The concept of ‘One Health’ refers to a unified approach for balancing and optimising the health of people, animals, and the environment. As Elin Pöllänen and Walter Osika explain, this approach has become particularly salient following the Covid-19 pandemic. Drawing on evidence from Sweden, they assess the benefits and limitations of applying One Health principles to future pandemic prevention strategies.
The Covid-19 pandemic can be referred to as a creeping crisis: the increased risk of pandemic outbreaks due to human activities has been known for many years, yet authorities failed to act or acted insufficiently, which made an acute crisis inevitable. Covid-19 reminded humanity, once again, about the connection between human, animal and environmental health, and the need for novel concepts and strategies to move beyond systemic vulnerabilities in current systems.
Sweden was not sufficiently prepared for a pandemic, according to the National Commission put in place to examine the nation’s management of Covid-19. Measures were installed too late or were too minor, particularly at the onset of the pandemic. There was a failure to protect vulnerable populations and precautionary principles were primarily applied to economic issues rather than healthcare, highlighting the need for a self-critical process. However, preventive efforts and particularly the role of animal and environmental health for pandemic policies have remained largely undebated and unrefined, which is something we have focused on in recent research.
Since the outbreak of Covid-19, several international initiatives such as the proposed global pandemic treaty have emphasised the need to integrate the principles of “One Health” into the global governance architecture to improve pandemic prevention. One Health is a concept based on human-animal-environmental interconnection that encourages cross-sectoral collaborations between the human, animal, and environmental sectors to optimise health for all sectors.
Sweden has formally established One Health in its successful work against antimicrobial resistance, where early preventive efforts and a high priority commitment has led to Sweden having the lowest antibiotic use (in animal husbandry) in the EU. One Health is also practically, but not formally, included in collaborations and plans concerning zoonotic diseases. This work is more practically oriented than strategic.
The collaboration has not been integrated into formal pandemic management. This was exemplified by the exclusion of the animal sector from the early pandemic response until they volunteered to provide testing based on their vast experience of working with (and communicating about) zoonotic diseases. Another area of development is the role of the environmental sector and environmental health in One Health, which, despite increased efforts, is still ambiguous and largely excluded. The environmental sector is not included in the Swedish National pandemic group or the Zoonotic council.
We conclude that there are no clear indications of Sweden including One Health or considering human-animal-environmental health interconnection in pandemic management, as seen internationally. This might be because the risk of a pandemic happening in Sweden is considered low and Sweden has come a long way in cross-sectoral collaborations on antimicrobial resistance and zoonotic diseases.
We see risks of complacency and stagnation where progress is needed in several One Health related areas. Annual reports note increasing and systematic problems within the animal industry. Whilst One Health is described as a useful framework for antimicrobial resistance and Agenda 2030, it is not related to Sweden’s own environmental targets, despite the need for vast improvements for ecosystem health and biodiversity. Additionally, Sweden consumes in a way that would require four planets to sustain, which contributes to global pandemic risks and exhaustion of the earth.
Importantly, there are fundamental problems with One Health as a concept itself that, if left unaddressed, will continue to maintain anthropocentric framings of human-animal-environmental relations and health. The concept is underdeveloped in terms of an ethical framework and transparency in how different interests, stakeholders and relations are impacting its power dynamics. One Health follows the same trajectory as problem framing overall, with a technical/external framing where in the case of pandemics, the strategy has been to respond once a disease emerges (diagnosis, treatment, vaccinations).
With a focus on risk mitigation, surveillance and treatment, One Health mainly works to safeguard the “fullest” version of human health, as defined by the WHO. Animals and environments are mainly seen as risks to human health (or means of production), leaving environmental health largely undefined, and animal health narrowed down to the absence (or control) of infectious diseases, neglecting social well-being and mental health aspects.
What is needed for One Health and pandemic prevention overall is complementing interest in internal dimensions (culture, attitudes, mindsets), which could create deeper changes in systems where systemic errors are occurring. Efforts of “deep prevention”or “primary prevention”, could address and act on underlying drivers of pandemics and disease such as deforestation, high consumption of animal protein, and wildlife trade.
Improvements in routines, collaborations, and systems during “peacetime” could strengthen pandemic response and preparedness, but would be insufficient in the sense that they uphold a warlike relation to animals and nature. The report Making peace with nature by UNEP highlights the violent (“suicidal”) relation humans have to nature, which needs to be combated for sustainability.
Similarly, current animal welfare law has been compared to international humanitarian law because it legitimises a constant war on animals. The interlinkage of human, animal and nature rights further emphasise the need for complementary “peacetime” laws with animals and nature, and shines light on the connections between prejudice towards animals and human intergroup relations through mechanisms of dehumanisation. The value of improved human-animal-nature relations was identified during the pandemic, where the presence of nature and animals acted as protective factors and provided unexchangeable support for humans in times of crisis.
It has been concluded that Sweden was not prepared for a pandemic despite having resources at hand, and according to our analysis, Sweden has the resources for pandemic prevention, but is lacking adequate awareness and ambition. Based on our findings and previous studies on One Health and its areas of development, it is uncertain if a new, formal definition of One Health with principles, or initiatives such as that by DG Sante, will lead to measures based on the strong, and diverse, connections that exist between humans, animals, and environments.
Today, a complementary concept, or vision, is needed that can advance public health policy to also include global and more-than-human solidarity, and contribute to policies that act on underlying drivers of disease that have long been in sight, but out of mind.
This article is part of a series summarising contributions to a PERISCOPE report on research on best practice in multi-level pandemic governance. The series brings together contributions from four organisations who have conducted interdisciplinary research as part of the EU Horizon 2020 PERISCOPE project: the London School of Economics, the Karolinska Institute, the Federation of European Academies of Medicine, and the Centre for European Policy Studies. For more information about PERISCOPE, please see the project’s website.