Covid-19 drives 'prevention over cure' strategy; hinges on global co-operation

The One Health approach recognises that human-linked climate change, as well as food production and lifestyle patterns, may be factors driving viruses to spill over from animals to humans.
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The Dutch philosopher Desiderius Erasmus is credited with coming up with the term “prevention is better than cure” in the 1500s, but it took a devastating pandemic 500 years later for governments to seriously look at that approach on a global scale.

Last week, the number of Covid-19 infections reported to the World Health Organisation topped 200 million. While massive resources and energy have been poured into fighting the disease with vaccines, the WHO is tackling the question of how to prevent it happening again.

The focus of those efforts is summed up in the strategy known as One Health , or a recognition that all human activities and habits have consequences in the one ecological system shared by life on Earth and need to be considered in public health policies.

With most diseases stemming from animal origins, human population expansion and deforestation, for example, can create more opportunities for wildlife-borne diseases to infect humans. The added challenge for the One Health approach is a need for international cooperation in a world fractured by political division and suspicion.

One Health was the main theme of the May summit of the World Health Assembly, in which member-states of the WHO make decisions to improve public health. For the first time, the assembly stressed the need for all countries to adopt the One Health approach.

“One Health has always been around, but there wasn’t really an urgency to implement it,” said Wanda Markotter, director of the University of Pretoria’s Centre for Viral Zoonoses, in South Africa. She was named co-chair of the One Health High-level Expert Panel in May.

Wasting time

The World Health Assembly summit this year contrasted with last year’s meeting that focused on gaining agreement from China to allow WHO-appointed experts into the country to study the origins of Covid-19 , first identified in the city of Wuhan.

Since then, the US and other countries have requested further access to laboratories in Wuhan that studied bat coronaviruses similar to the virus causing Covid-19. This is based on a hypothesis the virus may have escaped from one of the labs, a view China has rejected and which has worsened relations between Beijing and Washington .

For Markotter, who specialises in bat-borne diseases , the political spat detracts from the real problem exposed by Covid-19: an outbreak in one corner of the world can become a pandemic that kills millions and causes untold economic costs.

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“It’s just wasting time, because that’s not going to solve the issue … it’s all over the world now, you can’t get rid of it, so having those conversations is not going anywhere,” she said.

The One Health High-level Expert Panel has 26 members and reflecting its broad mandate falls under the WHO and three other organisations – the Food and Agriculture Organization, the World Organisation for Animal Health, and the United Nations Environment Programme.

Members were chosen from 700 applicants and include scientists from the US and China.

Gao Fu, director general for the Chinese Centre for Disease Control and Prevention, is a member.

The purpose of the panel is to “provide guidance on One Health-related matters that support improved cooperation among governments,” according to a WHO press release.

Densely packed

France and Germany have both voiced strong support for the initiative, recognising that human-linked climate change , as well as food production and lifestyle patterns, may all be factors creating conditions for viruses to make the jump from animals to humans.

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“We are densely packed, we’re exploiting pristine environments, we are creating and driving the ecologic pressure … that [is] driving the risk at the animal/human species barrier,” said Mike Ryan, executive director of WHO’s Health Emergencies Programme, at a press briefing in August last year. “We live on a planet in which we’re adding a billion people a decade.”

The need to feed this population has revolutionised food production, driving the destruction of animal habitats to make way for crops and livestock, and increasing the risk of virus spillovers. The WHO estimates 70 per cent of new human disease outbreaks in the past 50 years have been zoonotic, or originating in animals.

Markotter and other panel members are drafting practical means for WHO members to recognise and tackle these issues, and she says sharing information is key to the success of One Health.

“That’s one of the first things that needs to happen on a global level, not just to detect pathogens, but also things like changes in land use. We don’t really have a system where we share these environmental risk changes that can maybe lead to spillovers” she said.

Virus spat

Creating such a system, however, faces the challenge of deteriorating US-China relation s.

Politicians in Washington have said China’s Wuhan labs are a possible source of the Covid-19 virus, while Beijing has responded by pointing the finger at laboratories in the US .

Some researchers and scientists have doubts whether the US and China can bridge their mutual distrust to share the kind of data a One Health model would require.

“This kind of [pandemic prevention] system, model or treaty, whatever you want to call it, it exists, it just hasn’t played the role it was supposed to,” said Cheng Xiaohe, a professor of international relations at Renmin University in Beijing.

Cheng said that with the US and China trading barbs over the origins of Covid-19, global initiatives such as One Health would struggle to gain traction in Washington and Beijing.

“This pandemic has poisoned US-China relation s, it’s not an area for collaboration but competition. Both countries are still finger-pointing each other, blaming each other,” he said.

Small world

Virologist Tony Della-Porta is a former biosafety consultant for the WHO. He investigated laboratory accidents in Taiwan and Singapore during the 2002-03 severe acute respiratory syndrome (Sars) outbreak , which started in southern China and killed 774 people.

Della Porta, who ran WHO-sponsored biosafety workshops for the Chinese Centre for Disease Control and Prevention between 2005 and 2007, said information sharing in China needed to be reformed to handle disease outbreaks.

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“I think that the real issue is not the origin of the Covid-19 outbreak but the time it took to recognise it and then to put in place controls” to contain the disease, he said.

Official delays in China in containing both the Sars and the Covid-19 outbreaks were similar, he said. “It’s in their interests to act early, but they are a centrally-controlled government, so it’s very difficult for the people at the bottom.”

Markotter said she was hopeful issues related to information-sharing could be resolved because in the case of infectious diseases it was in everyone’s interest.

Scientists have a “small window of opportunity” to make One Health a reality, said Markotter.

“Covid taught us that what happens in a small part of the world is everybody’s problem.”

This article was first published in South China Morning Post.