From a scourge and an enemy to be beaten, to a wake-up call and an opportunity to build back better, the COVID-19 pandemic has been called many things.
Those working in the public health, animal health, and environment sectors agree on this: As we build back better post-pandemic, we must step up One Health efforts to better prepare for and respond to outbreaks of zoonotic diseases.
What is One Health?
One Health recognizes the close connection between people, animals and our environment. It provides an integrated, unifying approach so that health threats can be addressed holistically, with experts from multiple sectors working together.
“It’s not that One Health is new. We’ve been working with countries and UN partners in the WHO European Region for many years on tackling zoonotic and vector-borne diseases, or other challenging issues such as antimicrobial resistance, with One Health in mind,” says Peter Sousa Hoejskov, Technical Officer for Food Safety and Zoonotic Diseases, at WHO/Europe.
“But COVID-19 has turned everything upside down,” he adds. “It has certainly made countries and the international community sit up and recommit to bolster One Health efforts. The need to rethink the whole health system, to set up governance structures, funding streams, and forge a better way to work in an integrated fashion – that all came out of COVID-19.”
One Health support tailored to countries’ needs
Hoejskov has seen, first-hand, how these renewed commitments have been put into practice.
Since 2021, he has worked with partners to roll out workshops – at countries’ request – across the Region. The workshops have aimed at reinforcing the One Health approach to zoonotic disease prevention and control.
Some workshops have looked at building knowledge and capacity in integrated surveillance and information sharing, others at formalizing and strengthening collaboration amongst different sectors, and others still at equipping countries to better prepare for and respond to outbreaks of zoonotic diseases.
“In some countries, for example in Azerbaijan, in March 2023, we focused on strengthening coordination mechanisms to address zoonotic diseases,” explains Hoejskov. “So, we looked at how different ministries and agencies work or don't work together; how they share information; and how they coordinate their interventions when it comes to surveillance or outbreak response.”
“Another area we have been focusing on is helping countries create operational frameworks on preparedness for and response to zoonotic disease outbreaks. These frameworks set out roles and responsibilities, spelling out what the different ministries can do on their own and what they need to do together. These frameworks are not just words on paper. They are legal instruments, ensuring greater compliance and accountability,” concludes Hoejskov.
To date, 8 countries and areas – Albania, Armenia, Azerbaijan, Croatia, Kazakhstan, Kosovo*, Romania and Serbia – have benefitted from these workshops, and more countries – including Bulgaria, Georgia and Kyrgyzstan – will benefit from such workshops in 2023 and beyond.
The case of Serbia, Kazakhstan and Romania
In Serbia, a One Health workshop led by WHO/Europe and the World Organization for Animal Health (WOAH) was held in December 2021.
It brought together representatives from Serbia’s Ministry of Health, Veterinary Directorate of the Ministry of Agriculture, and National Institute of Public Health, and zoonoses epidemiologists and other experts from the Belgrade city institutes of public health, regional veterinary institutes, the University of Belgrade and University of Novi Sad.
The participants learnt how to carry out a joint field investigation during a zoonotic disease outbreak, using a methodology created and successfully tested by WHO, the Food and Agriculture Organization (FAO) and WOAH, and learnt about other countries’ experiences in tackling zoonotic diseases.
The event saw the establishment of a working group that later, through the course of 2022, developed a national protocol for joint field investigation and response to priority zoonotic diseases outbreaks, with the support of WHO/Europe and WOAH. The protocol has been endorsed by the Ministry of Health and is set to be endorsed by the Ministry of Agriculture as well.
“Many of today’s health threats require a One Health approach. Although the cooperation between sectors always existed in Serbia, the protocol provides us with a formal framework for cooperation and sharing of responsibilities between sectors,” said Dr Dragana Dimitrijevic, Head of the Department for Epidemiological Surveillance within Serbia’s National Institute of Public Health, and Chair of the working group that developed the protocol.
In Kazakhstan, 25 people – government representatives and laboratory, food safety, biosafety, veterinary and ecology experts from 8 public and animal health ministries and organizations as well as academia – came together for a 3-day workshop in 2021.
The participants helped refine a new One Health operational tool – a stepwise algorithm to assess and strengthen multisectoral coordination, developed by WHO, FAO and WOAH – as the organizations sought to test the tool before rolling it out globally.
The workshop culminated in the development of an action plan for implementing One Health in different areas of work, which was then incorporated into Kazakhstan’s national health strategy, Healthy Nation 2025, shared by 4 ministries focused on health, agriculture, ecology and emergencies.
In 2022, the country conducted an analysis of existing legislation on intersectoral collaboration at the human-animal-environment interface. The resulting recommendations on improving collaboration in food safety, control of zoonotic diseases and antimicrobial resistance (AMR) are now being fed into updated national legislation, to be finalized by 2025.
The workshop bore fruit in other areas, too. Dr Zaure Akhmetova, Deputy Chair of the Committee for Sanitary and Epidemiological Control of Kazakhstan’s Ministry of Health explains, “With WHO’s support, we held a number of training and educational events on food safety, biosafety, AMR and laboratory surveillance for public health and veterinary experts. As a result, Kazakhstan was the first country in the world to benefit from the Global Laboratory Leadership Programme, which is based on One Health principles. Thanks to WHO/Europe, we have made our cross-sectoral labs stronger, and built a roadmap to combat AMR.”
In Romania, the principles gleaned from the 2022 One Health workshop have already been put to good use in real-life situations that have since emerged.
“Zoonotic diseases continue to pose a threat in the European Region, and Romania is no exception,” says Vadym Zavatskyi, One Health expert with WHO in Romania. “With recent avian influenza cases reported in the country, the animal and public health services are on alert, and the virus is monitored closely. This is a clear example of multisectoral collaboration rooted in a One Health approach. The 2022 One Health workshop has no doubt helped strengthen collaboration and response to zoonotic diseases.”
WHO/Europe is also holding subregional One Health workshops, more recently in February 2023, when it brought together countries in the Western Balkans to support their response to foodborne and zoonotic diseases.
* All references to Kosovo, whether the territory, institutions or population, in this text shall be understood in full compliance with United Nations Security Council Resolution 1244 (1999) and without prejudice to the status of Kosovo.