Episode 15 - Joining forces for humans, animals, environment: One Health

Intro (00:00:18:24)

Science on the Menu. A podcast by the European Food Safety Authority.

James (00:00:19:01)

Hello everybody and welcome to a very special two-part episode of our podcast ‘Science on the Menu’. Today we're going to cast our net a little wider than just the science of food safety and EFSA. In fact, we're going to be talking about a topic which touches on many different aspects of the world around us and which, by extension, involves the work of no fewer than five European Union agencies.

That topic is One Health which, broadly speaking, can be described as an approach to addressing threats to health and well-being that recognize the interconnection between the health of people, animals, plants, and the environment. And we're delighted to have a stellar line up of guests with us today, all of whom have kindly agreed to share with us their perspectives about One Health.

Before we jump into the discussion, I'm going to introduce everyone quickly and ask each of you to explain in a couple of sentences what it is the agency you work for does.

Starting with you, Mike. Mike Catchpole, who is the Chief Scientist at the European Centre for Disease Prevention and Control, also known as ECDC. Welcome, Mike. And please tell us what it is the ECDC does.

Mike (00:01:26:23)

James, thank you for inviting me. ECDC’s mission is to identify, assess and communicate about infectious disease threats to human health

James (00:01:36:24)

Thank you, Mike. Let's move on now to Dario Piselli, an expert in environment and health from the European Environmental Agency. Welcome, Dario. Please tell us what the European Environment Agency does. 

Dario (00:01:49:01)

The main task of the agency is to provide sound, independent information about the state of European environment.

James (00:02:00:09)

Thank you, Dario.

Coming close to home now. Over to you, Carlos. Carlos das Neves is the Chief Scientist at EFSA. Can you explain briefly what EFSA does?

Carlos (00:02:11:17)

The European Food Safety Authority’s core mission is to help ensure the safety along the food chain. For those listening to us, everything from the farm, from the ocean, from where we produce foods all the way to our tables.

James (00:02:26:13)

We're going to go to our fourth guest now, Wim De Coen who is the Head of Hazard Assessment at the European Chemicals Agency. 

Welcome. Can you tell us briefly what it is that ECHA does?

Wim (00:02:39:15)

ECHA’s mission is to safeguard human health and the environment. We do that through ensuring the safe use of chemicals in Europe.

James (00:02:48:03)

And finally, I'm really pleased to introduce as well to the call Steffen Thirstrup. Steffen is the Chief Medical Officer at the European Medicines Agency. Welcome, Stefan. Can you tell us a little bit about what the European Medicines Agency does, please? 

Steffen (00:03:04:08)

Yeah, thank you for having me here. The European Medicines Agency is responsible for the scientific evaluation of medicines, both for humans and animals, that are brought to the market of Europe.

James (00:03:19:09)

That is our line-up for today. And what a line-up it is. We have experts from five EU agencies dealing with all different aspects of public health, animal health, environment and so on. So, we've very happy to have you guys here today.

Let's jump straight into the discussion now. I'd like to start with you Carlos.

I gave a brief outline at the top of the show about what One Health is, but I'd like you to just explain a little bit more detail what we're talking about when we say the words One Health and why we should care about One Health. 

Carlos (00:03:53:06)

Thank you very much, James. Indeed, this concept, this approach, it has been in the making for many years. And as you've highlighted in the beginning, this interconnection between animals, humans, the environment, the plants, all these are linked. And for those listening, I think we can all understand that from the choices we make about what we eat, the way we travel - just to give to common examples - it impacts a variety of things. One health is this capacity to understand that problems are interlinked. Therefore, solutions should also be linked. And for us at EFSA, why is this important? My colleagues may challenge me - I would say there is no better example than food to implement One Health because it can transmit diseases, because it impacts our climate, because climate has an impact on the way we produce foods, because we all need food. Animals are food, plants can be foods. It's easy to say that what affects one, affects all. So, by going together, looking at the problem, we like to say ‘holistically’, all pieces of the puzzle together, we may have better solutions. And for us, we do this with just four words which the United Nations is also supporting, by the way: better cooperation, better collaboration, better capacity building, and with your help James, better communication.  

James (00:05:15:22) 

That's great. Thanks. I think that really sets the scene nicely. 

I'd like to bring Mike in here from ECDC, to maybe focus on a specific example. Mike, in your introduction, you mentioned the concept of antibiotic resistance, and this is something that the EU agencies, all of whom are represented on this call, is an issue we take very seriously. We go to great lengths to coordinate efforts, promote the prudent use of antibiotic medicines. Can you tell us a bit more about what antibiotic resistance is and why it's relevant to speak about it in the context of a One Health approach?

Mike (00:05:55:20) 

Antibiotic resistance, to put it most simply and starkly, is the term that we use to describe the situation when the medicines that we use to treat infectious disease no longer work. And if we don't control and prevent antimicrobial resistance there's a very real prospect that in the future it’ll become difficult to treat many cancers or give lifesaving treatments such as kidney transplants just because of the risk of serious untreatable infections. It is probably the biggest public health hazard we face in terms of infectious disease today. It develops because the bugs, the bacteria, the viruses, other pathogens develop a resistance to one, more or many of the medicines that we use to treat infection through a number of different mechanisms.

Although there are many different mechanisms, I think the important thing to note is that actually it's the excessive or inappropriate use of antibiotics, whether used in animals or in humans, that increases the risk that the resistance will develop to those medicines. 

Now, you asked about is whether this is a One Health issue. Absolutely. Many of the medicines that we use to treat infections in humans are also used in animals. And just as importantly, there are important group of bugs which we called zoonoses, which can be transmitted between animals and humans. So, if resistance develops as a result of the use of antibiotics in animals and resistance develops in those animals that can be transmitted to humans, and then we're faced with the prospect of infections that are very difficult, if not impossible, to treat. So, it's absolutely a crucial One Health issue.

James (00:07:36:06)

I imagine then the ECDC and EFSA would be working together on this issue?

Mike (00:07:44:10)

Absolutely, in fact we work very closely - ECDC, EFSA and the European Medicines Agency. We've produced over the last few years a series of joint reports called the JIACRA reports, which analyse the relationship between the use of antimicrobials or antibiotics and the resistance to antibiotics in both humans and animals. These reports inform and allow us to evaluate policy to control this problem. In fact, we're just about to publish the latest version of that, and it shows some encouraging results, but perhaps I'll mention those later as we go along.

James (00:08:21:08)

Thanks very much, Mike. 

You mentioned the European Medicines Agency. That gives me a good excuse to bring Stefan in here.

I wanted to ask you about another recent global health crisis where your agency, the European Medicines Agency, had a critical role to play. I'm talking about the COVID-19 pandemic. 

EMA, ECDC, EFSA, they all swung into action from the beginning of the pandemic to provide advice to the European Commission and national governments on how the disease was spreading in the EU, the risk to animals, humans and of course in your case, the Medicines Agency, on the safety of the vaccines that were developed to combat the disease.

What did we learn from working together as agencies during this very challenging period? And would you say we're better placed now to deal with another similar event should it happen in the future?

Stefan (00:09:14:22) 

Let me take the last question first. I'm definitely confident that we are in a much better place now to face the next pandemic or the next big epidemic reaching us because we know these things will happen. Also talking about climate change and so forth that the likelihood of zoonotic infections creating a pandemic looks like it's increasing. So, yes, we learned a lot. I think also not only learned, but we also confirmed that we are good at working together and having a good working relationship.

We had emergency plans in our in our cupboards, in our safes and some of them were polished off during the swine flu back in 2006 and 2009. They definitely needed an update and of course, there are a lot of lessons learned activities. We recently published the Lessons Learned paper and we got input for that from colleagues around the table here today as well. And I think we are definitely in a better position to deal with whatever comes down the road. 

May I also just pick on the AMR discussion? Because I completely agree with what Mike said. We have another challenge here and that's where we also have a lot of interest in working and guiding industry because we have a gap here. We have no treatment for these resistant bugs. So, there is a huge interest in developing new medicine to treat resistant bacteria. That's also a role of the European Medicines Agency to engage with academia and the pharma industry to try find new solutions for this bigger problem.

James (00:10:56:15)

Brilliant. Thanks, Stefan, you've made the link there back to AMR with the ECDC. 

I wanted to turn now to you, Wim, at the European Chemicals Agency. We've already spoken now about One Health from a kind of disease, medicines, food point of view. But one aspect we shouldn’t neglect in the One Health story is chemicals.

Can you explain where ECHA fits in to all of this? And give us a practical example of how the work you're doing makes this bridge between the health of humans, animals, plants,  and the environment.  

Wim (00:11:31:17) 

I think chemicals really are a key element in the One Health activities. And let's take a practical example to continue on the AMR: we're currently contributing to the assessment of the Azole fungicides to make a practical example. Basically, these substances are used in various sectors and here we are contributing together with all the agencies around the table today and at the JRC to make a better assessment, where are they used? We're already contributing potentially to resistance. 

That's a practical example, but maybe the recent development this week, allow me to bring up a broader example, which is the one substance, one assessment principle, which was launched by the Commission this week, and that's actually one of the core drivers where ECHA really will play a role in where we will go in particular with this initiative to a broader assessment, but a single assessment of chemicals. And I think there is a lot of potential for all the agencies under this umbrella to make sure that instead of having fragmented assessments of substances and chemicals to do this now in a holistic way, in a more consolidated way so that we have a single reliable sources of truth on the chemical, the hazards and the risks so that we can better manage the risks and move forward to a more sustainable chemicals management.

James (00:13:06:24) 

So, the one substance, one assessment approach hopefully it leads to better scientific outcomes, as you say, but I guess there are also economic savings to make as well. If you're pooling the resources of European Union agencies, then at the end of the day, you would hope to see a saving for the European taxpayer.

Wim (00:13:26:09)

Absolutely. I think you can see this as a library organising its books. I like to use that image - if we're managing chemicals, it's like having one definitive book for each chemical substance in your library rather than having multiple books with different information scattered across various shelves, etc.

It allows us indeed to go for economic savings not only at authorities but also at the industry side. So, hopefully that will bring a lot of benefits in the future. 

James (00:14:00:24)

Great. Thanks a lot, Wim. 

We're going to turn to you now, Dario Piselli from the European Environment Agency. 

It's obviously vital to consider how humans, animals and plants interact with the ecosystems of which they're a part and how this in turn may affect their health. 

The EEA, as I understand it, has been leading the way in assessing the impact of environmental factors on human health in Europe and provides us with a lot of knowledge about measures to protect the environment and how this might benefit our health.

How does this sort of fit with the One Health approach? Why is this important? And are there some areas as far as the environment is concerned where we still need to improve and use the One Health perspective?  

Dario (00:14:45:12)

The environment historically was seen as a more neglected aspect of One Health.

I think this is just by virtue of the history of the concept and how it emerged that it was focusing more on the animal and human health interface. But of course, as we are discussing now, this is no longer the case and why does it matter bringing in the environment? First of all, it just makes sense from the point of view of economic and societal costs.

A growing body of research shows that if we intervene earlier in those time sequences that may lead to a disease outbreak in humans or any other health emergency for that matter, we may reduce the incidence of that disease in humans and the economic costs of outbreaks. And by intervening earlier, I mean making sure that we monitor for the presence of pathogens or contaminants in the environment or wildlife or disease vectors or even earlier in the chain addressing the ultimate drivers of pathogen spillovers of human health emergencies - really looking at how we can prevent the emergency at source. 

Secondly, I think it makes sense because if we focus on the links between environment and health, if we illuminate those links, we make an important case for decision makers for protecting nature and climate in the first place. I think there's a lot of evidence that people really respond very much to the argument that human health benefits are a great excuse for protecting the environment, which has all sorts of other benefits as well.

In terms of the knowledge gaps that you were mentioning or the issues that we need to put more focus on, precisely because the environment traditionally was a bit more neglected, there's actually a lot that we need to do to catch up with. We've been talking a lot about antimicrobial resistance, and I think there's a lot of scope for improving the environmental monitoring of antimicrobials, antimicrobial resistance, boxing the environment.

This is a task that hopefully will come soon to the EEA. We're stepping up to do that because it's also part of the proposed revisions of the EU water legislation, and this could bring a lot of value to the existing collaborations between the other agencies that were just mentioned. There's a lot of other topics as well of course; I think there's a lot of value in looking at all environment topics from this One Health perspective for the reasons that I was mentioning earlier.

Michael (00:17:16:22)

I absolutely agree with Dario's analysis, and I just would make the point that actually through the COVID pandemic, the role of wastewater surveillance has been recognized as an increasingly important way of early detecting the presence of pathogens in a community. So, I fully agree on that. 

Also, the environment's importance as we see the inexorable change in climate, the environments in which say mosquitoes that can spread infectious diseases exist will change, and we need to look very carefully at how we can work with our colleagues in the Environment Agency to modify that risk.  

James (00:17:58:20)

Thanks a lot. 

I was reading the other day about research that's being done on wastewater at airports across the world and how this can give an idea of how a pandemic or epidemic disease might spread across the world during a situation like the one we had, for example, with COVID.

Dario mentioned this idea of what the agencies can do working together. And I want to come back to you Carlos, on that, because the five agencies that we have on this podcast here today, they're part of a cross-agency taskforce that works to coordinate One Health related activities in the EU and the five agencies just published a statement, a kind of expression of commitment to support the EU's One Health agenda.

Can you tell us a bit more about this? What's the long-term objective here?

Carlos (00:18:58:08)

I think together here, myself and my colleagues, we've highlighted quite a few examples that should help everyone realize that everything is more or less linked. And when I sit here with my colleagues here in Parma, in our office, we look at whether it was the AMR that Mike mentioned, whether it's this waste accumulation of waters, which, by the way, are also part of the food chain.

All these examples suddenly make us realize we can't get the job done alone; we need to team up. And we see also Europe moving in this vision of looking to these problems, these challenges in this global, this holistic way. And when we talk about sustainability, whether these are food systems of health or of the environment, there is a political push.

So, when the commission is motivated to implement One Health, when the Member States across Europe are also saying we want to embody more the One Health, the agencies could not stand behind. So, we have teamed up in this cross agency. 

What would we like to achieve? We've set ahead of us four big goals: number one, to coordinate better the way we do One Health, even within our own institutions. The way we link our colleagues, the units, the work we do - that's the easiest one perhaps.

Let's be more ambitious: level two, we all depend on science. We are all producing opinions or policy advice based on the best available science. What if the science we need is not out there? Let's team up and let's talk to the science engines of Europe, to the universities, to the research institutes as one big group of five agencies, and tell them: “Gentlemen, ladies, we need this, this, this, and that. Without this science, we cannot do our work”. 

Then number three: we also have a lot of colleagues across these agencies, scientists, a few thousand when we put the five together, that would benefit from joint training. Because very often you've heard, with the example of chemicals: Why should I assess a chemical in foods? That Mike also needs on a medical drug, that Dario will have to evaluate in the environment, and that saves someone perhaps also from a disease with Mike. Let's get together and do this only one single time. For that, perhaps we should also train the people - one same mentality if I can say. 

Last but not least, we would like to be together closer to the policy advisors and to the Member States and to provide better support.

I'm thinking for example, that the European Union has a big desire to expand and to welcome in the Union new Member States that have a lot of potential, but which also have some challenges - you mentioned the vector borne diseases, migration, so many issues that we can all work better with them. Let's go together as a team, a really One Health team and not the five of us in different months.

I think we could also be more rational, more lean, more economic, and I hope that the final products will benefit, which at the end is the long-term, benefit the consumer, benefit the citizen.  

James (00:22:25:23) 

That's all we have time for the first part of our special podcast today on One Health. The second part will be released very soon
so, stay tuned for more information about that. 

If you're interested in any of the work that the five agencies you've heard from today are involved with, then do check out our respective websites. 

We also have a very special Instagram account, a joint Instagram: It's called One Health, One Environment EU.

For the time being that's it. And we'll see you soon again. Bye bye.