Local leaders unitedly push for One Health approach. Will G20 leaders tango?

Shobha Shukla, Bobby Ramakant *

Before G20 leaders and experts meet next week for the second health working group meeting under Indonesian G20 presidency, local leaders from several cities across the Asia Pacific region have unitedly called for implementing One Health approach.

"A #OneHealth approach recognizes that the health of humans is closely connected (and inter-dependent) to the health of animals and our shared environment. Successful public health interventions that comprise the human-animal-environment interface require the broad, committed collaboration of individuals, politicians, and technical and policy organizations from all levels of society,” said Dr Tara Singh Bam, Asia Pacific Director of the International Union Against Tuberculosis and Lung Disease (The Union).

Zoonotic diseases that spread between animals and humans, are a threat to SDGs

Human populations are growing and expanding into new geographic areas, including those that have hitherto been the primary domains of animals. With more and more people coming in closer contact with wild and domestic animals- both livestock and pets- this has increased opportunities for the spread of existing or known (endemic) and new or emerging zoonotic diseases, which include COVID-19, rabies, tuberculosis (TB), and Ebola, among others.

Just recently towards the end of April 2022, China had reported the first-ever human case of H3N8 new strain of bird flu influenza. Such localized disease-outbreaks can spread globally if we do not avert or address them quickly and effectively enough. This warrants agencies, working on human health, animal health, and the environment, to collaborate, coordinate and respond properly. The role of national leaders, especially sub-national leaders, becomes vital in this regard, said Dr H Mohamad Subuh, Chairperson of Association of All Indonesian Health Offices (ADINKES), Indonesia.

Most of the epidemics and pandemics that have (and continue to) threatened the world are of animal origin. Recent examples range from SARS in 2003, the H1N1 pandemic in 2009, the 2014 Ebola outbreak in West Africa, Zika in 2016, COVID-19 pandemic in 2019, and Monkeypox. “75% of all emerging infectious diseases are zoonotic,” said Dr Andre Furco, Technical expert – One Health, World Organization for Animal Health.

These experts were speaking at a special session hosted jointly by Indonesia’s Ministry of Home Affairs, Ministry of Health, Ministry of Agriculture, ADINKES, The Union, World Organisation for Animal Health (WOAH), United Nations Food and Agriculture Organization (FAO), and Asia Pacific Cities Alliance for Health and Development (APCAT).

Local leaders hold the power to translate global promises into transformative changes

"We cannot protect human health without considering the impact of human activities that disrupt ecosystems, encroach on habitats, and further drive climate change", had said Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO) earlier this year. He had added that, “…to keep people safe, One Health must be translated into local-level systems.”

That is why local leaders from around 80 cities of over a dozen countries in Asia and the Pacific had endorsed a Declaration rooted in One Health approach, at the 6th Asia Pacific Summit of Mayors (6th APCAT Summit) in December 2021, said Professor Tjandra Yoga Aditama, former Director General (Disease Control), Ministry of Health, Indonesia, and former Director (communicable disease control), of the WHO for South-East Asia region.

Dr Andre Furco added: “We cannot anymore work in silos, as these diseases are at the interface of human health, animal health and environment. So we need to work together to be able to better respond to them. One Health approach must be applied at the local level with a whole-of-society approach.”

“Successful implementation can only happen if those who are in the driving seat lead on One Health. That is why the role of Mayors and other leaders is so key,” said Budi Gunadi Sadikin, Minister of Health, Indonesia. “I believe that by strengthening the communication, collaboration, and coordination between the sectors of human health, animal health and environment, we will be able to make an impact.”

Dr Paula Fujiwara, who has devotedly worked on lung health since decades, and is currently the Chair, Global Plan to end TB Task Force, and Scientific Advisor, APCAT agreed: “Spread of SARS, TB and other microbes are some examples and the result of increased interaction of animals with human spaces. APCAT has shown its success in tobacco control by providing mayors with a shared platform to collaborate, share experiences and best practices, and improve communication among local governmental and non-government stakeholders. APCAT could leverage this experience to accelerate uptake of a One Health approach that would be novel and impactful in addressing health threats.”

Local leaders, like Mayors, are often in the best position to design and implement locally tailored solutions that are culturally appropriate and sustainable, for addressing a wide range of health and development challenges, as well as they are key resources for offering ground information and best practices to others. That is why Dr Paula Fujiwara said: “You hold the power to develop local One Health legislation, to form and lead relevant and multisectoral One Health Task Forces, to build and implement the action plan for advocacy on One Health approach.”

One Health approach is cost-effective too

“COVID-19 is a warning to work collectively across human health, animal health, and environment sectors. One Health is a cost-effective and practical approach for improving human health, animal health, and environment," said Khagaraj Adhikari, senior Member of Parliament, and former Health Minister, Nepal, who is also the current Chair of Asia Pacific Parliamentarians’ Alliance for Health and Development (APCAT Parliamentarians).

“We must prioritise #OneHealth political advocacy with MPs, Mayors, and other local leaders. We must establish legal and other mechanisms that are needed to implement One Health effectively. We must build local and national capacities, and technical skills. We must invest in local solutions and increase public participation,” said Khagaraj Adhikari, whose contribution in advancing tobacco control as Nepal’s Health Minister is widely respected.

The Indonesian Ministry of Home Affairs also echoed Adhikari's call for an enabling environment so that local governments can fully implement the One Health approach on the ground. Dr Teguh Setyabudi, Director General, Regional Development, Ministry of Home Affairs, Indonesia, said that "One Health documents must be translated into local plans so that budgetary allocations can be made. With proper policy, plans and funding, local government leaders will be able to implement these strategically."

Globally, as WHO is working with governments worldwide for a possible Global Treaty on Pandemic Prevention, Dr Gyanendra Gongal, Regional Advisor, WHO Regional Office for South-East Asia, said that it includes, "facilitation of multilateral and trans-sectoral implementation of a One Health approach to pandemic prevention” as one of its agendas.

Dr Tara Singh Bam, who is also the Board Director of APCAT, said to CNS (Citizen News Service): “APCAT has always believed in leadership, accountability and transparency and delivery. The Mayors' Alliance needs to work together with subnational governments, national governments, donors and all other partners. APCAT will continue to collaborate, build communications, and strengthen capacity for this cause. We believe in the whole of government approach and we believe with this we will be able to translate the One Health approach into concrete actions on the ground.”

Can we escape the cycle of panic and neglect?

The recent human health emergencies have exposed fault-lines in health systems, and highlighted key lessons to help us prevent and be better prepared for (and hopefully avert) the next pandemic. Can we escape the cycle of panic and neglect? The cost of inaction is too high for humanity and our planet to bear perhaps.