One Health is a novel paradigm that recognizes that human and non-human animal health is interlinked through our shared environment. Increasingly prominent in public health responses to zoonoses, OH differs from traditional approaches to animal-borne infectious risks, because it also aims to promote the health of animals and ecological systems. Despite the widespread adoption of OH, culling remains a key component of institutional responses to the risks of zoonoses. Using the threats posed by highly pathogenic avian influenza viruses to human (...) and animal health, economic activity and food security as a case exemplar, we explore whether culling and other standard control measures for animal-borne infectious disease might be justified as part of OH approaches. Our central premise is that OH requires us to reformulate ‘health’ as universal good that is best shared across species boundaries such that human health and well-being are contingent upon identifying and meeting the relevant sets of human and non-human interests and shared dependencies. Our purpose is to further nascent discussions about the ethical dimensions of OH and begin to describe the principles around which a public health agenda that truly seeks to co-promote human and non-human health could potentially begin to be implemented. (shrink)

Emerging infectious diseases such as Ebola, Hendra, SARS, West Nile, Hepatitis E and avian influenza have led to a renewed recognition of how diseases in human beings, wildlife and livestock are interlinked. The changing prevalence and spread of such infections are largely determined by human activities and changes in environment and climate—where the latter are often also caused by human activities. Since the beginning of the 21st century, these insights have been brought together under the heading of OneHealth—a concept that (...) calls for interdisciplinary collaboration between various sciences as well as professional practices to promote and protect the health of human and non-human animals and the natural environment. Just as insights from public health have led to a broadened focus for health policy and medical care, from treating individual patients to protecting and promoting population health, OneHealth calls for an even broader perspective, including a concern for the environment and animals, and for social-cultural factors that affect human, animal and environmental health. OneHealth not only covers collaborative work to understand and control zoonotic diseases, but also other ways in which interactions between animals, plants and humans may positively or negatively impact on each other’s health. Thus, studies in veterinary medicine and environmental sciences may lead to new insights in human medicine, and vice versa. Acknowledgment of the links between environmental, animal and social health is of course not a novel insight. Hippocrates already pointed to the importance of a clean environment as a requirement for good health; the early public health movements emphasized hygienic living conditions including good-quality housing, sewage systems and clean air and water; and the founders of modern medicine such as William Osler and Rudolf Virchow promoted …. (shrink)

The COVID-19 pandemic has shown that zoonotic diseases are a great threat for humanity. During the course of such a pandemic, public health authorities often apply the precautionary principle to justify disease control measures. However, evoking this principle is not without ethical implications. Especially within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. In this article, we (...) analyze the ethical dimensions of the use of the precautionary principle in zoonotic disease control and formulate criteria to protect animals and the environment against one-sided interpretations. Furthermore, we distinguish two possible conceptions of the precautionary principle. First, we notice that because of the unpredictable nature of zoonotic diseases, public health authorities in general focus on the idea of precaution as preparedness. This reactive response often leads to difficult trade-offs between human and animal health. We therefore argue that this policy should always be accompanied by a second policy, that we refer to as precaution as prevention. Although zoonotic diseases are part of our natural world, we have to acknowledge that their origin and global impact are often a consequence of our disturbed relation with animals and the environment. (shrink)

To tackle zoonotic disease threats, a One Health approach is currently commonplace and generally understood as an integrated effort of multiple disciplines to promote the health of humans, animals and the environment. To implement One Health strategies in zoonotic disease control, many countries set up early warning systems, in which human and veterinary health professionals cooperate. These systems, like the Dutch Zoonoses Structure, can be successful to detect emerging disease threats. However, these systems are not well equipped to handle moral (...) dilemmas that can arise in zoonotic disease control, like the culling of healthy animals. This research studies the role of normative presuppositions of professionals involved in zoonotic disease control policies in the Netherlands. We found that these professionals in general adhered to a holistic view of the One Health concept, however, in practice an anthropocentric approach was dominant. Public health was identified as the trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. The lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle which is frequently evoked to justify disease control measures. (shrink)

Culling is used in traditional public health policies to control animal populations. These policies aim primarily to protect human interests but often fail to provide scientific evidence of effectiveness. In this article, we defend the need to move from a strictly anthropocentric approach to disease control towards a One Health ethics, using culling practices as an example. We focus on the recent badger culls in the UK, claiming that, based on data provided by the English Government, these culls may be (...) unjustified, all thing considered. We highlight the relevance of ethical reasoning rooted in One Health for this discussion, and make several suggestions including a moratorium on culling until data are provided to support the effectiveness of culling; to conduct a randomized trial to compare proactive culling with alternative methods; to apply deliberative democratic methods to assess public opinion towards the culls, and to find in Brexit an opportunity for aiming for more effective control measures. (shrink)

Johnson and Degeling have recently enquired whether one health requires a comprehensive normative framework, concluding that such a framework, while not necessary, may be helpful. In this commentary, we provide a context for this debate, and describe how pragmatism has been predominant in the OH literature. We nevertheless argue that articulating a comprehensive normative theory to ground OH practice might clear existing vagueness and provide stronger guidance in relevant health dilemmas. A comprehensive theory will also be needed eventually to ground (...) notions such as universal good. We, thus, call for the systematic articulation of a comprehensive, metaethical theory, concomitantly with already ongoing normative work. (shrink)

Bioethics is a field in which innovation is required to help prevent and respond to zoonotic diseases with the potential to cause epidemics and pandemics. Some of the developments necessary to fight pandemics, such as COVID-19 vaccines, require public debate on the benefits and risks of individual choice versus responsibility to society. While these debates are necessary, a more fundamental ethical innovation to rebalance human, animal, and environmental interests is also needed. One Health (OH) can be characterized as a strategy (...) that recognizes and promotes the synergy between human, animal, and environmental health. Yet, despite the recognition that these entities are interdependent, there is a pronounced inequality in the power relations between human, non-human animal, and the environmental interests which threatens the well-being of all. Until OH can ensure the moral status of animals and the environment and thereby the equal consideration of these interests, it will struggle to protect non-human interests and, as a result, human health. To create a sustainable health system requires a renewed concept of justice that is ecocentric in nature and an application of OH that is flexible and responsive to different ethical interests (e.g., person-centred care and physician responsibilities). Ultimately, to save themselves, humans must now think beyond themselves. Bioethics must assume a key role in supporting the developments required to create and maintain relationships able to sustain environmental and human health. (shrink)

The COVID-19 pandemic once again confirmed that zoonotic diseases are a serious threat to humanity. These infectious diseases, transmitted from animals to humans, have the power to cause a global health crisis. Over time the risk on these outbreaks has increased. Some of the main drivers are global population growth, urbanization, worldwide transport, increased demand for animal protein, unsustainable agriculture, and climate change. This development has fueled a renewed interest in the relation between human, animal and environmental health. This was (...) framed in the concept of One Health: the integrative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment. At present, One Health is the worldwide standard to combat zoonotic diseases. In an ideal world such a strategy should lead to a better health for humans, animals and our environment. However, in practice it is not self-evident that a One Health approach in zoonotic disease control is actually in the interest of animals or the environment. From a holistic One Health perspective it can be difficult to accept the culling of healthy animals to protect public health. The same goes for long term confinement of free-range poultry, whose housing systems are often not suitable for this purpose, to prevent avian influenza outbreaks. Or antimicrobial reduction policies that lead to higher disease incidence and mortality in animals. These ethical considerations formed the start of this thesis. The aim of my research is to clarify the ethical assumptions of a One Health approach in zoonotic disease control, to explore how these can be coherently understood and justified and to indicate what this implies for policymaking. The outcome of my research contributes to the development of an ethic of One Health and will hopefully lead to a more socially acceptable zoonotic disease control. This project is related to the interdisciplinary Wageningen UR strategic research theme ‘Global One Health’. From my conceptual analysis, it follows that there is no universal interpretation of the One Health concept nor of a One Health approach in zoonotic disease control. Nevertheless, One Health has produced several successes in zoonotic disease control, surveillance and research. Due to its ambiguity, the One Health concept functions as a boundary object: by leaving room for interpretation to fit different purposes it facilitates cooperation. In many cases this results in the promotion of health of humans, animals and the environment. However, there are also situations in which this mutual benefit of a One Health approach is not that evident. For instance, when healthy animals are culled to protect public health. To address these moral dilemmas, it is important to develop an ethical framework. Such an ethic of One Health starts with acknowledging the moral status of animals and the indirect moral obligations we have towards ecosystems. Furthermore, it is necessary that we find an appropriate definition of health, which encompasses all three components of One Health. In chapter 3, I present the results of an empirical study on normative presuppositions of health professionals involved in zoonotic disease control policies in the Netherlands. This study reveals that in theory these professionals adhere to a holistic view of the One Health concept. However, in practice an anthropocentric approach was dominant. The study identified public health as a trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. Furthermore, a lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle. In chapter 4, I discuss that within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. It must at least be clear that there is a harm and some scientific evidence for a cause and effect relation. Furthermore, precautionary measures should be effective, consistent, proportional and not counterproductive. An assessment of their effect should be integrated in the standard decision-models of public health authorities. Moreover, to ensure societal support these considerations should be transparent and open for dialogue. I present two possible conceptions of the precautionary principle. First, it is noticeable that because of the unpredictable nature of zoonotic diseases, public health authorities focus on the idea of ‘precaution as preparedness’. This reactive response leads to difficult trade-offs between human and animal health. I therefore argue that this policy should always be accompanied by a second policy: ‘precaution as prevention’. Addressing the underlying drivers of zoonotic diseases is a necessary condition to justify disease control measures that harm animals and ecosystems on the basis of the precautionary principle. In chapter 5, I elaborate the responsibilities of veterinarians within the One Health framework. Veterinarians are professionally responsible for the health and welfare of the animals under their care. Moreover, society expects veterinarians to safeguard food safety and public health. These societal expectations are sometimes overdemanding. A holistic perspective on One Health offers veterinarians a way out of the dichotomy between public and animal health, that is at the basis of many moral dilemmas in zoonotic disease control. This is explained with the ‘encapsulated health’ argument: the best way to safeguard human health is to promote the health of animals and the environment. In chapter 6, I conclude that before we decide to implement certain disease control measures, an ethic of One Health requires that we choose those interventions that have the least impact on the health of animals and ecosystems, while still effective enough to stop the disease. My research indicates that the contemporary conception of One Health is necessary but insufficient to address moral dilemmas related to emerging zoonotic diseases. A holistic interpretation of the One Health concept confronts us with underlying value conflicts but will ultimately promote human health more than the current anthropocentric conception. (shrink)