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Saturday, April 17, 2021

Why India needs a ‘One Health’ vision to tackle the crisis caused by the pandemic

'One Health' initiatives, by their multidisciplinary nature, entail working across ministries and navigating tacit institutional hierarchies and allocating leadership roles. This holistic view of health is important in the post-pandemic scenario.


Updated: April 6, 2021 8:20:08 pm
CovidPeople queue up at a vaccination centre in Pune (Express Photo By Pavan Khengre)

(Written by Rajib Dasgupta and Raman Muthusamy)

There are an estimated 25 million farmers in some form of poultry business in India producing about 4 billion broilers and 93 billion eggs a year. The industry is growing at 6-8 per cent per annum. The COVID-19 pandemic in India in its early phase (January to March 2020) had been erroneously linked to the consumption of chicken. This may have, in part, been on account of bird flu outbreaks in several states in the preceding few months. Significantly, it led to a dramatic crash in poultry consumption and prices, followed by the lockdown and its economic consequences. With the continued lack of demand from the hotel-restaurant-catering segment, the poultry industry continues to be in a state of crisis and the ongoing bird flu outbreaks across 10 states have slowed the recovery process. On the back of the pandemic, the ‘One Health’ approach has been reignited to tackle preventable conditions at the animal-human-ecosystems interface.

Well into the COVID-19 situation in India, the Government of India set up a National Expert Group on ‘One Health’ as a multi-sectoral, transdisciplinary, collaborative group in May 2019. The move recognised that several recent human pandemics, including COVID-19, influenzas (H1N1, H7N9) and Severe Acute Respiratory Syndrome (SARS) have animal origins, and that a One Health approach has long been advocated by the World Health Organisation (WHO), Food and Agriculture Organisation (FAO) and World Organisation of Animal Health (OIE). The overarching purpose is to encourage collaborations in research and sharing of knowledge at multiple levels across various disciplines like human health, animal health, plants, soil, environmental and ecosystem health in ways that improve, protect and defend the health of all species.

Till the 19th century, animal medicine and human medicine were not strictly separate and research was conducted in these two fields without clear boundaries. By the 20th century, there was a veritable explosion of scientific knowledge and medicine became increasingly specialised and professionalised; human medicine and veterinary medicine thus diverged. Sir William Osler promoted the term “One Medicine” – embracing animal and human medicine – in the 19th century and Dr Calvin Schwabe revived the concept in veterinary public health.

‘One Health’  was later proposed as a concept for interdisciplinary collaboration, and soon environment health was factored in too. The Pilanesberg Resolution in 2001 was targeted at multilateral and bilateral donors and governmental authorities to consider potential wildlife health impacts in development projects. The Wildlife Conservation Society (WCS) introduced the term “One World-One Health” in 2007 along with 12 recommendations (the Manhattan Principles) that focused on establishing a more holistic approach to preventing epidemic disease and maintaining ecosystem integrity.

Covid-19 A man gets vaccinated against Covid-19 (Express photo by Praveen Khanna)

What is often not reckoned with is the fact that the most important barriers to multisectoral action are political, not technical. The articulation or framing of the problem can be in terms of development, equity, economic or health gains; the extent to which this resonates with high-level political agendas is crucial to achieving buy-in from different sectors. One Health initiatives, by their multidisciplinary nature, entail working across ministries and navigating tacit institutional hierarchies and allocating leadership roles. ‘One Health’  consortia may also not though succeed fully if they remain a purely governmental endeavour; the cooperation and active engagement of individuals, communities and society are needed.

Multi-sectoral action in health has been categorised into four broad types: One, where the health sector is a minimal actor (e.g. ensuring children attend school); two, where the health sector has a supporting role (e.g. in cross-sectoral policies to address health disparities); three, where the health sector is a bilateral or trilateral partner to produce joint or “co-benefits” and maximise health benefits (e.g. tobacco taxation to improve both health and revenues); and four, where the health sector takes the lead where collaboration is essential for it to deliver its core mandate (for example, ensuring adequate water and energy supplies to health facilities).

There are already several cross-cutting efforts operating in India to develop protocols for a database of research into zoonotic diseases. But to date, there is no single agency or framework that embraces all interdisciplinary sectorial players under a single umbrella to carry forward the ‘One Health’  agenda — even in this difficult time. Inarguably, the National Expert Group has a tough mandate: To “promote multi-sectoral, transdisciplinary collaboration and cooperation.” Accountability, transparency and trust are essential to drive such action, but can remain elusive.

Much will depend on the vision, core values and guiding principles of how the Expert Group approaches multi-sectoralism and transdisciplinarity. “Strong man” leadership is rarely fit for the purpose. The key to success will be consultative and collaborative leadership — cultivate champions in different sectors who can agree on common objectives — that promotes innovation, adaptation and flexibility in terms of political, financial and administrative accountability. Success is likely if One Health initiatives are institutionalised in existing structures and not championed by novel structures outside of mainstream systems.

The recently announced Prime Minister Atmanirbhar Swasth Bharat Yojana (PM-ASBY), supported by a Rs 3,500 crore loan from the Japan International Cooperation Agency (JICA), to boost the fight against the COVID-19 pandemic in India shall hopefully use One Health as a foundational principle. India being home to a large portion of the world’s livestock farmers, the absence of a policy framework that ratifies the ‘One Health’ approach in development and health policies is a major hurdle in eliminating poverty and poverty-related diseases. We await a vision, a strategy and a roadmap for India’s ‘One Health’ agenda.

(Rajib Dasgupta, Jawaharlal Nehru University and Raman Muthusamy, Tamil Nadu Veterinary and Animal Sciences University are co-investigators in the GCRF One Health Poultry Hub, an international One Health research programme working in India, Bangladesh, Sri Lanka and Vietnam exploring safer, more sustainable poultry systems which will reduce the risk of zoonotic disease outbreak locally and globally.)

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