We must take a One Health approach to improve human pandemic infection control – The BMJ – The BMJ

The covid-19 pandemic must serve as a wake-up call

It is now clear that global and national preparedness and response to the covid-19 pandemic has been inadequate. Many of the basic principles which underpin public health and wellbeing have been transgressed whether through political hubris, narrowness of vision, or deficiencies in healthcare education.

With the exception of tropical medicine, human medicine in affluent societies in the last 50 years has given relatively little priority, for understandable reasons, to infectious disease. The emergence of HIV and the challenge of antimicrobial resistance have driven some reconsideration in recent years. Nevertheless, the focus in both training and practice has been dominated by the challenges presented by non-communicable diseases in individuals. By contrast, in veterinary medicine infectious diseases have always been of great significance andthe accumulated experience of handling infections in populations of animals can contribute greatly to human pandemic infection control.

The 2015-30 Sustainable Development Goals, ratified by 193 nations, recognised the value of an integrated and ethical approach to society and the environment. From a healthcare perspective, they emphasised the importance of a One Health approach which embraces human, animal, and environmental health and appreciates their critical interdependence. Recent pandemics (e.g. SARS, MERS, 2009 H1N1 influenza, covid-19) emphasise the need for us all to prepare and respond more effectively to the spillover of infections from animals to humans as well as the challenges posed by our degradation of the natural world. The economic benefits of this approach amply justify the costs involved. [1]

The deleterious consequences of infections spilling over between animals to humans are exponentially magnified by the global connectivity of modern times. The covid-19 pandemic had its origins in the natural world, most likely through transmission from bats. Spillover and adaptation to novel host species represents the natural evolutionary trajectory for many viruses (e.g. HIV-1, RSV, measles, common cold coronaviruses). Failure to recognise this reality promotes the risk of similar pandemics in the future. The risk of spillover is increased through our failure to respect the ecological boundaries and habitats of wildlife and our inability to prevent the current accelerating environmental destruction and incursions into wilderness habitats to seek resourceswood, minerals, or clearance for crops and livestock. Trade that brings humans and their livestock into contact with wildlife also increases the risk of spillover.

We suggest that education and training in human and veterinary medicine must more effectively embrace the concept of preventative eco-health whereby the health of all animals (including humans) is protected through preservation of the integrity of the natural world, its services, diversity, and natural ecological barriers. Recent analysis has shown that the cost of preventing further pandemics over the next decade by protecting wildlife and forests equates to just 2% of the estimated financial damage caused by covid-19. [1] Moreover, with shared drivers for disease emergence and, very often, shared pathogens, the human medical and veterinary medical sectors must adopt effective multi-speciality coordination for surveillance and rapid detection (e.g. the UK governments human-animal infections and risk surveillance [HAIRS] group). While efforts to capture the full extent of microbial diversity (e.g. Global Virome Network) are underway, predicting the timing, location and agent of the next epidemic or pandemic remains very challenging. A holistic, more eco-centric, educational and preventative approach, as well as increased governmental and global commitment to pandemic preparedness, should alleviate the most extreme challenges posed by any future pandemic.

The covid-19 pandemic has provided us all with a wake-up call. It has starkly demonstrated the interconnectivity of global healthcare challenges and has led to dramatic changes in societal behaviours and working practices. Widespread global concern over environmental issues will only be assuaged through more effective collaboration in research and practice between medical and veterinary practitioners in partnership with biologists and environmentalists. Education must therefore equip practitioners to function effectively in this new environment. At a time when the worlds biodiversity is facing both a mass extinction event and an increase in emerging infections, professionals in human, animal and environmental health must function as a broader multidisciplinary team. [2] It follows that educational barriers separating human, animal, and environmental health workers should be cast aside in favour of a more integrated training regime. The One Health concept, as advocated by William Osler, Calvin Schwabe, and Lawson Soulsby must be at the foundation of this integrated approach.

Camilla T.O. Benfield, course director, MSc One Health: ecosystems, humans and animals, Royal Veterinary College, London, UK

David Heymann, professor of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK

Judy MacArthur Clark, past president, Royal College of Veterinary Surgeons, London, UK

AJ Trees, Lord Trees, House of Lords, London, UK

Babulal Sethia, past president, Royal Society of Medicine, London, UK

The Soulsby Foundation (www.SoulsbyFoundation.org) supports research in One Health through fellowships which enable medical and veterinary professionals, early in their careers, to forge international multidisciplinary collaborations, gain global perspectives, and experience the many cultural contexts of One Health.

Declaration of Interests:The Soulsby Foundation is a charitable incorporated organisation, registered charity number 1174783. CB is director of the joint RVC-LSHTM MSc in One Health course and in receipt of a 2018 Soulsby Fellowship. DLH, JMC, AJT and BS are Trustees of the Soulsby Foundation in receipt of no remuneration.

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We must take a One Health approach to improve human pandemic infection control - The BMJ - The BMJ