One Health requires us to reorient our perceptions and value systems

I became interested in health at the community level at quite an early stage. This is why I also studied public health. From the very beginning, the One Health concept dovetailed with my own thinking in terms of interdependencies. When I was writing my doctoral thesis in the US, I was involved in a big project at the University of Minnesota funded by USAID, where we worked closely with African countries to improve their health systems through a One Health approach. Four years ago, I was elected co-chair of The Lancet One Health Commission which draw me even closer to the concept. After Ebola and later SARS-CoV-19, both viruses of zoonotic origin, we saw a sudden surge of interest in One Health and the work of our Commission.

Our Commission propagates a radical slow change in society. To achieve our ultimate goal of One Health, which entails healthy, sustainable social-ecological systems, we will also have to change the economic system. But this must be done slowly, otherwise it will result in chaos. By now it should be clear to everyone – and climate change is perhaps the most obvious manifestation – that we are headed for a catastrophic disaster if we continue with business as usual. One Health therefore also necessitates a radical reorientation of our perceptions and value systems. It won’t work if that happens only locally. It requires international agreements, so it is crucial to work with UN organisations. The commitment of national development agencies is also critical because they co-fund UN organisations, the World Bank and other multilateral bodies that support One Health. Even more could be achieved if funding for the supported initiatives and projects was tied more explicitly to One Health goals.

We continue to measure growth and progress with the gross domestic product (GDP). This means that primary forests, for example, have no value per se. Only when trees are cut down, shipped and sold, or when minerals are mined, do they receive an economic value. From a One Health perspective, GDP creates disastrous disincentives because it encourages activities such as deforestation with inevitable negative repercussions for human health and the shared environment. If we had a different definition of economic profit, of capital and prosperity, then the economic system would reward not this destruction and the ensuing diseases but activities that foster the health of humans, animals and the environment.

At the Commission, we focus on three key aspects: first, as already mentioned, we need to redefine economic success which requires new metrics to measure it. The second important aspect is global policy. During the COVID-19 pandemic, the idea of a "pandemic treaty" emerged. WHO member states are currently working on this. The aim of such a treaty would be to facilitate data sharing and additional funding for research and development, primarily with a view to monitoring zoonotic viruses and establishing early warning systems. The equitable distribution of vaccines would also be part of such a treaty. The initial ambitious goals have, however, already been heavily watered down by powerful individual countries.

Exactly. We saw how countries in the West responded very differently to the pandemic based on the assessments of their health experts. A global treaty of this kind would perhaps imply that countries would no longer be able to simply close their borders when they wanted or hold back vaccines that they do not even need.

Education. We must integrate collaborative, interconnected thinking and an understanding of the interdependence of humans, animals and the environment in education at all levels – on a global scale. When schoolchildren later occupy decision-making positions – be it in the financial sector, public health or engineering – they will contribute to this "radical slow change" with their knowledge. A shared global understanding of a healthy, sustainable social-ecological system (SES) is imperative to achieve this.

Yes and no. There are more governments in Africa today with a One Health strategy than in Europe. Interestingly, many of these policies were developed with the support of donors from Europe and the USA – mostly from countries that do not yet have such a strategy themselves. This has a flipside: as soon as the funding for One Health desks, offices and positions in the concerned ministries of African states dries up, so does the interest in One Health activities. To that extent, I would question whether the fact that several African countries have a One Health strategy actually translates into decision-makers understanding the concept and recognising its need.

That is not correct. If we examine the spread of the virus at the height of the pandemic, we find no difference between African and Western countries. In fact, circulation of the virus was partly higher in Africa. The lower mortality rate and number of hospitalisation cases in African countries is largely due to differences in immune responses. There is growing evidence in research to support this.