Future of “One Health” in Africa

by Dr Sarah Paige

West Africa’s 2014-2015 Ebola epidemic was the worst the world has ever seen. “Patient zero” was a two-year old boy, Emile, who lived in a small border town in Guinea. While the origin of his infection is unknown, many hypothesized, early on, that he acquired Ebola through consuming ‘bushmeat’. This assumption resulted in a region-wide hunting prohibition by public health authorities. The role of public health authorities in implementing such a ban is unprecedented. Wildlife management has historically been the exclusive purview of national wildlife authorities. The quick leap from Ebola infection to public health-mandated bushmeat ban demonstrates the subtle, yet influential role of One Health upon the global stage.

One Health is a research framework premised upon the interconnection and co-constitutive nature of human health, animal health, and ecosystem integrity. The One Health concept is not new; Medical Geographers, Disease Ecologists, and Environmental Anthropologists served imperial interests during the late 1800s through mid1900s by surveying “new” landscapes and cataloguing concomitant health risks embedded within those landscapes. However, the discipline faded from biomedical prominence in the 1940s. It was during this period that antibiotics were discovered; colonial independence was simply a matter of time; and the rich world experienced its ‘epidemiological transition’ where its burden of disease swung from infectious disease to non-communicable, chronic illness. Combined, these shifts pulled attention and investment away from research to understand and interrupt the complex ecological factors behind tropical diseases.

The discovery of the origins of HIV catapulted the One Health concept back to prominence. By 2000, the scientific community reached consensus that HIV originated as Simian Immunodeficiency Virus (SIV) in non-human primates[1–3]. SIV underwent a number of species “jumps” and mutations among chimpanzees (Pan troglodytes), sooty mangabeys (Cercocebus atys), and humans. “Jumps” were attributed to the practices of hunting and butchering [4–6]. Realizing that this global pandemic was the result of a cross-species disease transfer forced the public health community to seriously engage the science of One Health, as the relationships between people, animals and the environment underpin the emergence of HIV.

Today, the One Health framework has been used to explain and predict emerging infectious diseases, including zoonotic diseases. Zoonoses, or infections from animal sources, are responsible for up to 70% of emerging infectious diseases [7]. Emerging zoonoses discourse implicates broad structural shifts in global society and corresponding changes in human-environment relationships [8]. These shifts reflect biological, social, environmental, and demographic factors that modify microbes, landscapes, climate, and human-environment interaction. Changes operate synergistically to facilitate the emergence and re-emergence of infectious pathogens like Ebola. Places where many shifting forces converge are in the developing world, and especially in sub-Saharan Africa, where daily livelihood activities, in concert with ecological biodiversity, increasingly dense and mobile populations, and constrained livelihood options, serves as a catalyst to disease emergence [9].

While the framework is robust in the sense that it engages with complex and systems based science, its inevitable flaw is the lack of engagement with the social sciences [10,11]. This absolute lack of engagement with the social, political, economic, spiritual, cultural, and material conditions of people who are on the front-lines of exposure and therefore, most vulnerable to infection from a novel pathogen, will render One Health obsolete. Novel zoonotic diseases do not emerge spontaneously. Humans and animals must come into contact, and specific types of contact, in order for a pathogen to spillover. Without a careful examination of local lives at the fine scales where human and animals coexist and collide, emerging infections policy makers and funders risk recreating ineffective top-down approaches to human health and wellbeing that neglect attending to the social and ecological conditions which shape disease risk for people and animals.

As it turns out, young Emile was likely infected with Ebola through exposure to bat feces when playing near a tree that was also a fruit bat roost. The impact of the hunting ban on hunting families’ nutritional wellbeing will likely never be fully explored, as ‘bushmeat’ hunting has long been an ‘undesirable’ practice, therefore, there was no international outcry on behalf of African subsistence hunters. As Sagan Friant points out emerging infectious diseases and hunting bushmeat is a “Complex Problem.”

Dr Sarah Paige

Health Geographer: University of Wisconsin-Madison

Read more about Sarah and her view on being a futurist

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