One Health is an integrating idea that brings different sectors together to solve the health, productivity, and conservation challenges and has major implications for India. India with its diverse wildlife, one of the largest livestock populations and high density of human population, carries heightened risks for inter-compartmental spread of diseases. Covid pandemic, recent outbreaks of Lumpy Skin Disease in cattle and the constant threat of Avian Influenza show that it is not just about addressing diseases from human health point of view (zoonosis) but we need to address the livestock and wildlife aspects. This also opens opportunities for leveraging the complementarity and strengths that is inherent in each sector and devise integrated, robust and agile response systems.
There are many One Health efforts underway in various Ministries of the Government of India, in private organizations in addition to a range of activities globally. This presents a prospect to review the areas of focus underlying each effort, identify opportunities for collaboration and work towards filling any remaining gaps. Considering this, The Prime Minister's Science, Technology, and Innovation Advisory Council (PM-STIAC) in its 21st meeting, approved to set up a National One Health Mission with a cross-ministerial effort which will serve to coordinate, support, and integrate all the existing One Health activities in the country and fill gaps where it is appropriate.
The Mission aims to coordinate across achieving overall pandemic preparedness and integrated disease control against priority diseases of both human and animal sectors, with early warning systems built on integrated surveillance system and response readiness for endemic as well as emerging epidemic or pandemic threat.
The mission will also address critical pillars of preparedness in the form of targeted R&D to develop important tools such as vaccines, diagnostics and therapeutics, readiness in terms of clinical care, streamline data and information linkages and access across sectors as well as close community participation to keep our readiness to respond.
The following specific efforts will be undertaken in the National One Health Mission :
Implementing integrated disease surveillance within and across human, animal, and environmental sectors to address communicable diseases of zoonotic, transboundary animal diseases and diseases of epidemic/pandemic potential. This includes building early warning systems and integrating information coming from clinical and epidemiological data, information from various surveillance programs regardless of the agencies across sectors implementing it and deploying novel approaches such as environmental surveillance for timely and more accurate detection of diseases.
Integration across sectors for Integrated Surveillance
Environmental surveillance system- The One Health Mission envisions a robust network of sentinel-based surveillance that provides an ongoing real time picture of pathogens/disease spread that when linked to other sources of information, can be powerful adjunct to fill a major gap in our understanding of disease transmission dynamics across multiple diseases across human, animal husbandry and wildlife.
Sentinels include sewage, vectors (such as mosquitoes, ticks, rodents etc.), milk, places of aggregation such as animal trade and water holes, abattoir effluents and ports of entry such as airports. This system can also serve as the backbone, once established to bring the environmental components, including signs of habitat change, AMR surveillance, water quality etc. A pictorial representation environmental surveillance, its methodologies and sentinels is depicted below
Environmental surveillance provides cost effective and sensitive approaches to detect diseases that are priority for elimination or eradication since as the disease prevalence goes down and program gets closer to elimination, traditional surveillance methodologies may not provide sufficient sensitivity. Introducing environmental surveillance can serve as a powerful and novel adjunct to the disease elimination programs. List of diseases that are on target for elimination and concerted efforts are to be undertaken to implement sentinel-based surveillance for these diseases.
Develop robust outbreak investigation mechanisms for effective investigation and control of diseases across human, animal husbandry and wildlife sectors with framework for joint investigations. This includes building outbreak response teams at national levels linked to respective state programs and strengthening district level outbreak response teams such as Rapid Response Teams (RRTs), with clear framework for functioning as a connected system for routine disease control programs for addressing both endemic and emerging diseases.
Joint Outbreak Investigation & Response Process
All the aspects of pandemic preparedness will be embedded in the routine prevention programs to ensure sustainability and continued improvement of both aspects.
These outcomes of the One Health Mission will be supported by critical enabling initiatives. Many of these initiatives are ongoing and will be strengthened under the mission and several new activities that will facilitate the goals of the mission will be undertaken.
Critical enabling activities of the One Health Mission
State pilots are being developed to better inform the implementation and to ensure that the Mission is grounded and informed by ongoing activities and capabilities. Moreover, following detailed mapping exercises are being conducted. This will ensure continuous strengthening of the existing programs and systems.
Disease gap prioritization exercise: A comprehensive collation of all the diseases of One Health priorities (zoonotic, transboundary animal diseases and diseases of epidemic/pandemic potential) and available interventions (vaccines, therapeutics, and diagnostics) across human, animal husbandry and wildlife sectors has been performed with extensive consultations. Gaps thus identified will be prioritized to serve as a guide for targeted R&D or epidemiological studies. This is envisioned to be a live database that will be continuously updated as the program evolves.
Mapping of existing surveillance programs: Before considering integrating disease surveillance, a comprehensive mapping of all ongoing disease surveillance programs (both active and passive surveillance) across the sectors has been undertaken. Overlaps and potential opportunities for integrating them further will be taken up.
Mapping of laboratory capabilities of existing and upcoming BSL-2, 3 and 4 levels for better understanding of country’s capabilities has been done. This critical lab infrastructure will be better integrated into a national network to achieve effective resource utilization and capacity building both for routine disease control and addressing emerging pandemics.
Mapping institutional capabilities: India has strong capabilities both within and outside government departments. A mapping exercise was undertaken to assess the core capabilities of institutions of the stakeholder departments and highlight where they can contribute towards the Mission. This will further provide a collective understanding of the roles to be played in building a One Health ecosystem.
The ability to predict, detect and respond to an infectious disease reflects fundamental capability of a system, and the efforts mentioned above are useful not just for natural origins of the infection but also accidental or intentional spreads. One Health concept is comprehensive and encompasses overall health of all living beings as well as that of the environment. This includes issues such as food security, water quality, antimicrobial resistance, and climate change. These are also being handled globally through quadripartite and G-20 forum. This mission aims to take up the specific issue of integrated disease control and pandemic preparedness within the broader landscape of One Health. Achieving meaningful progress in a focused manner will not only help in addressing this important topic and but also will provide valuable insights and lessons to further take up other issues of One Health.
Data related efforts are the most significant backbone of One Health Mission. An integrated data platform will be built to host data on disease spread across all sectors, data to guide R&D and preparedness efforts, data for better public health and other program design and monitoring effectiveness etc.
A Federated model will be followed where-in data will be held in different distributed places and it will be integrated by APIs and other technical means by harmonizing the input, and following the data standards. All the stakeholder departments will be contributors and users of this platform. The data platform will host data related to, but not limited to-
Integrating surveillance and routine care data within sectors and across sectors like integrating across human health sectors (efforts on linking vector born and NCDC data). Integrating information across sectors, such as between IDSP/NDLM/NRC-W and beyond.
Disease incidences and outbreaks across sectors
R&D and preparedness efforts
Various analytics such as disease modeling, epidemiology capabilities etc. for better decision making
A schematic representation of the integrated data ecosystem is mentioned below-