One Health is fast emerging as the new default setting, but it won’t be easy 

One Health (OH) has emerged as a contemporary rage in public health discourse following the COVID-19 pandemic, and is increasingly central to the organisation of health services and disease control programmes. Globally, OH is led by the ‘Quadripartite’ – a collaboration of the Food and Agriculture Organization of the United Nations, the United Nations Environment Programme, the World Health Organization and the World Organisation for Animal Health to address risks at the human-animal-ecosystems interface.  

The One Health Joint Plan of Action (‎2022‒2026)‎ is an integrative effort of multiple disciplines working locally, nationally, and globally to achieve optimal health for people, animals, and the environment. The overarching purpose is to encourage collaborations in research and sharing of knowledge at multiple levels across various disciplines like human health, animal health, plants, soil as well as environmental and ecosystem health, in ways that improve, protect, and defend the health of all species. 

The history behind One Health

Veterinary medicine and human medicine were not strictly separated by demarcated boundaries until the 19th century, and research overlapped in these two fields. The 20th century, however, witnessed a veritable explosion of scientific knowledge with medicine rapidly becoming specialised and professionalised; a direct consequence was the divergence of human medicine and veterinary medicine. Sir William Osler first used the term ‘One Medicine’ – embracing animal and human medicine – in the 19th century and Calvin Schwabe later sought to revive the concept in the second half of the 20th century. One Medicine can be traced to Rudolf Virchow whose seminal work on Trichinella spiralis in pork led to valuable public health interventions; he coined the term “zoonosis” and proclaimed that there should be “no dividing line” between animal and human medicine. Osler, who taught medical students at McGill College and veterinary students at the Montreal Veterinary College in the 1870s, promoted the One Medicine concept. 

The emergence of welfare states was marked by a significant decline in epidemics (and deaths) of major communicable diseases such as cholera, plague, malaria and smallpox. However, non-communicable diseases (NCDs) began to rapidly rise. The 1980s and 90s were marked by the emergence of several novel diseases in the wake of globalisation that brought back infectious diseases into clinical, public health and policy agendas. The anxiety of emerging infections in the wake of globalisation such as Severe Acute Respiratory Syndrome (SARS), Ebola, Nipah, West Nile and Middle East Respiratory Syndrome (MERS) were on account of their rapid spread and relatively high mortality, as well as the expensive and slow development of drugs and vaccines to help tackle them. Many of these emerging pathogens have been linked to animal sources, including wild animals. Bats have been linked to a disproportionate number of emerging zoonoses compared with other mammalian groups; they are reservoir hosts of a several zoonotic viruses, including those with high case fatality rates, such as Nipah and Hendra paramyxoviruses, filoviruses, SARS-like coronaviruses and now COVID-19. 

The term ‘One Health’ emerged as a concept for interdisciplinary collaboration. Several conferences were held around this concept of working together and promoting global health that would not only be inclusive of human and animal health but also accord due consideration to the environment. The Pilanesberg Resolution in 2001, for example, called for the recognition of animal health sciences as critical to the design and management of sustainable programmes for both livestock and wildlife. It was essentially targeted at multilateral and bilateral donors and governmental authorities to consider potential wildlife health impacts when development projects (particularly livestock development) were planned or implemented and called for successful conservation and development outcomes at the wildlife-livestock-human health interface. The Wildlife Conservation Society (WCS) introduced the term ‘One World-One Health’ in 2007, along with 12 recommendations, which later came to be known as the ‘Mission Principles’. These principles focused on establishing a more holistic approach to preventing epidemic disease and maintaining ecosystem integrity for the benefit of people, domesticated animals and the foundational biodiversity that supports planetary health (though this term emerged in the context of climate change). 

The Indian scenario 

Early in the COVID-19 pandemic in India, the Department of Biotechnology announced a National Expert Group on One Health in May 2020 as a multi-sectoral trans-disciplinary collaborative group. Kerala formulated a One Health Scheme in the context of zoonotic diseases (animals to humans) such as scrub typhus, Kyasanur forest disease and Nipah virus disease outbreaks in the State. The Department of Animal Husbandry and Dairying (DAHD), Government of India, supported pilots in Karnataka and Uttarakhand to develop a national One Health Framework. These pilots were geared towards early prediction, detection, and diagnosis of zoonotic diseases through increased quality, availability, and utility of data evidence. The specific aims included: establishing an inter-sectoral coordination mechanism at the Central and State levels; One Health gap assessment; integration with the digital architecture of the National Digital Livestock Mission; creating a roadmap to scale up the OH programme at the national level and developing and implementing the OH communication strategy. 

Subsequently, the Prime Minister’s Science, Technology, and Innovation Advisory Council (PM-STIAC) recommended a ‘One Health Mission’ to coordinate, support, and integrate all existing One Health activities in the country and to fill gaps where appropriate. The mission seeks to develop a “unified pandemic preparedness plan” to address priority ‘One Health diseases’ (diseases of zoonotic nature, transboundary animal diseases as well as diseases of epidemic/pandemic potential) through cross-ministerial coordination as well as to engage with non-governmental stakeholders including academia, the private sector and international agencies for “better disease control and preparedness.” India’s G20 Presidency (2022-23) provided a further fillip to these initiatives with the first G20 Health Track — Health Emergencies Prevention, Preparedness and Response —focussing on One Health and Antimicrobial Resistance (AMR). 

There is, however, a lot more to One Health than zoonosis and pandemics. Commonly interpreted through a health security lens, OH foregrounds zoonotic pathogens. To re-emphasise, One Health is an approach for “collaboration of multiple disciplines and sectors working locally, nationally and globally to attain optimal health for people, animals and the environment” and therefore, comprise of shared interests where common goals are set and the team works towards the benefit of the overall health of a population. One Health reinforces the vision of Sustainable Development Goals (SDGs) that recognise good health “depending on and contributes to other development goals, underpinning social justice, economic prosperity and environmental protection.” An expanded scope of One Health therefore includes a wide range of issues such as, but not limited to, neglected tropical diseases, vector-borne diseases, food safety and food security, environmental contamination, climate change and other non-traditional health threats shared by people, animals, and the environment. 

The importance of multi-disciplinary approaches 

The soul of One Health is a multi-disciplinary approach and multi-sectoral collaborations. Successful OH collaborations encompass benefits from the synergistic impact of combining detailed and logistically-challenging field sciences (ecology, field biology) with analytical approaches (epidemiological modelling, pathogen phylogenetic analysis) and laboratory science (serology, pathogen diagnostics, immunology). While conservation, ecological and veterinary professions are today increasingly engaged with OH, much of the medical profession remains not aware, or involved. 

The most important barriers to multisectoral action are in the realm of politics and governance. OH initiatives, multi-disciplinary in nature, entail working across ministries and navigating tacit institutional hierarchies and allocating leadership roles. The articulation or framing of the problem can be in terms of development, equity, economic or health gains; the extent to which this resonates with high-level political agendas is crucial to achieving buy-in from different sectors. 

Multi-sectoral action in health has been categorised into four broad types: (i) where the health sector is a minimal actor in contexts where other individual sectors undertake their core business and have spillover effects for health (e.g. when ensuring children attend school and learn well for the education sector); (ii) where the health sector has a supporting actor role (e.g. in cross-sectoral policies to address structural forces and social norms that drive health disparities); (iii) where the health sector is a bilateral or trilateral partner with two or more sectors to produce joint or ‘co-benefits’ and maximise health benefits (e.g. tobacco taxation to improve both health and revenues); and (iv) where the health sector is the lead actor, in contexts where collaboration with other sectors is essential for the health sector to deliver its core mandate in delivering health services (e.g. ensuring adequate water and energy supplies to health facilities). 

Much will depend, in the Indian context, on the vision, core values and guiding principles of how the One Health Mission approaches multi-sectoralism and transdisciplinarity. Accountability, transparency, and trust are essential to drive multisectoral action, but can remain elusive. The key to success will be consultative and collaborative leadership that promotes innovation, adaptation, and flexibility in terms of political, financial, and administrative accountability. 

We have conducted extensive consultations and research into the ‘agenda setting’ of One Health in the Indian context and our findings are summarised as follows: 

1. Citizen science input into One Health: There is a need to bring citizen science into the One Health governance framework to make it more inclusive through local capacity building and the production of knowledge at the local level, including understanding diverse cultural and behavioural realities. Innovation at the local level should be actively promoted. One Health needs to be understood as a driver to a sustainable system rather than an abstract concept for prevention of diseases and their spillage. 

2. Top-down and bottom-up governance framework: The One Health governance framework in India should be bi-directional, based on top-down and bottom-up approaches. Identification and involvement of local champions and utilising local knowledge in framing the One Health governance framework will result in collaborative ownership. 

3. Multisectoral collaboration: Global, regional, national and local level coordination and communication are vital to the One Health governance framework and intersectoral coordination and communication. In the multisectoral governance framework for One Health in India, the role and responsibilities of all stakeholders should be determined, along with accountability and deliverables on their part. An environment of inter-ministerial and inter-departmental dialogues for OH should be nurtured. 

4. Resource allocation: One Health has not received adequate investment; adequate resource allocation and optimum utilisation across sectors need to be addressed at the outset of the development of the One Health governance framework. Understanding should also be developed around sectoral needs and incentives devised to keep different sectors motivated to contribute to OH governance. Dedicated funding is required to promote the agenda of One Health in the face of the competing priorities for human health and animal health. 

5. Geopolitics and political economy of One Health: Understanding the geopolitical issues and political economy of OH will help prioritise upstream and downstream issues that have a bearing on the implementation of the OH governance framework. 

6. Analytical skills in the government: The One Health governance framework should capitalise on existing analytical skills within government departments. Along with the required capacity- building within the government, there is a need for a roadmap for OH governance framework based upon adequate functioning structure, leadership and fixed accountability. 

7. Different types of data: There is a need to establish a mechanism to generate and analyse qualitative data on social and behavioural aspects, and quantitative data on economics and disease surveillance, to provide evidence for policy development and refinement. Multi-sectoral collaboration will foster data sharing and the creation of data repositories at all levels. 

(Dr. Rajib Dasgupta is professor (community health) at Jawaharlal Nehru University, New Delhi, and co-investigator UKRI-GCRF One Health Poultry Hub)