«One Health» – mit neuem Gesundheitsverständnis gegen die nächste Pandemie

Prologue

"One Health"Against the next pandemic

Text: Samuel Schlaefli
Design: Seraina Hügli & Lucas Pfister (Capisci)

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Jakob Zinsstag is one of a select group of researchers who warned early on about the risks of zoonoses - infectious diseases that can transfer from animals to humans.

For more than 20 years, the epidemiologist has been helping countries in Asia, Latin America and Africa to mitigate zoonoses. To do this, he breaks down walls between human and veterinary medicine by insisting on research that connects different disciplines and involves those affected. Early on, Zinsstag articulated the "One Health" concept, and he is a pioneer advocating for its practical implementation worldwide.

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This web report asks: How can the next pandemic be prevented? And what impact comes from a paradigm shift in medicine towards "One Health"?

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SARS-CoV-2 is only one virus among thousands with the potential to spread from wildlife to humans. Due to deforestation, the destruction of wildlife habitats and factory farming, this risk is continuously increasing. According to experts, the era of pandemics has just begun.

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Jakob Zinsstag has opened his personal archive, spanning 30 years of field research, to us for this web reportage. The illustrations are based on his photographs and our personal encounters with the researcher. We delved into important aspects of "One Health" in sub-chapters and interviews with experts.

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Overview

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Close to the animal

From veterinarian in the Jura
to head of research in Abidjan

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When Jakob Zinsstag was not conducting research in Mongolia, Tanzania, Burkina Faso, the Ivory Coast, Guatemala or Ethiopia, you could surely find him in his office at the Tropical Institute in Basel, until the relocation at the end of 2021. In the "Tropeli", as they like to say in Basel. Although officially the research institute has been called the Swiss Tropical and Public Health Institute (Swiss TPH) for quite some time.

In the following picture series, we compiled some impressions from the daily research routine of the well-travelled epidemiologist.

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Through the entrance of the classic old building, you enter the public area, where generations of Swiss missionaries, development workers, researchers and travelers received vaccinations - against typhoid, rabies, diphtheria, hepatitis and yellow fever.

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Protecting against viruses that, for most of us, belong in another world. A world where, for the minority, travel adventures and hitchhiking on potholed tracks begin, while for the majority, poverty, poor sanitary conditions and recurring epidemics determine everyday life. Through this public area, where young backpackers wait for their injections and stamps next to internationally active women entrepreneurs and ethnologists, one enters a newer building, without similar history. There we visited the epidemiologist Jakob Zinsstag for the first time at the end of June 2021.

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Audio: In Zinsstag's modest office, threads from all over the world come together. During a zoom call with a PhD student from Liberia and researchers from the Pasteur Institute, he discusses issues involved in isolation of rabies viruses. He effortlessly switches between French and English, the two most important languages for his research.

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Audio: In Zinsstag's modest office, threads from all over the world come together. During a zoom call with a PhD student from Liberia and researchers from the Pasteur Institute, he discusses issues involved in isolation of rabies viruses. He effortlessly switches between French and English, the two most important languages for his research.

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Zinsstag's PhD student Garmie Voupawoe is researching rabies strains in Liberia. He tried to isolate the RNA in dogs so that the Pasteur Institute could analyze it. But something went wrong when the samples were taken. Now the researchers are brooding over possible solutions, thousands of kilometers apart via video connection.

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The Swiss TPH is associated with the University of Basel. Its research focuses are infectious diseases, non-communicable diseases, interdependencies between environment, society and health, and national health systems. The researchers work globally in over a hundred countries, especially those with low and middle incomes. Today, the Swiss TPH operates 15 research stations in Africa, with the Ifakara Health Institute in Tanzania and the «Centre Suisse de Recherche en Côte d`Ivoire» among the top health research centers on the continent. Covid-19 has also been an important topic since the beginning of 2020. More than 20 research projects are directly related to the ongoing pandemic.

Doctoral students from the Global South and Switzerland conduct cross-border research, here and there. Zinsstag's office door is always open to them, including Said Abukhattab, who wants to improve hygiene in poultry processing in his country of origin, Palestine, and build a "One Health" center there. And Ayman Ahmed, who is working on his dissertation on the virome of mosquitos in Sudan, which serve as intermediate hosts for the transmission of infectious diseases to humans.

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Zinsstag's path to Swiss TPH runs from the farm to the academy. As a young child, he developed a natural rapport with animals. Wherever this little boy is, there are animals. At home, there are cats and dogs; on his grandparents' farm there are cows, pigs and chickens. He regularly helps there, assisting at calf births and mucking out stalls.

After high school, he studied veterinary medicine in Bern and began working in 1986 as an assistant veterinarian in the Jura. He helps farmers when cattle or horses suddenly fall inexplicably ill, and natural remedies and ancient healing rituals are no longer effective. "Monsieur, on vous appelle parce que le secret n’a pas marché", people tell him (We call you because the secret treatment has not worked). Zinsstag works almost as often in stables covered with manure and hay as in his tidy practice. Often, he is asked to treat a farmer's wife or a farmer's ailment while at the farm.

At the end of the 1980s, boredom sets in for Zinsstag, and curiosity drives him away from the farms at home and towards research in Africa and Asia. Two continents that fascinated him since an early age. In 1994, he took over management of the "Centre Suisse de Recherches Scientifiques" in Abidjan, the capital of the Ivory Coast.

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His start there is tragic: after eight chimpanzees are found dead in the Tai National Park in November 1994, a doctoral student is infected with a disease-causing virus. Despite receiving different instructions from Zinsstag, she had dissected an animal. After experiencing fever, diarrhea, vomiting and blotchy skin, when neither malaria therapy nor antibiotics could alleviate the symptoms, she was evacuated by Rega to Basel University Hospital.

The doctoral student was lucky, the subsequently identified "Tai Forest Ebola Virus" was less deadly than the strain that would lead to an unprecedented Ebola epidemic in West Africa 20 years later. In all, 11,000 people died from the virus, named after a river in the Democratic Republic of Congo, near which the first infection was reported in 1976. The virus reservoir for Ebola is mainly in bats and flying foxes. The virus can disappear for years before suddenly reappearing and being transferred to humans. Such infectious diseases, which occur in both animals and humans and can transfer between species, are called zoonoses.

On the following page, we describe some known zoonoses in a more detail.

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1920s HIV (Human Immunodeficiency Virus)

Virus: HIV
Natural reservoir: Chimpanzees for HIV Type 1, and soot mangabey (baboon species) for HIV type 2
Intermediate host: none
First occurrence: Kinshasa, Democratic Republic of Congo
Distribution: Worldwide
Symptoms: Flu-like symptoms, fever, weight loss, destruction of T cells and the resulting immunodeficiency
Deaths: Up to 47.8 million (as of end 2020)

1996 Avian flu (Highly pathogenic avian influenza)

Virus: H5N1
Natural reservoir: Wild waterfowl
Intermediate host: poultry
First occurrence: Guangdong, China
Distribution: Southeast Asian countries (over 100 million ducks and chickens died or had to be slaughtered)
Symptoms: High fever, shortness of breath, pneumonia
Deaths: 455 (as of December 2020)

1976 Ebola (Ebola virus disease)

Virus: Ebola virus
Natural reservoir: Probably African fruit bats and bats
Intermediate host: Monkeys
First occurrence: Simultaneously in Democratic Republic of Congo and South Sudan
Distribution: Largest outbreak to date between 2014 and 2016 in Guinea, Liberia and Sierra Leone
Symptoms: Fever, vomiting, diarrhea
Deaths: 11,323 (2014 - 2016)

2003 SARS (Severe acute respiratory syndrome)

Virus: SARS-CoV
Natural reservoir: bat (horseshoe bats)
Intermediate host: Viverrids (masked palm civet)
First occurrence: Guangdong, China
Distribution: 26 countries in Asia, Europe, North America and South America
Symptoms: high fever, pneumonia
Deaths: 916 (as of October 2021)

2012 MERS (Middle East respiratory syndrome)

Virus: MERS-CoV
Natural reservoir: Probably bats
Intermediate host: Camels
First occurrence: Saudi Arabia
Distribution: 27 countries, large outbreak in South Korea in 2015
Symptoms: Fever, diarrhea, shortness of breath
Deaths: 888 (as of October 2021)

2019 COVID-19 (Coronavirus disease 2019)

Virus: SARS-CoV-2
Natural reservoir: Probably bats
Intermediate host: Unknown (as of February 2022)
First occurrence: Wuhan, China
Distribution: Worldwide
Symptoms: Severe fever, chest pain, pneumonia, loss of smell and/or taste.
Deaths: 5`727`698 (as of 5.02.2022)

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1920s HIV (Human Immunodeficiency Virus)

Virus: HIV
Natural reservoir: Chimpanzees for HIV Type 1, and soot mangabey (baboon species) for HIV type 2
Intermediate host: none
First occurrence: Kinshasa, Democratic Republic of Congo
Distribution: Worldwide
Symptoms: Flu-like symptoms, fever, weight loss, destruction of T cells and the resulting immunodeficiency
Deaths: Up to 47.8 million (as of end 2020)

1996 Avian flu (Highly pathogenic avian influenza)

Virus: H5N1
Natural reservoir: Wild waterfowl
Intermediate host: poultry
First occurrence: Guangdong, China
Distribution: Southeast Asian countries (over 100 million ducks and chickens died or had to be slaughtered)
Symptoms: High fever, shortness of breath, pneumonia
Deaths: 455 (as of December 2020)

1976 Ebola (Ebola virus disease)

Virus: Ebola virus
Natural reservoir: Probably African fruit bats and bats
Intermediate host: Monkeys
First occurrence: Simultaneously in Democratic Republic of Congo and South Sudan
Distribution: Largest outbreak to date between 2014 and 2016 in Guinea, Liberia and Sierra Leone
Symptoms: Fever, vomiting, diarrhea
Deaths: 11,323 (2014 - 2016)

2003 SARS (Severe acute respiratory syndrome)

Virus: SARS-CoV
Natural reservoir: bat (horseshoe bats)
Intermediate host: Viverrids (masked palm civet)
First occurrence: Guangdong, China
Distribution: 26 countries in Asia, Europe, North America and South America
Symptoms: high fever, pneumonia
Deaths: 916 (as of October 2021)

2012 MERS (Middle East respiratory syndrome)

Virus: MERS-CoV
Natural reservoir: Probably bats
Intermediate host: Camels
First occurrence: Saudi Arabia
Distribution: 27 countries, large outbreak in South Korea in 2015
Symptoms: Fever, diarrhea, shortness of breath
Deaths: 888 (as of October 2021)

2019 COVID-19 (Coronavirus disease 2019)

Virus: SARS-CoV-2
Natural reservoir: Probably bats
Intermediate host: Unknown (as of February 2022)
First occurrence: Wuhan, China
Distribution: Worldwide
Symptoms: Severe fever, chest pain, pneumonia, loss of smell and/or taste.
Deaths: 5`727`698 (as of 5.02.2022)

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Chad 1998

Chad 1998Vaccinating the goats along with the children

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In affluent western industrialized countries, most people no longer realized the danger of viral infectious diseases until the emergence of SARS-CoV-2. With a lot of research and investment into health systems, we managed to eradicate zoonotic diseases, such as rabies, and protect ourselves against epidemics, such as SARS. However, for many people in Asia and Africa, zoonotic infectious diseases are a constant companion, especially those living in poverty. Anthrax, tuberculosis, brucellosis, rabies, Japanese encephalitis, Lassa fever and sleeping sickness - millions still suffer from communicable diseases today.

The pork tapeworm (Taenia solium), which is transmitted from pigs to humans and can lead to meningitis, affects 50 million people a year, 80 per cent of them in southern developing countries. 53 percent of global outbreaks of new infectious diseases between 1996 and 2009 affected the African continent. Even before Covid-19, around two million people died annually from zoonotic diseases, mainly in high poverty countries.

Water scarcity, lack of waste disposal, absence of a functioning state and environmental degradation increase the risk of epidemics. Jakob Zinsstag's research is therefore usually closely connected to development cooperation. It aims to gain new knowledge, and at the same time, improve people's living conditions. His findings appear in academic journals, and also in people's everyday lives.

In 1997, Marcel Tanner, the former director of Swiss TPH, contacted Zinsstag. In addition to his management function in Ivory Coast, he was writing his doctoral thesis in epidemiology. Tanner wanted to recruit him for a project to improve health care for nomads in Chad. Zinsstag agreed - a decision that would shape his entire academic career. For nomads, camels, cattle, goats and donkeys are their most important assets. Accordingly, they live close to their animals and risk exposure to zoonotic pathogens.

Zinsstag began his research in 1998 on the southeastern shore of Lake Chad and soon realized that while many animals are vaccinated against several diseases, the nomads are not. Someone said to him at the time, "The health of the animals is our responsibility; our health is God's." Not a single child was fully vaccinated against whooping cough, diphtheria or tetanus. The infant mortality rate was correspondingly high. Another reason for this was that nomads fall through the gaps of the national health system because they are always on the move travelling after sources of water and food.

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While Zinsstag was pondering solutions to the country's public health malaise in the sandy expanses of Chad, he remembered the work of the American Calvin Schwabe, a veterinarian and epidemiologist just like himself. "That was a kind of revival experience for me," he recalls. Schwabe was already calling for veterinary and human medicine to think together in the 1960s. He questioned the common division between medicine for humans and medicine for animals. There was no paradigmatic difference between the two disciplines, he wrote, based on his field research with nomads in Sudan. The scientific foundations were the same for both disciplines.

As medical historian Abigail Woods points out in a book on the subject, the separation of veterinary and human medicine was institutionalized with the founding of the first veterinary school in Lyon in 1761. The founder, Claude Bourgelat, wanted to teach a part of human medicine at his school but was denied. "This was the beginning of siloed thinking in medicine," Zinsstag is convinced. Since then, human medicine has been regarded as the supreme discipline, while veterinary medicine has always had something of a stable smell. Or as the researcher says: "Veterinarians are still considered second-class physicians in most cultures.”

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The human genome is 99 percent identical to that of chimpanzees and 95 percent identical to that of pigs. A virus that kills a pig can therefore with some probability also harm humans. "There is a reason that practically every drug is first tested on animals before it is approved for humans," says Zinsstag. "Thinking of public health systems in terms of a human-animal continuum, where viruses and other pathogens can move back and forth with relative ease, is therefore compelling." To protect humans against zoonoses such as rabies, Ebola or SARS-CoV-2, you have to go through animals, the epidemiologist is convinced.

By focusing on animals, for example, rabies could be eradicated in Africa or Asia, as has been achieved in many places in Europe. "With two to three billion euros, we could vaccinate all dogs in the cities and eradicate this terrible disease," says Zinsstag. The zoonotic infection is usually transmitted via a dog bite and is practically 100 per cent fatal without vaccination. As soon as the first symptoms appear, it is already too late. Currently, around 60,000 people die of rabies every year, mainly in Africa and Asia. In 2013, a Swiss TPH team showed that this could be prevented using two integrated vaccination campaigns in the Chadian capital N`Djamena with around 1.5 million people and 35,000 dogs. Rabies was temporarily eradicated. For years, the researcher has been lobbying international organizations and African governments to eradicate rabies.

Calvin Schwabe called his approach of integrated human-veterinary medicine "One Medicine". In Chad, Zinsstag put it into practice for the first time. Whenever a veterinarian went to remote villages to vaccinate animals against anthrax and peripneumonia, she also took health workers with her. While one took care of vaccinating the cows, the other took care of the children, women and men by vaccinating them against yellow fever, diphtheria, tetanus and pertussis.

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In a 2007 study, the researchers were able to show that after a five-year pilot, only about ten percent of children between one and eleven months of age were fully immunized and that the rate of vaccinations had increased from 100 vaccinations per day for children and women to 130 during the integrated program. In addition, because the veterinary and human health offices now cooperated closely, transport costs for personnel and materials, as well as the costs of refrigerating the vaccine doses, were greatly reduced. According to the researchers, separate vaccination campaigns for humans and animals would have cost about 15 per cent more. The use of synergies in transport and cold chain paid off. For the first time, it was possible to provide basic health care to a part of the population that traditionally had no access to it.

Since 1998, Jakob Zinsstag has regularly returned to Chad for research. The following photo series shows a field visit in 2013 to a group of ethnic Fulani at Lake Chad.

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The Era of Pandemics

The Era of PandemicsAnd the birth of a "One Health" movement

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Zinsstag further develops Schwabe's "One Medicine" into a theory of "One Health", a holistic understanding of health that turns away from the increasing specialization in veterinary and human medicine. He officially used the term "One Health" for the first time in 2005 in an article for the prestigious journal "The Lancet". There he reports on his experiences in Chad and outlines possibilities for zoonosis monitoring through the integrated control of viruses in animals and humans.

To illustrate the potential of "One Health", he describes an outbreak of Rift Valley fever in Mauritania. Symptoms of disease in humans there were accidentally diagnosed as yellow fever. Only after veterinary services became involved and reported many miscarriages in livestock due to Rift Valley fever was the correct diagnosis also made in humans.

"Such a double-barreled approach could also be extended to the study of wildlife populations, but this rarely happens because different institutions take care of the same disease in an often poorly coordinated way," he wrote in 2005. During research visits to Mongolia and West Africa, he realized that public health and veterinary services often do not communicate with each other. Although this would seem obvious with regard to zoonoses and the risk of epidemics.

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Zinsstag's article in "The Lancet” appeared nine years after the first major outbreak of Avian flu in Southeast Asia, seven years after the Nipah virus outbreak in Malaysia and Singapore, and two years after the SARS virus outbreak in China, which spread to 26 countries and nearly triggered a pandemic. Considering what happened in Wuhan, China, in December 2019, his claims at the time seem almost prophetic.

The accumulation of antiviral drugs and research into vaccines alone would not be enough to prevent future pandemics, the epidemiologist said. There is an urgent need to adapt livestock farming and live animal markets to new risks. He pointed out that chickens and pigs increasingly serve as reservoirs for infectious diseases. This is because factory farming, with thousands of genetically uniform animals in a confined space, provides an ideal breeding ground to spread zoonotic pathogens and transmit them to humans. Therefore, it is crucial to minimize the interaction between domesticated animals and wild animals, which are often involved early in a pandemic - especially in live animal markets, Zinsstag said in 2005.

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Zinsstag knew what he was talking about. During his research trips to Asia and Africa, he was repeatedly shocked by the conditions at markets where wild and farm animals were kept in very confined spaces, then slaughtered and sold. Snakes next to poultry, pangolins next to wild pigs. The meat was often displayed for sale in the blazing sun, exposed to insects and spoilage.

"Markets like this are pure viral spills," said Zinsstag. "They really should be banned - or at least much better supervised." The well-travelled epidemiologist is well aware of the issues concerning bans. Millions of people depend on such markets, and they are still deeply embedded in the everyday life of many cultures.

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"Covid-19 came as little surprise to me and most epidemiologists," says Zinsstag. Too many factors had pointed to an imminent outbreak: first and foremost, the conditions in the constantly expanding wildlife markets, the intensification of agriculture and the genetic wasteland in profit-driven factory farming. The risk that a pandemic could be triggered by a zoonotic pathogen has risen continuously since his 2005 warning. Between 2011 and 2018 alone, the World Health Organization (WHO) documented 1,483 epidemics in 172 countries, including influenza, SARS, Ebola, plague, Zika and yellow fever.

The risks of zoonotic infectious diseases have long been known, not only in the scientific community. National and international public health institutions also repeatedly warned of a coming pandemic. Three reports show this from 2005, 2012 and 2019.

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«A world at risk», WHO 2019 A few months before the outbreak of the Corona pandemic, WHO experts issued an urgent warning about the increasing risk of a pandemic. The world is not prepared for a fast-spreading, respiratory-transmitted infection. Due to continuously increasing mobility, a virus or bacterium could spread globally within a very short period. They calculated that today, a contagious virus similar to the Spanish flu of 1918, with a four times larger world population and much more air travel, would be globally distributed in less than 36 hours. The consequences: 50 to 80 million dead, panic, political destabilization and economic collapse.

Council for Agricultural Science & Technology, 2005 A task force consisting of researchers, senior officials from national veterinary services and WHO described the main drivers for the spread of zoonotic pathogens: high population growth, increasing mobility, rampant environmental destruction, new transmission interfaces through the spread of wild animals and the animal trade, profound changes in agriculture, with increasing monocultures, genetically identical animals and overuse of antibiotics. They called on states to invest more in monitoring zoonoses.

«Ecology of Zoonoses», W. Karesh et al., Lancet 2012 A team of authors led by William Karesh, a US-based "One Health" pioneer, points out that zoonotic infectious diseases cause one billion cases annually and lead to millions of deaths. The authors identify endemic zoonoses as the greatest risk to the health of the global community. They call for increased collaboration between doctors in clinics, public health experts, ecologists, veterinarians and economists to better understand the causes of zoonoses and develop effective prevention measures.

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«A world at risk», WHO 2019 A few months before the outbreak of the Corona pandemic, WHO experts issued an urgent warning about the increasing risk of a pandemic. The world is not prepared for a fast-spreading, respiratory-transmitted infection. Due to continuously increasing mobility, a virus or bacterium could spread globally within a very short period. They calculated that today, a contagious virus similar to the Spanish flu of 1918, with a four times larger world population and much more air travel, would be globally distributed in less than 36 hours. The consequences: 50 to 80 million dead, panic, political destabilization and economic collapse.

Council for Agricultural Science & Technology, 2005 A task force consisting of researchers, senior officials from national veterinary services and WHO described the main drivers for the spread of zoonotic pathogens: high population growth, increasing mobility, rampant environmental destruction, new transmission interfaces through the spread of wild animals and the animal trade, profound changes in agriculture, with increasing monocultures, genetically identical animals and overuse of antibiotics. They called on states to invest more in monitoring zoonoses.

«Ecology of Zoonoses», W. Karesh et al., Lancet 2012 A team of authors led by William Karesh, a US-based "One Health" pioneer, points out that zoonotic infectious diseases cause one billion cases annually and lead to millions of deaths. The authors identify endemic zoonoses as the greatest risk to the health of the global community. They call for increased collaboration between doctors in clinics, public health experts, ecologists, veterinarians and economists to better understand the causes of zoonoses and develop effective prevention measures.

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The increasing risk of a pandemic, as we are currently experiencing with Covid-19, was known for a long time. American zoologist Peter Daszak has been talking for years about an "era of pandemics" and French health ecologist Serge Morand about an "epidemic of pandemics". Jakob Zinsstag is also convinced that Covid-19 will not be the last pandemic. However, he sees the "One Health" approach as our best chance to escape the maelstrom of epidemics and pandemics.

Practitioners of "One Health" not only think in terms of diseases and possible therapies. They also think in terms of "human-environment systems" as described by Nobel laureate Elinor Ostrom. They try to think about antibiotic resistance together with food security, hygiene in animal markets, with the water supply and the risk of zoonotic diseases. They recognize that health care always thrives or perishes within social systems; that prevention and therapy only work when adapted to local conditions.

Or as Zinsstag says, "It's no use sending vaccinations to places where no one understands what they're supposed to be good for in the first place." And it is just as unpromising to try to enlist people in the fight against zoonoses if they have never heard of them.

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The public health benefits of One Health are now widely recognized, at least at the UN level. Since 2010, the approach has been driven by technical cooperation between the World Health Organization (WHO), the World Organisation for Animal Health (WOAH) and the Food and Agriculture Organization (FAO). Initially, the focus was on avian influenza, rabies and antibiotic resistance, later joined by Ebola and Covid-19. In 2020, the UN Environment Programme (UNEP) also joined the tripartite organization. This brought the interdependencies between the environment and zoonoses increasingly into focus at the UN level as well. Since May 2021, there has also been a One Health High Level Expert Panel (OHHLEP), in which some of the world's best epidemiologists, virologists, immunologists and environmental scientists focus on zoonotic diseases.

Since the pandemic, Zoom workshops, panel discussions and interdisciplinary reports on "One Health" came into vogue. Dozens of development organizations, NGOs and think tanks are lobbying for a "One Health" or even "Planetary Health". In an expert report for the G20 countries in June 2021, the term "One Health" appears 30 times - without once specifically defining what is meant by it or how this approach could be operationalized.

In October 2021, a network consisting of 270 universities, NGOs and health care organizations presented the "Sao Paulo Declaration on Planetary Health. While it lists all the evil of this world - global warming, declining biodiversity, increasing inequality - and speaks with much pathos of the "Great Transition" and a "resilient post-pandemic world", it gives little indication of what this means for reforming the global health system. And how such "planetary health" could be put into practice.

The doctor and climate activist Eckart von Hirschhausen once aptly said on a panel on the topic: "One Health is like world peace. Everyone thinks it's good, but no one knows how to achieve it." Jakob Zinsstag doesn’t have the key to world peace either. But when it comes to the practical implementation of "One Health", few have as much experience as he does.

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At eye level

At eye levelHealing with the Mayas in Guatemala

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In 2016, Jakob Zinsstag travelled to the Peten region of Guatemala with ethnologists and a linguist from Swiss-TPH to set up a system for monitoring zoonotic diseases with Mayan communities living in the rural areas. In the past, they suffered recurrent outbreaks of brucellosis and leptospirosis, both bacterial infections transmitted by animals with the latter also through contaminated water. The researchers' goal was to bring together the biomedical approaches of Swiss TPH with the traditional practices of Mayan medicine. This should make it possible to localize an infection source more quickly and treat people more effectively.

Language, ethnicity, worldview, values and culture are central to the implementation of public health interventions. Zinsstag's group therefore worked closely with ethnologist Mónica Berger González from the Universidad del Valle de Guatemala, who has been researching traditional Mayan medicine for many years.

The researchers first had to understand hierarchies that had developed and learn how the Mayas traditionally dealt with diseases in animals and humans. To do this, Zinsstag used a sick chicken as a "boundary object". He first had the chicken examined by a Mayan healer. The diagnosis: the whole farm was jinxed, he had to perform an exorcism ceremony, and then the animal would get better. Zinsstag's diagnosis: Gastritis, easily treated with a commercial antibiotic.

Berger González talks in the project video about how the Mayas are affected by zoonoses and what opportunities she sees in "One Health" for the communities.

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In Guatemala, Zinsstag and his colleagues relied on the people themselves as being the best early warning system for detecting zoonoses. To do this, they had to create an understanding of how zoonoses work and why they are dangerous. "For the Mayans, animals are basically something positive. They have no idea that viruses can transmit from animals to humans and make them sick," the epidemiologist explains.

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Exact terms were defined with which villagers could tell the nursing staff in a local health station how certain complaints felt in their language, the Q`eqchi`. "The biggest challenge in Guatemala was not medical but linguistic," says Zinsstag. "Translation was the key to medical success."

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During many common workshops, the different votes had to be translated by translators from Q`eqchi` into Spanish or English - and back again. Together, 23 terms were defined for respiratory problems, for fever and diarrhea symptoms that corresponded to a known clinical picture. In addition, brochures in the local language were prepared to help the population to express themselves clearly to the medical staff. Now, whenever someone stated that he or she had "susto" or "itzel yax", the health workers in the local wards knew: Caution is required, this could be a zoonotic disease, and further clarification is needed.

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Brigit Obrist was part of the project’s core team in Guatemala. The ethnology professor at the University of Basel is now emeritus. She has worked with Swiss TPH for almost 30 years. Initially she wanted to become a doctor but soon realized that classical biomedicine was not her thing. During her studies in the USA, she became acquainted with "medical anthropology", i.e., an ethnology that focuses on the relationship between being human and health and on the fact that medical practice often raises existential questions about society and culture.

Like Jakob Zinsstag, she was contacted in the 1990s by Marcel Tanner, who later became the director of the Swiss TPH. He asked the young ethnologist to collaborate on a research project on health in the city of Dar es Salaam, Tanzania. "Marcel Tanner had a broader view of public health than most other health experts," Obrist recounts. "He understood early on that health always had to do with politics and that his own view of health was also rooted in a certain understanding of the world."

For Obrist, biomedicine, with its pharmaceuticals, medicines and vaccinations, is to be understood just as much as a cultural achievement of our society as explanatory models for health and illness in other societies.

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Looking back on the collaboration with the Maya healers in Guatemala, she says: "In the end, we did not succeed in building an epistemic bridge between the researchers from Switzerland, those from Guatemala City and the local healers." The understanding of health and disease was too different. In addition, for the Mayas in Peten, the perceived danger posed by zoonotic diseases was low in the context of their difficult living conditions.

When Obrist last spoke with her research colleague in Guatemala in 2020, violence had escalated due to gang warfare, and poverty had worsened. Many peasants were no longer able to cultivate their land due to threats from mafia-like large landowners. "Under such conditions, no one is interested in monitoring zoonoses anymore."

Here she sees a fundamental problem with health interventions in the Global South - even in "One Health" projects: "The social and political realities are often ignored in favor of focused interventions that are primarily oriented towards biomedical criteria." In retrospect, the anthropologist says that the original aspirations in Guatemala were probably too big. "But we definitely learned a lot about the importance of social processes in relation to health and illness.

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Audio in German: Brigit Obrist sees great potential for social change in the "One Health" approach. For this to happen, however, it must be linked to political and social reform demands.

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Audio in German: Brigit Obrist sees great potential for social change in the "One Health" approach. For this to happen, however, it must be linked to political and social reform demands.

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Despite the setbacks, Jakob Zinsstag looks back on the project in Peten less critically than Obrist: "Many remained true to their understanding of health, but we were at least able to create options for the population," he says. "Some women chose to have a ceremony with a healer in their village first after our project and then went to the hospital for treatment of their infection."

What makes this project stand out for him is the successful transdisciplinary collaboration. Epidemiologists, social scientists, human and veterinary doctors from Switzerland and Guatemala worked closely with local healers, village presidents, nurses and politicians. In his opinion, it is only through such dialogue that effective strategies against the spread of zoonoses can be developed.

As president of the group for transdisciplinary research at the "Academy of Natural Sciences" and as co-president of the OECD Commission on Transdisciplinary Research, Zinsstag is fighting against entrenched scientific silos. He also observes such silos in Swiss research funding, where his truly systemic and transdisciplinary projects have mostly been rejected so far.

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One man, one mission

One man, one missionOn Roadshow for a Global "One Health"

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A sunny Saturday afternoon in October 2021 in Sierre, a tranquil Valais town picturesquely nestled in the surrounding vineyards: Marie Monique Robin, a French journalist and director, has invited Zinsstag and other guests to a podium. She had just published the book "La fabrique des pandémies" about the causes of the Covid-19 pandemic. Based on this book, she is making a documentary film in which Zinsstag will appear as an expert.

About 40 listeners have come to the baroque parquet hall with pink walls and angel reliefs in the "Hôtel de Ville". Zinsstag is wearing a black suit and a white shirt. Compared to the other panelists, he seems overdressed.

During the panel, he tries to relate to the audience. Therefore, he tells the story of the fight against fox rabies in Valais. Here, in 1978, chicken heads inoculated with vaccine and dropped from a helicopter as bait succeeded in saving the Rhone Valley from the virus. Due to this success, kilometer-long "vaccination-walls" were established in other mountain valleys. From 1985, rabies was only present in the Swiss central Plateau region. A few years later, it was also eradicated there. "A success story in the fight against zoonotic epidemics," says the epidemiologist.

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Audio in French: When Jakob Zinsstag passionately talks about his research in Africa on the podium, the audience hangs on his every word.

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Audio in French: When Jakob Zinsstag passionately talks about his research in Africa on the podium, the audience hangs on his every word.

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At the end of the panel, the researcher faces questions from the audience. He is accessible and interested in an exchange with the public. "The Covid-19 pandemic has shown: We need to communicate better and more widely," he says. A medical student who is engaged in “One Health” in his leisure talks about having read all of Zinsstag's scientific articles.

On the way to the car, he briefly discusses with the filmmaker a planned shoot on a "One Health" research project in Ethiopia. Then he drives back to Basel with his wife Maria, a Protestant pastor. During an epic sunset over Lake Geneva, he talks about ski tours on Mont Blanc, which he would still like to do, about vaccination opponents in his family and at the Swiss TPH, and about how he once nudged Green Party senator Maya Graf to submit a motion in the Federal parliament regarding integrated animal/human antibiotic resistance monitoring.

Zinsstag thinks it is important for researchers to engage themselves politically. For example, in favor of more climate protection. He is a member of the Green Party and is currently considering whether he should sign a petition by the climate activists from the "Extinction Rebellion" group, most of whom he likes.

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The following morning, Zinsstag will get up at 5.15am to cycle from Bruderholz, where he lives, to the train station. There he meets his youngest daughter and takes her by train to Berlin. She accompanies her father to the "World Health Summit", where the big names in global health and development cooperation are appearing: WHO Director Tedros Adhanom Ghebreyesus, UN President Antonio Guterres, UNICEF Director Henrietta Fore, virologist Christian Drosten from the Berlin Charité hospital. As many as five panels on this Sunday revolve directly around "One Health" issues. Zinsstag will speak on "One Health: Good Practices and Challenges".

During the moderated discussion, the five experts will discuss the need for collaborations across different sectors and the fact that the goal formulated in 1972 for industrialized countries to spend 0.7 percent of their GDP on development aid has been achieved by very few countries (including Switzerland), and that this is one reason why "One Health" projects in the Global South fall by the wayside. He also talks of the urgent need for new curricula in the health system to include "One Health" and of the difficulty to gain doctorates in academia via the transdisciplinary research.

Zinsstag talks about his online lecture (MOOC) on "One Health", which is open access and free for all, allowing him to reach over 1000 students a year around the world. "Outreach is important; we need to communicate "One Health" much more widely," he says.

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Wanda Markotter
Director of the Centre for Viral Zoonoses, University of Pretoria

John Amuasi
Co-director of The Lancet "One Health" Commission

Maria Flachsbarth
State Secretary, German Federal Ministry for Economic Cooperation and Development

Marisa Peyre
Epidemiologist and Vice Director Cirad

Jakob Zinsstag
Professor of Epidemiology, Swiss TPH

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Wanda Markotter
Director of the Centre for Viral Zoonoses, University of Pretoria

John Amuasi
Co-director of The Lancet "One Health" Commission

Maria Flachsbarth
State Secretary, German Federal Ministry for Economic Cooperation and Development

Marisa Peyre
Epidemiologist and Vice Director Cirad

Jakob Zinsstag
Professor of Epidemiology, Swiss TPH

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Maria Flachsbarth, CDU politician and State Secretary at Germany's Federal Ministry for Economic Cooperation and Development, asks at some point: "And who is going to pay for all this?" Jakob Zinsstag answers: "One Health saves costs in the medium term, we don't have to pay for it at all." As proof, he cites a brucellosis project in Mongolia, where the cost ratio of "One Health" to conventional treatment was 1:3. "When health ministries combine their budgets, everyone benefits!"

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Three days after the "World Health Summit" in Berlin, Zinsstag is standing in a lecture hall at the federal technology institute ETH Zurich. His presentation is entitled "Covid-19 from the perspective of One Health". Around 20 interested people are sitting in the room, wearing masks, well separated from each other..

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Zinsstag has adapted his lecture to the venue - a world-class technical university. He combines dry epidemiology - slides packed with mathematical formulas - with adventurous tales from his field research in Africa and Asia.

More than at previous events, he addresses the social debate about the current pandemic: "The Covid-19 pandemic is extremely normative. We have to weigh numbers of deaths against economic decline. How do we weigh private rights against public spirit?" asks the epidemiologist. "As a Christian, getting vaccinated is an act of solidarity and charity," he says during the lecture. And he is impressed by Switzerland's handling of the pandemic so far. "Many people don't realize that we had one of the softest lockdowns in the world.”

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Audio in German: At ETH Zurich, Zinsstag once again explains the most important aspects of a "One Health" and emphasizes the need for systematic thinking.

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Audio in German: At ETH Zurich, Zinsstag once again explains the most important aspects of a "One Health" and emphasizes the need for systematic thinking.

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In the discussion that followed, a young woman asked: "Humans have lived closely with animals for centuries. Why is that becoming a problem now?" Zinsstag explains the phenomenon of encroachment. "We are going deeper and deeper into the primeval forests and coming into contact with wild animals and their viruses more and more often. This is dangerous."

To illustrate, he explains the emergence of the Nipah virus in 1997 in southeast Malaysia, in a place called Sungai Nipah. There, entrepreneurs had installed large open-air pig farms. The pigs died first, followed shortly afterwards by the first employees who had previously contracted meningitis. Later, employees of a slaughterhouse in Singapore were also affected. The meat was destined for export to China, because pigs are rarely eaten in predominantly Muslim Malaysia.

After laboratory tests, it turned out that the natural reservoir of the virus was fruit-eating bats. These bats had been driven out of their natural habitat in Borneo by slash-and-burn agriculture for palm oil production and were now looking for food in the fruit trees along the pig farms. Droppings, urine or eaten fruit fell into the facility, where first the animals and later the humans became infected with the virus. The zoonotic infection was fatal in almost half of the cases: out of 265 infected, 108 died. Since then, the virus has resurfaced in various locations in Southeast Asia, infecting over 700 people as of 2018.

The Nipah virus outbreak is a direct result of environmental degradation and factory farming. "Monocultures are a problem because the larger a homogeneous population is, the easier viruses can spread," says Zinsstag. "We really need to ramp up biodiversity and rethink agriculture."

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Ethiopian pilot

For holistic zoonosis
surveillance

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In Ethiopia, ten percent of the population live as nomads or semi-nomads, mainly in the Somali region. That is about ten million people. The remote region in the extreme east of the country on the border with Somaliland is one of the poorest in Ethiopia. Insecure food supply, lack of water, droughts, poor sanitation infrastructure and land erosion determine the lives of the population.

As blood samples show, Q-fever and Rift Valley fever are regularly transmitted between humans and animals. However, bovine tuberculosis (Mycobacterium bovis), which is transmitted to humans via milk, among other things, as well as rabies, brucellosis, anthrax and avian flu are also recurrent.

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Since 2014, Zinsstag's team, together with Swiss veterinarian Rea Tschopp, who lives permanently in Ethiopia, has been building a partnership with Jigjiga University in the Somali region. The "Jijiga One Heath Initiative" (JOHI) is a mammoth organizational project: in order to be able to better monitor the diseases, the team first had to get all stakeholders on board and convince them of the usefulness of "One Health".

A Somali doctoral student, with whom Zinsstag works closely, visited widely scattered nomadic groups for this purpose. At the same time, the researchers forged contacts with politicians at local, regional and national level and organized participatory meetings with the population. Finally, zoonosis surveillance was integrated into official health institutions. And to build research capacity and "One Health" know-how, an exchange programme was started in Basel, through which doctoral students from the University of Jigjiga are trained in Basel.

Jakob Zinsstag regularly visits his partners of the "Jigjiga University One Health Initiative" in Ethiopia, even though this became increasingly difficult last year due to the political unrest in the country. The following photo series shows impressions of a visit in January 2021.

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In August 2017, Zinsstag visited a sub-project of JOHI for the first time, which was set up by a master’s student on site: the "Integrated Rangeland and Disease Surveillance Response Office". In a simple clay building, calendars and overview maps of the region hang on green-painted walls. In the center is a large desk with two PC workstations. The person responsible for the surveillance of infectious diseases in animals sits at one, the person responsible for surveillance in humans at the other. The physical proximity is to ensure that one is always up to date on what is going on at the other.

All zoonosis surveillance data is collected here: For example, the analysis results of milk samples. If phleboviruses that trigger Rift valley fever suddenly appear in them, the villages in the vicinity are warned at an early stage. The virus, which is transmitted to humans via milk, blood or mosquitoes, can trigger brain infections and internal bleeding, which is fatal in 50 percent of cases.

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One of Zinsstag's PhD students is currently experimenting with the possibility of using smartphones for epidemiological assessments. In a pilot project, nomadic groups who are provided with a mobile phone with GPS are contacted by phone every two to four weeks by JOHI researchers. The location is recorded, and questions are asked about the health of the animals and the family. Epidemiologists thus have real-time data at their disposal and can detect emerging epidemics at an early stage. This is an inexpensive and relatively easy-to-implement type of zoonosis monitoring that could set a precedent beyond Jigjiga.

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Audio: Zinnstag tells of the importance of integrating the JOHI project in local and regional governance. He is convinced that the JOHI project has model character.

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Audio: Zinnstag tells of the importance of integrating the JOHI project in local and regional governance. He is convinced that the JOHI project has model character.

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In January 2020, JOHI researchers, with the support of Swiss TPH, started a laboratory for molecular diagnostics in humans and animals. Two months later, the first Covid-19 cases appeared in Ethiopia. The local Somali government then asked Zinsstag if they could also evaluate Covid-19 tests in the laboratory. Without further ado, the lab was converted into a Covid-19 testing lab.

"At the beginning of the pandemic, our "One Health" lab was the only one across thousands of kilometers for a population of eight million people to be tested for SARS-CoV-2," Zinsstag says. By December 2020, 40,000 Covid-19 tests had been evaluated in the lab. After that, one machine broke down. Due to the political turmoil in the country, it could not be repaired until April 2021.

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"One Health" quo vadis?

Towards a society of human-animal-environment relations

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In December 2021 Jakob Zinsstag moved into a new building at Swiss TPH in Allschwil, near Basel. He had to give up his individual office; instead, there are now flexible workplaces and "team homes" in the stylish new building overgrown with climbing plants. "To be honest, I'm still pretty lost," admits Zinsstag during our last meeting at the beginning of January. He had planned to go to Ethiopia in December on a project visit. But due to the riots in the Tigray region and the increasingly civil war-like conditions in the country, he had to postpone the visit. Instead, shortly after our meeting, he flies to Nairobi for filming for Marie-Monique Robin's documentary. He will then travel on to Chad, where his team is currently setting up a "vaccination ring" around the capital N`Djamena. At checkpoints at the city limits, all dogs are to be vaccinated, in order to eradicate rabies.

It has been 24 years since Zinsstag first travelled to Chad, remembered Calvin Schwabe's "One Medicine" approach, and began vaccinating children at the same time as goats. Since then, the practical implementation of "One Health" has determined his life. Since then, the epidemiologist has been tirelessly calling for more investment in pandemic prevention, more cooperation between human and veterinary doctors, and more proactive surveillance of pathogens in wild and farm animals that have the potential to spread to humans.

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Zinsstag often puts forward economic arguments too. He likes to show a graph with curves piled up like camel humps along an X-axis. Their central message: the earlier a virus and possible zoonoses are detected, the greater the chance of containing a disease outbreak before a pandemic breaks out - and the lower the cumulative costs in the end.

After all, once a pandemic is unleashed, it becomes expensive. The International Monetary Fund (IMF) forecasts the global cumulative losses of the Covid-19 pandemic at $22 trillion by 2025. The economic slump is the most severe in 70 years. And as always, it is hitting the poorest hardest: the World Bank warned last year that the number of people in extreme poverty could rise to 740 million by the end of 2021. This is the first significant increase in 20 years. Much of the progress made towards poverty reduction under the UN's Sustainable Development Goals (SDGs) threatens to be undone by the pandemic.

In other ways too, Covid-19 has once again brought global inequality dramatically home to us: According to the WHO, more than 80 percent of the vaccinations went to the G20 countries, i.e., the richest industrialized and emerging countries. Low-income countries, especially in Africa, will have received 0.6 percent of global vaccines by the end of 2021. The health and economic crisis is also a humanitarian crisis.

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In 2012, the World Bank called on its members for the first time to invest in the systematic control of zoonoses - primarily for economic reasons. However, it was not listened to very much. Today, around $4 billion per year are invested worldwide in the prevention of zoonoses. By comparison, the US national security budget for 2020 was $714 billion, about 180 times as much. Only $2 billion a year go into global forest protection and around $260 million into combating the illegal wildlife trade. Both would be effective measures to curb zoonoses and thus the risk of future pandemics.

In a paper soon to appear in the medical journal "The Lancet", Zinsstag and 21 colleagues argue that a functioning global "One Health" prevention system would be cheaper by a factor of ten thousand than the current expenditure for the Covid-19 pandemic. The researchers call for a paradigm shift away from a focus on detection and treatment in humans to prevention and control in animals and along "human-environment systems". According to the experts, the evidence that this could save both human and animal lives, and even at lower costs, is clear today. Nevertheless, a consistent national implementation of a "One Health" strategy, with the necessary budgets, is still the exception.

It has been obvious for many years clear where one could start with pandemic prevention. In a study published in Science magazine in 2020, scientists calculated the costs of combating zoonoses in the known hotspots through forest protection programs, "One Health" initiatives and a ban on the wildlife trade. The result: $22 billion - $31 billion per year. If one adds positive side effects, such as the additional storage of carbon dioxide by healthy forests, it would be "only" $18 billion - $27 billion. The authors' demand: At least part of the billions invested in stimulus programs in the context of the current crisis should flow into pandemic prevention.

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Major initiatives for zoonosis monitoring and pandemic prevention already existed in the past. They are called "Predict", "Stop Spillover" and "Global Virome Project". Hundreds of millions of US dollars have been invested in them. Within the framework of the ten-year "Predict" project of the US development agency "USAID", virus transmissions to people with close contact to wild animals were continuously monitored in 31 countries. At the same time, training programs were set up to raise awareness of zoonotic risks in communities near forests with wildlife that acted as a large pathogenic reservoir. "But all these initiatives could not prevent Ebola or Covid-19," says Zinsstag.

In the following, we looked at the most important global initiatives - and the criticism of them.

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No interest in global vaccination campaigns

Zinsstag is convinced that most people have not thought about the opportunities of medicine along human-animal-environmental systems. Despite the promising successes of practical "One Health" projects, the focus is still one-sidedly on vaccination and therapy. He also criticizes global vaccination programs implemented by foundations and UN organizations. His proposal to vaccinate not only children, but also animals to better protect children from zoonotic infections has so far fallen on deaf ears. That would not fit in with the established strategy, the people in charge told him.

"You can see from statements like this what the real obstacles are in the paradigm shift towards One Health." This is all the less understandable, he said, as there are now definitely examples that show that "One Health" works in practice - and that it can even save costs. We have compiled some of such projects on the following map.

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Jigjiga One Health Initiative, Ethiopia
"Jigjiga One Health Initiative" in the Ethiopian-Somali Region shows how "One Health" can be operationalized at local level. Swiss TPH initiated the project in 2014 together with Jigjiga University (JJU) and the Norwegian-Swedish Armauer Hansen Research Institute (AHRI). It is being funded by the Swiss Agency for Development and Cooperation (SDC) for 12 years. The aim is to strengthen local public health research and teaching, to build knowledge and capacity. At the same time, a system for integrated zoonosis surveillance among nomads is to be established.

One Health Office, Kenya
Since 2012, Kenya has a national "One Health Office", in which human and veterinary doctors work closely together for the prevention and early detection of zoonoses. This is a priority regarding infectious diseases such as rabies, trypanosomosis, dengue and salmonellosis.

Canadian Science Centre for Human and Animal Health
The Canadian Science Centre for Human and Animal Health in Winnipeg operates laboratories for highly infectious diseases (biosafety level 4) in animals and humans under one roof - saving 26% of operating costs, according to World Bank estimates.

Emilia-Romagna Zoonoses Observatory
In the Emilia-Romagna region (Italy), an integrated surveillance system for West Nile virus has been in operation since 2013. The virus, which is transmitted via mosquitoes, has spread rapidly in the recent years, as a result of global warming. Mosquitoes, wild birds, horses and humans are regularly sampled to immediately contain potential focal points of the virus. According to the researchers who designed the system, the integrated approach has saved more than one million euros in six years compared to monitoring animals and humans separately.

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Jigjiga One Health Initiative, Ethiopia
"Jigjiga One Health Initiative" in the Ethiopian-Somali Region shows how "One Health" can be operationalized at local level. Swiss TPH initiated the project in 2014 together with Jigjiga University (JJU) and the Norwegian-Swedish Armauer Hansen Research Institute (AHRI). It is being funded by the Swiss Agency for Development and Cooperation (SDC) for 12 years. The aim is to strengthen local public health research and teaching, to build knowledge and capacity. At the same time, a system for integrated zoonosis surveillance among nomads is to be established.

One Health Office, Kenya
Since 2012, Kenya has a national "One Health Office", in which human and veterinary doctors work closely together for the prevention and early detection of zoonoses. This is a priority regarding infectious diseases such as rabies, trypanosomosis, dengue and salmonellosis.

Canadian Science Centre for Human and Animal Health
The Canadian Science Centre for Human and Animal Health in Winnipeg operates laboratories for highly infectious diseases (biosafety level 4) in animals and humans under one roof - saving 26% of operating costs, according to World Bank estimates.

Emilia-Romagna Zoonoses Observatory
In the Emilia-Romagna region (Italy), an integrated surveillance system for West Nile virus has been in operation since 2013. The virus, which is transmitted via mosquitoes, has spread rapidly in the recent years, as a result of global warming. Mosquitoes, wild birds, horses and humans are regularly sampled to immediately contain potential focal points of the virus. According to the researchers who designed the system, the integrated approach has saved more than one million euros in six years compared to monitoring animals and humans separately.

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Switzerland is not one of the global biodiversity hotspots, and open wildlife markets are not popular there. Nevertheless, there are new challenges on the horizon with regard to increasing zoonoses: for example, the spread of the Asian tiger mosquito, which can transmit dengue, Chikungunya, Zika and West Nile viruses. Zinsstag says: "In Emilia-Romagna in northern Italy, the West Nile virus is already endemic. We are closely monitoring the spread at Swiss TPH and expect the first case in Switzerland any day." Although the infection is usually asymptomatic in humans, it can lead to fever and, in rare cases, meningitis. There is no vaccination against it.

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Audio: According to Jakob Zinsstag, zoonosis monitoring in animals and humans should also be coupled in Switzerland. Today, these are still separated between the Federal Office of Public Health (FOPH) and the Federal Food Safety and Veterinary Office (FSVO).

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Audio: According to Jakob Zinsstag, zoonosis monitoring in animals and humans should also be coupled in Switzerland. Today, these are still separated between the Federal Office of Public Health (FOPH) and the Federal Food Safety and Veterinary Office (FSVO).

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Applied research against the epidemics of the Anthropocene

A "One Health" approach that is consistently implemented, as Jakob Zinsstag and other pioneers understand it, goes far beyond the optimization of health systems. It also calls for a rethinking of the sciences. It requires more investment in transdisciplinary research that not only generates knowledge but contributes to changes in human-animal-environmental systems. And it replaces specialization in health research, with a one-sided focus on sequencing pathogens and developing drugs and vaccines.

In July 2020, Zinsstag co-led a report for the Global Science Forum of the Organisation for Economic Cooperation and Development (OCDE). The report uses case studies to show how transdisciplinary research can help find solutions to the big challenges nowadays and how governments and universities can promote them. The most important finding: building bridges between different scientific disciplines and working towards a common language must be recognized as scientific excellence in its own right.

This also requires new degree programs with a transdisciplinary curriculum, so that medical and veterinary professionals learn to collaborate with each other and with researchers from other disciplines. "We need to redefine the role of science in times of the Anthropocene," says Zinsstag. "Today more than ever, research must contribute to concrete solutions for the urgent problems of our time."

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Keyword Anthropocene: "One Health" also challenges our common, human-centered perspective. It asks us to recognize that the ecosystems that surround us, and the well-being of the animals that live in them, are the basis for all life on earth - including that of humans. In this respect, every saved tree, every palm oil plantation that is not created in a biodiverse area, every thwarted wildlife trade and every wildlife market for luxury consumption that closes is also part of "One Health". And they are all contributions towards preventing the next pandemic.

But developments are currently moving in a different direction: during the first year of the pandemic, clearing of primary forest in the tropical belt increased by 12 percent. In Brazil, deforestation for agricultural land in 2021 has almost reached the peak of 2006 again.

World population, meat consumption, mobility and global warming continue to rise. In 2030, 60 percent of people will live in cities. These are expanding more into fragile ecosystems, creating new, potentially dangerous interfaces for zoonotic diseases. An estimated 1.67 million unknown viruses lurk in animal reservoirs in such ecosystems - and nearly half have zoonotic potential, so they could eventually transfer to us.

How does Jakob Zinsstag deal with this depressing outlook? "I remember what [Martin] Luther said" he says. "Even if I knew that the world would end tomorrow, I would still plant a tree today." The pioneer will continue to preach the virtues of "One Health". And with the ongoing Covid-19 crisis, the prospects are not bad that his gospel will increasingly be heard beyond academic circles.

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Imprint

Research / Concept / Text

Samuel Schlaefli
Journalist & Editor
Werkraum Warteck
Burgweg 15
4058 Basel

text@samuelschlaefli.ch
www.samuelschlaefli.ch

Illustration / Design / Production

Seraina Hügli & Lucas Pfister
Capisci - Visual Knowledge Transfer
Aargauerstrasse 70 / 248048
Zurich

ciao@capisci.ch
www.capisci.ch

This web report was published in February 2022 in cooperation with the "NZZ am Sonntag" and the "NZZ Magazin" and financially supported by the "Schweizer Klub für Wissenschaftsjournalismus" and the "Gebert Rüf Stiftung". We would like to express our sincere thanks for this!

Texts, illustrations, photographs and other parts of this web report may only be used with the permission of the authors. They assume no liability for the content of external websites linked in this story. All image rights are listed under "Sources". The rights to the illustrations are held solely by capisci.ch.

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Sources and image rights

Sources

Important sources (as of February 2022)

A world at risk. Global Prepardness Monitoring Board 2019 annual report, September 2019.

Has COVID taught us anything about pandemic preparedness? Nature news feature, 13. August 2021.

Benefits of Animal Interventions for Zoonosis Control. Emerging Infectious Diseases, April 2007.

Human impact on wildlife to blame for spread of viruses, says study. The Guardian, 8. April 2020.

Global assessment report on biodiversity and ecosystem services. Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), Mai 2019.

Outbreaks of vector-borne and zoonotic diseases are associated with changes in forest cover and oil palm expansion at global scale. Frontiers in Veterinary Science, März 2021.

Preventing the next pandemic: Zoonotic diseases and how to break the chain of transmission. United Nations Environment Programme and International Livestock Research Institute, Juli 2020.

Report of the scientific task force on preventing pandemics. Harvard Global Health Institute, August 2020.

Towards integrated surveillance-response systems for the prevention of future pandemics. Infectios Diseases of Poverty, Oktober 2020.

Does more environmental damage: eating meat from the wild or a factory farm? The Guardian, 26. Mai 2020.

Report on biodiversity and pandemics of the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES), Oktober 2020.

Zoonotic host diversity increases in human-dominated ecosystems. Nature, August 2020.

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Image sources

Image rights (photographs and videos)

Image sections:
Image rights for all photographs and videos (where not otherwise noted): Jakob Zinsstag / Swiss TPH

Video on Guatemala in chapter "At eye level":
Nido Films

In-depth sections (in order per in-depth section):

In-depth zoonosis:
1. Espen Rasmussen / VII / Redux / laif (Young men working as grave diggers in a large cemetery on the outskirts of Freetown help health workers in full protective clothing bury a body. Ebola Outbreak, Sierra Leone, 2015)

2. UPI/laif (Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19

3. The NewYorkTimes/Redux/laif (Mission Rabies staff gives anti rabies injection to a dog owned by local residence in Goa, India.)

4. Manu Quintero/Redux/laif (The Aedes Aegypti mosquito is the vector of Zika virus as well as Dengue and Chikungunya.)

5. The NewYorkTimes/Redux/laif (A team of researchers catch bats as they fly out of the Khao Chong Phran Cave at dusk in Ratchaburi, Thailand, December 2020.)

6. Frommann/laif (Petrischalen mit Bakterienkulturen)

7. Daniel van Moll/laif (A local burial team in Freetown, Sierra Leone retreiving corpses of Ebola victims from a township, 2014.)

In-depth wildlife markets:
1.Gilles Sabrie/NYT/Redux/laif (A wet market in Wuhan, China, January 11, 2021.)

2. ChinaFotoPress/laif (Vendors prepare to butcher poultry at Zhonghuan poultry wholesale market after the market was closed after bird flue cases on April 7, 2013 in Wuhan, Hubei Province of China.)

3. Michael Wolf Estate/laif (A man coming home with two turtles from the wildlife market in guangzhou, china: the asiatic softshell turtle, and a big headed turtle.)

4. Roger Lemoyne/Redux/laif (A woman eats while tending a bush-meat street stall in Saigon, Vietnam in 1990’s.)

5. Sinopix (A police officer inspects conditions at the Xinyang wild animal market in Guangzhou.)

6. Sinopix/laif (Guangzhou animal market sells all kinds of animals in terrible conditions and slaughters many at the market.)

7. Hitoshi Katanoda/Polaris/laif (Beijing, China: Workers wearing facial mask in the food market in the morning.)

8. Michael Wolf Estate/laif (Giant asian pond turtles for sale at market in Guangzhou, China.)

9. Gilles Sabrie/NYT/Redux/laif (Contact tracers in hazmat suits investigate a market where a COVID-positive traveler had visited merchants days earlier in Wuhan, China, Jan. 11, 2021.)

10. The NewYorkTimes/Redux/laif (Live young crocodiles, which are protected by law, awaited slaughter at the Friday bushmeat market in Mbandaka, DRC, in May 2016.)

11. Mark Leong/Redux/laif (A collection of medicines claiming to contain wild animal ingredients – mostly tiger but some antelope, pangolin and others.)

12. Michael Wolf Estate/laif (Chinese medicine. Snake wine for sale at a chinese market in Guangzhou, China)

13. U Aung Xinhua / eyevine / eyevine / laif (Confiscated elephant tusks are burnt during the destruction ceremony of confiscated elephant ivory and wildlife parts in Nay Pyi Taw, Myanmar, on Oct. 4, 2018.)

14. Mark Leong/Redux/laif (Evidence room at the Ministry of Forestry's Police Rapid Reaction Force headquarters in Medan.)

15. Stefano De Luigi / VII / Redux / laif (Scales of giant pangolin seized by french customs in Charles de Gaulle airport.)

16. Francesco Pistilli/laif (Most layer egg-hens live their lives in wire battery cages, Italy, 2015.)

17. Francesco Pistilli/laif (After weaning the swines stay in the same crowded cage for 4 to 6 months, then they're divided in 2 groups: fattening or reproduction. Italy, 2012)

18. John Stanmeyer / VII / Redux / laif (Dead chickens at the UD. Putra Bintang chicken farm as a consequence of Bird Flu. Bali, 2004.)

19. Hollandse Hoogte/laif (Minkfarm Rasmussen B.V. is one of the companies that protested against closure. Niederlande, 2012.)

20. Hollandse Hoogte/laif (Minkfarm Rasmussen B.V. is one of the companies that protested against closure. Niederlande, 2012.)

In-depth environment & zoonoses:
1. Maria Magdalena Arrellaga/NYT/Redux/laif (An aerial photo of a fire burning in the Brazilian state of Mato Grosso, Aug. 29, 2020.)

2. Patrick Aventurier/hemis/laif (Hmong cultures in the Amazon forest. French Guiana, 2019)

3. Victor Moriyama/NYT/Redux/laif (Land being burned for cattle grazing in the Amazon rainforest near Porto Velho, Brazil, Sept. 9, 2019.)

4. Kadir van Lohuizen / laif (A giant palm oil plantation in Mantangai. Kalimantan, Indonesia 2016.)

5. The NewYorkTimes/Redux/laif (An area of the Amazon rainforest in the Jamanxim National Forest which has been illegally slashed and burned stands next to a section of virgin forest in Novo Progresso, state of Para. Brazil, 2014.)

6. Aurelien Brusini/hemis/laif (Unexplored area on the border between the heart of the Amazonian Park of French Guiana and the Trinity National Nature Reserve, 2019.)

7. Lindsay Mackenzie/Redux/laif (A Pennant’s Red Colobus sits on a tree branch in the Gran Caldera de Luba Reserve. Equatorial Guinea, 2013.)

8. BOURSEILLER Philippe /hemis/laif (Malaysia, Borneo, Danum Valley Conservation Area.)

9. Joao Luiz Bulcao/Polaris/laif (The Amazon rainforest is becoming increasingly vulnerable to forest fires due to a combination of droughts, climate change and human activities. Brazil, 1998.)

10. Joshua Stevens/NYT/Redux/laif (An image provided by NASA's Earth Observatory shows a map of fires burning in South America as seen in a mid-August 2019 satellite image.)

11. The NewYorkTimes/Redux/laif (Munduruku men and boys survey the damage to their tribe’s protected land caused by illegal gold miners in Posto de Vigilancia. Brazil, 2018.)

12. Polaris/laif (The mosquito-borne Zika virus, which is suspected of causing brain damage to babies in Brazil, is expected to spread to all countries in the Americas except for Canada and Chile. USA, 2016.)

13. Damon Winter/NYT/Redux/laif (A piece of heavy farm equipment works a sea of red dirt, where native forest once stood, as the field is prepared for soy bean cultivation, in Mato Grosso. Brazil, 2009.)

In-depth global Initiatives:
All pictures (except 2, 3, 5) from the series "The Virus Hunters" by Simon Townsley. We thank the photographer for his support!

Bild 2: Mehmet Demirci/Redux/laif (The first COVID-19 vaccine doses arrived in bulk to North Carolina Monday morning December 18, 2020.)

Bild 3: Alecsandra Dragoi / Guardian / eyevine / laif (AstraZeneca unveils The Discovery Centre (DISC) in Cambridge. 23.11.2021)

Bild 5: Institute of Virology and Immunology IVI/NZZ

In-depth One Health Switzerland:
1. Frieder Blickle/laif (Milchkühe auf dem Rückweg von der Weide zum Bauernhof. Schweiz, 2009.)

2. Institute of Virology and Immunology IVI/NZZ

3. Ruben Sprich Xinhua / eyevine / eyevine / laif (Swiss Secretary of State Roberto Balzaretti, Swiss Foreign Minister Ignazio Cassis, Swiss President Alain Berset and Finance Minister Ueli Maurer attend a news conference in Bern. Switzerland, Dec. 7, 2018.)

4. Institute of Virology and Immunology (IVI)

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Jakob Zinsstag at a research session as part of the "Jigjiga One Health Initiative" (JOHI) at the University of Jigjiga in Ethiopia.

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The epidemiologist in conversation with Dr Bashir, President of the University of Jigjiga in the Somali Region of Ethiopia.

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The Jigjiga One Health Initiative (JOHI) team with a staff member of the Swiss Agency for Development and Cooperation (SDC) at Gode Airport, Somali Region, Ethiopia.

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Talking to a staff member of the ultrasound service in the hospital of Dlanzadgad, in Gobi province, Mongolia.

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Blood sampling sheep in Kyrgyzstan for brucellosis detection.

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Global field research: Togolese veterinarian Bassirou Bonfoh together with Jakob Zinsstag meets Kyrgyz peasant women and their children.

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Jakob Zinsstag on a research trip in the Mongolian province of Gobi. There, camels are a reservoir for the dog tapeworm.

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With start-up funding from JOHI, this man has built up a pharmacy with animal medicines that are otherwise difficult to obtain in the Somali region.

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A standard antibiotic for the treatment of bacterial infections in cattle and goats.

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A group of Somalis rest in the shade of a tree. In the background are tablets with Koranic suras.

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Stone mill and smartphone: ancient and new technologies often coexist for Swiss TPH researchers.

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Jakob Zinsstag with partners of the JOHI. On the right sits the director of the University Hospital, on the left the president of Jigjiga University.

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The researchers talk to a women's group. JOHI is also intended to contribute to better health care for women and professional support for births.

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A Somali woman talks about her experiences in the framework of JOHI.

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Sharmarke Dugsyie is a PhD student in sociology within the JOHI project.

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Risky proximity

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"Wuhan Huanan Seafood Wholesale Market" - this name made headlines around the world in early 2020. This "wet market", a fresh market with living animals, was almost certainly the epicenter of the Covid-19 pandemic. In December 2019, several people who had shopped at the market had been hospitalized for the first time with an unknown lung infection. According to WHO, 55 per cent of the first Covid-19 patients had contact with Huanan Market or another market in Wuhan.

Most epidemiologists and virologists have now concluded that SARS-CoV-2 has a zoonotic origin. The alternative "lab leak" theory, according to which the virus escaped from a laboratory in Wuhan, could not be completely disproved yet, but is considered unlikely by most experts. But why did the decisive "spillover" of the virus from animals to humans take place here, at a market in the center of Wuhan, a city of 9 million people in Hubei Province, 800 kilometers west of Shanghai?

A good insight into the conditions on the ground is provided by a study published in July 2021 in the scientific journal "Nature" by a group led by Oxford zoologist Chris Newman with the participation of researchers from China and Wuhan. Xiao, one of the researchers working at the Lab Animal Research Center in Wuhan, visited 17 "wet markets" in Wuhan selling wild animals every month between May 2017 and November 2019, including the notorious Wuhan Huanan Seafood Wholesale Market. There he talked to the sellers and noted which animals were sold, how many of them, at what price and whether the animals came from farms or were caught in the wild.

The actual purpose was to collect data on the spread of the SFTS virus, a zoonotic infectious disease that has been endemic in parts of China, Korea, Vietnam and Japan since 2011, killing up to 30 per cent of those infected. Today, his data serve to shed some light on the origins of the Covid-19 pandemic. For example, it seems unlikely that SARS-CoV-2 was transmitted to humans by a pangolin or a bat, as was assumed at the beginning of the pandemic. This is because neither species was sold on the market, according to the study.

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Between May 2017 and November 2019, at least 47,381 wild animals were sold at 17 markets in Wuhan. These included 38 species of mammals, birds and reptiles; 31 of which are under international protection.

Nature, June 2021

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One can imagine the wildlife section of the market in Wuhan before December 2019 like a small zoo - but without the hygienic safety precautions common in zoos. And without a minimum of space and precautions for animal health. Raccoon dogs, civets, Siberian weasels, porcupines and wild boars, vipers, cobras and even Siamese crocodiles transited Wuhan's markets. According to the report in "Nature", the condition of the animals was often pitiful due to transport and the close confinement. Most of the time, the animals were sold alive to customers for consumption, but, if necessary, they were slaughtered right at the stall.

It is not that the wildlife trade in China was not regulated by law before the outbreak of the pandemic. Sellers were obliged to show a certificate of origin and quarantine for the traded animals. However, this was not the case at the markets the Chinese researcher visited. All wildlife trade observed in Wuhan was therefore actually illegal. In six mammal species, the researchers found gunshot marks or injuries caused by traps in almost a third of the animals, indicating illegal hunting. In a 2020 study, American and Australian researchers examined 142 zoonotic viruses in more detail. They concluded that the risk of spillover is highest for endangered and threatened species.

Neither the missing papers nor the illegal capture seemed to be a cause for concern for the officials of the "Wuhan Forestry Bureau", who are responsible for controlling the wildlife trade, on their forays into the markets.

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Ideal conditions for spillovers

Conditions like those that prevailed at the markets in Wuhan are a horror scenario for virologists, epidemiologists and public health officials: dozens of wild animal species under one roof, crammed into a very small space, under fear and stress, without effective hygiene controls and measures for animal health and species protection. The conditions are perfect for pathogens to multiply and spread to other species.

In addition, on-site slaughter exposes vendors and customers to the constant risk of coming into contact with body fluids (blood, faeces, saliva) from infected animals. What was brewing in the middle of the megacity of Wuhan between 2017 to 2019 in the wildlife markets was the perfect storm.

To date, it is not clear which wild animal the virus originated from and how it spread to humans. There are many possibilities: Of the 38 wildlife species documented in Wuhan, zoonotic pathogens had been detected in 33 since 2009 - in wild populations, at markets or on commercial farms. Rabies, SFTS, H5N1 and a number of bacteria harmful to humans were found. The masked palm civet, a viverrid species sold in Wuhan's markets, is believed to be a carrier of SARS-CoV-1 and is linked to the 2003 SARS outbreak that killed 800 people.

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"It would make sense to ban live animal markets, as China and other countries have done. But we also need to remember that there are communities, especially in low-income rural areas in Africa, that depend on wildlife for the livelihoods of millions of people."

Elizabeth Maruma Mrema, Secretary-General UN Convention on Biological Diversity

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Bans - but with what consequences?

A few weeks after the "Wuhan Huanan Seafood Wholesale Market" was closed, the Chinese government banned the sale of wild animals and products made from them at markets, in restaurants and on the internet on 26 January 2020. There was much praise for this. Immediately, there were also calls for wet markets to be closed worldwide. On 6 April, more than 240 conservation groups sent an open letter to WHO demanding that it immediately ban live wildlife markets and wildlife products used in traditional medicine.

For millions of people, the consumption of wild animal meat is still strongly culturally embedded today - it is considered normal, traditional, healthy and desirable especially in comparison to industrial factory farming. The thousands of small markets where fresh meat from farmed and wild animals is bought are extremely popular, especially in Asia and Africa.

Most wet markets are limited to fresh meat from livestock and fish, with a minority selling live wild animals, as in Wuhan. In the countryside, on the other hand, hunting wild animals is an important part of the food supply for many, especially for indigenous peoples. Critics of a general ban on wildlife trade and consumption therefore argue that this would result in the loss of an important source of protein for millions of people and would penalize poor and vulnerable communities in particular.

In Central Africa, for example, people get up to 50 percent of their protein needs from bush meat, i.e., meat from the forest. Robert Nasi of the Center for International Forestry Research argues that for these proteins to be replaced by livestock, enormous areas of rainforest would have to be cleared.

There is also no direct empirical link between bans and the reduction of the risk of pandemics, Stephanie Brittain, who researches conservation at Oxford University, told the British "Guardian" newspaper. In her opinion, a ban on wild animal meat would mainly lead to it taking place outside controls in underground and illegal markets - with the result that the risk of zoonoses could even increase.

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Opaque billion-dollar business

The consumption of and trade in wild animals has increasingly evolved from a necessity to a luxury for the rich in recent decades. At the markets in Wuhan, marmots cost an average of $25 per kilo, about five times as much as a kilo of pork. The most expensive snake, a large viper species, was sold for $70 per kilo. Studies from China show that the probability of eating wild animals is the highest among men with high incomes and good education who live in cities. The flourishing wildlife trade can also be explained, at least in part, by China's meteoric economic rise.

Professional wildlife farms have expanded rapidly in recent years, especially in China. In 2016, "non-traditional" animal farms had a turnover of around $77 billion and employed 14 million people. The Chinese online magazine "Sixth Tone" recently told the story of Wei Ningxiang, a farmer who raised around 7,000 cobras and other oriental snakes on his farm in Guangxi to sell to restaurants. Before stricter regulations in 2020, a total of 20 million snakes were said to have been bred for sale in the autonomous region in southern China.

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Between $7 billion and $23 billion are generated annually by illegal wildlife trade.

Estimate of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES)

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Trophies and traditional medicine

Wildlife trade has become a global business worth billions of dollars. Well-organized legal and illegal wildlife hunters and traders ensure that the emerging middle classes in Asian and African cities with millions of inhabitants are supplied with wildlife for consumption, for traditional medicine or for trophies. The scales of pangolins, for example, are used in many places in Asia as an ingredient for traditional medicine. The meat, in turn, is considered a delicacy. As a result, pangolins have become the most hunted animal of all. After the four Asian species were almost wiped out and placed under protection, the Asian demand is now mainly satisfied by imported pangolins from Africa. The greater the poverty among people living close to wildlife habitats, the more they hunt. Studies from Ghana, Cameroon, Tanzania and Madagascar point this out.

Wildlife is also traded as pets, for zoos and as trophies, especially in the USA and Europe. The profit generated by legal global wildlife trade has more than quintupled in the past 14 years. In 2019, it amounted to around $107 billion. With ten to 20 million marine and terrestrial wild animals per year, the US is now one of the largest wildlife importers in the world, with a rapid increase between 2000 and 2015.

This poses risks: in 2003, zoonotic monkeypox was introduced into the US for the first time, infecting 71 people. The virus occurs regularly in countries in Central and West Africa and can be fatal. It is probably transmitted through contact with bushmeat and had been introduced into the USA via an imported wild animal. Since the Netflix blockbuster "Tiger King", we also know that in some US states there is a "laissez-faire" attitude towards the import and commercialization of wild animals.

Juhani Grossmann is a team leader at the Basel Institute on Governance's Green Corruption Program. His research focuses on the money flows behind the wildlife trade. "Organized crime has long since discovered the wildlife trade for itself," he says. "Often the same networks are involved as in the illegal arms and drug trade." His team helps governments uncover such illegal networks. "In doing so, we take a `follow the money` approach and look at the money flows to track down key players."

We asked Grossmann how big he thinks the risks of wildlife trade are in relation to zoonoses.

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“Breeding" viruses in factory farming

Nightmares for zoonosis experts are not only caused by wild animal markets, but also by stables in intensive agriculture. This is another ideal breeding ground for zoonoses with pandemic potential. In China, there are now farms with up to 100,000 cows, in Australia and the USA with up to 50,000. All these animals live in a very confined space; infectious diseases can spread like wildfire, and lack of hygiene has a devastating effect.

The epidemics caused by MERS, SARS, BSE, avian and swine flu are all linked to intensive cattle, pig or poultry farming. Due to the industrialization and standardization of agriculture, genetic diversity in animals has been lost, which is increasingly becoming a health risk for humans. Once a virus is introduced to a farm for the first time, it spreads rapidly and can mutate into versions that transmit to humans.

The increase in zoonoses is therefore directly related to our meat consumption. This has quadrupled globally since 1961. At the same time, the number of mammals, reptiles, birds and fish in the wild has halved. Twelve species of domesticated mammals, including pigs, cattle, horses, sheep and goats, now accommodate about 50 per cent of the known zoonotic viruses.

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In response to avian flu and the spread of the H5N1 virus between 2004 and 2005, over 100 million chickens were killed in Asia as a precautionary measure to prevent a global pandemic. In spring 2004, the economic damage to China alone was estimated at $22 billion.

PLOS One, May 2009

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Mass culling against “pandemic within a pandemic”

The Covid-19 pandemic has also taken its death toll on farm animals. In November 2020, the Danish government announced that 15 to 17 million minks would be culled and buried. Previously, a mutation of SARS-CoV-2, called "cluster 5", had been discovered in mink that had transferred to humans. There was great fear that the mutation could destroy the success of the vaccination, i.e., that the minks could trigger a pandemic within the pandemic.

The panicked mass killing had an unexpected repercussion a few months later: 13,000 tonnes of animal cadavers had to be dug up and incinerated in May 2021, after putrid gases leaked from the earth and threatened to contaminate the groundwater.

Denmark's mink industry is finished. Many entrepreneurs had gambled on the lucrative trade in the coveted pelts. More than 1,100 farms, each with thousands of animals, had produced 40 per cent of the pelts sold worldwide. Covid-19 threw another spotlight on the enormous risk of such animal monocultures.

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Fotos Forschung Tschad

Chad

The ethnic Fulani at Lake Chad are specialized in cattle farming. The animals are their most important capital.

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The research team spends the night in the field together with the Fulani and their animals. "I still love field research and working with the animals outside," says the epidemiologist.

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In conversation with the nomadic pastoralists. The translator (back to the camera) runs a health station in the region and was Zinsstag's long-standing connection to the Fulani at Lake Chad.

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The cattle drink water at Lake Chad and pick up parasites, such as schistosomiasis or liver flukes.

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Jakob Zinsstag takes stool samples to examine them for eggs of schistosomiasis parasites.

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First, the samples are mixed
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The parasite eggs remain in the sediment, which is examined under the microscope.

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The epidemiologist and his doctoral student Helena Greter have set up a laboratory in the field with which they can examine the stool samples for parasites on site.

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Zinsstag shows a project partner the sample under the microscope.

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Under the microscope, you can
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Treatment of cattle with a medication against schistosomiasis.

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Global investment against the next pandemic

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We humans are incredibly bad at adapting our behavior to potential risks in the future. This is also true in pandemic prevention. Politicians should give it the necessary weight and create the necessary budgets. Because like measures against the climate crisis, pandemic prevention is also worthwhile in many respects, especially economically.

But prevention is not particularly "sexy" politically. It does not win elections. It is only when a virus is raging, taking human lives and the humanitarian consequences become obvious, that political capital can be made from pandemic control. Even if it is then merely a matter of combating the symptoms with medication, vaccinations and protective measures.

A blatant example: Donald Trump deliberately cut back on investments in pandemic prevention during his term in office. In September 2019, three months before the Covid-19 outbreak in Wuhan, the president withdrew funding from the world's most comprehensive pandemic-early-warning system, “Predict”. Dozens of researchers had to be dismissed. Although funding was briefly restored after the emergence of SARS-CoV-2, the damage had already been done.

In the following overview, we describe the largest global anti-zoonosis programs (hover over logos for more information).

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Predict
This $200 million project was initiated in 2009 by the American development agency USAID together with the University of California. It was implemented with the "Eco Health Alliance" in cooperation with universities, conservation projects and natural history museums in 30 partner countries. So-called "virus hunters" collected over 140,000 biological samples worldwide, including mucus and saliva samples from over 10,000 bats and 2,000 other mammals. A total of 1,200 potentially zoonotic viruses were identified, 160 of which were new coronaviruses. The program officially ended in September 2020.

Stop Spillover
This $100-million project aims at a better understanding of zoonoses and their risks. The monitoring of viruses, which was started in "Predict", will be continued. In addition, tests for and measures against the spread of zoonoses will be developed. The project is funded by USAID and implemented by Tufts University together with a global consortium of experts from the human, veterinary and environmental sciences.

Global Virome Project
For years, ideas have been circulating for a kind of "Human Genome Project" for viruses. In 2016, researchers, UN representatives, foundations and interested parties from the private sector met and founded the “Global Virome Project”. The vision: to sequence and characterize 99 per cent of the world's viruses with zoonotic and pandemic potential and to develop an early warning system based on this. The initiators are already talking about the "beginning of the end of the pandemic era". The big sequencing offensive is expected to cost around $4 billion, i.e., around 70 per cent of the WHO's current annual budget.

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Predict
This $200 million project was initiated in 2009 by the American development agency USAID together with the University of California. It was implemented with the "Eco Health Alliance" in cooperation with universities, conservation projects and natural history museums in 30 partner countries. So-called "virus hunters" collected over 140,000 biological samples worldwide, including mucus and saliva samples from over 10,000 bats and 2,000 other mammals. A total of 1,200 potentially zoonotic viruses were identified, 160 of which were new coronaviruses. The program officially ended in September 2020.

Stop Spillover
This $100-million project aims at a better understanding of zoonoses and their risks. The monitoring of viruses, which was started in "Predict", will be continued. In addition, tests for and measures against the spread of zoonoses will be developed. The project is funded by USAID and implemented by Tufts University together with a global consortium of experts from the human, veterinary and environmental sciences.

Global Virome Project
For years, ideas have been circulating for a kind of "Human Genome Project" for viruses. In 2016, researchers, UN representatives, foundations and interested parties from the private sector met and founded the “Global Virome Project”. The vision: to sequence and characterize 99 per cent of the world's viruses with zoonotic and pandemic potential and to develop an early warning system based on this. The initiators are already talking about the "beginning of the end of the pandemic era". The big sequencing offensive is expected to cost around $4 billion, i.e., around 70 per cent of the WHO's current annual budget.

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But what is meaningful pandemic prevention? Not everyone is enthusiastic about the American mammoth-projects: In June 2018, researchers from Australia, the UK and the USA criticized the claims of the “Global Virome Project” in an opinion piece in the scientific journal Nature as excessive and arrogant.

Virus genome sequencing will contribute little to a better understanding and prediction of disease outbreaks. Much simpler, cheaper and more cost-effective, they say, is active, real-time monitoring of emerging viruses in human populations. Jakob Zinsstag and other "One Health" experts take a similar view, focusing on surveillance in animals.

For Zinsstag, huge projects focused on virus sequencing seem like counting trees when one should be looking at the entire forest. "The `Global Virome Project` is mainly encyclopedic, but not impact-oriented research," he says. "The virologists want to sequence everything. We epidemiologists, on the other hand, are interested in the interfaces of transmission - that's the key to pandemic prevention."

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"Virus diversity studies are only the first step in research for better pandemic preparedness. The focus must be on the animal population and intermediate hosts."

Christian Drosten, Director of the Institute of Virology, Berlin Charité Hospital

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At the global level, there have recently been calls for an intergovernmental committee for pandemic prevention, similar to the climate (IPCC) and biodiversity (IPBES). This could facilitate coordination in zoonosis and pandemic control between countries and set guidelines on how "One Health" can be operationalized in health systems.

One practical measure that could be implemented immediately would be "One Health Impact Assessments" (OHIA), comparable to the Environmental Impact Assessments (EIA) currently in use. In the case of large-scale projects with far-reaching impacts on the environment, such as the construction of pipelines, dams or roads, the impact on animal, human and environmental health would first be clarified – along with the extent to which they could promote zoonoses.

Developing and emerging countries in particular could benefit from such OHIAs. There, billions are invested in agricultural, industrial, energy and transport infrastructure - often in extremely biodiverse regions and vulnerable ecosystems.

In a special report on the interactions between biodiversity and pandemics published in October 2020, experts from the UN Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) call for the economic costs of pandemic risks to be passed on to the production and price of consumer goods. In concrete terms, this would mean that a piece of beef whose production is based on soy cultivation from Brazil, which drives the clearing of rainforest, minimizes biodiversity and thus fuels the risk of pandemics, would become significantly more expensive.

This would also have a social reform component: It would make those who contribute most to environmental degradation and the associated risks for zoonotic diseases pay for future pandemics: the rich.

In the UN Environment Programme's report on zoonoses from the same year, agroecology is brought into play as a means of pandemic control. Agriculture that focuses on biodiversity instead of monocultures and helps to preserve wildlife habitats could make an important contribution to pandemic prevention. The environmental program therefore also calls for a move away from subsidies for industrialized agriculture based on monocultures, as is still common in many places today, including Switzerland.

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"Covid-19 is neither the first nor the last health crisis we will experience. My research colleagues estimate that we will see a pandemic or health crisis at least every five years from now on. And that might be the optimistic scenario - the reality could be much worse."

Sally Davies, doctor and former Chief Medical Officer (CMO) of England

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Hesitant steps

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In tranquil Mittelhäusern, 13 kilometers southwest of Bern, the laboratory of the Institute of Virology and Immunology (IVI) is located among scattered farms. It is a reference laboratory for the diagnosis, control and research of highly contagious viral animal diseases in Switzerland. Ebola or Lassa viruses can be handled in the laboratory with security level 4, and biologists, virologists, microbiologists and immunologists have been researching highly contagious coronaviruses in animals for years.

This is one of the reasons why a team succeeded in producing a synthetic clone of SARS-CoV-2 as early as mid-February 2020. The basis for this was a virus sequence that had been isolated from a patient in Wuhan, China, and sent to Mittelhäusern. Dozens of research groups worldwide then used the clone for their own Covid-19 research.

We wanted to know from Barbara Wieland, the new head of the Institute of Virology and Immunology, how major she considers the danger of zoonoses for Switzerland.

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Lack of a national strategy against zoonoses

Veterinary and human medical issues have been part of the same department in Switzerland since 2012, but the two federal offices function largely autonomously. Here the Federal Office of Public Health (FOPH), there the Federal Food Safety and Veterinary Office (FSVO). This contradicts the idea of "One Health", with integrated veterinary and human medicine.

There is one exception, in the fight against antibiotic resistance. On 18 November 2015, the Federal Council adopted the "Antibiotic Resistance Strategy" (StAR), which explicitly refers to a "One Health" approach. In the same year, a National Research Program "Antimicrobial resistance - a One Health approach"(NRP 72) was launched. In 2016, implementation began with the participation of the Federal Office of Public Health (FOPH), the Federal Office for Agriculture (FOAG), the Federal Food Safety and Veterinary Office (FSVO) and the Federal Office for the Environment (FOEN). In the foreword to the strategy, Federal Councilor Alain Berset writes that human medicine, veterinary medicine, agriculture and the environment must work more closely together, as this is the only way to contain antibiotic resistance. In a manner of speaking, it is a plea for "One Health".

It is all the more astonishing that there is still no such national "One Health" strategy for zoonotic infectious diseases. Although a "One Health sub-organ" was founded in 2017, which, according to the founding document, explicitly focuses on the monitoring and containment of zoonoses and vectors of infectious diseases. According to the statutes, the goal is the "exchange of experiences in the field of "One Health" and the use of synergy potentials". Furthermore, the communication of "One Health" topics is to be promoted. The members are again representatives of the FSVO, the FOPH, the FOEN and the FOAG, as well as veterinarians and chemists from the cantons and the head of veterinary medicine of the army.

Between 2017 and 2021, the sub-organ held twelve meetings and several workshops. The minutes of the workshop held on 5 July 2021 state that the members are planning to set up a body called "One Health Switzerland", which will be accompanied by a scientific group of experts. "The will to build the best possible structure One Health Switzerland is perceptible!", reads the end of the minutes. Six months later, when asked, the FSVO states that there is currently no draft for the structure of the panel. For now, the sub-organ will continue to work as before.

The "One Health" sub-organ has a secretariat, which is attached to the FSVO and run as part-time workload by the group of Katharina Stärk, Head of Animal Health at the FSVO. We asked her about the goals of this "sub-organ" and its role in the current pandemic.

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Deadly viral spillovers

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"Zoo..., what?" We have often heard this question in recent months when we have told someone about our research. Few people know what the term "zoonosis" means. This is astonishing, because they have shaped the history of mankind and several times marked the beginning of great social upheavals.

The bubonic plague in the mid-14th century, which wiped out a third of the European population, was caused by the pathogen Yersinia pestis, a zoonotic bacterium.

The large outbreaks of tuberculosis in Europe in the 19th century, which killed one in four people, were caused by zoonotic mycobacteria (in addition to human tuberculosis). An important cause of the epidemic was industrialization and urbanization, which brought millions of people into close contact in poor hygienic conditions. Until today, more than one million people die of tuberculosis every year, mainly in developing countries.

The AIDS pandemic, which continues to this day, can also be traced back to a zoonosis. The natural hosts of HIV are bats. Genetic samples show that the virus had already transferred to humans at the beginning of the 20th century in remote villages in the jungle of the Democratic Republic of Congo. But it was not until the 1980s, fueled by increasing mobility and cheap air travel, that HIV was able to spread globally and become a pandemic. At the end of 2020, 38 million people worldwide were living with an infection, two thirds of them in Africa.

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The term zoonosis is a fusion of the two Greek words zoon for animals and noson for disease. Accordingly, zoonoses are diseases that are transmitted from animals to humans (zooanthroponosis) or, in rarer cases, from humans to animals (anthropozoonosis). This virus transmission can occur directly, for example through a dog bite in the case of rabies. Or via an intermediate host, as in the case of West Nile virus, which originally occurs in wild birds and is transmitted to humans by mosquitoes (indirect zoonosis).

Disease-causing agents that jump from animals to humans are mainly viruses, such as HIV or SARS-CoV-2, and bacteria, such as tuberculosis, borreliosis or anthrax. Zoonotic transmissions occur through direct contact with blood, saliva, faeces or other body fluids from living or dead animals, for example during slaughter. Zoonotic pathogens can also be transmitted through water and animal food, such as milk, eggs or insufficiently cooked meat.

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Experts estimate that there are around 1.7 million viruses in mammals and birds that are not yet known to us. Of these, between 540,000 and 850,000 have zoonotic potential and could spread to humans.

Workshop Report on Biodiversity and Pandemics of the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES)

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Increasing zoonosis risk

In 2008, a study by a group led by the environmental scientist Kate Jones and the zoologist Peter Daszak became world famous among epidemiologists and virologists: the researchers succeeded for the first time in quantifying the rapid increase in infectious diseases and locating them locally. In the period between 1940 and 2004, they identified 335 new pathogens, including mutated versions of known pathogens, such as tuberculosis, and completely new pathogens, such as HIV.

Over 60 per cent of human pathogens were due to zoonotic diseases and 72 per cent of these originated in wild animals (including SARS and the Ebola virus). What was particularly alarming was that their study showed a significant increase in new pathogens over time. During the peak in the 1980s, almost five times as many new pathogens were registered as in 1940.

The researchers named socio-economic factors (population growth and densification), environmental factors (altitude and rainfall) and ecological factors (diversity in wildlife) causing increases in zoonoses.

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Over the past two decades, major global infectious disease outbreaks have occurred every four to five years, including SARS, H1N1, MERS and Covid-19, in addition to HIV/AIDS and Ebola with 29 regional outbreaks in 50 years.

G20: A global deal for our pandemic age, June 2021

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When the forests burn, the viruses spread

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The current destruction of nature is unprecedented in human history, the UN warned in May 2019. The most comprehensive report on the state of global ecosystems and biodiversity by the UN Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) has just been published. For three years, 455 experts from various disciplines and more than 50 countries systematically analyzed over 15,000 reports from researchers and authorities. Their conclusion: the loss of biodiversity on Earth is proceeding at a record pace. One million animal and plant species are close to extinction. Important drivers of this trend: industrialized agriculture and deforestation.

One year later, experts compiled the results of 167 studies on the origin of zoonoses and the causes of pandemics for the UN Environment Programme (UNEP). They concluded that the enormous loss of biodiversity and forest areas strongly drives zoonoses and the associated risk of pandemics. "Pandemics, such as the Covid-19 outbreak, are predictable and predicted consequences of how humans produce food, trade, consume animal meat and change their environment", the report states.

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Currently, around 10 million hectares of forest are destroyed every year. This is mainly due to international corporations that produce lucrative trade goods such as palm oil, rubber, soy or meat on cleared areas.

UNEP report on pandemic prevention, July 2020

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Land purchases as a pandemic risk

Markus Giger is an agricultural economist and researcher on environmental and sustainability issues at the “Center for Development and Environment” at the University of Bern. He had little to do with viruses and zoonoses - at least until recently. Since 2012, Giger has been meticulously documenting the trade in large areas of land in a database as part of the international “Land Matrix Initiative”. The data shows how land sales have developed over time, who the buyers and sellers are and how land purchases affect nature.

By November 2020, the database had registered 2,485 completed extensive land sales, covering more than 200 hectares of land, and affecting low- and middle-income countries, mainly in Africa, Southeast Asia and Latin America. Of the total 43 million hectares of land, over 70 per cent is used to produce export goods for international markets, mainly palm oil, animal feed and beef.

Last year Giger overlaid the mapped data of land sales (see chart / Giger M. et al. 2021) for the first time from his matrix with a map of global biodiversity hotspots. The result: 87 percent of the land-deals involved regions with medium to high biodiversity. In addition, over 30 percent of the deals involved protected land or land with border to protected areas.

We asked Markus Giger about how the researcher evaluates the current data.

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30 per cent of infectious diseases detected since 1960 can be traced back to land changes, mainly deforestation, urbanization and agricultural expansion.

IPBES Report on Biodiversity and Pandemics, October 2020

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Markus Giger's database contains, for example, Deal No. 1166 - a land purchase for palm oil production in the Republic of Congo. The 180,000 hectares of land (over 250,000 football pitches) include huge tracts of previously untouched rainforest and border two national parks. The investor is "Atama Resources" from Mauritius, a company that manages funds in the British Virgin Islands and Malaysia. The extensive palm oil production for which the land was bought has not yet begun. But satellite images show that an access road has already been built and initial tree-cutting has been done.

Through such roads, humans come across wild animals and their viruses and carry pathogens into densely populated areas. They are corridors for pathogens that greatly increase the risk of zoonotic spillovers and disease outbreaks.

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A feast for generalists

In biodiverse areas, the abundance of diverse animals and plants acts as a buffer for pathogens; viruses can only spread slowly. Burning forests for palm oil and soy monocultures reduces this buffering capacity. Studies show that in ecosystems that have been highly modified by humans, hosts of zoonotic diseases can spread more easily and favor the spillover of pathogens between wildlife, livestock and humans. This is evident, for example, in the regular flare-ups of the Ebola virus since the 1990s. The outbreaks mostly affected places in Central and West Africa where large-scale deforestation had previously taken place.

As a result of forest destruction, specialized animal species, such as monkeys, are rapidly decreasing. Adapted species, so-called generalists, including many rodents and bats, on the other hand, are spreading. They are known as pathogenic reservoirs, in which pathogens can multiply without the carriers themselves becoming ill or dying. Such generalists are often at the beginning of direct or indirect zoonoses.

Generalists can adapt relatively well to destroyed habitats with low biodiversity. If they are displaced, they can also settle in and around villages in close proximity to humans.

Simone Sommer is Professor of Evolutionary Ecology and Conservation Genetics at the University of Ulm. She has been studying the effects of environmental changes on wild animals and the increase in zoonotic diseases for years. She uses molecular genetic sequencing methods to investigate a large number of different pathogens and changes in immunogenetic diversity, especially in the microbiome, i.e., the community of intestinal bacteria. In extensive, multi-year studies in southern Africa, Brazil and currently in Panama, Sommer's team is investigating the effects of changes in land use as well as the destruction of ecosystems on the ecology and health of wild animals.

In a recently published study from Panama, the researchers were able to show in spiny rats that fragmentation of natural habitats has led to changes in the regulation of intestinal flora. The gut flora is crucial for human and animal health. Negative changes increase susceptibility to infections and facilitate zoonoses.

While rodents are relatively good at adapting to changing environmental conditions, even they can no longer keep up with the rapid pace of environmental change in the Anthropocene. Sommer interprets the results from Panama as a warning of a further increase in epidemics and pandemics of zoonotic origin.

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Audio in German: In a podcast for the Kunsthaus Zürich's "Earth Beats" exhibition, Simone Sommer explains why nature is systemically relevant for our health.

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Audio in German: In a podcast for the Kunsthaus Zürich's "Earth Beats" exhibition, Simone Sommer explains why nature is systemically relevant for our health.

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A good climate for zoonoses

The loss of biodiversity, the worsening climate crisis and the increase in zoonoses are closely connected. Global warming not only drives animals out of their habitats - and with them pathogens - but it also creates better living conditions for disease-carriers (vectors). These include ticks, which transmit borreliosis, a bacterial infection that can lead to inflammation of the brain and meningitis. Or the Anopheles mosquito, which transmits malaria.

Many zoonotic diseases spread particularly well in warm, humid climates. That is why viruses are now invading areas that were previously considered safe. For example, the West Nile virus, which was discovered for the first time in southern Germany during the hot summer of 2018. The pathogen is native to large parts of Africa and Asia. In the 1990s, it also reached the USA, where the virus spread rapidly. For a few years now, cases have also been increasing in Europe.

In the same year, two new tick species were registered in Germany for the first time, which are originally native in Africa and Asia. They were probably brought in by migratory birds. It is quite possible that this happened earlier, but they were only able to survive in Germany due to the higher temperatures.

Climate protection is also pandemic protection, that much is clear. Forest protection, especially in the tropical belt, is one of the most effective measures against the advancing climate and biodiversity crisis. Forests absorb huge amounts of carbon dioxide through photosynthesis. At the same time, they are protective walls against future zoonoses.

Compared to the costs of a pandemic, those for the protection of species and the climate are low. Political measures against deforestation and the wildlife trade over ten years would only cost two percent of the measures against the current Covid-19 pandemic, as noted by a team of ecologists and economists in a study published in the journal “Science” in 2020.

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"The scientific facts are clear: if we continue to exploit wildlife and destroy our ecosystems, we can expect to see a steady increase in such diseases spreading from animals to humans in the following years."

Inger Andersen, Director of the United Nations Environment Programme (UNEP)

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Zögerliche Schritte Richtung integrierter Gesundheit

Fragen der Veterinär- und Humanmedizin sind in der Schweiz zwar seit 2012 im selben Departement angesiedelt, doch die beiden Bundesämter funktionieren weitgehend autonom. Hier das Bundesamt für Gesundheit (BAG), dort das Bundesamt für Lebensmittelsicherheit und Veterinärwesen (BLV). Dies widerspricht der Idee einer «One Health», mit integrierter Tier- und Humanmedizin.

Eine Ausnahme gibt es im Kampf gegen Antibiotikaresistenzen. Am 18. November 2015 hat der Bundesrat die «Strategie Antibiotikaresistenzen» (StAR) verabschiedet, die sich explizit auf einen «One Health»-Ansatz bezieht. Im gleichen Jahr wurde ein Nationales Forschungsprogramm «Antimikrobielle Resistenz – ein One-Health-Ansatz» (NFP 72) lanciert. 2016 begann die Umsetzung unter Beteiligung des Bundesamts für Gesundheit (BAG), des Bundesamt für Landwirtschaft (BLW), des Bundesamts für Lebensmittelsicherheit und Veterinärwesen (BLV) und des Bundesamtes für Umwelt (BAFU). Im Vorwort der Strategie schreibt Bundesrat Alain Berset, dass Humanmedizin, Tiermedizin, Landwirtschaft und Umwelt enger zusammenarbeiten müssten, nur so sei die Eindämmung der Antibiotikaresistenzen möglich. Sozusagen in Plädoyer für «One Health».

Umso erstaunlicher ist, dass es bis heute keine solche nationale «One Health»-Strategie für zoonotische Infektionskrankheiten gibt. Zwar wurde 2017 ein «Unterorgan One Health» gegründet, das laut Gründungsdokument explizit auf das Monitoring und die Eindämmung von Zoonosen und Vektoren von Infektionskrankheiten ausgerichtet ist. Laut Statuten ist das Ziel der «Austausch von Erfahrungen im Bereich One Health und die Nutzung von Synergiepotentialen». Weiter soll die Kommunikation von «One Health»-Themen gefördert werden. Mitglieder sind wiederum Vertreter des BLV, des BAG, des BAFU und des BLW, zudem Veterinäre und Chemiker der Kantone sowie der Chef Veterinärmedizin der Armee.

Zwischen 2017 und 2021 hat das Unterorgan zwölf Sitzungen und mehrere Workshops abgehalten. Im Protokoll des letzten Workshops am 5. Juli 2021 ist nachzulesen, dass die Mitglieder die Gründung eines Gremiums «One Health Schweiz» planen, das von einer wissenschaftlichen Expertengruppe begleitet wird. «Der Wille zum Aufbau der bestmöglichen Struktur One Health Schweiz ist spürbar!», steht am Ende des Protokolls. Sechs Monate später heisst es auf Anfrage beim BLV, es gäbe derzeit noch keinen Entwurf für die Struktur des Gremiums. Vorerst arbeite man im Unterorgan weiter wie bisher.

Das Unterorgan «One Health» hat ein Sekretariat, das dem BLV angegliedert ist, und in einem Teilpensum von der Gruppe von Katharina Stärk, Leiterin Tiergesundheit beim BLV, geführt wird. Wir haben bei ihr nachgefragt, welche Ziele dieses «Unterorgan» verfolgt und welche Rolle diesem bei der aktuellen Pandemie zukommt.

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«One Health» – mit neuem Gesundheitsverständnis gegen die nächste Pandemie

Prologue

"One Health"Against the next pandemic

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Close to the animal

Close to the animal

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Chad 1998

Chad 1998Vaccinating the goats along with the children

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The Era of Pandemics

The Era of PandemicsAnd the birth of a "One Health" movement

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At eye level

At eye levelHealing with the Mayas in Guatemala

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One man, one mission

One man, one missionOn Roadshow for a Global "One Health"

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