Does One Health require a novel ethical framework?

Transdisciplinary approaches to addressing factors that influence antimicrobial use in dairy cattle: A scoping review

Interest in antimicrobial resistance (AMR) associated with livestock farming is increasing. During the 1990s, 30-40 academic papers a year on the use of antibiotics in dairy farming were indexed on the scientific database PubMed, but this has grown to more than 200 a year in the 2020s. Most (85%) of these papers are published in veterinary or livestock science journals. There has been a corresponding increase in social science interest in why responsible antibiotic stewardship in the livestock sector is so challenging. However, most social science insights are published in journals specific to the lead authors' field(s), missing opportunities for knowledge translation to veterinary and animal science. This threatens to inhibit the transdisciplinary One Health approaches required to tackle the problem. Between 1 June and 31 December 2021, we undertook a scoping review of papers on the use of antibiotics in dairy farming indexed in PubMed, Scopus and Web of Science. Our aim was to identify studies that incorporate social science approaches and methodologies, and to note the main field of the journal in which these studies are published. Papers were most likely to be published in veterinary science, dairy science and/or livestock science journals (61, 29 and 18 respectively out of 127 papers) and were most likely to be concerned with antibiotic use, prescribing practice, and/or diagnosis (94%, 39% and 33% of included papers respectively). Only 27% of papers meeting our inclusion criteria included a qualitative approach to understanding reasons for antibiotic use. Even fewer acknowledged underlying drivers of behaviour, whereas such reasons are frequently highlighted in social science literature. Thus, to address the global health threat from antibiotic resistance, more work is needed to bring together the disparate but equally valid disciplines, methodologies and researchers working on antibiotic use in the livestock sector.

Supporting One Health for Pandemic Prevention: The Need for Ethical Innovation

Bioethics is a field in which innovation is required to help prevent and respond to zoonotic diseases with the potential to cause epidemics and pandemics. Some of the developments necessary to fight pandemics, such as COVID-19 vaccines, require public debate on the benefits and risks of individual choice versus responsibility to society. While these debates are necessary, a more fundamental ethical innovation to rebalance human, animal, and environmental interests is also needed. One Health (OH) can be characterized as a strategy that recognizes and promotes the synergy between human, animal, and environmental health. Yet, despite the recognition that these entities are interdependent, there is a pronounced inequality in the power relations between human, non-human animal, and the environmental interests which threatens the well-being of all. Until OH can ensure the moral status of animals and the environment and thereby the equal consideration of these interests, it will struggle to protect non-human interests and, as a result, human health. To create a sustainable health system requires a renewed concept of justice that is ecocentric in nature and an application of OH that is flexible and responsive to different ethical interests (e.g., person-centred care and physician responsibilities). Ultimately, to save themselves, humans must now think beyond themselves. Bioethics must assume a key role in supporting the developments required to create and maintain relationships able to sustain environmental and human health.

Justifying the More Restrictive Alternative: Ethical Justifications for One Health AMR Policies Rely on Empirical Evidence

Global consumption of antibiotics has accelerated the evolution of bacterial antimicrobial resistance. Yet, the risks from increasing bacterial antimicrobial resistance are not restricted to human populations: transmission of antimicrobial resistant bacteria occurs between humans, farms, the environment and other reservoirs. Policies that take a 'One Health' approach deal with this cross-reservoir spread, but are often more restrictive concerning human actions than policies that focus on a single reservoir. As such, the burden of justification lies with these more restrictive policies. We argue that an ethical justification for preferring One Health policies over less restrictive alternatives relies on empirical evidence as well as theory. The ethical justification for these policies is based on two arguments: (i) comparatively greater effectiveness, and (ii) comparatively better tracking of moral responsibility. Yet the empirical assumptions on which these claims rest are limited by existing empirical knowledge. Using livestock farming as an example, we suggest that scientific research into characterising antimicrobial resistance and linking practices to outcomes ought to be guided (at least in part) by the imperative to supply the context-specific data needed to ethically justify preferring a One Health policy over less restrictive alternatives.

Evolution and expansion of the One Health approach to promote sustainable and resilient health and well-being: A call to action

One Health is a transdisciplinary approach used to address complex concerns related to human, animal, plant, and ecosystem health. One Health frameworks and operational tools are available to support countries and communities, particularly for the prevention and control of zoonotic diseases and antimicrobial resistance and the protection of food safety. However, One Health has yet to be implemented in a manner that fully considers the complexities and interconnectedness of the diverse influences that have impacts at a larger system level. This lack of consideration can undermine the sustainability of any positive outcomes. To ensure the One Health approach can function effectively within the new global context of converging and escalating health, social, economic, and ecological crises, it must evolve and expand in three overlapping dimensions: (1) Scope: the partners, knowledge, and knowledge systems included, (2) Approach: the techniques, methodologies, and scholarship considered, and (3) Worldview inclusivity: the interweaving of other worldviews together with the mainstream scientific worldview that currently predominates. Diverse partners and knowledge from outside the mainstream health and scientific sectors, including Indigenous peoples and representatives of local communities, and traditionally generated knowledge, must be included. These systems of knowledge can then be braided together with mainstream science to comprise a holistic framework for decision-making. Scholarship and methodologies being applied in other fields and contexts to solve complex challenges and manage uncertainty, such as collaborative governance, social-ecologic systems theory, and complexity science, must be recognized and incorporated. The spectrum of considered worldviews must also expand to authentically integrate the expanded scope and approach into action and sustainable impact. By increasing community and social engagement and by recognizing and entwining different worldviews, the plurality of disciplines, and traditional and scientific ways of knowing to address community concerns in the contexts in which they exist, we can ensure that One Health remains effective and true to its paradigm in our rapidly changing and complex world.

In critique of anthropocentrism: a more-than-human ethical framework for antimicrobial resistance

Antimicrobial resistance (AMR) is often framed as a One Health issue, premised on the interdependence between human, animal and environmental health. Despite this framing, the focus across policymaking, implementation and the ethics of AMR remains anthropocentric in practice, with human health taking priority over the health of non-human animals and the environment, both of which mostly appear as secondary elements to be adjusted to minimise impact on human populations. This perpetuates cross-sectoral asymmetries whereby human health institutions have access to bigger budgets and technical support, limiting the ability of agricultural, animal health or environmental institutions to effectively implement policy initiatives. In this article, we review these asymmetries from an ethical perspective. Through a review and analysis of contemporary literature on the ethics of AMR, we demonstrate how the ethical challenges and tensions raised still emerge from an anthropocentric framing, and argue that such literature fails to address the problematic health hierarchies that underlie policies and ethics of AMR. As a consequence, they fail to provide the necessary tools to ethically evaluate the more-than-human challenges that the long list of actors involved in managing AMR face in their everyday practices. In response to such shortcomings, and to make sense of these challenges and tensions, this article develops an ethical framework based on relationality, care ethics and ambivalence that attends to the more-than-human character of AMR. We formulate this approach without overlooking everyday challenges of implementation by putting the framework in conversation with concrete situations from precarious settings in West Africa. This article concludes by arguing that a useful AMR ethics framework needs to consider and take seriously non-human others as an integral part of both health and disease in any given ecology.

One Health: An Effective and Ethical Approach to Leptospirosis Control in Australia

The increasing concerns over emerging infectious diseases and potential pandemics led to the formation of One Health, a collaborative, multidisciplinary approach to address the risks from human–animal–ecosystem interactions. This multi-sectoral approach is specifically important in Australia, a biodiverse country with unique flora, fauna, and many infectious diseases, including leptospirosis. Leptospirosis is a relatively rare but potentially fatal zoonosis, with an attributed mortality of around 60,000 deaths per year worldwide. In recent years, sporadic cases and alarming outbreaks of leptospirosis have been notified in many states and territories of Australia, noteworthily in 2018 and 2019. The sudden outbreaks in these two years have raised a question about the possibility of a more severe menace or a potential threat to both humans and animals. Amid the fight against leptospirosis, One Health has been shown to be an excellent and ideal framework, especially in Australia, the country that has taken the lead in zoonosis control using this approach. In this review, the focus will be put on the effectiveness and ethics of One Health in leptospirosis control under the Australian setting to further advocate the implementation of this framework for many other infectious diseases.

Who is the biological patient? A new gradational and dynamic model for one health medicine

One Health medicine aims to improve health by focusing on the relations between the health of humans, animals, and the environment. However, One Health does not provide a clear idea of these relations, which are still represented as conceptually separated and not as one health, as the name implies. Inspired by holobiont research, I suggest a new model and conceptual framework for One Health that expands the notion of the biological patient by providing a gradational and dynamic understanding of environments, patients, and their relations. This new model conceptualizes humans and non-humans, individual organisms, and collectives, as belonging to one system that allows for more or less inclusive understandings of patients. As such, it resolves the conceptual tensions of different One Health approaches and supports the implementation of One Health as an interdisciplinary research field.

Research-Practice-Collaborations Addressing One Health and Urban Transformation. A Case Study: Commentary on "Research-Practice-Collaborations in International Sustainable Development and Knowledge Production-Reflections from a Political-Economic Perspective"

One Health is an integrative approach at the interface of humans, animals and the environment, which can be implemented as Research-Practice-Collaboration (RPC) for its interdisciplinarity and intersectoral focus on the co-production of knowledge. To exemplify this, the present commentary shows the example of the Forschungskolleg "One Health and Urban Transformation" funded by the Ministry of Culture and Science of the State Government of Nord Rhine Westphalia in Germany. After analysis, the factors identified for a better implementation of RPC for One Health were the ones that allowed for constant communication and the reduction of power asymmetries between practitioners and academics in the co-production of knowledge. In this light, the training of a new generation of scientists at the boundaries of different disciplines that have mediation skills between academia and practice is an important contribution with great implications for societal change that can aid the further development of RPC.

The Berlin principles on one health - Bridging global health and conservation

For over 15-years, proponents of the One Health approach have worked to consistently interweave components that should never have been separated and now more than ever need to be re-connected: the health of humans, non-human animals, and ecosystems. We have failed to heed the warning signs. A One Health approach is paramount in directing our future health in this acutely and irrevocably changed world. COVID-19 has shown us the exorbitant cost of inaction. The time to act is now.

Competing ethics in a pilot strategy to implement parasitology training and research in post-Ebola Sierra Leone

Much of the focus of public health research post-Ebola in Sierra Leone has been on rebuilding the healthcare system. However, very little attention has focused on capacity building in knowledge necessary for (bio)medical research, specifically around emerging opportunistic human pathogens that contribute to the high morbidity and mortality rates in Sierra Leone. In collaboration with academic staff from the University of Makeni, we engaged in a small-scale pilot intervention to strengthen medical parasitology teaching and research. The cultural competencies and ethical expertise provided by Sierra Leonean academics was critical to work in local communities and ensuring consent to undertake research. Yet, at the end of a day of collecting samples, in small pieces of conversation, the staff also explained ethical constraints they experienced taking part in research collaborations. They illustrate that, while on the surface all may seem well with a project, there can be harmful effects in terms of accessibility, ownership, cultural responsiveness and accountability, which should be taken into consideration when establishing networks and collaborations with universities from low-income countries.

More philosophical work needed in One Health on ethical frameworks and theory

We thank Zohar Lederman and Benjamin Capps for engaging with our paper on One Health (OH) and ethical frameworks, however we want to take issue with them on three points. First, they appear to misunderstand the distinction we appeal to between ethical theory and ethical frameworks, and so misinterpret what we are trying to achieve in our paper. Second, in spite of what they seem to imply, we agree that an OH approach can obscure differences in values, and that to progress the field there needs to be recognition of competing values and their implications for OH. Finally, we are puzzled by their interest in pursuing a deliberative process, as this seems at odds with other positions they take in their paper, and also opens up many questions that need to be addressed.

One health ethics: a response to pragmatism

Johnson and Degeling have recently enquired whether one health (OH) requires a comprehensive normative framework, concluding that such a framework, while not necessary, may be helpful. In this commentary, we provide a context for this debate, and describe how pragmatism has been predominant in the OH literature. We nevertheless argue that articulating a comprehensive normative theory to ground OH practice might clear existing vagueness and provide stronger guidance in relevant health dilemmas. A comprehensive theory will also be needed eventually to ground notions such as universal good. We, thus, call for the systematic articulation of a comprehensive, metaethical theory, concomitantly with already ongoing normative work.

One Health and Zoonotic Uncertainty in Singapore and Australia: Examining Different Regimes of Precaution in Outbreak Decision-Making

A One Health approach holds great promise for attenuating the risk and burdens of emerging infectious diseases (EIDs) in both human and animal populations. Because the course and costs of EID outbreaks are difficult to predict, One Health policies must deal with scientific uncertainty, whilst addressing the political, economic and ethical dimensions of communication and intervention strategies. Drawing on the outcomes of parallel Delphi surveys conducted with policymakers in Singapore and Australia, we explore the normative dimensions of two different precautionary approaches to EID decision-making—which we call regimes of risk management and organizing uncertainty, respectively. The imperative to act cautiously can be seen as either an epistemic rule or as a decision rule, which has implications for how EID uncertainty is managed. The normative features of each regime, and their implications for One Health approaches to infectious disease risks and outbreaks, are described. As One Health attempts to move upstream to prevent rather than react to emergence of EIDs in humans, we show how the approaches to uncertainty, taken by experts and decision-makers, and their choices about the content and quality of evidence, have implications for who pays the price of precaution, and, thereby, social and global justice.