Healthy People, Healthy Animals, Healthy Planet: The Role of One Health
Countries seeking to build strong, resilient health systems need to address the interconnections among human, animal, and environmental health. Recent outbreaks of Ebola and Zika highlight these interconnections and the fragility of health systems. Ahead of Universal Health Coverage day on December 12th, Dr. David Mutonga, Palladium’s East & Central Africa Regional One Health Technical Advisor on the USAID-funded Preparedness & Response Project, discusses how the “One Health” approach is encouraging a paradigm shift in addressing infectious disease threats.
What is the One Health Approach?
One Health is a collaborative effort designed to bring together different sectors and disciplines—human health, animal health (both domestic and wild), and agriculture and the environment—to ensure optimal health of people and animals and protect the environment. For too long, we have worked in separate silos. Those working in human health focus on preventing and responding to diseases once they are in humans. Often, however, if diseases reach humans, we know there has been a breakdown in the system. In fact, about two-thirds of infectious diseases and 60% of emerging diseases in humans are zoonotic, meaning they are transmitted between animals and humans.
Diseases with animal “reservoirs” can be especially difficult to control. Ideally, intervention strategies target the animal source, preventing diseases from infecting animals and the “jump” of diseases from animals to humans. Waiting until people are affected to address these health issues puts more lives at risk and costs more in terms of financial, human, and other resources.
One Health aims to transform how governments, development agencies, the private sector, civil society, and other partners organize themselves to address the nexus of human, animal, and environmental health. It involves jointly working together to assess how different interactions drive emergence of new diseases: environmental destruction, habitat encroachment, population explosion, the rise in demand for game meat, new patterns of interaction among domestic and wild animals, and more. All of these factors have consequences for the health of people, animals, and the planet. By working together, we can better achieve enduring and sustainable social and economic value when it comes to health for all.
How does One Health work in practice?
The case of Rift Valley Fever provides a good example. I worked on Rift Valley fever during a previous assignment with the Kenyan Ministry of Health, as an epidemiologist in the division that was responsible for disease surveillance and epidemic response. Northeastern Kenya faced an outbreak of the fever a decade ago. In September 2006, there had been warnings predicting unusually heavy rainfall. By mid-December 2006, there were a number of unusual human cases and deaths reported in Garissa. Patients presented with acute illness characterized by fever and bleeding. Blood serum samples taken and tested confirmed the Rift Valley Fever virus.
When we went to investigate, we found that cases of the virus had been circulating in humans for more than a month before detection and for several months in animals before they appeared in humans. Rift Valley Fever is transmitted from animal-to-animal through mosquitoes, which had proliferated in the massive flooding caused by the heavy rains. The human cases of Rift Valley Fever were mainly found among those who handle food/animal products and those who tend to the animals. By the end of the outbreak in March 2007, there were reports of about 700 human cases, including 158 deaths across 18 districts in six of Kenya’s eight provinces, and an estimated economic loss of about 5 billion KES.
Kenya formed a Rift Valley Fever Task Force in 2007 (previously the multisectoral avian influenza task force) to assist the government to respond to the disease. However, it was noted that if teams only work together during an outbreak and disband, the preparedness for response is not effective. In 2008, the country then set up a zoonotic diseases standing committee called the Zoonotic Diseases Technical Working Group. In 2010, the working group established a secretariat called the Zoonotic Diseases Unit. The multisectoral groups established linkages with key stakeholders and developed new coordination tools, including a mapping of potential Rift Valley Fever hotspots.
In 2015, the Kenya Meteorological Department again issued a warning about unusually heavy rainfall and possible Rift Valley fever outbreak. Using the One Health approach, a multisectoral team initiated several interventions: vaccinating animals in the hotspots; carrying out heightened surveillance in animals and people; and conducting educational outreach to those who take care of animals. While the rainfall was not as heavy as predicted, there were no reported cases of Rift Valley Fever. Even if there had been cases in humans, it is likely that they would have been detected and responded to much earlier, reducing number of potential cases and deaths.
How is Palladium supporting countries to adopt a One Health approach?
Palladium brings One Health policy and advocacy expertise to the USAID-funded Preparedness & Response (P&R) Project (led by DAI). The P&R Project is one of the initiatives under the Emerging Pandemic Threats 2 (EPT2) program and a vehicle for implementing the Global Health Security Agenda (GHSA). The GHSA is a partnership spearheaded by the US government, and consisting of over 50 nations, international organizations and non-governmental stakeholders.
Instead of the boom-and-bust approach to outbreaks, these initiatives strive to help governments build stronger, more resilient systems to prevent, detect, and respond to emerging or re-emerging diseases. Ultimately, this helps improve health security in the face of challenges such as antimicrobial resistance.
The private sector also has a key role to play. Often, private sector players are hard hit when emerging pandemic threats occur, because they have employees who work at the front-line and are at higher risk of exposure. At the same time, some private partners have very good systems and practices that the public sector can leverage to strengthen preparedness; they can also influence and advocate for governments to put strong systems in place.
Through P&R, Palladium works in Africa and Asia to support government efforts to establish and strengthen multisectoral coordination structures and design and implement national response and preparedness plans. A recent highlight is the launch of Uganda’s National One Health Platform. We also help strengthen existing One Health platforms through support for policy development, advocacy strategies, data for decision making, and other activities.
We know that if One Health is working, we can identify environmental factors, prevent and detect diseases in animals early on, and prevent or slow the spillover of diseases to humans. We can also deepen understanding on ways to balance the needs of people, animals, and the environment so that all can thrive. By combining our collective energies across all sectors and stakeholder groups to improve responses upstream, we can strengthen health systems and strive for better health outcomes. And when health outcomes are improved, we can save lives and resources.