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Elnaiem A, Mohamed-Ahmed O, Zumla A, Mecaskey J, Charron N, Abakar MF, Raji T, Bahalim A, Manikam L, Risk O, Okereke E, Squires N, Nkengasong J, Rüegg SR, Abdel Hamid MM, Osman AY, Kapata N, Alders R, Heymann DL, Kock R, Dar O. Global and regional governance of One Health and implications for global health security. Lancet 2023; 401:688-704. [PMID: 36682375 DOI: 10.1016/s0140-6736(22)01597-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
The apparent failure of global health security to prevent or prepare for the COVID-19 pandemic has highlighted the need for closer cooperation between human, animal (domestic and wildlife), and environmental health sectors. However, the many institutions, processes, regulatory frameworks, and legal instruments with direct and indirect roles in the global governance of One Health have led to a fragmented, global, multilateral health security architecture. We explore four challenges: first, the sectoral, professional, and institutional silos and tensions existing between human, animal, and environmental health; second, the challenge that the international legal system, state sovereignty, and existing legal instruments pose for the governance of One Health; third, the power dynamics and asymmetry in power between countries represented in multilateral institutions and their impact on priority setting; and finally, the current financing mechanisms that predominantly focus on response to crises, and the chronic underinvestment for epidemic and emergency prevention, mitigation, and preparedness activities. We illustrate the global and regional dimensions to these four challenges and how they relate to national needs and priorities through three case studies on compulsory licensing, the governance of water resources in the Lake Chad Basin, and the desert locust infestation in east Africa. Finally, we propose 12 recommendations for the global community to address these challenges. Despite its broad and holistic agenda, One Health continues to be dominated by human and domestic animal health experts. Substantial efforts should be made to address the social-ecological drivers of health emergencies including outbreaks of emerging, re-emerging, and endemic infectious diseases. These drivers include climate change, biodiversity loss, and land-use change, and therefore require effective and enforceable legislation, investment, capacity building, and integration of other sectors and professionals beyond health.
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Affiliation(s)
- Azza Elnaiem
- Royal Free London NHS Foundation Trust, London, UK
| | - Olaa Mohamed-Ahmed
- UK Health Security Agency, London, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Tajudeen Raji
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ammad Bahalim
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Logan Manikam
- Global Health Programme, Royal Institute of International Affairs, London, UK
| | - Omar Risk
- Department of Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | | | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Simon R Rüegg
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | | | - Nathan Kapata
- Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia
| | - Robyn Alders
- Global Health Programme, Royal Institute of International Affairs, London, UK; Development Policy Centre, Australian National University, Canberra, ACT, Australia
| | - David L Heymann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Kock
- Royal Veterinary College, University of London, London, UK
| | - Osman Dar
- Global Operations, London, UK; Global Health Programme, Royal Institute of International Affairs, London, UK
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Labonté R, Wiktorowicz M, Packer C, Ruckert A, Wilson K, Halabi S. A pandemic treaty, revised international health regulations, or both? Global Health 2021; 17:128. [PMID: 34742296 PMCID: PMC8572070 DOI: 10.1186/s12992-021-00779-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A special session of the World Health Assembly (WHA) will be convened in late 2021 to consider developing a WHO convention, agreement or other international instrument on pandemic preparedness and response - a so-called 'Pandemic Treaty'. Consideration is given to this treaty as well as to reform of the International Health Regulations (IHR) as our principal governing instrument to prevent and mitigate future pandemics. MAIN BODY Reasons exist to continue to work with the IHR as our principal governing instrument to prevent and mitigate future pandemics. All WHO member states are party to it. It gives the WHO the authority to oversee the collection of surveillance data and to issue recommendations on trade and travel advisories to control the spread of infectious diseases, among other things. However, the limitations of the IHR in addressing the deep prevention of future pandemics also must be recognized. These include a lack of a regulatory framework to prevent zoonotic spillovers. More advanced multi-sectoral measures are also needed. At the same time, a pandemic treaty would have potential benefits and drawbacks as well. It would be a means of addressing the gross inequity in global vaccine distribution and other gaps in the IHR, but it would also need more involvement at the negotiation table of countries in the Global South, significant funding, and likely many years to adopt. CONCLUSIONS Reform of the IHR should be undertaken while engaging with WHO member states (and notably those from the Global South) in discussions on the possible benefits, drawbacks and scope of a new pandemic treaty. Both options are not mutually exclusive.
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Affiliation(s)
- Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Mary Wiktorowicz
- Dahdaleh Insitute for Global Health Research, York University, 88 The Pond Road, Suite 2150, Toronto, ON, M3J 2S5, Canada.,School of Health Policy and Management, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Corinne Packer
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Arne Ruckert
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Bruyère Research Institute and Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, Ottawa, ON, K1Y 4E9, Canada
| | - Sam Halabi
- O'Neill Institute for National and Global Health Law, Georgetown University, 600 New Jersey Avenue, NW, Washington, DC, 20001, USA.,Colorado School of Public Health at Colorado State University, Sage Hall, 700 South Mason St., Fort Collins, CO, 80523, USA
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