This study examined the long-term impacts on respiratory rehabilitation services before and after the coronavirus pandemic and its transition to Class 5 status, using insurance data from Kanagawa Prefecture, Japan (2014 to 2024). Using seasonal autoregressive integrated moving average predictions and interrupted time series analysis, we analyzed changes in rehabilitation volume and patient numbers across 3 periods: prepandemic, pandemic, and post-Class 5 transition. The result shows service intensity increased from 12.0 to 14.2 units per patient per month, indicating greater complexity of care needed. Most notably, we identified a consistent lag pattern, with rehabilitation demand surging 1 to 2 months after each infection wave peak, providing a predictable sign for healthcare administrators. The fifth wave triggered the most dramatic response with service volume increasing by approximately 80% and patient numbers by 50% above projected values. Patient composition analysis revealed a consistent presence of both COVID-19 and non-COVID-19 patients throughout the study period. Also, the most important findings were significant increases in monthly rehabilitation claims, persisting irreversibly, even after the pandemic officially ended. The sustained increase in respiratory rehabilitation demand likely exacerbated resource allocation challenges for other rehabilitation services, suggesting potential tradeoffs in care delivery. While significant level and trend changes occurred after the pandemic's emergence, no statistically significant decrease followed the Class 5 transition, with elevated levels continuing. This persistent shift suggests the need to strengthen healthcare system resilience through optimal resource allocation, professional training, and alternative delivery models, including telerehabilitation.
Older adults are disproportionately exposed to greater risk of harm and adverse outcomes in humanitarian emergencies. This systematic review explores and evaluates contemporary evidence on the role of paramedics in responding to humanitarian emergencies, with a specific focus on their ability to reduce the vulnerability potential for older adults. A systematic review of the literature was undertaken using Joanna Briggs Institute evidence summary and PRISMA guidelines. From an initial yield of 4,440 results, 16 sources of evidence met the criteria for inclusion and data extraction. Predominantly North American, the literature confirmed that older adults experience disproportionate and complex vulnerability in humanitarian emergencies. As frontline healthcare workers, paramedics are uniquely positioned to respond to community and individual vulnerability before, during, and after emergency exposure, but they experience significant impediments to optimizing practice. There is an unmet professional need to improve paramedic's capacity to address older adults' vulnerabilities and to enhance their rights to healthcare, personal protection, and health and social security. This review provides key recommendations for reconceptualizing the duty of care and improving the capacity of paramedics to respond to the vulnerabilities of older adults manifested by humanitarian emergencies.
The current conversation regarding the potential for a mirror organism, opposite in chirality to typical life on Earth, presents a unique opportunity for the biosafety and biosecurity policy communities. It allows for meaningful and productive conversation before the technology can create a complete mirror organism. Because of their unusual structure and chemistry, mirror organisms might evade immune systems or survive undetected in the environment, posing atypical concerns that current risk assessment and mitigation systems are not built to manage. Due to a lack of data about how mirror life might interact with living things, this emergent biotechnology presents a case study in how to develop a future policy framework to mitigate novel risks: flexible and adaptable, forward-looking, and ready to act before problems arise. Building on existing proposals for cautious, conditional oversight for mirror life, this commentary advances a proposal for adaptive governance, tiered checkpoints, early warning signals, institutional roles, and international coordination systems that evolve as the science develops. It also argues that with structured risk forecasting, regimented oversight, and shared global norms, it is possible to support responsible scientific innovation while protecting against the risks of mirror life.
Places widely known as "wet markets" have been identified as posing a risk to human health, since these food retail spaces are broadly considered to have unhygienic conditions and support the wild animal trade. While costly regulatory interventions into these markets have been proposed, there is little scientific consensus about responsibility for developing evidence about the risks of such markets or conducting surveillance of markets. The aim of this scoping review was to assess the empirical research that has been done using this term, "wet markets," in order to better understand the kinds of knowledge generated about places referred to as "wet markets" and to identify relevant policy recommendations related to these spaces. We conducted a scoping review searching PubMed, Web of Science, and Scopus databases in March 2024 and identified 335 unique articles, 144 of which met inclusion criteria for final review. The majority of studies focused on the prevalence of pathogens in meat from domesticated sources and vegetables. Studies were predominantly conducted in Asia. Notably, this scoping review did not find any empirical studies on the wild animal trade alongside food trade at "wet markets." We did find distinct differences between narratives among Western public health institutions and empirical evidence on food safety and foodborne illness in Asia. Institutions concerned with health security and One Health should consider research designed to improve the evidence base for targeted interventions and strengthen surveillance in order to better respond to risks as well as better grasp their measurable magnitude.
The COVID-19 pandemic did not take us completely by surprise. The experts in public health worldwide heard the warnings and tried to alert and act. In many places, surveillance systems to monitor the emergence of new pathogens were set up. Many countries worldwide worked on prevention and preparedness for epidemic-prone infectious diseases. The rapidity of the identification of a novel human virus, and the quick sharing of its full sequence compared to past epidemics is proof of the continuous improvement of our systems worldwide. Immediately after the emergence of SARS-CoV-2, the first difficulty facing this completely new virus was to set up specific and sensitive diagnostic tools. The implementation of efficient and robust RT-qPCR in a timely manner has been critical for the global response. MediLabSecure, an international One Health project working on preparedness and prevention of zoonotic viruses in 22 Mediterranean, Black Sea, and Sahel countries, had been crucial to support the rapid and efficient implementation of diagnostic and sequencing tools in the region. During the first months of the pandemic, MediLabSecure shared protocols with all beneficiary countries, and sent reagents and positive controls corresponding to more than 23,000 reactions with public health and veterinary laboratories from 21 countries involved in SARS-CoV-2 diagnostics. This support facilitated and was significant for the first detection of cases in 15 countries of the network. Additionally, MediLabSecure shared sequencing protocols and trained scientists and technical staff for the sequencing and characterization of the virus during the pandemic. The One Health approach involving veterinary and public health laboratories proved highly beneficial for both sectors. This case study aims to advocate the importance of One Health and international capacity building projects, such as MediLabSecure, as essential actors in the multisectoral fight against emerging infectious diseases and for the efficiency and resilience of our public health systems.
In this article, we propose a metagenomic next-generation sequencing (mNGS) system for symptomatic clinical respiratory disease samples in Israel to enable detection early enough to contain novel pathogen outbreaks, limit international spread and expedite countermeasure development. We built an open-source, interactive SEIR (susceptible, exposed, infectious, recovered)-based model extending the work of Sharma et al (2023) for 7 representative known respiratory pathogens with pandemic potential, aiming to estimate costs and detection time for the identification of a novel respiratory pathogen in Israel through a network of mNGS monitoring in hospitals. We find that a novel pathogen with SARS-CoV-2-like characteristics could be detected within 68 days (interquartile range [IQR]: 53 to 80) after the first 2 emergency department presentations and 213 (IQR: 94 to 429) total infections across Israel. This surveillance system would cost US$24 million annually over 10 years when implemented in Israel's 6 largest hospitals, covering 37% of the population. Our open-source interactive model allows policymakers and experts to explore different system configurations and their associated tradeoffs between cost, detection speed, and population coverage.
The classical One Health paradigm-centered on the biological interdependence of humans, animals, and the environment-does not adequately address the deepening psychosocial consequences of climate change, ecological collapse, armed conflict, and mass displacement. This commentary presents the International Mental Health Organization (IMHO) and the International Health Tribunal (IHT) as institutions that operationalize a new architecture of global health governance rooted in psychosocial protection. IMHO deploys interdisciplinary crisis response strategies that integrate mental healthcare, community-based resilience programs, and legal-humanitarian diplomacy. Concurrently, IHT establishes a precedent-based framework for prosecuting systemic neglect of psychosocial health under international law. Based on case studies from Colombia, Gaza, Haiti, and Mozambique, I illustrate how traditional health frameworks systematically overlook collective trauma and emotional collapse. I also introduce practical tools-such as cumulative trauma indicators, regional stabilization hubs, and the proposed Convention on Mental Health Protection-to institutionalize psychosocial foresight within the One Health Security doctrine. Ultimately, these institutions reframe mental health not as a derivative concern, but as a foundational element of international security, and call for an intergenerational and intercontinental pact to uphold psychosocial resilience as a universal legal and ethical imperative.
Cross-border biological threats are increasing both in frequency and complexity. Whether of natural, accidental, or deliberate origin, they pose serious risks for public and animal health, economics, and national security. They can also create vulnerabilities capable of being exploited by malicious actors, worsening health crises, and undermining trust in response efforts. Although both the health and security sectors share a common interest in mitigating these threats, they often operate in silos. The One Health approach, which aims at optimizing the health of animals, people, and the environment, has gained momentum in recent years; however, its implementation faces challenges such as weak governance, lack of resources, and, notably, the exclusion of security actors whose roles and capacities remain underrecognized. Security actors play a vital role in preventing, detecting, and investigating criminal activities related to biological incidents as well as supporting health actors with biological threat response. There is a general lack of understanding of the One Health approach within the security community and health is often predominately viewed through a human safety viewpoint often omitting animal and environmental health. This commentary advocates for the mutual integration of One Health and security approaches to strengthen resilience against cross-border biological threats. Concrete examples and recommendations to foster integration are discussed such as updating legislation, formalizing information sharing mechanisms, and undertaking joint capacity building, all while recognizing common challenges in mutual integration. To protect people, animals, and the environment alike, it is time to act to ensure coordinated efforts to mitigate cross-border biological threats.
Pig farmers in the United States have a demonstrated historical and ongoing commitment to continuously improving pork production practices. This commitment includes employing One Health practices on their farms through the 6 We Care® Ethical Principles (WECP). These principles are a producer-conceived, philosophical guidance for pork production that empowers and protects people who work on the farms and live in communities where pork is produced. Simultaneously, these principles safeguard the planet's environment and natural resources and ensure the wellbeing of pigs themselves. As such, they directly align with One Health practices that recognize the connections between human, animal and environmental health. While historically, the One Health approach has been applied to emerging and reemerging zoonotic diseases, this approach is equally applicable across all aspects of pork production. Embedded within the US swine industry are programs such as Pork Quality Assurance® Plus, Transport Quality Assurance®, and the Common Swine Industry Audit. These education and certification programs employ One Health strategies in a way that has direct, "in-barn" application and ensure producers are following industry-established best practices. The One Health approach was implemented by the US swine industry in 2013, with the detection of porcine epidemic diarrhea virus (PEDV) for the first time in the US herd. This disease led to a herd mortality of up to 50% and significant reduction in the number of pigs produced in the United States during a 12-month period. The impacts of the virus were devastating and the response to it required an interconnected, multifaceted approach. We verify the use of a One Health approach through the application of the WCEPs by the US swine industry to respond to the 2013 PEDV outbreak.
When scientific scandals occur in non-Western countries, the focus of media and scientific discussions is often placed on the "rogue scientist" and the reactions of prominent Western scientists to the controversy. But the reactions and actions of the overall national scientific communities are often ignored or erased. Yet, even in countries with less developed public debate traditions, scientists have a role to play in shaping governance, ethics, and responsible research. We illustrate this point by highlighting the responses of the Chinese and Russian scientific communities to the actions of Chinese scientist He Jiankui and Russian scientist Denis Rebrikov, both of whom conducted or planned controversial human germline genome editing experiments. By placing the spotlight on the debates that occur within the larger scientific communities in these 2 countries, we aim to highlight the varied ways these communities have engaged with the public and government authorities to shape public discourse in debates and deliberations around controversies involving science and technology, and what they are able to achieve even in the confined space permitted by authoritarian regimes. Recognizing the work of local scientific communities is important not only to identify commonalities that can be leveraged to promote ethics and governance of emerging areas, such as germline genome editing, at the global level but also to promote continued mobilization against irresponsible scientific behavior in these countries.
Biological research, including dual-use research of concern and pathogens with enhanced pandemic potential, faces mounting regulatory scrutiny that may impact pandemic preparedness and scientific progress. At a 2024 deliberative workshop in Reno, Nevada, biosafety professionals, biosecurity experts, and life sciences researchers discussed potential barriers to effective governance, including ambiguous regulatory definitions, resource disparities between regulated institutions, and fragmented oversight frameworks that impose burdens without improving safety or security. By incorporating biosafety professionals' expertise into policymaking, fostering a collaborative dialogue over punitive and inconsistent enforcement, and securing ongoing funding for biosecurity programs, we call for actionable strategies to reduce risk while advancing safe, secure, and transformative biotechnological breakthroughs in the life sciences and strengthening national security.
One Health is an integrated, unifying approach that aims to sustainably balance and optimize human, animal, and environmental health by recognizing their interdependence and encouraging collaboration across sectors and disciplines. While progress has been made in applying One Health to complex health issues, putting these strategies into practice remains difficult due to resource (eg, funds), structural (eg, governance) and situational (eg, political) constraints and gaps in infrastructure and capacity. These limitations often force decisionmakers to prioritize certain health issues over others. Prioritization by its nature counters the ethos of One Health, reducing the complexity of health systems to a few key outcome goals or actions. To leverage the strengths of One Health, while recognizing the rigidity of real-world health systems, we propose key considerations and strategies for prioritization within this framework. We advocate for cross-sectoral communication structures that support proactive, collaborative networks. Effective collaboration must extend beyond professional circles to include meaningful engagement with communities, ensuring that local context and lived experience inform decisionmaking. We highlight the importance of multisolving-identifying interventions that provide cobenefits across sectors-and the need for adaptive strategies that address both immediate needs and long-term goals. As we navigate a polycrisis of health threats (such as pathogens) and threat multipliers (such as climate change and antimicrobial resistance), embracing flexibility and adaptive thinking is essential for translating One Health ideals into practical applications that are feasible, politically viable, and socially relevant.
Strengthening biosecurity is critical for preventing the misuse of life sciences and achieving the goals of the Biological Weapons Convention (BWC). However, the global biosecurity landscape is hindered by fragmented efforts, inconsistent regulations, and limited resources, particularly in low- and middle-income countries and regions. Addressing biosecurity challenges requires active engagement of diverse stakeholders, including government, international organizations, academia, professional associations, industry, and civil society organizations. All of these stakeholders play key and complementary roles in different aspects of biosecurity. In this article, we examine 4 case studies for multistakeholder engagements and analyze major stakeholders for their relevant biosecurity roles, strengths, and limitations. We also provide policy recommendations and practical steps to fully realize the potential of multistakeholder engagement, including building networks and coalitions of stakeholders, creating educational and training initiatives, advocating for biosecurity standards, and improving communication channels that are suited to the interests of stakeholders. Additionally, we highlight the importance of having an inclusive and diverse representation of stakeholders. Multistakeholder engagement could enhance biosecurity and lower global risks while building robust structures to successfully handle biological threats in the future by promoting synergies while maximizing the optimal use of available resources.
Diseases caused by pathogens that affect animals, humans, and their shared environment (zoonoses) impact regional and global health security. Context-specific recommendations could help control animal-to-human pathogen spillover and mitigate the risk of epidemics and pandemics. Our objective is to share the codevelopment of a guidebook to counter zoonotic spillover in Southeast Asia and how participatory approaches and implementation science guided One Health actor groups towards a common goal. The project was a collaboration between the International Network for Governmental Science Advice Asia and the US National Academies of Sciences, Engineering, and Medicine. Experts in disciplines including virology, bioinformatics, wildlife conservation, biodefense, epidemiology, participatory research, and implementation science codeveloped behavior change and policy recommendations. Participatory exercises, including silent reflections, role-playing, and the "systems-thinking iceberg" enabled dynamic discussions that helped incorporate diverse perspectives. The team identified ways to overcome linguistic and discipline-specific language barriers, time differences, limitations to voluntary participation, and technological challenges. The frameworks and concepts that guided the team were the Consolidated Framework for Implementation Research, the principle that participatory approaches enable positive social learning, and the concept that interventions can be adapted to the local context but should not be reinvented. Participatory approaches can support One Health actor groups work toward a collective vision, which catalyzes a process that can improve local ownership, ultimately working to strengthen health security.
When outbreaks of emerging and reemerging zoonotic diseases are discussed, little attention is paid to differential gender impacts, or to gender involvement and roles in different settings during the outbreak. Gender roles shape how individuals' interactions with animals, wildlife, other people and the environment, which influences exposure to zoonotic pathogens. For example, in some rural communities, men may face risks of exposure to emerging pathogens during hunting whilst women who primarily take care of domestic animals may face prolonged exposure to other zoonotic diseases. In some settings, women (and men) lack access to health protection, education or communication with health officials (medical doctors or veterinarians). In some cultures, women are not allowed to speak directly with male service providers, further limiting their access to critical information and services. One Health is a holistic, inclusive approach which should be incorporating a gender lens when considering zoonoses. This includes thinking about the need to create appropriate gender sensitive policies that address disparities in surveillance, response, prevention, detection, and control of the disease (or health issue) being addressed. In this paper, we highlight these issues through several case studies that demonstrate the importance of including gender in zoonotic disease response and, ideally, when implementing prevention measures.
Risk assessments for emerging infectious disease threats are often conducted independently of affected communities. Participatory approaches to risk assessment present an opportunity to integrate community knowledge early in the risk-based decisionmaking process. We conducted a scoping review to understand the breadth of evidence from human, animal, and environmental health disciplines for integrating community participation in steps of the risk assessment process. A systematic literature search in PubMed, Scopus, Ei Compendex, Embase, Web of Science, and Global Health Database identified 4993 articles, of which 138 met inclusion criteria for the review. The types of participatory approaches described in the risk assessment literature varied by degree of community involvement, types of communities engaged, and activities implemented to engage communities. There was substantial evidence from environmental contamination and climate change studies on conducting hazard and exposure assessments within a community-based participatory research model. However, examples of community participation in problem formulation, capacity assessments, data report-back, and pathway mapping were limited. Additionally, the limited examples of community-initiated and community-driven risk assessments suggest a need for improving community involvement from the earliest stages of research priority setting through all phases of data collection, analysis, and interpretation. Further research is also needed on adapting participatory approaches for emerging infectious disease risk assessments.
The zoonotic origin of the COVID-19 pandemic renewed calls for establishing and improving One Health surveillance capabilities globally, yet a lack of universally recognized best practices and clear guidance on how to implement coordinated surveillance across multiple sectors has hindered progress. Without shared surveillance goals, multisectoral data sharing policies and standards, and interoperable tools to aid the establishment and implementation of coordinated surveillance using a One Health approach, many countries are left piecing together systems together without a way to measure success. We have identified 3 priority components that countries should consider addressing and publishing examples of in order to initiate and document examples of successful coordinated surveillance planning and implementation: (1) shared surveillance goals, (2) multisectoral data sharing policies and standards; and (3) interoperable tools. These 3 components could serve as building blocks for the development of regional and global minimal One Health data standards for collection, sharing, and use of multisectoral data to address health threats from a One Health collaborative approach that efficiently minimizes human, animal, and economic costs of epidemics such as COVID-19.
