One health for humans, animals, and the environment this is the meaning of the One Health approach, which now more than ever is urgent to adopt the challenge is to put it into practice through true governance for the protection and promotion of health no longer myopically confined only to human health, The SARS-CoV-2 pandemic is the biggest global shock in decades. A tsunami that claimed millions of and devastated the economy. But is there at least one lesson we can draw from this annus horribilis?
The Director-General of the World Health Organization (WHO), Tedros Ghebreyesus, said: The pandemic reminds us of the intimate and delicate relationship between humans and the planet. Any effort to make our world safer is doomed to fail unless we address the critical interface between people and pathogens, and the existential threat of climate change, which is making our Earth less habitable
Virologist Ilaria Capua, Director of the One Health Center of Excellence at the University of Florida, clarifies the concept even better the only way we have to never relapse is the awareness that we live within a system of which they are part people, animals, plants and in general the environment in which we are all immersed. Therefore, there are not only individuals and communities, but there also is not only the human species to preserve the health of the planet and all its inhabitants must have equal dignity if we want to create a sustainable, resilient and lasting ecosystem. We are all elements of a single system, in which the health of each human, animal, or environmental element is strictly interdependent from that of the others 2.
In practice, we must take the view that there is only one health or One Health. And, given the relationship between the various components in which none predominates over the others, why not describe it as a circular and integrated system? For this reason, some prefer to speak of circular health. One Health’s holistic vision represents a model for protecting and promoting the health of populations based on the integration of different disciplines. This perspective has solid scientific and historical roots but is too often little known or ignored in practice. Almost fifty years ago a green paper Canadian marked a revolutionary turning point (for the time) in the way of understanding health: the report outlined a conceptual framework for a holistic vision of health as a result of the integration between human biology, environment, lifestyle and health organization 3.
Therefore, One Health can be considered at the root of famous (but rarely implemented) health strategy documents proposed by WHO. They include the 1978 Alma Ata Declaration 4, the 1986 Ottawa Charter 5, 2012 Health 2020, and more recently the 2016 Shanghai Declaration 6. These documents have been officially recognized by the majority of European health ministries, the European Commission, and various international organizations. Unfortunately, either out of a political will or a lack of ability to manage change in decisions impacting development and public health, these WHO recommendations were either disregarded or only partially adopted. Indeed, it can be said that to date and at all levels of government, governance for health and development is weak, obsolete, and underperforming 8,9.
The pandemic that all countries are facing is demonstrating the enormous price ethically and economically unsustainable and unjustifiable as a result of weak governance. To strengthen governance and practices for health development, and the reduction of inequities, we need two fundamental elements. The first concerns a vision of the future that can influence decision-making in all policies, not just health policies. Here the One Health perspective is both scientifically and strategically fundamental. Clearly, the second element is inherent in the political will and active participation of civil society to implement this vision in daily practice.
Microorganisms, The Environment, And Man
That an ‘invisible’ microorganism has threatened human health is not a new thing: from the epidemic of (probably) smallpox in the Greek encampment at Troy described by Homer in the Iliad, to the black plague of 1348 which wiped out a third of the European population, to the Spanish of 1918 which caused at least 50 million deaths worldwide 2. The black plague that inspired Boccaccio’s Decameron is a good example of the interrelation between animals, man, and the environment: the protagonist is a bacterium, Yersinia pestis, which makes rats sick and from these, through a flea, is transmitted to humans causing the plague and especially affecting the most fragile and the poorest. All in dirty environments or with poor hygienic conditions.
Microbes, as Capua states, become the new links between apparently separate worlds: human health, animal health, and the health, or rather the unhealthiness, of the environment. The source of the infection is therefore the non-human animal and it is known that about 75% of emerging infectious diseases affecting humans are of animal origin. The best known of these zoonoses that have occurred in the last forty years is HIV, Ebola, SARS of 2003, Avian influenza, Zika, and, most recently, SARS-CoV-2.
FAO, WHO, and the World Organization for Animal Health (OIE) have published a guide to support various countries in the fight against these diseases according to the One Health 10 approach. More recently, WHO drew up a Manifesto 11 with six prescriptions for post-Covid-19 healthy and green recovery
safeguard nature guarantee access to clean water ensure a rapid and healthy energy transition promoting healthy and sustainable food systems build healthy and livable cities;
cancel the incentives for fossil fuels these recommendations are perfectly in line with the Sustainable Development Goals of the 2030 Agenda 12 and with One Health’s foundations regarding the impact of the environment on human health.
The Coronavirus pandemic represents an even more striking example of the connections between human, animal, and ecosystem health and of how humans are invading natural habitats that do not belong to them. The One Health model helps us to understand that this pandemic in practice we have been looking for, creating the conditions for the virus to pass from animal to man. All human activities that cause biodiversity loss – deforestation, land-use changes, intensive farming and farming, trade and consumption of wild animals (e.g. in the infamous wet markets of the Far East) increase wildlife contact and farmed animals and therefore between potential pathogens and people 1
Deforestation appears to be the most important factor in increasing global zoonosis. A recent WWF Italy report states that 80% of world deforestation is due to the expansion of pastures for meat production and the spread of soybean and coffee monocultures (especially in South America) and oil palm plantations (Indonesia and Malaysia). These are raw materials that are generally destined for export, in particular to China, Europe, and the United States. Over the past thirty years, 420 million hectares of land have been deforested, more or less the equivalent of the surface of the entire European Union, most of which in tropical areas. Approximately 10 million hectares are lost each year due to the conversion of forests to agricultural land14. Today, therefore, the development of a pandemic could follow a sequence that can be summarized as follows: 1) deforestation, 2) loss or extermination of predators and unlimited growth of reservoir species, 3) illegal collection and trafficking of this species, 4 ) wet animal markets, 5) species leap
Big Data And Artificial Intelligence
The circular health model is perfectly in line with the whole-of-society approach and the whole-of-government approach supported by WHO in the Health 2020 strategy. This type of approach considers engaging various sectors of society and facilitating their active participation in decision-making processes related to public health measures. The One Health approach appears to be a good method of responding to the current pandemic, and perhaps the only feasible one to avoid future ones. It must become the compass to follow to effectively detect, respond and prevent future zoonoses or other public health risks. Interdisciplinarity, sustainability, and interdependence are the keywords of the One Health approach. Therefore, not only synergy between the world of veterinary medicine, human medicine, and ecology, but also a collaboration with the social and humanities, the physical sciences, and the life sciences.
Let’s give some examples. The analyzes we can do with big data allow us to constantly monitor environmental parameters such as temperature and humidity, and we know that vector-borne diseases such as malaria and dengue increase with the increase of these two variables. With the analysis of big data we can, for example, measure the level of fine dust, the UV index, the presence of pollen, the strength of hurricanes, the warming of the sea, and the melting of glaciers. To these are added the individual and collective data and the public and private ones. A mass of data that can be examined using sophisticated statistical analysis systems and with the help of so-called ‘supercomputers’, capable of simultaneously managing hundreds of terabytes of data.
If used ethically and within a vision for the collective good like One Health, big data analytics can be very useful in the decision-making process. One of these supercomputers is located at CERN in Geneva, which is home to the world’s largest particle accelerator. In addition to the supercomputer with enormous computing capacity, the center made available the Zénodo platform. This is used to store and analyze data relating to Covid-19 in a structured manner. The platform is open access, meaning you can upload information from researchers from all over the world and in all fields. A collaboration has also been created between the Geneva Center and the Florida One Health Center. The American institution will receive information on pollution, useful for evaluating their influence on the course and severity of the disease due to Covid-19, and meteorological data (temperature, humidity, frequency, and quantity of precipitation …). They will be used to verify whether these climatic alterations have an impact on the epidemic. A collaboration between the world of particle physics and the world of microorganisms that Ilaria Capua defines as ‘ collective intelligence
Alongside the use of big data, the use of artificial intelligence is becoming more and more widespread. IBM Watson Health’s project combines computational capacity (millions of scientific articles and real clinical data archived) with AI which, through a grid of symptoms and patient information, can give precise diagnostic indications to the attending physician 16. Researchers from MIT in Boston have developed a system that can diagnose Covid-19 with a single cough. The AI, through a particular algorithm, analyzes the tone of the voice, the emotional state, and the rhythm of breathing, and compares them with thousands of coughs of patients with Covid-19 or normal subjects, managing to identify subjects of all asymptomatic but virus-positive with a reported diagnostic accuracy of 98.5-100% 17. Work is currently underway to develop the model into an App, to be used on one’s smartphone or laptop, which if adopted on a large scale could become a free and repeatable pre-screening tool, potentially saving thousands of lives.
Artificial intelligence is increasingly projecting itself towards a better-defined Alternative Intelligence, a new operational concept that highlights the collaborative intelligence between machine and human. According to a recent review, AI has so far been applied in at least four fields of the health system in the fight against Covid-19: diagnosis, therapy, decision making in the clinical area, and public health. It could potentially be applied in four other areas: surveillance, combination with big data, reorganization of interventions and medical-surgical services, and management of patients with Covid-19 18. The study concludes that in the face of increasing pressure on limited health resources, the use of AI-driven techniques used in the prevention, diagnosis, monitoring, therapy and vaccine research, and public health decision-making processes, can help improve efficiency. and the effectiveness of efforts to combat this (and future) pandemic. Efforts that might otherwise be overwhelmed by a large number of patients.
The urgency of a new way of thinking and acting for health
The One Health model applied to post-Covid-19 recovery goes beyond the purely biomedical conception of health (prevention, treatment, rehabilitation, including effective drugs and protective vaccines), and stresses that human health cannot be separated from animal health and all the factors that make life on our planet possible. The new paradigm of health can therefore be represented as a sphere, in which each component integrates with the others, in contrast to the classic (vertical) view of health represented by the various layers of the cylinder
The current pandemic has taught us that since health is ONE – that of humans, animals, and the environment, the factors to reduce the risk of new pandemics are the same as those needed to protect biodiversity: stop deforestation and land use for agriculture and intensive farming, elimination of wet markets and limitation of wildlife trade. One Health also requires the involvement of every social sphere and therefore the cooperation of many bits of intelligence and skills, the activation of new behaviors in different areas of society itself (local communities, citizens, political decision-makers), breaking down the disciplinary boundaries between physical sciences and life sciences and between the different scales of intervention (regions, nations, continents) since the virus knows no borders.
One Health And Governance For Health
As mentioned above, this conceptual framework must be followed up with new innovative practices and with coherence and political will that has been lacking in the past. One Health requires a new way of thinking and acting for individual, collective and global health; it should be understood as a relevant and innovative strategy in all sectors that benefit from the collaboration between different disciplines – doctors, veterinarians, environmental scientists, economists, and also sociologists and psychologists. But to do this it is necessary, as a first step, to break down the boundaries between the various sectors of science and to induce experts from different disciplinary sectors to work together. This, depending on the problem to be addressed, means improving the levels of coordination, cooperation, and integration of the measures to be taken to promote the development and protect and improve collective health. Therefore, alongside the integration of different disciplines, it is necessary to invest – and put “more health” – in every social sphere: from agriculture to science, from education to politics, from information to economics.
The second step concerns the rejuvenation of educational paths to allow future generations to assimilate this new integrated model. The third refers to training courses in general. Training in this field is essential to ensure that current policymakers are fully aware that any choice they make about human health, animal and plant health, and environmental health affects others. Here a new science is being born, full of “consequences” and new opportunities to maximize the impact on sustainable development and health 19.
An Essential Approach
In conclusion, the challenge is to put One Health into practice through true governance for the protection and promotion of health, no longer myopically confined only to human health. In this process of change, the involvement of civil society is essential. One Health represents an essential approach for integrated management in public health. Indeed, it addresses the needs of the most vulnerable populations based on the intimate relationship between their health, animal health, and the environment in which they live. In other words, One Health considers and understands the broad range of socio-economic and environmental determinants. These determinants characterize the possibilities to protect and promote health and reduce the inequities that exist in this area.
To this end, we must create a culture for health by involving society more in its various articulations (associations, voluntary work but also business and private) to put the person and the community at the center. After all, health is universal and remains a common good. 2,400 years ago the philosopher Aristotle stated: “the doctor heals, nature heals”! One Health should become the mainstream approach to public health supported by interdisciplinary research, cross-sectoral policies, and effective health and development governance at all levels of decision-making. In light of the lessons we are learning from the Covid-19 pandemic, adopting a One Health perspective is a necessity and an opportunity that can no longer be postponed.