Strengthening preparedness against global health threats: A paradigm shift based on One Health approaches

1. Introduction

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for the dramatic COVID-19 pandemic [1,2], shows clearly that global health threats are due to multifarious causes, complex determinants and drivers. Moreover, the impact caused by the pandemic is said to be syndemic, since it involves a multitude of factors (such as socio-economic, cultural and environmental) affecting communities on a global scale [[3], [4], [5]].

The evidence that emerges strongly suggests the need to develop and implement multidisciplinary, multi-sector and multi-actor preparedness strategies to address this complexity and reduce fragmentation of strategies in the implementation of procedures and plans required to anticipate and contain a health emergency [6].

The zoonotic origin of most emerging pathogens and the crucial role played by humans in the over-exploitation of the environment, suggest intercepting possible drivers of global health threats at the human-animal-environmental interface and reducing their possible impact with strong prevention actions. The identification of drivers of potential threats before they affect societies requires assessing context-specific risks with the support of multiple stakeholders, and translating complex data from multiple sources into accessible information for action [7].

To support this aim the One Health approach, as defined by the WHO, represents a valid scientific strategy “to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes” [8].

Adopting and integrating the OH approach into plans and policies, both at national and international level, requires a radical change of strategy in terms of governance, capacity building, training and research to overcome the current fragmentation and barriers and to allow the required interaction, collaboration and coordination across sectors and disciplines.

The Group of Twenty (G20) is the international forum that brings together the world's major economies. The forum has met every year since 1999 and the G20_2021 thematic was focused on People-Planet-Prosperity [9].

The Think20 (T20) is the official engagement group of the G20, bringing together leading think-tanks and research centers worldwide. It serves as the ‘ideas bank’ of the G20 and aims at providing research-based policy recommendations to the G20 leaders [10].

With the aim of providing concrete recommendations to the G20_2021 to enhance the integration of the OH approaches in preparedness strategies, we delivered through the T20 the Policy Brief (PB) titled “One health-based conceptual frameworks for comprehensive and coordinated prevention and preparedness plans addressing global health threats” [11].

We discuss here the evidence reported in the PB on the unmet strategic needs that are presently hampering the implementation of efficient pandemic preparedness strategies and how these could be addressed through a OH approach.

2. Rationale for integrating one health approaches in preparedness strategies

WHO defines emergency preparedness as “the knowledge and capacities and organizational systems developed by governments, response and recovery organizations, communities and individuals to effectively anticipate, respond to, and recover from the impact of likely, imminent, emerging, or current emergencies” [12].

The One Health High Level Expert Panel established in 2021, defines OH as “…. An approach (which) mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development” [13].

The integration of OH approaches in preparedness strategies could support the consolidation of those preparedness pillars (Fig. 1) which rely on the coordinated action of multiple sectors and disciplines [14,15].

3. Actionable recommendations

Adopting and implementing OH approaches in prevention and preparedness strategies have been consistently advocated on the basis of its strategic benefits considering that the emergence of infectious diseases and pandemic threats is influenced by multiple factors (including behavioural, environmental, social and economic ones) and that OH could address all these factors thanks to its multidisciplinary approach [16,19,[44], [45], [46], [47], [48], [49]].

In order to enhance the operationalization of OH preparedness strategies we suggest here two key areas that need to be addressed to facilitate and accelerate this process.

The first area refers to the mainstreaming of OH approaches in preparedness and prevention plans, making OH an integral part of the national, regional and international strategy aimed at countering the evolving of potential threats to global health rather than a distinct One Health action plan addressing specific sectors like zoonosis or AMR [37,50]. We propose the implementation of a One Health-based Conceptual Framework to promote the integration of OH with identified priorities for action (Appendix 2 in [11]). On the basis of specific indicators, the national surveillance system should identify local potential drivers for possible threats to health and monitor them. As discussed, these drivers may involve various sectors beside health and therefore a multidisciplinary and multisectorial surveillance system should be considered. The information and data collected, analysed with a One Health approach, support the elaboration and updating of prevention and preparedness plans and provide evidence for appropriate decisions and related actions (Fig. 2).

The need of assessing the risk of drivers potentially involved in the development of threats and of promptly detecting threats of unknown origins, should motivate the identification of metrics and indicators which allow the multidisciplinary of the OH approach being operational, monitored and evaluated.

The conclusions of FAO's evaluation of the largest animal health programme in the world on zoonotic diseases and AMR using OH approach, stress the need of setting a One Health Sustainable Development Goal because the lack of such indicators may reduce national commitment to the implementation of One Health [51].

The second area in need of proper action involves governance, operational research, and capacity building to cope with barriers and obstacles which are hampering OH integration.

In line with these needs, we identified specific recommendations which were provided to the G20–2021 with the PB titled “One health-based conceptual frameworks for comprehensive and coordinated prevention and preparedness plans addressing global health threats” [11].

We recommended to the international bodies guidance for specific governance structure across sectors and disciplines at national and international level, to ensure harmonised institutionalisation of One Health strategies (including guidance for setting means for integrated data collection and analysis, risk assessment, and resource allocation).

We recommended also the development, in coordination with the countries that are already implementing One Health strategies, of a cost-effectiveness evaluation framework, with modular options to tailor for local conditions. Ad-hoc operational research, to assess and quantify the added value and sustainability of One Health strategies in the fields of prevention and preparedness should also be considered.

Finally, we stress the urgency to motivate the national governments to devote adequate resources to the development and implementation of trainings on prevention and preparedness with multidisciplinary and multisectoral approaches to enhance awareness of benefits of sharing data and information and capacity of analysing complex set of data to take appropriate actions [52].

4. Conclusions

We are required to make important and urgent decisions on complex situations, and we need to base them on a comprehensive analysis of data and information from multiple areas and sectors that might be relevant to decision-making. OH interoperable databases and data democratization platforms can facilitate the sharing of required information and should be considered as integral part of the proposed prevention-preparedness synergic system. This could also enhance IHR implementation and could therefore be included in the emerging idea of a Pandemic Treaty [53,54].

Sharing with the relevant stakeholders the identified risks for potential pandemics, or other global health threats, facilitates their participation to the dynamic cycle of protecting the environment through a sustainable behaviour, decreasing the risk of potential new threats, and supporting identification of possible drivers of pandemic. In addition, this process will keep all the stakeholders involved informed, active and resilient in case of emergency.

Addressing global health threats through a lens that highlights the complexity of the involved system is what leads to identifying in OH as a viable framework to support global health strategies. Given the wide range of determinants of emergence and impact that operate within globalized yet local contexts, no convenient blueprints can be put on the table to counter current and future global health threats. Rather, local custom-made solutions will need to be found through the engagement and consensus of multiple actors. The T20 final communiqué to G20–2021 [55], the Declaration of the G20 Health Ministers [56] and the G20 Health and Finance Ministers communiqué [57] have considered the recommendations provided with the PB [11]. We hope that this can contribute to further the current debate about OH strategies operationalisation, lead to concrete actions capable of transforming the current OH momentum into long-term commitments and promote paradigmatic shifts in prevailing thinking around preparedness that can translate in more effective global and local strategies supported by equitable sharing of innovation, prevention and response focused technologies.

OH preparedness can enhance our understanding of risk factors of complex global health threats at the human-animal-environment interface. It can also prove a new point of view from which we can hypothesize future potential scenarios and adapt national and regional prevention and preparedness strategies, to counteract the current megatrends that are damaging our entire planet [46,[58], [59], [60], [61]].

Funding

ISS research 2020-22_ ISS20-d955b07fd1e4

Declaration of Competing Interest

None