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Executive summary:

Industrialisation, urbanisation, and globalisation have substantially improved human life expectancy over the past century. In tandem, an expanding array of interlinked threats to humans, other animals, plants, and a myriad of other biotic and abiotic elements in our shared ecosystems has been generated. These threats include emerging and re-emerging infectious diseases, antimicrobial resistance (AMR), non-communicable diseases (NCDs), jeopardised food safety and security, freshwater scarcity, climate change, pollution, and biodiversity loss. These pressing health and sustainability challenges exceed the scope of any single discipline, government ministry, or societal sector, underscoring the need for interdisciplinary, transdisciplinary, and multisectoral collaboration, as well as for a socioecologically oriented systems perspective that appreciates the fundamental interconnections between humans, other animals, and the wider ecosystem.

When this Commission first convened in 2019, One Health was a highly visible, but also greatly evolving, concept and approach. Predominantly driven by the veterinary sector, the primary focus of One Health in early years had been on zoonotic diseases, but more recent years have seen an increasingly interdisciplinary and transdisciplinary expansion and diversification of the concept, a proliferation of initiatives, and growing concerns about fragmentation and insufficient conceptual clarity. There was a need to advance not only conceptual expansion, but also consensus, as well as aligned, interdisciplinary, transdisciplinary, and multisectoral efforts towards One Health operationalisation, implementation, and institutionalisation. We set out to address these needs and leverage One Health as a crucial and viable approach to achieving equitable, sustainable, and healthy socioecological systems—the vision of the Lancet One Health Commission. The zoonotic underpinnings of the COVID-19 pandemic and its wide-ranging effects across sectors necessitated a radical rethink of the role of One Health in pursuing sustainable development and substantially shaped the importance and trajectories of the Commission's work.

The Commission's methodology entailed convening a diverse, transnational, and interdisciplinary group of experts, who conducted an informed synthesis and appraisal of the current state of knowledge and evidence regarding the need for and value of One Health, which resulted in the proposal of key avenues for One Health operationalisation, implementation, and institutionalisation. We build on new and evolving One Health advances, including the One Health Joint Plan of Action, launched by the One Health Quadripartite, and the definition of One Health, One Health principles, and theory of change put forth by the One Health High-Level Expert Panel (OHHLEP).

This Commission is guided by a One Health ethos comprising principles of holism and systems thinking, epistemological pluralism, equity and egalitarianism, and stewardship and sustainability. The Commission also engages a socioecological systems perspective that sheds light on the crucial importance of the environment, including plants, soil, water, air, wildlife, biodiversity, and climate. In our approach, we have deliberately avoided boundaries between humans, other animals, and the environment. As reflected in the key messages, the evidence synthesis and appraisal was structured via sections dedicated to surveillance, infectious diseases, AMR, NCDs, health systems, and food systems.

The Lancet One Health Commission provides a cutting-edge appraisal of where One Health has come from, where it is now, and what a viable future should be. One Health was not mentioned in the 2030 Sustainable Development Agenda; however, the impact of the COVID-19 pandemic brought into acute focus the fundamental interconnections between humans, other animals, plants, and a myriad of other biotic and abiotic elements in the ecosystem, and, consequently, how healthy sustainable socioecological systems could be achieved via a One Health approach. The consensus around One Health that has been built by the One Health Quadripartite and OHHLEP, which has been reinforced by this Commission, is essential for addressing the threats to health posed by infectious diseases, AMR, NCDs, and planetary crises; harnessing data and artificial intelligence for disease surveillance and health-care delivery; forging equitable partnerships and inclusive collaborations; and generating necessary insight into socioecological interconnection. As such, One Health is a crucial catalyst in the pursuit of an equitable, sustainable, and healthy future, and must be central to the post-2030 global health and sustainability agenda.

The role of animal movement in spreading infectious diseases is highly recognized by various legislations and institutions such as the World Organisation for Animal Health and the International Animal Health Code. The increased interactions at the nexus of human-animal-ecosystem interface have seen an unprecedented introduction and reintroduction of new zoonotic diseases with high socio-economic impacts such as the COVID-19 pandemic. Rift Valley fever (RVF) is a zoonotic disease that affects both humans and animals and is transmitted by Aedes mosquitoes or through contact with the body fluids of infected animals. This study seeks to characterize movement patterns of pastoralist and how this movement behaviour increases their susceptibility to RVF virus exposure. We levarage on a rapidly growing field of movement ecology to monitor five herds collared from 2013 - 2015 in an RVF endemic semi-arid region in Kenya. The herds were also sampled for RVF antibodies to assess their exposure to RVF virus during the rainy seasons. adehabitatLT package in R was used to analyze the trajectory data whereas the first passage time (FPT) analysis was used to measure the area utilized in grazing. Sedentary herds grazed within 15km radius while migrating herds presented restricted space use patterns during the dry seasons and transient movement during the start and end of the rainy season. Furthermore, RVF virus antibodies were generally low for sedentary herds whereas the migrating herds recorded high levels during their transition periods. This study can be used to identify RVF risk zones for timely and targeted management strategies.

Background: Emerging and reemerging zoonotic diseases have become a global concern due to their frequent occurrence. Large delays between onset of emerging zoonotic disease outbreaks and their reporting and control are indicative of weak animal and human health systems.

Objectives: The objective of this paper is to tackle the time delay by suggesting a One Health Early Warning and Response System (OH-EWRS) aiming at improving the surveillance and notification of zoonotic diseases by strengthening ‘bottom-up’ approaches and systems for early detection, especially in hot spot areas where they emerge.

Methods: In this conceptual paper, we searched online database including PubMed, Google and Google Scholar to explore the scientific landscape for zoonotic diseases and One Health Early Warning and Response Systems published in English up to December, 2020. In addition, the authors made use of their own expertise and critically reviewed the retrieved papers that were found to be of relevance as the three authors are experts in their own fields, coming from different backgrounds, but are all working to improve the prevention and control of zoonotic disease outbreak.

Results: The OH-EWRS advocates for collaboration between relevant stakeholders including nongovernmental organisations, country offices of international and intergovernmental technical organisations, governmental bodies, research institutes, the private sector and local communities with the aim of an integrated One Health prevention and control system. The OH-EWRS considers various priorities and objectives of the different stakeholders, taking into account possible conflict of interests and considering the need for trust, transparency and mutual benefits.

Conclusions: Although the operationalisation, governance and institutionalisation of the OH-EWRS should be the responsibility of government bodies, inputs from and feedback to relevant stakeholders through a bottom-up and top-down approach are essential elements for the application of the successful operationalisation of a OH-EWRS.

Introduction: Multiple outbreaks of Rift Valley Fever (RVF) with devastating effects have occurred in East Africa. These outbreaks cause disease in both livestock and humans and affect poor households most severely. Communities living in areas practicing nomadic livestock movement may be at higher risk of infection. This study sought to i) determine the human exposure to Rift Valley fever virus (RVFV) in populations living within nomadic animal movement routes in Kenya; and ii) identify risk factors for RVFV infection in these communities.

Methods: A cross-sectional descriptive study design was used. Samples were collected from the year 2014 to 2015 in a community-based sampling exercise involving healthy individuals aged ≥18 years from Isiolo, Tana River, and Garissa counties. In total, 1210 samples were screened by ELISA for the presence of immunoglobulin IgM and IgG antibodies against RVFV. Positive results were confirmed by plaque reduction neutralization test.

Results: Overall, IgM and IgG prevalence for all sites combined was 1.4% (95% CI 0.8–2.3%) and 36.4% (95% CI 33.8–39.2%), respectively. Isiolo County recorded a non-significant higher IgG prevalence of 38.8% than Garissa 35.9% and Tana River 32.2% (Chi square = 2.5, df = 2, p = 0.287). Males were significantly at higher risk of infection by RVFV than females (OR = 1.67, 95% CI 1.17–2.39, p<0.005). Age was significantly associated with RVFV infection (Wald Chi = 94.2, df = 5, p<0.0001). Individuals who had regular contact with cattle (OR = 1.38, 95%CI 1.01–1.89) and donkeys (OR = 1.38, 95%CI 1.14–1.67), or contact with animals through birthing (OR = 1.69, 95%CI 1.14–2.51) were significantly at a greater risk of RVFV infection than those who did not.

Conclusion: This study demonstrated that although the Isiolo County has been classified as being at medium risk for RVF, virus infection appeared to be as prevalent in humans as in Tana River and Garissa, which have been classified as being at high risk. Populations in these counties live within nomadic livestock movement routes and therefore at risk of being exposed to the RVFV. Interventions to control RVFV infections therefore, should target communities living along livestock movement pathways.

Background: Rift Valley fever (RVF) is a zoonotic viral vector-borne disease that affects both animals and humans and leads to severe economic consequences. RVF outbreaks are triggered by a favorable environment and flooding, which enable mosquitoes to proliferate and spread the virus further. RVF is endemic to Africa and has spread to Saudi Arabia and Yemen. There is great concern that RVF may spread to previously unaffected geographic regions due to climate change. We aimed to better understand the spatiotemporal pattern of the 2007 RVF outbreak at the human-animal-environment interface and to determine environmental factors that may have effects on RVF occurrence in Gezira state, Sudan.

Materials and methods: We compiled epidemiological, environmental, and spatiotemporal data across time and space using remote sensing and a geographical information system (GIS). The epidemiological data included 430 RVF human cases as well as human and animal population demographic data for each locality. The cases were collected from 41 locations in Gezira state. The environmental data represent classified land cover during 2007, the year of the RVF outbreak, and the average of the Normalized Difference Vegetation Index (NDVI) for 6 months of 2007 is compared with those of 2010 and 2014, when there was no RVF outbreak. To determine the effect of the environmental factors such as NDVI, soil type, and RVF case's location on the Blue Nile riverbank on RVF incidence in Gezira state, a multilevel logistic regression model was carried out.

Results: We found that the outbreak in Gezira state occurred as a result of interaction among animals, humans, and the environment. The multilevel logistic regression model (F = 43,858, df = 3, p = 0.000) explained 23% of the variance in RVF incidence due to the explanatory variables. Notably, soil type (beta = 0.613, t = 11.284, p = 0.000) and NDVI (beta = - 0.165, t = - 3.254, p = 0.001) were the explanatory environmental factors that had significant effects on RVF incidence in 2007 in Gezira state, Sudan.

Conclusions: Precise remote sensing and the GIS technique, which rely on environmental indices such as NDVI and soil type that are satellite-derived, can contribute to establishing an early warning system for RVF in Sudan. Future preparedness and strengthening the capacity of regional laboratories are necessary for early notification of outbreaks in animals and humans.

Rift Valley fever (RVF) is a zoonotic disease affecting humans and animals. It is caused by RVF virus transmitted primarily by Aedes mosquitoes. The data presented in this article propose environmental layers suitable for mapping RVF vector habitat zones and livestock migratory routes. Using species distribution modelling, we used RVF vector occurrence data sampled along livestock migratory routes to identify suitable vector habitats within the study region which is located in the central and the north-eastern part of Kenya. Eleven herds monitored with GPS collars were used to estimate cattle utilization distribution patterns. We used kernel density estimator to produce utilization contours where the 0.5 percentile represents core grazing areas and the 0.99 percentile represents the entire home range. The home ranges were overlaid on the vector suitability map to identify risks zones for possible RVF exposure. Assimilating high spatial and temporal livestock movement and vector distribution datasets generates new knowledge in understanding RVF epidemiology and generates spatially explicit risk maps. The results can be used to guide vector control and vaccination strategies for better disease control.

Rift Valley fever (RVF) is an emerging mosquito-borne viral hemorrhagic fever in Africa and the Arabian Peninsula, affecting humans and livestock. For spread of infectious diseases, including RVF, knowledge, attitude and practices play an important role, and the understanding of the influence of behavior is crucial to improve prevention and control efforts. The objective of the study was to assess RVF exposure, in a multiethnic region in Kenya known to experience RVF outbreaks, from the behavior perspective. We investigated how communities in Isiolo County, Kenya were affected, in relation to their knowledge, attitude and practices, by the RVF outbreak of 2006/2007. A cross-sectional study was conducted involving 698 households selected randomly from three different ethnic communities. Data were collected using a structured questionnaire regarding knowledge, attitudes and practices that could affect the spread of RVF. In addition, information was collected from the communities regarding the number of humans and livestock affected during the RVF outbreak. This study found that better knowledge about a specific disease does not always translate to better practices to avoid exposure to the disease. However, the high knowledge, attitude and practice score measured as a single index of the Maasai community may explain why they were less affected, compared to other investigated communities (Borana and Turkana), by RVF during the 2006/2007 outbreak. We conclude that RVF exposure in Isiolo County, Kenya during the outbreak was likely determined by the behavioral differences of different resident community groups. We then recommend that strategies to combat RVF should take into consideration behavioral differences among communities.

Rift Valley fever (RVF) is a viral mosquito-borne disease with the potential for global expansion, causes hemorrhagic fever, and has a high case fatality rate in young animals and in humans. Using a cross-sectional community-based study design, we investigated the knowledge, attitudes and practices of people living in small village in Sudan with respect to RVF outbreaks. A special One Health questionnaire was developed to compile data from 235 heads of household concerning their knowledge, attitudes, and practices with regard to controlling RVF. Although the 2007 RVF outbreak in Sudan had negatively affected the participants' food availability and livestock income, the participants did not fully understand how to identify RVF symptoms and risk factors for both humans and livestock. For example, the participants mistakenly believed that avoiding livestock that had suffered spontaneous abortions was the least important risk factor for RVF. Although the majority noticed an increase in mosquito population during the 2007 RVF outbreak, few used impregnated bed nets as preventive measures. The community was reluctant to notify the authorities about RVF suspicion in livestock, a sentinel for human RVF infection. Almost all the respondents stressed that they would not receive any compensation for their dead livestock if they notified the authorities. In addition, the participants believed that controlling RVF outbreaks was mainly the responsibility of human health authorities rather than veterinary authorities. The majority of the participants were aware that RVF could spread from one region to another within the country. Participants received most their information about RVF from social networks and the mass media, rather than the health system or veterinarians. Because the perceived role of the community in controlling RVF was fragmented, the probability of RVF spread increased.

Objective: Rift Valley fever (RVF) is a mosquito-borne infection with great impact on animal and human health. The objectives of this study were to identify ecological factors that explain the risk of RVF outbreaks in eastern and central Kenya and to produce a spatially explicit risk map. Methods: The sensitivity of seven selected ecological variables to RVF occurrence was assessed by generalized linear modelling (GLM). Vegetation seasonality variables (from normalized difference vegetation index (NDVI) data) and 'evapotranspiration' (ET) (metrics) were obtained from 0.25-1 km MODIS satellite data observations; 'livestock density' (N/km(2)), 'elevation' (m), and 'soil ratio' (fraction of all significant soil types within a certain county as a function of the total area of that county) were used as covariates. Results: 'Livestock density', 'small vegetation integral', and the second principal component of ET were the most significant determinants of RVF occurrence in Kenya (all p < 0.01), with high RVF risk areas identified in the counties of Tana River, Garissa, Isiolo, and Lamu. Conclusions: Wet soil fluxes measured with ET and vegetation seasonality variables could be used to map RVF risk zones on a sub-regional scale. Future outbreaks could be better managed if relevant RVF variables are integrated into early warning systems. 

Rift Valley fever (RVF) is an emerging viral zoonosis that causes frequent outbreaks in east Africa and on the Arabian Peninsula. The likelihood of RVF global expansion due to climate change and human anthropogenic factors is an important issue. The causative agent, RVF virus, is an arbovirus that is transmitted by several mosquito species and is able to infect a wide range of livestock as well as people. The infection leads to mass abortions and death in livestock and a potentially deadly hemorrhagic fever in humans. RVF has severe socio-economic consequences such as animal trade bans between countries, disruption of food security, and economic disaster for farmers and pastoralists as well as for countries. Human behavior such as direct contact with infected animals or their fluids and exposure to mosquito bites increases the risk for contracting the disease.

To better understand the challenges associated with RVF outbreaks and to explore prevention and control strategies, we used the One Health approach. The local community had to be involved to understand the interaction between the environment, animals, and humans. We focused on Sudan, Saudi Arabia, and Kenya. First, we systematically reviewed the literature and then we performed cross sectional community-based studies using a special One Health questionnaire. Climatic and remote sensing data were used in combination with statistics to develop a sub-region predictive model for RVF.

For both Saudi Arabia and Sudan, the ecology and environment of the affected areas were similar. These areas included irrigation canals and excessive rains that provide an attractive habitat for mosquito vectors to multiply. The surveillance systems were unable to detect the virus in livestock before it spread to humans. Ideally, livestock should serve as sentinels to prevent loss of human lives, but the situation here was reversed. Differences between countries regarding further spread of RVF was mainly determined by better economic and infrastructure resources.

In Sudan, there was a lack of knowledge and appropriate practices at the studied community regarding RVF disease symptoms and risk factors for both animals and humans. The community was hesitant in notifying the authorities about RVF suspicion in livestock due to the lack of a compensation system. The perceived role of the community in controlling RVF was fragmented, increasing the probability of RVF transmission and disease.

In Kenya, our study found that better knowledge about RVF does not always translate to more appropriate practices that avoid exposure to the disease. However, the combination of good knowledge, attitudes, and practices may explain why certain communities were less affected. Strategies to combat RVF should consider socio-cultural and behavioral differences among communities. We also noticed that RVF outbreaks in Kenya occurred in regions with high livestock density exposed to heavy rains and wet soil fluxes, which could be measured by evapotranspiration and vegetation seasonality variables. We developed a RVF risk map on a sub-regional scale. Future outbreaks could be better managed if such relevant RVF variables are integrated into early warning systems.

To confront RVF outbreaks, a policy is needed that better incorporates ecological factors and human interactions with livestock and environment that help the RVF pathogen spread. Early detection and notification of RVF is essential because a delay will threaten the core of International Health Regulations (IHR), which emphasizes the share of information during a transboundary disease outbreak to avoid unnecessary geographical expansion.