recognizes the interconnected nature of human, animal, and environmental health in an attempt to inform health policy, expand scientific knowledge, improve healthcare training and delivery, and address sustainability challenges. Education will play a particularly important role in realizing the One Health concept; however, a shortage of collaborative student programs, insufficient environmental training for health professionals, and a lack of institutional support impede progress. As a group of students from ecology, medicine, veterinary medicine, and global public health, we offer a vision for improving tertiary education to prepare environmental and health professionals to address a changing world. We outline the need for, and challenges facing, One Health and suggest ways to implement a collaborative educational network, both within the US and internationally. We also emphasize training opportunities and highlight potential hotspots of One Health excellence in the US, which are poised to use existing educational resources to train a new generation of One Health professionals.

Integrating a One Health approach in education to address global health and sustainability challenges

Issues of global environmental change, global health, emerging disease, and sustainability present some of the most complex challenges of the twenty-first century. Individual disciplines cannot address these issues in isolation. Proactive, innovative, and trans-disciplinary solutions are required. Recognizing the inherent connectedness of humans, animals, plants, and their shared environment, One Health encourages the collaboration of many disciplines—including human and veterinary medicine, public health, social science, public policy, environmental science, and others—to address global and local health challenges. Despite great progress in this shift toward transdisciplinarity, the environmental component of the One Health paradigm remains underrepresented in One Health discourse. Human and animal health issues are commonly discussed under the umbrella of the One Health paradigm, while upstream environmental drivers and solutions are less prominent. We assessed the current integration of environmental issues in One Health publications and leadership. There is room for enhanced integration of environmental knowledge in the implementation of One Health approaches. We discuss the potential benefits from the collaboration between One Health and ecohealth, and explore strategies for increased environmental involvement.

Need for Enhanced Environmental Representation in the Implementation of One Health

Background Climate change has myriad implications for the health of humans, our ecosystems, and the ecological processes that sustain them. Projections of rising greenhouse gas emissions suggest increasing direct and indirect burden of infectious and noninfectious disease, effects on food and water security, and other societal disruptions. As the effects of climate change cannot be isolated from social and ecological determinants of disease that will mitigate or exacerbate forecasted health outcomes, multidisciplinary collaboration is critically needed. Objectives The aim of this article was to review the links between climate change and its upstream drivers (ie, processes leading to greenhouse gas emissions) and health outcomes, and identify existing opportunities to leverage more integrated global health and climate actions to prevent, prepare for, and respond to anthropogenic pressures. Methods We conducted a literature review of current and projected health outcomes associated with climate change, drawing on findings and our collective expertise to review opportunities for adaptation and mitigation across disciplines. Findings Health outcomes related to climate change affect a wide range of stakeholders, providing ready collaborative opportunities for interventions, which can be differentiated by addressing the upstream drivers leading to climate change or the downstream effects of climate change itself. Conclusions Although health professionals are challenged with risks from climate change and its drivers, the adverse health outcomes cannot be resolved by the public health community alone. A phase change in global health is needed to move from a passive responder in partnership with other societal sectors to drive innovative alternatives. It is essential for global health to step outside of its traditional boundaries to engage with other stakeholders to develop policy and practical solutions to mitigate disease burden of climate change and its drivers; this will also yield compound benefits that help address other health, environmental, and societal challenges.

https://www.ecohealthalliance.org/wp-content/uploads/2016/02/Climate-Change-and-Health-Transcending-Silos-to-Find-Solutions_2015.pdf

Timothy A. Bouley

Papers

One health : operational framework for strengthening human, animal, and environmental public health systems at their interface

Integrating a One Health approach in education to address global health and sustainability challenges

Need for Enhanced Environmental Representation in the Implementation of One Health

Climate Change and Health: Transcending Silos to Find Solutions