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Achieving a common good

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WORKING for the common good is not a very fashionable concept these days but it might usefully be revived in the context of One Health and might even make a good slogan. This thought is prompted by a remark by Sarah Cleaveland, of the University of Glasgow, during a panel discussion on One Health at a conference in Cambridge this week. When the panel was asked what might be done to break down some of the mistrust around One Health that seems to exist in the medical profession, and to encourage more engagement, Professor Cleaveland replied that ‘achieving a common good’ could be a unifying factor. Eric Fevre, of the University of Liverpool, who was also on the panel, agreed, noting that medics who were interested in solving a particular problem got very involved in One Health; the problem was that many either didn't know about, or weren't involved in dealing with, the issues it was trying to address, and he believed that education had a part to play in changing this.

The discussion took place in a session on One Health during a five-day conference on ‘Challenges in disease elimination’, held in Cambridge from September 12 to 16. Organised by the Royal Society of Tropical Medicine and Hygiene (RSTMH), the meeting looked at some of the challenges involved in eliminating diseases such as polio, tuberculosis and malaria, as well as the neglected tropical diseases, including rabies, as defined by the World Health Organization (WHO). In addition it hosted the inaugural Soulsby Lecture, held in honour of veterinary parasitologist Lord Soulsby, a proponent of One Health, which was given by fellow veterinary parasitologist, Lord Trees. It was perhaps fitting that this inaugural lecture took place just a week after the G20 summit meeting in China, at which world leaders agreed on the need to take action on antimicrobial resistance (see p 266 of this issue). Lord Soulsby chaired a House of Lords Science and Technology Committee inquiry which, in 1998, produced a report on antimicrobial resistance highlighting many of the issues that, almost 20 years later, are now worrying world leaders.

In his lecture, Lord Trees discussed the increasing relevance of One Health at a time when the connectivity between human, animal, plant and environmental health is becoming more apparent. Zoonoses represented the most obvious example of where a One Health approach was appropriate, but it was by no means the only one; others included antimicrobial resistance, drug development, animals as models of disease in a real world setting, disease surveillance and delivery of healthcare. Referring particularly to river blindness, caused by the filarial worm Onchocerca volvulus, he explained how research on Onchocerca species infections in cattle had shed new light on the disease, illustrating how, by taking a holistic view, it was possible to obtain new insights into diseases and potential treatments.

Giving a presentation at the meeting, Professor Cleaveland explained how a One Health approach could lead to fairer and more effective interventions in efforts to eradicate endemic zoonoses, which, she pointed out, disproportionately affect the world's rural poor. Such communities had limited access to human and animal health services and, she suggested, there was a need to think more creatively about how to provide those services, and how to link disease interventions, rather than considering them separately. National and global health initiatives had tended to address emerging and endemic zoonoses as distinct priorities but, she suggested, aligning these priorities within a One Health framework could provide a more effective and equitable approach to improving health for all, reducing disease threats in both high- and low-income countries.

Discussing rabies, Professor Cleaveland noted that mass vaccination of dogs had been shown to be both feasible and cost-effective in terms of eliminating the disease in people; the challenge now was to put these findings into effect. Implementation was key, and with rabies, as well as for other diseases, one approach was to build ‘platforms of trust’ that could encourage application at a local level.

Professor Fevre discussed disease surveillance at the human-animal interface, noting that surveillance for zoonotic diseases required an understanding not just from a human perspective but also in terms of the epidemiology of the disease in animal reservoirs and, where appropriate, the environment. Referring to work by Jonathan Rushton, at the Royal Veterinary College, he explained how ‘value chains’ provided a good way of understanding how food chains interconnected and the points at which people might be at greatest risk of exposure to pathogens. This, in turn, allowed surveillance to be targeted more effectively.

Bernadette Abela-Ridder, team leader on neglected zoonoses at the WHO, argued that eliminating these diseases in communities where people depended on and lived in close proximity to their animals was integral to efforts to improve heath and wellbeing, and, in many respects, should be seen as a starting point for all of the Sustainable Development Goals of the United Nations. A One Health approach, involving all relevant sectors, was vital, but questions remained about how best to achieve this; there was a need to think about how to prioritise work in terms of the benefits to animal and human health, and also about how to share costs.

In a presentation drawing attention to the benefits of One Health beyond the early detection and control of zoonoses, Esther Schelling, of the Swiss Tropical and Public Health Institute in Basel, discussed the importance of involving all relevant stakeholders in discussions and providing evidence of the added benefits and synergies that a transdisciplinary approach could bring.

As at other conferences on One Health, it was clear from the discussion at the RSTMH meeting that, for all the obvious advantages, concern remains about how to get more people to buy into and apply the concept, and about how to get more members of the medical profession involved (see, for example, VR, August 8, 2015, vol 177, p 134). Against this background, it would nice to think that ‘achieving a common good’ might turn out to be a unifying theme.

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