Make science evolve into a One Health approach to improve health and security: a white paper

Exploring Disease Management and Control through Pathogen Diagnostics and One Health Initiative: A Concise Review

The "One Health" initiative is a critical strategy that recognizes the interconnectedness between human, animal, and environmental health in the spread and containment of infectious pathogens. With the ease of global transportation, transboundary disease outbreaks pose a significant threat to food safety and security, endangering public health and having a negative economic impact. Traditional diagnostic techniques based on genotypic and phenotypic analyses are expensive, time-consuming, and cannot be translated into point-of-care tools, hindering effective disease management and control. However, with advancements in molecular methods, biosensors, and new generation sequencing, rapid and reliable diagnostics are now available. This review provides a comprehensive insight into emergent viral and bacterial pathogens and antimicrobial resistance, highlighting the importance of "One Health" in connecting detection and effective treatment. By emphasizing the symbiotic relationship between human and animal health, this paper underscores the critical role of "One Health" initiatives in preventing and controlling infectious diseases.

Severe pigeon paramyxovirus 1 infection in a human case with probable post-COVID-19 condition

Pigeon paramyxovirus 1 (PPMV-1) is an antigenic host variant of avian paramyxovirus 1. Sporadic outbreaks of PPMV-1 infection have occurred in pigeons in China; however, few cases of human PPMV-1 infection have been reported. The purpose of this article is to report a case of severe human PPMV-1 infection in an individual with probable post-COVID-19 syndrome (long COVID) who presented with rapidly progressing pulmonary infection. The patient was a 66-year-old man who was admitted to the intensive care unit 11 days after onset of pneumonia and recovered 64 days after onset. PPMV-1 was isolated from the patient's sputum and in cloacal smear samples from domesticated pigeons belonging to the patient's neighbour. Residual severe acute respiratory syndrome coronavirus 2 was detected in respiratory and anal swab samples from the patient. Sequencing analyses revealed that the PPMV-1 genome belonged to genotype VI.2.1.1.2.2 and had the 112RRQKRF117 motif in the cleavage site of the fusion protein, which is indicative of high virulence. This case of cross-species transmission of PPMV-1 from a pigeon to a human highlights the risk of severe PPMV-1 infection in immunocompromised patients, especially those with long COVID. Enhanced surveillance for increased risk of severe viral infection is warranted in this population.

Intersectoral collaboration in a One Health approach: Lessons learned from a country-level simulation exercise

Intersectoral collaboration is an essential component of the One Health (OH) approach, which recognises the interconnectedness of the health of humans, animals, and the environment. The OH European Joint Programme (OHEJP) developed a national foodborne outbreak table-top simulation exercise (SimEx) to practice OH capacity and interoperability across the public health, animal health, and food safety sectors, improving OH preparedness for future disease outbreaks. The Portuguese OHEJP SimEx highlighted strengths and weaknesses regarding the roles and functions of available systems, the constraints of existing legislation, the importance of harmonisation and data sharing, and the creation of common main messages adapted to each target sector. However, there is still a long way to go to ensure cooperation among the Public Health, Animal Health, and Food Safety sectors, as a OH approach relies not only on the awareness of "field experts" but also on political and organisational willingness and commitment.

Future directions for One Health research: Regional and sectoral gaps

Implementation of a One Health approach varies considerably between different geographical regions and remains challenging to implement without greater inclusivity of different disciplinary capacity and expertise. We performed comparative analyses of abstracts presented at the 1st World One Health Congress (WOHC 2011) and 6th WOHC (2020) to explore and describe the evolving demographics and disciplinary scope of One Health research. We classified abstracts into six One Health research categories and twenty-three subcategories. We also recorded corresponding authors' country and regional affiliation as well as study country (i.e., the country in which the research was conducted) to explore potential asymmetries between funding recipients and study subjects. The WOHC has seen a significant expansion in participation over the last 10 years. The numbers of abstracts accepted to the Congress increased threefold over the last decade (i.e., 302 abstracts in 2010, and 932 abstracts in 2020). At both Congresses, "Disease Surveillance" accounted for the largest proportion (105/302 (35%) and 335/932 (36%) in 2010 and 2020, respectively) of all abstracts accepted. However, "Environmental and Ecological Issues" (33/302 (10%) and 94/932 (11%)), and "Sustainable Food Systems" (19/302 (6%) and 44/932 (4%)) were less well-represented categories of One Health research in both 1st and 6th WOHC respectively. In contrast, "Antimicrobial Resistance" related research increased substantially over time (4/302 (1%) in 2011) and (119/932 (13%) in 2020). There were also differences in the type of research by authors based in "Very High Human Development" index countries compared to "Medium and Low Human Development. "Public Policy" dominated the former, whereas "Disease Surveillance" dominated the latter, suggesting potential regional differences regarding One Health research priorities. The results of the study highlight potential regional gaps and differences in One Health research priorities, with respect to emphasis on operational (surveillance) versus strategic (policy) One Health activities.

Serovars, Virulence and Antimicrobial Resistance Genes of Non-Typhoidal Salmonella Strains from Dairy Systems in Mexico

Salmonella isolated from dairy farms has a significant effect on animal health and productivity. Different serogroups of Salmonella affect both human and bovine cattle causing illness in both reservoirs. Dairy cows and calves can be silent Salmonella shedders, increasing the possibility of dispensing Salmonella within the farm. The aim of this study was to determine the genomic characteristics of Salmonella isolates from dairy farms and to detect the presence of virulence and antimicrobial resistance genes. A total of 377 samples were collected in a cross-sectional study from calves, periparturient cow feces, and maternity beds in 55 dairy farms from the states of Aguascalientes, Baja California, Chihuahua, Coahuila, Durango, Mexico, Guanajuato, Hidalgo, Jalisco, Queretaro, San Luis Potosi, Tlaxcala, and Zacatecas. Twenty Salmonella isolates were selected as representative strains for whole genome sequencing. The serological classification of the strains was able to assign groups to only 12 isolates, but with only 5 of those being consistent with the genomic serotyping. The most prevalent serovar was Salmonella Montevideo followed by Salmonella Meleagridis. All isolates presented the chromosomal aac(6')-Iaa gene that confers resistance to aminoglycosides. The antibiotic resistance genes qnrB19, qnrA1, sul2, aph(6)-Id, aph(3)-ld, dfrA1, tetA, tetC, flor2, sul1_15, mph(A), aadA2, blaCARB, and qacE were identified. Ten pathogenicity islands were identified, and the most prevalent plasmid was Col(pHAD28). The main source of Salmonella enterica is the maternity areas, where periparturient shedders are contaminants and perpetuate the pathogen within the dairy in manure, sand, and concrete surfaces. This study demonstrated the necessity of implementing One Health control actions to diminish the prevalence of antimicrobial resistant and virulent pathogens including Salmonella.

Contribution of the one health approach to strengthening health security in Uganda: a case study

BACKGROUND

The One Health approach is key in implementing International Health Regulations (IHR, 2005) and the Global Health Security Agenda (GHSA). Uganda is signatory to the IHR 2005 and in 2017, the country conducted a Joint External Evaluation (JEE) that guided development of the National Action Plan for Health Security (NAPHS) 2019-2023.

AIM

This study assessed the contribution of the One Health approach to strengthening health security in Uganda.

METHODS

A process evaluation between 25th September and 5th October 2020, using a mixed-methods case study. Participants were Subject Matter Experts (SMEs) from government ministries, departments, agencies and implementing partners. Focus group discussions were conducted for five technical areas (workforce development, real-time surveillance, zoonotic diseases, national laboratory systems and emergency response operations), spanning 18 indicators and 96 activities. Funding and implementation status from the NAPHS launch in August 2019 to October 2020 was assessed with a One Health lens.

RESULTS

Full funding was available for 36.5% of activities while 40.6% were partially funded and 22.9% were not funded at all. Majority (65%) of the activities were still in progress, whereas 8.6% were fully implemented and14.2% were not yet done. In workforce development, several multisectoral trainings were conducted including the frontline public health fellowship program, the One Health fellowship and residency program, advanced field epidemiology training program, in-service veterinary trainings and 21 district One Health teams' trainings. Real Time Surveillance was achieved through incorporating animal health events reporting in the electronic integrated disease surveillance and response platform. The national and ten regional veterinary laboratories were assessed for capacity to conduct zoonotic disease diagnostics, two of which were integrated into the national specimen referral and transportation network. Multisectoral planning for emergency response and the actual response to prioritized zoonotic disease outbreaks was done jointly.

CONCLUSIONS

This study demonstrates the contribution of 'One Health' implementation in strengthening Uganda's health security. Investment in the funding gaps will reinforce Uganda's health security to achieve the IHR 2005. Future studies could examine the impacts and cost-effectiveness of One Health in curbing prioritized zoonotic disease outbreaks.

One Digital Health Intervention for Monitoring Human and Animal Welfare in Smart Cities: Viewpoint and Use Case

Smart cities and digital public health are closely related. Managing digital transformation in urbanization and living spaces is challenging. It is critical to prioritize the emotional and physical health and well-being of humans and their animals in the dynamic and ever-changing environment they share. Human-animal bonds are continuous as they live together or share urban spaces and have a mutual impact on each other's health as well as the surrounding environment. In addition, sensors embedded in the Internet of Things are everywhere in smart cities. They monitor events and provide appropriate responses. In this regard, accident and emergency informatics (A&EI) offers tools to identify and manage overtime hazards and disruptive events. Such manifold focuses fit with One Digital Health (ODH), which aims to transform health ecosystems with digital technology by proposing a comprehensive framework to manage data and support health-oriented policies. We showed and discussed how, by developing the concept of ODH intervention, the ODH framework can support the comprehensive monitoring and analysis of daily life events of humans and animals in technologically integrated environments such as smart homes and smart cities. We developed an ODH intervention use case in which A&EI mechanisms run in the background. The ODH framework structures the related data collection and analysis to enhance the understanding of human, animal, and environment interactions and associated outcomes. The use case looks at the daily journey of Tracy, a healthy woman aged 27 years, and her dog Mego. Using medical Internet of Things, their activities are continuously monitored and analyzed to prevent or manage any kind of health-related abnormality. We reported and commented on an ODH intervention as an example of a real-life ODH implementation. We gave the reader examples of a "how-to" analysis of Tracy and Mego's daily life activities as part of a timely implementation of the ODH framework. For each activity, relationships to the ODH dimensions were scored, and relevant technical fields were evaluated in light of the Findable, Accessible, Interoperable, and Reusable principles. This "how-to" can be used as a template for further analyses. An ODH intervention is based on Findable, Accessible, Interoperable, and Reusable data and real-time processing for global health monitoring, emergency management, and research. The data should be collected and analyzed continuously in a spatial-temporal domain to detect changes in behavior, trends, and emergencies. The information periodically gathered should serve human, animal, and environmental health interventions by providing professionals and caregivers with inputs and "how-to's" to improve health, welfare, and risk prevention at the individual and population levels. Thus, ODH complementarily combined with A&EI is meant to enhance policies and systems and modernize emergency management.

Pseudomonadota in the oral cavity: a glimpse into the environment-human nexus

The phylum Pseudomonadota is amongst the most represented in the environment, with a comparatively lower prevalence in the human oral cavity. The ubiquity of Pseudomonadota and the fact that the oral cavity is the most likely entry portal of bacteria from external sources underlie the need to better understand its occurrence in the interface environment-humans. Yet, the relevance oral Pseudomonadota is largely underexplored in the scientific literature, a gap that this review aims at addressing by making, for the first time, an overview of the diversity and ecology of Pseudomonadota in the oral cavity. The screening of scientific literature and human microbiome databases unveiled 1328 reports of Pseudomonadota in the oral cavity. Most of these belonged to the classes Beta- and Gammaproteobacteria, mainly to the families Neisseriaceae, Campylobacteriaceae, and Pasteurelaceae. Others also regularly reported include genera such as Enterobacter, Klebsiella, Acinetobacter, Escherichia, Burkholderia, or Citrobacter, whose members have high potential to acquire virulence and antibiotic resistance genes. This review provides evidence that clinically relevant environmental Pseudomonadota may colonize humans via oral cavity. The need for further investigation about Pseudomonadota at the environment-oral cavity interface and their role as vectors potentially involved in virulence and antibiotic resistance transmission is demonstrated. KEY POINTS: • Neisseriaceae, Campylobacteriaceae, and Pasteurelaceae are part of the core oral microbiome • Enterobacteriaceae, Acinetobacter, or Burkholderia are frequent in the oral microbiome • Gut dysbiosis may be associated with colonization by ubiquitous oral Pseudomonadota.

Review of major meat-borne zoonotic bacterial pathogens

The importance of meat-borne pathogens to global disease transmission and food safety is significant for public health. These pathogens, which can cause a variety of diseases, include bacteria, viruses, fungi, and parasites. The consumption of pathogen-contaminated meat or meat products causes a variety of diseases, including gastrointestinal ailments. Humans are susceptible to several diseases caused by zoonotic bacterial pathogens transmitted through meat consumption, most of which damage the digestive system. These illnesses are widespread worldwide, with the majority of the burden borne by developing countries. Various production, processing, transportation, and food preparation stages can expose meat and meat products to bacterial infections and/or toxins. Worldwide, bacterial meat-borne diseases are caused by strains of Escherichia coli, Salmonella, Listeria monocytogenes, Shigella, Campylobacter, Brucella, Mycobacterium bovis, and toxins produced by Staphylococcus aureus, Clostridium species, and Bacillus cereus. Additionally, consuming contaminated meat or meat products with drug-resistant bacteria is a severe public health hazard. Controlling zoonotic bacterial pathogens demands intervention at the interface between humans, animals, and their environments. This review aimed to highlight the significance of meat-borne bacterial zoonotic pathogens while adhering to the One Health approach for creating efficient control measures.

The role of pharmaceutical industry in building resilient health system

Objectives

This study explores the interrelationship among the current sustainability agenda of the pharmaceutical industry, based on the United Nation sustainable development goals (SDGs), the elements of the Joint External Evaluation (JEE) tool, and the triad components of the One Health approach.

Methods

A cross-walk exercise was conducted to identify commonalities among SDGs, JEE assessment tool, and One Health approach. An in-depth study of 10 global pharmaceutical firms' corporate sustainability reports and COVID-19 response plan for 2019-2020 was also conducted.

Results

The result of the exercise showed the existence of a direct and indirect relationship among the SDGs, elements of JEE assessment tool, and One Health approach. For example, both no poverty (SDG 1) and zero hunger (SDG 2) are linked with food safety targets under the JEE and with human and animal health under the One Health approach.

Conclusion

This study adds a new dimension emphasizing the possibility of tailoring the pharmaceutical industry's activities under the sustainability agenda to strengthen global health security while remaining consistent with the One Health approach.

One Health security lessons from a year-long webinar series on international COVID-19 response

Following the principles outlined by the Global Outbreak Alert and Response Network, the Federal Bureau of Investigation's International Biosecurity and Prevention Forum, the European Commission's Joint Research Centre, and the Middlebury Institute of International Studies' James Martin Center for Nonproliferation Studies cohosted a webinar series from April 2020 to January 2021 on COVID-19 management across Africa, Europe, and North America. We provide here an overview of the webinar series and discuss how lessons learned during the COVID-19 pandemic and debated during the webinars can be used to bridge One Health with biological threat-driven health security. This report can be used to inform recommendations for future One Health security approaches to strengthen global capacity and multidisciplinary cooperation.

Enhancing global health security in Thailand: Strengths and challenges of initiating a One Health approach to avian influenza surveillance

Infectious disease surveillance systems support early warning, promote preparedness, and inform public health response. Pathogens that have human, animal, and environmental reservoirs should be monitored through systems that incorporate a One Health approach. In 2016, Thailand's federal government piloted an avian influenza (AI) surveillance system that integrates stakeholders from human, animal, and environmental sectors, at the central level and in four provinces to monitor influenza A viruses within human, waterfowl, and poultry populations. This research aims to describe and evaluate Thailand's piloted AI surveillance system to inform strategies for strengthening and building surveillance systems relevant to One Health. We assessed this surveillance system using the United States Centers for Disease Control and Prevention's (U.S. CDC) “Guidelines for Evaluating Public Health Surveillance Systems” and added three novel metrics: transparency, interoperability, and security. In-depth key informant interviews were conducted with representatives among six Thai federal agencies and departments, the One Health coordinating unit, a corporate poultry producer, and the Thai Ministry of Public Health-U.S. CDC Collaborating Unit. Thailand's AI surveillance system demonstrated strengths in acceptability, simplicity, representativeness, and flexibility, and exhibited challenges in data quality, stability, security, interoperability, and transparency. System efforts may be strengthened through increasing laboratory integration, improving pathogen detection capabilities, implementing interoperable systems, and incorporating sustainable capacity building mechanisms. This innovative piloted surveillance system provides a strategic framework that can be used to develop, integrate, and bolster One Health surveillance approaches to combat emerging global pathogen threats and enhance global health security.

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Infectious disease surveillance systems are often siloed by host, pathogen, and route of entry.

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Thailand initiated an Avian Influenza surveillance system and adopted a One Health model.

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The system is strongest in acceptability, simplicity, representativeness, and flexibility.

Operationalizing "One Health" as "One Digital Health" Through a Global Framework That Emphasizes Fair and Equitable Sharing of Benefits From the Use of Artificial Intelligence and Related Digital Technologies

The operationalization of One Health (OH) through digitalization is a means to deploy digital technologies (including Artificial Intelligence (AI), big data and related digital technologies) to better capacitate us to deal with growing climate exigency and related threats to human, animal and plant health. With reference to the concept of One Digital Health (ODH), this paper considers how digital capabilities can help to overcome ‘operational brakes’ in OH through new and deeper insights, better predictions, and more targeted or precise preventive strategies and public health countermeasures. However, the data landscape is fragmented and access to certain types of data is increasingly restrictive as individuals, communities and countries seek to assert greater control over data taken from them. This paper proposes for a dedicated global ODH framework—centered on fairness and equity—to be established to promote data-sharing across all the key knowledge domains of OH and to devise data-driven solutions to challenges in the human-animal-ecosystems interface. It first considers the data landscape in relation to: (1) Human and population health; (2) Pathogens; (3) Animal and plant health; and (4) Ecosystems and biodiversity. The complexification from the application of advance genetic sequencing technology is then considered, with focus on current debates over whether certain types of data like digital (genetic) sequencing information (DSI) should remain openly and freely accessible. The proposed ODH framework must augment the existing access and benefit sharing (ABS) framework currently prescribed under the Nagoya Protocol to the Convention on Biological Diversity (CBD) in at least three different ways. First, the ODH framework should apply to all genetic resources and data, including DSI, whether from humans or non-humans. Second, the FAIRER principles should be implemented, with focus on fair and equitable benefit-sharing. Third, the ODH framework should adopt multilateral approaches to data sharing (such as through federated data systems) and to ABS. By operationalizing OH as ODH, we are more likely to be able to protect and restore natural habitats, secure the health and well-being of all living things, and thereby realize the goals set out in the post-2020 Global Biodiversity Framework under the CBD.

Feasibility of virtual reality based training for optimising COVID-19 case handling in Uganda

BACKGROUND

Epidemics and pandemics are causing high morbidity and mortality on a still-evolving scale exemplified by the COVID-19 pandemic. Infection prevention and control (IPC) training for frontline health workers is thus essential. However, classroom or hospital ward-based training portends an infection risk due to the in-person interaction of participants. We explored the use of Virtual Reality (VR) simulations for frontline health worker training since it trains participants without exposing them to infections that would arise from in-person training. It does away with the requirement for expensive personal protective equipment (PPE) that has been in acute shortage and improves learning, retention, and recall. This represents the first attempt in deploying VR-based pedagogy in a Ugandan medical education context.

METHODS

We used animated VR-based simulations of bedside and ward-based training scenarios for frontline health workers. The training covered the donning and doffing of PPE, case management of COVID-19 infected individuals, and hand hygiene. It used VR headsets to actualize an immersive experience, via a hybrid of fully-interactive VR and 360° videos. The level of knowledge acquisition between individuals trained using this method was compared to similar cohorts previously trained in a classroom setting. That evaluation was supplemented by a qualitative assessment based on feedback from participants about their experience.

RESULTS

The effort resulted in a COVID-19 IPC curriculum adapted into VR, corresponding VR content, and a pioneer cohort of VR trained frontline health workers. The formalized comparison with classroom-trained cohorts showed relatively better outcomes by way of skills acquired, speed of learning, and rates of information retention (P-value = 4.0e-09). In the qualitative assessment, 90% of the participants rated the method as very good, 58.1% strongly agreed that the activities met the course objectives, and 97.7% strongly indicated willingness to refer the course to colleagues.

CONCLUSION

VR-based COVID-19 IPC training is feasible, effective and achieves enhanced learning while protecting participants from infections within a pandemic setting in Uganda. It is a delivery medium transferable to the contexts of other highly infectious diseases.

A Focus on Methodology: A Mixed-Methods Approach to Conduct a Comprehensive Evaluation of the Need for One Health Education for Medical and Veterinary Students in the Context of COVID-19

BACKGROUND

The collaboration of health professionals across the interface of human, animal and environmental health, as embodied by the One Health concept (OH), is increasingly recognised as crucial for tackling diseases such as Ebola and COVID-19. This study was conducted prior to the COVID-19 pandemic, but in light of the current pandemic, the outcomes of this study highlight the need for educating Medical (MD) and Veterinary (DVM) students on the principles of OH. The purpose of this study was to determine the need for Interprofessional Education (IPE) initiatives that would familiarise MD and DVM students with the principles of OH, crucial to dissolving the siloes that have historically deterred collaboration.

METHOD

We used a sequential explanatory Methods Research (MMR) approach design to evaluate the readiness of 428 students consisting of MD, DVM and dual degree Master of Public Health (MPH) students (MD/MPH, DVM/MPH) for IPE, as well as to obtain faculty perspectives across these disciplines, on the need for curricula inclusion of IPE and OH. Two methods of data collection were employed: A survey and 2 focus groups interviews.

RESULTS

The use of an MMR approach allowed us to comprehensively evaluate the need for OH education through the lenses of the students and faculty using a joint display that facilitated data integration and evaluation. Overall, the dual degree students had the greatest readiness for IPE, and MD students the lowest level of readiness for shared learning. The dual degree students had the most accurate understanding of OH competencies that consider the impacts of climate change, food security, antimicrobial resistance, health policy formation and zoonoses occurrence on human health. Themes derived from the focus group interviews revealed that faculty perceived OH education as crucial for preparing MD and DVM students for practice.

CONCLUSION

The comprehensive assessment of the student and faculty perspectives, obtained using an MMR approach, illustrated that the incorporation of OH competencies within the MD and DVM curricula are crucial for preparing students for practice in the global environment. The dual degree pathway provides insight into how OH can be successfully incorporated within the curricula of these programmes.

Mechanistic insights of hexavalent chromium remediation by halloysite-supported copper nanoclusters

Chromium (Cr) pollution is a significant environmental concern with remediation challenge. Hexavalent chromium (Cr(VI)) is more toxic than trivalent chromium (Cr(III)) due to its mutagenicity and oncogenicity. In this investigation, a multi-functional material, copper nanoclusters (CuNCs)-halloysite nanotubes (HNT) composite (CuNCs@HNT), has been synthesised in an eco-friendly manner and utilised for Cr(VI) remediation. Advanced analytical tools confirmed the seeding of ultra-fine CuNCs onto HNT surfaces. The maximum adsorption capacity of CuNCs@HNT is 79.14 ± 6.99 mg/g at pH 5 ± 0.1 with an increment at lower pHs. This performance was comparable for real surface stream water as well as other reported materials. The pseudo-second-order kinetic-, intra-particle diffusion- and Freundlich isotherm models well fit the experimental data implying that the chemisorption, multiphase diffusion and multi-molecular layer distribution occurred during adsorption. The Fourier-transform infrared and the x-ray photoelectron spectra also ensured the transformation of Cr(VI) to Cr(III) indicating the material's suitability for concurrent adsorption and reduction of Cr(VI). While coexisting cations and anions did not overwhelm this adsorption, CuNCs@HNT was regenerated and reused five successive times in adsorption-desorption cycles without significant loss of adsorption capacity and material's integrity. Therefore, this multi-functional, biocompatible, low-cost and stable CuNCs@HNT composite may have practical application for similar toxic metals remediation.

Human and Animal RNA Virus Diversity Detected by Metagenomics in Cameroonian Clams

Many recent pandemics have been recognized as zoonotic viral diseases. While their origins remain frequently unknown, environmental contamination may play an important role in emergence. Thus, being able to describe the viral diversity in environmental samples contributes to understand the key issues in zoonotic transmission. This work describes the use of a metagenomic approach to assess the diversity of eukaryotic RNA viruses in river clams and identify sequences from human or potentially zoonotic viruses. Clam samples collected over 2years were first screened for the presence of norovirus to verify human contamination. Selected samples were analyzed using metagenomics, including a capture of sequences from viral families infecting vertebrates (VirCapSeq-VERT) before Illumina NovaSeq sequencing. The bioinformatics analysis included pooling of data from triplicates, quality filtering, elimination of bacterial and host sequences, and a deduplication step before de novo assembly. After taxonomic assignment, the viral fraction represented 0.8–15% of reads with most sequences (68–87%) remaining un-assigned. Yet, several mammalian RNA viruses were identified. Contigs identified as belonging to the Astroviridae were the most abundant, with some nearly complete genomes of bastrovirus identified. Picobirnaviridae sequences were related to strains infecting bats, and few others to strains infecting humans or other hosts. Hepeviridae sequences were mostly related to strains detected in sponge samples but also strains from swine samples. For Caliciviridae and Picornaviridae, most of identified sequences were related to strains infecting bats, with few sequences close to human norovirus, picornavirus, and genogroup V hepatitis A virus. Despite a need to improve the sensitivity of our method, this study describes a large diversity of RNA virus sequences from clam samples. To describe all viral contaminants in this type of food, and being able to identify the host infected by viral sequences detected, may help to understand some zoonotic transmission events and alert health authorities of possible emergence.

A bolder One Health: expanding the moral circle to optimize health for all

One Health is a ground-breaking philosophy for improving health. It imaginatively challenges centuries-old assumptions about wellbeing and is now widely regarded as the 'best solution' for mitigating human health problems, including pandemic zoonotic diseases. One Health's success is imperative because without big changes to the status quo, great suffering and ill-health will follow. However, even in its more ambitious guises, One Health is not radical enough. For example, it has not embraced the emerging philosophical view that historical anthropocentrism is an unfounded ethical prejudice against other animals. This paper argues that One Health should be more imaginative and adventurous in its core philosophy and ultimately in its recommendations and activities. It must expand the circle of moral concern beyond a narrow focus on human interests to include nonhuman beings and the environment. On this bolder agenda, progressive ethical and practical thinking converge for the benefit of the planet and its diverse inhabitants-human and nonhuman.

Antimicrobial resistance in the protracted Syrian conflict: halting a war in the war

The Syrian conflict has damaged key infrastructure and indirectly affected almost all parts of the Middle East and Europe, with no end in sight. Exhausting conditions created by the Syrian crisis and related massive displacement promote the emergence of numerous public health problems that fuel antimicrobial resistance (AMR) development. Here, we explore the current situation of the Syrian displaced population, and AMR inside Syria and among refugees in host countries. We then suggest a roadmap of selected key interventions and strategies to address the threat of AMR in the context of the Syrian crisis. These recommendations are intended to urge health policy-makers in governments and international health organizations to optimize and push for implementing an effective policy taking into consideration the current obstacles.

Biothreat & One Health: Current scenario & way forward

There is an increased connectedness among humans, animals, and the environment and the current pandemic has taught the interlinking of the health of humans, animals and the planet. This inter-connectedness and factors like population growth, migration, urbanization, and climate change contribute significantly to the enhanced probability of emergence of previously unknown wildlife source pathogens at any place, any time, and without warning. Lurking in the background is the massive potential for the deliberate use of biological agents as weapons by State or non-State entities. Biological weapons have been used in wars since antiquity, however, newer research and techniques have led to these being real threats with a vast potential of harm to humans, animals, and crops. Over a period, it has become increasingly difficult to differentiate between deliberate and natural biothreat incidents. The response to both types is alike to safeguard lives, livestock, crops and the environment and reduce the consequent socio-economic ramifications. Biothreat may be targeted towards humans, animals, or crops, or all these concurrently. Every country including India is at risk of biothreat. The concept of one health is thus essential for responding to emerging infectious diseases or biothreats. Comprehensive surveillance for early detection, reporting and early concerted action is needed for prevention and blunting the effect of biothreats, which require close coordination and collaboration among various stakeholders within each country as well as globally.

Harnessing Clinical Trial Capacity to Mitigate Zoonotic Diseases: The Role of Expert Scientists in Ethiopia

Background: The emergence and resurgence of zoonotic diseases have continued to be a major threat to global health and the economy. Developing countries are particularly vulnerable due to agricultural expansions and domestication of animals with humans. Scientifically sound clinical trials are important to find better ways to prevent, diagnose, and treat zoonotic diseases, while there is a lack of evidence to inform the clinical trials' capacity and practice in countries highly affected with the diseases. This study aimed to investigate expert scientists' perceptions and experiences in conducting clinical trials toward zoonotic diseases in Ethiopia.

Methods: This study employed a descriptive, qualitative study design. It included major academic and research institutions in Ethiopia that had active engagements in veterinary and public health researches. It included the National Veterinary Institute, the National Animal Health Diagnostic and Investigation Center, the College of Veterinary Medicine at Addis Ababa University, the Ethiopian Public Health Institute, the Armauer Hansen Research Institute, and the College of Health Sciences at Addis Ababa University. In-depth interviews were conducted with expert scientists. Data were collected from October 2019 to April 2020. Data analysis was undertaken using open code 4.03 for qualitative data analysis.

Results: Five major themes, with 18 sub-themes, emerged from the in-depth interviews. These were: challenges in the prevention, control, and treatment of zoonotic diseases; One Health approach to mitigate zoonotic diseases; personal and institutional experiences in conducting clinical trials on zoonotic diseases; barriers in conducting clinical trials toward zoonotic diseases; and strategies that promote conducting clinical trials on zoonotic diseases. Conducting clinical trials on zoonotic diseases in Ethiopia is hampered by a lack of clearly articulated ethics and regulatory frameworks, trial experts, financial resources, and good governance.

Conclusion: In Ethiopia, conducting clinical trials on zoonotic diseases deserves due attention. Strengthening institutional and human resources capacity is a pre-condition to harness effective implementation of clinical trials on zoonotic diseases in the country. In Ethiopia where skilled human resource is scarce, One Health approach has the potential to form multidisciplinary teams to systematically improve clinical trials capacity and outcomes in the country.

One Digital Health: A Unified Framework for Future Health Ecosystems

One Digital Health is a proposed unified structure. The conceptual framework of the One Digital Health Steering Wheel is built around two keys (ie, One Health and digital health), three perspectives (ie, individual health and well-being, population and society, and ecosystem), and five dimensions (ie, citizens’ engagement, education, environment, human and veterinary health care, and Healthcare Industry 4.0). One Digital Health aims to digitally transform future health ecosystems, by implementing a systemic health and life sciences approach that takes into account broad digital technology perspectives on human health, animal health, and the management of the surrounding environment. This approach allows for the examination of how future generations of health informaticians can address the intrinsic complexity of novel health and care scenarios in digitally transformed health ecosystems. In the emerging hybrid landscape, citizens and their health data have been called to play a central role in the management of individual-level and population-level perspective data. The main challenges of One Digital Health include facilitating and improving interactions between One Health and digital health communities, to allow for efficient interactions and the delivery of near–real-time, data-driven contributions in systems medicine and systems ecology. However, digital health literacy; the capacity to understand and engage in health prevention activities; self-management; and collaboration in the prevention, control, and alleviation of potential problems are necessary in systemic, ecosystem-driven public health and data science research. Therefore, people in a healthy One Digital Health ecosystem must use an active and forceful approach to prevent and manage health crises and disasters, such as the COVID-19 pandemic.

What role for One Health in the COVID-19 pandemic?

This commentary discusses the contributions that One Health (OH) principles can make in improving the global response to the COVID-19 pandemic. We highlight four areas where the application of OH has the potential to significantly improve the governance of infectious diseases in general, and of COVID-19 in particular. First, more integrated surveillance infrastructure and monitoring of the occurrence of infectious diseases in both humans and animals can facilitate the detection of new infectious agents sharing similar genotypes across species and the monitoring of the spatio-temporal spread of such infections. This knowledge can guide public and animal health officials in their response measures. Second, application of the OH approach can improve coordination and active collaboration among stakeholders representing apparently incompatible domains. Third, the OH approach highlights the need for an effective institutional landscape, facilitating adequate regulation of hotspots for transmission of infectious agents among animals and humans, such as live animal markets. And finally, OH thinking emphasizes the need for equitable solutions to infectious disease challenges, suggesting that policy response mechanisms and interventions need to be reflective of the disproportionate disease burdens borne by vulnerable and marginalized populations, or by persons providing health care and other essential services to those sick.

The Fox and the Crow. A need to update pest control strategies

The recent discovery that cats and mustelids can be infected by SARS-CoV-2 may raise the question of monitoring domestic, feral and wild populations of such animals, as an adjunct to the elimination of COVID-19 in humans. Emergency solutions might consider large scale control of these animals in the wild. However, looking at science recently published on native vertebrate pest control reveals first that usual controls do not succeed in reducing animal numbers and associated damages, second that controlling can be counter-productive in increasing the infectious risks for humans and livestock. The examples of red fox and corvids are detailed in a European context, illustrating the urgent need for an ethical evaluation of ecological and economic costs and benefits of pest control strategies. A complete scientific evaluation process must be implemented and up-dated regularly, to be organized in four major steps, once the aim of the control strategy has been defined: (1) evaluating damages/risks caused by the animals, to be balanced with the ecosystem services they may provide, also in terms of economic costs; (2) unravelling spatial and temporal population dynamics of target animals to identify, if any, optimal control scenarios - which could be done within an adaptive management framework; (3) estimating the economic costs of implementing those optimal control scenarios, to be compared to the economic costs of damages/diseases; (4) finally evaluating how the control strategy reached its aims. A modern fable of the Fox and the Crow should deliver a timely moral for an ethical, ecological and economical appraisal of pest control strategies in Europe.

Are Animals a Neglected Transmission Route of SARS-CoV-2?

Little information on the SARS-CoV-2 virus in animals is available to date. Whereas no one husbandry animal case has been reported to date, which would have significant implications in food safety, companion animals play a role in COVID-19 epidemiology that opens up new questions. There is evidence that SARS-CoV-2 can infect felines, dogs and minks, and there is evidence of human-to-animal infection. Likewise, the S protein nucleotide sequence of the SARS-CoV-2 virus isolated in domestic animals and humans is identical, and the replication of the SARS-CoV-2 in cats is efficient. Besides, the epidemiological evidence for this current pandemic indicates that the spillover to humans was associated with close contact between man and exotic animals, very probably in Chinese wet markets, thus there is a growing general consensus that the exotic animal markets, should be strictly regulated. The examination of these findings and the particular role of animals in COVID-19 should be carefully analyzed in order to establish preparation and containment measures. Animal management and epidemiological surveillance must be also considered for COVID-19 control, and it can open up new questions regarding COVID-19 epidemiology and the role that animals play in it.