One Health, the new Quadripartite Alliance, and the International and Multilateral Financing Intermediate Fund (FIF)

One Health, a collaborative, multisectoral, and transdisciplinary approach connecting the health of humans, animals (both domestic and wildlife), and the environment, is not a new concept but has been around for decades because of the increased frequency and severity of infectious diseases that potentially can cross over to us from animals. The ‘One World-One Health’ concept first emerged at a 2004 symposium organized by the Wildlife Conservation Society in New York, with the realization that as a result of globalization and the territorial expansion of humans into isolated and well-balanced ecosystems, including that of wild fauna,?combined with changes in climate,?we were witnessing an emergence and re-emergence of infectious and non-infectious diseases.? The main output of the event was the 'Manhattan Principles' with 12 recommendations for establishing a more holistic approach to preventing epidemic/epizootic disease. Later on, the Berlin principles of 2019 built the foundation of One Health, which aims to integrate ecosystem health while addressing current pressing issues such as climate change and antimicrobial resistance.

Although the One Health concept is recognized by many national, bilateral, and multilateral fora, and from mere enunciation within public health conferences has become the dominant topic in ad hoc congresses, ?such as the recent ‘One Conference 2022’ (Health, Environment, and Society) ?organized by EFSA and held in Brussels, it is still invisible to public health decision-makers. ?Indeed, the road is still long before the concept is fully incorporated into the mindset of legislators, and effectively communicated to the general public. ?Since the animal, human, and environmental domains are critically interlinked, One Health requires breaking down the interdisciplinary barriers that separate human and veterinary medicine from ecological, evolutionary, and environmental sciences, and combining and integrating the related expertise to promote our collective future well-being.

The new?One Health?definition and the Quadripartite alliance

A very positive further step towards fully recognizing One Health was taken in February 2021, when the UN Agencies, Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and the World Health Organization (WHO) called upon the United Nations Environment Programme (UNEP) to join the Tripartite Alliance, reaffirming the importance of the environmental dimension in the context of the One Health collaboration.? In the same year, the G20 announced that it is necessary to adopt a One Health approach to assess and address health emergencies with cross-border impact.?Moreover, to develop a common language and understanding among the UN agencies, in 2021 the One Health High-Level Expert advisory panel (OHHLEP) presented a newly formed operational definition of One Health, which states ‘One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent.

With the new definition, a special emphasis is on the environment as a key pillar of human, animal, and plant health monitoring, and on the partnership of the related sectors, but also policy-makers, health authorities, and scientists.??On 17 March 2022, with the signing of the Quadripartite Memorandum of Understanding (MoU) with UNEP, the tripartite became quadripartite and it was agreed to jointly develop a strategy and action plan to prevent future zoonotic pandemics. The MoU came to provide a legal and formal framework for the four organizations to tackle the challenges at the human, animal, plant, and ecosystem interface using a more integrated and coordinated approach. The framework will also contribute to reinforcing national and regional health systems and services, and to driving change and transformations required to mitigate the impact of current and future health challenges at global, regional, and country levels.??

To respond to international requests to prevent future zoonotic pandemics and to promote health sustainably through the One Health approach,?the newly expanded alliance, supported and advised by OHHLEP, developed a comprehensive One Health Joint Plan of Action (OH JPA) that will be implemented over a period of 5 years (2022-2026). The OH JPA provides an overarching framework for longer-term actions aimed at mainstreaming and operationalizing One Health at global, regional, and national levels. It also supports countries in establishing and achieving national targets and priorities for interventions, mobilizing investment,?promoting the?whole of society approach, and enabling collaboration, learning, and exchange across regions, countries, and sectors.??

The work aims to pursue six action tracks: - to strengthen health systems under a One Health approach; - to reduce the risks from emerging or resurfacing zoonotic epidemics and pandemics; - to control and eliminate endemic zoonotic, neglected tropical, or vector-borne diseases; to strengthen the assessment, management, and communication of food safety risks; to curb the silent pandemic of antimicrobial resistance, and to better integrate the environment into the One Health approach.?

The Global One Health approach to tackling the pandemic threats

The COVID pandemic, whilst focussing attention on the animal/human/environmental nexus and the real-life implications of diseases originating in animals that might prove deadly for humans, has shone a light on the extreme precariousness of our infrastructure, governance, and communities in times of public health emergency. To overcome this weakness, governments must assure proper funding and foster collaboration among institutions, stakeholders, and scientists in line with the One Health approach. The global community is now confronted by a global outbreak of Monkeypox, which, on July 23 this year, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC). ?Looming next is concern about the most recent Langya virus that spread from shrews to Chinese farmers, causing fevers and in some cases, severe liver and kidney abnormalities. Against this backdrop, the question is not whether there will be other virus threats spurring major health emergencies, but when and where it will happen, unless we humans change how we interact with the ecosystem in general, and particularly with wildlife.??

After the extensive discussions and decisions by the G7 and G20 in 2021, and consultations among the quadripartite that resulted in the OHHLEP 's newly formed operational definition of One Health, and the OH JPA, One Health reached momentum on May 2022 when the World Health Assembly (WHA) approved a process to develop a new international instrument on pandemic prevention (potentially a treaty, convention, or agreement) to enable a more coordinated global response to major epidemics and pandemics, and to go beyond the International Health Regulations (IHR) of 2005, which in practice has been unable to deal on time with outbreaks principally because of enforcement limitations. Previously, on 3 March 2022, the European Union Council gave a green light to start negotiations for an international agreement on pandemic prevention, preparedness, and response adopted under the WHO. The constituted intergovernmental negotiating body, after holding two meetings in 2022 to agree on ways of working and timelines and to discuss progress on a working draft, will then deliver a progress report to the 76th WHA in 2023. The pandemic treaty is foreseen to be adopted by 2024. The concept behind it is that a pandemic is a global challenge, and no single government or institution can address the threat of future pandemics alone.

The Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness, and Response

In parallel to the above international endeavors, the World Bank with the WHO, and the broad support from members of the G20, approved on June 30, 2022, a new international and multilateral financing mechanism to provide long-term funding to address pandemics. The funding instrument called ‘Pandemic Prevention, Preparedness, and Response (PRP) Financial Intermediary Fund (FIF) was officially established by the WHO Board of Directors at its inaugural meeting on September 8-9, 2022. The FIF will allocate?$12.5 billion over five years and has already received a commitment of $1.3 billion from several donor countries and non-governmental organizations.??A dedicated stream of additional, long-term financing will go to low- and middle-income countries to strengthen their PPR capabilities and address critical gaps through investments and technical support at the national, regional, and global levels. The FIF is something the global community strongly supports to prevent future pandemics, which means also preventing the public health risks represented by the silent pandemic of antimicrobial resistance: decreasing the risk of infections leads to less pressure for antimicrobial resistance, which reduces the risk of infectious outbreaks.

Unfortunately, although One Health will be eligible for financing from the FIF, as pointed out by Laura Khan, Co-Founder of the One Health Initiative, the preparedness and response part of the mechanism receives the lion’s share in terms of attention and funding compared to the prevention part.? We need to do more in terms of prevention and estimating investment benefits compared to costs. There is a saying: an ounce of prevention is worth a pound of cure.?To give an example of?a country adopting a One-Health Strategic Action Plan hinged on prevention activities, it is interesting to cite Cameroon, where a cost-benefit study on the 2016 Avian Influenza (HPAI H5N1) outbreak, and the response from 2021-2022, showed that for every $1.55 invested during 2016, the return on investment was $4.65, that includes concrete benefits such as the preservation of thousands of jobs related to the poultry sector, which contributed 4% to the GDP, and widespread availability of chicken, which is a primary human source of animal protein. If a multi-sectoral and interdisciplinary approach is central to the prevention of public health risks, decision-makers must commit to greater funding and careful and efficient spending for pandemic early warning systems and epidemic intelligence gathering inside the One Health approach. Veterinarians, notably epidemiologists and virologists, and other animal health professionals need to be part of the pandemic prevention solution. ?Accordingly, in order to fully operationalize the One Health concept, the hope is that FIF will also have to include funding for veterinary extensive education and hands-on training in zoonotic diseases, and environmental health aspects, to build capacities using a One Health approach?to collaboratively prevent zoonotic disease threats at the human–animal– environment interface. So far, veterinarians did not have a prominent role within the national and international management and monitoring structures of the pandemic task forces. For the reasons set out above, it is clear how their partial involvement could compromise the success of efforts to combat future pandemics.