The entire world faces complex challenges related to the rapid spread of the serious coronavirus that causes the condition "coronavirus infectious disease," or COVID-19. Epidemiologists and virologists are working hard to understand where the virus came from, how it has adapted to humans, and how it is spreading. Although the exact source of the virus is still uncertain, currently available evidence points toward horseshoe bats (Rhinolophus affinis) and pangolins appear to have acted as intermediate hosts that would have allowed transmission to humans in the Wuhan region[1], followed by rapid spread across China, Europe and the rest of the world.
The possibility of new viruses emerging in wild or domesticated animals is well known (e.g., HIV/AIDS, the highly pathogenic avian influenza H5N1, swine flu H1N1, Ebola virus, Middle East Respiratory Syndrom MERS, etc.). The first SARS epidemic in 2002 showed the devastating impact that coronaviruses can have. It can lead to massive economic disruptions, high mortality rates and the possibility of re-emergence[2].
Human, animal and environmental health: everything is interconnected
Diseases transmitted between animals and humans, called zoonoses, are becoming increasingly common as the distance between humans and wild animals decreases, making interactions between them more frequent. The increasing demand for raw materials and resources such as timber, minerals, fuel and cropland, mainly for the production of animal feed, is leading to global ecosystem degradation and ecological disruption. Intensive or industrial agriculture is often presented as the solution to feed the world's growing population, but causes widespread loss of biodiversity; soil and water pollution; and high greenhouse gas emissions. The intensification of livestock production also increases the risk of disease transmission due to the proximity of large numbers of animals in confined spaces. This mainly plays a role in countries where livestock production is developing rapidly, but where the necessary hygiene measures involved are not sufficiently observed. Deforestation caused by logging, mining, road construction and rapid urbanization leads to disruption of wildlife habitat. This causes wild animals to move and may cause these species to interbreed with other animal species and with humans, increasing the risk of spreading zoonotic pathogens[3].
All these changes are occurring at an unnatural rate and contributing to more frequent and intense contact between humans and wildlife that can act as "reservoirs" of new zoonoses.
One Health is essential to address complex health crises
The current pandemic of the COVID-19 coronavirus highlights once again that human and animal health are interrelated and linked to the health of the ecosystems in which they live. This interconnectedness between the health and well-being of humans, animals and the environment is known as "One Health. One Health as a concept was developed to respond more adequately to the spread of serious infectious diseases and zoonoses by taking an integrated approach to health[4]. After many unsuccessful attempts to properly address complex health crises, it became clear that collaboration between different disciplines - involving researchers, laboratories, government agencies and civil society - is fundamental to addressing the spread of disease from all possible angles and combating infectious diseases.
Despite efforts to operationalize One Health, infectious disease monitoring and control systems are still not always shared among medical, veterinary and environmental disciplines worldwide. When there is effective collaboration, we are better prepared to respond quickly and effectively to emerging infectious diseases. For example, veterinarians and ecologists play a central role in identifying "reservoirs" for zoonoses in both wild and domesticated animals.
Especially in low-income countries, these multidisciplinary partnerships are essential to maximize the use of the limited resources available to achieve public health improvements. The fact that in Africa and Southeast Asia more than 241 million people become ill each year and 312,000 die from food-related illnesses[5] (many of which are directly linked to the consumption of contaminated water or food of animal origin) clearly demonstrates that there is no health and food security without food safety and hygiene. Solving these complex problems requires concerted efforts from different sectors: medics; veterinarians; microbiologists; clean water, sanitation and hygiene experts; sociologists; gender specialists, economists, etc.
To limit the (further) spread of COVID-19 coronavirus, it is critical to understand that each local context is unique. They are unique from a sociocultural perspective, but they also differ in the infrastructure available or the conditions under which people live. Millions of people do not have good access to (potable) water (44% of the urban population in African countries do not have access to piped water and this percentage increases dramatically in rural areas)[6]. People without good access to clean water will struggle to implement current hygiene recommendations from medical authorities - such as hand washing to prevent the spread of COVID-19. Social distancing ("social distancing") is difficult to implement when large groups of people depend on the informal economy for their livelihoods and often live and work with many people in small spaces.
Tailored solutions and messages will need to be developed to ensure that populations apply the advice and thereby effectively limit the spread of the virus. The role of NGOs, local civil society and community leaders who know the local context well is fundamental to developing tailored prevention strategies in (rural) areas poorly served by public services where government and proper medical facilities are often absent. Again, all this must be done within the framework of a collaborative health approach, One Health. Important here is an integrated approach according to the One Health principle.
A paradigm shift
In the current situation, the One Health approach is proving to be important not only in response to a specific health crisis, but also to rethink the basis of our societies and production systems. Exploring how human, animal and environmental health systems can work together is an important part of learning from the current crisis to strengthen our resilience during this pandemic and to prepare for new threats such as future pandemics and the effects of climate change.
The global crisis caused by COVID-19 is more than a public health emergency. It is a political, economic and social crisis that will have long-term consequences for people's economic well-being, their habits and the role of politicians in dealing with complex emergencies on a global scale. To find ways out of this crisis, we urge a deep examination of our current production systems, consumption and (international) trade[7]; of local and international markets, and of agriculture and animal husbandry.
Sustainable agricultural systems, such as agroecology, can help restore the balance of the ecosystem by producing healthy food in an environmentally friendly way, protecting biodiversity, promoting fair and sustainable market channels, supporting local food chains and respecting animal welfare. These will all contribute to the well-being of people, other living things and entire ecosystems.
Amidst all the measures to contain the virus, restrictions on movement and international transportation, local food chains are proving much more resilient than large-scale industrial agriculture whose complex value chain is fragmented and dependent on international trade. Local food systems, small-scale agriculture and agroecological initiatives need to be strongly supported globally. Globally, small-scale farmers supply 70% of the food in markets, providing a pillar of food security while conserving natural areas and biodiversity through sustainable farming and ranching practices.
If we want to be better prepared for emerging infectious diseases, we must embrace One Health in all its aspects: by collaborating across medical, veterinary and environmental disciplines, by strengthening public health services, but also by dramatically changing our relationship as societies and economies to nature, starting with supporting local food chains, small-scale farmers and agroecological production methods.
Authors:
Margherita Gomarasca, coordinator Vétérinaires Sans Frontières International (coordinator@vsf-international.org)
Giorgia Angeloni, President Vétérinaires Sans Frontières International (giorgia.angeloni@gmail.com)
Sarah Farrand, coordinator Vétérinaires Sans Frontières-NL (coordinator@dierenartsenzondergrenzen.nl)
References:
[1] Lam, T.T., Shum, M.H., Zhu, H. et al. Identifying SARS-CoV-2 related coronaviruses in Malayan pangolins. Nature (2020). https://doi.org/10.1038/s41586-020-2169-0 [2] Vincent C. C. Cheng, Susanna K. P. Lau, Patrick C. Y. Woo, Kwok Yung Yuen (2007) Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection. Clinical Microbiology Reviews Oct 2007, 20 (4) 660-694; https://cmr.asm.org/content/20/4/660 [3] https://www.theguardian.com/environment/2020/mar/18/tip-of-the-iceberg-is-our-destruction-of-nature-responsible-for-covid-19-aoe [4] https://www.cdc.gov/onehealth/basics/history/index.html [5] https://www.who.int/news-room/detail/03-12-2015-who-s-first-ever-global-estimates-of-foodborne-diseases-find-children-under-5-account-for-almost-one-third-of-deaths [6] https://www.oecd.org/water/GIZ_2018_Access_Study_Part%20I_Synthesis_Report.pdf [7] https://www.nuevatribuna.es/articulo/sociedad/covid19-coronavirus-pandemia-sistemaalimentario-desabastecimiento-alimentos-cultivos/20200330152535172851.html