By Tamra Lysaught; Zohar Lederman; Sangeetha Watson, 

Centre for Biomedical Ethics, NUS Yong Loo Lin School of Medicine,

Benjamin Capps, Department of Bioethics, Dalhouse University, Canada,

Michele Bailey, Department of Physiology, NUS Yong Loo Lin School of Medicine,

David Bickford, Rimba, 4 Jalan 1/9D, 43650 Bandar Baru Bangi, Selangor, Malaysia,

Richard Coker, London School of Hygiene and Tropical Medicine, United Kingdom &

Paul Anantharajah Tambyah, Department of Medicine, National University Health System, Singapore

In the last 20 years, Asia has been a hotspot for emerging infectious diseases, the majority of which have been zoonotic in origin – meaning that they are shared between humans and animals. Severe Acute Respiratory Syndrome (SARS), Nipah virus, A H5N1, A H7N9 and other novel avian influenzas are zoonoses that have emerged from within Asia. These and other zoonotic Emerging Infectious Diseases (zEID) have significant impact on public health. Governments in the region and international agencies such as the World Health Organization are on high alert to respond to any potential threats.1


Singapore has a significant role in the prevention and control of zEIDs in Southeast Asia, and based on its experience with SARS in 2003, has developed multi-agency planning and infrastructure to respond to zEID threats. This was activated during the outbreak of influenza A H1N1 in 2009.2 In 2012, the government created a One Health (OH) platform to bridge gaps and strengthen cooperation between the three government agencies responsible for human health (the Ministry of Health – MOH), food safety and animal and plant health (Agri-Food & Veterinary Authority of Singapore – AVA), and the environment (National Environmental Agency – NEA).3


The OH approach has been described as the cross-disciplinary collaborative effort of researchers and policymakers working locally, nationally and globally to “attain optimal health for people, animals, and our environment”.4 It advocates for an ecological perspective covering human and non-human health, drawing attention to the linkages between socio-economic, cultural and environmental factors that shape our understanding of zEIDs across species.5 However, despite endorsements from numerous organisations – including the U.S. Centers for Disease Control and Prevention, the WHO and the World Organisation for Animal Health (OIE) – OH currently lacks an ethical foundation.

A multi-disciplinary group of researchers from the NUS Centre for Biomedical Ethics, the Department of Medicine, the Department of Physiology, the Department of Biological Sciences and the Saw Swee Hock School of Public Health set out to address this gap in a project funded by a Communicable Diseases: Public Health Research Grant from the Ministry of Health. This project was a mixed methods study that engaged local opinion leaders on the conceptual and ethical priorities of the OH approach in Singapore. Key findings from this project, recently published in PLOS One, suggest that the experts felt that zEID planning under an OH approach would benefit greatly from an ethical ecological framework that accounts for justice in human, animal, and environmental health.6


Justice is commonly conceived as fairness, relating to fair distribution of resources and burdens.7 Although justice is well studied in public health, conflicts also arise around the fair distribution of benefits and burdens between human and animal populations. Viewed through the lens of justice, OH should broaden the ethical discourse to include zoological and ecological concerns. In addition, urban cities and city-states (including Singapore) should play a greater role in helping to manage the regional circumstances that cause zEIDs to spill over into human populations in the first place. As global citizens, Singaporeans have an interest in tackling these conditions even in predominantly rural regions, because endemic zoonotic pathogens can rapidly decimate human and animal populations in low-resourced settings and spread into neighbouring countries, causing widespread morbidity, mortality and even socio-economic instability. Those diseases can develop into pandemics through international trade and travel channels. As a major global hub, Singapore can be better prepared through wider investment in regional OH infrastructure. We can also share our expertise in responding to zEIDs through expansion of existing programmes and collaborations.

References

1. Coker RJ, Hunter BM, Rudge JW, Liverani M, Hanvoravongchai P. Emerging infectious diseases in southeast Asia: regional challenges to control. Lancet. 2011; 377: 599-609.

2. Ong CWM, Ho KY, Hsu LY, Lim AYT, Fisher DA, Tambyah PA. Reacting to the emergence of swine-origin influenza A H1N1. Lancet Infect Dis. 2009;9:397-398.

3. Agriculture and Veterinary Authority, Working Together As One: Annual Report 2014/2015. https://www.ava.gov.sg/docs/default-source/publication/annual-report/ava-2014-2015-ar. Accessed December 13, 2016.

4. American Veterinary Medical Association. One Health: A new Professional Imperative. https://www.avma.org/KB/Resources/Reports/Pages/One-Health.aspx. Accessed December 14, 2016.

5. Capps B, Bailey MM, Bickford D, et al. Introducing One Health to the ethical debate about zoonotic diseases in southeast Asia. Bioethics.2015;29:588-596.

6. Lysaght T, Capps B, Bailey M, et al. Justice is the missing link in One Health: Results of a mixed methods study in an urban city state. PLoS One. 2017;12:e0170967.
7. Rawls JA. Theory of Justice. Cambridge, MA: Belknap Press of Harvard University Press; 1971.