A TIMELY serious One Health issue…

Tackling the ebola epidemic in west Africa: why we need a holistic approach

Immediate medical action is not enough to manage the disease. We need cross-sector collaboration and integrated research [One Health]

By Naomi Marks

Guardian Professional, Thursday 19 June 2014 12.18 EDT

As the death toll from ebola in west Africa continues to rise, there is a growing awareness of the threat of diseases transmitted from animals to people.

Ebola, a haemorrhagic fever that causes uncontrolled bleeding, is dramatic in its manifestation and has a case fatality rate of up to 90%. Its emergence can be sudden and unexplained, and, as the recent crisis shows, it can spread across communities and borders with alarming speed.

What the outbreak confirms is that if animal transmitted diseases such as Ebola – known as zoonoses – are to be tackled effectively, the response must go beyond media focus and immediate medical action when an epidemic hits. There is a crucial need for multidisciplinary working over the longer term to gain a holistic understanding of the drivers of these diseases.

This so-called one health approach takes as its premise an understanding that human health, animal health and environmental health are all interlinked. It calls for collaborative efforts between natural and social scientists – including doctors, vets, environmental scientists, geographers and anthropologists – at local, national and international levels.

Such a holistic understanding of health is not new. It is however increasingly gaining traction among those in the field, with the veterinary sector proving to be particularly quick to recognise the benefits of one health. A recent joint research initiative from the Department for International Development (DfID) and the social science, natural environment, medical and bioscience research councils, recognises the benefits of the approach. It aims to fund multidisciplinary research that would, among other benefits, reduce the impact of zoonoses on vulnerable people and their livestock.

When natural and social scientists work together – not just alongside each other, but meaningfully integrate their findings – it can be very productive. However, breaking down the barriers between researchers is one thing. The real challenge is to persuade those with the funds and the power to make cross-sector action happen. One of the issues that urgently needs to be tackled is a reconsideration of funding models to help facilitate cross-sector working.

Over the past 40 years more than 60% of emerging infectious diseases affecting people have had their origin in wildlife or livestock. Many of these zoonoses may cause death more slowly than Ebola, and remain unnoticed by anybody outside the immediate populations affected by them, but their effects are often devastating.

An example is trypanosomiasis, a disease caused by parasites transmitted by the tsetse fly, which affects both humans and animals and is widespread in large parts of Africa. This disease is one of four zoonoses being studied by the multidisciplinary research programme Dynamic drivers of disease in Africa, which is considering the complex links between ecosystems, zoonoses, health and wellbeing. While there were 88 Ebola cases reported in 2012, 50 of them fatal, there are an estimated 30,000-50,000 new cases of trypanosomiasis reported each year, with some 48,000 deaths recorded annually. In addition, the disease is likely to be misdiagnosed as in its early stages it is often confused with malaria and in its later stages with Aids.

Trypanosomiasis is fatal when left untreated and even when it is, it has a prolonged recovery period. As a result, it can ruin lives and livelihoods. The UN Food and Agricultural Organisation says the disease probably threatens rural development and poverty alleviation in sub-Saharan Africa more than any other disease.

Like ebola, a multidisciplinary approach to understanding trypanosomiasis is essential if it is to be controlled. Take Zambia, where trypanosomiasis has historically acted as a limitation on human settlement, with families keeping away from fertile but highly tsetse-infested areas. Land pressure is increasingly leading to colonisation of these areas. Land clearance for cash crops such as cotton is also thought to be having an effect on tsetse populations, and thus the spread of the disease.

In addition, there are likely to be social differences in vulnerability to trypanosomiasis, based on gender roles, livelihood patterns and the different ways in which people interact with their environment. These points are aside from other, 'macro' changes, such as climate change and urbanisation, which may be having an effect on tsetse ecology and disease transmission. Thus, it can easily be seen how medical research on its own is insufficient to understand and tackle the disease.

The stories behind a host of other zoonoses – from rift valley fever to ebola – are just as complex. Only multidisciplinary research can help to reveal and unravel their complexity. Without a holistic understanding of all the inter-related factors affecting the emergence, transmission and spread of zoonoses, disease management or elimination will remain beyond our reach.

Naomi Marks works for the Dynamic Drivers of Disease in Africa Consortium.

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Permission to post on One Health Initiative website by:


Naomi Marks

Communications Officer

Dynamic Drivers of Disease in Africa Consortium

STEPS Centre

Institute of Development Studies

Brighton, BN1 9RE


Twitter @DDDAC_org

Tel: +44 (0) 1273 915606




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Ebola virus – A One Health History




Eminent virologists, Drs. Karl Johnson (physician) and Fred Murphy (veterinarian) worked at CDC as co-equal investigators, together discovering the etiologic agent of Ebola hemorrhagic fever, the Ebola virus. Dr. Johnson described their “One Health” collaborations:

“Fred Murphy and I collaborated on zoonotic viruses, their pathogenesis, epidemiology, and ecology; initially at great distance but later in daily contact at CDC.  Although Ebola virus was perhaps the most notable project, our work over many years truly exemplifies the concept of One World, One Medicine, One Health.
My prayer is that support, both scientific and financial, for the marriage of human and veterinary medicine will grow at an ever expanding rate.  The earth requires it.”



Dr. Fred Murphy (veterinarian), Dr. Johnson’s CDC colleague-collaborator in the discovery and identification of the etiologic agent of Ebola hemorrhagic fever, the Ebola virus.

“My recent delving into the foundations of medical and veterinary virology has provided much evidence of common roots and incredible early interplay, much more than we see today. For example, Walter Reed and his colleagues, the discoverers of the first human virus, yellow fever virus, acknowledged the influence of Friedrich Loeffler and Paul Frosch, who had discovered the first virus, foot-and-mouth disease virus, a few years earlier.”