Beyond the best buy: Unlocking better value through One Health

Beyond the best buy: Unlocking better value through One Health

Written by Tim Jesudason and Carolyn Henry 

Investments in mass drug administration (MDA) for neglected tropical diseases (NTDs), including schistosomiasis, are widely recognised as one of global health’s most cost-effective investments. Advocates for global health investment have often pointed to the remarkably low cost of treatment, sometimes less than US$0.50 per person, alongside the significant health and economic benefits these programmes can deliver at scale.

But if MDA is already one of global health’s “best buys”, how can we increase the value generated by those investments? We believe the answer lies in integrated, holistic and sustainable programming.

As countries move from disease control towards elimination, treatment alone is often not enough to sustain progress. A community can receive highly effective treatment and still see infection return because of ongoing contact with parasite-infested water, inadequate sanitation, vectors continue to breed, or animal hosts continue to maintain the transmission cycle. If additional investments can reduce reinfection, they could make an already cost-effective programme more valuable still.

This is one of the economic questions explored in a recent brief from the World Health Organization, Food and Agriculture Organization, and the World Organisation for Animal Health. It examines the potential returns from investing in One Health: an approach that recognises the interconnected nature of human, animal, and environmental health.

At Unlimit Health, we think about One Health in practical terms: how can we generate greater impact from the resources and systems that already exist?

One Health in practice

During a One Health Systems Strengthening Workshop in Zanzibar in January 2026, participants discussed opportunities for greater coordination. They noted that water purification tablets are already distributed quarterly at community level, creating an opportunity to explore integrating deworming treatment alongside other activities. Rather than creating a parallel delivery platform, existing infrastructure could potentially support multiple interventions, reducing operational costs while making access easier and cheaper for communities to participate.

The workshop also highlighted the need to look beyond the most obvious integration points. Schools and health facilities are established platforms for delivering multiple health interventions, but opportunities across animal and environmental health have received less attention.

In our SUSTAIN research project, for example, partners are exploring how human and animal health systems can work together to support disease control, including opportunities for joint surveillance and integrated service delivery in areas where diseases affect both people and animals.

The economic argument

The economic opportunity lies in identifying where consolidation into existing systems can generate benefits across sectors while reducing duplication and making better use of limited resources.

There are also costs borne by communities that could be averted. This is important because priorities for people in endemic settings may be going to work, tending crops, or caring for their family, rather than seeking treatment for a disease whose consequences are not immediately visible. Asking someone to make separate journeys for deworming, nutrition, and antenatal care carries a real economic cost.

The challenge is demonstrating this value. The new brief reviews 97 studies, around 80% of which report positive returns from One Health investments. But the evidence has limitations. Most studies examine only two sectors, methodologies vary, and relatively little research isolates the additional value created specifically through integration. This is the paradox of measuring One Health: trying to create tangible, meaningful data while capturing the complexity of the inter-related dynamics.

Decision makers need to know what they are getting for every dollar invested. We have decades of evidence allowing us to estimate the cost per person treated or disability-adjusted life year (DALY) averted for many health interventions. We are much less able to quantify the value generated when a single investment simultaneously strengthens human health, animal health, environmental protection, and preparedness.

Yet, the evidence we do have suggests that the potential returns could be substantial. The brief estimates that strengthening One Health approaches to pandemic prevention would require around US$10.3–11.5 billion annually. By comparison, the IMF estimated the cumulative loss in global economic output from COVID-19 at US$13.8 trillion over 2022–2024. While not directly comparable, the difference in scale illustrates the potentially enormous economic value of prevention.

The challenge at hand

This points to a central challenge for health economics. Our tools are very good at measuring interventions with identifiable costs and countable health outcomes. They are less equipped to capture benefits that cross sectors or emerge over time, such as an antimicrobial-resistant infection that never develops; an outbreak detected earlier because surveillance systems are connected; income preserved because services were delivered together; or the pandemic that never happens.

These may represent some of the largest returns generated by One Health. Yet because they fall across different ministries, budgets, sectors, and time horizons, they are difficult to capture within conventional assessments of value for money. The question is not whether we move away from the economic rigour that has helped identify global health’s best buys. It is whether we can apply that same rigour to measuring the full value of investments that deliver benefits across sectors and over the long term.

That means developing better cross-sectoral economic models, understanding where costs and savings fall, incorporating opportunity costs borne by communities, and finding credible ways to value resilience and risk reduction. It also means identifying where integration genuinely adds value and where it does not.

MDA remains an extraordinarily cost-effective investment. One Health offers an opportunity to build on that foundation and ask how the systems and resources that have enabled treatment to reach millions can deliver even greater and more sustainable returns. If we can better measure that value, the next generation of global health “best buys” may be combinations of investments that prevent disease, strengthen systems, and deliver returns across human, animal, and environmental health.