Social insights on the implementation of One Health in zoonosis prevention and control: a scoping review

Measuring the One Health impacts associated with creating access to veterinary care before and during the COVID-19 pandemic

Integrating community perceptions into One Health assessments is critical to understanding the structural barriers that create disproportionate health outcomes for community members, their pets, and the ecosystems that encompass them, particularly in historically marginalized and under-resourced communities. The validated One Health Community Assessment (OHCA) survey instrument was used to evaluate the associated impacts of The Humane Society of the United States' Pets for Life (PFL) programming on communities' perceptions of One Health. This evaluation took place across two phases, totaling four years. In phase one (May 2018 - December 2019), the PFL intervention was administered to one urban and one rural under-resourced community, while two demographically-paired communities served as comparison sites. Five OHCA subscales (human health, pet health, environmental health, community health, perceived links) were employed to measure changes in perceptions of One Health and fourteen OHCA items were used to measure perceptions of access to human healthcare, pet care, and the environment. Initiation of the confirmatory second phase of the study (May 2020-October 2021), in which all four communities received the intervention, coincided with the onset of the COVID-19 pandemic. The pandemic and its resulting public health mandates hindered both PFL programming and data collection. Generalized Estimating Equations were employed in both the first and second phase analyses to model changes in perceptions of One Health associated with the PFL intervention. In the study's first phase, PFL in the urban community was associated with significant increases in perceptions of community health and environmental health, and perceived access to human health care, pet care, and the environment. The presence of PFL during the study's second phase was associated with increased perceptions of environmental health. The variables of PFL and the pandemic were not able to be isolated within the analyses. However, due to the severe, negative One Health implications associated with the COVID-19 pandemic, the phase two results were interpreted from the perspective of the pandemic being the largest driver of the results. The results are consistent with previous research on the effects of the pandemic on community perceptions of health. These findings offer initial support for the hypothesis that deployment of resources focused on companion animals may affect perceptions across the One Health triad and confirms previous research on effects of the COVID-19 pandemic.

How studies on zoonotic risks in wildlife implement the one health approach - A systematic review

Background

The recent COVID-19 pandemic and the emergence of infectious diseases at the human-animal interface highlight the global challenge of mitigating zoonotic risks. The One Health approach emphasizes the interconnectedness of human, animal, and environmental health, urging for holistic and interdisciplinary strategies in disease prevention. Despite growing interest, the attention to wildlife in pandemic prevention remains limited. This systematic literature review aims to evaluate recent One Health research on zoonotic diseases and wildlife in terms of study design, interdisciplinary collaboration, and participatory approaches. Key questions addressed include the consideration of One Health domains, disciplinary involvement, and the inclusion of non-academic stakeholders.

Methods

Following PRISMA guidelines, PubMed and Web of Science were searched for primary research papers on zoonotic diseases and wildlife from 2018 to 2023. Eligibility criteria included a focus on wildlife, zoonotic diseases, and adoption of the One Health approach.

Results

A total of 228 primary research papers were retrieved. Out of these, 105 studies were included in the review. Few studies integrated human, animal, and environmental domains simultaneously in data collection (4.8 %) and knowledge generation (29.5 %). While extensive knowledge was generated for animal health (97.1 %) and human health (84.8 %), environmental health (34.3 %) remained underrepresented. Laboratory methods predominated (82.9 %), with limited integration of social science methodologies (19 %). The majority were epidemiological studies (86.7 %), yet analytical design within these was sparse (17.1 %). Participation of non-academic stakeholders was limited (36.2 % included non-academics; 3.8 % encompassed participative approaches).

Conclusions

The synthesis of the domains human, animal and environmental health remained fragmentary in the studies reviewed. Environmental health is underrepresented and the interdisciplinary involvement of social sciences lacks. Neglecting these fields of competence impedes comprehensive understanding of disease dynamics and hampers effective zoonosis prevention strategies. In result, greater inter- and transdisciplinary collaboration, along with participatory approaches, are still needed for advancing One Health research.

Global burden of enteric infections related foodborne diseases, 1990-2021: findings from the Global Burden of Disease Study 2021

Background

Understanding the global burden of enteric infections is crucial for prioritizing control strategies for foodborne and waterborne diseases. This study aimed to assess the global burden of enteric infections in 2021 and identify risk factors from One Health aspects.

Methods

Leveraging the Global Burden of Disease (GBD) 2021 database, the incidence, disability-adjusted life years (DALYs), and deaths of enteric infections and the subtypes were estimated, including diarrheal diseases, typhoid and paratyphoid fever, invasive non-typhoidal Salmonella (iNTS) infections, and other intestinal infectious diseases. The estimates were quantified by absolute number, age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized DALY rate with 95% uncertainty intervals (UIs). Thirteen pathogens and three risk factors associated with diarrheal diseases were analyzed.

Results

In 2021, the global age-standardized DALY rate of enteric infections was 1020.15 per 100,000 popultion (95% UI: 822.70-1259.39 per 100,000 population) with an estimated annual percentage change (EAPC) of -4.11% (95% confidence interval: -4.31% to -3.90%) in 1990-2021. A larger burden was observed in regions with lower Socio-demographic index (SDI) levels. Diarrheal disease was the most serious subtype with Western Sub-Saharan Africa exhibiting the highest age-standardized DALY rate (2769.81 per 100,000 population, 95% UI: 1976.80-3674.41 per 100,000 population). Children under 5 and adults over 65 years suffered more from diarrheal diseases with the former experiencing the highest global age-standardized DALY rate (9382.46 per 100,000 population, 95% UI: 6771.76-13,075.12 per 100,000 population). Rotavirus remained the leading cause of diarrheal diseases despite a cross-year decline in the observed age-standardized DALY rate. Unsafe water, sanitation, and handwashing contributed most to the disease burden.

Conclusion

The reduced burden of enteric infections suggested the effectiveness of previous control strategies; however, more efforts should be made in vulnerable regions and populations through a One Health approach.

Implementation of One Health surveillance systems: Opportunities and challenges - lessons learned from the OH-EpiCap application

As the complexity of health systems has increased over time, there is an urgent need for developing multi-sectoral and multi-disciplinary collaborations within the domain of One Health (OH). Despite the efforts to promote collaboration in health surveillance and overcome professional silos, implementing OH surveillance systems in practice remains challenging for multiple reasons. In this study, we describe the lessons learned from the evaluation of OH surveillance using OH-EpiCap (an online evaluation tool for One Health epidemiological surveillance capacities and capabilities), the challenges identified with the implementation of OH surveillance, and the main barriers that contribute to its sub-optimal functioning, as well as possible solutions to address them. We conducted eleven case studies targeting the multi-sectoral surveillance systems for antimicrobial resistance in Portugal and France, Salmonella in France, Germany, and the Netherlands, Listeria in The Netherlands, Finland and Norway, Campylobacter in Norway and Sweden, and psittacosis in Denmark. These evaluations facilitated the identification of common strengths and weaknesses, focusing on the organization and functioning of existing collaborations and their impacts on the surveillance system. Lack of operational and shared leadership, adherence to FAIR data principles, sharing of techniques, and harmonized indicators led to poor organization and sub-optimal functioning of OH surveillance systems. In the majority of studied systems, the effectiveness, operational costs, behavioral changes, and population health outcomes brought by the OH surveillance over traditional surveillance (i.e. compartmentalized into sectors) have not been evaluated. To this end, the establishment of a formal governance body with representatives from each sector could assist in overcoming long-standing barriers. Moreover, demonstrating the impacts of OH-ness of surveillance may facilitate the implementation of OH surveillance systems.

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

The international authorities, such as the Food and Agriculture Organization of the United Nations, World Health Organization, World Organization for Animal Health, United Nations Environment Programme, and World Bank, have endorsed the One Health concept as an effective approach to optimize the health of people, animals, and the environment. The One Health concept is considered as an integrated and unifying approach with the objective of sustainably balancing and optimizing the health of people, animals, and ecosystems. Despite variations in its definitions, the underlying principle remains consistent - recognizing the interconnected and interdependent health of humans, animals, and the environment, necessitating interdisciplinary collaboration to optimize health outcomes. The One Health approach has been applied in numerous countries for detecting, managing, and controlling diseases. Moreover, the concept has found application in various areas, including antimicrobial resistance, food safety, and ecotoxicology, with a growing demand. There is a growing consensus that the One Health concept and the United Nations Sustainable Development Goals mutually reinforce each other. The World Bank has recommended five domains as foundational building blocks for operationalising the One Health approach, which includes: i) One Health stakeholders, roles, and responsibilities; ii) financial and personal resources; iii) communication and information; iv) technical infrastructure; and v) governance. The domains provide a generalised overview of the One Health concept and guide to its application. We conducted a scoping review following the five-staged Arksey and O'Malley's framework. The objective of the review was to map and synthesise available evidence of application of the One Health approach to five major zoonotic diseases using the World Bank domains. Publications from the year 2004, marking the inception of the term 'One Health,' to 2022 were included. Information was charted and categorised against the World Bank domains identified as a priori. We included 1132 records obtained from three databases: Embase, Medline, and Global Health; as well as other sources. After excluding duplicates, screening for titles and abstracts, and full text screening, 20 articles that contained descriptions of 29 studies that implemented the One Health approach were selected for the review. We found that included studies varied in the extent to which the five domains were utilised. Less than half the total studies (45%) used all the five domains and none of the studies used all the sub-domains. The environmental sector showed an underrepresentation in the application of the One Health approach to zoonotic diseases as 14 (48%) studies in 10 articles did not mention it as a stakeholder. Sixty two percent of the studies mentioned receiving support from international partners in implementing the One Health approach and 76% of the studies were supported by international donors to conduct the studies. The review identified disparate funding mechanisms employed in the implementation of the One Health approach. However, there were limited discussions on plans for continuity and viability of these funding mechanisms in the future.

Global One Health index for zoonoses: A performance assessment in 160 countries and territories

The One Health (OH) approach is used to control/prevent zoonotic events. However, there is a lack of tools for systematically assessing OH practices. Here, we applied the Global OH Index (GOHI) to evaluate the global OH performance for zoonoses (GOHI-Zoonoses). The fuzzy analytic hierarchy process algorithm and fuzzy comparison matrix were used to calculate the weights and scores of five key indicators, 16 subindicators, and 31 datasets for 160 countries and territories worldwide. The distribution of GOHI-Zoonoses scores varies significantly across countries and regions, reflecting the strengths and weaknesses in controlling or responding to zoonotic threats. Correlation analyses revealed that the GOHI-Zoonoses score was associated with economic, sociodemographic, environmental, climatic, and zoological factors. Additionally, the Human Development Index had a positive effect on the score. This study provides an evidence-based reference and guidance for global, regional, and country-level efforts to optimize the health of people, animals, and the environment.

Demographics and tenure of the Chilean urban dog population. A mathematical model

BACKGROUND

Irresponsible dog ownership in urban areas is a public health concern with significant implications for human, animal, and environmental welfare. Factors such as abandonment, variations in adoption, insufficient supervision, emerging identification initiatives, and collective feeding impact the growth of stray dog populations and the transmission of diseases. Developing a modeling tool to understand the dynamics of canine population growth and the effect of human behavior on this phenomenon is essential.

METHODS

An ordinary differential equation model was developed to depict the growth dynamics and movements of urban dog populations, distinguishing between those with owners (restricted and semi-restricted) and those without (stray and community dogs). Two equilibrium states of the system were analyzed: with and without the presence of individually owned dogs. An increase rate for the population of individually owned dogs was calculated, and a local sensitivity analysis was conducted to assess the impact of parameters on the reduction of this population. Additionally, two global sensitivity analysis methods were used to evaluate the simultaneous influence of the parameters.

RESULTS

Findings indicate that system equilibrium depends on various dog categories. Although total eradication of stray and community dogs is unlikely, equilibrium levels are directly related to subpopulation growth rates, responsible ownership practices, and adoption and abandonment rates. The growth rates of the population of dogs without individual owners have a direct and proportional influence on their regulation, while adoption rates have an inverse and proportional effect. The study, through global sensitivity analysis, identifies key parameters for each dog subpopulation. For restricted dogs, environmental carrying capacity is the most variable factor; for semi-restricted dogs, awareness of responsible ownership is crucial. The abandonment of restricted dogs significantly impacts stray dog dynamics, while the transition from stray to community status is an important variable factor for community dogs.

CONCLUSION

Addressing the situation of unowned dogs requires a collective effort to reduce risks associated with the spread of zoonotic diseases, environmental pollution, and biodiversity loss, thus contributing to public health and environmental conservation.

Assessing the Adoption of One Health Approaches in National Plans to Combat Health Threats: The Pilot of a One Health Conceptual Framework in Armenia

Due to several factors, such as environmental and climate changes, the risk of health threats originating at the human-animal-environment interface, including vector-borne diseases (VBDs) and zoonoses, is increasing. Low-resource settings struggle to counter these multidimensional risks due to their already-strained health systems and are therefore disproportionally affected by the impact caused by these changes. Systemic approaches like One Health (OH) are sought to strengthen prevention and preparedness strategies by addressing the drivers of potential threats with a multidisciplinary and multisectoral approach, considering the whole system at the human-animal-environment interface. The integration of OH in national plans can be challenging due to the lack of effective coordination and collaboration among different sectors. To support the process of knowledge coproduction about the level of OH integration in prevention and preparedness strategies against health threats in Armenia, a situation analysis was performed on Crimean-Congo hemorrhagic fever/virus and anthrax (identified by local stakeholders as priorities to be addressed with the OH approach), and actions to strengthen the national OH system were identified with the support of a OH conceptual framework. The study highlighted that multidisciplinary and multisectoral efforts towards prevention and preparedness against VBDs and zoonoses threats need to be strengthened in Armenia, and priority actions to integrate the OH approach were identified.

China's application of the One Health approach in addressing public health threats at the human-animal-environment interface: Advances and challenges

Background

Due to emerging issues such as global climate change and zoonotic disease pandemics, the One Health approach has gained more attention since the turn of the 21st century. Although One Health thinking has deep roots and early applications in Chinese history, significant gaps exist in China's real-world implementation at the complex interface of the human-animal-environment.

Methods

We abstracted the data from the global One Health index study and analysed China's performance in selected fields based on Structure-Process-Outcome model. By comparing China to the Belt & Road and G20 countries, the advances and gaps in China's One Health performance were determined and analysed.

Findings

For the selected scientific fields, China generally performs better in ensuring food security and controlling antimicrobial resistance and worse in addressing climate change. Based on the SPO model, the "structure" indicators have the highest proportion (80.00%) of high ranking and the "outcome" indicators have the highest proportion (20.00%) of low ranking. When compared with Belt and Road countries, China scores above the median in almost all indicators (16 out of 18) under the selected scientific fields. When compared with G20 countries, China ranks highest in food security (scores 72.56 and ranks 6th), and lowest in climate change (48.74, 11th).

Conclusion

Our results indicate that while China has made significant efforts to enhance the application of the One Health approach in national policies, it still faces challenges in translating policies into practical measures. It is recommended that a holistic One Health action framework be established for China in accordance with diverse social and cultural contexts, with a particular emphasis on overcoming data barriers and mobilizing stakeholders both domestically and globally. Implementation mechanisms, with clarified stakeholder responsibilities and incentives, should be improved along with top-level design.

Orientation of One Health development: think globally and act locally

One Health is dedicated to maintaining and fostering a dynamic balance among humans, animals, and the environment. Since 2013, it has seen considerable developments globally. This review aims to encapsulate the history of One Health, as well as chart its future trajectory. Numerous research institutions founded under the principles of One Health have been established, and several pragmatic projects are currently underway. While it is imperative to solidify foundational education, further policy support is required to cultivate the One Health paradigm. Identifying research directions at a political level is necessary to provide the technical support needed for practical application. The future of One Health envisions a comprehensive approach to primary prevention, the utilization of open and shared data sets, as well as real-world surveys and interviews. This integrated approach is encapsulated in the concept of One Health Delivery. At this stage, One Health Delivery needs to build a systematic framework that focuses on integrating and communicating across disciplines and training researchers with complete practical skills.

Demystifying a buzzword: Use of the term "human-animal-interface" in One Health oriented research based on a literature review and expert interviews

As of today, 75% of infectious human diseases are caused by zoonotic pathogens, which use the interface between humans and animal species to cross. Due to this ability, zoonoses affect more than just one health sector and the effective control is a matter of the One Health concept. One defining feature of this concept is the "human-animal-interface". However, even though the term is ubiquitously used in the field of infectious disease research, a clear definition of the term is lacking, leading to a rather nebulous understanding of what this interface really encompasses. Based on this observation, this study aimed to analyze the use of the term "human-animal-interface" in scientific literature to identify patterns and categories facilitating a scientific categorization. A systematic literature search of two electronic databases was performed complemented by interviews with health experts in the field of zoonoses/One Health conducted between March 2019 and May 2021. From identified publications, keywords and interface descriptions were extracted and categorized. Interviews followed a questioning route, were audio recorded, transcribed, and qualitative content was inductively categorized. Findings are based on 208 publications and 27 expert interviews. "Transmission" and "zoonosis" were the most frequent literature-based keywords, while the interviewees clearly favored "interface" followed by "contact". Seven categories of contact interfaces were inductively derived: direct contact (physical contact), consumption of animal products, use of animal products (blood transfusion, skin), contact with animal products (blood, secretion, meat), indirect contact (dust, inhalation, droplets), environmental contact (same surface or food), vector contact). Precise descriptions of the interfaces varied greatly depending on the pathogen domain (bacterial, viral, fungal). Specific patterns could be identified that were consistent between the literature and experts. The study results showed a general concordance in defining and describing the human-animal-interface indicating a general understanding of the term. However, studies on a larger scale are recommended (e.g. systematic review) to allow a more thorough view of the understanding and definition of the human-animal-interface.

Assessment of integrated patterns of human-animal-environment health: a holistic and stratified analysis

BACKGROUND

Data-driven research is a very important component of One Health. As the core part of the global One Health index (GOHI), the global One Health Intrinsic Drivers index (IDI) is a framework for evaluating the baseline conditions of human-animal-environment health. This study aims to assess the global performance in terms of GOH-IDI, compare it across different World Bank regions, and analyze the relationships between GOH-IDI and national economic levels.

METHODS

The raw data among 146 countries were collected from authoritative databases and official reports in November 2021. Descriptive statistical analysis, data visualization and manipulation, Shapiro normality test and ridge maps were used to evaluate and identify the spatial and classificatory distribution of GOH-IDI. This paper uses the World Bank regional classification and the World Bank income groups to analyse the relationship between GOH-IDI and regional economic levels, and completes the case studies of representative countries.

RESULTS

The performance of One Health Intrinsic Driver in 146 countries was evaluated. The mean (standard deviation, SD) score of GOH-IDI is 54.05 (4.95). The values (mean SD) of different regions are North America (60.44, 2.36), Europe and Central Asia (57.73, 3.29), Middle East and North Africa (57.02, 2.56), East Asia and Pacific (53.87, 5.22), Latin America and the Caribbean (53.75, 2.20), South Asia (52.45, 2.61) and sub-Saharan Africa (48.27, 2.48). Gross national income per capita was moderately correlated with GOH-IDI (R2 = 0.651, Deviance explained = 66.6%, P < 0.005). Low income countries have the best performance in some secondary indicators, including Non-communicable Diseases and Mental Health and Health risks. Five indicators are not statistically different at each economic level, including Animal Epidemic Disease, Animal Biodiversity, Air Quality and Climate Change, Land Resources and Environmental Biodiversity.

CONCLUSIONS

The GOH-IDI is a crucial tool to evaluate the situation of One Health. There are inter-regional differences in GOH-IDI significantly at the worldwide level. The best performing region for GOH-IDI was North America and the worst was sub-Saharan Africa. There is a positive correlation between the GOH-IDI and country economic status, with high-income countries performing well in most indicators. GOH-IDI facilitates researchers' understanding of the multidimensional situation in each country and invests more attention in scientific questions that need to be addressed urgently.

Establishment of an indicator framework for global One Health Intrinsic Drivers index based on the grounded theory and fuzzy analytical hierarchy-entropy weight method

BACKGROUND

One Health has become a global consensus to deal with complex health problems. However, the progress of One Health implementation in many countries is still relatively slow, and there is a lack of systematic evaluation index. The purpose of this study was to establish an indicator framework for global One Health Intrinsic Drivers index (GOH-IDI) to evaluate human, animal and environmental health development process globally.

METHOD

First, 82 studies were deeply analyzed by a grounded theory (GT) method, including open coding, axial coding, and selective coding, to establish a three-level indicator framework, which was composed of three selective codes, 19 axial codes, and 79 open codes. Then, through semi-structured interviews with 28 health-related experts, the indicators were further integrated and simplified according to the inclusion criteria of the indicators. Finally, the fuzzy analytical hierarchy process combined with the entropy weight method was used to assign weights to the indicators, thus, forming the evaluation indicator framework of human, animal and environmental health development process.

RESULTS

An indicator framework for GOH-IDI was formed consisting of three selective codes, 15 axial codes and 61 open codes. There were six axial codes for "Human Health", of which "Infectious Diseases" had the highest weight (19.76%) and "Injuries and Violence" had the lowest weight (11.72%). There were four axial codes for "Animal Health", of which "Animal Epidemic Disease" had the highest weight (39.28%) and "Animal Nutritional Status" had the lowest weight (11.59%). Five axial codes were set under "Environmental Health", among which, "Air Quality and Climate Change" had the highest weight (22.63%) and "Hazardous Chemicals" had the lowest weight (17.82%).

CONCLUSIONS

An indicator framework for GOH-IDI was established in this study. The framework were universal, balanced, and scientific, which hopefully to be a tool for evaluation of the joint development of human, animal and environmental health in different regions globally.