Invest In Integrated Public Health Model

Unlike any other outbreaks of infectious disease in recent times, COVID-19 sparked a global health, economic, and societal emergency for almost three years. Thanks to the unprecedented speed with which vaccine was developed and made available to people throughout the world, the pandemic is no more public health emergency of international concern. Although the fatal viral disease has killed more than 6.8 million people as of May this year, with true mortality being possibly more than three times and numbers continuing to rise. The new projection reveals that the impact is more severe than previously speculated, and far exceeds the $10 trillion estimates released in 2020 (WB, 2021). 

Zoonotic diseases

The World Organisation for Animal Health (2023) has estimated that more than 60 per cent of total infectious diseases, including over two-thirds of emerging and re-emerging diseases in humans, originate from domestic animals or wildlife. At the same time, almost 80 per cent of pathogens of bioterrorism concern originate in animals. Humans and animals live in the vicinity and often share the same environment, and at the same time share numerous pathogens among them. Several pathogens that originated from animals can be transmitted to humans and vice versa. Such diseases are termed zoonotic. For such transmissions between humans and animals, the environment plays a crucial role. Therefore, a multi-sectoral engagement becomes important to reduce such transmission. The concept of “one health” is being promoted to address upcoming public health problems. 

As the world population increases, human populations are encroaching upon new geographic areas for meeting growing needs for food, thus limiting areas for wildlife. This trend has caused more people to live in close contact with wild and domestic animals. Both livestock and pets play a vital role in human lives that can range from food, fiber, livelihoods, or companionship. However, being in close contact with animals and their environment creates more chances for pathogens to cross between animals and humans. 

As to meet the growing demands of food for the increased population, the earth has experienced unique alterations in climate and land use patterns. Deforestation and intensive farming practices are some examples. Moreover, such alterations in environmental conditions and habitats have provided new avenues for disease-causing pathogens to pass to animals and to humans and vice versa. At the same time, increase international travel and trade of animal products may provide unique opportunities for disease-causing pathogens to spread across borders and reach globally. 

The cumulative effects of climate change, land use patterns, and increased international travel and trade have led to the spread of both endemic, and new or, emerging zoonotic diseases. Such diseases affect millions of people and animals around the globe and accounts for significant proportions of deaths every year.  Zoonotic diseases such as rabies, salmonella infections, avian flu, West Nile Virus infection, anthrax, ringworm, and Ebola are a few examples of diseases of public health importance. 

Investment in an integrated public health approach results in early warning of risks, help prioritise resource allocation and promote equitable distribution of services to the people. It is important to note that investments in public health are highly effective to prevent disease outbreaks along with other benefits such as improvement in quality of life. 

Many of the sustainable development objectives are interrelated and efforts in one area result in benefits in other areas too. An integrated approach such as one health has been shown to have beneficial effects not only to prevent the transmission of zoonotic diseases but also to have additional benefits in areas of agriculture, food production, and environmental protection. The complex nature of the interactions between people, animals, and plants ecosystem makes one health approach critical to addressing future health risks and challenges. For example, reducing deforestation would generate benefits of billions of dollars from lowering carbon dioxide emissions and its positive effect on human health.

In the past, our approach to the pandemic was to focus on containment and control once a disease has appeared. This approach is often costly and causes havoc among people and is myopic. Moreover, investing in disease prevention is often scarce in resource-limited countries and scattered among many interrelated issues than to integrate approaches such as one health.  

Policy initiative

Human activity is the principal reason for new, emerging, and re-emerging diseases. As population increases and human societies extend encroachment on natural habitats, they disrupt the ecological equilibrium resulting in the spread of animal pathogens to human populations. Similarly, increased urbanisation correlates to increases in allergies, asthma, and other chronic diseases in humans. The use of antibiotics as a growth promoter in animal food production can be another example of the growing antibiotic resistance problem in humans. 

The current undertakings in one health approach of the Government of Nepal are grossly not sufficient to tackle upcoming public health problems. However, the government has initiated some efforts to tackle problems related to AMR, avian flu, and rabies. There are several hindrances to the implementation of one health approach such as weak organisational structure, low level of technical expertise, lack of legal framework, and insufficient coordination and data sharing among organisations working in human, animal, and environmental health. Therefore, it is called upon to raise awareness among policymakers for promulgating appropriate policies and guidelines. At the same time, increasing focus and investment in one health approach is urgently needed for our country. 

(Dr. Lohani is the clinical director at the Nepal drug and Poison Information Centre. lohanis@gmail.com)