Making the case for a One Health approach: From the 7th World One Health Congress in Singapore

From the seventh World One Health Congress held earlier this month in Singapore, we bring you this conversation with Dr Osman Dar and Dr Catherine Machalaba, both members of the One Health High-Level Expert Panel.

In this episode, we explore what One Health is, approaches in practice, including addressing Nipah virus in Malaysia, how the value of One Health interventions can be measured, finishing with some causes of concern when it comes to realising One Health—and where there is room for optimism. 

Guests:

• Dr Osman Dar, Consultant in Global Health at the UK Health Security Agency and Project Director for the Global Health Program at Chatham House
• Dr Catherine Machalaba, Principal Scientist for Health and Policy at EcoHealth Alliance 

The World One Health Congress was sponsored by the Indo Pacific Centre for Health Security. Find out more at: https://worldonehealthcongress2022.miceapps.com/client/sites/view/WOH2022 

We encourage you to join the conversation on Twitter at @CentreHealthSec and @WOHCongress.

Transcript

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government. 

Mr Sean Starmer 00:14

Hello, and welcome to Contain This. My name is Sean Starmer, and I'm with the Centre for Health Security. We're recording this from the World One Health Congress in Singapore. This is the seventh iteration of a major conference first held in Melbourne in 2011. The Centre for Health Security is a sponsor of the conference and we're very pleased that our support has helped fund the attendance of a number of researchers from countries in Southeast Asia and the Pacific. While I've been here, I've caught up with two engaging conference speakers to give them the opportunity to make the case for a One Health approach to some of the most pressing problems we face.

Dr Catherine Machalaba 00:46

Hi, everyone. I'm Catherine Machalaba. I'm Principal Scientist for Health and Policy at EcoHealth Alliance and a member of the One Health High Level Expert Panel. My background is in environmental science and health and I have a strong interest in One Health economics.

Dr Osman Dar 01:03

Hi, everyone. I'm Osman Dar. I'm a consultant in Global Health at the UK Health Security Agency. By training I'm a public health physician specialised in communicable disease control. I’m also a project director at Chatham House's global health programme, and also work with Catherine on the One Health High Level Expert Panel.

Mr Sean Starmer 01:24

Thank you both for joining us. There’s been a fascinating series of discussions over the past four days. Can you start by giving us a short version of what the concept of One Health entails?

Dr Catherine Machalaba 01:40

One Health is really an approach. So it's not a separate discipline, but it's an approach that allows us to see connections that we might not see if we're just working with one sector, one single silo siloed approach. So we think about the connections between human health, animal health and ecosystem health, these are really fundamental. So things like water quality, water provision, food, you know, food production, and upstream pollination and soil quality. These are things that we depend on every day. Of course, as those systems are degraded, we appreciate that then there are these health impacts, economic impacts with you know, critical infrastructure being damaged, as we've seen with climate change, these connections become very clear when we take a One Health approach. So it's allowing us to see the risks more clearly as well as the impacts and then identify the right stakeholders, sectors to be part of the solutions. 

Dr Osman Dar 02:35

And I just build on that by saying, there's sort of two key elements to it. One is that it's, it recognises that there's a strong interlinkage and codependence between human health, animal and wildlife health, both domesticated wildlife, wildlife, and ecosystems, the environment. So there's firstly, there's that understanding that we're all linked together, inextricably. Then the other element of it is that it's about collaboration, and, and cross-sectoral working at all levels of society. So marginalised groups up to, you know, heads of state, and across nations. The way it's operationalised, we frame as four C's communication, coordination, collaboration, and cross-sectoral capacity building. The other important element to the approach is that we see it as being embodied by these underlying values and principles. And it's good if we talk a little bit about those. So there's five of them. One is equity. So equity between the sectors, between the disciplines, and between nation states as well, so so making sure that equity is embedded in the approaches. Then the next is socio-political parity. That's a bit of a mouthful. But but but it's important to state that everyone has a voice, and that our leaders and politicians and policymakers are held accountable for for the decision, the decisions that are made and this transparency and that accountability is part of the process that allows for inclusiveness as well. It makes sure that marginalised groups, ethnic minorities, indigenous communities are part of the conversation part of the decision making and agenda setting. The next is socioecological equilibrium. Because we live in live in a world of sort of limited resources. It's about optimising the health between humans, animals and, and ecosystems. You know, with any intervention, there's winners and losers, and it's important that we're able to sort of holistically look at tradeoffs, risks, you know, identify the co-benefits across the sectors. The fourth and fifth are stewardship, and transdisciplinarity. Stewardship recognises that humans or humans are the conscious stream of living organisms, in essence, so we have this stewardship function. We are sort of the apex species and we have this sort of intergenerational responsibility to ensure their ecosystems and environments are healthy. And the transdisciplinarity sort of speaks for itself. So it's it's ensuring that humans, the human sector, the animal sector, the environmental sector work together, and we include all the other relevant sciences and disciplines, whether it's social sciences, or indigenous health, or even history and economics.

Mr Sean Starmer 05:21

When did the concept of One Health first start getting currency in conversations among scientists or policymakers?

Dr Osman Dar 05:30

As a concept, it perhaps it wasn't called One Health, but it's an it's an ancient concept, you know, lots of societies have have understood the integrated nature between humans, animals, and ecosystems. 

Dr Catherine Machalaba 05:42

It had a very humble beginning. So a colleague was working on Ebola virus actually, in great apes, not even in humans, but it was, you know, recognising that, wow, we're seeing these sentinel events. If we're thinking about human health outcomes, you know, we're seeing impacts on on gorillas first, if we look for the signals, we can really predict out well, you know, we're likely to have an outbreak in humans. But we're also seeing this really substantial decline in in great apes. And, you know, this is concerning for a lot of reasons ecologically, tourism wise, intrinsic value of species, I think it gained a lot of traction with avian influenza, when there was this direct economic impact on on farmers on really livelihoods and human health outcomes. It's gotten a lot of traction with with the response component of we need to do better, we need to act but there's this health protection component too that can really benefit from this more holistic thinking, we're seeing the importance in terms of preventing spillover, but it can be much broader, you know, we need it, we need this approach for a much broader suite of sustainable development outcomes that are important.

Mr Sean Starmer 06:53

So if we're looking at the world through a One Health perspective, what are some of the danger signs or pressures on environmental health or animal health that might lead to problems for human health in the future?

Dr Catherine Machalaba 07:14

There's really a lot of wide scale changes, you know, there's there's a lot of good that comes with globalisation, including exchange of capacity and knowledge. You know, so we want the good outcomes. But there's a lot of really rapid ecological change and new interactions between species, fundamentally changing ecosystems, sometimes irreversibly. So if we think of something like land use change, this takes many forms, it may be mining, it may be timber logging, it may be converting primary forest into monoculture, you can think about all of the ecological changes that happen and also the human changes that happens. When we design a development project, that's not really built into the impact assessment process. So this is where somewhere that you know, this is somewhere that a One Health approach can really be helpful to say, wait it's not just, you know, species that we have to be monitoring, although that's very important. But we also have to be thinking about human health changes and animal health changes, building that into the equation. The cost that we can expect from something like malaria from, you know, conversion to palm. And there's, you know, it's not that something is necessarily outright good or outright bad. It's those tradeoffs and the co-benefits that we have to consider.

Dr Osman Dar 08:26

You'd almost want a sort of One Health impact assessment done at any stage of a big industrial or land use change project. Anything that's what we call anthropocentric, so driven by human activity, we'd want to be thinking more holistically about what are the actual impacts going to be not just on, you know, the bottom line and profits, but on human health, on animal health and on the environment. I know a health impact assessment isn't a compulsory part of the regulatory process. But really, if we're going to be more responsible, and really think about the impacts of these large-scale projects, whether it's land use, you know, whether it's roads and rail networks, transport networks, or its extraction, or building a dam or whatever it is, we should really be starting to embed proper One Health impact assessments into that process.

Mr Sean Starmer 09:12

I've been struck by some of the fascinating examples from speakers over the last couple of days of flow on effects from decisions around land use or population movements or agricultural practices and how these can have flow on effects for animal or human health.

Dr Catherine Machalaba 09:37

I think there there are a lot because it's it is really context specific. So the first detection of Nipah virus was in Malaysia in 1999. And there was this connection between bats that were coming into agricultural areas, seeking out you know, delicious fruit on these trees. Then you have this partially eaten fruit falling into pigs styes where you had intensive pig production systems that then allowed for spread in pigs but also spillover to humans. The good news is that a One Health approach ultimately was taken. So you had pig safe farming areas, you had areas that were designated as not pig safe, you also had distancing of orchard trees and pig styes. So these very pragmatic solutions, you know, if a country says I'm going to prioritise livestock development and more intensive livestock production, we need to be thinking about these connections, we need to be thinking about the lessons learned and saying, maybe this is not appropriate in this area. We think a lot about avian influenza, if you have wild bird fly aways or migration areas, you really want to be, you know, building this in and the risk of avian influenza, not just to poultry, but also to wild birds, too and to humans.

Dr Osman Dar 10:48

And that's probably why biologists and ecosystems specialists, environmentalists, wildlife scientists are so such an important part of the One Health picture and one that's probably undervalued and, and under invested in certainly, you know, again, with Australia, you've got a long experience, and perhaps a tortured history with the introduction of non-native species into Australia and the effects that those have had. And that applies to livestock and other you know, other animals as well. So particularly in the colonial period in Africa, for example, a lot of non-native livestock was introduced. That's perhaps why we saw the first Rift Valley Fever outbreaks in in East Africa. And in the 30s, you suddenly had these non-native small ruminant species being amplified and intensively farmed, and you started seeing spillover from wildlife into the, into those domestic susceptible animal species and then into humans. So that's how the jump then occurs, as you start seeing more and more interactions between the wildlife, between domesticated animals and humans that creates the spillover.

Mr Sean Starmer 11:59

What approaches do you suggest that governments or practitioners take to encourage this sort of a cross-disciplinary approach to analysing a problem and coming up with solutions? 

Dr Catherine Machalaba 12:15

I think these One Health coordination platforms that a lot of countries are developing are incredibly powerful. They're bringing together stakeholders that are in a practical way, on a routine basis, you sort of get used to interacting with colleagues from other sectors to have the right players on board so that if you do have a proposed policy, like a livestock development project that's going through that One Health vetting, and it's really considering the tradeoffs, it's considering the co-benefits, it's seen where there's maybe just marginal investment needed to get the gains for another sector. 

Dr Osman Dar 12:45

What's really important is also that through that process, there's more of a cultural understanding of the other sectors, needs, drivers, motivations. And this applies whether you're talking across the public sector or the private sector. So for example, when we've been doing our work with extract extractive industries in the private sector, we've tried to make the case around, not so much that this is your, you know, a corporate social responsibility for you to prevention or health promotion activities. But it's actually a risk management business continuity issue for you. We were able to make that case when you had the Ebola outbreak in West Africa, suddenly all these mining companies had to suspend their operations. So when they start thinking in terms of risk management and business continuity, suddenly the CEOs, the chief operating officers, look up and they think that this is this is an investment for us, it's a protection. Likewise, on the on the on the public sector side, it's really important if you if we're thinking about sustainability, that we don't just frame the issue around human health outcomes. If you really want the animal health sector involved, if you really want the environmental sector involved, you have to speak to their priorities. And there's a little bit of horse trading involved. But you have to think about animal health outcomes as well. You have to think about animal welfare issues, you have to think about ecosystem outcomes, if you want there to be sustainability and interactions. 

Mr Sean Starmer 14:05

What approaches do we have to evaluate the value associated with One Health intervention? The costs will be obvious, it's going to cost additional time for coordination and may lead to additional costs associated with implementing some of these approaches. How do you how do you measure the value of an intervention?

Dr Osman Dar 14:34

On the prevention side, yes, it's about making the economic argument around it that you know, for example, if we do dog dog-mediated rabies vaccinations, we know that if we if we vaccinate 70% of dogs we’ll probably stop all human infections. And you can attach a cost to that right. It costs me X amount to vaccinate 70% of dogs and monitor them, but this is how much it costs me to give immunoglobulin post-exposure prophylaxis or treat a human case of rabies. And these are the financial savings that can be made by, by doing so. And there's a lot of evidence around around that that prevention element of it. What's needed now, is what I was talking about earlier, that you do this co-benefit analysis, you do this trade off analysis. You know, what is the cost of me triple wrapping a piece of chicken? Right? Fine, I've wrapped it three times in plastic. But now I've created a a mountain of plastic waste, right? So how do I assess that kind of cost? Yes, that third wrapping maybe prevents one in you know, 10 million Campylobacter infections, but maybe single wrapping would have been fine, right? And what is the cost of this extra, this triple burden of plastic waste? So I think we need to be a little bit more creative about how we do that sort of trade off analysis. But the only thing I'd add to that is that it doesn't necessarily always have to be framed around risk and this fear of an outbreak or fear of something. There's this there's a whole positive wellbeing angle to this as well. You know, health is not just about the absence of disease, it's about a sense of well-being as well. And that applies across One Health too. People want to live in healthy, pleasant, nice, environments, in harmony with nature, in harmony with the animals around them. And there's there's a value that can be ascribed to that.

Mr Sean Starmer 16:21

Tell us a bit more about the Quadripartite and your work as part of the One Health High Level Experts Panel. 

Dr Catherine Machalaba 16:29

So the quadripartite is a new mechanism, it builds on the former former tripartite, and so it's four organisations, it's the World Health Organization, the World Organization for Animal Health, the FAO, the Food and Agriculture Organization of the UN, and the United Nations Environment Programme. So the United Nations Environment Programme came in in March of 2022. And this formed the quadripartite.

Dr Osman Dar 16:54

These four organisations are the normative technical standard setting agencies of the UN system. World Organization for Animal Health is outside the UN system. But it's also a global agency that’s tasked with that for animal health. Now, a lot of countries use them to set their own standards and develop their frameworks and the activities of their line ministries. And really before this, there hadn't been enough cooperation and collaboration between these agencies. The approach was a little bit disjointed. One ministry was being told one thing and others being told another thing. There was a there were wide views and definitions for One Health. So one of the things the One Health High Level Expert Panel did was look at all the global definitions, we looked at 40 definitions, came to a consensus, developed a consensus through a UN process that as independent external advisors, and came up with a unified definition and those underlying principles that I sort of articulated earlier. And that was one big thing, because it was it was a wide community that was having lots of academic arguments around this. And finally, we had consensus and something to unify around. The other thing was that they needed to sort of have developed a structure for implementation, as we were talking about, operationalising the concept. And so what the quadripartite have done with sort of our support as an advisory body is developed the One Health Joint Plan of Action. This has sort of six action tracks. And this is going to sort of be the global framework that countries are advised to follow to develop their One Health activities and sort of start those collaborations across three sectors. There's six tracks in that, one is around sort of integration, collaboration, getting the governance systems and structures in place to get line ministries and national structures to work together. The second is around emerging infections and those with pandemic potential. The third is around endemic and neglected tropical diseases. The fourth is around food safety issues, and sustainable food systems. The fifth is around antimicrobial resistance. From our perspective at the One Health level, high level expert panel that shouldn't just be about antibiotic resistance in humans, but it should be about wider biotic resistance. So you know, anthelminthic resistance, antiprotozoal resistance in in animals, insecticide resistance, pesticide resistance, the issues with residues around that, that should be part of the conversation when you look at AMR more holistically, and then the sixth is around environment and health and issues around biodiversity. Which shouldn't which shouldn't be an afterthought. So that should be a central track within the process. And our role is to sort of support them as independent advisors in supporting that implementation.

Mr Sean Starmer 19:39

What's next on the work agenda for the One Health High-Level Expert Panel, for OHHLEP?

Dr Osman Dar 19:43

Well, we have to do pick up the work around drivers, the drivers of emergence. We've sort of categorised animal health drivers, human health drivers, ecosystem drivers, but all the drivers where there's which are anthropocentric, so it's, it's as a result of human activity. And we're sort of classifying those and thinking about which of those need to be addressed in order to, you know, prevent that sort of spillover event. We're also doing quite a bit of work around the surveillance piece, how we can do better surveillance and do it more holistically across the three sectors. But I think that's going to be keeping us busy. At the at the moment, we also sort of need to do some work around the monitoring and evaluation framework for that Joint Plan of Action for One Health and, you know, thinking about some of the things that I was talking about earlier, how do you measure and monitor co-benefits? How do you make sure those underlying principles that I spoke about are being embedded and put into practice? How do you assess tradeoffs and risk mitigation? So that's some of what we're doing. So it's such an interesting, fun time to be in this space.

Mr Sean Starmer 20:51

What did you learn this week at the conference that surprised or perhaps concerned you? 

Dr Catherine Machalaba 21:00

I think in terms of concerns, you know, we know what the challenges are broadly, and we know what the solutions are broadly too. And I think, you know, we heard about the need for a lot more research. And we do, of course, need more research. At the same time, we really have a lot of the solutions, we just have to apply them. I think that we're just too too shy as a scientific community to sort of say, okay, we have enough evidence to do XYZ. And that really has to happen. I think it is a moral failure if we don't do that. And it I mean, there's there's the cost of inaction is so high on climate change, on biodiversity loss, on pandemic risk, on endemic diseases.

Dr Osman Dar 21:38

We've all shared our worries about some of the things we're hearing about the new pandemic treaty or pandemic instrument that's being thought about, that there isn't enough on the prevention side of things with contained within the treaty. And I think that's a real cause for concern because we we have the International Health Regulations as a legal framework across countries, which largely focuses on the surveillance aspect of it and the response aspect of it. The treaty, or the new instrument, would really add value to that if there was sufficient focus on prevention, a One Health approach to that prevention.

Mr Sean Starmer 22:17

Catherine, let's finish on a happy note. What have you heard this week, that gives you a cause for optimism?

Dr Catherine Machalaba 22:22

I think there's been a lot of focus on different aspects that we haven't heard a lot about, like WASH - water and sanitation and hygiene - someone said you know, in one of the plenaries, getting the health minister to attend the meeting on wetlands and wetland protection, so, I think the fact that we are hearing about things that are really core to prevention, but also health protection very far upstream, and that's incredibly exciting for our future.

Dr Osman Dar 22:46

We want we want policymakers to be broader and more expansive in their thinking, you know, a little bolder. If you take something like antimicrobial resistance, so much of it can be prevented if you make that upstream investment in infrastructure, water and sanitation infrastructure. So many of the countries in Southeast Asia, South Asia, they still have, they still have infrastructure in their urban settings, which are from, you know, the colonial period. A city that now has 10 million people has infrastructure that is set up to cater for, you know, 400,000 people and it's, it's decades old, the sewage pipes are mixing with the with the water pipes, and then you're starting to see, you know, extreme typhoid drug resistance. So so there's a lot of, there needs to be a broad set of ideas that come into play when commissioning and choosing interventions, we need to start thinking a little bit more upstream.

Mr Sean Starmer 23:45

Thanks for listening. That's all for our discussion today at the World One Health Congress but we hope you can join us again for the next episode of Contain This, a podcast from the Australian Government's Indo Pacific Centre for Health Security. Goodbye.

Contain This is produced by the Indo Pacific Centre for Health Security. We acknowledge the Traditional Owners and Custodians of country throughout Australia and the Indo Pacific region. We recognise their continuing connection to land, waters, and community and pay our respects to Elders past and present. You can follow us on Twitter at centrehealthsec.