Agriculture, environment, and health ministries from around the world are investing in primary prevention to reduce the risk of zoonotic disease spillover and the threat of another global pandemic. This article shares insights from an open call for support on primary prevention action launched by Nature for Health to help identify the geographic scope of the demand, and highlights the positive response from countries interested in tackling this complex issue.

Pandemic threat demonstrates importance of prevention

COVID-19 highlighted more starkly than ever the interconnectedness between the health of humans, animals, and our natural environment. Without significant efforts to address disease spillover, research indicates that epidemics and pandemics will occur more often, spread more rapidly, and do further damage to human health – and in turn to the global economy.

It is important that countries with high risk factors for zoonotic spillover are prepared for outbreaks and able to detect new diseases early on. It is also important that they can respond quickly to prevent such outbreaks from spreading. However, pandemic prevention measures are typically reactive, focused solely on reducing or containing the spread of a disease. Primary prevention, or preventative One Health, is a proactive approach which addresses the drivers of infectious disease emergence – the ecological and anthropogenic factors and activities that increase the risks of spillover – reducing the chance of diseases spilling over from animals to humans in the first place.

Nature for Health to champion primary prevention

Nature for Health (N4H) is a global initiative set up to do just that – reduce future epidemics, pandemics and related health risks through strengthening the environmental aspects of One Health. One Health is the collaborative efforts of multiple disciplines working locally, nationally, and globally, to sustainably balance and optimize the health of humans, animals, plants, and ecosystems.

With seed funding from the German government, N4H is a Multi-Partner Trust Fund bringing together a Consortium of leading UN agencies, intergovernmental organizations, and civil society groups in the field of environment and health. In its first eight years with current funding, N4H plans to work, in overlapping phases, with 18 low- and middle-income countries or regions to catalyze integrated policymaking and evidence-based action on the ground, develop cross-sectoral capacity and help establish robust governance mechanisms.

Open Call Expression of Interest

To identify partner countries for its first phase of work, N4H issued an open call for Expressions of Interest, inviting governments to submit their interest in receiving technical support from the N4H Consortium. The response showed an extremely high level of interest. One in four countries worldwide responded, resulting in more than 60 applications from 49 countries, which expressed interest in joining a systemic process to implement preventative One Health approaches. In order to demonstrate the kind of collaborative cross-sectoral working that will be integral to a successful systems approach, the process required EoIs to be endorsed by at least two separate ministries within each government.

The Expressions of Interest (EoIs) focused on three key areas: 1) the risk of zoonotic disease spillover, 2) a commitment to collaboration and One Health, and 3) their potential as an N4H partner. EoIs were received from countries with different ecosystems and risk profiles across Africa, Latin America, Asia, the Middle East and Europe; the number of applications alone demonstrates the high level of interest in primary prevention and avoidance of pathogen spillover.

*Figure 1: N4H Expressions of Interest received according to region*

High threat to biodiversity, high risk of spillover

Despite the diversity of contexts, the responses revealed a number of patterns and common issues and highlight the correlation between threats to biodiversity and disease spillover risk.

Applicants noted that anthropogenic pressures such as population growth, climate change and changes in land use were threatening biodiversity and the environment. 92% of applications emphasized that evolving human-livestock-wildlife interfaces and encroachment into wildlife habitats is increasing the risk of disease spillover from animals to humans. While drivers varied according to different countries and regions, intensive livestock production and the consumption of bushmeat were the main causes indicated across the applications. Other commonly cited land use changes driving this encroachment included livestock farming in wildlife areas, deforestation for intensive agriculture and animal rearing/husbandry, and mining and development projects for infrastructure and dam construction.

Finally, applications signalled that changes in migration patterns – for example due to conflict and political instability, urbanisation, high poverty and extreme climate change impacts – also put countries at an increased risk of zoonotic disease spillover.

*Figure 2: Human activities that increasingly threaten biodiversity*

Potential for cross-collaboration

As One Health seeks to work across human, animal, plant, and ecosystem health, the N4H Expressions of Interest fittingly came from Ministries of Environment, Agriculture and Health. However, there were also applications from the ministries of foreign affairs, forestry, and education. As mentioned, all EoIs required endorsement from at least two ministries. These applications demonstrated strong interest in working across traditional boundaries to develop integrated policies and actions and combining traditional knowledge and varied perspectives from many parts of the system.

In two cases, endorsement even came from the Prime Minister's Office, showing a high level of support and commitment towards the integrated efforts that will be needed to implement preventative One Health approaches regionally, nationally, and even sub-nationally.

Different stages on the One Health journey

The keen interest in working in a systemic way with N4H on the highlighted issues driving high-risk human-livestock-wildlife interfaces is evidence of a growing understanding around the world of the human-animal-environment health interdependencies, and the need for a One Health approach.

More than half of the countries that expressed interest in working with N4H reported already having a One Health strategy in place but stressed that it was not yet fully implemented. The other countries indicated some informal interactions or are currently working on a collaboration strategy. Only a handful have made no progress in this area, and all were interested in support.

The key One Health topics proposed as a potential focus for N4H included the anthropogenic activities threatening biodiversity and encroaching on wild spaces, as well as capacity building, joint risk assessments, and disease surveillance, which was flagged in one fifth of EoIs.

Looking forward

The Expressions of Interest were initially assessed for eligibility – being on the ODA list and having endorsement letters from at least two ministries – before being reviewed by the N4H Technical Advisory Group. The final countries were then selected by the Steering Committee based on geographic and representational balance, and to ensure the inclusion of countries at different stages in their preventative One Health journey.

Six countries were selected as the Phase I N4H country partners: Ecuador, Ghana, Mongolia, Rwanda, Vietnam, and Zambia. Over the coming 2-3 years, these countries will work with N4H Consortium Partner organisations to define, develop, and drive interventions relevant to preventative One Health. Two subsequent phases will enable an additional 10 - 12 country partners to join the N4H initiative in the future.

However, current funding is woefully insufficient to meet the needs expressed. The N4H Expression of Interest call revealed massive demand for participatory multi-stakeholder implementation of One Health approaches towards preventative action. To reach all countries at elevated risk from zoonotic disease spillover (estimated to be around 50), significantly more resources are needed.

N4H continues to work on multiple fronts to mobilize additional funding partners. And in parallel, by establishing a Learning Network, N4H will be able to gather and share best practices and lessons learned in implementing One Health approaches with countries beyond its six initial partners. As the response to the N4H call indicated, the risk of zoonotic spillover and spread is significant and has become a high-level global threat which must be taken seriously by all of us.

By acting together, we can stop pandemics

before they spill over.

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Global Appetite for Primary Prevention Revealed