We collectively have only one health
What science has known and told us for a long time is the interconnectedness of humans, animals and the environment, which is essentially the One Health approach. Like Rudolf Virchow, the father of comparative pathology who coined the term “zoonosis” Put the:
“Between animal medicine and human medicine there are no dividing lines – and there should not be. The object is different, but the experience gained is the basis of all medicine.
While Virchow’s vision of “One Medicine” was not appreciated during his lifetime, the Covid pandemic has renewed interest in the implementation of policies and the development and implementation of programs and tools for surveillance, early warning, prevention and operational measures that merge human, animal and environmental health for the benefit of all. Better now than never.
But why didn’t Virchow’s virtuous vision of One Medicine/One Health come to fruition sooner?
This is all the more curious as it is widely accepted that most of the gains in life expectancy over the past two centuries result not from the practice of medicine, but rather from investments in public health measures, including improved sanitation and food security, cleaner environments, including air and water , and vaccines against infectious diseases.
In other words, improved environments and preventive measures as a whole.
Yet for the past century and more, Virchow’s “One Medicine” vision has been largely ignored and not prioritized in the context of public health.
Given the considerable attention and coordinated efforts towards pandemic prevention, preparedness and response, “Prevention” does not seem to be favored or supported with sufficient research, resources and determination.
Why is this so?
Answering this question is important because for many, compared to preparedness and response, not prioritizing prevention seems misguided as it is likely cheapest to finance and offers the greatest benefit.
Reasons for this disconnect could be, for example, the fact that decision-makers often focus on the immediate or, at best, the medium term, and that voters rarely, if ever, pressure them to support something that does not has not happened or may never happen. – until he does.
One need only consider the covid pandemic and its continued impact on the global economy, countries and individuals to imagine what the world would be like if a bat virus had not invaded the human population of Wuhan. In a way, it’s the perfect poster story for “counterfactual” thinking.
Another dimension to consider is that, in relation to investments and visibility, human health is by far the highest, followed by animal health, then environmental health which is far in third place.
This may be because human and animal health have much greater abilities to attract attention and it is easier for those engaged in these areas to communicate their specific concerns to decision makers..
Otherwise, as a society, we exploit the environment at our long-term, but short-term expense to some powerful vested interests in the private and public sectors, making environmental health more difficult to ensure.
Over the past two years, One Health-based surveillance and monitoring approaches have been increasingly reflected in resolutions and meetings of multilateral working groups in many parts of the world.
For instance, the G20 will hold a Summit in November 2022. It is currently chaired by Indonesia and the next chair will be assumed by India in December 2022. Both countries are showing leadership by working to improve integrated One Health monitoring and control systems.
The United Nations General Assembly will hold a special high-level session on pandemic prevention, preparedness and response and global health in 2023, with indications that it will include One Health. “Good health and well-being” is one of the seventeen Sustainable Development Goals (Goal 3), linked to all the other SDGs.
Another important world meeting is the world health summit who this year was held in Berlin in October and included sessions on preventing the next pandemic and One Health in action.
Could it be that the time and opportunity to realize Virchow’s vision of one medicine and one health has finally arrived? Or will these efforts dissipate again like the many previous attempts?
To answer these questions, experts have recently made a focused and granular effort to analyze the impact and usefulness of coordinated operations to monitor and control infectious diseases in humans, animals and the environment, as well as the sustainability of these approaches.
Multidisciplinary experts brought together to three days in early October in Annecy, France debate, shape and seek consensus on principles and potential roadmaps for implementing One Health disease surveillance and control in diverse settings.
The underlying premise of the meeting was that there is a need to identify appropriate strategies to establish coordinated surveillance and control of infectious diseases principles-based programs that incorporate a deeper understanding of underlying systems and value propositions (alignment of incentives and disincentives) in a way that will ensure resilience and long-term sustainability.
The results of this intensive workshop will be forthcoming and will be worth watching.
With regard to pandemic resources, a new financial intermediary fund (FIF) for pandemic prevention, preparedness and response (PPR) held its inaugural meeting in September 2022 and had over $1.4 billion in financial commitments announced with more expected in the coming months.
This represents a unique opportunity to include efforts for coordinated One Health approaches to disease surveillance and control, and a significant advance in understanding longer-term value, based on deeper and more robust analyzes of rates of return on healthcare investments.
The FIF requires that its program design have robust requirements for performance measurement, program monitoring and evaluation that will not only help assess impacts, but also promote sustainability after external funding ends.
This is important since, To enable lasting impact and coordinated One Health-focused investments in disease surveillance and control, it is necessary to understand and align the interests of those who benefit with those who pay fairly and transparently.
This understanding is essential to systematically “incentivize” the sustained actions necessary for effective and efficient implementation of One Health disease surveillance and control programs.
Nobody wants another pandemic. And it may well be a truism that “an ounce of pandemic prevention is worth billions spent on preparedness or response.”
But understanding and effectively communicating the “local” value proposition of One Health to relevant stakeholders in the context of improving lives and livelihoods may be what it will take to embed this thinking into health systems. human, animal and environmental health to support them so that Virchow’s vision of “one medicine” for all is finally realized.
In many ways, One Health-based investment for pandemic prevention and infectious disease control exemplifies the concept of “enlightened self-interest” – the condition in which individuals (or groups) who act to promote the interests of others (or groups other than those to which they belong) ultimately serve their own interests.
However, what is needed to enable rational actors to realize their self-interest is deeper understanding, empirical demonstration and effective communication individual stakeholder value propositions associated with coordinated One Health disease surveillance and control programs. Failing that, two centuries from now, our descendants will still be wondering why more people didn’t “get” Virchow’s vision or buy into the concept of One Health….
Editor’s note: The opinions expressed here by Impakter.com columnists are their own, not those of Impakter.com –In the featured photo: On September 21, 2022, a woman smiles as she finally gets her turn for her family’s goats to drink water at Hula Hula Springs in Marsabit County, Kenya. Source: © WHO / Billy Miaron to illustrate the news of the launch of the One Health quadripartite joint action plan (WHO, FAO, UNEP, WOAH founded as OIE)