7.I AM BECAUSE WE ARE: The South African Foot and Mouth Disease Outbreak as Practical Illustration of One Health Viability

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 I am because we are:The South African Foot and Mouth Disease outbreak as practical illustration of One health viability. When one tugs at a single thing in nature, he finds it attached to the rest of the world. -John Muir Interspecies infection and interactions have historically been handled by veterinary and medical specialists only as far as it pertained to their respective fields but the modern threat of infectious diseases is often accompanied by a need for increased interdisciplinary cooperation and synergy. The rejection of this status quo is gaining momentum as the call for a shift toward One Health gains popularity. Interdependence of different species and the assumption that an inherent connection exists between man, animal and environment serves as the foundational premise that gave rise to the One Health concept. South Africa recently saw the resurgence of Foot and Mouth Disease in a December 2019 outbreak. The human animal interface in this infectious, nonzoonotic outbreak where 14 000 cattle were affected serves as a context for a community that illustrates the interconnected wellbeing as grounds for following a One Health approach. The ‘One Health’ concept flows from a growing idea that an interconnected global community should collectively take responsibility for not only the health but the wellbeing of members of said community in a unified attempt to take control of multifactorial medical challenges. Initially seen in the notion known as ‘One Medicine’, the potential of interdisciplinary collaboration for mutual benefit began to gain momentum in the early 2000’s. (LEE, 2013). One health was born of, and fuelled by, fear. (Gibbs, 2014) The movement was triggered by several international zoonotic crises that made the codependency of different disciplines clear in the complex and multifactorial obstacles facing both veterinary and medical professionals. (GIBBS, 2005). Largely a response to international fear during this wave of what appeared to be several serious epidemics, the ‘One Health’ concept is still in its infancy. (GIBBS E. P., 2002) . Although meant as a paradigm shift and commitment to wider interdisciplinary action that protects the wellbeing of society is often described as a hollow concept that has very little proven efficacy. (Okello, Paul , Gibbs, Vandersmissen, & Welburn, 2018). The idealistic nature of the rose-coloured interdisciplinary synergy is often met with scepticism that can only be proved or disproved through widespread operationalisation practical application that demonstrates the efficacy of this approach in improving global health and wellbeing. In an effort to debunk One Health scepticism the viability of the philosophy has to be either empirically proved or practically demonstrated. (HÄSLER, GILBERT, Jones, & PFEIFFER, 2012) The concept of One Health relies on the premise of co-dependence between the human race, animals and the environment. This serves as an attempt to illustrate the viability of One Health as concept by looking at a tangible example of intertwined human and animal livelihoods and the necessity of applying an interdisciplinary approach in order to preserve the wellbeing that medical and veterinary professionals are responsible for. An effective way of demonstrating the 21 LIELIE VILJOEN IVSA South Africa

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 viability of One Health as philosophy and approach is the practical demonstration thereof. As much as this approach was born in response to an immediate threat, the “inextricable” connection of humans, animals and the environment often lacks tangibility and is only evident during zoonotic outbreaks. Southern African agricultural landscape is clearly divided into commercial and subsistence farming. The commercial farming community survives FMD outbreaks and severe economic losses as its productivity and financial security enables them to afford the necessary measures, vaccinations, quarantine camps and drugs as well as the enormous cost of the animals in affected herds that had to be culled. Subsistence farmers, on the other hand, are a far bigger and more vulnerable group of South African farmers. The FMD outbreak in the Molemole area directly impacted this subset of the South African farming community. Subsistence farming is defined by Barnett et al. as: ‘farming and associated activities which together form a livelihood strategy where the main output is consumed directly, where there are few if any purchased inputs and where only a minor proportion of output is marketed.’’ (Barnett, 1997) These communities are markedly affected by FMD outbreaks, control measures and culling as livestock is directly responsible for the survival of families that are unable to make ends meet with their nonfarm employment. Although the FMD outbreak does not constitute a traditional One Health issue with classical zoonotic considerations, the wellbeing of subsistence farming communities is directly linked to that of animals (Morton, 2007). Seventy-five percent of the world’s 1.2 billion poor (defined as consuming less than one purchasing-power adjusted dollar per day) work and live in rural subsistence farming communities, illustrating the scale of the interrelated wellbeing and tangible One Health in these communities (International Fund for Agricultural Development, 2001). These agricultural practices enable entire communities to survive under the breadline and the loss of this lifeline is part of the threat that infectious diseases pose to these communities. These practices are ancient and forms part of engrained traditions and norms that stem from lifetimes of dependence on animals and the environment. Cattle herds are also used as a bankable asset that carries individuals through unemployment, drought, disease and social disruptions (Van Averbeke & Khosa, 2007). The role of animals in these socio-economic landscapes is not only one of income, direct food source and means of survival, but a symbol of prosperity and integral part of traditions and cultural practices (Scoones, 2009). The FMD outbreak, control measures and culling does thus not only pose a threat to the financial survival of rural communities but to the way of life that these communities have come to know. This exemplifies practical One Health and, in absence of worldwide empirical proof through operationalisation of this approach, the tangibleinextricable bond between man, animal and environment demonstrates One Health in a patent and practical way. The global threat of infectious disease outbreaks is gaining relevance in this day and age. The importance of this specific example, however, is the illustration of the threat that not only links human and animal health through transmission of an infectious disease, but through the disruption of a synergy that constitutes the backbone of subsistence farming communities. The demonstration of One Health principles as part of the natural dynamic of human animal interaction proves the viability and necessity thereof by 22

confirming the livelihood shared by man and animal is inherently interconnected. The destruction of the status quo in these communities illustrates theoretical concepts in a practical and tangible manner. This shows not only the viability but the necessity of One Health as approach to and component of global prosperity. GIBBS, E. P. (2005). Emerging zoonotic epidemics in the interconnected global community. Veterinary Record 157, 673-679. GIBBS, E. P. (2002). The domestic animal/wildlife interface: issues for disease control, conservation, sustainable food production and emerging diseases. Annals of the New York Academy of Sciences, 969. Bibliography:

Okello, A. L., Paul , E., Gibbs, J., Vandersmissen, A., & Welburn, S. (2018). One Health and the neglected zoonoses: turning rhetoric into reality. Vet Record, 169. LEE, K. &. (2013). Operationalizing the One Health approach: the global governance challenges. Health Policy and Planning , 778-785 . Gibbs, E. P. (2014). The evolution of One Health: a decade of progress and challenges for the future. Veterinary Record, 85. HÄSLER, B., GILBERT, W., Jones, B., & PFEIFFER, D. (2012). The economic value of One Health in relation to the mitigation of zoonotic disease risks. Current Topics in Microbiology and Immunology, 127-151. Barnett, A. (1997). AIDS Briefs: Subsistence Agricul- ture. USAID Health and Human Resources Analysis and Research for Africa Project. Morton, J. F. (2007). The impact of climate change on smallholder and subsistence agriculture. PNAS, 19683. International Fund for Agricultural Development. (2001). Rural Poverty Report 2001: The Challenge of Ending Rural Poverty. Rome: IFAD. Van Averbeke, W., & Khosa, T. (2007). The contribu- tion of smallholder agriculture to the nutrition of rural households in a semi-arid environ- ment in South Africa. Water SA, 413-418. Scoones, I. W. (2009). Introduction: Livelihoods in Crisis: Challenges for Rural Development in Southern Africa. IDS Bulletin, 341.