Rethinking “One Health” through Brucellosis: ethics, boundaries and politics

Abstract

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.

Brucellosis in the Middle East: Current situation and a pathway forward

“…Rather, it is because of a lack of actual disease burden data in vulnerable, impoverished sections of low-and middle-income populations and the little political and social influence this group of people has on decision-making [44,45,65]. Therefore, to reduce disease neglect, it is necessary to circumvent disregard of brucellosis-prone communities, which can also lead to distrust of official organizations, policies, and measures [66]. Because nonspecific symptoms of brucellosis (e.g., fever in humans and abortion in livestock) may also be present following successful implementation of control measures, benefits of disease control are indiscernible.…”

“…To achieve this goal, appropriate intersectoral cooperation and multidisciplinary involvement should be realized. Along with public health and veterinary authorities, other governmental administrative bodies are required to be involved in the planning and execution of these programs, which are responsible for social welfare, rural and pastoralists' affairs, basic and higher education, environment, national and local financing, and municipalities [66]. Awareness programs should raise the visibility of disease impact to all stakeholders, including legislators, national and local responsible policy-making authorities, veterinary practitioners and workers, physicians and healthcare providers, livestock producers, dairy product processors and vendors, remote nomadic and rural smallholder farmers, and customers, who all have significant roles in disease prevention and provide overarching links between all sectors [44,65].…”

Guest Editorial

“…They focus on four kinds of boundaries: geographical, professional, disciplinary and participatory. Hermesh et al (2019) first point to the relevance of the West Bank to Brucellawhich is endemic in Israel, mainly due to illegal trade. They next challenge claims that the professional and the political can be kept separate, suggesting that this move is an attempt to erase the agency of professional stakeholders who are apolitical.…”

“…Third, the authors criticize the OH commitment for interdisciplinary collaboration as insufficient in the case of Brucella in Israel, and they call for each stakeholder group to better define their responsibility and strengthen the mechanisms and processes through which they maintain accountability. Lastly, Hermesh et al (2019) criticize a 'weak' process of participatory community engagement with mere advisory capabilities. The authors instead call for a stronger community engagement forum where decisions are actually made.…”

“…While Hermesh et al (2019) fail to address perhaps the most crucial boundary of all from a OH perspective-that separating human from non-human species-their discussion certainly enriches our understanding of the potential complexities that OH policies and interventions would have to face in order to be effective and ethically justified.…”