The Lancet Commission calls for global policy shift—One Health as the key to the future

The world is facing an interconnected health crisis: zoonoses, antimicrobial resistance, environmental degradation, and climate change threaten millions of lives. An international expert group, The Lancet One Health Commission, warns in its first report of severe consequences if governments, business, and international organizations fail to change course immediately.

The Bernhard Nocht Institute for Tropical Medicine (BNITM) played a key role as a leading partner. The central message: Only a consistent One Health approach—considering human, animal, and environmental health together—can break the escalating chain of health crises. The report is published in The Lancet.

The COVID-19 pandemic starkly demonstrated how closely human, animal, and ecosystem health are intertwined. But infectious diseases are only the tip of the iceberg. Antibiotic resistance, which causes millions of deaths each year, polluted air, contaminated water, and biodiversity loss threaten not only global health but also food security, economies, and social stability. Political strategies have so far largely ignored these interconnections.

One Health addresses this gap: it is an integrated approach that systematically incorporates the links between human health, animal health, and the environment into research, policy, and practice. The Commission calls for this approach to be firmly embedded in all relevant policy areas—from agriculture and climate to environmental policy and the economy.

At the same time, One Health demands fairness and equality between high-income and low- and middle-income countries. The lesson from the pandemic is clear: in the global competition for vaccines, protective equipment, and diagnostics, resource-limited countries must not be left behind. Global health security can only succeed if resources are distributed equitably and capacities are strengthened everywhere.

How was the report developed?

The Lancet One Health Commission was established in 2019 and brings together 40 international experts from medicine, veterinary science, environmental research, social sciences, and economics. The report is based on a comprehensive review of current data, case studies, and scenario analyses. Its aim: to compile scientific evidence, quantify risks, and formulate recommendations for action.

Two BNITM scientists contributed their expertise in global health, infection epidemiology, tropical medicine, and disease surveillance: Prof. Dr. John Amuasi, leader of the Global One Health Research Group, co-chairs the commission, BNITM-chair and Infectious Diseases Department leader Prof. Dr. Jürgen May is a commissioner.

Findings: Systemic—and human-made—threats

The analysis is clear: zoonoses play a central role. Of all known infectious agents that cause disease in humans, about 60% originally come from animals. For newly emerging infectious diseases, the proportion is even higher: more than 70% of these “emerging diseases”—such as Ebola, SARS-CoV-1, or SARS-CoV-2—originate from pathogens that jumped from animals to humans.

At the same time, hundreds of children die every day from preventable diarrheal diseases due to lack of clean water. Air pollution claims millions of premature deaths each year. Ecosystems are approaching tipping points: coral reefs have shrunk by half since the 19th century, and between 2010 and 2015, 32 million hectares of tropical forest were lost.

The Commission also highlights the economic impact: the African swine fever outbreak in China wiped out more than 40% of the national pig population and caused economic damage exceeding 140 billion U.S. dollars. At the same time, integrated surveillance systems can save lives and reduce costs: in Italy, West Nile virus is monitored not only in humans but also in mosquitoes, wild birds, and horses. This integrated approach enabled early interventions—saving more than €160,000 over six years compared with human-only surveillance.

‘The window of opportunity is closing’—Voices from the commission

“Health is not an isolated medical issue. It arises within complex ecosystems,” says Professor May, Chair of the Board and Head of the Department of Infectious Disease Epidemiology at BNITM and a Commission member. “If we keep thinking in silos, we risk pandemics, drug-resistant pathogens, and the collapse of food systems.”

Professor Amuasi adds, “Governments and international organizations must embed One Health into national strategies and budgets. But implementation will only succeed if stakeholders work together as equals. This also applies to the recently concluded pandemic agreement. Only then can we build trust worldwide and prevent pandemics.” Amuasi heads the BNITM Global One Health Research Group and was corresponding author of the report.

Outlook: A roadmap for the future

The Commission presents a clear agenda. It calls for an international One Health governance structure, comparable to the Paris Climate Agreement. National governments should enshrine One Health in legislation and strategies, reallocate budgets, and establish early warning systems for diseases at the human-animal-environment interface. Equally important is a paradigm shift in economics—away from growth-only thinking towards models that prioritize well-being, sustainability, and equity.

One Health should be integrated into university curricula, development programs, and international trade and climate agreements. The Commission stresses: protecting human health starts in farms, forests, air, and water. Only then can the United Nations’ Agenda 2030 Sustainable Development Goals—from health to climate and biodiversity—be achieved.

Responsibility lies with all UN member states, supported by the quadripartite World Health Organization (WHO), World Organization for Animal Health (WOAH), Food and Agriculture Organization of the United Nations (FAO), and United Nations Environment Program (UNEP).

Provided by
Bernhard-Nocht-Institut für Tropenmedizin