One Health or Planetary Health for pandemic prevention?

It is a well accepted narrative that the disruption of forests, rapid urbanisation, and population growth are driving zoonotic events simply by increasing close contact between people and animals. However, these predictor variables (eg, urbanisation, land usage, human population density) only explain about 30% of the total variation in zoonotic potential. With advancing technologies, it has been shown that vertebrate RNA viruses, despite transmitting between species, have co-evolved with their hosts for millions of years, which only strengthens the theory that zoonotic diseases caused by RNA virus spillover, such as COVID-19, are linked to human activities and transformation of ecosystems.

Genomic analysis cannot be used to predict spillover and pandemics, mainly because of the scarcity of empirical data and the reliance on reviewing studies and databases. This setback implies that our notion of urbanisation and population growth as the most important drivers of spillover is only part of the story. Attempts to overcome this scarcity by use of complicated statistical methods only compensate somewhat for the missing links and inadequate research efforts. Such a situation shows a clear gap in knowledge on what the other drivers of spillover are. Dedicated studies for establishing these drivers are scarce, given that reducing close contact with animals, including restricting global wildlife trade, is not enough.

A considerable framework shift is needed to change this situation. We therefore ask for the comprehensive integration of planetary health across scientific communities, with clear governance and interdisciplinary links to climate change, which is currently the most immediate threat to the biosphere of our planet. WHO and the UN should drive such integration.

The approach could be inspired by the Arctic Monitoring and Assessment Programme, which is currently the sole international programme that has a true holistic combined planetary approach with clear links to the UN. This programme incorporates ecosystem dynamics including wildlife, infectious diseases, hazardous substances, food supply, and human health, and this type of holistic interdisciplinary programme is the only way to to prevent pandemic zoonotic outbreaks and achieve the UN Sustainable Development Goals.

To date, One Health alone fails to show that it can actually deal with pandemics in practice. John Amuasi and colleagues make excellent suggestions in their Correspondence about a COVID-19 One Health Coalition. However, responding to the COVID-19 pandemic and avoiding zoonitic outbreaks in the future will necessitate a complete change in the intensity of human-managed ecosystems, with decreased deforestation and species extinction, including a reversal of the world's climate tipping points.