“One Health” and Global Health Governance

One Health in existing international law

At the international level, the One Health approach aims to overcome siloed ways of thinking among the varying organisations and actors involved in the field. It aims to improve multilateral coordination of pan­demic prevention, preparedness, and re­sponse. Data collection for disease surveillance is one area in particular need of such coordination. International law only par­tially addresses this area, and only with respect to separate instruments. To fill the gap, the current draft pandemic treaty includes a number of legal obligations related to One Health. Under Article 5 of the current draft pandemic treaty, states would be required to integrate measures that address the determinants of disease occurrence at the human-animal-environ­ment interface into their national pandemic prevention plans. This includes climate change, land use change, wildlife trade, desertification, and AMR.

Representing another commitment to One Health, the draft calls for surveillance capacities to be improved. Current disease surveillance relies on reporting disease-related events within each state’s territory; at the international level, several different instruments currently exist to this end, and they are hardly ever interconnected. This disconnect is most evident in the inadequate and poorly integrated surveillance mechanisms of different organisations.

In the area of human health, the International Health Regulations (IHR) of 2005 are the main tool for reporting diseases to the WHO. The IHR are applied to an open list of diseases and play a central role in the transparent exchange of data through the WHO Hub for Pandemic and Epidemic Intelligence. However, the Regulations are a strictly anthropocentric tool of inter­national law, as states only need to notify the WHO when a disease spreads among humans. Under this framework, depending on the nature of the disease, early infection detection and control are usually impossible. None of the proposed IHR reforms would address this shortcoming, as states would likely refuse to commit to more ex­tensive obligations such as identifying and reporting outbreaks, even among animals, within a certain amount of time.

The WOAH, by contrast, has tools to pro­mote animal health surveillance. In partic­ular, these include the Terrestrial Animal Health Code and the Aquatic Animal Health Code. Unlike IHR, these codes have lists of (currently 117) diseases for which surveillance is a high priority – even though unlisted diseases should also be reported. More comprehensive wildlife surveillance could be envisioned, but would require revising these tools. Similarly, the Codex Alimentarius developed by the FAO allows for monitoring practices in the food supply chain which might increase the risk of the spread of disease.

While the WHO, WOAH, and FAO are equipped with surveillance systems, the Quadripartite consisting of these three organisations plus the UNEP points out in its 2022 One Health Intelligence Scoping Study that the UNEP is underrepresented in the set of cooperative activities. This raises the question of how an expanded Global Early Warning System (GLEWS+) could include all four organisations. One possi­bil­ity would be to establish new links between the three existing health surveillance sys­tems of the WHO-WOAH-FAO on the one hand, and the UN Biodiversity Lab and the World Conservation Monitoring Centre on the other. Such frameworks can monitor relevant changes in biodiversity. However, it will probably be challenging to establish a reporting obligation for states, as it is too difficult to determine precise parameters for which states must report and when. Still, the UNEP could contribute to One Health monitoring, for example through reports documenting how climate change is affect­ing the migration of known pathogens. Identifying areas that are affected or more likely to be affected by climate change would be an important step toward more accurate risk assessment and early warning.

Prioritisation and capacity building

In addition to identifying a framework for action and strengthening surveillance capacities, the One Health approach neces­sitates the research-based global collection of various metrics. This should make it pos­sible to assess national authorities’ existing capacities to prevent zoonotic diseases and AMR, to identify different priorities, and to assess the performance of national policies. This data, which will reflect a country’s health, economic, and social circumstances, would enable decision makers to identify whether certain factors need to carry more weight than others in a given case. The assessment needs to be global and consis­tent before national action plans are devel­oped, as the One Health approach should be implemented within an international framework and be based on common in­dicators.

There are several models for both the formulation of One Health commitments at the international level and for their imple­mentation by national authorities. One of these models is found in the Vienna Con­vention for the Protection of the Ozone Layer and its Montreal Protocol. According to the Convention and the Protocol, a core obligation of states is to significantly reduce the use of chemical substances that have been scientifically proven to directly dam­age the ozone layer, and the UNEP iden­tified so-called “actionable tasks” to this end. These tasks form indicators of what needs to be implemented at the national level; and a multilateral fund has been established to provide financial support for this implementation. This fund is also based on a four-way collaboration, in this case between the UNEP, the United Nations Development Programme (UNDP), the United Nations Industrial Development Organization (UNIDO), and the World Bank. Similarly, the World Bank’s recently cre­ated Pandemic Fund could help ensure that states commit resources to One Health tasks as they are formulated.

The EU’s options for action

Zoonosis prevention represents the first field in which the EU can take action. The possibilities for activity are opened up, above all, via the competences in the area of the internal market according to Article 114 of the Treaty on the Functioning of the European Union (TFEU). In the Global Health Strategy, the EU explicitly refers to “deep prevention”, which means that health hazards should be identified before patho­gens are transmitted from animals to humans. Particularly relevant in this so-called upstream prevention is the illegal but also legal trade in wildlife, as well as changes in the use of land that are asso­ciated with the destruction of natural habitats.

Numerous initiatives already exist to implement the Washington Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), which aims to stop the illegal trade of wildlife. This includes the EU Action Plan Against Wildlife Trafficking, which itself makes explicit reference to the One Health ap­proach. While the EU is still one of the most important transshipment points for the illegal wildlife trade, legal trade also threatens human health, as zoonotic dis­eases can likewise occur within the EU and abroad as a by-product of legal trade. This is especially true because trade bans are pri­marily based on the risk to the animals in­volved as opposed to the potential health risks to humans. General bans do not ap­pear to be very effective, but the EU could, analogous to the CITES regulation, specifi­cally regulate trade in those animal species that show a hazard potential. To classify this potential, the World Wide Fund For Nature’s grid could be applied by relevant research institutes and a fundamental trade ban or a stronger obligation to test wild animals could be derived from it. In addi­tion, it is also necessary to expand testing and monitoring capacities within the EU with regard to the animal trade especially in cases of factory farming. The recent out­break of avian influenza on a mink farm in Spain serves as a stark reminder that new mutations with a zoonotic potential can emerge even within the EU.

In the fight against AMR, the EU could also help member states and companies to develop new medical countermeasures and facilitate access thereto. This applies to, among others, antimicrobial drugs, vac­cines, and diagnostics. Here, it will be im­portant to establish innovative incentive systems for research and development; it will also be important to promote trans­national cooperation in public-private partnerships – such as the Innovative Medicines Initiative (IMI) – that undertake research projects under the EU’s Horizon 2020 program. This would spread the risk of projects failing across several member states and the EU. Such supporting activity is clearly within the EU’s competences under Articles 6 and 168 of the TFEU. Here, for example, the EU Commission is cur­rent­ly planning to introduce a voucher model as part of the new EU pharmaceutical strat­egy to create greater incentives for investing in the development of new antimicrobial drugs. However, this is highly controversial, mainly because alternative proposals have not had much discussion. Either way, an incentive model could constitute just one component of the EU’s approach.

Additionally, the EU is one of the partners of the Global AMR R&D Hub, a part­ner­ship which also includes the G7 and 17 ad­ditional countries as well as two philanthropic organisations. The Hub recently issued a report in which it identified priori­ties for public and private investments, signalling the EU and the G7 as leaders in One Health financing. The recent Paris Climate Finance Summit, co-hosted by French President Emmanuel Macron and Barbados Prime Minister Mia Mottley, also underscored the need to overhaul the global financial system to provide countries with the resources needed to fight climate change, biodiversity loss, and poor air quality. The EU can be a key driver in this effort.

Ultimately, similar to GLEWS at the international level, the environmental sector is currently insufficiently represented at the EU level. The One Health European Joint Programme, for example, is based on an association of 44 national institutions and associations from the food, veterinary, and medical sectors. Among them, exclusive environmental agencies are underrepresented. This asymmetry hampers the chances of getting the most out of an EU One Health strategy.

Content-related references to One Health

In its strategy, the German government identifies three strategic goals: (1) prioritisation of areas in which Germany can best contribute; (2) multilateral action; and (3) coherence at all levels. It is noteworthy that explanations of the first goal already reference One Health, where a “cross-sectoral approach” and “system-oriented action” are emphasised. The first goal is divided into four priorities: (1) promoting health and preventing disease; (2) addressing environmental, climate, and health issues holistically; (3) strengthening health systems; and (4) combating cross-border threats.

Under these priorities, the German government mentions combating AMR first in its strategy. Here, the focus is on implementing the Global Health Protection Program, developing and implementing national action plans, and establishing and expanding surveillance systems. Furthermore, the German government is committed to researching new antimicrobial drugs through global product development partnerships and to producing reports on antimicrobials in development (“pipeline reports”). The rest of the strategy document makes regular references to AMR and the control thereof through a One Health approach.

With a view to zoonoses and the prevention of future epidemics and pandemics, the German government intends to make targeted use of the One Health approach. However, it limits itself to stating that cross-disciplinary and cross-sectoral action is necessary in partnership with the relevant international organisations. Yet the statements become more specific when addressing a holistic approach to environmental, climate, and health issues. Specifically, the German government aims to reduce environmental and climate impacts that pose health risks while also striving to preserve biodiversity and prevent the occurrences of invasive species.

The national level is of particular importance within this framework especially with regard to interdepartmental cooperation, companies’ due diligence obligations, and health systems’ adaptation. The German government already established an infor­mal ministerial network on One Health in 2021. However, non-governmental organi­sations (NGOs) and the private sector need to be involved to establish a more comprehensive societal stakeholder perspective on the matter.

Implementation in Germany

The nature of the One Health approach re­quires it to touch various ministries simul­taneously and necessitates interdepartmen­tal cooperation. While the Federal Ministry of Health is the ministry most affected, other ministries must also be involved with­in an institutionalised framework. In par­ticular, the Federal Ministry of Economics and Climate Protection, the Federal Minis­try for the Environment, the Federal Min­istry of Food and Agriculture, the Federal Foreign Office, and the Federal Ministry for Economic Cooperation and Development need to work together to implement a One Health approach. To facilitate this collaboration, the Ministry of Health should further support the informal One Health network and expand the circle of participants by regularly including civil society, academia, and the private sector. The net­work – be it informal or formal – could function as a body to prepare resolu­tions, regulations, and discuss legislative initia­tives that address aspects of One Health.

In addition, the German healthcare system must also adapt to a changing world through the lens of a One Health approach. On the one hand, One Health approaches must be conveyed in trainings of human and veterinary medical personnel, and physicians must be trained in the diagnosis and treatment of zoonoses that have not been widespread in Germany up to now. Particular attention should be paid to new zoonoses that arise due to the changing climate, such as dengue and malaria. On the other hand, if such diseases, which have so far been described as “tropical”, appear in Europe and Germany, it will become necessary to increase treatment capacities. At present, only 14 clinics in Germany treat more than ten patients with “tropical” dis­eases each year. In view of progressing climate change, the number of hospitals equipped for this purpose should be in­creased over time.

Recently, on 14 June 2023, the German government unveiled its first-ever National Security Strategy, which included the sub­ject areas of pandemic prevention, pre­paredness, and response. Notably, the One Health approach is explicitly incorporated as a component of the Strategy. So far, how­ever, policy shifts and budgetary commitments do not extend beyond what already exists in the German setting. Beyond the lack of concrete action, framing the One Health approach as part and parcel of the National Security Strategy comes with both prospects and pitfalls: on the one hand, it entails including it in the government’s priority-setting; on the other hand, it might lead to One Health being placed in a secu­rity silo that excludes other stakeholders.