One Health

The sustainability of our existence relies on the health of every human, every animal, and the environment we all share. Published today, "The Lancet One Health Commission: harnessing our interconnectedness for equitable, sustainable, and healthy socioecological systems" highlights challenges like climate change, food security, and antimicrobial resistance to lay out the One Health approach to informing and implementing solutions.

Senior Executive Editor at The Lancet Pam Das is joined by lead Commissioners, Andrea Winkler and John Amuasi, to explain the past, present, and future of the One Health concept.

You can read the Commission here:

https://www.thelancet.com/commissions-do/one-health?dgcid=buzzsprout_tlv_podcast_lancetonehealth25_lancet

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Pam: Hello and welcome to the Lancet Voice. It's July, 2025, and I'm Pam Das Senior Executive Editor at The Lancet. Today we're going to be talking about the new one Health Commission, published today by the Lancet. And I'm joined by two of the lead commissioners, Andrea Winkler and John Amuasi. This commission is especially important right now because there's an urgent need to apply new approaches to tackle some of the world's most intractable problems, and it's the culmination of six years of work to get it to publication.

We hope you enjoy the conversation.

I had to welcome Andrea Winkler and John Amey. Perhaps if I can hand over to you, Andrea and John to introduce yourselves and tell us a bit about yourself. Thank you 

Andrea: very much, Pam, for the kind introduction. I'm Andrea Winkler, together with John Amuasi, I've been co-chairing the Lancet One Health Commission and from now on we are going to refer to this long title that you just mentioned as One Health.

And it indeed it was a long journey together. I'm working out of the Technical University of Munich, department of Neurology and Center for Global Health. As well as the University of Oslo, department of Community Medicine and Global Health. 

John: Thank you very much, Andrea. My name is John Amway, as has already been mentioned and working very closely with Andrea Winkler over the past six years, I should say, on this Lancet One Health Commission.

I sit at the Kwame and Kuma University of Science and Technology in Kumasi, Ghana, which is in West Africa. Where I head the Department of Global Health of the School of Public Health and also lead the Global Health and Infectious Diseases Research Group. I also work with the Institute in Tropical Medicine in in Hamburg, Germany, where my research group is also admitted.

Pam: Great. Thank you, Andrea, John, and welcome. So let's start One Health. Now that's not really a new approach. The term has been around for over two decades. Indeed. When I was reading through the commission, you made a citation in the introduction about the first time an article was published in the biomedical world anyway, was in 2005, so that's 20 years ago.

Can you tell us. What is One Health and what the thinking and the need was behind having a Lancet Commission? Indeed.

Andrea: Pam, one half the term, one Health has been coined for approximately two decades. You are absolutely right and maybe John can say more about this in a moment, I would like to say that one, health as an approach or as a philosophy.

Being focused on the interdependencies of life has a very long tradition in history and can already be found in, in, in ancient Greek Egypt, but also throughout cultures, indigenous knowledge and various religions. And we have detailed this quite nicely at the beginning of our report now, when we look at.

The more biomedical approach there have been people, doctors, scholars like Hypocrite, Aristotle, Ghislaine, who have also already picked up those interdependencies between humans, animals, and the environment. And then in the 19th century, there was the German physician, Ru, who in fact pointed out that.

There is this intrinsic interconnection and there's no scientific barrier. I just quote, nor should there be between veterinary medicine and human medicine. The experience of one must be utilized for the development of the other. That was Rudolph Ko in the late 19th century. Then, and then we move via veterinarians.

Mainly one has to say, this is mainly really a concept that has been evolving from the Veterinarian sciences and James Steele, William Osler as, as well as other veterinarians have paved the way to our one health definition as we. Have it today and in 1964 there was a milestone that was actually Kavin Schwa who called for collaboration between medical and veterinary professions and coined the concept of one medicine.

So we are not quite there yet, and there's when other movements really interesting movements that hardly get. Mentioning like Rachel Carson or also Kenyan, professor of veterinarian and not anatomy, actually Wangari Mattai, who founded the Green Belt Movement, who have, again, explicated this connection between humans and animals and their shared environment.

And then we come to the more contemporary currents. And maybe John, you would like to take over from this. 

John: Thank you very much, Andrea for that. And I must say you very nicely explained how One Health really has existed in terms of a concept for a very long time. And we see how this is reflected across different societies, across different parts of the world in the ways they have thought about living life within various ecosystems.

In fact, Calvin Schwab whom you rightly invoked. He was motivated or inspired by his observations with Dinka pastoralists in the Sudan and how they lived amongst the animals and took care of them. And he realized that really they, their livelihood and their wellbeing was closely connected.

Only to their animals, but also to the environment with within which they all lived. They seem to have an understanding of this fundamental interconnectedness, and they lived and considered things within that mil. But I must say that the advent of biomedicine particularly the discovery of of an antibiotics.

Also the golden age of technology and technological advancement really shifted our thinking away from this fundamentally interconnectedness and almost led us to think that, oh we can in a way isolate ourselves from the rest of the world and live very healthy long lives. I remember. You would recall when an antibiotics were discovered, a lot of declarations were made that, okay, very soon would have no more disease upon the earth and anticipating wonderful life for human beings outside of any sickness because we saw the wonder of antibiotics.

Now we've come round and all the way back to what you mentioned in the beginning, Hippocrates way of thinking about really this fundamental interconnectedness of humans, animals in the shared environment. And more recently you, although One Health has been around as a term for, close to two decades, I should say, as you rightly mentioned, one Health was never mentioned in the sustainable development goals.

One Health was never mainstream in the Global Health discourse. Even when the accelerators to the sustainable development goals were being put forward we attempted to put One Health Forward and this did not work. Now we see One Health as, as the main driver of the WHO Pandemic Agreement. It's central and the WHO Pandemic agreement is the only, the second legally binding instrument that has been passed by the WHO second only to IHR.

And that tells you how thinking about One health and its utility in global health has really changed. And now it's very much at the forefront. I think it's an exciting time for global health. When we finally accept at the highest levels that the health of humans, animals, and the shared environment is fundamentally disconnected, and that's how we've gotta think about health.

If we want to have what we've put in our lives at One Health Commission, healthy, sustainable, extra psychological systems. 

Andrea: If I can just take us back and mention a couple of more milestones that should be mentioned. I think, and Pam, you very widely mentioned that actually the first mentioning of One Health was in an article about Ebola published in 2003.

Then One Health, the term was for the first time mentioned at a subsequent conference and then picked up in the Manhattan Principles. And I think the Manhattan principles really stand out. That was 2004. So yes, it is 20 years. And they have coined also what One World, one Health. One World, one Health approach.

So that has, again. Paved the way then to the Berlin principles that have picked up on the Manhattan principles in 2021, and not the least, there have been after that 2004 creation of terminology, there has been a proliferation of different one health endeavors platforms. The World Bank has taken on one Health.

And has published on it, has published use cases, investment cases, and what we have to say, just to conclude this question, is obviously also at the highest level, at the global level or international organization level, there was the formation of the tripartite. So for the first time that three international organizations got together, which was the.

WHO, the FAO and war the World Organization of Animal Health. Previously OIE, that was 2010. And in 2022, the UNEP, the United Nation Environment Program was added to the tripartite to become the quarter apartheid and the quad Apartheid is instrumental in moving forward. One Health. Also was instrumental to collaborate with and exchange with throughout our commission and the report.

And the last thing I would like to mention is the one health high level expert panel that has been created founded just shortly before the quarter apartheid. And who represents an advisory board? An interdisciplinary, multi-sectoral, very equitable advisory report to the One Health Quarter Apartheid.

Pam: Thank you, Andrea. Thank you, John. So I can see the journey that one health has taken. It goes back to the start of civilization almost, it goes back a long way and I guess. The commission does just that describes that journey of evolution of the field and explores some of those interrelationships and brings together and synthesizes that current state of knowledge and evidence regarding the need and value for One Health for addressing today's health and sustainability challenges.

You mentioned John. The pandemic agreement. And of course, I guess one of the most recent events, which is very much still in our minds, is the COVID-19 pandemic. I wondered if you could tell us, how the COVID Pandemic and other sort of global events have really shaped the Global One Health field.

John: I think the COVID-19 pandemic was as we, everyone has called it a wake up call to the world to recognize that, health as it stands is complicated at various levels, particularly even as human beings. That the health of people in one location is closely connected to the health of everyone in across the world.

And this is what gave birth to. The saying, no one is safe until everyone is safe. It's such a poignant, maybe a bit hackneyed, but true statement in every sense of the word. And even more true now because of ability to move around very quickly across the world thanks to travel. And if you think about it even a little more deeply, even our ability to shape.

Thinking via information across the world. You don't need to even move in person. But the things that we write, the things we say, shape people's thinking and influence people's behaviors in very interesting ways that have implications for our health. Both the spread of communicable and non communicable disease is something that we address.

Even in our report but specifically with regard to COVID-19 and because of its origins, knowing we know very well that this originated in bats and then spread to human beings. And this recognizing how a virus in bats could have such a profound impact not just on human beings, but on the entire world.

Several other species were impacted both directly and indirectly. This is what has brought one health to the fore in, in, in global discourse. And I'd mentioned earlier that either to prior to COVID-19, one Health was recognized across global health but did not have prominence. It was literally not mentioned anywhere.

If you go to a lot of ma if you go it went to many major funders websites, I would mention any names or look at their portfolios. There was hardly any mention, explicit mention of One Health. But now it is very difficult to see any funding call for any kind of health related research that does not invoke one health in one shape or form or the other.

And as I'd alluded to earlier. You now have One Health as the vehicle for operationalizing the WHO Pandemic Agreement, which is only the second only to IHR legally binding instrument of the WHO. And this is all thanks to, I can put that way, the COVID-19 pandemic because it was the events following the outbreak that motivated the formation of the international negotiating body.

In fact, their mandate was specifically. In relation to COVID-19, to address the shortfalls, if I can put it that way, of the International health regulations IHR, and to develop some new provisions which would allow for a different way of addressing outbreaks and pandemics very specifically from a one health perspective.

This is what COVID-19 has done. COVID-19, if I can say, has been the vehicle that has propelled one health to the forefront in global health. 

Pam: Thank you, John, for telling us about how the COVID to 19 pandemic really shaped the field and it's very timely then that we do have this commission now 'cause we can.

Sort of draw some lessons from those events. I'd like to delve some more into the commission now if we may. It's a fantastic piece of work. It's an enormous body of work and it transcends. So many areas in global health. So far. You've spoken about the origins in terms of, traditionally one health has been driven really by the veterinary and zoonotic areas, but this commission does a lot more, doesn't it?

It goes much further than that. Could you tell us what are the most important aspects of the commission and your findings in this report? Absolutely right.

Andrea: It has been quite a job to, to come up with the report to say the least. But I think we are very happy as it stands now. There will always be gaps of course.

However to answer your question, there are quite a few new aspects that the commission. Brings, brings out, emphasizes on it. Doesn't mean that other aspects are not important. I've just mentioned before that one health has been centered originally very much around infectious diseases, mainly zoonosis and mainly basically what humans can catch from animals.

So that in itself, we do not really consider that particular small part. As one health in the broader sense, it's not just about the health of humans, it's also about the health of animals. If they are sick through their pathogens. This is also an issue, not just whether the pathogen can jump to humans.

Now, what we have done in the commission is that we are shedding more light on. The shared environment we call that the socioecological system and the socio socioecological system can be built or unbuilt, it's nature. It's. Forest and built is our homes, hospitals, cities. So we focus our first part really and try to explicate what it means.

What is the so socioecological system and what are the interdependencies within that system. So I think that is new. We then go on. To surveillance and infectious diseases also that is not new. We bring about new aspects and reemphasize its importance. What is also new, and of course it's a bit of a difficult question because if you ask a mother, which one of your children is the most beautiful, it's always a difficult answer.

What is new as well is really the non-communicable diseases. So we put a lot of emphasis on entities, the non-communicable diseases, and how a one health approach could could help reducing the burden of nc. And then we also go on and shed some more light on health systems and ask for integration of one health into, into health systems approaches. And then we also have a use case on food food safety, food security, and food systems. Although again, this is not new. We mention new aspects, but the really new thing is environment center stage and bringing in aspects like non-communicable diseases.

John: Yeah, if I could add to that perhaps. And thank you very much, Andrea. Even in infectious diseases, which you rightly mentioned is not new. In fact, it's infectious diseases have been particularly, and any particular zoonotic diseases have been at the heart, or if not the focus of one health since this inception.

But we bring some new angles to the role of infectious diseases particularly. Around co-infections and even the interactions between infectious diseases and noncom caral diseases or what that implies. But even more specifically, when it comes to infectious diseases, antimicrobial resistance is something that we flag and have dedicated some time to in the report.

In antimicrobial resistance we challenge the status quo. With regard to the hypothesis around how antimicrobial resistance arises and spreads there's a growing body of evidence showing clearly that it's not as linear as has been thought, and that it really differs between high income settings and low income settings.

And what we do is to show that what we thought we knew. It's not all there is, and that there's a lot more we don't know. The narrative around antimicrobial resistance is only now being written. It needs to be pursued and this will, to a large extent, inform policies around how we address antimicrobial resistance.

But what we do is to suggest that what we currently have may not be fit for purpose. A lot more research is needed to really understand this. In addition, I'll just add one more thing. We also show how the current global health financing system, or actually the global health or the global finance system is antithetical to One Health fundamentally IE the GDP growth paradigm is really and anti One Health.

We obviously cannot discard this immediately. But what we call for is a slow radical change where value is placed. Not necessarily on a country's gold reserves or GDP for that matter, but on factors and indices that truly reflects health as wealth. And we love using the analogy of how, unfortunately a tree standing in the forest appears to be of less value than a tree that is a log in a shipping container heading to one part of the world or the other.

This again, reflects the need for a change in the way we do global economics so that we can achieve. The ultimate vision, which we put forward in the last one. Health Commission of Healthy, sustainable Socioecological Systems. 

Andrea: Just to add to this before we come to the next question, is what the Lancet One Health Commission report also stands out for is the metrics.

There are actually no one health. Metrics that have been fully recognized to date. There is a Global One Health Index that has great potential, is based on open access indicators and has also been implemented in different settings. However, in the commission, we have spent a lot of, energy or putting a lot of energy in synthesizing the metrics that we have that could help one health measurement, and that is reflected in actually three very detailed tables. None of these metrics ins in itself will do justice to One Health, but we have prepared the basis. For any further endeavor around a true equitable one health measure.

And I think that is also something that is really new and that is very timely as a lot of accountability measurement endeavors are currently going on at the highest level. And I think that this will serve our partners well. Thank you. 

Pam: Great. Thank you. Great points, John. Andrea, the report concludes with making 10 recommendations on One Health Operationalization implementation and institutionalization.

Perhaps we haven't got time to talk about all the 10 recommendations, but if you could just highlight some of the key ones, that would be great. 

John: I can begin with this. I will highlight a few, and I'm sure Andrea will also highlight a few. One, which we highlight very strongly is the need for a one health governance framework.

This we think is critical to truly operationalizing one health. We do have the one health high level expert panel, which Andrea spoke about. We have this we have the Quadripartite which is advised or technically supported by this one Health iLEVEL expert panel. But then in truly operationalizing one Health, we would need to have a system that is beyond just these four major global entities coming together.

One that hopefully can stand independently and carry out various actions and mandates independently. Without necessarily having to always seek consensus among the four, if I could put it that way. And when you think about it with the WHO Pandemic agreement, we call it the WHO Pandemic Agreement, it's implementation.

Operationalization is via a one health approach. One health approach is way beyond the WHO and involves the other members of the quadripartite. But this tells you that there is really a strong need. For a well established one health governance framework, and we call for this and make it very clear that this is important.

We also speak to the one health financing issues. I've already mentioned this. Where is the money going to come from? We need to find very innovative mechanisms, and the world has demonstrated that when we sit together and think hard and agree on what is important to us. We can find the money. We were able to find the money to address the HIV pandemic, if I put it that way.

The UN aids model was beautiful. Just creaming off a little bit of money from airline tickets to support hiv aids research and treatment. This was never done before. And certainly there, there must be many innovative approaches to. Sustainable financing for one Health Endeavors.

I'll speak to a last one. And this is the promotion of the One Health Ethos or the way of thinking about One Health at the lowest levels. When I say the lowest levels, I'm talking about educational levels where children are already oriented regarding the world in which we live. So one help doesn't become this highfaluting concept, which is discussed in boardrooms or among ministries, but really becomes a way of thinking of the people of the world.

When we all begin to think in the same way about our inter interconnectedness, about the shared environment, it makes it easier whether you are discussing in an engineering boardroom or in an agricultural boardroom or some other boardroom, everyone, or a classroom or whatever setting everyone has.

This shared ethos which makes it a lot easier to agree on what must be done, what the trade offs should be, so that, as I've been saying, we can achieve this vision of healthy, sustainable socioecological systems. I'm Sean Andre. I got a couple more of these recommendations from the report to share.

Andrea: Yeah, thank you John, you have already. Mentioned our recommendation in, in, in a very complete way, almost complete way, but there are a couple of recommendations or aspects I can add. We advocate for One Health. All policies according to the way that health in all policies has been mentioned previously.

And we are calling out people, calling out institutions, organizations to implement. We feel that non-health related policies are just as important, if not more important than health related policies to integrate One Health. And we we go then into details and also explain about this. We mention in the recommendation the need to integrate human animal and environmental health systems and surveillance systems as part of health systems surveillance is already more advanced.

There have been more activities, more achievements in terms of integration, but still. There's a way to go. When we come to health systems at large, there is not so much integration of One Health. Talking about the WHO Health system building blocks one Health needs to be integrated there. Then also just to add to what John said, we call for a radical transformation of global economics that prioritizes equity, sustainability and wellbeing as a key measure of progress.

And with it comes the finance system that John has very rightly alluded to. We have also recommendations around knowledge one, health knowledge generation integration, the generation of a one health literate citizenry that John has already alluded to where one health training or one had literacy training starts already.

At the very beginning in kindergarten and not the least within families. And then our last recommendation is on integrated food systems that prioritize the need of the population, but also the sustainability of food production. At a large and at the same time, harnesses digital and tech development.

We also call out the private sector. Maybe this is the last that I will say in terms of our recommendations. There are 10 altogether, but of course there are many sub recommendations as well. We call out the private sector to come on board and to take action. When it comes to One Health throughout the different production chains corporate sustainability of the private sector, et cetera.

So 10 recommendations and I think they're worthwhile being absorbed. Thank you very much, Pam. 

Pam: Great. Thank you. That was a very comprehensive delivery of what is gonna be a very exciting report, I think post-publication. But let's be real. It's a bleak time in global health right now. There are multiple wars and conflicts.

We have climate change upon us substantial cuts now to health and development programs globally. There's a broader retreat by countries to their health commitments. How easy do you think the uptake of one Health will be by governments in this current climate? 

Andrea: We have a challenge. Only say a couple of sentences and then pass on to John.

'cause I think he can answer this very well. In fact, one health is centered around added value. At the end of the day means let's get together, let's integrate and spend less money. Spend less resources, maybe I shouldn't say money, but spend less resources and through the joint agenda setting, arrive at benefits for different sectors so that bleak moment Pam could be a chance for one health to be taken up because it is actually propagating the joint.

Usage of resources, the integration, not reinventing the wheel. So if we as researchers can make our case to the stakeholders, the decision makers, the politicians, that one health is the way to go, one health could actually help overcome the crisis and hopefully reflect in the new development agenda. John mentioned previously that unfortunately it has been out, left out in the 2030 development agenda.

John: Thank you very much for that, Andrea, and indeed times are bleak. But think about it this way, that even in this most bleak of times, we got the NHO Pandemic agreement passed. It may not have been everything that we had hoped for from the beginning, but it is something sub substantial and certainly a very powerful tool which can be applied to change the way in which we do things.

So for me, that alone is evidence that there is a bright future ahead for global health and for the utility of one health within global health for that matter. The discussion around the nexus of the pandemic agreement, particularly the a pathogen based sharing, I think is a very, also very crucial opportunity to accentuate the one health approach.

And so I feel that we live, we are living in challenging times, but there's also a lot of goodwill and it's very difficult for anyone to forget COVID so quickly. And this alone reassures me that irrespective of the current times, one health will, will retain prominence will remain as an approach.

And also it is a reflection of the need to very gently and respectfully understand why people think the way they do. And to not only modify our thinking, but also. Where they are for lack of expression absolutely wrong, provide them with the ample evidence in as a, again, I say in a respectful, thoughtful way, understanding of where they're coming from, present the evidence to them that will allow them to change their minds so that we can truly arrive at the same shared ethos, which will allow us to make those critical trade-offs.

That are necessary if we want to achieve these healthy, sustainable socio-ecological systems. And this concept of trade-offs is so important. And once we share a certain understanding of what growth development means within the context of sustainability using a one health lens, then I'm confident that we will achieve these healthy, sustainable socioecological systems.

Pam: Great. Thank you very much John and Andrea for that very clear response. So let's try and draw things to an end. Although in many ways I feel this is the beginning, what do you hope the commission's report will lead to? What will be some of the next steps to the commission's work post-publication 

Andrea: in our recommendations, we have set out very clear timelines and we have called out stakeholders who.

Have to take action. So we are hopeful that those stakeholders really feel called to take action and do the needful. They're very ambitious. The timelines are extremely ambitious, and they're also there to be changed. There will be delays, but it, my hope would be that it's a wake up call throughout the global health.

Architecture at different levels. Our recommendations are not just for the global decision makers. We detail global, regional, and national local levels in our recommendations. So it is my hope that throughout the architecture, the global health architecture at different levels, our report, our recommendations.

Could gain visibility and would lead to action. 

John: Yes. If I may quickly add to that, beyond the commission's report we are hopeful that it would serve as a, not necessarily a blueprint, but a blueprint of sorts indeed, to how the WHO pandemic agreement is operationalized to how a one health governance, the system is set up to how One health metrics are developed. We really think that it's a tool which can be applied together with some of the very wonderful tools that have been developed by the one health high level expert panel and the Quadripartite to really guide the operationalization of one health across various spheres and settings.

Taking into consideration various underrepresented groups women, children, various ethnic groups race and gender, and several others. We really believe that this adds up to the setting of tone or the pace for the personalization of One Health, and we're looking forward to. Promoting this.

We think the Lancet is a highly visible avenue by which this report can go far. We want it to go viral a across not only academia, but into, to really spread into the geopolitics of our world. 

Andrea: We would also, if I may add Pam, be very keen on an afterlife, not just following. Up on our recommendations as we have pronounced them just now.

But the world is continuing to turning hopefully, and will continue to turn and to move around his its own axis. But things do change and we obviously have not had the full breath to just cover everything. For example, urban One Health. I think it's very important to be looked at in more detail.

John already mentioned the intersectionalities, gender women, and one health. That also needs to be explored more in detail, brain health, not just including neurology, but also mental health. And one health needs to be. Dissect it and brain health definitely needs to be thought afresh and with a one health lens.

We need to, as John said update the metrics, develop metrics, equity metrics will be key to one health metrics. And there's actually much more than we can do. And I just want to finish on that note because. Pam, you mentioned that we live in bleak times, and yes, there is increased conflict, there is increased migration, and so far this hasn't really been done.

We would also love to apply a one health lens to the topic of migration and conflict. There are some very interesting publications so far at smaller scale, but we would like to really. Upscale that important topic and look at migration and conflict through a one health approach. 

Pam: Great. Thank you very much Andrea and John for discussing this very important piece of work.

I'm confident this will be the roadmap that you have set out for this commission to do to in the field and in global health more broadly. Thank you very much for talking with us.

Gavin: Thanks so much for joining us today at Lanzo Voice. If you've enjoyed the podcast, please leave us a review on the podcast platform that you generally use. And we'll see you again next time. Take care.