Dr Naoko Yamamoto is Assistant Director-General, Universal Health Coverage/Healthier Populations at the World Health Organization. Prior to joining WHO, she served as Senior Assistant Minister for Global Health in Japan’s Ministry of Health, Labour, and Welfare. She also served in numerous health-related positions within the government of Japan. She holds a medical degree, a PhD in epidemiology and a Masters in Public Health.
What is the One Health initiative? To what challenges and issues does this approach respond?
I would like to start with some facts : the health of humans, animals and planetary ecosystems is closely interlinked. Changes in the balance of these ecosystems are increasingly emerging as a threat, including through infectious and non-infectious diseases. In the past 20 years, 75% of all emerging or re-emerging health hazards facing humans have been zoonotic diseases.
In this context, One Health is an approach to respond to the health risks emerging from the animal-environment interface, and to design policies and research for better public health outcomes. Through One Health, we want to better prevent diseases, especially zoonotic diseases, improve food safety, fight against Antimicrobial Resistance - AMR, and better protect our environment.
What are the challenges we are responding to? First, we are aiming to work in a more coherent and coordinated manner thanks to a cross-sectoral approach. Second, although One Health is not a new concept – it has existed for over 10 years – we need more research and data on evaluating and measuring impacts and effectiveness.
Over one year following the outbreak of the Covid-19 pandemic, which lessons do you draw for international cooperation to prevent future pandemics?
Before Covid-19, we faced, as human beings, painful experiences with other infectious diseases such as Ebola Fever and Zika Virus transmitted through animals and humans. But Covid-19 has been a wake-up call that human health cannot be considered in silo.
Thus, the first lesson learnt during the Covid-19 crisis is that we need to connect animal, environmental and human health. To do so, we should increase research in this interconnected area.
The second lesson is that the early detection and warning system is weak. We need a joint monitoring platform, that would include environment, animal and human health.
Such a multi-sectorial and multilateral system requires human resources and financing capacities and cannot be maintained without a continuous and strong political commitment.
What role can WHO play in promoting an integrated approach to prevent future pandemics?
The approach integrating human, animal, and environmental health, that I just mentioned, is part of our 5-year strategic plan adopted at the 71st World Health Assembly to advance all health-related targets under the SDGs. We have identified areas that require enhanced work: climate change, nutrition and food safety, One Health, Antimicrobial Resistance.
The WHO activities in this regard are to create a scientific database and guidelines, and to support countries to increase their national capacities, train staff, and provide technical support. We also work together with other UN agencies and engage in discussions at global level (e.g. COP26, UN Food Systems Summit) to advocate and spread our knowledge and experience.
With the Covid-19 crisis, voices are being raised in favour of a review of the International Health Regulation processes to make them more effective. How do you believe they could be revised, and how could this revision integrate a One Health approach?
The Independent Panel and Review Committee are currently reviewing preparedness for and response to COVID-19 and the International Health Regulation (IHR). They will produce recommendations. Based on this experts’ report, we, member states, will start discussions about amendments of the IHR, if it is necessary. But it may take time. In addition, there are things that are beyond the scope of IHR but should be addressed, such as joint research.
The IHR focuses on preparedness and responses for emergencies. Each country has a national IHR focal point who works to share information and to the global community through the WHO. Without necessarily changing the IHR, we can start by strengthening this focal points system, and create more dynamic hubs with collaborative networks, such as the international food safety networks, WHO collaborative centers. A strong platform for early detection and monitoring is crucial.
The Covid-19 pandemic revealed gaps in national government’s anticipation and coordination efforts in the face of a health crisis. Can a One Health approach help answer this issue, and how can it be implemented in practice by governments?
Many governments are still struggling to manage the Covid-19 pandemic, whether it be managing their health care system, obtaining vaccines, or missing basic water and sanitation services. The issue of equity has also come to the forefront during this pandemic given its disproportionate impact on vulnerable communities and individuals. When it comes to a One Health approach, the Covid-19 pandemic has also shown that when dealing with interlinked health, environment and animal health, a sectoral approach must go even further. To prevent the next health pandemic, we therefore need a One Health approach and focus on the sustainability of our ecosystems. Governments need to create One Health platforms and discuss with all sectors to enhance monitoring, training, capacity building, and research. Today, many countries are missing these foundational structures.
At the global political level, we are seeing mobilisation for a One Health approach: the French government proposed to create a High Level Expert Panel for One Health, which have supported by other countries. This Panel would gather technical experts and leaders to recommend the research agenda, data extraction and investments that should be prioritized. In this endeavour, the WHO - together with the FAO, OIE and UNEP - has a role to play: we will host this High Level Expert Panel soon and create new guidelines building on our existing expertise.
To tackle the inter-related climate and biodiversity crises, 2021 is a critical year for the international community to deliver ambitious agreements during COP15, COP26 and the UN Food Systems Summit. What space and role do you see for the One Health approach and initiative in these agreements and resulting frameworks?
COP26 has four pillars: adaptation and resilience, energy transition, clean transport, nature and finance. As the WHO, we are engaging in the COP26 and bringing in the health perspective to each of these pillars, and in this context, we will be putting forward the One Health approach as a way forward. We plan to host a youth summit in Milan prior to COP26 to hear the voices of young people, and bring those voices to the international summit.
There will also be the UN Food Systems Summit in September. WHO is working with other UN agencies to support countries to make commitments to addressing challenges related to our food systems, as food systems need to transform to ensure no harm to people and planetary health ; a One Health approach is key to realize this.
In putting forward a One Health approach more broadly, the WHO is not only working with other UN agencies and governments, but also with local governments, the private sector, research institutes, consumers and people on the ground, and civil society organizations. Working with a broader network of actors is more necessary than ever to address these pressing, interrelated challenges, especially environmental ones.
The newly installed Global Leaders Group on antimicrobial resistance of the Tripartite Joint Secretariat on Antimicrobial Resistance (WHO, FAO, OIE) has emphasized on the crucial need to strengthen the environmental dimension of the fight against AMR and increase involvement of actors in this field. How do you consider the greater integration of environmental considerations into AMR discussions?
One Health and AMR are not new concepts. Around 2010, the United Kingdom started ringing the bell about AMR issues to be tackled at global level. Science reports started showing growing evidence. In 2015, the global community adopted a Global Action Plan for Antimicrobial Resistance at the World Health Assembly. Then other international organizations endorsed it. In September 2016, a high level meeting on AMR resulted in a declaration that led to the creation of a coordination group and joint secretariat on AMR. In 2020, the Tripartite Joint Secretariat on Antimicrobial Resistance launched the Global Leaders Group and we now know that we need more emphasis on the environmental sector. We need to discuss AMR linked to soil, water, oceans.
We have come to realize that animal, human and environmental health are equally important. In the One Health approach, there are many axes: monitoring of specific resistance-profiles and AMR specific issues, emergency and risk-management, and sustainability of the planet. They might seem to be different issues, but AMR issue can address under an umbrella of One Health and they should be worked on together, coherently towards the same goal.
The long-term uptake of a One Health approach requires coordination and cooperation of One Health leaders, to think critically and work collaboratively across sectors. What should be the priorities of WHO to support the development of such a workforce?
Long term commitment is not easy. New issues always come up. WHO’s priority is to collect data and evidence. And based on data and evidence, we can propose tools, support countries in implementing best practices and approaches, participate in measuring our actions, and set short-, mid- and long-term goals.
Countries have different capacities and limitations. WHO works to increase capacity at country level through training, funding mechanisms, knowledge hubs, or other platforms to share knowledge.
The WHO Academy, which French has strongly supported and then followed by the international community, represents excellence in the knowledge of public health. Through multi-stakeholder collaboration including academia and research institutes, we already created and shared several modules, contributing in filling the gap between high income and low income regions of the world, as well as across countries.
As I mentioned, One Health is not a new concept, but we have learned from Covid-19 that we really need to adopt this approach, notably through multi-sector and multi-actor coordination. To translate One Health into practice, we can continuously invest in research, better data, for the better health of the planet and humans. In this endeavour, young people have a critical role to play.
Les analyses et propos présentés dans cet article n'engagent que son auteur. Audrey Fontaine, Junior Fellow de l'Institut Open Diplomacy, travaille sur les politiques de santé et le système sanitaire international. Audrey Fontaine, Junior Fellow de l'Institut Open Diplomacy, travaille sur les politiques de santé et le système sanitaire international. Rose Vennin, Junior Fellow de l'Institut Open Diplomacy, s'intéresse à la transition écologique et à la réduction des inégalités.