Emerging infectious diseases, antimicrobial resistance, climate change, food safety and security, and the growing burden of non-communicable diseases were identified as some of the most pressing challenges to global health security at the Second International Symposium on One Health Research (ISOHR) held in Guangzhou, China on 23–24 November 2019. The symposium was jointly organized by Sun Yat-sen University (China), Griffith University (Australia), South China Agricultural University (China) and Guangzhou Medical University (China). A transdisciplinary collaborative approach, known as One Health, was identified as a key opportunity to promote human, animal and environmental health within and between countries around the world.1 The symposium sought to facilitate a shared understanding of transdisciplinary synergies and the need for a multi-sectoral collaboration in research and practice to tackle the growing threats to global health security.
The ISOHR brought together more than 260 experts, scholars and emerging researchers from China and around the world in as diverse areas as public health, clinical medicine, veterinary medicine, laboratory science, food safety, environmental health, agricultural science, military medicine, health systems and policies. More than 50 organizations including multiple Chinese Government departments and research institutions, and representatives from World Health Organization, Centers for Disease Control (USA), and Queensland Government (Australia) participated in the symposium.
Over the past two centuries the world has witnessed spectacular innovations and successes in public health and medical science. The most notable among those were the invention of vaccines (1796 AD) and antibiotics (1928), the eradication of small pox (1979) and the introduction of a simple, low-cost oral rehydration therapy (sugar-salt-clean water solution) for treatment of dehydration caused by diarrhea. Collectively, these innovations have saved tens of millions of lives.2–4 These achievements may have provided a sense of complacency to some for wining over epidemic diseases. Ironically, this complacency was challenged by the emergence of some of the deadly diseases such as human immunodeficiency virus (HIV) in the 1980s, severe acute respiratory syndrome (SARS) in 20025, and lately, the 2019 coronavirus disease (COVID-19).
The novelty of the virus, and the nature and speed of the interspecies and cross-border transmission of COVID-19 prompted World Health Organization to declare it a ‘Public health emergency of international concern’6, whereas SARS prompted the overhaul of the global health governance mechanisms resulting in the International Health Regulations 2005.7
Infectious diseases
The ISOHR observed with a great concern that over the past five decades, the world has witnessed the emergence of about 40 new diseases including Legionnaires' disease, HIV/AIDS, hepatitis C, mad-cow disease, SARS, Middle East respiratory syndrome (MERS), Nipah and Ebola virus diseases. Twenty of these diseases were found in China alone.8 Many of these new diseases along with the existing climate-sensitive vector-borne diseases such as dengue, Zika and West Nile virus, remain ongoing threats to health security worldwide.9 Many emerging diseases, after a period of absence or being controlled, re-emerge as epidemic with devastating impacts. For example, dengue in Bangladesh in 201910, measles in the Pacific since 201711 and polio in the Philippines in 201912. Malaria, multidrug-resistant tuberculosis, HIV/AIDS, neglected tropical diseases and viral hepatitis are affecting billions of people worldwide, and are responsible for more than 4 million deaths annually, where the vast majority are in low- and middle-income countries (LMICs).13 The ISOHR noted that approximately 75% of emerging diseases originate in animals (zoonoses) with greater frequency of outbreaks and significantly higher burden in LMICs than high-income countries.14–17
The ISOHR acknowledged the role of economic globalization in the twenty-first century and the associated growth in tourism and trade. These and other developments have significantly increased the mobility of populations and trade in goods worldwide and increased the risk of infectious disease spread across regions and countries. In some areas this has resulted in a continuing epidemic and pandemic threat. The impact of global climate change, agricultural intensification, rapid economic growth combined with population growth and urbanization, further complicate public health challenges globally and more specifically in LMICs.18 Today, more than half of the world’s 7.7 billion population live in the South Asia and South-East Asia—a region which includes China, India, Indonesia, Bangladesh, Pakistan and Vietnam.19 This densely populated region hosts some of the fastest growing economies in the world, and faces a wide range of challenges including climate change, food safety and emerging infectious disease threats. Many of these countries are often dubbed as ‘emerging disease hotspots’.20
In the recent past, the region has experienced some of the deadliest epidemics resulting in formidable losses not only to health but also impacting heavily on their economies with substantial sociological and political repercussions.20 For example, after the 2002–03 SARS pandemic21, which caused enormous losses to health and economies of over 30 countries, the highly pathogenic avian influenza (H5N1) has become endemic in parts of China and other countries in the region including Bangladesh, Indonesia, and Vietnam, and in parts of Africa.22 The combination of avian and human strains in a favorable environment can result in a sustained spread from birds to human, and then human to human with a potential for a pandemic causing large-scale illnesses and deaths worldwide. There is an overwhelming body of evidence that infectious disease occurs at human-animal-environment interface and that their transmissions and the magnitude of impacts are influenced by many factors including behavioral, social, environmental, and cultural.20 These recognitions have been the catalyst to call for a broad-based, holistic approach, known as One Health (OH), which is defined as, “The collaborative effort of multiple health science professions, together with their related disciplines and institutions – working locally, nationally, and globally – to attain optimal health for people, domestic animals, wildlife, plants, and our environment”.23
Countries are increasingly recognizing the value of working collaboratively and sharing knowledge, expertise and resources for the protection of their own country and to address the collective vulnerability in today’s globalised world. This recognition is evidenced by the Australian Government’s regional health security initiative known as ‘Indo-Pacific Centre for Health Security’ established in 2017.24 The initiative is focused on a holistic, transdisciplinary and multisectoral approach, known as “One Health” (OH), to strengthen the health security capacity across the Indo-Pacific region.24
The ISOHR noted with concern that the growing antimicrobial resistance was a significant threat to the core of modern medicine as it seriously hampered both the efficacy and sustainability of an effective public health response to infectious diseases. The complex root of the problem and the process of widespread, systematic misuse of antibiotics in human and animal medicine, and in food production, demand systematic and coordinated action involving multiple sectors and disciplines beyond health.25 As antimicrobial resistance affects people in all countries, the ISOHR called for a OH approach to address this and other emerging health challenges both locally and globally.
Chronic Diseases
Infectious diseases and antimicrobial resistance are not the only causes of concern for the global health security. Similarly, the scope of OH is not limited to infectious disease only. The growing burden of chronic disease, the double burden of malnutrition which is defined as the coexistence of overnutrition (overweight and obesity) and undernutrition (stunting and wasting)26, climate change and its impacts are some of the emerging threats all countries are facing in one way or another.