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Introduction

On February 23–25, 2021, a planning committee convened by the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine (the National Academies) held a 3-day virtual workshop titled Systematizing the One Health Approach in Preparedness and Response Efforts for Infectious Disease Outbreaks.¹ The workshop gave particular consideration to research opportunities, multisectoral collaboration mechanisms, community-engagement strategies, educational opportunities, and policies that speakers have found effective in implementing the core capacities and interventions of One Health principles to strengthen national health systems and enhance global health security. It featured presentations on the following topics:²

• Strategies to systematize One Health in national prevention, detection, preparedness, and response efforts;
• A review of One Health programs integrated into national and global public health efforts to learn what programs are currently in effect;

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¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

² The full Statement of Task is available in Appendix A.

• Integration of animal and human health surveillance systems for cross-reporting to better understand pathogens transmitted between animals and people;
• Feasibility of introducing and integrating One Health into existing coordination mechanisms and into national action plans for health security based on the Joint External Evaluation;³
• Strengthening the global health workforce with One Health capacities;
• Policies that underscore the interconnectedness of animal, plant, human, and environmental/ecosystem health;
• Implications of using a One Health approach to improve preparedness versus a reactive response that is required to apply medical countermeasures after the onset of an outbreak;
• Promising practices for engaging with communities and influencing behaviors that lower the risk of infectious disease through the One Health approach;
• The tension between public health needs, the private sector, and data sharing within the One Health context in preparedness and response efforts; and
• Potential priority actions to unite organizations—public and private, domestic and international—in efforts to overcome newly discovered hurdles based on lessons learned from the COVID-19 pandemic.

ORGANIZATION OF THE PROCEEDINGS OF THE WORKSHOP

In accordance with National Academies policies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on information presented, questions raised, and improvements suggested by individual participants. Chapter 2 presents the workshop’s keynote address, which outlined the One Health concept, gaps in current pandemic surveillance and response efforts, and strategies for continued integration of this approach into practice. Chapter 3 examines implementation of One Health practices that were presented in case studies of ongoing public health initiatives and research and interventions conducted in response to the COVID-19 pandemic. Chapter 4 explores current methods and challenges of integrating One Health ideology into existing epidemiological surveillance systems, as identified in two panel discussions. Chapter 5 summarizes two plenary presentations addressing potential steps to build the future One Health workforce and

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³ For more information, see https://www.who.int/ihr/procedures/joint-external-evaluations/en (accessed May 25, 2021).

experiential-learning initiatives currently under way. Chapter 6 summarizes four plenary presentations focusing on recently developed capabilities and innovation, collaboration, and investment efforts that could substantially mitigate future pandemic threats. Chapter 7 reviews the feasible goals and steps to improve future outbreak preparedness efforts that panelists discussed in breakout rooms.

Opening Remarks

One Health is a collaborative, multilevel, transdisciplinary approach to preventing, detecting, preparing for, and responding to outbreaks of infectious disease. Fundamentally, it recognizes the interconnectedness of the health of people, animals, plants, and their shared environment. One Health has the goal of achieving optimal health outcomes for people, animals, and the environment. It addresses diverse issues, including zoonotic diseases (those spread from animals to humans), emerging infectious diseases (e.g., coronavirus disease 2019 [COVID-19], antimicrobial resistance, food safety and food security, vector-borne diseases, wildlife diseases, and other shared health threats) (CDC, 2018). At the time of the workshop, the ongoing COVID-19 pandemic had raised worldwide awareness of the threat posed by infectious diseases and the need to improve prevention and response capacities. New opportunities have thus emerged to advance One Health initiatives and establish worldwide, collaborative pandemic prevention and response systems to enhance global health security.

Casey Barton Behravesh, director of the One Health office at the U.S. Centers for Disease Control and Prevention (CDC) and member of the workshop planning committee, gave welcoming remarks and explained that the workshop was organized with the goal of examining ways to systematize and integrate the One Health approach as part of the outbreak prevention, detection, preparedness, and response apparatus. This included examining successful implementations of One Health at local, national, and international levels; identifying gaps and challenges; and discussing future capacity building. Created in 1996, the Forum on Microbial Threats provides structured opportunities for discussion and scrutiny of critical—and possibly contentious—scientific and policy issues related to the prevention, detection, surveillance, and response to emerging and reemerging infectious diseases in people, plants, and animals, as well as the microbiome in health and disease. To this end, the Forum on Microbial Threats convenes workshops spanning a range of issues. Recent topics have included exploring the frontiers of innovation—including diagnostics, vaccines, and antimicrobials—to tackle microbial threats (NASEM, 2020); the growing understanding of how the interplay between people and microbes affects host physiology and noncommunicable diseases (NASEM, 2019a); and

lessons learned from influenza pandemics and other major outbreaks that can be applied to better prepare countries for future pandemics (NASEM, 2019b).

Barton Behravesh provided context regarding the critical aspects of the One Health approach relevant to preparing for and responding to infectious disease outbreaks. She noted that even the fields of chronic disease, mental health, injury, occupational health, and noncommunicable diseases have benefited from a One Health approach. With applications at the local, regional, national, and global levels, One Health has gained momentum in every region across the world over the past decade, including within the United States.⁴

This momentum is in part driven by public health emergencies, such as Ebola virus disease and the COVID-19 pandemic, Barton Behravesh explained. Global health initiatives, such as the World Health Organization’s (WHO’s) International Health Regulations (WHO, 2008b) and the promotion of veterinary services performance by the World Organisation for Animal Health (OIE), have also increased awareness about the critical need for a One Health approach (OIE, 2012). Barton Behravesh noted that One Health is increasingly recognized by governments, the private sector, nongovernmental organizations, academic partners, and others as an effective way to combat health threats that affect people, animals, plants, and the shared environment. No single person, sector, or organization can adequately address issues at the human–animal–environment interface alone, Barton Behravesh maintained. Instead, effective preparedness and response efforts to these shared health threats require a One Health approach that emphasizes multi-sectoral collaboration and interdisciplinary partnerships. Collaboration, communication, and coordination across all relevant sectors and disciplines allow for effective planning and implementation of responses to zoonotic and infectious disease threats at all levels.

Emerging and endemic zoonotic diseases pose a threat to not only the health of people, animals, plants, and ecosystems but also global health security. Barton Behravesh explained that One Health is an important component of advancing the Global Health Security Agenda (GHSA),⁵ a global effort to strengthen the world’s ability to prevent, detect, and respond to infectious disease threats. Scientists estimate that 60 percent of known infectious diseases and 75 percent of emerging infectious diseases are zoonotic (Taylor et al., 2001). The COVID-19 pandemic has highlighted the value of One Health coordination, collaboration, and communication during a pandemic response, Barton Behravesh claimed. The impact of One

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⁴ For a review of challenges in the design and implementation of a One Health approach, see Ribeiro et al. (2019).

⁵ For more information, see https://ghsagenda.org (accessed May 26, 2021).

Health collaboration can strengthen health systems, improve interagency communication and global health security, develop a proactive agenda, and maximize health outcomes for all.

Barton Behravesh also acknowledged that the transdisciplinary conservation medicine, EcoHealth, and planetary health approaches to protecting the health of humans, animals, plants, ecosystems, and the planet recognize that humans and animals share environmental challenges, the risk of infectious diseases, and other aspects of health. Hence, the EcoHealth, planetary health, and One Health initiatives are interrelated.

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