One Health: Its Origins and Future

Ronald M. Atlas

Abstract One Health is an emerging concept that aims to bring together human,
animal, and environmental health. Achieving harmonized approaches for disease
detection and prevention is difficult because traditional boundaries of medical and
veterinary practice must be crossed. In the nineteenth and early twentieth centuries,
this was not the case—then researchers like Louis Pasteur and Robert Koch and
physicians like William Osler and Rudolph Virchow crossed the boundaries
between animal and human health. More recently, Calvin Schwabe revived the
concept of One Medicine. This was critical for the advancement of the field of
epidemiology, especially as applied to zoonotic diseases. The future of One Health is
at a crossroad with the need to more clearly define its boundaries and demonstrate its
benefits. Interestingly, the greatest acceptance of One Health is seen in the devel-
oping world where it is having significant impacts on control of infectious diseases.

Contents

1 Introduction.......................................................................................................................... 2
2 Louis Pasteur and Vaccination ........................................................................................... 2
3 Robert Koch and the Etiology of Infectious Diseases....................................................... 4
4 Calvin Schwabe and Epidemiology.................................................................................... 6
5 Contemporary Revival of One Health................................................................................ 8
6 Future of One Health .......................................................................................................... 11
References.................................................................................................................................. 13

R. M. Atlas (&)
University of Louisville, Louisville, KY, USA
e-mail: r.atlas@louisville.edu

Current Topics in Microbiology and Immunology (2012) 365: 1–13 1

DOI: 10.1007/82_2012_223
 Springer-Verlag Berlin Heidelberg 2013
Published Online: 25 April 2012
2 R. M. Atlas

1 Introduction

The One Health concept aims to establish collaborations that cut across the
boundaries of human, animal, and environmental health. For some, the interrela-
tionships between humans, animals, and the environment make a compelling
reason to move forward with the development of the field of One Health.
For others, though, there remains a lack of definition and a sense that a holistic
approach will obviate the specific needs of individual disciplines.
Both research and practice have become highly specialized and it is difficult to
break down the existing silos that limit the capacity for collaboration; though this
was not the case always. The roots of the One Health concept date to the
late nineteenth century—the time when Louis Pasteur and Robert Koch were
pioneering the field of microbiology and Rudolph Virchow and Sir William Osler
were establishing the basis of modern medical education and practice.
Both Virchow, a major figure in human medicine in the nineteenth century who
pioneered the filed of cellular pathology, and Osler, who became the preeminent
figure in medical education in the late nineteenth and early twentieth centuries, had
collaborative relationships that crossed the divide of human and veterinary med-
icine. Osler taught Parasitology and Physiology at the Montreal Veterinary College
in addition to his primary duties at the medical school of McGill University; at the
Montreal Veterinary College Osler conducted research on hog cholera (classical
swine fever) and other diseases of dogs and cattle; his textbook, The Principles
and Practice of Medicine (1892), set the standards for medical education (Kahn
et al. 2007). Virchow’s support for veterinary medicine led to the development
of veterinary pathology and the establishment of public health meat inspection
programs which today are the domain of veterinarians largely because of their
professional expertise in animal pathology (Kahn et al. 2007). Virchow is quoted
as saying: ‘‘between animal and human medicine there are no dividing lines—nor
should there be.’’ (Saunders 2000).

2 Louis Pasteur and Vaccination

In his research efforts that led to the development of a rabies vaccine, Pasteur
certainly saw no dividing line. Pasteur began to work on rabies in 1880 with the
aim of finding a way to prevent this disease that had begun to plague Europe.
He sought to build upon his success on developing a vaccine to protect chickens
against fowl cholera. By 1894, Pasteur was able to demonstrate that vaccination
with an attenuated virus that had been passed from one species to another could
protect dogs against rabies. By exposing the spinal chords to air of rabbits that had
been infected by canine rabies and by transferring the infection from one rabbit
to another every 2 weeks, Pasteur was able to further reduce the virulence of
the rabies virus. He demonstrated the successful results of a preventive rabies
vaccination experiment on dogs. The pre-exposure vaccination of canines is
One Health: Its Origins and Future 3

widely practiced today and is credited by greatly reducing the incidence of cases of
human rabies. Pasteur then moved on to the post-exposure vaccination of humans,
thereby crossing the divide of animal and human health.
Since the death of the child was almost certain, I decided in spite of my deep concern to
try on Joseph Meister the method which had serve me so well with dogs…I decided to
give a total of 13 inoculations in ten days. Fewer inoculations would have been sufficient,
but one will understand that I was extremely cautious in the first case. Joseph Meister
escaped not only the rabies that he might have received from his bites, but also the rabies
which I inoculated into him. (Pasteur 1885).

Three months later, Pasteur repeated the experiment on a young shepherd, Jean-
Baptiste Jupille, severely bitten by a rabid dog. On 26 October 1885, Pasteur
showed the promising results of his treatment against rabies in humans to the
French Academy of Sciences. From that time onwards, patients bitten by rabid
animals flocked to Pasteur’s laboratory. On 1 March 1886, Pasteur presented a
paper to the French Academy of Sciences with the results from the inoculation of
350 people. There was a single failure, due to the fact that the treatment had been
applied much too late, when the virus had probably already reached the nervous
system. A few months later, Pasteur reported the results of 726 inoculations. At a
meeting on March 1, 1886, Pasteur declared: ‘‘Rabies prophylaxis after a bite is
justified. There is cause to create a rabies vaccine establishment’’. Pasteur had
discovered the way to prevent rabies in both dogs and humans, setting the path
forward for controlling this disease. This is the paradigm of the One Health
approach.
The control of dog rabies still remains the single most important factor in
minimizing the public and veterinary risks of rabies in the developing world.
Although there are intensive vaccination programs for the number of cases of
rabies declines, but as vaccination of dogs declines, the number of cases of rabies
increases. Tragically, there still are over 50,000 fatal human cases per year and
according to the World Health Organization (WHO); more than 2.5 billion people
are at risk in over 100 countries. The AIDS epidemic has complicated the situation
as people afflicted with the disease increasingly abandon their dogs, making
vaccination efforts more difficult. Using baited vaccines distributed in the envi-
ronment for rabies control of stray dogs and wildlife, e.g., fox and raccoons, is
problematic if there are significant populations of immunocompromised individ-
uals in the area.
Pasteur’s work on rabies was neither done in isolation—nor was it the only
infectious disease where he helped pioneer vaccines to control infectious diseases
of both humans and animals. Henri Toussaint and Pierre Galtier were French
veterinarians who also sought to develop vaccines against fowl cholera, anthrax,
and rabies (Williams 2010). In 1880, Pasteur published that he had developed a
vaccine that could protect poultry against fowl cholera. The vaccine was attenu-
ated by prolonged exposure to oxygen. For his work on fowl cholera, Pasteur used
a culture of Pasterurella multocida that he had received from Toussaint. This was
critical for the successful development of the fowl cholera vaccine.
4 R. M. Atlas

Toussaint went on to develop a vaccine against anthrax using heat killed

Bacillus anthracis. Unfortunately, as this bacterium forms heat resistant spores, the
‘‘killed’’ vaccine was not always successful. Toussaint also experimented
with carbolic acid attenuated B. anthracis. Pasteur used oxygen and potassium
bicarbonate attenuated bacteria in his anthrax vaccine to protect sheep and other
animals against anthrax. For his rabies vaccine, Pasteur built upon the work of
Galtier who had shown that passage through domestic animals could alter the
virulence of the rabies virus.
As a result of the demonstration that vaccines developed in the laboratory could
prevent disease in animals and humans, Pasteur set a path for the control of many
once-deadly diseases. Smallpox, once a deadly human disease, and rinderpest,
a disease of cattle that shaped the history of Africa, have been eliminated.
Both attenuated and heat killed vaccines are critical in both veterinary and medical
practice today. The convergence of people, animals, and our environment
has created a new dynamic in which the health of each group is inextricably
interconnected. Pathogens can spread great distances as a result of modern
transportation systems and global commerce.
Vaccination is a core element of One Health. In the developing world, it is said
that vaccinating cattle which feed the village is seen as more important than
vaccinating children (Karen Becker, unpublished comment at the One Health
Summit, November 17, 2009). The One Health Medicine community has sought
to highlight the importance of rabies through worldwide educational programs
on World Rabies Day. Clearly, the efforts to eliminate rabies that began with
Pasteur’s development of a rabies vaccine will need to integrate a number of
human, animal health, and environmental factors, i.e., a One Health approach is
key. Confronting zoonoses through closer collaboration between medicine and
veterinary medicine is critical and vaccines and other means of controlling
infectious diseases in animals is a critical part in protecting human public health
(Kahn et al. 2007).

3 Robert Koch and the Etiology of Infectious Diseases

Pasteur’s arch rival Robert Koch also did not differentiate between infectious
diseases of humans and animals. As a child, Koch was caretaker of the family’s
chickens, cows, pigs, and horses. Later as a family physician Koch maintained
guinea pigs, rabbits, and even apes in his district hospital at his own expense. Koch
had hoped to study with Virchow but was denied the opportunity. Perhaps, that
was fortunate as Virchow was strongly opposed to the germ theory of disease.
Koch would go on to develop the theory that microorganisms were the agents
responsible for numerous human and animal diseases. In 1873, Koch began his
studies on anthrax which culminated with his demonstration that the etiology
of the disease was due to infection by the bacterium Bacillus anthracis (Koch
1877). Koch went on to study the etiology of tuberculosis in both cattle and
One Health: Its Origins and Future 5

humans. Through his research, Koch was able to find a causal relationship between
infection by a specific bacterium and a specific disease in both animals and
humans.
Until late in the nineteenth century disease had been regarded as resulting from a lack of
harmony between the sick person and his environment; as an upset of the proper balance
between the yin and the yang, according to the Chinese, or among the four humors,
according to Hippocrates. Louis Pasteur, Robert Koch, and their followers took a far
simpler and more direct view of the problem. They showed by laboratory experiments that
disease could be produced at will by the mere artifice of introducing a single specific
factor—a virulent microorganisms—into a healthy animal (Dubos 1959).

Koch went on to study various diseases of animals in the developing world.

He travelled to Cape Town and later to Egypt and East Africa to arrest epidemic
outbreaks of rinderpest in cattle. Koch used blood and serum from convalescent
animals to immunize and thereby protect healthy animals. While, in Africa, Koch
also studied human cases of malaria and suggested using prophylactic ingestion of
quinine and the use of netting to avoid the mosquito bites that had been shown to
be responsible for transmitting the etiologic agent of malaria. The first monument
dedicated to Koch was erected on the Italian island of Brioni in recognition of his
help in eradicating malaria there in 1900. In 1905, Koch was in Africa working on
three diseases—East Coast fever of cattle, tick borne relapsing fever of humans,
and tsetse fly borne trypanosomiasis of humans and animals showing that the
disease cycles involved vectors and nonhuman reservoirs for the pathogens. Koch
and his colleagues, for example, showed that trypanosomes underwent develop-
mental cycles in tsetse flies and tried to control the disease by ecological changes,
including thinning trees, cutting back brush, and eradicating crocodiles, the source
of blood for the tsetse fly Glossina palpalis. In trying to control this disease, Koch
clearly recognized the importance of the environment and how specific environ-
mental factors can impact animal and human health.
The ecology of infectious diseases is increasingly recognized as an appropriate
way of viewing animal and human health. There are classic examples of how
environmental disturbance leads to the spread of infectious disease; for example,
the numerous cases of yellow fever that occurred when the Panama Canal was
built as mosquitoes carried the yellow fever virus from the reservoir of monkeys in
the jungle canopy to the people constructing the canal in the exposed path where
the jungle was cleared. But even ecologically conscious development can alter the
ecology in ways that lead to the spread of infectious disease, e.g., the concentrated
outbreak of Lyme disease in 1975 after the town of Lyme Connecticut restored
forests, as a result houses were much closer to wooded areas allowing deer and
infected deer ticks to come in contact with more people. By restoring a forest, a
rare disease that was known before a century became a major concern that has
spread across the United States.
As proclaimed by the epidemiologist William Foege, who played a critical role
in devising the global strategy that led to the eradication of smallpox in the late
1970s and in increasing immunization rates in developing countries in the 1980s,
6 R. M. Atlas

‘‘You can’t tell the story of human health separate from animal health or envi-
ronmental health’’ (Foege 2004). Microorganisms circulate among human and
animal hosts and environmental reservoirs. Disruption of the environment can lead
to transmission of animals and humans; evolution of new microbial traits can occur
in response to the changes in the environment; and reservoirs of pathogens and
virulence traits can persist in the environment, poised to enter the cycle at an
opportune time (Atlas et al. 2010).

4 Calvin Schwabe and Epidemiology

Despite the clear interrelationships between human and animal disease and the
environment, twentieth century veterinary and medical practice and research
diverged with specialties and the intellectual silos became the norm in developed
countries. Countering the movement toward separation, Calvin Schwabe sought to
bring the fields of human and animal health care and infectious disease surveil-
lance together. It was Schwabe’s view that:
There is no difference of paradigm between human and veterinary medicine. Both sciences
share a common body of knowledge in anatomy, physiology, pathology, on the origins of
diseases in all species (Schwabe 1964).

Schwabe began his career in the School of Medicine at the American University
in Beirut, Lebanon in 1956. He subsequently founded and chaired a joint
Department of Tropical Health in the Schools of Medicine and Public Health and a
Department of Epidemiology and Biostatistics in the School of Public Health at
American University. He later established the Department of Epidemiology and
Preventive Medicine at the University of California Davis School of Veterinary
Medicine—the first of its kind in the world at a school of veterinary medicine.
There, he pioneered the use of human disease tracking techniques in the study of
animal disease and is considered the founder of veterinary epidemiology.
Schwabe is credited with originating the term One Medicine which later
became known as One Health (Kaplan and Scott 2011). Schwabe’s views on One
Medicine had their origins in his work with Dinka pastoralists in Sudan in the
1960s and reflected his broad interests in epidemiology, diseases of animals
transmissible to humans, interactions of veterinary and human medicine, parasitic
zoonoses and their control, tropical health, public health practice, livestock health
in pastoral societies, ancient origins of human and veterinary medicine, and the
philosophy of science (Zinsstag et al. 2011).
Today, ‘One Medicine’ is commonly referred to as ‘One Health’ worldwide. The change
in terminology occurred during the first decade of the 21st century. ‘‘One Health’’ evolved
from the earlier used term ‘‘One Medicine,’’ which historically implied the crossing over
between veterinarians and physicians. One Health recognizes that humans and animals do
not exist in isolation, but are parts of a larger whole, a living ecosystem, and that the
activities of each member affect the others. Thus, One Health considers health as a whole:
that of humans, animals, and the environment they exist on (Kaplan and Scott 2011).
One Health: Its Origins and Future 7

The public health value of joining veterinary and human medical efforts in
disease surveillance is especially obvious when it comes to zoonotic diseases.
Take, for example, the identification of West Nile virus in the United States.
In 1999, several elderly people in New York City became fatally ill with signs of
encephalitis. At the same time, crows began dying in large numbers in the same
area. Because of the separation of human and animal disease diagnostic processes,
initially there was no thought about a connection between them. Dr. Tracey
McNamara, head veterinary pathologist at the Bronx Zoo, began to investigate
why a growing number of crows were becoming ill and dying and why a cor-
morant, several flamingos, and a bald eagle at the Bronx Zoo also had died.
Analyses of human blood specimens by the Centers for Disease Control and
Prevention (CDC) initially suggested St. Louis encephalitis (SLE), a disease that
had previously occurred in the area and is transmitted from infected birds to
humans by mosquitoes. Analysis of samples from the dead zoo birds by the US
Department of Agriculture National Veterinary Services Lab in Ames, Iowa,
revealed a virus too small to be SLE virus. An epidemiologist at the New York
City health department raised concern that the large numbers of dead birds might
be connected to the human cases of encephalitis. It soon became clear that the
human and bird deaths were being caused by the same virus and that was a newly
emerging disease. Nearly 3 months after the initial outbreak, government scientists
announced that the disease was caused by West Nile virus, which had never before
been found in the Western hemisphere. If there had been a One Health approach to
surveillance and diagnosis, the etiology of the disease could have been revealed
much sooner.
Studies on the genes of West Nile virus suggest that it was first evolved in
Africa and also that as birds migrated from Africa to other continents of the Old
World, they spread the virus to new bird species and eventually to mosquito
vectors which then transferred the virus to other birds and humans (Zimmer 2011).
Modern molecular methods are facilitating the detection of emerging viral dis-
eases. In a fascinating application of these molecular techniques, the source of the
AIDS epidemic may have been identified as coming from colonial Africa a century
ago (Timberg and Halperin 2012). These analyses have shown that the HIV-1
group M, which is responsible for human AIDS, probably originated in chim-
panzees in Cameroon before 1900 and most likely was transferred into the blood of
a hunter who was harvesting bush meat (Timberg and Halperin 2012). That
individual most likely infected others so that the virus moved down the Sangha and
Congo Rivers into Kinshasa. At that time, colonial efforts to exploit local rubber
and ivory created routes to transport these resources that became pathways for
infectious disease propagation; for example, syphilis reached epidemic proportions
along porter routes and riverside trading posts in Cameroon and throughout the
Congo Basin. The large population of the city of Kinshasa and the movement of
porters to carry supplies and exploited resources are postulated to have created the
conditions for the AIDS epidemic that moved worldwide.
Today, scientists like Nathan Wolfe are carrying out molecular analyses on
viruses in the developing world. Wolfe founded and directs the Global Viral
8 R. M. Atlas

Forecasting Initiative (GVFI), which is a pandemic early warning system that

monitors the spillover of novel infectious agents from animals into humans. The
molecular surveillance being carried out by GVFI aims to characterize the
diversity of viruses and other agents as they move from animals into human
populations, providing basic insights into how new diseases enter humans and
improving our ability to decrease the frequency of such events. Given that, most
major diseases of humanity originate in animals and exposure to wild and domestic
animals leads to continuous spillovers of novel agents into humans, such sur-
veillance may provide the necessary warning to prevent major pandemics. If such
monitoring had been in place a century ago, we might have averted the HIV/AIDS
pandemic.
Indeed a fundamental goal of the One Health movement is to integrate human
and animal disease surveillance and early detection in both animal and human
populations. There is a need to support integrated environmental, animal, and
human health research on the factors promoting emergence of disease, on inter-
ventions to prevent their occurrence, and on interventions that protect human and
animal health. Modern molecular analytical tools may provide the means of
accomplishing the necessary surveillance of emerging pathogens in animals,
e.g., H5N1 avian influenza viruses, and thereby provide a way of predicting and
preventing jumps to humans of pathogens that could cause deadly pandemics.

5 Contemporary Revival of One Health

A half century after Schwabe coined the term One Medicine, the Wildlife
Conservation Society organized a One World, One Health symposium in Sep-
tember 2004. The symposium focused on the current and potential movements of
diseases among human, domestic animal, and wildlife populations. Examining
case studies on Ebola, Avian Influenza, and Chronic Wasting Disease led to the
conclusion that only by breaking down the barriers among agencies, individuals,
specialties, and sectors would be able to unleash the innovation and expertise
needed to meet the numerous serious challenges to the health of people, domestic
animals, wildlife, and the integrity of ecosystems.
The group produced a list of 12 recommendations, which they called the
‘‘Manhattan Principles,’’ for establishing a more holistic approach to prevent
epidemic/epizootic disease and for maintaining ecosystem integrity for the benefit
of humans, their domesticated animals, and the foundational biodiversity that
supports us all (Cook et al. 2004). Key among these recommendations was the
need to recognize the essential link between human, domestic animal and wildlife
health and the threat disease poses to people, their food supplies and economies,
and the biodiversity essential to maintain the healthy environments and func-
tioning ecosystems we all require.
Two years later, the American Veterinary Medical Association (AVMA) began
an effort to foster the One Health Concept. Under the leadership of Roger Mahr
One Health: Its Origins and Future 9

(AVMA President 2006–2007) it formed a task force chaired by Lonnie King to study
the feasibility of an initiative that would facilitate collaboration and cooperation
among health science professions, academic institutions, governmental agencies, and
industries to help with the assessment, treatment, and prevention of cross-species
disease transmission and mutually prevalent, but non-transmitted, human and animal
diseases and medical conditions. The task force issued a report entitled One Health: A
New Professional Imperative (http://www.avma.org/onehealth/onehealth_final.asp)
which had as a main recommendation the formation of a One Health Commission. The
AVMA was joined by the American Medical Association in trying to move forward the
formation of the One Health Commission. As an intermediate step, a One Health Joint
Steering Committee, which I chaired, was formed in 2008 to define the scope of the
One Health Commission.
The One Health Commission was chartered in June 2009 (http://www.one
healthcommission.org/). The professional partners associated with the One Health
Commission are the: American Veterinary Medical Association, American Public
Health Association, Association of Academic Health Centers, Association
of American Medical Colleges, Association of American Veterinary Medical
Colleges, Infectious Diseases Society of America, and Iowa State University One
Health Consortium.
The mission of the One Health Commission is the establishment of closer
professional interactions, collaborations, and educational and research opportuni-
ties across the health sciences professions, together with their related disciplines,
to improve the health of people, animals, plants, and our environment. Two pri-
mary goals have been identified to achieve its mission toward One Health: (1) To
inform all audiences about the importance of the One Health approach by estab-
lishing a leading center for One Health communications and resources and (2) to
transform the way human, animal, plant, and ecosystem health-related disciplines
and institutions work together by promoting and enabling demonstration projects
that illustrate the importance and value of the One Health approach. The aim is to
establish interdisciplinary programs in education, training, research, and estab-
lished policy; provide more opportunities for information sharing related to disease
detection and diagnosis, as well as education and research; to achieve more pre-
vention of diseases, both infectious and chronic; and to foster new therapies and
approaches to treatment for unmet needs.
The One Health Commission convened a One Health Summit in 2008 at the
National Academies in Washington DC to raise awareness of the importance of
transcending institutional and disciplinary boundaries to improve health for all
species (http://www.avma.org/onlnews/javma/jan10/100101i.asp). The summit
was designed to be a forerunner to a National Academies study that would define a
roadmap for advancing the One Health Concept. Although there was great
enthusiasm expressed at the summit by Federal Agencies and various scientific,
public health, medical, and veterinary organizations, the proposed National
Academies study has not moved forward with developing a One Health agenda
and it remains to be seen how broadly the Commission can impact the research and
practice agenda in the United States and beyond.
10 R. M. Atlas

One of the goals of the One Health Commission is to inform all audiences about
the importance of the One Health approach by establishing a leading center for
One Health communications and resources. This communication function seems
to be being better met by the One Health Initiative which was independently
formed by Laura Kahn, Bruce Kaplan, and Thomas Monath; these three individ-
uals brought together the public health, veterinary, and medical perspectives,
respectively, and formed an effective outreach program; they have been joined by
others who support the One Health Concept. The One Health Initiative aims to
forge coequal, all inclusive collaborations between physicians, osteopaths, veter-
inarians, dentists, nurses, and other scientific-health and environmentally related
disciplines. The web site maintained by the One Health Initiative (http://www.
onehealthinitiative.com/) provides a conduit for keeping the global community
informed of upcoming meetings and other relevant activities. It also hosts the
archive for the One Health Newsletter which publishes articles about various
aspects of One Health (www.onehealthinitiative.com/newsletter.php).
A major outcome of the One Health effort initiated by the American Veterinary
Medical Association was the formation by The Centers for Disease Control and
Prevention of a One Health Office. The One Health Office brings together CDC
personnel and resources from multiple organizational units and disciplines to more
precisely address the convergence of human and animal health. The CDC’s One
Health Office works to facilitate, sponsor, and coordinate research and program
activities that seek to attain optimal health for people and animals through an
integrated approach considering the interrelatedness among humans, animals, and
the environment in which they live. Working together with the US Department of
Agriculture the CDC One Health Office has begun to forge the collaborative efforts
that are at the heart of the One Health movement.
Growing support by government agencies is evident in a series of workshops
that are establishing a formal process for advancing a One Health agenda.
In March 2009, the Public Health Agency of Canada, in collaboration with other
Canadian ministries and several major international organizations hosted an expert
consultation titled ‘‘One World, One Health: From Ideas to Action’’ in Winnipeg,
Manitoba. The purpose of the consultation was to identify and shape country level
recommended actions to globally advance the framework for advancing One
Health. The Report of the Expert Consultation concluded that moving forward the
animal, human, and ecosystem interface concepts of ‘‘One Health’’ required
commitment at all levels—international, regional, national, and local.
The World Organization for Animal Health (OIE), Food and Agriculture Orga-
nization of the United Nations (FAO), World Health Organization (WHO), and
Centers for Disease Control and Prevention (CDC) convened a subsequent meeting
on 4–6 May 2010 at the Stone Mountain Conference Center in Atlanta, Georgia, to
build upon the recommendations and conclusions drawn from the Winnipeg expert
consultation. The meeting, entitled ‘‘Operationalizing ‘One Health:’ A Policy
Perspective-Taking Stock and Shaping an Implementation Roadmap,’’ brought
together a select group of leaders, including specialists from national Ministries of
Health and Agriculture, the European Commission, the UN, the World Bank, and
One Health: Its Origins and Future 11

other institutions from the academic, policy and economic sectors to contribute their
expertise and experience to the discussion. The participants identified ‘‘critical
enabling initiatives’’ that would promote One Health goals.
The group recognized that for One Health to become an operational reality
there would need to be a cultural change so as to appreciate the importance of the
connection between humans, animals, and ecosystems; increased visibility of the
value added by the One Health approach in preventing, detecting, and controlling
diseases that impact both humans and animals; designated funding to support
interdisciplinary collaborative programs; and improved collaboration in surveil-
lance, communications, outbreak response, and sample sharing. Seven workgroups
were formed to collaboratively develop and implement the key activities that
collectively would result in the operationalization of One Health through training,
communication, capacity building, and institutional support. These groups are
progressing in developing plans.
In addition to the government meetings that are trying to develop a path forward
for One Health, there have been several major scientific and public health meetings
that are bringing together the scientific, medical, and veterinary communities who
are finding common ground for future collaborations. For example, a regional One
Health conference was held in South Africa in 2011. The American Society for
Microbiology also organized sessions on One Health at the annual meetings of the
American Association for the Advancement of Sciences in 2010, 2011, and 2012.
Immediately following the last of these sessions, which dealt with demonstration
projects in the developing world, the Global Risk Forum (GRF) held a One Health
Summit in Davos Switzerland in 2012 that examined the risks and opportunities
for One Health from an integrative health risk management perspective. That
Summit recognized that today’s human health management requires a holistic One
Health perspective and that only an integrative approach will ensure sustainable
health management in an era of climate change, resource depletion, land degra-
dation, food insecurity and development challenges.
The first International One Health Congress, held in February 2011 in Mel-
bourne Australia, was the largest One Health meeting held to date with more than
650 people from over 60 countries. In addition to the themes of One Health already
discussed, the Congress expanded into the area of food security and safety. The
conference was quite successful in facilitating dialog. A second International One
Health Congress is planned for early 2013 in Bangkok, Thailand. These meetings
seem to reflect growing support for One Health.

6 Future of One Health

Despite the obvious value put forth by the proponents of One Health, there are
serious challenges to the development of One Health. There has yet to be agree-
ment on the scope of One Health—different groups have proposed a variety of
definitions. Zinsstag et al. (2011) state that ‘‘One health is anything that adds value to
12 R. M. Atlas

the health of animals and humans, or economic savings, not achievable without
cooperation of the two medicines. It should just become normal that doctors and
veterinarians work together as closely as possible.’’ (Zinsstag et al. 2011). The One
Health Commission defines One Health differently stating that ‘‘One Health is the
collaborative effort of multiple health science professions, together with their related
disciplines and institutions—working locally, nationally, and globally—to attain
optimal health for people, domestic animals, wildlife, plants, and our environment’’
(http://www.onehealthcommission.org). While a uniform definition may not be
essential, it would serve as a focal point for defining constituencies and boundaries of
relevant activities.
The One Health Initiative does not offer a specific definition but says that ‘‘The
One Health concept is a worldwide strategy for expanding interdisciplinary col-
laborations and communications in all aspects of health care for humans, animals
and the environment.’’ It states that the synergism achieved will advance health
care for the twenty-first century and beyond by accelerating biomedical research
discoveries, enhancing public health efficacy, expeditiously expanding the scien-
tific knowledge base, and improving medical education and clinical care. Viewing
One Health this broadly suggests that it is everything for everybody, in which case
it lacks the necessary focus to impact the health of humans, animals, and the
environment. Hence, it may not be surprising it is proving difficult to gain broad
acceptance for the One Health concept.
Many physicians in particular object to the term holistic which often is used to
describe One Health—this may be a visceral reaction to the term ‘‘holistic medi-
cine’’, which is not widely supported by physicians. Also, there are those in the fields
of human medicine who see One Health as a field being championed primarily by
veterinarians and they are suspicious of the motives. And of course, there are the
silos that have been developed in both research and practice—it is always difficult to
break down boundaries and foster new cross-cutting relationships.
The value of One Health is best appreciated from a public health perspective,
especially in the developing world where limited resources force coordinated
actions between physicians, veterinarians, and ecological conservationists.
According to Lonnie King (2008) we must confront the ‘‘triple threat’’ since
infectious diseases can easily cross geographic boundaries, especially in a time of
unprecedented global travel and commerce and because infectious agents can
move from animal hosts to human hosts and back, adapt to the ever-changing
natural environment, and cause a public health crisis that no country can afford to
ignore. To prevent the evolving infectious diseases we know today and to prepare
for the emerging infectious threats of tomorrow, we need to consider infectious
diseases not only as they relate to human health. This human–animal–environment
interface impacts nearly all aspects of public health, including the risk of exposure
and illness, the scope of disease emergence and spread, approaches to surveillance
and early warning, basic and applied research and the effectiveness of interven-
tions for prevention and control. The ‘‘triple threat’’, thus, demands new ways of
working in public health and new collaborations that do not exist today.
One Health: Its Origins and Future 13

Given that over 60 % of emerging infectious disease events is caused by the

transmission of an infectious agent from animals (zoonoses), with 75 % of these
originating from wildlife, employing a systematic One Health approach has great
potential for reducing threats to global health from infectious diseases. The One
Health approach should advance health care for the twenty-first century and
beyond by accelerating biomedical research, enhancing public health efficacy,
expeditiously expanding the scientific knowledge base, and improving medical
education and clinical care (Atlas et al. 2010).

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