As COP29 wraps up, it is important to recognise the ethical issues that policymakers face when implementing the One Health approach and other health and climate change policies.
The impact of climate change to health has been widely evidenced, including WHO’s work stream on Climate Change and Health. In the United Nations Climate Change Conference (COP29), WHO and the global health community earlier this week have presented the COP29 Special Report on climate change and health.
This work follows COP28, where WHO, alongside other Quadripartite organisations (the Food and Agriculture Organization of the United Nations (FAO), United Nations Environment Programme (UNEP),) and World Organisation for Animal Health (WOAH) published a guide to implementing the One Health Joint Plan of Action. The guide builds up on The One Health Joint Plan of Action published in 2022 and provides a blueprint for nations to develop and implement their One Health Strategies.
Despite these guides and action planning, there is a significant lack of mechanisms proposed which could address ethical issues that arise as part of the implementation of the One Health approach. This is surprising given the high stakes of the COP29 processes and geopolitical wrangling over significant issues of climate justice.
The High-level Roundtable on One Health emphasises the need for a holistic approach, including integrating expertise in public health and environmental sciences. But more focus needs to be placed on the ethical dimensions of the implementation of One Health Plans, since it is only in implementation that change happens.
None of the plans specifically mentions ethics or ways to recognise and address ethical issues arising from implementation. The implementation plans recognise principles of good governance, including equality and accountability, without specific recommendations on how they link to One Health. Justice is mentioned once as a relevant factor among diverse perspectives. The plan recommends operating technical advisory groups without recognising that ethical expertise is also a relevant part of “technical advice”.
Yet each proposition for policy, legislation and financing would benefit from justice, equality and other ethical principles in mind. There is a risk with this form of blueprint thinking about One Health implementation plans that the notion of ethical implementation gets watered down or entirely lost. A closer link with national and international bioethics committees and insights from climate justice and planetary health experts would ensure that ethical deliberation is built into the implementation process. There are already good examples of organisations working on translating One Health approach to a local and regional level, such as One Health Networks (OHNs) and Centre for Planetary Health Policy in Germany. Yet more contextualising of ethical challenges linked to Planetary health and One Health approaches that arise across different geographical areas would benefit implementation efforts.
Advice on ethical issues linked to One Health approach is one of the case studies in “Ethics & Expertise” project. We have seen varying degrees of commitment to and institutionalisation of this approach across three countries we focus on (UK, Germany, Australia). We have also noted conceptual overlap between One Health, Planetary Health, and Global Health approaches.
Yet ethical issues linked to the One Health approach are rarely, if ever, discussed in policy documents or brought up in a public discourse. Ethikrat’s, German Ethics Council’s, report on One Health and NCOB’s publication on health and climate change are welcome exceptions. The issues, however, are multiple, including the following:
- Responsible use of antibiotics in humans, animals, and the environment. Overuse and over-prescription of antibiotics, self-medicating or not completing the course of antibiotics risk developing and increasing AMR. Other ethical concerns are linked to responsible and appropriate use of antibiotics for animals, limiting the use to therapeutic purposes, i.e. to cure sick animals rather than to promote growth.
- Ethics of (zoonotic) infectious disease control. One of the most effective way to prevent the spread of infectious diseases is culling infected animals (and those in close proximity. This indiscriminate slaughtering raises ethical questions about animal moral status and welfare.
- Impact of climate change on AMR. With changing climates and landscapes, animals are increasingly pushed out of their habitats, increasing the likelihood of contact between wild animals, domestic animals, and humans.
- Equity and access. Prioritising access to antibiotics raises ethical questions about equality of access. It is important to enable individuals to access the medicine they need and make informed decisions about their Health. Limiting their access can infringe on individuals’ autonomy to make decisions linked to their own Health.
- Non-human agency and solidarity. There are a number of ethical issues linked to extending moral concern to the non-human world. This is a cause taken up in the legal sphere by the Community Environmental Legal Defence Fund in the US and Australian Earth Laws Centre.
- Development and promotion of new antibiotics. The industry is motivated to develop and sell more profitable drugs, including antibiotics. Rather than considering public concerns, they may focus on their own profit (Adebisi 2023).
- Global resource transfers to address AMR. Countries with limited resources may not be able to address AMR in the same way as countries in the Global North, thus questioning the need for resource transfer from the Global North to the Global South.
(the list is compiled drawing on Hays et al, 2022 and Adebisi 2023)
“Ethics & Expertise” project aims to identify ethics expertise around these issues and see how, if at all, it is integrated in the development of policies, regulations, and implementation plans across different countries. We aim to draw attention to the need to integrate ethics expertise into holistic and non-anthropocentric approach to implementation of One Health agenda, starting at the inter-governmental and inter-agency level, all the way to local implementation.