The concept of "Unified health"

How to anticipate new pandemics

Svyatoslav Plavinsky, XX2 century

Will we be able to prevent pandemics in the future? Many experts believe that it is not. Some time ago, in connection with the COVID-19 pandemic, a group of authors analyzed the pandemics that have occurred over the past hundred years and came to the conclusion that there is a fairly high probability of a new pandemic within the next 30-50 years. Epidemiologists have long said that there should be a pandemic — however, they expected a pandemic of a new variant of the influenza virus and were preparing for it. International sanitary legislation was written largely after the outbreak of SARS-CoV-1, and everyone was preparing for the emergence of a new pandemic strain of the influenza virus and significant human losses.

Unfortunately, humanity has a very short memory. When the influenza virus pandemic began in 2009, countries turned on the mechanisms developed at that time to counteract the pandemic — they tried to introduce a mask-glove regime, put thermal imagers and buy medicines against the flu. However, that virus had some affinity with a virus that had already caused a pandemic once in the late 1950s, and the elderly had some cross-immunity: since elderly people die first of all from influenza, the lethality of this form of pandemic influenza turned out to be lower. The catastrophe did not happen, and people began to forget that there should be stocks of drugs and protective equipment in case of a pandemic. 

Prevention of epidemics: the concept of "Unified health"

Today, experts talk about the need to organize sentinel surveillance, when teams of specialists — epidemiologists, veterinary epidemiologists, veterinarians — constantly monitor those places where a person comes into contact with wildlife. In addition, animal health is monitored in veterinary medicine: for example, specialists monitor whether there is a mass death of wild animals. Since it is quite difficult to observe some areas like rain forests, remote monitoring is being discussed — for example, using satellite data. In particular, in the mid-2000s, the United Kingdom within the framework of the project Foresight (English "foresight") proposed to organize remote monitoring techniques for what is happening in the wild. Finally, the sanitary authorities of all countries of the world should monitor the health of pets, monitor outbreaks of diseases among them, and now the idea is very often expressed that they should cooperate with public health structures at the same time.

At the United Nations level, the concept of "One Health" is currently being discussed. Historically, human health monitoring exists separately from animal health monitoring and environmental monitoring. The UN proposes to establish cooperation between the relevant structures, as well as to agree on international standards and regularly exchange information between countries. Today, the Convention on biodiversity allows not to provide other countries with information, for example, about the genetic structure of animals that are unique to a particular country, for example, in order to protect tourism or protect biodiversity. But as a result, some countries, referring to this convention, refuse to share information about new pathogens. However, there are also positive examples of cooperation: Chinese researchers, having sequenced SARS CoV-2, immediately posted the genetic sequence of the virus in publicly accessible databases, which made it possible for vaccine manufacturers not to decipher the virus themselves, but to take ready-made data and make a new vaccine. 

Many public figures admire how quickly humanity has developed vaccines, but they forget that in many ways this is a consequence of the outbreak of SARS-CoV-1: it was then that it was established that coronaviruses cause atypical pneumonia, it was then that their genetic sequence was deciphered, it was then that mechanisms for creating vaccines against SARS-CoV-1 began to be developed. Thanks to this, when SARS-CoV-2 appeared and its structure was deciphered, vaccine developers already knew what to do. But we do not know what will happen if the pathogen is from another group of viruses, and therefore monitoring and exchange of information in a standardized form is needed. It is no coincidence that international cooperation in the field of zoonosis control began as an interaction of three organizations: the Food and Agriculture Organization of the United Nations, the World Organization for Animal Health and the World Health Organization. Later, they were joined by the UN Environment Program, which in 2020 released a report on the development of approaches from the position of "Unified Health".

Prevention of future epidemics

So, the first preventive measure that will prevent future pandemics is monitoring. In addition, it is necessary to eliminate sources for a possible transition. To do this, international documents recommend that interventions be conducted under the leadership or direction of communities, that is, citizens themselves should be involved in this. So, we need complete sanitation, organized by the community, — a system for combating infections transmitted by oral-fecal route. It is not enough to arrange, for example, the supply of toilets — people need to learn how to use them. There are cultural peculiarities when people do not want or do not have the habit of using toilets, and this is a source of oral-fecal diseases. 

There is another problem that is not directly related to zoonoses, but is nevertheless discussed in connection with animal health — antimicrobial resistance. Now there are pathogens that are resistant to antibiotics used in animals, so it is wrong to treat animals with the same antibiotics that are used in humans. Therefore, special antibiotics are needed for use in animals.

The next preventive measure is animal immunization: dogs are immunized against rabies, ungulates (intermediate hosts) or dogs (final hosts) are immunized against echinococcosis. In addition, it is possible to immunize people against rotavirus, against cholera. It is also necessary to establish control over the population of vectors and intermediate hosts: for example, deratization is carried out for this purpose. Finally, information and educational campaigns are also needed. People need to be taught that, for example, a domestic cat may have diseases that people don't know about yet, and if the owners let the cat go to nature in the country, this is the way for the pathogen from a wild animal or bird to jump to the cat, and then to a person. 

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