Benoit Bosquet, Daniel Dulitzky, and Martien Van Nieuwkoop*
The unprecedented impact of COVID-19 has brought into alarming focus the risk posed by infectious diseases that can explode into full-blown global pandemics. The East Asia and Pacific region, with its expanding agriculture, urban sprawl, extensive animal trade, and large concentration of human and livestock population, is particularly susceptible to such outbreaks, which unfortunately are increasingly common. The possibility of another pandemic is not far-fetched. A shift is critically needed, away from reactive responses toward a comprehensive, integrated approach aimed at prevention and preparation.
Pandemics are preventable, if policymakers are willing to plan and finance an approach that recognises that that human health is inseparable from the health of the environment and animals, both wild and domesticated. This approach, which emphasises prevention, is known as “One Health” because it rests on an understanding of the interdependence of humans and the natural environment and is designed as an integrated framework.
One Health is particularly relevant for the East Asia and Pacific region, which is undergoing large-scale and rapid landscape, trade, consumption, and demographic change, and is one of the global hotspots for emerging infectious diseases caused by transmission from animals to humans. SARS, the Nipah virus, and H5N1 viruses all emerged from East and Southeast Asia, not to mention COVID-19, and research suggests that the next global pandemic could begin again in this region.
Multilateral institutions including the World Bank, the Food and Agriculture Organisation, the United Nations Environment Programme, the World Organisation for Animal Health, and the World Health Organisation as well as individual countries are renewing their commitments to the One Health approach, which mobilises sectors and communities to work together and use interventions that cut across a range of sectors, including health, environment, agriculture, and food to address the complex origins and breadth of emerging infectious diseases.
An early instance of this multi-sectoral strategy occurred after the emergence of the Nipah virus in Malaysia in 1998-99, when hog farms and fruit orchards were expanded to areas adjacent to forests that were fruit bat habitat, resulting in animal-to-human disease transmission and a serious epidemic. Detecting this chain required collaboration among experts from forestry, wildlife, veterinary, and human health. Malaysia and Thailand ultimately required fruit orchards to be distanced from hog farms, and mandated increased surveillance of areas at high risk of disease spillover, followed by an expansion of agricultural extension services.
Việt Nam is a country where climate change, an overstretched healthcare system, and limited infrastructure in rural areas, combined with rapid population growth and a prominent agricultural sector create vulnerabilities to infectious disease outbreaks. Concerns about antimicrobial resistance, stemming from widespread use of antibiotics in the healthcare system and in aquaculture and livestock production, have spurred Việt Nam to approve a national action plan that includes an inter-ministerial surveillance strategy and upgrades to laboratory capacity to track and detect resistant bacteria. More broadly, several government agencies this year issued a five-year master plan for prevention and control of diseases transferred from animals to humans.
In recent years, countries in the region have updated legislation relating to animal health, diseases transferrable from animals to humans, and food safety, but considerable gaps remain in policies and in the implementation of national action plans. Steps should be taken now to improve coordination and the exchange of critical data between human health, animal health and environmental health sectors. Implementing One Health principles will require a shift from programmes focused narrowly on specific diseases to ones that strengthen overall systems, including by going beyond the health sector to livestock keepers, park rangers, extractive industries, and communities responsible for environmental stewardship.
And while this approach requires investment, an ounce of prevention could be worth a pound of cure. The World Bank recently proposed an investment framework to incorporate One Health and prevention considerations into investment decision-making processes, which found that globally, prevention costs guided by One Health principles range from US$10.3 billion to $11.5 billion per year – less than one percent of the cost of COVID-19 in 2020.
To be sure, the costs and benefits of this approach can be uneven: benefits will largely accrue at the national and global levels, while the costs of reducing deforestation, monitoring wildlife trade, and enhancing the safety of livestock farms are largely borne locally and in countries most susceptible to infectious disease outbreaks. Nevertheless, pandemic prevention is a global public good – no country can be excluded from benefiting and there is no limit to the number of countries that can benefit.
In addition, many of the activities associated with infectious disease prevention are important contributors to employment and economic growth. For example, in Việt Nam, agriculture represents 37 per cent of total employment and the agriculture, aquaculture, and forestry sectors contributed almost 15 per cent to the country’s GDP. However, the attendant benefits of climate change mitigation and adaptation, greater food safety, sustainable agriculture, and human health will pay economic dividends as well.
There is a clear opportunity for the East Asia and Pacific region to muster support for the global coordination of policy and financing required for successful implementation of One Health. In a world still recovering from the devastation of COVID-19, governments need to optimise scarce funding resources across a range of financial, fiscal, social, and health challenges. One Health is no panacea, but it offers a sustainable and cost-effective way to minimise the risk of a future pandemic. — VNS
*Benoit Bosquet and Daniel Dulitzky are the East Asia Pacific Regional Directors for Sustainable Development and Human Development, respectively, at the World Bank.
Martien Van Nieuwkoop is the Global Director for Agriculture and Food at the World Bank.