The “next” pandemic in the USA is not a question of “if” but of “when.” Just as States scramble to win or shore up their victories against COVID-19, a second front appears. Can the USA win a two-front war with microbes?
Two parallel infections now afflict separately humans and pigs. A new strain of the H1N1 swine flu virus, which killed 285,000 people when it merged in 2009, is now spreading among humans working on pig farms in China. The National Academy of Science reported this new threat in June ( https://www.pnas.org/content/early/2020/06/23/1921186117). How can the risks to humans from this new virus, G4 EA H1N1, be contained? This human infection is emerging at the same time that the world experiences the raging animal pandemic of African swine fever virus (AFS). AFS is forcing Asians to kill their domestic pig herds. AFS is now in 17 European nations and threatens to spread across all continents. No one knows now how to contain the AFS Pandemic among animals.
Once early surveillance detects such threats, what precautions are essential to avert the “next” pandemic? Much is at stake. Since February 18, 2020, when ACOEL published its first Blog on COVID-19, (at http://www.acoel.org/post/2020/02/18/CORONAVIRUS-We-Thought-We-Knew-Ye!-The-Wuhan-Potential-Pandemic.aspx ), the virus SARS-CoV-2 has stolen lives and livelihoods. Its impact has vastly exceeded that of the costly HIV-1/AIDs pandemic, or the 2009 H1N1 epidemic.
Like the plague, these diseases, along with SARS, EBOLA or West Nile virus, are the result of infections that spill over from the wild animal kingdom, transmitting disease to humans. This is known as zoonosis. HIV-1/AIDS came from primates in Africa, and since 1983 has killed 38 million humans, and currently sickens 36.9 million persons. When COVID-19 first appeared, it was thought to have come via Pangolins, but now is linked to bats (Rhinolophus), which live in habitats across SE Asia and China. Earth holds perhaps 700,000 different viruses, most not yet discovered. Of the 335 human diseases identified between 1960 and 2004, 61% are of zoonotic origin, and 72 % of all recent diseases are zoonotic.
The frequency of human infections from zoonotic diseases is increasing. Illnesses like Denge, chikungunya, or Zika have shown up in the Americas, and will be joined by others in the future. In 1999, West Nile virus, transmitted to humans by mosquitoes, made its first appearance in the Western Hemisphere in New York, after a drought followed by heavy rains. Since then, over 1,600 people have died of the disease.
Simultaneously while coping with COVID-19, it is evident that governments need to organize to avert a new zoonotic infections. Some are already here, others are coming. For example, Lyme Disease is a continuing threat. Other novel microbes can arrive quickly. Locally infected people travel, and airplanes bring the diseases to distant lands. It took months for rats to bring Bubonic Plague, the medieval “Black Death,” to Europe on sailing ships. Today a virus jumps continents in a few hours. As the economy restarts after COVID-19, governments will need new regimes of phyto-sanitary measures for trade, transportation, and tourism.
Zoonotic diseases are on the rise for several reasons. Escalating declines in biodiversity are the root cause. Biodiversity loss is a health risk multiplier. As populations of species thin, many to the point of extinction, the viruses and bacteria that they host spread out looking for new hosts. Deforestation, and other unsustainable developments, disrupt habitats for many species, which in turn shed their viruses. A zoonotic disease, whether bacteria like Lyme Disease, or a novel coronavirus like SARS, then finds new animal hosts, including eventually human beings. Building new roads or suburban subdivisions fragment the landscape, severs migration corridors, and disrupt ecosystems, thereby exposing more humans to zoonotic microbes. Since humans interface with these disturbed natural habitats, their likelihood of being infected increases.
Climate Change impacts are exacerbating biodiversity loss and augment humanity’s interface with zoonotic infections. Extreme weather events cause a cascade of other effects that influence disease. Heat and droughts create dry conditions, providing fuel for forest fires that end up fragmenting forests and driving wildlife closer to humans. Increased rainfall and humidity provide favorable conditions for mosquitoes to breed and for adult mosquitoes to survive.
If society waits for hospitals and health departments to cope with a zoonotic disease, it is too late. The most effective way to prevent or minimize zoonotic spillovers from animals to humans is to keep all animals healthy. Doing so requires greater attention to veterinary science and the health of domesticated animals and agriculture. For environmental law, it means enhancing nature conservation programs that sustain ecosystem health, everywhere. We reduce the likelihood of zoonotic spillovers by sustaining resilient ecosystems in wetlands, in suburbs, in rural countryside, as well as in parks and wilderness.
An inter-agency, or “whole of government” collaboration, is required. Such collaboration runs against the grain. We promote agriculture as commerce, with insufficient attention to veterinary health of farmed animals. The pandemic of AFS has destroyed the pork industry in China and impacts food supplies worldwide. Animal health is treated apart from human health. Humans and animals exchange TB, zoonotic tuberculosis. Developed economies tend to forget that the well-being of all plants, animals and humans is intrinsically connected, and profoundly affect by human activity. The reality is that there is only “One Health.”
The World Health Organization (WHO) and Food & Agricultural Organization (FAO) endorse a “One Health” approach. The US Centers for Disease Control does too. Consensus favoring a “One Heath” approach has grown, but has been too marginal to make much of a difference. The Wildlife Conservation Society and German government’s 2019 “Berlin Principles,” or the 2017 UN Environment Assembly recommendations, and proposals from the EcoHealth Alliance, have all proposed the “One Health” approach as essential to successfully manage risks of zoonosis.
To date, however, none of the “One Health” advocates translate this policy construct into meaningful action. At most they urge that veterinarians and public health agencies should cooperate. In truth, cooperation between veterinarians, public health agencies, and nature conservation authorities, whether locally or globally through the International Union for the Conservation of Nature (IUCN), today does not exist. All these entities largely ignore the tools that environmental law offers to effectuate the “One Health” approach.
To avert the spillover of viruses or bacteria from wild animals, it is essential to keep natural habitats healthy. At the outset, “One Health” should formally recognize the conservation of wild nature as its foundation. Conservation is too often discounted or deemed merely an amenity. Yet if governments at all levels fail to maintain healthy wild habitats, they invite spillovers of virus and bacteria seeking human hosts. Human incursions are increasing disrupting habitat in the forests of Africa, Southeast Asia the Amazon, or the woods of suburban North America. Disease spillovers increase in turn.
Sustaining biodiversity requires maintaining intact and functional ecosystems. These are the fundamental infrastructure for all of life, our health and our socio-economic well-being. Stemming current losses in biodiversity is the front line for protecting human health. Governments need to mainline biodiversity conservation to manage zoonotic disease risks.
Virtually all governments neglect these tasks. Government budgets reflect an ignorance about the measures that prevent zoonotic spillovers. Budgets invariably assign to Departments of Health more than twice the resources provided for nature conservation and they allocate exponentially more when funding military or police security. COVID-19 reveals the folly of this imbalance. Zoonotic diseases are non-traditional security threats, causing incalculable human and economic loss. The upshot: “Pay me now or pay me later.”
To avert the “next” pandemic, governments can deploy a number of environmental laws to implement a “One Health” approach. Environmental laws provide a suite of policies and best practices exists to avert the “next” pandemic. Given what COVID-19 has taught us, there is some urgency in deploying these tools. Would it not be irresponsible to fail to do so?” Will we? The war on COVID-19 has so far precluded debate about preparing to avert the “next” pandemic. We face the risk of “business as usual,” and choosing not to learn, as happened after the experience of SARS in 2003-2004.
Since the “next” zoonotic spillover is underway, it is essential to actively manage the interface between humans and animals. Surveillance of emerging diseases requires collecting data constantly, as a priority. To ensure that warnings from this surveillance are acted upon, each level of government needs to provide a strategic, high level coordinating council or executive body to oversee these efforts. Many governments do so now (See the 2019 Trilateral Guidance by WHO, FAO, OiE, at http://www.fao.org/3/ca2942en/ca2942en.pdf). The USA briefly had such a strategic unit, begun after the Ebola crisis by the Obama Administration. The White House Directorate for Global Heath and Security in the National Security Council addressed these non-traditional security issues. President Trump discontinued this unit. While the President’s Council on Environmental Quality (CEQ) could be tasked with these coordinating roles, CEQ’s weakened capacity means that Congress and future Presidents will need to do even more in order to coordinate all federal agencies to protect domestic health.
Every State government should have a gubernatorial body to prepare for and coordinate zoonotic risk management. Such bodies exist already in some cases. For example, New York State can and should activate the Governor’s Council of Environmental Advisors, as is authorized under Article 7 of the Environmental Conservation Law. A statutory body is needed to prevent a future executive from neglecting this strategic cockpit for “One Health.” Where no such authority exists, the legislature should provide for one.
A top priority for any executive coordinating body will be to address how to manage zoonotic risks while addressing the impacts climate change. For example, New York’s Climate Leadership & Community Protection Act of June 2019 provides tools that could be used to provide “One Heath” safeguards. In §75-0109 of the Environmental Conservation Law, this Act provides for off-setting carbon emissions through extending forests and other ecosystems to enhance the photosynthesis that removes carbon dioxide from the atmosphere. The same healthy habitats serve to avert zoonosis spillover.
The same Act amended New York State’s Community Risk And Resilience Act in ways that directly also could be deployed to protect against zoonotic diseases. § 17-A mandates that the Department of Environmental Conservation (DEC) address impacts on public health and species and to identify the most ”significant climate-related risks,” along with measures to mitigate those risks. § 17-B requires applicants for all permits to identify physical climate-risks and how to handle them and authorizes DEC to mandate mitigation measures. Increased disease spillovers are climate risks.
Environmental Impact Assessment (EIA) is another readily available tool. The data from environmental assessments can be harvested to identify zoonotic risks. Although President Trump is currently seeking to limit the role of the National Environmental Policy Act, the NEPA Regulations can and should address potential environmental impacts from zoonotic risks. Half the States also have their “little NEPAs” and assess zoonotic risks. The California Environmental Quality Act (CEQA) and the New York State Environmental Quality Review Act (SEQRA) are prime examples. They require all state and local governmental agencies to make a holistic evaluation of potential environmental impacts and risks. EIA effectively enables a “One Health” approach. Beyond collecting data on ecological zoonotic risks, EIA can identify options for sustaining health of ecosystems to contain spillovers of bacteria and viruses, identify the cumulative impacts exacerbating biodiversity loss, and identify how to fragmentation of intact ecosystems and restore migration corridors for species.
State building codes also serve a role to contain the spread of viruses within buildings. Codes can be revised to mandate “healthy buildings.” For example, ventilation and filtration systems should be retrofitted to reduce risk of airborne exposures to communicable diseases. See Joseph G. Allen and Joseph D. Macomber, Healthy Buildings: How Indoor Spaces Drive Performance and Productivity (Harvard University Press, 2020).
Ultimately, “One Health” is all about sustaining biodiversity. The federal systems of National Parks, Wildlife Refuges and National Forests provide opportunities to enhance stewardship of natural areas. State park systems, and state wetlands laws, do the same. Zoning and land use laws at the state and local level also can provide for care of natural systems to manage zoonotic risks. Municipal land use laws can provide, for example, for migration corridors through overlay zones, or obliging property owners to control mosquito breeding, all to minimize infection risks. When ecological habitats remain undisturbed, the bacteria and viruses in wild nature tend to remain relatively stable in their natural hosts, which dilutes the chances of spillovers to humans.
Finally, the federal government and the states can establish and enhance phyto-sanitary safeguards for their agricultural sectors, and control animal products imported into or through the states. Since 1947, the General Agreement on Tariffs and Trade (GATT) has respected the rights of countries to impose such safeguards. California has done so for many years to protect its agricultural sector. Theses phyto-sanitary norms need to be expanded robustly to address zoonotic risks. Precautions to prevent microbes entering in our airports and at State borders can be established.
Once a “One Health” approach is made operational, many state agencies will discover how they help avert the “next” pandemic. There are key roles for agencies regulating agriculture, produce markets, public health, environmental protection, forestry, wildlife conservation, transportation, and other State agencies are key parts of the “One Health” approach. States have substantial expertise in their universities, organizations like the Wildlife Conservation Society, as well as across their public health sectors. Each state and local agency needs to undertake continuous biodiversity-related heath surveillance in order to detect and manage emerging zoonotic disease spillovers to avert health emergencies. Each can be alert to end habitat fragmentation, and can provide buffer zones that manage disease-risk from human interfaces with animals in shared ecosystems.
Even in the middle of this COVID-19 Pandemic, governments need to be building back better, to be anticipating and preparing for the “next” pandemic. As Ben Franklin said in 1736, “An Ounce of Prevention Is Worth A Pound of Cure.” States cannot wait for Washington, D.C. They each must build their own resilience. Leadership from the States can pilot the nation toward the security of “One Health.”