One world, one health

With recent worldwide disease outbreaks including Ebola, SARS, Avian Flu, Swine Flu, and BSE all potentially having multi-species involvement, it is becoming increasingly urgent that governments and global health organisations adopt a ‘One Health’ approach says Professor Stuart Reid

One Health is the principle which recognises that greater cooperation is needed between human medicine, veterinary medicine and environmental and social sciences in the fight against today’s major diseases. The movement has a One Health Day as part of an international campaign to raise global awareness of the need for greater inter-disciplinary collaboration.

Given the huge public concern about diseases that can transfer from animals to humans, and vice versa, One Health has become a major thread of inquiry at the Royal Veterinary College (RVC). Many of our research programmes are aimed at improving health outcomes for both humans and animals. With the recent growth in antimicrobial resistance making bacterial diseases increasingly difficult to treat, the need for a One Health approach has become even more important.

One of the other strands of research at the RVC is an investigation focusing on the persistence of avian influenza in Vietnam

We work with fellow researchers and academics in some of the great medical teaching institutions around the world: Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine (LSHTM), and I recently joined forces to promote a more collaborative approach to zoonotic diseases and antimicrobial resistance. One of the other strands of research at the RVC is an investigation focusing on the persistence of avian influenza in Vietnam. The associated virus was first introduced to Vietnam in 2003 and has since circulated in poultry throughout the country, becoming a public health and food security issue. It is thought that using free-grazing ducks to help farm the land, a long-standing farming tradition in South East Asia, has helped spread the virus as the birds are transported from rice paddy to rice paddy.

The RVC’s research team have taken steps to raise awareness of how the use of free-grazing ducks as a farming method can spread the virus

We have learned that the free-grazing ducks, which can carry the virus, are also exported for consumption to other neighbouring countries through informal trade and thereby bypass the influenza surveillance systems.  The RVC’s research team have taken steps to raise awareness of how the use of free-grazing ducks as a farming method can spread the virus. The strategy hinges on the belief that greater awareness of the problem will trigger improvements in animal hygiene, transport and quarantine, leading to better animal and human health, and sustainable animal production so this traditional production system can continue to be used without spreading avian influenza virus throughout the country and even to neighbouring ones.

One of the great pleasures of being Principal of the RVC is that I have been privileged to witness at close-quarters ground-breaking research being undertaken to address some of major threats to human and animal health. As part of One Health Day in November last year the RVC organised several events and activities at our campuses in Hawkshead, Hertfordshire and in Camden, London. These focused on raising awareness, seeking a common understanding about the One Health approach, and disseminating One Health work conducted at the RVC among staff, students and visitors.

Our PhD students are engaged in a staggeringly wide range of projects including looking at issues around avian influenza in Bangladesh and Pakistan and public health policies connected with dairy production in Senegal and Togo and in Indian Punjab. Outcomes of the research, case studies and interviews are being shared online and promoted through social media to engage the wider public.

One of my colleagues, Professor Jonathan Elliott, Vice Principal for Research and Innovation comments: “Interdisciplinary research – where research is undertaken at the interfaces between different disciplines – is now recognised as giving rise to some of the biggest advances in science today. The RVC’s membership of the London International Development Centre, where academics from five different University of London Colleges work together on projects to address the Sustainable Development Goals, shows our commitment to this approach. Post-graduate research students are the scientists of the future so it is right that we educate them how to work across disciplines.”

When we consider the impact of zoonotic infectious diseases like Ebola, influenza, HIV and Zika from a One Health perspective we must consider driving forces like international travel and trade, agricultural practices, climate changes, demographic pressure and environmental pollution. The public are understandably alarmed by disease outbreaks but also play a part in the factors that cause them. It is vital that policymakers understand the interplay of the many factors involved in disease out breaks… and their control.

Delivery of a One Health comes at a financial cost and that requires commitment and a substantial investment of resources

Conversely, as well as understanding the science of public and animal health problems, researchers need to understand the social and policy context if measures are to be implemented effectively. To put it simply, we have to have the drugs and we have to have the vaccines available before we can make any sort of meaningful intervention. We then also need to have the social aspects mapped out and the ability to change people’s behaviour. But linking the technical and social aspects of public health will only get us so far. There is also a need to engage at the institutional level and secure government buy-in to the approach – although by “buy-in” I really mean “pay-out”. Delivery of a One Health comes at a financial cost and that requires commitment and a substantial investment of resources.

Rabies is one example of a disease that is crying out for One Health solution. We have the technical solutions but we haven’t yet got the social level solutions sorted. Most significantly we haven’t cracked the challenges faced at the institutional level. Similar issues arise in the area of antimicrobial resistance. It has been estimated that at least 700,000 people a year die from drug-resistant infections and UN Secretary General Ban Ki-moon recently said that anti-microbial resistance is a fundamental threat to global health. Ultimately the problem of antimicrobial resistance is an ecosystem problem. We understand aspects of antimicrobial resistance in humans, particularly in a hospital environment, and we understand to an extent resistance in animal populations. What we don’t yet understand is how it works in the ecosystem as a whole. Without that full picture, the solutions are unlikely to emerge.

To my mind, there can be no greater argument for the need of a One Health approach.

The RVC, in collaboration with London School of Hygiene and Tropical Medicine, delivers a unique One Health (Infectious Diseases) postgraduate programme, leading to Diploma and MSc qualifications. The programme offers a comprehensive foundation on the principles of diseases in the context of socio-ecological systems, global health and food safety.

Author: Professor Stuart W.J. Reid is Principal of the Royal Veterinary College. His research interests are in the application of quantitative epidemiological techniques to diseases of both animals and humans.