A One Health approach to antimicrobial resistance surveillance: is there a business case for it?

Antimicrobial resistance is a global problem of complex epidemiology, suited to a broad, integrated One Health approach. Resistant organisms exist in humans, animals, food and the environment, and the main driver of this resistance is antimicrobial usage. A One Health conceptual framework for surveillance is presented to include all of these aspects. Global and European (regional and national) surveillance systems are described, highlighting shortcomings compared with the framework. Policy decisions rely on economic and scientific evidence, so the business case for a fully integrated system is presented. The costs of integrated surveillance are offset by the costs of unchecked resistance and the benefits arising from interventions and outcomes. Current estimates focus on costs and benefits of human health outcomes. A One Health assessment includes wider societal costs of lost labour, changes in health-seeking behaviour, impacts on animal health and welfare, higher costs of animal-origin food production, and reduced consumer confidence in safety and international trade of such food. Benefits of surveillance may take years to realise and are dependent on effective and accepted interventions. Benefits, including the less tangible, such as improved synergies and efficiencies in service delivery and more timely and accurate risk identification, should also be recognised. By including these less tangible benefits to society, animal welfare, ecosystem health and resilience, together with the savings and efficiencies through shared resources and social capital-building, a stronger business case for a One Health approach to surveillance can be made

Economic evaluation of the eradication program for bovine viral diarrhea in the Swiss dairy sector

The aim of this study was to conduct an economic evaluation of the BVD eradication program in the Swiss dairy sector. The situation before the start of the program (herd-level prevalence: 20%) served as a baseline scenario. Production models for three dairy farm types were used to estimate gross margins as well as net production losses and expenditures caused by BVD. The total economic benefit was estimated as the difference in disease costs between the baseline scenario and the implemented eradication program and was compared to the total eradication costs in a benefit-cost analysis. Data on the impact of BVD virus (BVDV) infection on animal health, fertility and production parameters were obtained empirically in a retrospective epidemiological case-control study in Swiss dairy herds and complemented by literature. Economic and additional production parameters were based on benchmarking data and published agricultural statistics. The eradication costs comprised the cumulative expenses for sampling and diagnostics. The economic model consisted of a stochastic simulation in @Risk for Excel with 20,000 iterations and was conducted for a time period of 14 years (2008–2021)

Quantitative Risk Assessment of Developing Salmonellosis through Consumption of Beef in Lusaka Province, Zambia

Based on the Codex Alimentarious framework, this study quantitatively assessed the risk of developing salmonellosis through consumption of beef in Lusaka Province of Zambia. Data used to achieve this objective were obtained from reviews of scientific literature, Government reports, and survey results from a questionnaire that was administered to consumers to address information gaps from secondary data. The Swift Quantitative Microbiological Risk Assessment (sQMRA) model was used to analyse the data. The study was driven by a lack of empircally-based risk estimation despite a number of reported cases of salmonellosis in humans. A typology of consumers including all age groups was developed based on their beef consumption habits, distinguishing between those with low home consumption, those with medium levels of home consumption, and those with high levels through restaurant consumption. This study shows that the risk of developing salmonellosis in this population, from consuming beef, was generally low. At ID50 of 9.61 × 103 cfu/g and a retail contamination concentration of 12 cfu/g, the risk of developing salmonellosis through the consumption of beef prepared by consumers with low and medium levels of beef consumption was estimated at 0.06% and 0.08%, respectively, while the risk associated with restaurant consumption was estimated at 0.16% per year. The study concludes that the risk of developing salmonellosis among residents in Lusaka province, as a result of beef consumption, was generally low, mainly due to the methods used for food preparation. Further work is required to broaden the scope of the study and also undertake microbiological evaluation of ready-to-eat beef from both the household and restaurant risk exposure pathways

Helping to heal nature and ourselves through human-rights-based and gender-responsive One Health

Abstract: The health of our planet and humanity is threatened by biodiversity loss, disease and climate crises that are unprecedented in human history, driven by our insatiable consumption and unsustainable production patterns, particularly food systems. The One Health approach is a pathway to synergistically addressing outcomes in term of health and sustainability, but gender issues at the One Health and biodiversity nexus are largely ignored. By examining the roles and responsibilities of Indigenous and Local People, and especially women, in conserving natural resources, and the social costs of living at the Human-Animal-Environment interface under current conservation strategies, we show that women bear a disproportionate health, poverty and climate burden, despite having pivotal roles in conserving biodiversity. To mitigate risks of emerging infectious diseases, food insecurity and climate change impacts, a gender perspective has previously been proposed, but implementation lags behind. Endemic zoonotic diseases, human-wildlife conflict and environmental pollution lack gender-sensitive frameworks. We demonstrate that women can be powerful agents for change at all levels of society, from communities to businesses, and policy-making institutions, but gender inequalities still persist. We develop a framework for mainstreaming a gender-responsive and rights-based One Health approach, in order to heal ourselves and nature. Using a leverage-points perspective, we suggest a change of paradigm, from the pursuit of GDP and over-consumption, to a focus on human well-being and their reconnection with healthy environments, using a One Health understanding of nature and health. We recommend learning from Indigenous People to re-position ourselves within nature and to better conserve biodiversity. We also propose integration of gender equity in leadership, the respect of human rights, women’s rights (access to health care, healthy food, land tenure, natural resources, education, and economic opportunities), and the rights of nature, through the implementation of gender-responsive and rights-based One Health Action Plans, at policy-making level, in the private sector and the civil society. As the COVID-19 pandemic continues to unveil deep socio-economic inequities in the wealthiest economies and the vital role of nature in supporting our health, we argue to seize this opportunity to build back better and improve resilience and sustainability by using a gender-responsive and rights-based One Health approach

A systems analysis and conceptual system dynamics model of the livestock-derived food system in South Africa : a tool for policy guidance

Global food production systems are currently under scrutiny, in particular the health, nutrition, and environmental impacts of livestock-derived food (LDF). Despite South Africa’s recent socio­economic transformation and increased per-capita LDF consumption, the triple burden of malnutri­tion persists. Policy responses to such complex problems often fail because of linear thinking with short-term goals. However, a systems approach helps identify root causes, feedback mechanisms, potential unintended consequences, and opportu­nities for integrated, durable solutions. Participa­tion in the systems-thinking process improves stakeholder understanding and buy-in. Our par­ticipatory workshop facilitated the development of a systems map for South African LDF, identifying key system elements, linkages, and nexus points. The latter included climate change, land access and management, livestock management and produc­tivity, farming systems, food safety, policy articula­tion, agricultural knowledge, and income. Based on these findings, and an overview of related litera­ture, we produced a conceptual system dynamics model of the LDF system. We identified key vari­ables and causal relationships, vicious and virtuous loops, system archetypes, conceptual stock and flows, and links to Sustainable Development Goals. The LDF system is complex and dynamic, with a dominance of commercial enterprises across agriculture and food retail, presenting barriers for small and medium-scale individuals. Other key elements relate to population growth and urbaniza­tion, land access, deregulation of international trade, climate change vulnerability, feed production limitations, and food safety. Our work provides a unique reference for policymakers, identifying the need for deep structural change, highlighting the possible unintended consequences, and thereby mitigating the risk of system destabilization

Two different epigenetic information channels in wild three-spined sticklebacks are involved in salinity adaptation

Epigenetic inheritance has been proposed to contribute to adaptation and acclimation via two information channels: (i) inducible epigenetic marks that enable transgenerational plasticity and (ii) noninducible epigenetic marks resulting from random epimutations shaped by selection. We studied both postulated channels by sequencing methylomes and genomes of Baltic three-spined sticklebacks ( Gasterosteus aculeatus ) along a salinity cline. Wild populations differing in salinity tolerance revealed differential methylation (pop-DMS) at genes enriched for osmoregulatory processes. A two-generation experiment demonstrated that 62% of these pop-DMS were noninducible by salinity manipulation, suggesting that they are the result of either direct selection or associated genomic divergence at cis- or trans-regulatory sites. Two-thirds of the remaining inducible pop-DMS increased in similarity to patterns detected in wild populations from corresponding salinities. The level of similarity accentuated over consecutive generations, indicating a mechanism of transgenerational plasticity. While we can attribute natural DNA methylation patterns to the two information channels, their interplay with genomic variation in salinity adaptation is still unresolved

Morbiditäts- und Mortalitätskonferenzen in Niedersachsen: Status quo und Weiterentwicklungsbedarf

BACKGROUND Morbidity and mortality conferences (M&MC) are a tool to foster individual and organizational learning in hospitals, and they are important to improve patient safety. So far, no data has been available about the implementation of M&MC in Lower Saxony and the characteristics of M&MCs. The aim of this study was to assess the status quo of M&MC in Lower Saxony and to identify the potential for improvement. METHODS A cross-sectional survey study was conducted among chief physicians in surgery, internal medicine, anesthesiology/intensive care, gynecology/obstetrics and pediatrics (response rate: 50 %). RESULTS Apart from technical topics (37 %), the main issues addressed are process (92 %) and teamwork (64 %) issues. The results also show a strong heterogeneity in terms of structures and processes of implemented M&MC in Lower Saxony. Despite a high level of satisfaction (85 %) and perceived effectiveness (93 %), most participants see potential for improvement of "their" M&MC (58 %). CONCLUSION Chief physicians in Lower Saxony report both a high level of acceptance and the need for further improvement of the M&MCs, which represents good preconditions for further development towards effective M&MCs.Zusammenfassung Hintergrund Morbiditäts- und Mortalitätskonferenzen (MMK) sind ein Instrument sowohl des individuellen als auch des organisationalen Lernens in Krankenhäusern und wichtig für die Verbesserung der Patientensicherheit. Bisher war allerdings unklar, wie verbreitet die MMK in Niedersachsen ist und wie sie umgesetzt wird. Das Ziel der Studie war, den Status Quo der MMK in Niedersachsen zu erfassen und Verbesserungspotenzial zu eruieren. Methode Es wurde eine Querschnittstudie mittels Online-Befragung von Chefärztinnen und -ärzten der chirurgischen Fächer, internistischen Fächer, der Anästhesiologie/Intensivmedizin, der Gynäkologie/Geburtshilfe und Pädiatrie durchgeführt (Rücklauf-Quote: 50%). Resultate In den MMK werden neben fachlichen Themen (37%) zunehmend Probleme in den Prozessen (92%) und der Zusammenarbeit (64%) besprochen. Die Resultate zeigen auch, dass die MMK in Niedersachsen bezüglich Struktur und Prozessen sehr heterogen sind. Trotz hoher Zufriedenheit (85%) und subjektiv eingeschätzter Wirksamkeit (93%) der MMK sehen die meisten Teilnehmenden Verbesserungspotenzial (58%). Schlussfolgerung Da generell sowohl eine hohe Akzeptanz als auch das Bedürfnis nach einer Weiterentwicklung sichtbar sind, existieren gute Voraussetzungen, die MMK weiterzuentwickeln

Reflecting on One Health in Action During the COVID-19 Response

The COVID-19 pandemic, a singular disruptive event in recent human history, has required rapid, innovative, coordinated and collaborative approaches to manage and ameliorate its worst impacts. However, the threat remains, and learning from initial efforts may benefit the response management in the future. One Health approaches to managing health challenges through multi-stakeholder engagement are underscored by an enabling environment. Here we describe three case studies from state (New South Wales, Australia), national (Ireland), and international (sub-Saharan Africa) scales which illustrate different aspects of One Health in action in response to the COVID-19 pandemic. In Ireland, a One Health team was assembled to help parameterise complex mathematical and resource models. In New South Wales, state authorities engaged collaboratively with animal health veterinarians and epidemiologists to leverage disease outbreak knowledge, expertise and technical and support structures for application to the COVID-19 emergency. The African One Health University Network linked members from health institutions and universities from eight countries to provide a virtual platform knowledge exchange on COVID-19 to support the response. Themes common to successful experiences included a shared resource base, interdisciplinary engagement, communication network strategies, and looking global to address local need. The One Health approaches used, particularly shared responsibility and knowledge integration, are benefiting the management of this pandemic and future One Health global challenges