|Year : 2021 | Volume
| Issue : 2 | Page : 93-95
One health paradigm: Challenges and opportunities for mitigating vulnerabilities associated with health of living beings
Arun Kumar Sharma
Associate Editor, IJPH; Director, ICMR-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, India
|Date of Submission||18-Mar-2021|
|Date of Decision||21-Mar-2021|
|Date of Acceptance||28-Mar-2021|
|Date of Web Publication||14-Jun-2021|
Arun Kumar Sharma
Associate Editor, IJPH; Director, ICMR-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma AK. One health paradigm: Challenges and opportunities for mitigating vulnerabilities associated with health of living beings. Indian J Public Health 2021;65:93-5
|How to cite this URL:|
Sharma AK. One health paradigm: Challenges and opportunities for mitigating vulnerabilities associated with health of living beings. Indian J Public Health [serial online] 2021 [cited 2021 Sep 20];65:93-5. Available from: https://www.ijph.in/text.asp?2021/65/2/93/318364
Human settlements are ever-expanding and encroaching on the habitation of the other living beings, plants, and animals alike. The consumption of dairy and poultry products is substantial among humans all over the world, as a result, the poultry and meat processing industries are profitable sources of revenue as well as employment for a large number of people. Forests have always been invaded by humans for their own gains. This frequent interaction, on one hand, has been beneficial for the human race but on the other side it has also become a ground for the exchange of pathogens among the three worlds, that is human, animal, and plant. That animals can cause diseases among humans, is known since long time, as the Sushrut Samhita provides evidence of shared diseases among domestic and wild carnivores. Surprisingly, the diseases of the three living species domains have mostly been seen in a compartmentalized manner. We know these as veterinary sciences, plant biology, and of course the human medical sciences.
According to Jones et al., between 1940 and 2004, there has been emergence of 335 infectious diseases. More than 54% of these pathogens are bacterial or rickettsial contrary to popular belief that most of the Emerging Infectious Disease (EID) events are viral. It is further reported that 60.3% of EID events are caused by zoonotic pathogens and 71.8% of these zoonotic EID events were caused by pathogens of wildlife origin. The dominant ones among these are Nipah virus, severe acute respiratory syndrome (SARS) coronavirus, and Middle East Respiratory Syndrome (MERS) corona virus.
Between 1957 and 2014, Singh et al. have listed 62 published articles about outbreaks of wildlife-related zoonotic diseases in India including 11 viral, nine bacterial, 19 parasitic, and one fungal species and spread over 19 states. India's 275 million population is lives in 173,000 villages located in and around forests. During 2017, Integrated Disease Surveillance Program reported outbreak of 1683 diseases of viral origin that had epidemic and pandemic potential. However, the reported outbreaks represent only a fraction of total outbreaks as subclinical, sporadic, and nonidentified outbreaks were missed by the surveillance systems. A substantial fraction of these outbreaks are arthropod borne and a significant number belong to the category of zoonoses.
The piecemeal approach to addressing the zoonotic diseases of the humans and that of the animal population separately had created a knowledge gap; it is compounded by poor access of data of one domain by the scientists in other domain. Fortunately, this challenge has been recognized by the academicians and the scientists globally and as a result, the concept of one health is gaining ground and the scientists' communities are doing their best, through advocacy, to create a suitable political environment for adoption and implementation of one health with the aim of saving lives of all kinds from the harmful effect of the microbial predators present in and around us. The interaction between humans, animals, and plants is governed by the climate, natural geography, and the manmade environment. This intricate relationship and the need for tackling its hazardous effects on the mutually dependent health of all gave rise to the concept of one health.
The COVID-19 pandemic that began in December 2019, by its sheer magnitude, global spread, and devastating effect on the world economy has underlined the significance of putting one health on the center stage. Arguably, no disease since the Spanish Flu of 1918 has caused such devastating effects on the global equilibrium. Although the initial spreading mechanism remains unclear, it was believed the SARS-CoV2 virus was a zoonotic transmission through the Huanan seafood market that also traded live wild animals. As collateral, lack of access to disease-related data in various parts of the world either due to political reasons or due to lack of maintaining databases or simply because of nonexistence of data collection/capture mechanisms being in place also came into limelight. This sends clear signals of need for course correction, not only to bring under control the raging pandemic and but also to safeguard against vulnerabilities in future. The interaction between humans, animals, and plants will continue to rise, due to the pressure of population explosion in the third world. The poultry, animal husbandry industries will continue to grow due to ever-rising consumer base. Continued deforestation will be inevitable in order to provide accommodation to the rising population and thus the space for wild animals will continue to shrink and they will encroach human habitations, thereby increasing the risk of zoonoses as well as reverse zoonoses.
Reverse zoonosis has also gained significance after various researchers reported the transmission of SARS-CoV2 from humans to animals. Several cases of dogs, cats, and zoo animals have tested positive for SARS-CoV-2, mostly as a result of close contact with infected humans.,, Thus, the literature is replete with evidence of the close and complex interaction among the four paradigms, namely, animals, plants, humans, and their commonly shared environment. The most logical way to look at it is to consider it as an integrated, unified unit and therefore aptly named as One Health. However, we need to move beyond the conceptualization of the term and make it an operational entity. To do that, we need to bring them on one platform to understand each others strengths, weaknesses, available resources, opportunities, and threats. Once understood, we should use the strengths and resources, eliminate weaknesses; utilize the opportunities and tackle the threats.
One health, by bringing all stakeholders together will become a strong resource pool of knowledge and skillsets. If the veterinary scientists, clinicians, public health researchers, and environmental engineers had access to each others' data and had got on to investigate together, precious time would have been saved in understanding the epidemiology of COVID-19 and probably interventions could have been placed all over the world in time, thereby reducing the morbidity and mortality burden on humanity. If the knowledge that was generated from studies on SARS-CoV and MERS-CoV outbreaks, had been utilized in putting Standard Operating Procedures (SOPs) in place in wet markets, in handling of animals in poultry and meat processing units, the frequent jumping of species by microorganisms could have been monitored, immediate alerts would have been sounded and responses generated faster and damage control would have been more successful.
Hence, at this stage, we need to develop systems that will allow access to data generated in every domain for others to look into. Studies on etiopathogenesis of diseases rarely consider contribution of environmental risk factors in as much details as it does about other risk factors. To illustrate, let us take example of Chronic Obstructive Pulmonary Diseases (COPD). Tobacco smoking was considered as the single most important risk factor for COPD. However later on, a sizeable number of patients were found to be nonsmokers, so biomass fuel burning also became an established risk factor. Third, evidence is gradually emerging about the role of PM2.5 in COPD. However, the limitation is about not having enough exposure assessment studies in developing countries to give a quantitative measurement of risk attribution of PM2.5. The studies conducted in the USA and European countries are not good enough predictive models for developing countries because the concentrations of PM2.5 are different in two regions by a multiplier of five or more. Thus, the weakness lies in the lack of data and lack of enough research studies in this field.
Coming to the question of zoonotic diseases, risk is very high in the poultry farming and meat processing units. The other vulnerable group is those coming in contact with wild animals in forests and at the rural/forest interface where wild animals invade human settlements. Here, the biggest weaknesses are lack of awareness about zoonotic diseases among animal handlers. In a study conducted in Delhi, 109 instances of illness of the animal in one year but the only diagnosed condition was foot and mouth disease in nine cases. Moreover, the dairy workers had very little knowledge about cause of death of most of the cattle. No prescriptions or hospital records were available. There was hardly any practice of obtaining services of veterinary doctors in case of sickness of animals. In all, 248 episodes of illness were reported among the animal handlers in the past 1 year, out of that only in 22 (8.8%) instances the patient was taken to a hospital or consulted a physician. A hospital discharge slip or a prescription with the diagnosis was available only in eight cases. Thus, pointing to abysmally low awareness about need for treatment and significance of recording and reporting of diagnosis (unpublished data). Chinchwadkar and Panda also had similar observations to report. Among sixty livestock handler females, 75% had very little knowledge of zoonotic diseases.
The other challenge that we are facing is the rapid emergence of antimicrobial resistance (AMR) in both animals and humans. AMR is a collective term referring to the capacity of microorganisms (often pathogenic) to develop physical or biochemical mechanisms and processes that render antimicrobial agents ineffective, including antibiotics. It is estimated that globally 7 lakh deaths occur each year due to AMR bacterial infections. Gwenzi et al. in their review article concluded that insects and rodents acquire AMR through foraging of prey harboring AMR, which in turn proliferate and persist in various compartments of insects, rodents, and pets, including the skin and gut systems. The widespread use of antimicrobial treatments in veterinary medicines and pet foods also induces AMR microorganisms found in pets. Thus, several household insects (e.g., houseflies and cockroaches) and edible ones (e.g., crickets and grasshoppers), rodents (rats and mice), and pets (dogs and cats), harbor and act as reservoirs of AMR.
The above illustrative example points toward lack of awareness and practice of maintaining any records of illnesses among farm animals and animal handlers. This glaring deficiency in recording and reporting is a big challenge for the one health paradigm. Thus, at the face of it, we are staring at a mammoth task of building the One Health paradigm.
The links between animal, human, agriculture, and environmental health are increasingly being recognized. Enormous economic losses due to zoonotic diseases are making the world sit up and consider one health seriously. The five pandemics in the past 20 years have caused a cumulative economic loss of USD 3623.5 billion, to which 96% contribution came from the SARS-CoV2 pandemic in 2020 alone.
Outbreak of zoonotic diseases such as Ebola, Nipah, avian influenza, pandemic influenza (H1N1), and the most recent SARS-CoV-2 have forced the policymakers, planner, politicians, and funding agencies to invest in innovations to tackle outbreaks and pandemics, the scope of it is widening and risk of such pandemics in future is realistically high. As we go on creating persistent socioecological enabling drivers such as loss of biodiversity, climate change, land-use change, and degradation of nature, we will have to be prepared for implementing the one health approach as the only solution. Further nine of the UN Sustainable Development Goals have direct linkage with one health.
There is ample opportunity for implementing one health in India by improving capacity for public health actions, understanding and responding to drivers that threaten health, and by instituting optimum coordination and collaboration between all stakeholders. The primary focus of such collaboration should be on multidisciplinary and multiinstitutional approaches at all levels, namely, planning, policymaking, laboratory-based research as well as community-based research, The ultimate goal of this entire exercise should be to improve prevention, early detection, prompt treatment, and rapid recovery of affected living beings irrespective of the species involved.
The systematic approach to implementation has been well outlined in the document published by FAO of the UN. It includes political commitment, policy formulation, sustainable funding, program development, and implementation, knowledge sharing, institutional collaboration, capacity enhancement, engagement of civil society and active participation of the communities, and awareness raising. Since one health is an approach, it should be introduced at an opportune moment. It could be to tackle AMR, as a response to a pandemic and/or a large-scale outbreak of a zoonotic disease or through the route of academic and research institutes through initiatives taken by professional bodies. The one health approach in the above conditions can be successful only if it is systematically implemented through strong leadership and governance, adequate financing, development of appropriate human resources, providing laboratory support and robust surveillance systems, developing rapid response mechanisms along with SOPs, and continuous engagement in research. For this purpose, there is no need to create new institutions and centers, instead effective and fruitful partnerships and networks should be built and facilitated among the existing institutions for mutual collaboration and joint efforts. At the center of it should be citizen engagement. Successful implementations should be disseminated widely for improving its adoption by newer and developing economies with limited resources.
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