One Health Approach for Global Wellness

One Health is a holistic approach that aims to harmonise and optimise the health of humans, animals, and ecosystems.The holistic approach, endorsed by international organisations such as the World Health Organization (WHO), the World Organization for Animal Health (OIE), and the Food and Agriculture Organization (FAO) of the United Nations, emphasises collaborative efforts across human-animal-plant-environment interactions to promote the welfare of the entire ecosystem.

Evolution of One Health

1. Historical Integration: Before the 19th century, animal and human medicine were closely intertwined, with research conducted across both fields without clear boundaries.

2. Revival and Advocacy: In the 19th century, Sir William Osler promoted the concept of "One Medicine," emphasising the integration of animal and human medicine, which was later revived by Dr. Calvin Schwabe in veterinary public health.

3. Divergence and Concept Expansion: With the specialisation of medicine in the 20th century, human and veterinary medicine diverged. However, the concept of One Health later emerged, emphasising interdisciplinary collaboration between human and veterinary medicine, which further expanded to include environmental health.

4. Modern Initiatives: Initiatives such as the Pilanesberg Resolution in 2001, which urged consideration of wildlife health impacts in development projects, and the introduction of "One World-One Health" in 2007 by the Wildlife Conservation Society, marked significant milestones in promoting a holistic approach to preventing epidemic disease and maintaining ecosystem integrity.

Timeline of One Health in India

• Creation: In July 2022, the Prime Minister’s Science, Technology, and Innovation Advisory Council (PM-STIAC) endorsed the creation of the National One Health Mission

• Collaboration: Since then, 13 Ministries and Departments, along with science funding agencies like the Department of Science and Technology, the Department of Biotechnology (DBT), the Council of Scientific and Industrial Research (CSIR), the Department of Pharmaceuticals, and AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy), as well as the Ministries of Health, Animal Husbandry, Environment, and Defence collaborated to shape the mission, adopting one of the most comprehensive approaches to one health and pandemic preparedness globally.

• Central Hub: National Institute for One Health in Nagpur would serve as the central hub for coordinating both national and international efforts in the field and was started in 2022.

 Importance

• Goals: The 'National One Health Mission' aims to develop strategies for integrated disease surveillance, joint outbreak response, coordinated R&D, and seamless information sharing to control both routine and pandemic diseases more effectively.

• Agriculture and One Health: Countries like India, with significant agricultural systems, have a heightened interest in robust One Health systems due to the close proximity of animals and humans. This necessitates rigorous health surveillance to include domestic animals, livestock, and poultry.

• Tackling Animal Diseases: Diseases like foot and mouth disease, lumpy skin disease, and canine distemper not only affect animal productivity, trade, and conservation efforts but also underscore the importance of One Health initiatives.

• Better management:Detecting diseases early in animals can prevent their transmission to humans and the introduction of pathogens into the food chain, underscoring the need for coordinated readiness against threats like avian influenza, Nipah, and other potential pandemics.

• Wide Scope: The concept of 'One Health' encompasses more than just diseases; it includes broader aspects like antimicrobial resistance, food safety, plant diseases, and the influence of climate change on all these factors.

• Increasing zoonotic diseases: About 60 per cent of known infectious diseases in humans and 75 per cent of all emerging infectious diseases are zoonotic (United Nations Environment Programme (UNEP) and the International Livestock Research Institute (ILRI) study).

Recent initiatives and examples

•  National one Health Program for Prevention & Control of Zoonoses

It aims to prevent zoonotic threats, aiming to protect communities and minimise losses by enhancing inter-sectoral coordination. This involves utilising existing surveillance systems, engaging veterinary and wildlife institutes, conducting capacity building programs, and exploring networking and mapping of laboratory resources alongside information and communication efforts.

• National Rabies Control Programme (NRCP) 

India launched its new National Action Plan for Dog-Mediated Rabies Elimination (NAPRE) by 2030 on World Rabies Day, 2021. Endemic for rabies, India accounts for roughly 36% of global human rabies deaths transmitted by dogs.

• Programme for Prevention and Control of snakebite envenoming

The Union Health Ministry introduced the National Action Plan for Prevention and Control of Snakebite Envenoming (NAP-SE) with the goal of halving snakebite-related deaths by 2030 through a 'One Health' approach. India sees an estimated 3-4 million snake bites annually, causing about 50,000 deaths, accounting for half of all global snakebite fatalities.

• One Health Initiatives by States

Kerala: Establishment of a multi-disciplinary Central team by the National Centre for Disease Control to control the Nipah virus outbreak comprising experts in Zoonosis, Epidemiology, Respiratory and Emergency Medicine, and Animal Husbandry for thorough investigation.

Odisha: Successful implementation of the One Health intervention model aimed at eliminating human anthrax from the tribal district of Koraput.

Tamil Nadu: Development of a cost-effective data-driven rabies transmission model to combat rabies challenges effectively.

Challenges

• Silo mentality: The 'silo mentality' means working independently within one's own specific field such as epidemiology, veterinary medicine, public health or ecology, without collaboration across human, animal, and environmental health sectors. This hampers communication, coordination, and resource sharing, undermining the holistic approach central to One Health.

• Antimicrobial resistance (AMR): In India, high antibiotic use leads to challenges like increasing resistance among animals and insects, spreading through the ecosystem. Misuse, low awareness, and residue buildup of antibiotics hinder One Health efforts.

• Unavailability of proper records: The absence of proper records, such as prescriptions and hospital records, with medical professionals and institutions, hampers effective disease management and surveillance efforts. Rural areas of India are affected the most where healthcare infrastructure is limited.

• Lack of Knowledge: In developing countries like India, a significant weakness lies in the lack of awareness about zoonotic diseases among animal handlers and the general public.This hinders effective disease prevention and control efforts.

• Lack of Trust: Mistrust among different sectors hampers collaboration and communication. Blame and tensions, like veterinarians feeling unfairly accused of antimicrobial resistance, strain relationships with other sectors. This distrust can hinder efforts to address important health issues effectively.

• Limited Funding:Collaboration between sectors, particularly in environmental and agricultural fields, is hindered due to financial constraints.

• Lack of training programs: Limited training programs for health workers and insufficient long-term education on One Health hinders capacity building in India, hampering effective zoonotic disease management.

• Rural-Urban Divide: Disparities in healthcare access between rural and urban regions impede the effective implementation of One Health.Limited access to healthcare facilities and shortages of trained personnel in rural regions can delay disease diagnosis and response efforts.

• Environmental Factors: As urbanisation expands, wildlife habitats shrink, heightening the risk of diseases jumping from animals to humans. Environmental degradation, pollution, and climate change further disrupt disease transmission patterns, complicating control measures.

Way forward

•  Prioritising Wildlife and Veterinary public health (VPH):In India, where people live close to forests, their livelihoods are intertwined with the ecosystem, posing public health risks, including those associated with revered animals like cows and infection risks from primates like monkeys. Implementing Veterinary Public Health measures can mitigate disease transmission from animals to humans, safeguarding public health.

• Focus on research: Pandemic preparedness requires a strong focus on Research and Development (R&D) to develop vital tools like vaccines, therapeutics, and diagnostics, essential for India and global readiness against emerging diseases.

• Stakeholder collaboration: Coordinated efforts of government departments, academic centres, and the private sector are important as they are all critical stakeholders in achieving this goal.

• Better resource utilisation : Utilisation of expensive infrastructure and improved cross-sector linking will enhance the ability to tackle diseases like Nipah, which involve bats, pigs, and humans.

• Comprehensive monitoring: Disease surveillance has to go beyond humans and encompass preventive health and hygiene in livestock and poultry, improved standards of animal husbandry for greater food safety, and effective communication protocols between animal and public health systems.

• Integrating AI: India should aim to enhance its epidemiology and data analytic capabilities by leveraging artificial intelligence (AI), machine learning, and disease modelling under the mission, while also coordinating capacity building in epidemiology across sectors.

• Expansion of new methods: Emerging approaches like genomic surveillance from wastewater, effective during COVID-19, will extend to sites where animals gather, broadening disease surveillance across human, livestock, and environmental sectors.