“One Health” and Global Health Governance

Different dimensions of One Health

The One Health approach proposes a shift in how policy engagement in medicine, public health, animal health, and the environment should be pursued. Concep­tually as well as politically, it calls for thinking outside the box. Specifically, it means that the drivers of pandemic risk should be addressed collaboratively by different institutions that traditionally tended to confine themselves to their own areas of responsibility.

In this regard, OHHLEP’s Theory of Change has pinpointed the key areas of action for institutions. Its guidelines iden­tify dozens of health risk factors that require different types of solutions and that can be used to set actionable priorities. For example, climate change is accelerating the migration of disease vectors, such as mos­quitoes, across different parts of the globe while increasing international wild­life trade significantly increases the risk that zoonotic diseases could be spread. While OHHLEP’s Theory of Change is not exhaustive, it does help to determine pri­orities.

The question arises as to how vertical and horizontal prioritisation can be achieved at the international, regional, and national levels. This will require debate and initiatives among varying groups of actors. The current draft of the pandemic treaty, the EU’s Global Health Strategy, and the German government’s strategy are three necessary albeit insufficient tools to set these priorities. Again, it is important that the design and implementation of One Health at each level prioritises those areas that can be best addressed at said level, thus creating an efficient vertical division of tasks.

Draft pandemic treaty

The pandemic treaty will play a significant role at the international level in uniformly spelling out the One Health approach for the community of states. The draft pandemic treaty includes the definition of One Health that has been articulated by OHHLEP. Simi­larly, the guidelines in OHHLEP’s Theory of Change could be incorporated to set inter­national priorities. This is underscored by the fact that the pandemic treaty already focuses on certain priorities – namely zoonotic diseases, antimicrobial resistance (AMR), and One Health surveillance.

The EU’s Global Health Strategy

The EU proposed the pandemic treaty and is involved in its ongoing negotiations. It also addresses One Health in its Global Health Strategy published in late November 2022. The Strategy’s aim is to make health a central element of European foreign policy, not least because of the geopolitical poten­tial of international health engagement. It also aims to make up for failures in achiev­ing the health-related UN Sustainable Devel­opment Goals. The Strategy is thus to be understood as an external dimension of the European Health Union, which is currently being built, but it also allows con­clusions to be drawn about internal priori­tisations. In terms of content, the Strategy addresses the determinants of human health; how­ever, it also explicitly mentions climate change, environmental degradation, and food security in the context of One Health. The Global Health Strategy’s discussion of the One Health approach is relevant be­cause the document can be understood as a framework for action that sets political priorities for the EU Commission, identifies concrete fields of action in the area of One Health, and calls on EU member states to support individual measures.

The Global Health Strategy of the EU com­prises three basic priorities and 20 Guid­ing Principles. In the third priority, the docu­ment refers to One Health; this approach is to be pursued, it says, in order to prevent or combat future health threats. In addition, the individual Guiding Principles also make references to the approach. However, a dis­tinction must be made between the varying references, as some are rather generic while others are concrete. The latter are particularly pronounced in three Guiding Prin­ci­ples, which explicitly reference One Health and deserve special attention.

Guiding Principle 9.3 refers directly to the pandemic treaty and states that its goal is to pursue a One Health approach. While the EU Commission, as the lead negotiator for the EU’s member states, can contribute its preferences derived from the Global Health Strategy regarding a One Health approach, it must respect the European Council’s negotiating mandate, which limits its authority to negotiate to matters that fall within EU competence. However, in the annex to the Council Decision, which spells out the specific scope of the mandate, One Health is explicitly stated as a general objective and principle; the Commission can therefore fully engage on behalf of the member states. Combating antimicrobial resistance through a One Health approach is also mentioned in this context. The threat of AMR is a phenomenon that directly high­lights the consequences of the relationship between humans, animals, and the environ­ment. For example, the widespread use of antibiotics in human and veterinary medi­cine can increase the risk of bacteria, viruses, fungi, and parasites developing resistances. In the negotiations on the pan­demic treaty, the EU can therefore – with­in the scope of its competencies – address certain areas of One Health as well as AMR in line with the strategy.

Aside from being discussed in relation to the pandemic treaty, One Health can also be found in Guiding Principle 11.3 of the Global Health Strategy, namely in connection with intensifying the fight against AMR through the formulation of a com­prehensive One Health approach. The EU cites changes in the use of agricultural land, environmental degradation, complex food production, and more intensive trade and transport as particular risks that need to be addressed. In addition, the Global Health Strategy reiterates the danger posed by AMR and emphasises the need to devel­op new medical countermeasures.

Guiding Principle 12 defines the aim to link all policies that have an impact on global health within the Commission, the EU agencies, and the EU funding institutions. For the EU, this includes promoting a One Health approach in the future UN Global Biodiversity Framework as well as addressing biodiversity loss, illegal wildlife trade, pollution, and exposure to toxic sub­stances. Although the Global Health Strate­gy can be a nexus for various initiatives, it presents three specific areas of action for the EU: Zoonoses, AMR, and the involvement of environmental agencies.

The German government’s strategy

In October 2020, just two years before the publication of the EU’s Global Health Strat­egy, the German government presented its strategy on global health. Although it is not a binding document for the German gov­ern­ment, the strategy is significant in that it outlines a framework for action to be pursued by German (foreign) policy; more­over, it introduces new approaches and sets priorities. This is particularly relevant after the changes to the German government in 2021, as the new federal government ex­plicitly refers to the strategy and presents it as the basis for its actions.

Vertical prioritisation

Horizontally, the One Health concept must be concretely defined and silo thinking must be overcome; vertically, synergies must be created and actions dovetailed. In this context, as in other policy areas, the international, regional, and national levels have very specific roles that are tailored to their different competences and capabilities. These differences are often addressed only indirectly, meaning that a clear defi­nition of tasks and roles has been absent up to now. Within the framework of the sub­sidiarity principle, however, functions and objectives can be divided depending on whether they can be better implemented at the international, EU, or national level.

As seen in the context of the pandemic treaty, the EU’s Global Health Strategy, and the German government’s strategy for global health, all levels are integral for One Health. But there is a need for a vertical division of tasks in which priorities are set and targets are assigned. For better harmo­nization, established areas of networked governance, such as those seen in the field of agriculture or in the EU’s Green New Deal, should constitute the points from which actions can be oriented. In addition, concrete recommendations for action at the different levels can be found below.

• International level: The priority at the inter­national level should be to consolidate One Health surveillance. To this end, the Quadripartite should be strengthened through the pandemic treaty. The World Bank’s Pandemic Fund can also be used here, and the funding of capacities should be prioritised based on contexts. At the same time, the environmental dimension must be strengthened at the international level through regular re­ports and (climate change) risk assessments, for example. The German govern­ment can address these areas of the One Health approach in various contexts – in the negotiations on the pandemic treaty and the reform of the IHR as well as at the High-Level Meeting on Pan­demic Prevention, Preparedness, and Response, which is hosted by the United Nations General Assembly.

• EU-level: The European Union and regional organisations can influence how One Health approaches are implemented at a downstream level, for example through trade standards or bans. In addition, a regional grouping of countries should be initiated and supported to create incentives for research and development, and to mitigate risks.

• National level: At the national level, there is a need for stronger and, above all, in­stitutionalised cooperation between government departments. Similarly, One Health approaches should be transferred to areas of government action, such as due diligence, that have so far been ex­clusively dedicated to the protection of human rights and the environment. In addition, national health systems must be adapted to new challenges arising from climate change. The German Parlia­ment’s Global Health Subcommittee could incorporate these elements.