Where is One Health systems thinking in the Australian CDC planning?

Dr Andrea Britton, Dr Sandra Steele and Associate Professor Simon Reid, PHAA One Health Special Interest Group (SIG) committee members

PHAA’s One Health SIG members recognise the importance of multisectoral and transdisciplinary approaches, using systems thinking, to optimize health and well-being. This includes mitigation of wicked public health challenges such as disease emergence (including zoonoses), antimicrobial resistance, food security and the health effects of climate change.

In a recent CDC Corner article, Professor Martyn Jeggo (past Director of CSIRO Australian Animal Health Laboratory, which is now known as the Australian Centre for Disease Preparedness), describes the need for an inclusive, One Health approach to an Australian Centre for Disease Control (CDC). However, the Department of Health website for the Australian CDC (1) and much CDC-related commentary, lack discussion of the need for an integrated health approach.

 

What is One Health, and why must we operationalise this approach?

The definition of One Health, as developed by the One Health High Level Expert Panel (2) and adopted by the international Quadripartite alliance (3), describes 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 intrinsically linked and inter-dependent.”

Thus, a One Health approach can holistically address the many factors which contribute to disease emergence and re-emergence, antimicrobial resistance, and non-communicable diseases, encompassing global health security, disease surveillance, and effective national preparedness and response.

We therefore argue that operationalising One Health is essential to fully address the stated goals of a future Australian CDC, including non-communicable (and communicable) disease prevention, ongoing pandemic preparedness, and providing federal leadership in infectious disease outbreak responses (1). Just as the Quadripartite has signed a memorandum of understanding, the three sectors (human, animal and environment) need to be embedded within the Australian CDC from the start.

 

COVID-19, Japanese Encephalitis Virus and other disease outbreaks

The need for a national and global One Health approach was highlighted by COVID-19 (4). Government mandated public health restrictions and disease outbreaks had unexpected impacts on animal health and welfare (5, 6). Food security was threatened at all levels from supply to distribution.

Early concerns about possible spread of SARS-CoV-2 to animal species and their potential to become viral reservoirs were not realised in Australian domestic animals or wildlife. However, overseas, farmed mink (7) and pet hamsters (8) infected by humans became a source of human infections, resulting in mass culling of infected and at-risk animals. The significance of the high prevalence of SARS-CoV-2 infection in white tailed deer in North America remains unknown and requires continuing surveillance and management by human and animal health authorities (9).

 

Value of veterinary sector

Veterinary epidemiologists and Veterinary Public Health practitioners provided an experienced surge workforce for over-stretched and under-resourced Public Health departments in some jurisdictions. Indeed, the NSW state veterinary laboratory boosted the state’s COVID-19 testing capacity and tested and manufactured viral transport media for PCR swabs during shortages (5). An established One Health system would have optimised the management of these issues.

Similarly, the emergence of Japanese Encephalitis Virus (JEV) in eastern Australia (10) is a good example of the animal health sector’s ability to detect a zoonotic disease and proactively communicate with public health authorities, thus enabling timely identification of human cases and a more holistic multisectoral response. If an Australian CDC was able to support integrated surveillance systems and cross sectoral communication and cooperation, the JEV emergency may have been prevented or controlled much earlier.

 

Can existing institutions guide the formation of the Australian CDC?

It is possible to explore examples of existing national cross-sectoral institutions, such as Biosecurity Australia, that operate legislatively across states and territories. This could help guide the legislative structure of the CDC, given surveillance and public health response is governed by each jurisdiction. A One Health CDC will enable synergies in the development of integrated policy and practice across existing government agencies that currently function independently. These synergies will lead to new and innovative ways of delivering integrated surveillance and response when required.

 

Coordination across sectors

The new CDC focus on pandemic preparedness and prevention requires coordination across sectors to prevent pathogen spillover as described in Figure 1. By collaborating with peak wildlife organisations like Wildlife Health Australia and the proposed One Health surveillance and wildlife collaborating centre for Australia and Indo-Pacific, spillover of pathogens can be identified and appropriate actions taken to mitigate risk.

 

 

PHAA’s One Health SIG strongly advocates for a One Health approach for the future Australian CDC. The operational framework for this Centre could be delivered using a similar legislative structure to Biosecurity Australia for activities that are collaborative across sectors and jurisdictions. One Health governance within the CDC would provide leadership and enable collaboration and coordination across sectors, ensuring equitable real-time information and data sharing. We need to learn from past pandemics, break down siloed institutions and ways of operating in Australia, and build a novel One Health Australian CDC.

 

References

1. Department of Health and Aged Care. Australian Centre for Disease Control: Australian Government, 2022 [Available from: https://www.health.gov.au/initiatives-and-programs/australian-cdc].
2. One Health High-Level Expert P, Adisasmito WB, Almuhairi S, Behravesh CB, Bilivogui P, Bukachi SA, et al. One Health: A new definition for a sustainable and healthy future. PLoS Pathog. 2022;18(6):e1010537.
3. Joint Tripartite (FAO, OIE, WHO) and UNEP Statement: Tripartite and UNEP support OHHLEP’s definition of “One Health” [press release]. 1 December 2021.
4. Keusch GT, Amuasi JH, Anderson DE, Daszak P, Eckerle I, Field H, et al. Pandemic origins and a One Health approach to preparedness and prevention: Solutions based on SARS-CoV-2 and other RNA viruses. Proceedings of the National Academy of Sciences. 2022;119(42):e2202871119.
5. Steele SG, Toribio J-ALML, Mor SM. Global health security must embrace a One Health approach: Contributions and experiences of veterinarians during the COVID-19 response in Australia. One Health. 2021;13:100314.
6. Baptista J, Blache D, Cox-Witton K, Craddock N, Dalziel T, de Graaff N, et al. Impact of the COVID-19 Pandemic on the Welfare of Animals in Australia. Frontiers in Veterinary Science. 2021;7(1219).
7. Hammer AS, Quaade ML, Rasmussen TB, Fonager J, Rasmussen M, Mundbjerg K, et al. SARS-CoV-2 Transmission between Mink (Neovison vison) and Humans, Denmark. Emerging infectious diseases. 2021;27(2):547-51.
8. Yen H-L, Sit THC, Brackman CJ, Chuk SSY, Gu H, Tam KWS, et al. Transmission of SARS-CoV-2 delta variant (AY.127) from pet hamsters to humans, leading to onward human-to-human transmission: a case study. The Lancet. 2022;399(10329):1070-8.
9. Kuchipudi SV, Surendran-Nair M, Ruden RM, Yon M, Nissly RH, Vandegrift KJ, et al. Multiple spillovers from humans and onward transmission of SARS-CoV-2 in white-tailed deer. Proceedings of the National Academy of Sciences. 2022;119(6):e2121644119.
10. Department of Health and Aged Care. Japanese Encephalitis Virus 2022 [Available from: https://www.health.gov.au/health-alerts/japanese-encephalitis-virus-jev/about.
11. Bernstein AS, Ando AW, Loch-Temzelides T, Vale MM, Li BV, Li H, et al. The costs and benefits of primary prevention of zoonotic pandemics. Science Advances. 2022;8(5):eabl4183.