A Unified Front Against Infectious Diseases and Antimicrobial Resistance
Imagine a single health threat that claims more lives in Africa than HIV/AIDS, tuberculosis, and malaria combined. A threat that doesn't distinguish between humans, animals, or the environment they share.
Antimicrobial resistance causes 27.3 deaths per 100,000 people across the continent, the highest mortality rate worldwide 4 .
Approximately 75% of emerging infectious diseases have zoonotic origins, transmitting from animals to humans .
What if we could address these interconnected threats through a single, powerful approach? Enter One Health—a transformative way of thinking that recognizes the fundamental connection between human health, animal health, and our shared environment.
One Health represents a simple but revolutionary idea: the health of humans, animals, plants, and their environments are inextricably linked. This approach calls for collaborative, multisectoral, and transdisciplinary efforts across local, regional, national, and global levels to achieve optimal health outcomes 1 2 .
Human, animal, and environmental health are deeply interconnected systems.
Africa experiences a disproportionate share of zoonotic disease outbreaks, from endemic threats like brucellosis and leptospirosis to emerging dangers such as Ebola, Lassa fever, and COVID-19 1 . This vulnerability stems from several interconnected factors:
Deforestation and urbanization force wildlife into closer contact with human populations .
Intensive farming and wildlife hunting create new disease transmission pathways 1 .
Shifting temperatures and rainfall patterns expand the range of disease vectors 1 .
| Driver Category | Specific Examples | Impact on Disease Spread |
|---|---|---|
| Environmental | Deforestation, urbanization, bush burning | Displaces wildlife, increasing human-animal contact |
| Agricultural | Intensive farming, wildlife hunting, wet markets | Creates new pathogen transmission pathways |
| Socioeconomic | Bushmeat consumption, rapid population growth | Increases exposure to animal reservoirs |
| Climate-Related | Changing rainfall patterns, temperature shifts | Alters vector distribution and behavior |
While dramatic disease outbreaks capture headlines, AMR represents a more insidious crisis. A comprehensive report revealed that bacterial AMR was responsible for just over a quarter of the nearly 4 million infection-related deaths that occurred during a 12-month study period across Africa 9 .
The Central African Republic, Lesotho, and Eritrea faced the highest mortality rates, with over 200 AMR-associated deaths per 100,000 population 9 .
The leading bacterial villains in this silent pandemic are Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus—each causing over 100,000 deaths annually 9 .
Despite having lower overall antibiotic consumption compared to many regions, Africa suffers the highest AMR mortality rates globally. This paradox stems from several structural challenges:
| Metric | Finding | Significance |
|---|---|---|
| Overall AMR Mortality Rate | 27.3 deaths per 100,000 | Highest across all world regions 4 |
| Leading AMR Pathogens | S. pneumoniae, K. pneumoniae, E. coli, S. aureus | Each causes >100,000 deaths annually 9 |
| Countries with Highest AMR Mortality | Central African Republic, Lesotho, Eritrea | Exceed 200 AMR deaths per 100,000 population 9 |
| Key Drug Resistance Concern | Trimethoprim-Sulfamethoxazole | Possibly linked to HIV care protocols 9 |
Recognizing these interconnected threats, the African Union has established strategic frameworks to operationalize One Health approaches across the continent. The Africa Centres for Disease Control and Prevention (Africa CDC) launched its One Health Programme in 2018, creating a cross-divisional technical working group to coordinate efforts 2 .
The program's priorities reflect the multifaceted nature of the challenge:
Establishing cross-sectoral governance structures
Integrated monitoring of human, animal, and environmental health
Strengthening diagnostic capabilities across sectors
Training multidisciplinary One Health professionals
This continental strategy aligns with the broader African Union Agenda 2063, envisioning "The Africa We Want" with sustainable health systems capable of reducing the impact of zoonotic diseases and AMR 8 .
The African Union has established a One Health Coordination Group on Zoonotic Diseases to mobilize resources, expertise, and political will 8 . However, significant implementation challenges remain, including breaking down professional silos, developing skilled workforce, securing domestic financing, and establishing supportive legal frameworks 1 .
"We've really adopted a One Health approach to ensure that surveillance is not just in the human health sector, but looking at states across the animal as well as plants, as well as the environmental health sectors."
When highly pathogenic avian influenza H5N1 threatened Nigeria's poultry industry and human population in 2005, the country implemented a textbook One Health response that offers a template for future outbreaks .
The government established two critical bodies: a National Inter-Ministerial Steering Committee and a National Technical Committee on Avian Influenza. These groups brought together staff from multiple ministries—including agriculture and health—along with communicators and industry players .
Within one year of coordinated intervention, Nigeria successfully eliminated the H5N1 virus from its territory .
Rapid identification and isolation of infected flocks
Joint planning between human and animal health sectors
Involvement of poultry industry stakeholders in control measures
Clear messaging about risks and protective measures
Strengthened monitoring of both animal and human cases
| Response Component | Implementation Strategy | Outcome |
|---|---|---|
| Governance Structure | Inter-ministerial committees with multi-sectoral representation | Coordinated decision-making across human and animal health sectors |
| Containment Measures | Identification and isolation of infected flocks | Broken chains of transmission in animal populations |
| Stakeholder Engagement | Inclusion of poultry industry and communication experts | Effective implementation of control measures |
| Timeline | One year of coordinated intervention | Successful elimination of H5N1 virus in Nigeria |
Implementing effective One Health strategies requires specialized tools and resources. From diagnostic laboratories to field surveillance equipment, researchers and public health professionals need specific "research reagents" to detect, monitor, and contain health threats at the human-animal-environment interface.
Here are some essential components of the One Health toolkit in Africa:
Only 1.3% of laboratories in 14 African countries currently have this essential capability for AMR monitoring 9
Rapid, field-oriented diagnostic tools that can be deployed in resource-limited settings 3
Facilities that can safely handle dangerous pathogens, available at selected overseas laboratories in Africa 3
Technology enabling data sharing and coordinated response across sectors and borders
Initiatives like the Africa One Health University Network that build workforce capacity
While the One Health approach has gained significant traction across Africa, a 2020 review by the International Livestock Research Institute identified 315 One Health initiatives across 46 sub-Saharan African countries . However, serious implementation gaps remain—including limited awareness among policymakers, inadequate government funding, and insufficient data sharing between sectors .
Significantly, over 90% of One Health funding comes from outside the continent, highlighting the need for greater domestic investment .
As one analysis noted, "There is a significant gap in political commitment, skilled workforce, domestic financing and legal frameworks to strengthen coordination, collaboration, and communication among One Health stakeholders in Africa" 1 .
External Funding
Over 90% of One Health funding comes from outside the continent
Reimagining One Health in Africa requires more than just technical solutions—it demands a fundamental shift in how we approach health challenges. Key priorities include:
Elevating One Health to a head-of-state priority with dedicated funding 1
Expanding training programs like the Kofi Annan Fellowship and Africa One Health University Network 2
Investing in bacteriology capacity and diagnostic infrastructure 9
Establishing transnational networks for disease surveillance and response
The economic case for investment is compelling: zoonotic disease prevention actions cost less than 1/20th the value of lives lost each year 1 . This represents a strong return on investment for both African governments and development partners.
| Priority Area | Current Challenge | Recommended Action |
|---|---|---|
| Funding | Over 90% external funding; limited domestic investment | Increase government ownership and sustainable financing |
| Laboratory Capacity | Only 1.3% of labs in 14 countries can test for AMR pathogens | Strengthen bacteriology capacity and diagnostic networks |
| Workforce | Shrinking number of trained infectious disease specialists | Expand multidisciplinary training programs and fellowships |
| Coordination | Professional silos and fragmented response systems | Establish cross-sectoral coordinating mechanisms with clear mandates |
The complex health challenges facing Africa—from re-emerging infections to antimicrobial resistance—cannot be solved by the human health sector alone. By reimagining One Health as a collaborative, continent-wide strategy that bridges human, animal, and environmental health, Africa can transform its vulnerability into resilience.
As Dr. Jean Kaseya, Director General of Africa CDC, emphasizes, addressing these threats requires "a multi-sectoral approach, including infection prevention, strengthening healthcare and food systems, and investing in diagnostics and laboratory infrastructure" 4 .
The future of health in Africa depends on recognizing that our fates are intertwined—across species, across sectors, and across borders.