Commentary – Systematizing the One Health Approach in Preparedness and Response Efforts for Infectious Disease Outbreaks

By Michelle Grundahl, Biodefense MS Student

We can use a One Health approach to improve our next pandemic response to actually strengthen global health security – and we can choose to systemize and globalize right now.  One Health is a collaborative, multisectoral, and transdisciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment. The objective of this workshop – offered by The Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine – was to confront our emerging health threats through systematizing and integrating the One Health approach. Systematizing is defined as arranging an organized system; to make systematic. Living through the current pandemic required us to perform outbreak detection and response to SARS-CoV-2, but prevention and preparedness is actually what we should be doing prior to outbreaks. Topics in this workshop included integrating One Health into existing coordination mechanisms (into national action plans for health security) and integrating animal and human health surveillance systems.  Essentially, this new paradigm in biodefense will create a framework across sectors and bring order among disparate expertise. The adopters of One Health are ready for the challenge.

Should we create a National Pathogen Surveillance and Forecasting Center for biological threats? Pandemic prediction, prevention, and policies are our next step in responding to the current SARS-CoV-2 pandemic. Medical countermeasures are useful during outbreaks but perhaps it would be better to truly mitigate global health threats, and even prevent them. We can achieve global health security through relationship building and lateral leadership. Two themes were repeated during the workshop: (1) future public-private collaboration must happen and (2) strong health systems are needed (globally and locally).

Day one of the workshop focused on the practices of existing programs and how these could improve the current model for global public health responses. The Africa CDC provided their lessons from COVID-19 and they stressed the continued importance of using a holistic approach to health threats. Specifically, the creation of a new framework for the African continent – Framework for One Health Practice in National Public Health Institutes – recognizes that other countries are frequently hampered by siloed health systems. The African Framework explains that the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and Sustainable Development Goals (SDGs) call for a One Health approach in order to comply with the 2005 International Health Regulations (IHR).

Back in the United States, we learned about the activities at Harris County (Texas) Public Health office. They explained their operational approach using One Health practices. An example given was the removal of old tires (mosquito breeding grounds) to combat Zika. Another was their response to Hurricane Harvey when they sheltered people and their pets together. Most recently, Harris County did surveillance of SARS-CoV-2 in pets.

On day two, the sessions tackled the urgency of a One Health approach and how it can be applied immediately. The development of a One Health workforce is one path forward. Dr. Lonnie King suggests that we should value a “T-shaped worker who has a deep understanding and high proficiency in one area with the skills to work collaboratively and respectfully across disciplinary lines for synergistic problem-solving.” In fact, USAID has a workforce project to do just this. An example, Africa One Health University Network (the latest effort in this USAID project) is creating a competent future workforce by developing multi-skilled students, who can work outside of silos. Universities can integrate systems thinking and encourage collaboration across disciplines. Woutrina Smith reminded the audience that social context is important, too; we cannot forget to incorporate the social sciences into traditional science to effectively create solutions using the data that we generate. Transdisciplinary thinking is essential.

Day three looked at the future of One Health with the experience of SARS-CoV-2 in mind. Biosurveillance using shared international data would create the ability to better forecast outbreaks. This will require cooperation through public-private partnerships, along with policy changes. The workshop suggested the goal of building a “broad, threat-agnostic global health system.”  This includes learning from the past to determine future capabilities. Collaboration across disciplines, sectors, and communities can enhance the detection of threats. Surveillance is key here. Realistically, it is unfeasible to collect and monitor all global health data.  Local, national, and international epidemiological surveillance systems are still needed though. They should be designed (and refined) with One Health in mind. The session on “Precision Epidemiology, Human Behavior, and the Future of One Health” (led by Jonathan Quick) discussed machine learning, which can sort through the massive amounts of data that we may begin to collect. Intelligence and national security applications of this surveillance data were not obviously addressed in this three-day event. Future conversations to address this sort of data will need to include scientists and intelligence professionals. Regardless, most agree now that global health security is national security.

Many of the topics of this workshop focused on current and future actions; which were reminiscent of the challenges listed in 2016’s Pandemic Prediction and Forecasting Science and Technology Working Group of the National Science and Technology Council. The major theme for this workshop was that collaboration is a must if we want to improve resilience to global health threats. Other groups (outside of this workshop) are collaborating and systemizing at the state level. On March 1st, New Jersey passed a bill (A-1992/S-347) for the ‘New Jersey One Health Task Force’ to operationalize One Health in the state. Looking forward, will we excel in our reaction to the next pandemic? Will we also create multisectoral preparedness that allows us to forecast, or prevent, the next pandemic?

There were many heavy hitters speaking at this NASEM workshop, including: Peter Daszak from EcoHealth Alliance; Laura Kahn from Princeton University; Casey Barton Behravesh, Director of the One Health Office at the US Centers for Disease Control and Prevention; John Nkengasong from the Africa Centres for Disease Control and Prevention; Jonna Mazet, Professor of Epidemiology and Disease Ecology and Executive Director of the One Health Institute School of Veterinary Medicine at University of California, Davis; Tracey McNamara from Western University of Health Sciences; Peter Rabinowitz from University of Washington; Lonnie King, Dean Emeritus for the College of Veterinary Medicine at The Ohio State University; and Jonathan Quick, Managing Director of the Pandemic Response, Preparedness, and Prevention Health Initiative at The Rockefeller Foundation.

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