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Facing up to astronomical challenges in global health through a One Health approach

27 September 2019

Highlights from Dr Wendy Harrison’s Vice President speech to the Royal Society of Tropical Medicine and Hygiene

Our planet is facing significant challenges. Urbanisation and deforestation, war and political collapse, together with the rise of “anti-science”, represent particular challenges to global human health.

The sheer magnitude of these challenges can sometimes leave us, as individuals, as professional communities or even as sectors, feeling overwhelmed and unable to respond. It might be helpful to take inspiration from the fact that 50 years ago this year, we overcame an astronomical challenge – the earth’s gravitational pull – and put a man on the moon!

This was achieved by over 400,000 researchers and engineers from more than 20,000 universities and private companies, working together to overcome a single challenge in a world without Google Docs, Drop Boxes or Skype calls… Opportunities like this meeting, which brings together over 1000 researchers and over 100 NGOs from different regions and sectors, can help us overcome the challenges we face (and hopefully achieve stellar outcomes!).

One Health – a challenge and an opportunity

One Health – the theme of our discussions this year – is an excellent example of how the Society is uniquely placed to facilitate the convening of technical expertise and perspectives, and provide the space for genuine discussion, challenges and solutions.

Although the concept of One Health has been around for over 200 years, we still have some way to go to define how the alignment of veterinary and human public health and environmental services can improve health outcomes.

This concept is often applied to zoonotic diseases, and rightly so:

  • 60% of all human pathogens are zoonotic, with over 70% of emerging infections and the next global pandemic likely to be diseases of animal origin.
  • In many low-income countries, livestock production drives the rural economy and animals are often the only family asset. Zoonotic diseases affect not only the health of family members, but their ability to pay for health care, by reducing the value of or wiping out altogether their only assets.
  • The zoonotic potential of parasites can also derail the success of global disease programmes, such as the Guinea worm eradication programme, where emergence in dogs has caused significant and unanticipated challenges. The emerging issue of hybridisation of human and cattle schistosomiasis species also presents complications for the control and elimination strategies for schistosomiasis.

But a One Health approach has the potential to respond to a much broader and more complex set of issues, appreciating how the interactions with our environment, and the species with which we share that environment, contribute to health.

Take for example the issue of respiratory disease in women in rural India – this may initially be seen as a problem requiring the input of only the health profession; a closer examination of the immediate environment, however, will show that the fuel being used in the household stove is cow dung, and the dung is produced by cows that have been fed on pesticide-contaminated rice straw. When the dung is burned in the small, unventilated kitchen, it emits a hazardous gas that causes significant respiratory damage. To identify the cause of the condition, and to generate appropriate solutions, this problem must be viewed through human, animal and environmental lenses.

One definition that appeals to me is to think about One Health as a joint risk assessment, bringing different sectors together to identify all risk factors relating to public health events from the human, animal and environmental perspectives. Such partnerships allow joint planning of interventions that not only mitigate the risk from the point of view of each sector, but also ensure there are no unintended consequences of these interventions, alongside ongoing surveillance.

This year’s discussions provide encouraging examples of the successful application of One Health approaches, such as using trusted veterinary services to reach pastoralist and itinerant communities. As we know, accessing hard-to-reach communities will become increasingly important as we aim to leave no one behind – and in some settings, long standing livestock programmes are able to facilitate access to some of the most marginalised populations.

Despite the strong rationale and some examples of success, there are challenges to delivery at the necessary scale and with the available resources.

These challenges are often structural and predictable – multisectoral collaboration is always difficult, and this is compounded by the absence in many settings of a clear authority to lead and implement One Health approaches at the local, national and international level.

But they are also political and cultural: political in the sense that a One Health approach requires shifting away from sectoral or disease-specific agendas; and cultural in that One Health requires an openness for experts and professionals in human, environmental and veterinary health to work in an interdisciplinary (and perhaps more humble) way.

The potential contribution of the Royal Society of Tropical Medicine & Hygiene

The Royal Society is very well placed to respond to these challenges by bringing together the collective knowledge, experience and networks of members to affect change: through identifying research gaps, calling for increased funding, and driving policy change, utilising the society’s significant role as a trusted and impartial source of information for the public and policy makers.

We are also continuing to ensure that urgent priorities and neglected areas are communicated in a non-political way, amplifying messages and mobilising resources for the longer term – a particular challenge at a time when so much of the public debate is focused on short-term and domestic agendas, to the detriment of global issues that ultimately impact on national health and prosperity.

I propose three key examples of how the RSTMH can overcome One Health challenges:

  1. Multisectoral, humble collaboration: Act to facilitate more effective working across different sectors to overcome challenges, working toward the common goal of achieving health and wellbeing for all;
  2. Amplifying current messages to affect change: Our joint work to initiate the first international snakebite awareness day is an excellent example of the Society drawing on its expert network to credibly call for increased focus for a complex issue that requires consideration of the cultural aspects of animal/human contact, promotion of risk reducing behaviours, and production and distribution of effective and affordable antivenom therapies alongside strong health systems that are able to deliver immediate treatment.
  3. Catalytic funding: Advocating for further investment in joint risk assessment, planning and intervention, and surveillance will be needed on a continued basis in the coming years. This year we partnered with the National Institute of Health Research of the Department of Health and Social Care to triple the number of small grants made available, allowing us to be more responsive to the research needs of the community and consider providing catalytic cross-disciplinary funding that can be challenging to secure through other funding mechanisms. There is also dedicated funding for One Health through the Society’s collaboration with the Soulsby Foundation, which was established in 2016 by Lord Soulsby of Swaffham Prior to honour his life work in public service and his pioneering role as a champion of the concept of One Health internationally.

I am confident that this meeting will significantly contribute to developing a One Health agenda for the Society and the wider community, which will demonstrate the true value of intersectoral working and the value that the Society can provide.