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Confronting Health Threats in the Eastern Mediterranean Region Requires a One Health Approach

Confronting Health Threats in the Eastern Mediterranean Region Requires a One Health Approach

Monday, 3 October, 2022 - 09:00
Dr. Ahmed Al-Mandhari
WHO Regional Director for the Eastern Mediterranean

Today, the world faces huge challenges from health threats that can impact people, animals and the environment. In the past, experts and policy-makers addressed these threats separately, depending on their field of specialization, but today we recognize that the health of these different entities is often interconnected and has to be dealt with in a collective and coordinated manner.

Zoonotic diseases constitute 75% of new and emerging infectious diseases in humans; they are a major and growing public health threat, as demonstrated by the ongoing COVID-19 pandemic and the Ebola virus disease outbreaks in Africa. The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) highlights the risks that the Eastern Mediterranean Region is facing from emerging infectious zoonoses. Potential threats also exist from outbreaks like the one currently caused by monkeypox.

Zoonotic disease outbreaks have been taking a heavy toll on the Region. For example, dengue fever has been a growing threat for decades and can be lethal, killing up to 20% of those with severe disease. Crimean-Congo haemorrhagic fever continues to constitute a major threat to public health because of its epidemic potential and high case-fatality rate. Sporadic human cases and outbreaks of Crimean-Congo haemorrhagic fever have been reported in several countries and have placed a high burden on economies and food security. Influenza viruses, with the vast silent reservoir in aquatic birds, are impossible to eradicate. Zoonotic influenza infection in humans will continue to occur and the emergence of a different strain may cause an influenza pandemic. Human brucellosis is also endemic in most countries in the Region with serious public health consequences. The implementation of the One Health approach is especially important for preventing and managing zoonoses. Understanding objectives from a whole-system perspective is important for identifying common ground for different sectors to collaborate and implement effective, locally adapted and sustainable interventions.

The interconnectedness of the health of humans, animals and the environment is also exemplified by neglected tropical diseases such as leishmaniasis, vector-borne diseases such as malaria, antimicrobial resistance, food safety, and lack of access to clean water and nutritious food. These all represent major public health threats, which continue to affect people globally and across the Region, particularly the most vulnerable. Travel and migration, globalization, urbanization, expanded and evolving agricultural practices, conflict and forced displacement, and inadequate public health infrastructure are all related risk factors. Our Region is profoundly impacted by such threats due to its diverse and complex makeup. Nine countries and territories in the Region are experiencing large-scale, protracted humanitarian crises, with approximately 111 million people requiring humanitarian assistance and 18.7 million internally displaced.

In the last two decades, apart from COVID-19 that has claimed almost 350 000 lives in the Region and with almost 23 million cases reported since the start of the pandemic, the Region has suffered from diverse public health threats that have impacted human, animal and environmental health and taken a heavy toll on communities and economies. Climate change also impacts all aspects of life for humans, animals and the environment.

- One Health approach

The One Health approach is a multisectoral initiative that aims to address this complex array of threats. It recognizes that the health of humans, animals and the environment is interconnected and applies practices that support collective and coordinated action among different sectors in a more effective, efficient and sustainable way. It is also aligned with our regional vision “Health for All by All” initiated in 2018 with the aim of working in solidarity to ensure the right to health for everyone in the Region.

The World Health Organization, the Food and Agriculture Organization of the United Nations, the World Organization for Animal Health and the United Nations Environment Programme, known collectively as the Quadripartite, have adopted the One Health approach to provide global and regional leadership and guidance to build national capacities, as well as address gaps and challenges to implementation of the approach.

The four organizations have developed the One Health Joint Plan of Action (2022–2026), which provides an overarching strategic direction to promote and protect public health, animal health, food safety and security, and ecosystem health.

- Limited One Health capacities

The growing burden of some of the biggest global health issues results from inadequate leadership, governance and multisectoral coordination. Antimicrobial resistance, for example, and its health and economic consequences in the Region have resulted from a lack of regulation and inappropriate use of antibiotics in the health care sector, as well as their imprudent use within the veterinary sector and animal industry. Now antimicrobial resistance severely threatens effective treatment of infectious diseases.

Despite the growing acceptance in the Region of the One Health approach in recent years, with some countries adopting this approach to tackle specific emerging and re-emerging zoonoses, no initiatives address all priority health threats. The infrastructure and resources to prevent, detect early and respond to epidemic and pandemic threats remain inadequate in the Region.

Disease surveillance systems are fragmented in many countries and the mechanisms for information-sharing among the different sectors are mostly based on individual efforts. Improved efficiency and effectiveness of the use of data to guide decisions is urgently needed. However, integrated surveillance using a single electronic platform is yet to be implemented in many countries.

Rapid response teams are mostly not multidisciplinary. Workforce development programmes are not informed by risk assessment, and barely any country in our Region includes One Health in professional pre- or postgraduate programme or training. Limited human resources in the different disciplines also hinder progress in implementing One Health initiatives in the Region.

- Moving forward

To turn the approach into a reality across the whole Region, we as organizations, countries, governments and civil society need to recognize the importance of political commitment and national ownership in operationalizing One Health.

The regional Quadripartite is leading advocacy for the approach. The partnership is prioritizing zoonoses, antimicrobial resistance and food safety. It promotes clear governance and leadership for sound policy-making, strategic planning and multisectoral coordination and collaboration to address health threats at the interface between humans, animals and the environment.

Exploring opportunities to integrate One Health surveillance is critical for the early detection of health threats. An established mechanism for real-time information-sharing is needed among sectors to share alerts and guide risk assessments.

We need to ensure the availability of an adequate number of skilled and trained staff for the execution of related activities at different administrative levels in countries. We also need collaboration with academia to generate the required personnel needed in the different disciplines of the One Health approach and ensure the continuous capacity-building of existing personnel.

The opportunity exists to make our Region, and the world, a safer place if we establish a common strategy on One Health.

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