Implementing a One Health approach to emerging infectious disease: reflections on the socio-political, ethical and legal dimensions

Human and Veterinary Medicine Collaboration: Synergistic Approach to Address Antimicrobial Resistance Through the Lens of Planetary Health

Antimicrobial resistance (AMR) represents a critical threat to human, animal, and environmental health, challenging global efforts to maintain sustainable ecosystems and public health systems. In this review, the complex, cross-disciplinary issues of AMR are explored within the framework of planetary health, emphasizing the interconnectedness of human and veterinary medicine with broader environmental and social systems. Specifically, it addresses the social, economic, environmental, and health dimensions of AMR under the planetary health framework. The social aspects consider how public awareness, education, and healthcare practices shape antimicrobial use (AMU) and resistance patterns. The economic impact evaluates the cost burdens of AMR, including healthcare costs, loss of productivity, and the implications for the livestock and food production industries. The environmental dimension highlights the role of pharmaceutical waste, agricultural runoff, and industrial pollution in contributing to the spread of antimicrobials and resistant pathogens in ecosystems. To illustrate these challenges, a comprehensive literature review using the PubMed and Web of Science databases was conducted, identifying 91 relevant articles on planetary health and AMR. In this review, the knowledge from these studies and additional references is integrated to provide a holistic overview of the AMR crisis. By applying the four pillars of planetary health-social, economic, environmental, and health knowledge-in this manuscript, the necessity is underscored of collaborative strategies across human and veterinary medicine to combat AMR. Ultimately, this synergistic approach aims to shape the policies and practices that safeguard public health, protect ecosystems, and promote a sustainable future by implementing antimicrobial stewardship programs and encouraging prudent AMU.

Are we cultivating the perfect storm for a human avian influenza pandemic?

The emergence of highly pathogenic avian influenza (HPAI) A H5N1 virus in dairy cattle marks a troubling new chapter in the ongoing battle against zoonotic diseases. Since its initial detection in 1955, the H5N1 virus has primarily been associated with poultry, posing significant threats to both animal and human health. However, recent outbreaks in U.S. dairy herds across nine states have revealed an alarming expansion of the virus, with over 190 herds affected as of September 2024. This unprecedented spread in cattle has sparked intense concern among scientists and health officials, especially with reports indicating that up to 20% of dairy products may contain traces of the virus. The implications of the H5N1 virus establishing itself in cattle populations are profound. This potential endemic presence could transform dairy farms into reservoirs of the virus, facilitating its evolution and increasing the risk of human transmission. Mutations enhancing viral replication in mammals have already been identified, including the notorious PB2 E627K mutation linked to increased virulence. Moreover, the detection of the virus in the central nervous system of infected animals, including cats, underscores the broad tissue tropism and severe pathogenic potential of the H5N1 virus. Current containment efforts include stringent biosecurity measures and financial incentives for enhanced testing and personal protective equipment (PPE) for farmers. Yet, gaps in testing infrastructure and the resurgence of raw milk consumption pose significant challenges. The U.S. Department of Agriculture (USDA) and the Centers for Disease Control and Prevention (CDC) emphasize the critical need for comprehensive testing and pasteurization to mitigate the risk of human infection. As the scientific community races to adapt existing antiviral treatments and develop effective vaccines, the concept of a One Health approach becomes increasingly vital. This holistic strategy calls for coordinated actions across human, animal, and environmental health sectors to preemptively tackle emerging zoonotic threats. Strengthening surveillance, fostering international cooperation, and investing in research are essential steps to prevent the H5N1 virus from igniting the next global health crisis. The current avian influenza outbreak serves as a stark reminder of the delicate balance between human activities and viral evolution. Our collective ability to respond effectively and proactively will determine whether we can avert the perfect storm brewing on the horizon.

Towards an Ethical Analysis of Research in One Health (EAROH)

The COVID-19 and Monkeypox pandemics and the ongoing Marburg outbreak in Rwanda provide a stark reminder of the importance of espousing a One Health (OH) approach to zoonoses as well as other public health and global health issues. Recent years have in fact seen an exponential rise in biomedical and public health journals and publications explicitly adopting the name of OH. Not all research that pertains to be OH however is indeed OH research, insofar as it does not comply with the proclaimed OH goals of benefiting humans, animals, and the environment. Thus, to ensure such compliance a checklist or toolkit for an ethical analysis of research in OH (EAROH) should be required prior to publication in scientific journals or grant applications. Such a toolkit should be developed by a working group of scholars with expertise in OH ethics, animal ethics, and environmental ethics.

Ethics, One Health approaches, and SDGs: conference lessons for an emerging field

One Health ethics is an emerging field that has gained traction since its origin in approximately 2015. This article builds upon the insights shared during a panel discussion on One Health, Sustainable Development Goals (SDGs), and ethical conflicts at the 28th Annual International Sustainable Development Research Society Conference. The conference, themed Sustainable Development and Courage: Culture, Art, and Human Rights, aimed to advance and expand recent knowledge in the field. Key themes discussed during the conference panel included interdisciplinarity and multidisciplinary, risk, resilience, wicked problems with no readily available solutions, and praxis. A conclusion is that ethics should become more prominent within One Health discussions. Four aspects emerged from this discussion: (1) Ethics is needed to solve wicked problems within One Health approaches. (2) Aspects of multi-, inter-, and transdisciplinarity need to be considered together with their implications for ethics. (3) Two crucial concepts, risk and resilience, need to be addressed. (4) Ethical decision models are called for and need to be developed.

Beyond COVID: towards a transdisciplinary synthesis for understanding responses and developing pandemic preparedness in Alaska

Pandemics are regularly occurring events, and there are foundational principles of pandemic preparation upon which communities, regions, states, and nations may draw upon for elevated preparedness against an inevitable future infectious disease threat. Many disciplines within the social sciences can provide crucial insight and transdisciplinary thinking for the development of preparedness measures. In 2023, the National Science Foundation funded a conference of circumpolar researchers and Indigenous partners to reflect on COVID-19-related research. In this article, we synthesise our diverse social science perspectives to: (1) identify potential areas of future pandemic-related research in Alaska, and (2) pose new research questions that elevate the needs of Alaska and its people, pursuant of a specific body of pandemic knowledge that takes into account the ecological and sociocultural contexts of the region. In doing so, we highlight important domains of research in the social sciences from transdisciplinary perspectives, including the centering of Indigenous knowledges and needs, the contexts of risk perception and resilience, food and housing security, and more. We highlight the contributions of social sciences to pandemic knowledge and provide a foundation for future pandemic-related research in Alaska.

Integrating animal welfare into the WHO pandemic treaty: a thematic analysis of civil society perspectives and comparison with treaty drafting

The COVID-19 pandemic has exposed critical weaknesses in the global health system, highlighting the urgent need for a coordinated international approach to pandemic prevention and management. As negotiations for a new WHO pandemic treaty progress, the effective integration of animal welfare is crucial. This paper aims to investigate the perspectives of key civil society organizations on the integration of animal welfare provisions into the pandemic treaty. Through a thematic analysis of documents prepared by FOUR PAWS, Wildlife Conservation Society, and Action for Animal Health between 2020-2023, five major themes are identified: prevention of zoonotic spillover, One Health approach, animal health systems and infrastructure, sustainable and ethical animal management practices, and policy coherence and governance. A comparative analysis of these themes against the April 2024 draft of the pandemic treaty reveals areas of alignment and divergence. Due to the ongoing controversies and the need for further improvements, the WHO's intergovernmental negotiating body was unable to finalize the treaty text for the 77th World Health Assembly in May 2024, leading to an extended mandate until 2025. Based on the findings, the paper proposes recommendations to strengthen the integration of animal welfare into the treaty, arguing that incorporating these recommendations is critical for developing a transformative, equitable, and effective treaty that addresses the systemic drivers of pandemic risk.

Leptospirosis in India: insights on circulating serovars, research lacunae and proposed strategies to control through one health approach

Leptospirosis is one of the most neglected zoonotic infections of public health concern worldwide and a remerging infection in tropical countries such as India. The infection least explored disease and the epidemiological and other critical data are scarce for the disease rate reported and to control the infection. Leptospirosis as sapronosis is as underrated as the infection itself, and this article aims to explore the significance of this aspect of the disease. The research review aimed at the epidemiological understanding of the infection to control the negative impact of the disease. A mixed review and analysis were carried out to understand the knowledge published on the critical and understudied areas like epidemiology, transmission, diagnosis, treatment, and control of infection. A systematic analysis was carried out to extract information about the reported circulating strains, and research lacunae in India with the published data available in PubMed. The article elaborately discusses crucial inference areas of infection transmission and addresses lacunae in critically unacclaimed areas of infection to control the spread of infection using one health approach (OHA), and strategies to control leptospiral infection are proposed. The article also reviewed how and why Leptospirosis can be best studied and controlled by "One health approach" in India.

The development and validation of the One Health Community Assessment

Interdisciplinary collaborations to address human, animal, and environmental health have been emphasized since the inception of the One Health framework. A quantitative survey instrument was developed to measure perceptions of the impacts of pets on One Health. Using the exploratory sequential mixed methods approach, 20 interviews were conducted with individuals from a racially diverse and low-socioeconomic status community in the U.S. to understand their perceptions of One Health. Data from those interviews informed the development of a Likert scale survey measuring individual perceptions of community, human, pet, and environmental health and welfare, as well as the connections between the domains of the One Health triad (human, animal, and environment). The resulting One Health Community Assessment (OHCA) was administered in two urban and two rural underserved U.S. communities longitudinally (2018-2021) through door-to-door data collection as well as phone, email, and text surveys. Validation of the instrument was completed using data collected in the third and fourth years of the study (n = 654). Factor analysis with orthogonal varimax rotation was used to assess the structure and internal consistency of the OHCA. Five subscales explained 42.4% of the variance in our 92-item instrument: community health (Cronbach's α = 0.897), human health (α = 0.842), pet health (α = 0.899), environmental health (α = 0.789), and connections between domains of One Health (α = 0.762). The OHCA represents the first reliable and validated instrument to measure the impacts of pets on One Health.

Uncovering associations between interest in One Health and pre-existing conditions and behaviours: Evidence from a UK survey

This paper endeavours to unveil individual characteristics associated with an interest in One Health. Through the distribution of an online survey randomly distributed among the United Kingdom population, we discovered significant correlations between pre-existing attitudes towards and relationships with nature and animals and interest in One Health, which is quantified by the number of additional pages of One Health information participants agreed to view at the survey's conclusion. Additionally, individuals with poorer mental health demonstrated a higher level of interest in One Health. The findings suggest that interest in One Health and people's connections with nature and animals are driven by the same personal preferences. These insights point towards the potential for more targeted communication strategies to specific groups, facilitating more effective promotion of the One Health concept.

Bridging Food Systems and One Health: A key to preventing future pandemics?

Food Systems and One Health are two approaches increasingly known for the holistic perspective they bring when addressing the issues that concern them: food and health. This systematic literature review aims to explore the evidence for using these approaches in a concerted manner to better manage zoonoses. By zoonoses management, we refer to improving the ability to address current zoonoses as well as preventing future ones. A total of 98 scientific articles were screened, of which 29 were considered eligible due to their focus on operationalizing each approach to help address zoonoses, as well as a combination of the two. Most articles implement One Health to prevent zoonoses by guiding stakeholders in concerted and participatory decision-making processes. However, the One Health approach can also be adopted via data modelling. Several articles refer to the monitoring and evaluation process of One Health initiatives to prevent zoonoses and discuss best practices to successfully implement the approach. Contrastingly, only three studies adopt a Food System approach to manage zoonoses, despite the profound connections existing between our food systems and the emergence of zoonotic risks. We conclude that there is a lack of integration between the One Health and Food System approaches to manage zoonoses. We also show that experts call for integration, so that not only human, animal, plant, and environmental health are considered, but also the socio-economic trade-offs when monitoring and developing strategies to manage zoonoses. This can be reversed, enabling zoonotic risks to be addressed when planning for our food systems of tomorrow.

Navigating One Health in research-for-development: Reflections on the design and implementation of the CGIAR Initiative on One Health

Adopting One Health approaches is key for addressing interconnected health challenges. Yet, how to best put One Health into practice in research-for-development initiatives aiming to 'deliver impacts' remains unclear. Drawing on the CGIAR Initiative on One Health - a global initiative to address zoonotic diseases, antimicrobial resistance, and food and water safety - we reflect on challenges during program conception and implementation, prompting us to suggest improvements in multisectoral collaboration, coordination, and communication. Our approach involves conducting a researcher-centered process evaluation, comprising individual interviews that are subsequently thematically analyzed and synthesized. The key takeaway is that limited time for planning processes and short program timelines compared to envisioned development impacts may impede research-for-development efforts. Yet, collaborative work can be successful when adequate time and resources are allocated for planning with minimal disruption throughout implementation. Additionally, due to the multifaceted nature of One Health initiatives, it is important to pay attention to co-benefits and trade-offs, where taking action in one aspect may yield advantages and disadvantages in another, aiding to identify sustainable One Health development pathways. Forming close partnerships with national governments and local stakeholders is essential not only to promote sustainability but also to ensure local relevance, enhancing the potential for meaningful impact. Finally, regularly assessing progress toward development goals is critical as development stands as an overarching objective.

One Health research ethics review processes in African countries: Challenges and opportunities

One Health research has gained attention over the past few decades due to its potential to improve health challenges across the globe. However, obtaining ethics approvals for timely implementation of One Health research is a challenge in some contexts. Our study was undertaken to describe various challenges faced by researchers, research ethics committees (RECs) and members of regulatory bodies in Africa. An online survey was conducted between March and June 2021. The effect of predictors, including respondents' role (e.g., REC member, regulator and/or One Health researcher), sex, education, age, and country, on the perception of challenges and opportunities when conducting and reviewing One Health research, was investigated using multivariable linear regression models. Participants with different roles did not perceive any of the examined challenges differently during review of One Health-related research; but female participants (p = 0.026) and those with ten or more years of experience (p = 0.0325) perceived insufficient One Health knowledge as less of a challenge. Professional role was an important predictor (p = 0.025) for the perception of the establishment of a mandatory One Health review system. Respondents with multiple roles perceived the creation of ad hoc committees for review of One Health research under emergency situations to be less important (p = 0.02); and REC members perceived the creation of such committees to be less feasible (p = 0.0697). Our study showed that perceptions of the importance and feasibility of opportunities for improvement of One Health research ethics review under emergency and non-emergency situations varied across professional roles. This emphasizes the need to consider such improvement strategies; and the need for continuous and timely evaluation for improvement of ethics review of One Health and emergency research in Africa.

Cattle transporters' attitudes, indigenous knowledge, and current practices towards animal welfare, occupational well-being, and operational challenges: A survey of five regions in Ghana

Ghana is a significant cattle producer in Africa with an estimated cattle population of 3 million in 2020 [1]. The role of transporters in linking farms to markets and slaughterhouses is crucial in the livestock value chain. However, cattle transportation subjects the animals to high levels of stress, compromising their welfare, and transporters face challenges such as long working hours and harsh conditions. The objective of this study was to explore current practices, indigenous knowledge, and operational risks pertaining to animal welfare among transporters. The study was conducted in five regions connected by the N16, N10, and N6 Highway, the primary route for cattle transportation from the Ghana-Burkina Faso border to the coastal capital of Accra. A total of 78 transporters participated in the study. Out of the 78 participants in this study, the majority of transporters were young adults (56.5%) with secondary school education (45.9%) and 0-5 years of experience (37.2%). The average distance and time for transporting cattle was 528 km and 18 h, respectively. The transporters highlighted significant challenges encountered during cattle transport, including feed and water shortage, particularly prominent during the dry season (32.1%), as well as the occurrence of diseases and mortality, particularly high during the rainy season (41%). Furthermore, vehicular breakdowns were a common issue reported by transporters, with a substantial majority (88.5%) experiencing breakdowns during their last 10 trips. The results showed that most transporters (84.7%) had limited knowledge of animal welfare and had not received any formal education on livestock transportation. Instead, they gained experience as assistants on other trucks before becoming drivers. The findings of this study highlight the need for improved welfare standards for cattle during transportation and formal training programs for transporters in animal welfare and livestock transportation.

Potential zoonotic spillover at the human-animal interface: A mini-review

Wildlife markets and wet wildlife markets, a type of human-animal interface, are commonly trading centers for wild-caught and captive-exotic animals as well as their products. These markets provide an ideal environment for spillovers of zoonotic and emerging infectious diseases (EIDs). These conditions may raise serious concerns, particularly in relation to wildlife species that frequently interact with humans and domestic animals. EIDs pose a significant risk to humans, ecosystems, and public health, as demonstrated by the current COVID-19 pandemic, and other previous outbreaks, including the highly pathogenic avian influenza H5N1. Even though it seems appears impossible to eliminate EIDs, we may still be able to minimalize the risks and take several measures to prevent new EIDs originated from animals. The aim of this study was to review several types of human-animal interfaces with a high risk of zoonotic spillover, infectious agents, and animal hosts or reservoirs. Identifying those factors will support the development of interventions and effective disease control in human-animal interface settings.

Members' experiences and perceptions of participating in an Australian Regional One Health Network

BACKGROUND

The One Health framework is intended to optimise the interdependent health of humans, animals and ecosystems. It relies on effective collaborations across disciplines, sectors and communities. One Health networks have become increasingly important platforms for encouraging, creating and supporting collaborations. Their success is usually judged by evaluations of their outputs. However, there is also a need to understand member experiences and perceptions of the networks in which they participate. To that end, we undertook the first membership survey of a One Health network that was established in Australia in 2005.

METHODS

An online membership survey was created, comprising closed and open-ended questions.

RESULTS

Around one third of the Regional One Health Partnership ('the Network') participated in the study (33 members). Participants contributed a combined total of 170 years of experience in the Network and 414 years of combined experience working in/on One Health. The Network has provided excellent opportunities for cross sectoral collaboration that would otherwise not have been possible. Findings also highlighted the intangible benefits of membership such as the creation of a collaborative support group for emerging and established One Health practitioners.

CONCLUSIONS

The Network plays an important role in One Health collaborations in New South Wales and further afield. Commensurate with the literature on One Health collaborations globally, we identified a need for greater diversity amongst members, especially from First Nations people, local communities, non-government organisations and wildlife/environment experts, as well as concerted attempts to identify policy implications. Our membership survey tool could be adapted for future One Health Network membership surveys in Australia and internationally.

Public awareness of One Health in China

One Health is recognized as an increasingly important approach to global health. It has the potential to inform interventions and governance approaches to prevent future pandemics. Successfully implementing the One Health approach in policy will require active engagement from the public, which begs the question: how aware is the public of One Health? In this study, we examine the level and distribution of One Health awareness among the general public in China using a survey conducted in Beijing (n = 1820). We distinguish between awareness of the term of "One Health" versus awareness of the core set of ideas - the interconnection between the health of people, animals, and the environment. Our analysis shows that 40% of respondents reported that they have heard of the term, but more than double the number indicated that they recognize the core idea of interconnection between people, animals, and the environment. Specifically, about 83% of the respondents said that they believe people's health is closely connected to animal health and 86% believe people's health is closely connected to plant and environmental health. Multiple regression analysis indicates that women, younger people, and individuals with a higher level of education show higher levels of One Health awareness than their counterparts. Being aware of the term is associated with higher recognition of the core ideas. Policymakers and health practitioners should consider these findings when designing public awareness campaigns and educational initiatives to promote One Health principles.

China's One Health governance system: the framework and its application

One Health is an interdisciplinary approach that promotes the resolution of complex health issues through collaboration across multiple disciplines. In addition to accountability, the One Health governance structure fosters shared understanding, trust, and an appreciation for diverse perspectives and requirements. This article provides a comprehensive analysis of the current integration of the One Health approach within China's existing health governance framework. It also proposes strategies for further improvement, with emphasis on the level of implementation and contributions to the advancement of One Health governance through an examination of current health policies.

Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.

One Health for fascioliasis control in human endemic areas

Fasciola hepatica and F. gigantica are liver flukes causing fascioliasis, a worldwide zoonotic, complex disease. Human infection/reinfection occurs in endemic areas where preventive chemotherapy is applied, because of fasciolid transmission ensured by livestock and lymnaeid snail vectors. A One Health control action is the best complement to decrease infection risk. The multidisciplinary framework needs to focus on freshwater transmission foci and their environment, lymnaeids, mammal reservoirs, and inhabitant infection, ethnography and housing. Local epidemiological and transmission knowledge furnished by previous field and experimental research offers the baseline for control design. A One Health intervention should be adapted to the endemic area characteristics. Long-term control sustainability may be achieved by prioritizing measures according to impact depending on available funds.

Why is Success of South Korea's Covid-19 Response Fading?

South Korea demonstrated its ability to respond effectively with rapid policy measures and implementation in the early stages of the pandemic. However, at the end of second year of the pandemic, South Korea reached a peak in its number of daily new cases. Why didn't South Korea maintain the initial successful performance? To answer the question, this study examined South Korea's pandemic response process through Complex Adaptive Systems (CAS), focusing on actors' behavior according to the phase transition. We found that the South Korean government failed to interact with the rapidly evolving public due to the different evolving pace. Dissonance between the government and the public resulted in distrust, fatigue, and resistance to the government's policy among people. From the case study of South Korea, this study emphasizes that not only individual governments, but also the international community, should anticipate and interact with the rapidly evolving public to prepare for the pandemic and post-pandemic era.

How prepared is the world? Identifying weaknesses in existing assessment frameworks for global health security through a One Health approach

The COVID-19 pandemic has exposed faults in the way we assess preparedness and response capacities for public health emergencies. Existing frameworks are limited in scope, and do not sufficiently consider complex social, economic, political, regulatory, and ecological factors. One Health, through its focus on the links among humans, animals, and ecosystems, is a valuable approach through which existing assessment frameworks can be analysed and new ways forward proposed. Although in the past few years advances have been made in assessment tools such as the International Health Regulations Joint External Evaluation, a rapid and radical increase in ambition is required. To sufficiently account for the range of complex systems in which health emergencies occur, assessments should consider how problems are defined across stakeholders and the wider sociopolitical environments in which structures and institutions operate. Current frameworks do little to consider anthropogenic factors in disease emergence or address the full array of health security hazards across the social-ecological system. A complex and interdependent set of challenges threaten human, animal, and ecosystem health, and we cannot afford to overlook important contextual factors, or the determinants of these shared threats. Health security assessment frameworks should therefore ensure that the process undertaken to prioritise and build capacity adheres to core One Health principles and that interventions and outcomes are assessed in terms of added value, trade-offs, and cobenefits across human, animal, and environmental health systems.

Texas professionals are employing a one health approach to protect the United States against biosecurity threats

Texas is a geographically large state with large human and livestock populations, many farms, a long coastal region, and extreme fluctuations in weather. During the last 15 years, the state of Texas has frequently suffered disasters or catastrophes causing extensive morbidity and economic loss. These disasters often have complicated consequences requiring multi-faceted responses. Recently, an interdisciplinary network of professionals from multiple academic institutions has emerged to collaborate in protecting Texas and the USA using a One Health approach. These experts are training the next generation of scientists in biopreparedness; increasing understanding of pathogens that cause repetitive harm; developing new therapeutics and vaccines against them; and developing novel surveillance approaches so that emerging pathogens will be detected early and thwarted before they can cause disastrous human and economic losses. These academic One Health partnerships strengthen our ability to protect human and animal health against future catastrophes that may impact the diverse ecoregions of Texas and the world.

HiLi-chip: A high-throughput library construction chip for comprehensive profiling of environmental microbial communities

Investigating the contribution and associations of environmental microbes to ecological health and human well-being is in great demand with the goal of One Health proposed. To achieve the goal, there is an urgent need for accurate approaches to obtaining a large amount of high-resolution molecular information from various microbes. In this study, we developed a high-throughput library construction chip (HiLi-Chip) for profiling environmental microbial communities and evaluated its performance. The HiLi-Chip showed high conformity with the conventional Pacbio method in terms of α-diversity, community composition of abundant bacteria (>83%), as well as rare taxa (>84%) and human pathogens detection (>67%), indicating its advantages of accuracy, high-throughput, cost-efficiency, and broad practicability. It is suggested that the optimal strategy of the HiLi-Chip was a 2.4 μL PCR mixture per sample (∼2.4 ng DNA) with a 216-sample × 24-replicate format. We have successfully applied the HiLi-Chip to the Jiulongjiang River and identified 51 potential human bacterial pathogens with a total relative abundance of 0.22%. Additionally, under limited nutrients and similar upstream environments, bacteria tended to impose competitive pressures, resulting in a more connected network at the downstream river confluence (RC). Whereas narrow niche breadth of bacteria and upstream environmental heterogeneity probably promoted niche complementary and environment selection leading to fewer links at RC in the midsection of the river. Core bacteria might represent the entire bacterial community and enhance network stability through synergistic interactions with other core bacteria. Collectively, our results demonstrate that the HiLi-Chip is a robust tool for rapid comprehensive profiling of microbial communities in environmental samples and has significant implications for a profound understanding of environmental microbial interactions.

One Health risk challenges and preparedness regarding bovine tuberculosis at abattoirs in North-central Nigeria: Associated drivers and health belief

Background

Bovine tuberculosis (bTB) is a serious public health and neglected zoonotic disease responsible for 147,000 human cases and 12,500 deaths annually. This study assessed knowledge, risk perceptions, and preventive practices regarding bTB among occupationally exposed abattoir workers and drivers for transmission in slaughterhouses.

Methods

Using a pre-tested questionnaire, we surveyed a cross-section of workers in five main abattoirs in North-central Nigeria between 2018 and 2019. Data were analysed using descriptive statistics and univariable/multivariable logistic regression analyses at a 95% confidence level.

Results

All recruited respondents (n = 422: 77.7% meat processors and 22.3% meat and sanitary inspectors) participated and 10.4% had no formal education. About 44.0% and 27.0% of workers knew about bTB occurrence at the abattoirs and its transmission to humans, respectively. Less than one-third use personal protective equipment (PPE) during meat handling, only a few workers correctly practised routine handwashing, and 21.8% sterilized meat handling tools. A few participants (6.4%) had BCG vaccination against tuberculosis. Demographic characteristics (age, gender, occupation, and formal education) significantly influenced the perception and practices about bTB. A few workers perceived raw meat and milk, direct contact with infected carcasses, organs and contaminated fomites, contaminated environment through infected blood, dirty slaughtering floor, and aerosols of contaminated faeces as high-risk bTB transmission routes. Perceived drivers that influenced bTB transmission at abattoirs include unhygienic meat processing (OR = 5.4, 95%CI = 3.1–9.4, p < 0.001) and non-enforcement of abattoir standard operating systems (OR = 10.4, 95%CI = 6.0–18.5, p = 0.001).

Conclusion

The workers have low knowledge levels, perceptions, and practices toward bTB emergence. These demand the workers’ education on hygienic meat handling to mitigate the menace of the disease. Surveillance and preventive preparedness considering the identified drivers through the ’One Health’ approach are recommended.

An argument for pandemic risk management using a multidisciplinary One Health approach to governance: an Australian case study

The emergence of SARS-CoV-2 and the subsequent COVID-19 pandemic has resulted in significant global impact. However, COVID-19 is just one of several high-impact infectious diseases that emerged from wildlife and are linked to the human relationship with nature. The rate of emergence of new zoonoses (diseases of animal origin) is increasing, driven by human-induced environmental changes that threaten biodiversity on a global scale. This increase is directly linked to environmental drivers including biodiversity loss, climate change and unsustainable resource extraction. Australia is a biodiversity hotspot and is subject to sustained and significant environmental change, increasing the risk of it being a location for pandemic origin. Moreover, the global integration of markets means that consumption trends in Australia contributes to the risk of disease spill-over in our regional neighbours in Asia-Pacific, and beyond. Despite the clear causal link between anthropogenic pressures on the environment and increasing pandemic risks, Australia's response to the COVID-19 pandemic, like most of the world, has centred largely on public health strategies, with a clear focus on reactive management. Yet, the span of expertise and evidence relevant to the governance of pandemic risk management is much wider than public health and epidemiology. It involves animal/wildlife health, biosecurity, conservation sciences, social sciences, behavioural psychology, law, policy and economic analyses to name just a few.The authors are a team of multidisciplinary practitioners and researchers who have worked together to analyse, synthesise, and harmonise the links between pandemic risk management approaches and issues in different disciplines to provide a holistic overview of current practice, and conclude the need for reform in Australia. We discuss the adoption of a comprehensive and interdisciplinary 'One Health' approach to pandemic risk management in Australia. A key goal of the One Health approach is to be proactive in countering threats of emerging infectious diseases and zoonoses through a recognition of the interdependence between human, animal, and environmental health. Developing ways to implement a One Health approach to pandemic prevention would not only reduce the risk of future pandemics emerging in or entering Australia, but also provide a model for prevention strategies around the world.

Online citizen petitions related to COVID-19 in South Korean cities: a big data analysis

What do citizens demand of their governing bodies to cope with the spread of emerging infectious diseases after recognizing the growing danger? What are the similarities and differences in political participation via online citizen petitions regarding COVID-19 across cities with different degrees of pandemic experience? This study aims to answer these questions by examining citizen petitions regarding the COVID-19 pandemic in urban areas of South Korea. The pattern of citizens' requests is a part of integrative socio-ecological and political systems with spatial and temporal dimensions. We compare the pattern of online citizen petitions in four Korean cities, namely Seoul, Busan, Daegu, and Incheon, some of which were epicenters of the COVID-19 outbreak. By applying relevant big data analysis techniques such as text mining, topic modeling, and network analysis, we compare the characteristics of citizen petitions on COVID-19 in the four cities, particularly whether (and how) they want financial or welfare support or COVID-19 prevention. We find that cities that experience a rapid spread are likely to have more petitions for prevention than for support. By comparison, cities without such experience are likely to have more petitions for support. This study contributes by tracing citizen and local government interactions in response to emerging infectious diseases by empirically analyzing the related big data on petitions. Policy implications suggest that urban authorities should listen to analyze and respond to the urgent needs of citizens.

Social insights on the implementation of One Health in zoonosis prevention and control: a scoping review

BACKGROUND

The One Health (OH) concept has been promoted widely around the globe. OH framework is expected to be applied as an integrated approach to support addressing zoonotic diseases as a significant global health issue and to improve the efficiency and effectiveness of zoonosis prevention and control. This review is intended to overview the social impact of the implementation of OH on zoonosis prevention and control.

METHODS

A scoping review of studies in the past 10 years was performed to overview the integration feature of OH in zoonosis prevention and control and the social impacts of OH. PubMed and Web of Science were searched for studies published in English between January 2011 and June 2021. The included studies were selected based on predefined criteria.

RESULTS

Thirty-two studies were included in this review, and most of them adopted qualitative and semi-qualitative methods. More than 50% of the studies focused on zoonosis prevention and control. Most studies were conducted in low- and middle-income countries in Africa and Asia. Applying OH approach in diseases control integrates policymakers, stakeholders, and academics from various backgrounds. The impact of OH on economic is estimated that it may alleviate the burden of diseases and poverty in the long term, even though more financial support might be needed at the initial stage of OH implementation. OH implementation considers social and ecological factors related to zoonosis transmission and provides comprehensive strategies to assess and address related risks in different communities according to regions and customs.

CONCLUSIONS

Based on reviewed literature, although there seems to be a lack of guidelines for assessing and visualizing the outcomes of OH implementation, which may limit the large-scale adoption of it, evidence on the contributions of implementing OH concepts on zoonosis prevention and control indicates long-term benefits to society, including a better integration of politics, stakeholders and academics to improve their cooperation, a potential to address economic issues caused by zoonosis, and a comprehensive consideration on social determinants of health during zoonosis prevention and control.

Ethics and antibiotic resistance

INTRODUCTION OR BACKGROUND

Antibiotic resistance raises ethical issues due to the severe and inequitably distributed consequences caused by individual actions and policies.

SOURCES OF DATA

Synthesis of ethical, scientific and clinical literature.

AREAS OF AGREEMENT

Ethical analyses have focused on the moral responsibilities of patients to complete antibiotic courses, resistance as a tragedy of the commons and attempts to limit use through antibiotic stewardship.

AREAS OF CONTROVERSY

Each of these analyses has significant limitations and can result in self-defeating or overly narrow implications for policy.

GROWING POINTS

More complex analyses focus on ethical implications of ubiquitous asymptomatic carriage of resistant bacteria, non-linear outcomes within and between patients over time and global variation in resistant disease burdens.

AREAS TIMELY FOR DEVELOPING RESEARCH

Neglected topics include the harms of antibiotic use, including off-target effects on the human microbiome, and the lack of evidence guiding most antibiotic prescription decisions.

A review of the diversity of Cryptosporidium in Rattus norvegicus, R. rattus and Mus musculus: What we know and challenges for the future

The aim of this paper is to review the diversity of Cryptosporidium species and genotypes infecting synantropic rodents. A total of 27 papers published between 1990 and 2020 assed the presence of Cryptosporidium in these rodents worldwide and described 17 different species and genotypes of Cryptosporidium. A great variation in the prevalence values were observed (0-63%). The most frequent species/genotypes were Rat genotype I and IV for R. norvegicus and Rat genotype II and III R. rattus, while C. tyzzeri was for M. musculus. Cryptosporidium parvum, the second most common species after C. hominis involved in human cryptosporidiosis cases, was the third most detected Cryptosporidium species in R, norvergicus (9.4% of the positive samples) and the 3 rodent species are common host for C. muris, also recognized as zoonotic. Besides, these synanthopic rodents can harbor Cryptosporidium species whose natural hosts are cattle, bovids, pigs, other rodent species, birds and a broad range of mammals. Considering the diversity described so far, it would have a great epidemiological impact to know how the variation of Cryptosporidium species composition along urban-rural gradients is like, including synanthropic rodents, wild and domestic animals and environmental samples, and to analyze the causal factors of such variation.

The Power of Music to Prevent and Control Emerging Infectious Diseases

Music is a powerful approach to engage communities and disseminate information. Specifically, health campaigns employing music have been used to promote behaviors that can prevent emerging infectious diseases (EIDs). For example, hip hop artists supported campaigns to prevent acquired immunodeficiency syndrome in the 70s in the United States, while Brazilian funk promoted vaccination to mitigate the ongoing COVID-19 pandemic. Similarly, we broadcast musical messages in local languages to increase community awareness and support prevention measures in Guinea and Liberia in response to the recent Ebola outbreak in 2021. Given the potential of music to promote both individual and population-level behavioral changes to prevent transmission, there is a need to consolidate information on music-based health interventions, and on how we can measure their effectiveness. In this perspective, we provide examples of relevant initiatives, discussing challenges and solutions associated with implementing interventions based on our experience with the 2021 Ebola outbreak. We recommend four steps for a successful music-based health intervention including (1) establishing a task force, (2) compose a "catchy" song including critical preventive measures, (3) deliver the song to the target audience, and (4) evaluate the campaign effectiveness. We argue that close interactions between scientists and musicians can produce rapid musical content for disease prevention. We also identify and discuss several methodological frameworks for testing the effectiveness of such interventions. We conclude that support from public health authorities, government media departments, and international agencies, is necessary to deliver wide outreach and long-term sustainability of musical messaging toward effective EID prevention.

Evidence of bovine leukemia virus circulating in sheep and buffaloes in Colombia: insights into multispecies infection

Bovine leukemia virus (BLV) is the causative agent of leukemia/lymphoma in cattle. However, previous evidence has shown its presence in other species of livestock as well as in humans, suggesting that other species can be accidental hosts of the virus. In viral infections, receptors that are common to different animal species are proposed to be involved in cross-species infections. For BLV, AP3D1 has been proposed to be its receptor, and this protein is conserved in most mammalian species. In Colombia, BLV has been reported in cattle with high prevalence rates, but there has been no evidence of BLV infections in other animal species. In this study, we tested for the virus in sheep (n = 44) and buffaloes (n = 61) from different regions of Colombia by nested PCR, using peripheral blood samples collected from the animals. BLV was found in 25.7% of the animals tested (12 buffaloes and 15 sheep), and the results were confirmed by Sanger sequencing. In addition, to gain more information about the capacity of the virus to infect these species, the predicted interactions of AP3D1 of sheep and buffaloes with the BLV-gp51 protein were analyzed in silico. Conserved amino acids in the binding domains of the proteins were identified. The detection of BLV in sheep and buffaloes suggests circulation of the virus in multiple species, which could be involved in dissemination of the virus in mixed livestock production settings. Due to the presence of the virus in multiple species and the high prevalence rates observed, integrated prevention and control strategies in the livestock industry should be considered to decrease the spread of BLV.

Is One Health a Viable Strategy in Animal Health Litigation: Evidence from Civil Lawsuits in China

Simple Summary

Strategic litigation launched to protect animal welfare worldwide branches out with several tactical themes: environmental protection, child abuse, veterinarian malpractice, product liability and quasi-family member. Currently, the litigation strategy themed in One Health has been observed in legal practice in Chinese mainland. Using 1520 zoonosis related civil lawsuit judgments, this study aimed to assess the effectiveness of this litigation strategy in animal health cases from Chinese mainland. It has been confirmed that using the litigation strategy themed in One Health results in more successful outcomes and larger damage awards, so there might be a practical value in using this strategy in animal welfare lawsuits.

Abstract

Several litigation strategies are used to gain support from courts in order to protect animals. While the emerging litigation strategy themed in One Health stimulates judicial protection in the animal health sector, little is known about whether and how such strategies are supported by courts. In this article, we investigate how animal welfare litigation strategies influence judge’s choices within their discretion. We argue that litigators equipped with the litigation strategy themed in One Health are placed in an advantageous position in animal health cases, but that this tendency varies markedly across zoonoses. Specifically, we suggest that litigators utilizing One Health’s litigation strategy are associated with higher probabilities to win, whereas normal litigators are not. Further, we propose that litigators equipped with the One Health litigation strategy are awarded more damages from judges. We test and find support for our predictions using a cross sectional dataset of civil lawsuit cases centering on the animal health industry in Chinese mainland. Our findings indicate that courts indeed were persuaded by the One Health litigation strategy, even when bound by the discretion rules. At the same time, we suggest that for advocates who would like to litigate for animal welfare in the animal health sector, the litigation strategy themed in One Health might have potentially positive implications.

Stamping Out Animal Culling: From Anthropocentrism to One Health Ethics

Culling is used in traditional public health policies to control animal populations. These policies aim primarily to protect human interests but often fail to provide scientific evidence of effectiveness. In this article, we defend the need to move from a strictly anthropocentric approach to disease control towards a One Health ethics, using culling practices as an example. We focus on the recent badger culls in the UK, claiming that, based on data provided by the English Government, these culls may be unjustified, all thing considered. We highlight the relevance of ethical reasoning rooted in One Health for this discussion, and make several suggestions including a moratorium on culling until data are provided to support the effectiveness of culling; to conduct a randomized trial to compare proactive culling with alternative methods; to apply deliberative democratic methods to assess public opinion towards the culls, and to find in Brexit an opportunity for aiming for more effective control measures.

Operationalising the "One Health" approach in India: facilitators of and barriers to effective cross-sector convergence for zoonoses prevention and control

BACKGROUND

There is a strong policy impetus for the One Health cross-sectoral approach to address the complex challenge of zoonotic diseases, particularly in low/lower middle income countries (LMICs). Yet the implementation of this approach in LMIC contexts such as India has proven challenging, due partly to the relatively limited practical guidance and understanding on how to foster and sustain cross-sector collaborations. This study addresses this gap by exploring the facilitators of and barriers to successful convergence between the human, animal and environmental health sectors in India.

METHODS

A mixed methods study was conducted using a detailed content review of national policy documents and in-depth semi-structured interview data on zoonotic disease management in India. In total, 29 policy documents were reviewed and 15 key informant interviews were undertaken with national and state level policymakers, disease managers and experts operating within the human-animal-environment interface of zoonotic disease control.

RESULTS

Our findings suggest that there is limited policy visibility of zoonotic diseases, although global zoonoses, especially those identified to be of pandemic potential by international organisations (e.g. CDC, WHO and OIE) rather than local, high burden endemic diseases, have high recognition in the existing policy agenda setting. Despite the widespread acknowledgement of the importance of cross-sectoral collaboration, a myriad of factors operated to either constrain or facilitate the success of cross-sectoral convergence at different stages (i.e. information-sharing, undertaking common activities and merging resources and infrastructure) of cross-sectoral action. Importantly, participants identified the lack of supportive policies, conflicting departmental priorities and limited institutional capacities as major barriers that hamper effective cross-sectoral collaboration on zoonotic disease control. Building on existing informal inter-personal relationships and collaboration platforms were suggested by participants as the way forward.

CONCLUSION

Our findings point to the importance of strengthening existing national policy frameworks as a first step for leveraging cross-sectoral capacity for improved disease surveillance and interventions. This requires the contextual adaptation of the One Health approach in a manner that is sensitive to the underlying socio-political, institutional and cultural context that determines and shapes outcomes of cross-sector collaborative arrangements.

A systematic approach to public health - Novel application of the human factors analysis and classification system to public health and COVID-19

In this article, we argue for a novel adaptation of the Human Factors Analysis and Classification System (HFACS) to proactive incidence prevention in the public health and in particular, during and in response to COVID-19. HFACS is a framework of causal categories of human errors typically applied for systematic retrospective incident analysis in high-risk domains. By leveraging this approach proactively, appropriate, and targeted measures can be quickly identified and established to mitigate potential errors at different levels within the public health system (from tertiary and secondary healthcare workers to primary public health officials, regulators, and policymakers).

Increased Adherence to Infection Control Practices Among Medical Laboratory Technicians During the COVID-19 Pandemic: A Self-Reported Survey Study

Background

The adherence of medical laboratory technicians (MLT) to infection control guidelines is essential for reducing the risk of exposure to infectious agents. This study explored the adherence of MLT towards infection control practices during the COVID-19 pandemic.

Method

The study population consisted of MLT (n = 444) who worked in private and government health sectors in Jordan. A self-reported survey was used to collect data from participants.

Findings

More than 87% of the participants reported adherence to hand-washing guidelines and using personal protective equipment (PPE) when interacting with patients (74.5%), and handling clinical samples (70.0%). Besides, 88.1%, 48.2%, and 7.7% reported wearing of lab coats, face masks, and goggles, at all times, respectively. The majority reported increased adherence to infection control practices during the COVID-19 pandemic. This includes increased PPE use at the workplace (94.2%), increased frequency of disinfection of laboratory surfaces (92.4%) and laboratory equipment (86.7%), and increased frequency of handwashing/use of antiseptics (94.6%). Having a graduate degree was significantly associated with increased adherence of participants to the daily use of goggles/eye protection (p = 0.002), and the use of PPE while handling clinical samples (p = 0.011). Having work experience of >10 years was associated with increased adherence to the use of PPE while handling clinical samples (p = 0.001).

Conclusion

MLT reported very good adherence with most assessed infection control practices. In addition, they reported increased conformity with infection control guidelines during the COVID-19 pandemic.

Community-based prevention of epidemic Rocky Mountain spotted fever among minority populations in Sonora, Mexico, using a One Health approach

BACKGROUND

Rocky Mountain spotted fever (RMSF) is a significant public health problem in Sonora, Mexico, resulting in thousands of cases and hundreds of deaths. Outbreaks of RMSF are perpetuated by heavy brown dog tick infestations in and around homes. During 2009-2015, there were 61 RMSF cases and 23 deaths in a single community of Sonora (Community A).

METHODS

An integrated intervention was carried out from March-November 2016 aimed at reducing tick populations with long-acting acaricidal collars on dogs, environmental acaricides applied to peri-domestic areas and RMSF education. Tick levels were measured by inspection of community dogs to monitor efficacy of the intervention. A similar neighborhood (Community B) was selected for comparison and received standard care (acaricide treatment and education).

RESULTS

The prevalence of tick-infested dogs in Community A declined from 32.5% to 8.8% (p<0.01). No new cases of RMSF were identified in this area during the subsequent 18 mo. By comparison, the percentage of tick-infested dogs in Community B decreased from 19% to 13.4% (p=0.36) and two cases were reported, including one death.

CONCLUSIONS

Community-based interventions using an integrated approach to control brown dog ticks can diminish the morbidity and mortality attributable to RMSF.

Co-Circulation of Bovine Leukemia Virus Haplotypes among Humans, Animals, and Food Products: New Insights of Its Zoonotic Potential

Bovine leukemia virus (BLV) is the causative agent of leukemia/lymphoma in cattle. It has been found in humans and cattle-derived food products. In humans, it is described as a potential risk factor for breast cancer development. However, the transmission path remains unclear. Here, a molecular epidemiology analysis was performed to identify signatures of genetic flux of BLV among humans, animals, and food products. Sequences obtained from these sources in Colombia were used (n = 183) and compared with reference sequences available in GenBank. Phylogenetic reconstruction was performed in IQ-TREE software with the maximum likelihood algorithm. Haplotype (hap) distribution among the population was carried out with a median-joining model in Network5.0. Recombination events were inferred using SplitsTree4 software. In the phylogenetic analysis, no specific branches were identified for the Colombian sequences or for the different sources. A total of 31 haps were found, with Hap 1, 4, 5 and 7 being shared among the three sources of the study. Reticulation events among the different sources were also detected during the recombination analysis. These results show new insights about the zoonotic potential of BLV, showing evidence of genetic flux between cattle and humans. Prevention and control strategies should be considered to avoid viral dissemination as part of the One Health program policies.

Systemic factors for enhancing intersectoral collaboration for the operationalization of One Health: a case study in India

Background

One Health is a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional, national, and global levels—with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment. Operationalization of the One Health approach is still unclear for various local health systems with their respective targets. In this scenario, the empirical study of intersectoral collaboration between the human and animal health systems provides an opportunity to investigate the appropriate strategies and their enabling factors at the local health system level. Thus, this study documented and validated the innovative strategy for intersectoral collaboration, focusing on effectual prevention and control of zoonotic diseases with its enabling factors for a city in western India, Ahmedabad.

Methods

This case study was conducted in three phases: phase I (qualitative data collection, i.e., vignette interview), phase II (quantitative data collection through modified policy Delphi), and phase III (participatory workshop). The vignette data were handled for content analysis, and the Delphi data, like other quantitative data, for descriptive statistics. The participatory workshop adapts the computerized Sensitivity Model^® developed by Vester to analyse the health system dynamics.

Result

Out of the possible 36 strategies, this study validated the top 15 essential (must-have) and five preferred (should-have) strategies for the study area. For operationalization of the One Health approach, the enabling factors that were identified through the systems approach are micro-level factors at the individual level (trust, leadership, motivation, knowledge), meso-level factors at the organizational level (human resource, capacity-building, shared vision, decision-making capacity, laboratory capacity, surveillance), macro-level factors at the system level (coordinated roles, relationships, common platform), and external factors outside of the system (guidelines/policies, community participation, a specific budget, political will, smart technology).

Discussion

This study reveals that the micro-level factors at the individual level are potential levers of the health system. More attention to these factors could be beneficial for the operationalization of the One Health approach. This study recommends a systems approach through a bottom-up exploration to understand the local health system and its enabling factors, which should be accounted for in formulating future One Health policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00727-9.

Mitigating Future Respiratory Virus Pandemics: New Threats and Approaches to Consider

Despite many recent efforts to predict and control emerging infectious disease threats to humans, we failed to anticipate the zoonotic viruses which led to pandemics in 2009 and 2020. The morbidity, mortality, and economic costs of these pandemics have been staggering. We desperately need a more targeted, cost-efficient, and sustainable strategy to detect and mitigate future zoonotic respiratory virus threats. Evidence suggests that the transition from an animal virus to a human pathogen is incremental and requires a considerable number of spillover events and considerable time before a pandemic variant emerges. This evolutionary view argues for the refocusing of public health resources on novel respiratory virus surveillance at human-animal interfaces in geographical hotspots for emerging infectious diseases. Where human-animal interface surveillance is not possible, a secondary high-yield, cost-efficient strategy is to conduct novel respiratory virus surveillance among pneumonia patients in these same hotspots. When novel pathogens are discovered, they must be quickly assessed for their human risk and, if indicated, mitigation strategies initiated. In this review, we discuss the most common respiratory virus threats, current efforts at early emerging pathogen detection, and propose and defend new molecular pathogen discovery strategies with the goal of preempting future pandemics.

One Health education in Kakuma refugee camp (Kenya): From a MOOC to projects on real world challenges

Today, the world counts millions of refugees but only a fraction of them have access to higher education. Despite the multiple public health problems in refugee camps and the need to build local capacities to prevent and combat them, University level courses in public health are largely unavailable for refugees. This paper describes the development, implementation and evaluation of an innovative two-module blended-learning programme on One Health in Kakuma refugee camp (Kenya). This programme combines: (I) Interdisciplinary and multi-expert MOOC on "Global Health at the Human-Animal-Ecosystem interface"; (II) peer-to-peer learning involving students from University of Geneva Master of science in Global Health and research collaborations around specific and locally-relevant problems; (III) online mentoring and lecturing by experts from the Institute of Global Health of the University of Geneva in Kakuma. A total of 67 refugees applied to Module 1; 15 started the Module 1 in October 2017, of these 14 completed it and 6 passed the exams, finally five students started the Module 2 in October 2018 which they all passed in February 2019. Five student-led collaborative projects were developed focusing on the conception of a community-based monitoring system for prevalent diseases in the camp. With such a pedagogic approach, the programme provides an overview on Global Health challenges at the human-animal-ecosystem interface and the importance of the One Health approach, and introduces students to scientific research through interdisciplinary and international collaborations and innovation. The high number of applicants and positive feedback from students in Kakuma show the interest in One Health education in the camp. This learning experience ultimately aims at building local knowledge and capacity fostering "One Health" champions to reinforce local and national health system. This framework for One Health education could be potentially scaled up to other camps in Africa and the world.

'One Health' Actors in Multifaceted Health Systems: An Operational Case for India

The surging trend of (re)emerging diseases urges for the early detection, prevention, and control of zoonotic infections through the One Health (OH) approach. The operationalization of the OH approach depends on the contextual setting, the presence of the actors across the domains of OH, and the extent of their involvement. In the absence of national operational guidelines for OH in India, this study aims to identify potential actors with an attempt to understand the current health system network strength (during an outbreak and non-outbreak situations) at the local health system of Ahmedabad, India. This case study adopted a sequential mixed methods design conducted in two phases. First, potential actors who have been involved directly or indirectly in zoonoses prevention and control were identified through in-depth interviews. A network study was conducted as part of the second phase through a structured network questionnaire. Interest and influence matrix, average degree, network density, and degree of centralization were calculated through Atlas.Ti (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany), UCINET (Analytic Technologies, Lexington, KY, USA) software. The identified actors were categorized based on power, administrative level (either at the city or district level), and their level of action: administrative (policy planners, managers), providers (physicians, veterinarians), and community (health workers, community leaders). The matrix indicated that administrative actors from the district level were ‘context setters’ and the actors from the city level were either ‘players’ or ‘subjects’. The network density showed a strength of 0.328 during the last outbreak of H5N1, which decreased to 0.163 during the non-outbreak situation. Overall, there was low collaboration observed in this study, which ranged from communication (during non-outbreaks) to coordination (during outbreaks). The private and non-governmental actors were not integrated into collaborative activities. This study concludes that not only collaboration is needed for OH among the sectors pertaining to the human and the animal health system but also better structured (‘inter-level’) collaboration across the governance levels for effective implementation.

One health ethics: a response to pragmatism

Johnson and Degeling have recently enquired whether one health (OH) requires a comprehensive normative framework, concluding that such a framework, while not necessary, may be helpful. In this commentary, we provide a context for this debate, and describe how pragmatism has been predominant in the OH literature. We nevertheless argue that articulating a comprehensive normative theory to ground OH practice might clear existing vagueness and provide stronger guidance in relevant health dilemmas. A comprehensive theory will also be needed eventually to ground notions such as universal good. We, thus, call for the systematic articulation of a comprehensive, metaethical theory, concomitantly with already ongoing normative work.

The cycle of distrust in health policy and behavior: Lessons learned from the Negev Bedouin

BACKGROUND

Over the last decades, health systems worldwide have faced a decline in public trust. For marginalized minority populations, who generally suffer from poverty and political exclusion, the roots of this trend go much deeper, establishing a state of bi-directional distrust between them and health institutions. Although studied to a lesser extent compared to trust, distrust does impede health initiatives, such as infectious diseases prevention programs, mostly of so-called Neglected Zoonotic Diseases (NZDs). Where distrust prevails, even trust building actions such as defining rights and obligations, prioritizing "the greater good" and increasing transparency, are prone to failure. In this study, we deepen the understanding of the concept of distrust through a unique case study of Brucellosis, a prevalent bacterial zoonotic disease endemic to disadvantaged Bedouin communities in southern Israel.

METHODS

In the years 2015-2019, we qualitatively studied socio-political aspects in a governmental Brucellosis control campaign in southern Israel. We used in-depth interviews with 38 governmental and private health workers, agriculture and nature preservation workers, livestock owners and community leaders. Further, we conducted participant observation in 10 livestock pens and in policymaking meetings, and collected policy and media documents in order to triangulate the results.

RESULTS

We conceptualize three different types of distrust between authorities and marginalized communities-"intention-based distrust", "values-based distrust" and "circular distrust"-to better explain how distrust originates and reinforces itself, reproducing the endemicity of NZDs. Based on that, we portray a practical framework to reduce distrust in health policies, by reframing local discourses, reshaping disease monitoring schemes from enforcement-based to participation-based, and promoting political inclusion of disadvantaged communities.

CONCLUSIONS

The suggested analysis and framework redirect health policy objectives to not only acknowledge, contain and reduce the consequences of distrust, but also to strive for societal justice as a tool for health promotion.

Integrating Biomedical, Ecological, and Sustainability Sciences to Manage Emerging Infectious Diseases

Globalization accelerates the mobilization of microorganisms via international trade and transport. Growth in population, increasing connectivity, and rapid urbanization all exacerbate the consequent risk of pandemics of zoonotic diseases. Global problems require global solutions, particularly the co-ordination of international research in biomedical sciences, global ecology, and sustainability.

Dogs and pigs are transport hosts of Necator americanus: Molecular evidence for a zoonotic mechanism of human hookworm transmission in Ghana

Hookworm infection (Necator americanus and Ancylostoma spp) causes significant morbidity in resource-limited countries. Dog and pig ownership is associated with human infection, although the mechanism through which animals increase risk remains unknown. We first confirmed this association in Kintampo North, Ghana, using a retrospective analysis and serology, followed by a prospective molecular study of animal faeces. As a proxy of exposure to dog faeces, we analysed immunoreactivity of human serum to the zoonotic nematode Toxocara canis. Anti-Toxocara antibodies were present in 62% of samples (n = 89), and reactivity was associated with dog ownership. A subsequent prospective study revealed that 43% of dog and 56% of pig faecal samples contained hookworm eggs by microscopy. PCR analysis confirmed the presence of N. americanus DNA in 47% of samples from dogs and 56% pig samples. Nematode larvae were successfully cultured from samples collected from 36 dogs and seven pigs. These results demonstrate that dogs and pigs have a likely role in the transmission of N. americanus in endemic communities.

The state of One Health research across disciplines and sectors - a bibliometric analysis

There is a growing interest in One Health, reflected by the rising number of publications relating to One Health literature, but also through zoonotic disease outbreaks becoming more frequent, such as Ebola, Zika virus and COVID-19.

This paper uses bibliometric analysis to explore the state of One Health in academic literature, to visualise the characteristics and trends within the field through a network analysis of citation patterns and bibliographic links. The analysis focuses on publication trends, co-citation network of scientific journals, co-citation network of authors, and co-occurrence of keywords.

The bibliometric analysis showed an increasing interest for One Health in academic research. However, it revealed some thematic and disciplinary shortcomings, in particular with respect to the inclusion of environmental themes and social science insights pertaining to the implementation of One Health policies. The analysis indicated that there is a need for more applicable approaches to strengthen intersectoral collaboration and knowledge sharing. Silos between the disciplines of human medicine, veterinary medicine and environment still persist. Engaging researchers with different expertise and disciplinary backgrounds will facilitate a more comprehensive perspective where the human-animal-environment interface is not researched as separate entities but as a coherent whole. Further, journals dedicated to One Health or interdisciplinary research provide scholars the possibility to publish multifaceted research. These journals are uniquely positioned to bridge between fields, strengthen interdisciplinary research and create room for social science approaches alongside of medical and natural sciences.

Rethinking "One Health" through Brucellosis: ethics, boundaries and politics

One Health, as an international movement and as a research methodology, aspires to cross boundaries between disciplines. However, One Health has also been viewed as "reductionist" due to its overemphasize on physicians-veterinarians cooperation and surveillance capacity enhancement, while limiting the involvement with socio-political preconditioning factors that shape the impact of diseases, and the ethical questions that eventually structure interventions. The current article draws on a qualitative study of Brucellosis control in Israel, to address the benefits of broadening the One Health perspective to include ethical considerations and the socio-political aspects of health. Using in-depth-interviews, observations and document review, the article analyzes stakeholders' knowledge (policy makers, practitioners and livestock owners) to understand Brucellosis control interventions in the Negev region of Israel. The analysis highlights four different types of boundaries: geographical, professional, disciplinary and participatory. The variety of boundaries going beyond disciplinary ones, are often neglected by traditional One Health discourses, however they provide clearer understanding regarding the role of the Israel and Palestine relations; enforcement activities and trust creation; and mechanisms of decision-making and public participation, in Brucellosis interventions. A broad One Health analysis that addresses ethical concerns and socio-political environments, as well as human and veterinary medicine, encourages re-framing of causes and solutions when dealing particularly with Brucellosis in the Negev, but more generally with zoonotic diseases, low-trust settings and inequitable distribution of power. The inclusion of historical, political and bioethical considerations of Public Health in One Health creates opportunities to increase the relevance of One Health and expand its scope as a novel scientific paradigm.

Towards a comprehensive narrative and response to COVID-19 in Southeast Asia

The dominant narrative of the COVID-19 pandemic in Southeast Asia barely gives attention to the many social and cultural dimensions of the crisis, and humanities and social science experts remain at the margins of containment decisions. This short commentary highlight our potential contribution based on our disciplinary core principles and what has been learned from other epidemics, foremost HIV. It argues that we can help broaden the current epidemiological approach to understand and impact on the social drivers of vulnerability and risk for diverse populations in specific contexts, while promoting transformative change. We can achieve this through paradigmatic adjustments as well as a more daring and engaged role on our part.