Navigating the complexities of One Health requires input from all stakeholders – and in India, synergies are emerging, with the country committing to it as a key item on the political agenda for progress on development, equity, economic and health gains
The ongoing Covid-19 pandemic is a long overdue reminder of the interconnectedness of human, animal and environmental health and the urgency of developing global, regional and national One Health frameworks.
An intergovernmental negotiating body is currently drafting and negotiating an agreement under the One Health framework to strengthen pandemic prevention, preparedness and response in the form of a pandemic accord to be presented to the World Health Assembly in 2024. Along with the amended International Health Regulations, this will constitute a comprehensive, complementary and synergistic set of global health agreements.
The G20’s commitment
Due to the Covid-19 pandemic, Italy’s 2021 G20 presidency identified three key pillars of health – people, planet and prosperity – for creating resilient health systems for future unknown disease outbreaks. G20 health ministers underlined the importance of operationalising the One Health approach. They called for a multisectoral approach to strengthening surveillance, prevention, preparedness and response to health threats. The G20 also established a Joint Finance-Health Task Force to tackle antimicrobial resistance, enhance global cooperation and dialogue for pandemic preparedness, and exchange best practices among members. It envisaged increasing engagement among finance and health ministries for collective action, preparation for future health emergencies and resource mobilisation to foster the goal of One Health. The group came up with a ‘Call to Action’ to build One Health resilience in collaboration with the World Health Organization, the Food and Agriculture Organization, the World Organisation for Animal Health and the United Nations Environment Programme.
In 2022, the One Health Joint Plan of Action by the FAO, UNEP, WHO and WOAH supported Indonesia’s G20 presidency to come up with the Lombok G20 One Health Policy Brief. It identified seven key areas: awareness and advocacy, identification of gaps and opportunities, One Health governance, One Health funding and investment, the One Health joint action plan, implementation of One Health through all policies and strengthened One Health research.
G20 health ministers in 2022 also emphasised implementing national AMR action plans using scientific evidence. They acknowledged that the investment in disease prevention using the One Health approach is moderate, around $11.5 billion annually (according to the World Bank) compared to the response, which would cost $30.1 billion annually. Developing and adopting a One Health framework emerges as a cost-effective approach for underdeveloped, developing and developed economies alike. Such investment will help achieve Sustainable Development Goal 3, support global health security, and address health inequities and social cohesion.
Strengthening the G20 legacy, India’s 2023 presidency consolidated health priorities and commitments. We identified three key priorities for the G20 Health Track: health emergencies prevention, preparedness and response; the availability of and access to affordable medical countermeasures, vaccines, therapeutics and diagnostics; and digital health. We facilitated relevant discussions across various multilateral forums.
In view of repeated infectious disease outbreaks and to enhance future preparedness, the Prime Minister’s Science, Technology and Innovation Advisory Council reviewed ongoing activities across agencies and noted the existence of vertical programmes to address human, environmental and animal health. It recommended addressing gaps in the One Health approach and synergising efforts across sectors by establishing an integrated framework in the form of a ‘National One Health Mission’. A cross-ministerial steering committee unanimously agreed that the mission will steer research and development on emerging threats, promote linkages of data and databases across sectors, and encourage the use of emerging technologies for vaccine development, next-generation sequencing approaches and artificial intelligence tools for surveillance and disease modelling. The mission is steered by the Office of the Principal Scientific Advisor to the Government of India and includes key stakeholders from various ministries and departments including health and health research, science and technology, animal husbandry and dairying, agriculture, the environment and forestry, defence, and disaster management. To create an institutional mechanism linking various sectors within the One Health framework, the National Institute for One Health has been established in Nagpur, Maharashtra. Coordinated by the Department of Health Research, it will facilitate the mission’s R&D activities, and will be jointly operationalised by all ministries and departments working under the One Health mission. NIOH will lead the development of surveillance tools and methods, support outbreak investigations, and lead the development of required diagnostics, therapeutics and vaccines.
Institutionalising the core values of One Health
India unequivocally endorses integrating key equity considerations in the evolving roadmaps for operationalising One Health. First, Indigenous knowledge, which has traditionally respected the interconnectedness of human, non-human and ecosystem health, must be recognised and incorporated. Second, traditionally under-represented groups must be substantively and equitably included in treaty design and implementation. And third, health equity impact analysis and gender-based analysis must be used to identify and develop mitigation plans for potentially inequitable effects caused by epidemics.
The key principles and ethos of implementing One Health are equity; holism and systems thinking; inter- and transdisciplinarity, intersectorality and multilateralism; intersectionality (recognising that social identities such as gender, caste, class and race interact to render some groups more vulnerable to the impacts of health events); and One Health leadership and governance.
The political articulation of One Health
G20 and G7 members have emerged as key stakeholders for universal health coverage, and underscore health as a political choice. This concept is central to the global consensus and national political commitment to primary health care, embodied in the Astana Declaration. Unless political support to One Health is unwavering, consensus in principle may not be enough to knock down disciplinary silos and dismantle institutional hegemonies. Conversely, political structures and interests as well as corporations and other influential organisations constitute critical barriers to the multisectoral, transdisciplinary framing of One Health collaborations.
There are signals of synergies emerging in India, with Prime Minister Narendra Modi himself demonstrating leadership and a commitment to One Health as a key political agenda for development, equity, economic and health gains.