Indian Council of World Affairs

Abstract: The One Health approach, driven by international cooperation and coordinated action, addresses relevant issues of global health, including the construction of resilient health systems and emphasis on reducing inequalities, and provides better preparedness for handling future pandemics. 

In May 2023, the World Health Organization (WHO) announced that the COVID-19 pandemic was no longer classified as a Public Health Emergency of International Concern (PHEIC), after more than three years into the outbreak. It subsequently warned the world not to let its guard down as the global threat was not over and to be prepared to respond to an even deadlier disease outbreak than the COVID-19 pandemic. Health experts are researching the potential outbreak of a hypothetical ‘Disease X’ that could cause large-scale outbreaks like a pandemic. The WHO Director-General Tedros Adhanom Ghebreyesus underscored, "When the next pandemic comes knocking – and it will – we must be ready to answer decisively, collectively and equitably”. Thus, he highlighted the need for multilateral approaches driven by international cooperation, knowledge, data sharing, and integrated responses for future global emergencies. Implementing the One Health approach advocated during India’s G20 Presidency is a step in this direction. 

This viewpoint explores the concept of One Health and its capability to strengthen global healthcare systems that are available, accessible, and affordable. 

One Health Approach 

The One Health approach is a holistic perspective recognising that human encroachment on wildlife habitats, environmental impacts, and even lifestyle diseases don’t occur in isolation but are deeply intertwined across species and ecosystems. Though not a new concept, One Health has received renewed attention because of the increasing frequency and severity of threats linked to the health of humans, animals, plants, and the environment. Many of the global healthcare crises, including HIV/AIDS, Ebola and COVID-19, originated in animals and these zoonotic diseases were transmitted to humans. The concept is misinterpreted as implying access to healthcare services for all humans only. On the contrary, it underscores the crucial relationship and interconnectedness between human, animal, plant and environmental health. 

Figure 1: ONE HEALTH JOINT PLAN OF ACTION (2022-2026)
Source: https://www.woah.org/app/uploads/2022/04/one-health-joint-plan-of-action-final.pdf

The WHO defines One Health as an integrated approach that recognises the close interdependence between the health of humans, animals (both domestic and wild), plants, and the environment. The concept has evolved over the decade from encompassing the health relationship between humans and animals to including the sustainability and general well-being of global ecosystems. It aims at sustainably balancing and optimising the health of people, animals, plants and ecosystems to address the full spectrum of disease control, such as prevention, preparedness, and response. The COVID-19 pandemic has demonstrated the need for undertaking a One Health approach in an interconnected world. It demonstrates mobilising healthcare systems across the globe, multiple sectors, disciplines, health experts and communities at various levels of society to improve disease surveillance, early warning systems, and response strategies. 

India’s Key Healthcare Initiatives 

In May 2019, the Government of India established a National Group on ‘One Health’ as a multi-sectoral, trans-disciplinary, and collaborative group. It recognised that several pandemics have zoonotic origins, including COVID-19, influenza H1N1, H7N9, severe acute respiratory syndrome (SARS), and international organisations, such as the WHO, Food and Agriculture Organization (FAO), and World Organization of Animal Health (OIE) have been advocating for a ‘One Health’ approach for combating health threats to humans and animals.[i] Further, it recognises that unhealthy and environmentally unsustainable food consumption habits have also increased the disease burden. For instance, food safety and water sanitation are crucial sectors under the OH approach as vegetables, meat, milk products, and other environmental factors can all spread foodborne illnesses like vibrio species, E. coli, and salmonellosis. 

Systemic policy frameworks and institutional support by the government have put in place initiatives such as the National Health Policy (2017) acknowledges the importance of a holistic approach to health, including addressing issues that affect both humans and animals, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) (2018), providing a sum of access to ₹5 lakh per family annually for secondary and tertiary hospitalisation benefits to over 120 million beneficiary families, Ayushman Bharat Digital Mission (2021) aims to develop an integrated and interoperable digital health infrastructure and investments towards standards-based digital health transformation. 

Further, inter-ministerial collaborations and strategic partnerships between the Ministry of Health & Family Welfare, the Ministry of Environment Forest and Climate Change and the Ministry of Agriculture as well as the Inter-Sectoral Coordination Committee such as on Anti-Microbial Resistance (AMR) have played a pivotal role in shaping the healthcare landscape. A digitally connected healthcare system is now recognised as an important tool for improving accessibility and timely diagnosis, especially in rural and remote areas. For instance, e-Sanjeevani, a Government of India telemedicine application, provides doctor-to-doctor and doctor-to-patient consultations virtually and enables the provision of providing general and specialised health services in rural areas and isolated communities. 

Recently, doctors and technicians at AIIMS, Delhi, have developed new software for extending specialised diabetes consultations to primary healthcare centres in rural areas.[ii] On the other hand, the outreach of mental health services is also expanding with the help of technology, as in the National Tele-Mental Health Programme in India. Digital healthcare initiatives such as CoWIN for COVID-19 vaccination, U-WIN portal for Immunization services for pregnant women and children, e-Sanjeevani for Teleconsultations, among others have accelerated progress, enhancing healthcare accessibility and delivery. In highlighting the government's commitment to healthcare through five main pillars—preventive healthcare, early disease detection, affordable treatment and medications, increased doctor availability in smaller towns, and technological advancements in health services—Prime Minister Narendra Modi emphasized that "a nation's progress is closely linked to the health of its citizens." 

An Integrated Approach 

The pandemic exposed the vulnerabilities in the global healthcare structure and multilateral forums where a lack of coordination hindered the response to assist countries in the Global South. This further highlighted the fractured structure and the need for urgent reforms. India’s significant pharmaceutical sector provided aid to countries through vaccines and low-cost drugs during the COVID-19 pandemic. Despite being a developing country, India played a crucial role in global vaccine distribution during the pandemic. Through initiatives like the Vaccine Maitri program, India exported millions of doses to countries across the Global South, including nations in Africa, Latin America, and Asia. This demonstrated India’s capability to narrow the gap between the Global North and Global South by ensuring more equitable vaccine access. 

Over the years, the G20 agenda has expanded beyond economic governance to include issues of public health, sustainable development goals, climate change, and even environment-friendly lifestyles due to global interconnectedness and its complexities. Apart from maintaining and expanding health-related goals and addressing the topics of Tuberculosis, antimicrobial resistance, and implementing the One Health approach from the previous presidency, India’s G20 Presidency aimed to promote multilateral health cooperation, develop collective action, and infuse inclusivity in global health discussions and solutions. 

It prioritised health emergency prevention, preparedness, response, strengthening cooperation in the pharmaceutical sector and digital health innovations and solutions. Under the New Delhi G20 Declaration 2023, G20 leaders committed to promoting the One Health-based approach driven by the One Health Joint Plan of Action (2022–2026), which aims to create a framework to integrate systems and capacity for collectively preventing, predicting, detecting, and responding to health threats.[iii]

This also involved strengthening the global health architecture and seeking reforms in global governance to make them more inclusive and responsive to contemporary realities and fostering equitable access to medical resources, especially for the Global South. In March 2022, in recognition of Indian traditional medicine practices and expertise, the WHO announced the establishment of a Global Centre for Traditional Medicine (WHO GCTM) in Jamnagar, Gujarat, India, as the first global centre for traditional medicine. The centre aims to increase accessibility to healthcare in case of a global emergency by harnessing the potential of traditional medicine from across the world through modern science and technology, thereby establishing healthcare structures where they are most needed and how they are most understood among the masses.
 

As efforts to strengthen the global health architecture advanced, involving the Global South for an inclusive and reformed multilateralism was channeled through India’s G20 Presidency. The Presidency committed to enabling “equitable access to safe, effective, quality-assured, and affordable vaccines, therapeutics, diagnostics, and other medical countermeasures, especially in Low-and Middle-income Countries, Least Developed Countries (LDCs), and Small Island Developing States (SIDS)”. The push for digital technologies during the pandemic provided timely relief and consultations by maintaining constant doctor-patient engagements. Further, at the World Leaders’s Summit in Glasgow at COP26, India proposed the Lifestyle for the Environment (LiFE) initiative.[iv] This initiative incorporates behavioural changes at the societal level to promote a circular, zero-waste economy and embrace sustainable production and consumption patterns. G20 embraced the initiative and collaborated globally to advance sustainable lifestyles for climate action. 

The Brazilian G20 Presidency reaffirmed its commitment to advocate for and implement a One Health approach while underscoring its potential to promote “collaborative intersectoral and multidisciplinary actions to address knowledge gaps and strengthen surveillance, prevention, preparedness, and response to potential future health emergencies”.[v] Thus, fostering an integrated and collaborative approach that combines different sectors, such as health, agriculture, and education involves vertical coordination between local, regional, national, and international levels. 

Conclusion 

By recognising the interconnectedness of human, animal, plant, and environmental health, the One Health framework provides a comprehensive and holistic solution to tackling the health threats of today and tomorrow. The COVID-19 pandemic underscored the urgent need for a collaborative, cross-sectoral approach to global health, one that can prevent, detect, and respond to potential crises more effectively. India’s leadership during its G20 Presidency in promoting the One Health approach, along with its initiatives to advance sustainable lifestyles and equitable healthcare access, highlights the importance of multilateral cooperation in addressing the shared challenges of our time. India advocates for a more resilient and interconnected global healthcare system by strengthening global health architecture, reforming governance structures, promoting inclusive health solutions and promoting health related information flow and research. As the world moves forward, integrating One Health into global health policy and practice will be essential for preparing for future pandemics, ensuring equitable access to medical resources, and improving overall global health outcomes. The lessons learned from COVID-19 and the ongoing commitment to multilateral collaboration are a foundation for building a healthier, more sustainable, and more resilient world. Together, through a unified and comprehensive approach, we can ensure that the world is better prepared to face future health emergencies and safeguard the well-being of all its inhabitants. In that sense, One Health not only reflects the interconnectedness of the living world with the environment but also the interconnectedness among various countries and people that comprise humanity.

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*Avni Sablok, Research Associate, Indian Council of World Affairs (ICWA)
Disclaimer: Views expressed are personal

Endnotes

[i] Department of Biotechnology, Government of India, “National Expert Group on One-Health-regarding”, 14 May, 2020. Available at: https://dbtindia.gov.in/sites/default/files/National%20Expert%20Group%20on%20One%20Health.pdf  (Accessed on 6 August, 2024)

[ii] The Hindu, “Doctor’s Aid”, 5 August, 2024. Available at: https://indianexpress.com/article/opinion/editorials/aiims-software-can-extend-specialist-care-for-diabetics-in-rural-areas-9495191/ (Accessed on 6 August, 2024)

[iii] FAO, UNEP, WHO, WOAH, “ONE HEALTH JOINT PLAN OF ACTION (2022-2026)”, 2022. Available at: https://www.woah.org/app/uploads/2022/04/one-health-joint-plan-of-action-final.pdf (Accessed on 6 August 2024)

[iv] Ministry of Environment, Forest and Climate Change, Government of India, “Historic Resolution on Promoting Sustainable Lifestyles”, 1 March, 2024. Available at: https://pib.gov.in/PressReleasePage.aspx?PRID=2010786#:~:text=The%20concept%20of%20LiFE%20i.e.,environment%2Dfriendly%20lifestyles%20and%20practices. (Accessed on 9 August 2024)

[v] Ministry of Foreign Affairs and the Secretariat of Social Communication of the Presidency of the Republic of Brazil, “G20 Health Ministerial Declaration on Climate Change, Health and Equity, And on One Health”, 31 October, 2024. Available at: https://www.g20.org/en/tracks/sherpa-track/health (Accessed on 26 November, 2024)