Thoughts of FAO on ‘One Health’
The number of emerging infectious diseases and pandemic threats at the animal-human interface is increasing. In recent past the world has witnessed the emergence of novel diseases such as Nipah virus in Malaysia, intercontinental spread of Severe Acute Respiratory Syndrome (SARS), Highly Pathogenic Avian Influenza virus H5N1 and Influenza H1N1 (2009). These disease events have heightened worldwide public awareness of the multidimensional linkages between wild animals, livestock production and global public health. Human population pressures and the enhanced mobility of people, climate change, food and agricultural dynamics, and the progressive encroachment of forest and game reserves, are among the more frequently cited global factors amplifying emerging infectious diseases events.
A new approach has been devised to address the multiple factors influencing the emergence of infectious diseases: the ‘One Health’ approach. It can be best defined as a collaborative, international, cross-sectoral, multidisciplinary mechanism to address threats and reduce risks of detrimental infectious diseases at the animal-human-ecosystem interface. It strategically builds on the lessons learned from, and achievements of, the responses to H5N1 HPAI and H1N1 epizootics. This approach is acknowledged a feasible and viable model to address the multidimensional challenges that are rapidly evolving in a changing world. Disease emergence can no longer be seen in isolation but must now be viewed alongside a continuum of climatic changes, natural resource management, agricultural intensification, land utilisation patterns, trade globalization, and shifting farming, food distribution and marketing systems.
The current approach to disease prevention and control emphasizes transmission disruption; with early warning, early detection and early response mechanisms targeting also the new pathogens emerging. Whilst critically important, this approach in itself does not address the root causes of disease emergence. The only option to effectively deal with the latter is to tackle the drivers of new disease emergence. Changing the emerging disease dynamics at the driver level with the aim to counter the progressive flare-ups of diseases at the human-animal-environment interface requires reassessment of the global health security strategy, along with renovation of multiple aspects at the technical, social and institutional levels.
First, at the technical level, we confront three sets of drivers corresponding broadly with three sets of disease (re-)emergence. One, globalization, land use and/or climate change are mostly implicated when diseases invade a novel territory or geographic area, often with identical host ecology and involving relatively minor changes in pathogen characteristics. Two, disease emergence is facilitated by the mass rearing of animals as seen during intensification of animal agriculture. The high numbers of animals per farms and per units, and the geographic clustering of industrial production plants provide fertile grounds for pathogens to turn more host-aggressive. In densely populated areas with both commercial pig and poultry production, and traditional smallholder systems, there is often a dynamic transmission of pathogens, enhancing both disease spread and persistence. Three, emergence associated with interspecies jumps of pathogens with pandemic potential. This often concerns wildlife, resulting from human and livestock encroachment of forests and game reserves, exploitation of wildlife for food and recreation, and degradation of rich ecosystems.
Second, at the social level, different stakeholders have different concerns regarding food safety, health, security and wellbeing. Poor people in developing countries are primarily concerned with existing disease burdens, which are considered far more important than pandemic risks. Disease impacts are complex and vary between stakeholders, including disruptions to financial, human, natural, physical and social assets. All of these affect achievement of the UN Millennium Development Goals.
Third, at the institutional level, broadening health management and the creation of safer, more disease-resilient landscapes goes beyond the remit of veterinary and medical services. The extension of efforts towards sustainable agriculture and rural development, environmental stewardship, gender inclusion and socio-economic progress entails involvement of many professionals, requiring a major shift in terms of fostering alliances, partnerships and communication schemes.
The ‘One Health’ approach aims to restore social and ecological resilience in global health security. It is well known that prevention is better than cure, both in the fight against existing and new emerging diseases. Redressing the current disease burden in humans and attaining global health security is pivotal to achieve sustained economic growth, food security and poverty alleviation. Animal and human diseases represent tremendous economic and social burdens to governments, households and individuals alike. Regrettably, the current global investments to confront these challenges are imbalanced and not proportional to the tectonic weight of the economic and social burdens confronted, with negligible amounts being allocated to better understand disease emergence of animal origin.
We believe that to reverse this trend it is necessary focus on a set of 5 principles:
- Impact Assessment: the multidimensional impacts of both old and new human and animal diseases require adequate measurement in terms of costs, globally, and ranked by how these diseases withhold global health security;
- Drivers: the core factors influencing disease emergence and pandemic risks await clarification in order to be able to restore responsible, sustainable and safer animal agriculture and associated feed and food supplies;
- Wildlife: The emergence of wildlife pathogens as hazards and threats to food safety and public health in general has to be confronted and redressed, at the ecosystem level, as a component of natural resource management;
- Hazard Analysis Critical Control Points (HACCP): These critical control points need to be established to enhance hygiene and biosecurity routines and practices in food value chains and agro-ecological landscape levels;
- Partnerships: Alliances and associated communication efforts are to be pursued, adequate to a broadening of the set of global health security measures, with strengthened collaborations between medical, veterinary and environmental agencies with the concept of ‘One Health’ as a shared international public good that directly involves and engages the public at large.
The Food and Agriculture Organization of the United Nations (FAO) based in Rome, Italy, is teaming up with the World Health Organization (WHO) and the World Organisation for Animal Health (OIE) to jointly pursue the ‘One Health’ approach. Whilst FAO plays a critical role in raising the levels of nutrition, improving agricultural productivity, bettering the lives of rural populations and contributing to the growth of the world economy, there is increasingly recognition that global health and food security form twin objectives.