Stewardship of health security: The challenges of applying the One Health approach

Abstract

Experience with the control of epidemics, notably the 2004 outbreaks of avian influenza, has demonstrated that a "One Health approach," that recognizes that human, animal, and environmental health are interdependent, is the most effective way of dealing with threats from emerging infectious diseases (EID). However, introducing and applying a One Health approach is challenging for many countries. One of the key challenges relates to stewardship.The evolution of the strategies and policies used to introduce and adopt the One Health approach in the detection and response to EID over the period 2005 to 2017 is described at global level and in country case studies of Thailand and Indonesia. Both countries experienced significant outbreaks of H5N1 avian influenza from 2004 and have sought to adopt the One Health approach in their response strategies.The challenges for stewardship of health systems in introducing a One Health approach are described, and key lessons identified in regard to national level agency coordination, engagement of the broader civil society outside government, and developing a reliable, credible, and impartial decision-making process. The concept of stewardship provides valuable insights for policymakers on how to incorporate a One Health approach into their EID response systems. /journal/pad 23 2 | METHODS Case studies were undertaken of the policies and strategies that were introduced by the Governments of Thailand and Indonesia over the period following the outbreak of H5N1, from 2004 to the present.Case studies primarily used documentary sources (strategies, plans, and regulations) produced by the respective governments, studies, and research published in the literature, the in-depth understanding of the institutional context and operation of government of the two country authors (A. S. and W. A.), and the experience of the other two authors of the regional and global institutional context (K. H. and L. G.). 24HORT ET AL.

The application of the One Health approach in the management of five major zoonotic diseases using the World Bank domains: A scoping review

“…The included articles contained 29 studies describing the One Health implementation from 15 countries ( Table 2 ). Some articles contained multiple studies, with three articles describing studies in more than one disease [ 34 , 60 , 66 ] and four articles describing it in more than one country [ 60 , [67] , [68] , [69] ]. Seven articles provided evidence of 14 (48%) One Health studies from the sub-Saharan Africa [ 34 , 60 , 66 , 68 , [70] , [71] , [72] ] followed by five articles describing six studies (21%) in the East Asia & Pacific region [ 69 , [73] , [74] , [75] , [76] ].…”

“… Malta Brucellosis Serbia Brucellosis Hermesh et al, 2019 [ 82 ] To address the benefits of expanding the One Health perspective to include ethical and the socio-political aspects of health. Israel Brucellosis Hort et al, 2019 [ 69 ] To draw lessons on values of stewardship of stakeholders against infectious diseases to enable adoption of One Health approaches. Thailand Avian Influenza Indonesia Avian Influenza Nihal et al, 2019 [ 80 ] To review surveillance data and assess need and potential of One Health approach for surveillance of rabies.…”

“…16 (45%) mentioned all the domains while none of the studies mentioned all the sub-domains. While stakeholders were mentioned in all the studies in the selected articles, technical infrastructure was described the least (18 studies, 62%) in 12 articles [ 34 , 66 , [68] , [69] , [70] , [71] , [72] , [73] , 75 , [80] , [81] , [82] ]. Evidence on application of One Health and its domains was greater in Low- and Middle-Income Countries (LMICs) with 23 (79%) studies in 15 articles from LMICs [ 34 , 60 , 66 , 68 , [70] , [71] , [72] , [74] , [75] , [76] , [78] , [79] , [80] , [81] , 83 ].…”

The role of health systems for health security: a scoping review revealing the need for improved conceptual and practical linkages

“…In several cases, the impact of having already experienced health emergencies was noted as a key driver of change underpinning countries’ preparedness [ 82 ]. Key articles in this area referred to the capacity of governments to rapidly coordinate activities, to promote the engagement of multiple stakeholders, including civil society, the private sector, and international players, as well as to learn from experience with adaptive strategies [ 83 , 84 ].…”

Role of regulatory capacity in the animal and human health systems in driving response to zoonotic disease outbreaks in the Mekong region

“…These thicker capacities resonate with the literature on zoonotic disease prevention and response, given the need for the animal and human health sectors to “collaborate, coordinate and communicate” in relation to zoonotic disease control. In a comparative case study on stewardship of zoonotic disease prevention and response in Indonesia and Thailand, Hort et al [ 22 ] find that neither country has reached the point at which decisions in the event of an outbreak are seen as “credible, legitimate, and trusted by the general public” implying similar weaknesses of thicker capacities.…”