key: cord-0682771-p2r0ujv9
authors: Gruetzmacher, Kim; Karesh, William B.; Amuasi, John H.; Arshad, Adnan; Farlow, Andrew; Gabrysch, Sabine; Jetzkowitz, Jens; Lieberman, Susan; Palmer, Clare; Winkler, Andrea; Walzer, Chris
title: The Berlin Principles on One Health – Bridging Global Health and Conservation
date: 2020-10-12
journal: Sci Total Environ
DOI: 10.1016/j.scitotenv.2020.142919
sha: 2eb7491f8f9a116da9d4670a0fb0aa6b455c9dcf
doc_id: 682771
cord_uid: p2r0ujv9

For over 15-years, proponents of the One Health approach have worked to consistently interweave components that should never have been separated and now more than ever need to be re-connected: the health of humans, non-human animals, and ecosystems. We have failed to heed the warning signs. A One Health approach is paramount in directing our future health in this acutely and irrevocably changed world. COVID-19 has shown us the exorbitant cost of inaction. The time to act is now.

In 2018, the World Health Organization (WHO) added to its priority watchlist 'Disease X': '… a serious international epidemic caused by a pathogen currently unknown to cause human disease'. 1 J o u r n a l P r e -p r o o f Journal Pre-proof Today, a Disease X, COVID-19, is ravaging human populations and economies in a pandemic. This was foretold, but not prevented. In 2008, we were warned that the frequency of viral spill-overs from wildlife had increased significantly in the past decades. 2 Researchers repeatedly cautioned the global community of the massive health and economic impacts if a viral spill-over one day sparked a pandemic. [3] [4] [5] If we had adopted a precautionary approach to hazards and coordinated in advance a global preparedness plan that bridged all the normal sectoral silos, we would have greatly reduced the risks and impacts of a pandemic. Instead, due to the disconnect between science, economics and politics, we collectively failed.

Current population growth, massive land-use changes, and patterns of overconsumption are unsustainable. 6 Rapid and profound human-driven socio-economic changes are driving climate change. 7 This is coupled with a species-extinction crisis, habitat and soil degradation, pollution, extensive destruction of forests and of coral reefs, exploitation of wild species through proliferation of wildlife trade and markets which severely jeopardizes life on our planet. [8] [9] [10] The international spread of Emerging Infectious Diseases-impacting people, wildlife, domesticated animals, and plants, including, amongst many, COVID-19, Ebola virus disease, avian influenza, peste des petits ruminants, African swine fever, chytridiomycosis, wheat rust, cassava mosaic disease-and the emergent threat of antimicrobial resistance have created a world where regular outbreak and spillover events are the new norms. We are starkly reminded of the basic fact: Human, animal, plant, and environmental health and well-being are intrinsically connected.

Environmental changes such as rapid urbanization and the burning of fossil fuels increase greenhouse gas emissions, air pollution, and deposition of persistent particulates which worsen the impact of non-communicable diseases (NCDs) in humans 10, 11 , animals 11 , and plants. 12 Heat spikes J o u r n a l P r e -p r o o f Journal Pre-proof give rise to dehydration which subsequently compromises the cardiovascular systems of people 13 as well as other animals. Air pollution causes respiratory diseases such as chronic obstructive airway disease (COPD) and exacerbates diabetes, cardiovascular disease, stroke and COVID-19. 14 Beyond cities, increased frequency of extreme events (drought, floods) leads to harvest losses causing undernutrition and micronutrient deficiencies among poor populations. 13 We are failing the poor -the Bottom Billiontogether with the environment on which they directly depend, through unbridled, harmful, and ever-increasing consumption patterns and associated environmental destruction.

To address the myriad of 21 st century global health challenges, while ensuring the biological integrity of the planet for current and future generations, an urgent transformation is required in our thinking, values, and practices based on recognition of our interdependence and the interconnectedness of the threats we face. This is all the more critical now in the face of the COVID-19 pandemic.

In 2004, the Wildlife Conservation Society (WCS) brought together stakeholders to discuss global health challenges at the nexus of human, animal, and ecosystem health. The symposium "Building Interdisciplinary Bridges to Health in a Globalized World" at The Rockefeller University gave birth to the "Manhattan Principles". 15 These detailed a collaborative, trans-disciplinary approach, coined 'One World -One Health', or simply 'One Health'. One Health community with researchers and advocates of similar integrated health approaches such as EcoHealth and Planetary Health to join forces. Prior to the meeting, a group of 12 experts from diverse fields, including policy, sociology, philosophy, economics, ecology, meteorology, and human and veterinary medicine prepared a Call to Action, the "Berlin Principles on One Health".

These principles are an update of the Manhattan Principles, reintegrating ecosystem health and integrity while also addressing current pressing issues, such as pathogen spillover, climate change, and antimicrobial resistance. Notably, these discussions and the derivation of the Berlin Principles predate the COVID-19 outbreak and subsequent pandemic by several months; although the wording of the Principles might seem prescient, this pandemic was predicted and largely inevitable, and will happen again if decisive actions are not taken.

Over the past 10 years, the Government of Germany has become a key player in the global health landscape. 16 This development was triggered by strong governance, opportunities provided by the G7 and G20 presidencies, and Germany's commitment to combat the Ebola outbreak in 2014/15. The motivation for German involvement in global health is similar to that which has led to Germany's past leadership role in environmental issues: the recognition of the importance of pervasive interconnectedness in the age of globalization, supported by a strong and unwavering commitment to multilateralism.

It is obvious that no singular country, group, discipline or sector of society holds enough knowledge and resources to single-handedly prevent the emergence or spread of diseases while maintaining and improving the health and well-being of all species and ecosystems in today's globalized world. No one country can reverse environmental pollution, carbon release, marine degradation, patterns of land-use change, soil degradation, and species overexploitation and extinctions that, if left unmitigated, will continue to undermine the health of people, animals, and the environment. Intensive work within and across many disciplines is essential to develop expertise. The good news is that a whole range of levers and leverage points have now been identified with which decisionmakers in global and national politics, and in business and civil society, can contribute to a fundamental transformation, e,g, natural climate solutions as laid out by the IPBES Global Assessment 2019. 8,17

Underpinning the Berlin Principles is a broad One Health ethical framework that aims to foster the health of humans, animals and their shared environments and to endorse collaboration that breaks down disciplinary and policy silos to this end. 18, 19, 20, 21 The current entwined emergencies of public health, biodiversity loss and climate change clearly illustrate the impossibility of protecting human health in isolation from the health of other animals and the environment. But these three emergencies also bring to the forefront two related values that are key to developing joined-up ethical thinking in the context of One Health: solidarity and environmental justice. 22 Solidarity has recently played an important (though contested) role in public health ethics; one leading interpretation sees solidarity as publicly 'standing up beside' others. 23 Effectively tackling health at the nexus of climate change, biodiversity loss and a global pandemic requires public action, shared commitment and positive identification with others, especially those disproportionately affected by these three global emergencies. 23 'Standing up beside' others also involves improving or correcting past or present disadvantage or injustice. 23 And climate change, biodiversity loss and the current pandemic have starkly revealed high levels of environmental injustice, within and between nations. Communities exposed to disproportionate environmental pollution have suffered significant health impacts from Covid-19; biodiversity loss poses very serious risks to subsistence farmers, the rural poor and to members of traditional societies; while climate change is damaging economically disadvantaged communities who have contributed very little to bringing it about. 24 The quality of current and future human and animal health and well-being depend on humanity's respectful, humble and responsible environmental stewardship. Taking the UN Sustainable Development Goals as guidance, we must overcome sectoral and disciplinary silos, entrenched interests, and power dynamics to protect and promote One Health and well-being, to prevent disease and disability, to eliminate harmful drivers and perverse incentives, while promoting resilience and adaptation. We need cooperative, multilateral, and engaged democratic action at all levels of society, in every country, and at the international level.

COVID-19 is a wake-up call. We need a global paradigm shift, a giant step towards a safer and healthier future. China and Vietnam have publicly committed to a permanent ban of wildlife trade and associated markets related to human consumption. Other countries will and should surely follow, catalyzing opportunities to dramatically reduce the incidence of virus-spillover events between animals and humans and to significantly reduce the risk of a future pandemic. COVID-19 has conveyed a clear message to every person on this planet: Humanity is one part of a bigger entity and needs to very carefully consider every one of its actions. Today we must stop exploitive and destructive practices in agriculture, extractive industries, and land-use planning; and development programs must follow. Operationalizing the One Health approach is paramount in directing our future health in this acutely and irrevocably changed world. COVID-19 has shown us the exorbitant cost of inaction. The time to act is now. WBK, JHA, AA, AF, SG, JJ, SL, CP, and AW substantially contributed to discussions, revised the manuscript critically for important intellectual content.

CW supervised KG in all stages of the development, repeatedly revised the manuscript, drafted the first version and coordinated the Berlin Principles White Paper development.

The Climate and Environmental Foreign Policy Division at the German Federal Foreign Office financially supported the One Planet, One Health, One Future event, including salary for technical staff.

Eckart von Hirschhausen, Maike Voss (German Institute for International and Security Affairs)

Cristina Romanelli (WHO/CBD liaison

German Federal Agency for Nature Conservation), Vincent Munster (US National Institutes of Health)

Christian Griebenow (Veterinarians without Borders)

Arnulf Köhncke (World Wide Fund for Nature

Anja Junker (Medicins sans Frontiers), Ralf Klemens Stappen

Spillover and pandemic properties of zoonotic viruses with high host plasticity

One Health Economics to confront disease threats

Serological evidence of bat SARS-related coronavirus infection in humans

Detection of emerging zoonotic pathogens: an integrated one health Approach

Growth in human population and consumption both need to be addressed to reach an ecologically sustainable future. Environ Dev Sustain

Summary for policymakers of the global assessment report on biodiversity and ecosystem services of the Intergovernmental Science-Policy Platform on

Climate Change and Land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems

Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study

Particulate matter air pollution and respiratory impact on humans and animals

Plant health and global changesome implications for landscape management

The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate

Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective

Germany's expanding role in global health

Does One Health require a novel ethical framework

Public health ethics and more-than-human solidarity

Culling and the common good: re-evaluating harms and benefits under the one health paradigm

Ethical Promises and Pitfalls of OneHealth

Justice Is the Missing Link in One Health: Results of a Mixed Methods Study in an Urban City State

The place of solidarity in public health ethics

Biodiversity Loss Threatens Human Well-Being

Federal Foreign Office while working on the development of the Berlin Principles