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Info Service on Health Issues (May22/09) 25 May, Geneva (Nithin Ramakrishnan) – The Draft One Health Joint Plan on Action 2022-2026 developed by the quadripartite alliance of the secretariats of four international bodies does not include critical concerns of developing countries in the areas of human, animal, plant and environmental health. The Draft Plan was summarily presented by the World Health Organization Director-General to the World Health Assembly (WHA) through his report titled “Strengthening collaboration on One Health” (A75/16). The quadripartite are the WHO, Food and Agriculture Organization (FAO), World Organization for Animal Health (OIE) and UN Environment Programme (UNEP). The 75th session of the WHA is going on at the WHO headquarters in Geneva from 22 to 28 May 2022. The report says the draft plan will go through the governing bodies of each of the four organisations in the quadripartite alliance before its finalisation and launch. However, it is silent as to whether the draft needs to be deliberated upon, and approved, by these bodies. Given the scale and magnitude of the plan, it would be appropriate for the document to go through a detailed deliberation and Member State adoption after thorough negotiations. The draft plan which was prepared on 11 March was circulated to WHO Member States on 31 March, calling for written comments on the draft. The deadline for submission of written comments was on 22 April. There has been no further discussion on the draft. The DG’s report, which is silent on further discussions, however says “Based on all the comments received from the internal and external review, a revised draft was produced and presented to TEAM28, at which meeting the Quadripartite agreed on the vision, scope, and content of the draft Joint Plan of Action”. TEAM28 is the 28th Annual Meeting of Tripartite Executives (referring to the alliance before UNEP joined in March 2022). Interestingly, the TEAM28 meeting happened on 17-18 March, way before the opening up of the call for written comments on the draft by Member States. Moreover, the draft plan is supposed to be for the period 2022 to 2026, but the opportunity to deliberate the plan in 2022 WHA75 is very limited. The document is just one of several documents considered by WHA75 under combined agenda items 16.1 and 16.2. The lack of adequate time to deliberate upon this plan in WHA75 is worrisome, because the draft plan’s central focus is on Member States’ legislative policy and regulatory harmonisation at various levels. Although the plan is not a binding policy document, it attempts to alter the legislative content at various levels and therefore contributes to norm-setting. Such a plan should undergo adequate Member State scrutiny at all four organisations of the quadripartite including WHO. Draft joint action plan and developing country concerns The draft plan is divided into five parts: (i) Background, which explains One Health in practice, rational and scope of the plan, (ii) an action framework, which discusses theory of change, guiding principles, impact, outcomes, and operational objectives (iii) action tracks, which enlists several activities to be undertaken pursuant to the plan, (iv) governance, implementation and monitoring, and (v) Investing in one health. It also contains two appendices, containing glossary of words and initiatives of the Tripartite, so far. The Tripartite (WHO, FAO and OIE) emerged in the context of the Global Action Plan on Antimicrobial Resistance adopted by the WHA in 2015, and the partnership was established in a 2018 memorandum of understanding. The organisations had been working together in an ad hoc manner before in the area of intersection of human, animal and plant health. UNEP’s joining in March 2022 integrates another sector, “environmental health”, to this multidisciplinary approach. The draft plan states that it “builds also on the WHA74.7 resolution calling to build on and strengthen the existing cooperation among WHO, FAO, OIE and UNEP to develop options, for consideration by their respective governing bodies, including establishing a common strategy on One Health, including a joint work plan on One Health to improve prevention, monitoring, detection, control and containment of zoonotic disease outbreaks” (page 4).” It also says that the joint work plan “encompasses the priority areas of the Tripartite work plan 2021 and provides an overarching framework for longer-term actions” (page 4). What is alarming is that when the secretariats or international agencies working in the four different sectors join hands, they are supposed to integrate the working principles of all four organisations and their respective subject matter, but this is not done in a meticulous manner. Several important working principles and priorities of the developing countries in each of these sectors are dropped from the draft plan. The draft plan therefore raises several concerns. Below are five major concerns amongst many other concerns that require attention. Firstly, the draft plan’s objective is normative and it is heavily invested in standard setting and regulatory harmonization. Secondly, it welcomes the definition of the One Health High Level Expert Panel (OHHLEP) without much discussion about the same and its implications on the principles of equity and fairness. Thirdly, the draft plan ignores the development divide among Member States and undermines the principle of common but differentiated responsibilities. Fourthly, the draft plan sets up a giant funnelling system for retrieving information to the global centres of data analysis (obviously located in the Global North), without discussing much on how the information will be handled or benefits derived from such information will be shared equitably and fairly. Fifthly, the draft plan proposes a governance and monitoring mechanism containing limited (almost zero) involvement of Member States. On the norm setting nature of the joint action plan As mentioned above the draft plan asserts that it is not a binding policy document. However, it is an indirect attempt to set norms and standards both at national and international levels. Its main attempt is to review and harmonise legal and regulatory documents of the State parties and international organisations. The second operational objective of the draft reads: “Provide upstream policy and legislation advice and technical assistance, to help set national targets and priorities across the sectors for the development and implementation of One Health legislation, initiatives and programme” (page 15). It must be noted that several activities mentioned in the draft plan’s action tracks focus on legislative policy, such as 1.1.1 (general), 2.2.7 (gender), 2.2.10 (epidemics/infectious), 3.3.2 (endemics/tropical diseases), 4.3.1 (foodborne diseases), 5.1.2 (antimicrobial resistance), 6.1.5 (Indigenous peoples), 6.2.5 (biodiversity, the environment and climate change), 6.3.6 (environmental data and knowledge). Even the deliverables mentioned under activities numbered 2.1.2, 2.2.1, 2.2.2, 2.2.3, 2.2.5, 2.2.7, 2.3.3, 2.3.4, 3.2.2, 5.2.2 indicate a strong push for harmonisation of regulatory protocols and normative standards. This means the draft plan is a full-scale attempt at norm-setting, and therefore requires adequate Member State scrutiny. On the problem of definition The draft plan welcomes the definition of the One Health High Level Expert Panel (OHHLEP), almost without a second thought. The definition reads as follows: “One Health is an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent. The approach mobilises multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development” (page 6). It must be noted that during the meetings of the Convention on Biological Diversity, this definition was brought up for discussion by the Quadripartite Alliance and certain State Parties to the Convention, but developing countries like Bolivia, Bahamas, and Namibia have proposed member state scrutiny of the recommendations of the OHHLEP before their adoption into formal policy documents and actions. The definition lacks recognition of crucial principles such as equity and fairness and therefore the One Health approach would end up treating developed and developing countries alike, which casts doubt on the “oneness” idea and whether it is limited only for the integration of the technical areas. It has been a major criticism of the One Health Approach for the last decade that the approach and practices are not socially sensitive. The literature review by scholars such as Prof. Victor Galaz of Stockholm University reveals how a socially sensitive narrative about One Health is marginalised by the academia and policy makers. In a recent policy dialogue organised by TWN and Geneva Global Health Hub (G2H2) on 19 May, Dr. Syed Abbas, post-doctoral researcher from the Institute of Development Studies (UK), expressed further doubts whether the draft joint action plan is taking into consideration even the definition of OHHLEP comprehensively since the plan keeps human health as its central focus. A socially sensitive approach to One Health will point to the political-economic contexts in which zoonoses develop and are driven, such as structures of production, urbanisation, and global capitalist relationships and their impacts on disease emergence and spread locally, as pointed out by certain scholars (Galaz, Hincliffe, and Froster). This approach could call for integrated surveillance and response to be built on local contexts and understandings, meaning it should take into consideration the social, economic, and technological divide existing within and between countries. This points to the next concern of the developing countries on the draft plan. Undermining of common but differentiated responsibilities The guiding principles of the draft plan undermine the “common but differentiated responsibilities (CBDR)” principle by replacing it with “common and shared responsibility”, even after UNEP became a Quadripartite member of the alliance. CBDR is one of most important principles of international environmental law and post-COVID-19 pandemic there have been calls for incorporation of this principle into the global health emergency governance regime as well. The first guiding principle of the draft plan reads: “Cooperation and Shared Responsibility: The OH JPOA emphasises One Health as a shared responsibility and recognizes the crucial role of cooperation among countries, regional organisations, and other international organisations and stakeholders in supporting countries’ efforts to effectively address the health threats identified in this OH JPOA. The OH JPOA recognizes the expertise and abilities of these key stakeholders as essential resources for its effective implementation, coordination, and oversight.” This has effectively taken out the specific concerns and requirements of developing countries from the One Health Joint Plan of Action, and it consequently reduces their policy space without adequate guarantees of international support. Examples are activities mentioned under action tracks 2 and 6. Action track 2 focuses on “developing risk mitigation measures, including: maintenance of resilient healthy ecosystems, early interventions aiming to reverse or halt environment degradation and biodiversity loss, regulation of farming and trade in wildlife and wild animal products; and reduction of spill over risks at key animal value chain points and wildlife-domestic animal-human interfaces, including live animal markets (traditional markets)” (page 21). The activities resulting from this focus will necessarily include a lot of interventions in the functions of trade, livelihood and market in the developing countries and they will entail a reduction in market and income of these countries. However, there is no mention in the draft plan on how to address this financial loss, especially in the developing countries. Similarly, action track 6 in its introductory paragraph notes as follows: “… land-use change driven by agricultural, industrial, and urban expansion leads not only to unprecedented degradation of natural habitats threatens ecosystem integrity and food security, deforestation, and alarming loss of biodiversity, but also drives disease emergence and provides pathways for the spillover of emerging pathogens between domestic animals, wildlife, and humans” (pages 34-35). It goes on to say that in order to address threats arising from the above mentioned and like challenges, the priorities and mandates of the environmental sector need to be integrated into the One Health Approach. It calls for “integration of environmental data in One Health decision making, increasing the understanding of environmental issues in the One Health community, and strengthening the capacity of the environmental sector and institutions to have an equal voice at the One Health table and in decision-making” (page 35). On the other hand, the draft plan does not acknowledge that this action track and activities necessitated by the action track would entail changes in the agricultural and industrial practices. However, nothing concrete has been suggested to compensate for the transition costs in such changes for developing countries. The ideas contained in this action track are nothing short of climate change obligations and other environmental law obligations which are demanded of developing countries. But these are not accompanied by the corresponding obligations of the developed countries to share financial and technological resources. Unrestrained information flow, possible misuse and absence of benefit sharing arrangements The draft plan promotes accelerated Information sharing without adequate emphasis on the handling of information and equitable sharing of benefits and outcomes. One idea that runs consistently throughout all the six action tracks is the accelerated sharing of information. The draft plan seeks to promote free flow of information from the countries to the international organisations on a real-time time basis, without any Member State or governmental scrutiny in between. This is the idea that is promoted through the jargon and well sounding phrases like “integrated data collection systems” and “interoperable information systems and databases”. Examples include activities numbered 1.2.7 (adequate use of integrated One Health information, surveillance and emergency, response systems), 1.3.2 (effective communication structures and information and data sharing systems across organisations, sectors, and society), 3.2.2. (strengthen disease reporting and integrated data collection, information sharing and outbreak response to build multisectoral, One Health coordinated national surveillance and risk management capacity), 3.2.3 (link specialised disease programmes to Health Information Systems), 4.3.2. (databases and tools to collect, access and interpret relevant food safety data and other information, including water, food, and wildlife meat), 6.3.1 (interoperability between health, animal disease and environment databases and information systems); etc. However, even with this long list of activities focussing on information sharing, the draft plan has no discussion whatsoever on how the recipient institutions will handle such highly sensitive information, which has national security and economic stability implications. Moreover, there is no discussion in the plan about how these approaches or systems will ensure fair and equitable sharing of benefits and outcomes derived from such information sharing with all Member States and their populations, especially to developing countries. On the other hand, the draft plan seeks to provide support to integrating health and environment considerations and including such risks in impact assessments and performance standards of the World Bank’s International Finance Corporation and other financial institutions (activity 6.2.7). This provides the real scope for the data aggregators appointed by the Quadripartite to provide information to institutions like credit rating agencies. This is highly detrimental to the developing countries, as it will affect their credit availing and investments prospects. The draft plan can therefore be said to primarily promote cooperation and coordination in “knowledge generation” regarding emerging diseases or health threats and “developing the solutions” for the same. Everything that “comes after such sharing of information and generation of knowledge and solutions”, such as “localised and decentralised production of solutions” or “fair and equitable distribution of such solutions”, “provision of financial assistance to make such solutions affordable to the general public”, or even “ensuring safety and security standards in information handling” seems to be secondary to the developers of the draft plan. Governance Mechanisms devoid of Member State Participation The governance and monitoring mechanisms described under Part IV of the draft plan contain almost zero involvement of Member States and organisational governing bodies. The report does not speak about Member State participation and accountability either. Part IV of the report instead states that “The Tripartite and UNEP executives are accountable for the implementation of the OH JPOA and will provide leadership and oversight of its implementation and will ensure the engagement of their regional, sub-regional and country offices, where relevant” (page 41). It is further proposed that a Global Steering Committee composed of representatives of the four organisations will implement the work plans based on the draft plan, with coordination by one of the organisations on a rotational basis. The draft plan is silent on a reporting mechanism to the respective governing bodies of the organisations in the alliance. This means the plan and implementation remain as secretariat-led processes, without much accountability. It is a matter of common knowledge that there is very limited personnel accountability in the international organisations. For all the reasons cited above, it would not be wrong if one describes the draft plan on One Health Approach as a plan for ‘a climate change response, without implementation support’, ‘pandemic surveillance without response guarantee’, and ‘sharing of genetic resources without fair and equitable benefit sharing’. The draft plan’s theory and pathways of change described vividly in Part II prioritise the developed countries’ desire to have free and automatic access to information from different parts of the world but do not particularly guarantee what is needed for developing countries and their populations, who are vulnerable to wide-ranging socio-economic inequities. It is therefore very important that the Member States of the Quadripartite alliance discuss in detail the plan and approve it in their respective governance bodies.+
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