7.2.1 International Human Rights Framework

The United Nations human rights system consists of nine core treaties, which build on the foundational human rights instrument, the Universal Declaration of Human Rights.Footnote ⁵ Two principal treaties are the International Covenant on Civil and Political Rights (ICCPR)Footnote ⁶ and the International Covenant on Economic, Social and Cultural Rights (ICESCR).Footnote ⁷ Alongside these general instruments are several more specific treaties that focus either on particular human rights issues (for example the Convention Against Torture)Footnote ⁸ or on protecting particular vulnerable groups (for example the Convention on the Rights of the Child (CRC)Footnote ⁹ and the Convention on the Rights of Persons with Disabilities).Footnote ¹⁰ Typically, these human rights treaties are supported by a dedicated committee of experts that monitors states’ performance of their obligations, raises issues of concern, and provides guidance on what actions they should take. In some cases, these committees are also empowered to hear complaints from individuals who allege that their rights have been violated. For example, the Human Rights Committee can hear complaints about alleged violations of the ICCPR, while the Committee on the Rights of the Child accepts complaints from children about breaches of the CRC. The ability of the human rights committee to hear a complaint will depend on the respondent state having agreed to be subject to the committee’s jurisdiction, and the applicant is usually required to have exhausted all options for a resolution within the domestic legal system.Footnote ¹¹

Human rights treaties are also in place in several regional areas, such as the European Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR), the American Convention on Human Rights, and the African Charter on Human and Peoples’ Rights.Footnote ¹² The regional human rights systems usually have a court or commission (sometimes both) that has jurisdiction to hear complaints against states; for example, the European Court of Human Rights and the Inter-American Court of Human Rights.Footnote ¹³

7.2.2 Rights Most Relevant to One Health

One Health has been defined by the One Health High-Level Expert Panel (OHHLEP) as ‘an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.’Footnote ¹⁴

When discussing the relations between human rights and One Health, several specific human rights are immediately obvious as being relevant. These include the right to health, the right to an adequate standard of living, and the right to life. However, the list of rights that could be useful for achieving a One Health approach is broader than it might first appear.

The natural starting point for this discussion is the right to health. This is protected in international human rights law in Article 12 of the ICESCR. This is not a right to be healthy, but rather a right to the ‘highest attainable standard of health’.Footnote ¹⁵ The Committee on Economic, Social and Cultural Rights (CESCR) has explained that this is a relative standard, judged with regard to a person’s own circumstances and the available resources of the state.Footnote ¹⁶ It includes both freedoms – for example, to make choices about one’s own sexual and reproductive health – and entitlements, including access to quality health services, treatments, and medicines.Footnote ¹⁷ It also encompasses the full range of factors that contribute to a person’s standard of health, such as food, water, housing, sanitation, education, and safe working conditions.Footnote ¹⁸

The Committee has also acknowledged that enjoyment of the right to health depends on a healthy environment, recognising that environmental conditions like clean air, water, and soil are essential to a wide range of health outcomes, while a poor or polluted environment can have significant health ramifications.Footnote ¹⁹ For children, the right to health guaranteed in Article 24 of the CRC explicitly mentions the need to address environmental contamination.Footnote ²⁰ The African Charter recognises the right of all people to environmental conditions that are favourable to their environment,Footnote ²¹ alongside the right to the best attainable state of physical and mental health.Footnote ²² The latter has been applied in cases of environmental pollution.Footnote ²³ However, while the right to health has been interpreted by courts and committees to include the environmental determinants of health, in most international and regional treaties there is no explicit mention of the environment.

An important feature of human rights law is the understanding that all rights are interdependent. The CESCR has explained this in relation to the right to health:

The right to an adequate standard of living is protected under Article 11 of the ICESCR. This provision guarantees ‘adequate food, clothing and housing, and the continuous improvement of living standards’.Footnote ²⁵ The CESCR has expanded on the content of this right in several General Comments relating to food, water, and housing.Footnote ²⁶ In this work, it has explained the importance of governments adopting appropriate environmental policies to ensure the availability of safe and adequate food, housing, and water.Footnote ²⁷ It has also stressed the need to ensure that natural water resources are protected from contamination and managed in a way that addresses their potential as a habitat for disease vectors, noting the links between the right to water specifically and the right to health.Footnote ²⁸

The right to water is included in other human rights treaties, including the CRC, which guarantees to all children the right to safe drinking water as a component of the right to health in Article 24. The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) refers to water in relation to the provision of adequate living standards for all women.Footnote ²⁹ Wherever environmental degradation affects the availability of clean and secure water, the right to an adequate standard of living will be impacted, with potential also to impinge upon the right to health and, where serious enough, even the right to life.

The right to life is protected in the ICCPR, along with all regional human rights instruments.Footnote ³⁰ It includes both positive and negative components. In a negative sense, it operates as a prohibition against killing (at least arbitrarily; in some states, capital punishment is still permitted provided adequate legal processes are followed). In a positive sense, states are obliged to protect people against threats to life and provide the essential conditions for life.Footnote ³¹ The UN Human Rights Committee, which adjudicates on alleged breaches of the ICCPR, has recognised that environmental conditions can constitute a breach of the right to life where they are serious enough.Footnote ³²

There are other rights that are also connected to human well-being, and these too have a role to play in relation to One Health. They include the right to social security, protected under the ICESCR, which provides an essential economic safety net that can help to avoid negative impacts on health.Footnote ³³ Freedom from cruel, inhuman or degrading treatment or punishment is also an important right for promoting human health, as it prohibits any treatment of a person that could harm either their physical or mental well-being.Footnote ³⁴ The rights to equality before the law and to be free from discrimination are found in various forms across international human rights law.Footnote ³⁵ In the context of health, these are important rights for ensuring that all people can access health services and the necessary conditions for a healthy life regardless of race, religion, gender, sex, or any other factor.

When it comes to designing and implementing One Health policies, several other specific human rights may also be relevant. For example, under Article 13 of the ICESCR, states are required to realise the right to education, which ‘shall be directed to the full development of the human personality and the sense of its dignity, and shall strengthen the respect for human rights and fundamental freedoms’.Footnote ³⁶ Education plays a critical role in developing One Health thinking. As Villanueva-Cabezas et al. have argued, achieving the sort of transdisciplinary, planetary-level understanding necessary to advance One Health requires early and holistic education.Footnote ³⁷ While their work focused on undergraduate-level university training, there is arguably a role for secondary and even primary education to help embed long-lasting knowledges and practices in support of One Health.

Another relevant right is freedom of information, guaranteed under the ICCPR.Footnote ³⁸ This protects the right of all people to access information in different forms and is an important component of ensuring transparency and accountability in the implementation of laws and policy. Its relevance to One Health-based policies can be seen in the fact that accurate, timely, and accessible information about health problems is necessary for public education and understanding. Not only does this enhance the effectiveness of response strategies but it also helps ensure that policy responses are viewed as legitimate by those who are affected by them.

The right to freedom of movement might also be relevant to One Health-based policies, especially those that are intended to respond to pandemics or other major health issues.Footnote ³⁹ Freedom of opinion, expression and protest will also have a role to play in balancing state responses to public criticism of such policies.Footnote ⁴⁰ These freedoms can be limited under human rights law, but only where these are necessary and proportionate to protecting other human rights or to addressing issues of public health and safety.Footnote ⁴¹

The relevance of these civil and political rights to One Health can be seen in some of the legal disputes that arose during the COVID-19 pandemic. Human rights law was used as the basis to challenge lock-downs,Footnote ⁴² travel restrictions,Footnote ⁴³ border closures,Footnote ⁴⁴ vaccine mandates,Footnote ⁴⁵ access to vaccines,Footnote ⁴⁶ and regulation of misinformation.Footnote ⁴⁷ In many cases the need to safeguard public health and safety was viewed as a legitimate justification for the limitation of human rights, but courts have been clear that even then restrictions must be enacted via law, must remain reasonable, and should be the least restrictive means of protecting public health and safety.Footnote ⁴⁸

Taken together, these various human rights help to advance the objectives and practice of One Health, while also providing important standards and safeguards for the implementation of One Health policies.

7.2.3 The ‘Greening’ of Human Rights

As identified above, some of the rights within international human rights law are defined to include an environmental dimension, for instance children’s right to health. Others have been interpreted by courts and committees to include environmental preconditions. Over the past couple of decades, the role of the environment in supporting the enjoyment of human rights generally has been increasingly recognised. This process has been referred to as the ‘greening’ of human rights.Footnote ⁴⁹

In its early days, this approach framed environmental conditions as being instrumental to the enjoyment of human rights. For example, in several cases, courts and committees have found that air, water, or soil pollution constituted an unlawful interference with the enjoyment of human rights.Footnote ⁵⁰ Other cases held that logging, mining or other environmental destruction could represent a breach of rights to property, subsistence, health and even the right to life, especially for Indigenous peoples.Footnote ⁵¹ More recently, human rights bodies have begun recognising climate change as a potential violation of human rights.Footnote ⁵²

While these cases recognised the environmental preconditions for the enjoyment of human rights, courts were clear that there was no human right to a good environment per se. For environmental harm to constitute a breach of human rights it needed to result in an actual or imminent interference with human rights.Footnote ⁵³ In other words, it was people who were protected through human rights law, not the environment. What is more, human rights complaints cannot usually be based on a general concern for the environment. Instead, specific people need to be identified as the ‘victims’ of environmental harm.Footnote ⁵⁴ And because victimhood is based on experiencing actual or imminent harm, human rights law is ill-equipped to deal with long-term environmental risks.Footnote ⁵⁵

The ‘greening’ of human rights has therefore been monodirectional and instrumental, built on an understanding that the environment is necessary for human well-being but is otherwise not the concern of human rights law. Some domestic jurisdictions have recognised a legal right to a healthy environment but as will be discussed below, in most cases this is still understood in rather anthropocentric terms.

As a result of this process of greening human rights, we now have a field of human rights known as ‘environmental rights’.Footnote ⁵⁶ The evolution of environmental rights shows the extent to which human rights can advance environmental health and, by extension, helps us to understand the ways human rights can support One Health. The potential for a mutually beneficial relationship between human rights and One Health will be explored in more detail in the next section.

7.3.1 One Health Supports Human Rights

Because One Health aims to advance human health as one of its objectives, it naturally has benefits for fulfilling health-related human rights. Pursuing a One Health approach to health policy and regulation will help to ensure respect for and protection of human rights, particularly the rights to health, life, and an adequate standard of living (discussed above). For example, addressing the causes and spread of zoonotic diseases through environmental and animal health policies minimises public health risks that might undermine the right to the highest attainable standard of health.

One Health’s contribution to environmental health and animal health is also positive for human rights because environmental conditions are critical to the enjoyment of many human rights. A good example of this can be seen in the connection between the environment and wildlife and the rights of many Indigenous peoples. Human rights case law has shown that where the environment is damaged, for example through the impacts of climate change, the rights of Indigenous people to practice and pass on their culture can be breached, along with their right to property over their traditional lands.Footnote ⁵⁷ One Health-based policies that protect the environment and the species that live within it can help to protect these rights.

7.3.2 Human Rights Support One Health

Because of the thematic alignment of human rights with (at least) the human health pillar of One Health, the advancement of human rights will also likely help to support and promote the objectives of One Health. For example, many activities designed to address poverty and provide clean water, nutritious food, adequate housing, and essential healthcare will naturally promote the human health pillar of One Health. Beyond this alignment of purposes, human rights also support One Health through the framework of laws and principles on which modern human rights are built. This can provide valuable legal scaffolding to One Health policies. A key feature of this legal framework is the tripartite set of obligations that states take on; namely, the duties to respect, protect, and fulfil human rights. What is required by each level of duty will vary according to the specific right in question and, in some circumstances, the capacity of the state to perform its obligations.

The first level of obligation is the duty to respect human rights. This is a negative duty that requires states to refrain from actions that would interfere with human rights.Footnote ⁵⁸ It is particularly relevant for civil and political rights like the right to freedom from torture or cruel and inhuman treatment or punishment, and states are expected to take immediate measures to ensure these things do not occur.Footnote ⁵⁹ The next level up is the duty to protect human rights. This requires that states enact laws and adopt measures that will protect people from rights violations caused by private actors, such as corporations.Footnote ⁶⁰ The third and most demanding level of obligation is the duty to fulfil human rights. This requires that states take positive steps to ensure all people can enjoy their human rights.Footnote ⁶¹ The duty to fulfil is typically more onerous for economic, social, and cultural rights, as these can require greater investment of resources to be fully realised.

Human rights law also provides a progressive scaffolding that could be used to achieve One Health goals. For many human rights, the standard of obligation on states is one of progressive realisation, having regard to their capabilities and resources. This is the approach taken to most economic, social, and cultural rights, like the right to health and the right to an adequate standard of living.Footnote ⁶² Significantly for the operationalisation of One Health, these rights are intended to be achieved through international cooperation and assistance. This expectation is potentially useful for implementing One Health policies on a global scale and aligns with our understanding of the interconnectedness of natural systems. Together, these standards of obligation potentially promote state investment in One Health both domestically and internationally, as well as an approach which is geared towards ambitious targets achieved progressively over time.

The interdependence of human rights noted above also aligns with the integrated approach envisaged by One Health and promotes a way of thinking about diverse objectives that recognises their close connections. Human rights law also provides principles for balancing objectives when they compete with one another. There are some human rights that are viewed as being ‘non-derogable’, meaning that no violation of them could ever be permitted. They include, for example, freedom from torture and slavery. Other rights can be validly restricted where doing so is necessary to achieve some legitimate aim, including the protection of other rights. The limitation must be proportionate, however, and should represent the least restrictive option available. These requirements of necessity and proportionality could help inform a One Health response in circumstances where the objectives of animal, human, and environmental health conflict, or where One Health conflicts with other social or economic objectives.

Human rights also provide important standards and safeguards that could apply to the design and implementation of One Health-based policies. These include rights relating to freedom of information, expression, and movement; Indigenous rights to self-determination, land, and culture; and rights to a fair trial and equality before the law. These rights can help to ensure that policies which, for example, prohibit certain uses of land in the name of One Health do not have disproportionately harmful collateral effects on human rights.

One area that has been identified as requiring more work in the One Health space is gender.Footnote ⁶³ A commitment to human rights, particularly women’s rights, equality, and non-discrimination, could help to fill this gap. For example, this could occur by helping to focus attention on the different ways that women and girls are at risk of and experience infectious diseases and the factors that contribute to their vulnerability. For instance, a human rights-based approach helps to identify inequalities in distribution of work and economic power within communities that often leave women exposed to environmental health risks.Footnote ⁶⁴

A human rights-based approach can better ensure that adequate work is done to address health issues that specifically affect women, girls, and non-binary people. It can also promote an intersectional approach to health that acknowledges the connected factors across gender, race, religion, socio-economic status, and other dimensions that impact on health. Further, attention to human rights can help improve representation of women throughout law and policy-making areas, including at the highest levels of government and institutions.

The extent to which these gains can be realised is limited by the tension that exists between the multidimensional focus of One Health and the fundamental anthropocentrism of human rights. This will be examined in the following section.

7.4.1 Anthropocentrism

Human rights are, by definition, anthropocentric. The theoretical foundations of human rights are heterogeneous, with modern human rights law being traceable back to various philosophical traditions. But while there are variations, these theories are rooted in inherent human value, dignity, interests, or some combination of these. Human rights are generally considered to be things that are necessary for humans to live a life of dignity or to fulfil their interests.

For example, modern human rights law draws heavily on natural rights theory.Footnote ⁶⁵ This theory is based on the work of Western philosophers like Thomas Hobbes and John Locke, and posits that human rights are the entitlements that each human can claim based on their inherent human dignity. An alternative explanation is found in interest theories of rights, which view human rights as those things that are fundamentally in the human interest and weighty enough to impose an obligation on others.Footnote ⁶⁶ Interest theory has been used by scholars like Feinberg to argue for recognition of the rights of animals as well, though these would not presently be considered to fall within the scope of ‘human’ rights.Footnote ⁶⁷ Animal rights theorists like Saskia Stucki have argued for recognition of animals as rights-holders, based on their sentience or ‘self-hood’ and their inherent value. In this way, animal rights are framed in similar language to human rights: animals have rights by virtue of their being animals.Footnote ⁶⁸ However, this is a novel approach and is not yet commonplace among human rights thinking, and especially not within human rights law.

Whichever philosophical version of human rights we adopt, it is hard to escape the centrality of the ‘human’, either as the locus of inherent dignity giving rise to rights or the subject whose interests we seek to protect. As a result, attempts to include the environment within the scope of human rights have traditionally framed the environment as being instrumental to human well-being, as is evident in the ‘greening’ of human rights, described above. In terms of achieving One Health’s environmental and animal health objectives, while this approach acknowledges some interconnectedness between humans and the natural world, it positions human health as the end, and animal/environmental health as merely means. Human health therefore takes priority, and animal and environmental issues are only relevant to human rights to the extent that they advance or impact on human well-being.

The issue of pandemic prevention provides some illustrations of how a human rights approach might complicate One Health efforts. Zoonotic spillover is a key risk factor for pandemics, which can occur where human activity moves into new areas of the environment, exposing people to zoonoses. For example, encroachment into and logging of forests for timber or to clear land for agriculture increases the risk of zoonosis, but also promises important economic benefits to communities.Footnote ⁶⁹ Hunting of animals for food or commerce is another area of risk for zoonotic spillover, but again may be seen as an important activity for subsistence.Footnote ⁷⁰ To the extent that these activities support livelihoods or provide a means of subsistence, they could be seen as important for the fulfilment of human rights. Policies that seek to regulate or prohibit them could consequently face allegations that they breach human rights. Once a pandemic begins, human rights to freedom of movement and opinion might be viewed as constraining potential response efforts. Alternatively, a government seeking to avoid international pandemic prevention expectations might use the language of human rights to justify its position.

While there is clearly potential for human rights to frustrate One Health efforts by prioritising human interests over those of other animals or the environment, the significance of this shouldn’t be overstated. Human rights law has tools for dealing with competing interests and will permit the limitation of some rights where doing so is necessary and proportionate to achieving another legitimate aim. It is not the case that human rights will always be trumps. Furthermore, when it comes to activities that are environmentally harmful or hazardous, supporting the full enjoyment of human rights like the right to an adequate standard of living can reduce the need for people to rely on those practices for their livelihoods. Nonetheless, there has always been an inevitable anthropocentrism in human rights and a sense that the environment is valuable because of its usefulness for humans, rather than valuable in its own right. This understanding is fundamentally different from the more evenly weighted approach of One Health.

7.4.2 The Right to a Healthy Environment

More recently, there has been a shift towards greater recognition of the right to a healthy environment, which could potentially open the way for a more ecocentric approach that is more closely aligned with the tripartite framing of One Health.Footnote ⁷¹

In 2022, the United Nations General Assembly adopted a resolution recognising that ‘all people have the right to a clean, healthy and sustainable environment’.Footnote ⁷² The resolution was widely supported, with over 160 states voting in favour.Footnote ⁷³ It followed the adoption of a similarly worded resolution by the Human Rights Council the previous year.Footnote ⁷⁴ The resolutions call on states to ‘scale up efforts’ to guarantee the right to a healthy environment (as it is commonly abbreviated), though this request is not legally binding. Indeed, the non-legally binding status of the resolutions may partly explain the strong positive reception from UN member states, who might have been more circumspect had there been legal duties involved.

The resolutions were adopted against the backdrop of considerable recognition of similar rights within domestic jurisdictions and regional human rights systems. A recent study found that over 130 countries recognise some form of enforceable environmental right.Footnote ⁷⁵ Of these, eighty-four national constitutions included an explicit right to a healthy environment.Footnote ⁷⁶ Some have argued that this provides evidence that the right exists as part of customary international law, though this is by no means settled.Footnote ⁷⁷

Across these domestic jurisdictions, there is still considerable diversity in terms of how environmental rights are defined and, consequently, how well they might align with the three dimensions of One Health. Some rights have a more ecocentric approach, protecting the rights of animals, natural features like rivers or forests, or even the whole of nature.Footnote ⁷⁸ Some constitutions protect people’s right to an ecologically balanced or sustainable environment.Footnote ⁷⁹ Many constitutions guarantee a clean, safe, or unpolluted environment,Footnote ⁸⁰ suggesting a more anthropocentric, instrumental understanding of the relationship between nature and humans. This diversity and ambiguity make it hard to pin down the content of environmental rights and their corresponding duties. Even the term ‘healthy environment’ is open to various meanings and could refer to an environment that is healthy in its own right or merely healthy for humans.

The recent UN resolutions indicate that the international human rights community is starting to recognise the more subtle interconnections between the environment and humans, and the fact that environmental degradation could be a violation of human rights, even where no direct impact on human lives is evident. However, this approach is still one of recognising the human right to a healthy environment. Equivalent discussions on animal or environmental rights are underdeveloped or lacking at the international level.Footnote ⁸¹ As a result, despite all these advances, the right to a healthy environment is unlikely ever to truly overcome the anthropocentrism inherent in human rights.

8.2.1 Ethical Foundations of One Health

The ethical foundations of One Health are highly contested. A key problem is that the framework has multiple definitions/interpretations that are polysemic and can have different ethical and normative consequences. Notwithstanding, some argue that One Health does not have its own ethical framework and does not need one as it relies on existing ethics and principles.Footnote ¹⁶ Others argue that One Health can benefit from its own ethical framework,Footnote ¹⁷ or that it is a requirement for sound implementation.Footnote ¹⁸

While there are some near-universal agreed ethical principles within the framework (collaboration, interdisciplinarity, justice, and/or equity)Footnote ¹⁹ a key ongoing debate centres on whether the framework is intended to be anthropocentric, ecocentric, or something else.Footnote ²⁰ While the foundational premise is that public health, environmental health, and animal health are inherently interconnected and should be governed as such, the question remains as to whether environmental and animal health are managed for the benefit of public health, or because of their intrinsic value.

The recent definition of One Health, published by the One Health High-Level Expert Panel (OHHLEP), encourages equal consideration of animal, environmental, and human health, at least at face value: ‘One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent.’Footnote ²¹ Similarly, the Berlin Principles adapted in 2019, authored by another group of world-leading One Health experts, and updating the 2004 Manhattan Principles, include increased reliance on biodiversity conservation as a means of adhering to a One Health framework.Footnote ²² They also include other principles of equity and justice inherent in the One Health approach.

What we see in the practice of One Health, however, is a very different ethical framework than that which is called for in the literature. At the ground level, One Health remains a public health framework, and so the ideology of the framework remains stuck within that paradigm. This dichotomy between the operationalisation and theory of One Health has also been noted by ethicists. Sironi calls the two approaches the ‘prudent’ and the ‘radical’ approach, with the former representing a forward step for human health and the latter a true epistemological and ethical change, including proper integration of animal value into human societal systems.Footnote ²³ Beever and Morar distinguish between the ‘moderate’ and ‘strong’ approaches, with the former prioritising multidisciplinary collaboration and interconnectivity, and the latter focusing on interdisciplinarity and interdependence.Footnote ²⁴ The term ‘interdependence’ implies symbiosis, where each sphere of health takes care of the other. Each of these distinctions bears weight, but not necessarily across each and every iteration of One Health.

This primary debate has very practical implications for how One Health is operationalised. By way of example, managing animals with disease depends very much on the value we place on individual animals, conservation, and public health. Ultimately though, it is generally agreed that the ethics of One Health both in theory and practice remain anthropocentric, despite its promising foundations. Diller and Williamson argue this is because it is premised on the individually focused bioethics,Footnote ²⁵ and Coghlan argues that One Health has yet to expand its circle of moral concern.Footnote ²⁶ Yet even the anthropocentric theory of One Health is not without critique. Lysaght argues that there is an absence of justice, although Johnson and Degeling argue that justice is a developing principle of the framework. Ramakrishnan, and Laine and Morand, argue that the historical coloniality of public health systems has embedded neocoloniality into the framework, and its operationalisation by international organisations.Footnote ²⁷ Indeed, Ramakrishnan goes further to say that the One Health framework is ‘nothing but a vehicle enabling the incorporation of bio-surveillance obligations’.Footnote ²⁸ This is certainly also arguable given the current OHHLEP Theory of Change, where One Health still appears to be primarily focused on animal disease surveillance.Footnote ²⁹

This approach has very real implications for animal rights and welfare. If we view One Health as a way to conduct bio-surveillance, we are only focusing on the detection of the disease and not on the factors that cause the disease or its spread to people. For example, we would focus only on the detection of Hendra in flying foxes, and not protect the natural habitats in forests that feed them and prevent them feeding in human residential areas.Footnote ³⁰ The implications for flying foxes can be dire, as feeding in human areas can lead to net entanglement and lethal management where they can be viewed as ‘pests’.Footnote ³¹

What we can see is that the ethical foundations of One Health are important in determining the scope of One Health, whether that be One Health as bio-surveillance, a public health framework, or something beyond that considers animals rights and/or welfare, as well as the rights and welfare of nature more generally. The ethical foundations are also vital for providing guidance on resolving the conflicts that are inevitable between the three areas of the framework that we outline below.

Over the remainder of this chapter, we consider One Health frameworks as if they were an embodiment of an expanded ideology advocated for in much of the ethical literature. We ask: if One Health was a true representation of the interdependence of animal, environmental, and human health, how do animal rights fit in? This itself is an interesting question that does not fit the standard debate about the ethical foundations of One Health, because the main competing paradigms are anthropocentrism and ecocentrism, neither of which prioritises animals outside their value as a species. Instead, ecocentrism is based on the ethical framework of ecological holism, espoused by Aldo Leopold and his utilitarian concept of conservation: that what is good for the ecosystem is good for the whole.Footnote ³² This form of ecocentrism allows the dismissal of individual interests if they are detrimental to a hubristic form of ‘the whole’.Footnote ³³

Animal interests seem even further removed from a One Health ethical framework, except to the extent that animal disease can cause human health impacts. In practice, animal welfare is considered relevant in managing disease through, for example, the administration of antibiotics and other preventative medicine in agricultural animals. The question of whether intensive and industrial animal agriculture is problematic from the perspective of the animal is not seen as relevant. Coghlan and others argue that One Health operations work within the parameters set by industrial agriculture, through biosecurity laws and policies, and monitoring pathogens. They state that a bolder One Health ethic would recognise that the benefits of industrial agriculture do not outweigh the harm done to the billions of individual animals subject to its operations, in addition to the environmental damage caused as a result of the industry.Footnote ³⁴ Even further removed from the ethical debate are wild animals, although there has recently been some interest in the welfare of wild animals sold in live animal markets.Footnote ³⁵

So, One Health ethics have the potential to promote ecocentricity, but what can we learn regarding the inclusion of animal rights? And how do we fit all three paradigms into One Health law and governance? Philosophy and ethics already have much to offer on how to expand our circle of moral concern to animals, and this is the topic of the following section.

8.2.2 Ethical Foundations of Animal Rights

Traditional ideas about morality focused on the way humans treat other humans. As Deborah Cao, Katrina Sharman, and Steven White identify, this conception of morality was ‘human-centred and human-exclusive’.Footnote ³⁶ According to Cartesian philosophy, for example, other animals are unfeeling automata that ‘eat without pleasure, cry without pain, grow without knowing it; they desire nothing, fear nothing, know nothing’.Footnote ³⁷ As a result, even vivisection could be considered morally justifiable.Footnote ³⁸ Similarly, while Immanuel Kant expressly rejected the Cartesian view of animals as automata,Footnote ³⁹ he claimed that humans only have indirect duties in relation to animals, on the basis that mistreating animals would harm human moral character.Footnote ⁴⁰

In contrast, contemporary animal rights discourse ascribes moral status to other animals.Footnote ⁴¹ Prominent scholars that argue for animal moral rights,Footnote ⁴² including Tom Regan and Christine Korsgaard, base their arguments on a conception of other animals as living beings, many of whom have capacities for positive and negative feelings, who have inherent value. According to American philosopher Tom Regan, animals’ inherent worth stems from their individual subjective experience of life. He states, ‘the basic similarity is simply this: we are each of us [human and animal] the experiencing subject of a life, a conscious creature having an individual welfare that has importance to us whatever our usefulness to others’.Footnote ⁴³ Importantly, this value is not dependent on how useful animals are to others; they are not merely a means to human ends, but must – as Korsgaard argues – be treated as ‘ends in themselves’.Footnote ⁴⁴ From a moral standpoint, this places limits on how human should treat animals, because to treat animals in a way that fails to respect their inherent value is immoral and infringes their individual moral rights.Footnote ⁴⁵ From an animal rights perspective then, animals possess equal inherent value to humans, and are part of our moral community whose interests require human consideration.

While many animal rights scholars employ deontological theory in their arguments, they reject Kant’s emphasis on rationality and autonomy as the foundation for individual rights and his conclusion that humans only owe indirect duties to animals. In this respect, Regan points out that many animals, such as non-human primates, share the cognitive characteristics that are claimed to give rise to human moral rights and should therefore share those rights.Footnote ⁴⁶ On the other hand, many humans, including infants and persons experiencing severe mental disability, do not have these mental capacities and yet are recognised moral rights holders.Footnote ⁴⁷ If rationality and autonomy are the foundations for moral rights, these positions are untenable.

Animal rights scholars suggest alternatives to rationality and autonomy as the foundation for individual moral rights. For Regan, the defining characteristic that gives rise to moral rights is being a ‘subject of a life’.Footnote ⁴⁸ Similarly, Korsgaard argues that ‘all creatures who are capable of feeling pleasure and pain’ have moral standing.Footnote ⁴⁹ For some scholars, their theories in this respect serve to provide the foundation for both human and animal moral rights.Footnote ⁵⁰

The practical consequence of animal moral rights theories for One Health is that animal moral rights cannot be overridden solely on the basis that there might be an overall benefit to people and/or animals.Footnote ⁵¹ In contemporary public health practice, for example, the risk of an infectious disease spreading from animals to humans is often used to justify culling the diseased animals and those with whom they have been in contact.Footnote ⁵² This approach would be unacceptable if proposed in relation to humans, because humans are considered to have inherent value and moral rights. Similarly, if animals are considered to have inherent value and moral rights, their interests would need to be fully considered before deciding how best to respond to the disease threat.

8.2.3 Apparent Philosophical Conflict between One Health and Animal Rights

The philosophical conflict arising within the One Health framework is clear from competing ‘limbs’ of the framework itself; those being environmental, animal, and human health. The philosophical tension here arises from the focus on the macro (conceived holistically as nature as a whole, or the Earth, or conceived systemically as groups of people, other species or ecosystems),Footnote ⁵³ versus a focus on the micro (individuals of all species). Although interdependence is a core principle of One Health, there are, and always will be, circumstances where two or more of these limbs conflict. For example, conservation can impact on human wellbeing when communities are forced to relocate from their traditional lands (known as ‘conservation displacement’).Footnote ⁵⁴ Individual animals can be killed or relocated if they are viewed as not belonging to a particular ecosystem. Animals can also be killed and mistreated to provide sustenance for human health.Footnote ⁵⁵

This tension between working towards the optimisation of the wellbeing of a collective versus seeking to protect the individual from pain and suffering can also be seen in the two most prominent approaches to animal advocacy; welfarist and rights approaches. Early supporters of animals, for example, included English philosopher Jeremy Bentham, who based his regard for other animals on their ability to feel.Footnote ⁵⁶ Bentham’s concern with minimising pain and suffering underpinned his utilitarian ethic, reflecting a theory of morality that seeks to maximise happiness and minimise suffering for the greatest possible number of individuals.Footnote ⁵⁷ Determining the morality of conduct under this approach involves a calculation of all the pleasure and pain that will result from the conduct. This focus on aggregate pleasure, however, can be used to justify practices like experimenting on animals that will cause immense individual suffering. In contrast, animal rights advocates like Regan focus on the inherent worth of the individual and argue for individual rights that cannot be outweighed by aggregate consequences.Footnote ⁵⁸

Thus, the apparent conflict between animal rights and One Health has echoes both in similar debates of the past and in contemporary conceptualisations of One Health itself. While this makes resolving the apparent conflict challenging, it also means that developing an approach that reconciles the conflict need not require ‘reinventing the wheel’. In the next Part, we look at how similar conflicts have been addressed in compassionate conservation, multi-species justice, and rights of nature literature to develop a conception of animal rights as compatible with and as part of a broader One Health paradigm.

8.4.1 Compassionate Conservation

The theory of compassionate conservation seeks to mitigate the inherent conflict between the macro ecosystem and micro individual when making conservation decisions. It is premised on the ethical position that ‘all actions taken to protect biodiversity should be guided by compassion for all sentient beings’.Footnote ⁷¹ The theory argues against an either/or approach to conservation and individual animal welfare and instead posits that there are win-win solutions where both can be prioritised.Footnote ⁷² It is specifically contrasted against the apparent subordination of animals in traditional wildlife conservation practices that results from humans believing they have authority over decisions concerning animals and labelling certain animals problematic, thereby ignoring their sentience.Footnote ⁷³

Despite protestations from traditional conservationists, compassionate conservation expands the scope of concern to give conservation a more holistic perspective. It seeks to be inclusive not only of different philosophical thought, but of animals and their intrinsic worth.Footnote ⁷⁴ An additional major premise of compassionate conservation is that animal agency, and the effects of that agency on ecosystems and other species, is not systematically investigated in conservation research. This idea of agency is established by animals’ intelligence, sentience, social structures, and how they influence ecosystems and human–wildlife spaces.Footnote ⁷⁵ A study conducted by Wallach and others that researched Australia’s migrant vertebrate species provides insight into the value that a compassionate conservation approach can add.Footnote ⁷⁶ By adopting a more inclusive approach in their research, specifically an approach that does not solely focus on nativism, they were able to find that migrant species in Australia can act as safeguards for threatened native species.Footnote ⁷⁷ Even in areas where there are increasing levels of extinction, migrant species have the potential to improve local species richness.

Like compassionate conservation, One Health has been limited by anthropocentric notions of the human–animal relationship. Animal agency is not considered within the One Health research paradigm. If, however, we extended the approach taken in compassionate conservation research to the One Health space, we may be able to move past understanding wildlife and animals as ‘problematic’ in terms of pandemic potential. In this respect, there is some evidence that increased biodiversity leads to less transmission of microbes from animals to people under certain circumstances; however, this research is limited.Footnote ⁷⁸ It seems the traditional method of conservation research continues to impact One Health research in more than one way.

8.4.2 Multispecies Justice

The idea that humans exist within nature and are interdependent with other living things, embedded in the concept of One Health, is also central to multispecies justice theory. This theory operates to extend environmental justice theory through the inclusion of non-human animals, species, and ecosystems.Footnote ⁷⁹ This theoretical extension results in an amalgamation of environmental, ecological, and social justice that embraces non-human animals. From a multispecies justice perspective, considering different beings’ subjective experiences of life is critical to multispecies flourishing. A more comprehensive understanding of multispecies justice theory can be seen in Indigenous approaches, whereby respect for all things is required, as ‘disrespect to any part is disrespect to everything’.Footnote ⁸⁰ Aboriginal and Torres Strait Islanders, for example, would ensure that waterholes were kept clear, which maintained water supply for animals and thus contributed to their survival.Footnote ⁸¹ This approach clearly aligns with the Indigenous Australians’ law requiring care for country.Footnote ⁸²

A key issue that arises in the application of multispecies justice theory is how to address conflicts of rights and justice that are more prolific in the context of an expanded circle of moral concern.Footnote ⁸³ Nevertheless, there is evidence that individual rights and justice concepts can coexist, at least in some situations. An argument may be made, for example, that justice for sentient animals requires humans not to eat them. However, research is clear as to the human health benefits of a vegetarian diet, thus prohibiting the consumption of animals where plant-based foods are readily available may also work in favour of human justice.Footnote ⁸⁴ Moreover, such an approach would potentially benefit not only animal and human justice, but also environmental justice, as plant-based foods are more environmentally friendly than animal food products. In this respect, Poore and Nemecek’s study demonstrated that a global transition to predominantly plant-based diets would result in a reduction in deforestation of 76 per cent and a decrease of 49 per cent in greenhouse gas emissions from food production.Footnote ⁸⁵

8.4.3 Rights of Nature

Rights of nature refers to the conception of nature itself as a subject of rights. The importance of this conception lies in its contrast with traditional views of nature as human property that can be exploited.Footnote ⁸⁶ In broad terms, while rights of nature ‘have both multiple histories and multiple meanings’,Footnote ⁸⁷ it ‘propounds the inherent value of Nature, independent of its extractive value for humans, and seeks to give Nature a voice in decision-making structures’.Footnote ⁸⁸ In this respect, nature is taken to include the holistic conception of nature as a whole, and also nature as specific places (for example, the Whanganui river in New Zealand, or the Mar Menor lagoon in Spain).Footnote ⁸⁹

While nature would seemingly include animals, it is unclear whether rights of nature encompass animal rights. To understand rights of nature in this way would raise a similar issue to that which arises in compassionate conservation and multispecies justice: how should conflicts between the interests of nature/ecosystems and the interests of individual animals be resolved? Nevertheless, some courts have interpreted holistic forms of rights of nature as inclusive of individual animals. For example, in 2022 the Constitutional Court of Ecuador heard a case in which the release of a woolly monkey named Estrellita from a zoo was sought.Footnote ⁹⁰ Estrellita had been transferred from her home of 18 years to the zoo on the basis that keeping a wild animal is banned in Ecuador. The Court held that ‘[w]ithin the levels of ecological organization, an animal is a basic unit of ecological organization, and being an element of Nature, it is protected by the rights of Nature and enjoys an inherent individual value’,Footnote ⁹¹ thus finding that non-human animals can have legal rights.

To reconcile this apparent ‘[p]hilosophical animosity’, legal scholar Eva Bernet Kempers proposes understanding rights of nature as a ‘three-dimensional concept’.Footnote ⁹² In this theory, she distinguishes between the holistic, systemic, and individualistic (sentient and non-sentient) dimensions of nature. Bringing the individual and collective into the same conceptual understanding of rights can help to resolve rights conflicts. Bernet Kempers provides some examples in this respect: while animal rights may outweigh plant rights, they also need to be understood in the context of the health of species or ecosystems of which they are a part. This may mean that an endangered plant’s rights could prevail over the rights of a non-native animal whose activities present a risk to the ecosystem. Bernet Kempers notes that while this approach reconciles the apparent philosophical incongruity between individual and collective rights, it also risks ‘naturalizing’ rights, meaning it risks strengthening the natural state in which stronger beings can exploit weaker ones.

8.6.1 Common Legal and Policy Approaches to Zoonotic Disease Transmission

Most contemporary legal systems are underpinned by anthropocentrism, which is reflected in the legal status of animals as human property.Footnote ¹⁰³ In anthropocentric legal systems, humans are at the centre of legal concern and other animals’ interests merit only indirect consideration, when they align with human interests.Footnote ¹⁰⁴ Intensive animal agriculture can be considered an expression of anthropocentrism, as it utilises farming methods that sacrifice animal welfare concerns in order to maximise production and efficiency.Footnote ¹⁰⁵ Legal regulation of zoonotic disease transmission in the context of intensive animal agriculture in Australia, the United States, and China is reflective of anthropocentric attitudes. In each of these countries, animals are legally categorised as property,Footnote ¹⁰⁶ and intensive animal agriculture practices are widely employed.Footnote ¹⁰⁷

A common approach to ensuring animal welfare in animal agriculture (and more broadly) is to enact legislation that restricts property owners’ rights in relation to their animals. Restrictions might include requirements such as, for example, space allowances for chickens.Footnote ¹⁰⁸ Australia,Footnote ¹⁰⁹ the United States,Footnote ¹¹⁰ and China,Footnote ¹¹¹ all have laws that regulate what farmers can do in relation to their animals. Where, however, the interests of animals and productivity concerns misalign, commercial interests are likely to prevail. This is demonstrated through the broad failure of intensive farming systems to allow animals to engage in natural behaviours, like sows’ preference for nesting.Footnote ¹¹² While safeguarding animal welfare in animal farming should help to prevent zoonotic disease transmission, restrictions on intensive farming are generally insufficient to manage the risk of transmission in these contexts, as evidenced by zoonotic disease outbreaks linked to intensive farming methods.Footnote ¹¹³

Approaches to regulation for the prevention of zoonotic disease transmission focus primarily on controlling disease rather than addressing ‘the structural drivers of emergence and transmission’.Footnote ¹¹⁴ One common approach is to use surveillance to identify emergent zoonotic diseases. Surveillance includes gathering and interpreting health data. Systems are intended to identify emerging diseases early to limit outbreaks.Footnote ¹¹⁵ Surveillance is ordinarily undertaken at different levels; for example, in Australia at national and state or territory levels.Footnote ¹¹⁶ In Australia, surveillance is supported by the National Health Security Act 2007 (Cth) and responsibilities are shared by the Australian Government Department of Health, the Communicable Diseases Network Australia, and OzFoodNet.Footnote ¹¹⁷ In the United States, federal responsibilities for surveillance activities are shared by the federal Commissioner of Food and Drugs, the Director of the Centers for Disease Control and Prevention (including the National Center for Emerging and Zoonotic Infectious Diseases), and the Secretary of Agriculture (including the Animal and Plant Health Inspection Service).Footnote ¹¹⁸ Nevertheless, states have the primary role in surveillance, and there is a strong focus on surveillance in states with high levels of animal agriculture.Footnote ¹¹⁹ In China, human health and veterinary departments are responsible for monitoring zoonotic diseases,Footnote ¹²⁰ and the Law of Prevention and Treatment of Infectious Diseases governs infectious diseases divided into three classes.Footnote ¹²¹

Another common method to prevent the spread of zoonotic disease is biosecurity. This refers to procedures implemented to stop zoonotic disease from being introduced and spread amongst intensively farmed animals.Footnote ¹²² In these contexts, visiting wildlife are often responsible for the introduction of disease.Footnote ¹²³ In Australia, biosecurity procedures are driven by industry.Footnote ¹²⁴ In the United States, biosafety, biosecurity, and bio-surveillance are key activities implemented to reduce the risk of zoonotic disease spillover.Footnote ¹²⁵ Biosecurity is also an important tool for prevention of zoonotic disease spread in China.Footnote ¹²⁶ Nevertheless, significant obstacles exist to implementing effective biosecurity measures in intensive agricultural facilities. In particular, the scale and intensity of industrialised agriculture generate different and higher disease risks.Footnote ¹²⁷

Where the spread of zoonotic disease cannot be controlled through surveillance and biosecurity measures, the common approach is to mandate animal culling.Footnote ¹²⁸ Culling refers to killing diseased or at-risk agricultural animals to stop the spread of disease.Footnote ¹²⁹ In Australia, the Australian Veterinary Emergency Plan outlines the policies that should be followed where an emergency animal disease is present, including policies requiring killing and disposal of diseased and at-risk animals.Footnote ¹³⁰ The policy requires that ‘a high standard of euthanasia and respect for the animals is an essential consideration during an EAD response’Footnote ¹³¹ where a large number of animals may need to be quickly ‘destroy[ed]’.Footnote ¹³² In the US, zoonotic disease regulation provides for depopulation or culling, where a disease is identified in an animal population.Footnote ¹³³ The American Veterinary Medical Association provides rules for undertaking mass culling. These include requirements as to appropriate methods.Footnote ¹³⁴ States also have regulations in place in relation to culling.Footnote ¹³⁵ In China, compulsory culling is required in relation to farmed animals that are infected by specified diseases.Footnote ¹³⁶

8.6.2 Integrating the Three-Dimensional Framework for Moral Concern

The framework serves to highlight that humans are not the only stakeholder of moral concern in decisions relating to zoonotic disease transmission. Not only are humans, animals, and the environment interconnected – as acknowledged by the One Health approach – but they also all have moral value (individually and collectively) beyond their economic usefulness to humans. While all three limbs may be impacted by the negative consequences of zoonotic disease spillover in the context of intensive animal agriculture, under current legal and policy frameworks animals disproportionately suffer the worst consequences. Negative impacts for animals include loss of habitat to facilitate animal agriculture, poor welfare for farmed animals, infection, and potential culling (or death).

Changing the paradigm to acknowledge that humans, animals, and the environment are all of moral concern prompts a greater focus on tackling the structural drivers of zoonotic disease. This is because preventing initial spillover will minimise negative consequences for humans, animals, and the environment. The United Nations has identified seven key anthropogenic drivers of zoonotic disease spillover, which include an increasing demand for animal protein and unsustainable agricultural intensification.Footnote ¹³⁷ Law and policy should be directed towards minimising these drivers. In this context, this would mean implementing laws and policies to reduce demand for animal protein and to shift towards a ‘de-intensification’ of animal agriculture.

In terms of the demand for animal protein, in high-income countries where alternatives to animal proteins are widely available and affordable, policies should encourage consumption of alternative proteins such as pulses rather than animal proteins. Policies could include, for example, removal of subsidies to intensive animal agriculture producers, restrictions or bans on advertising animal products, education initiatives to highlight the benefits of more plant-centric diets and restrictions on inclusion of animal proteins in publicly provided food (e.g. in publicly funded universities, prisons, and the public service). In low and middle-income countries where there are challenges in the availability of alternative proteins, policies should be directed towards increasing availability. Notably, while there is increasing demand for animal protein, ‘the long-term trend for pulses is of sustained consumption levels’.Footnote ¹³⁸ Law and policy should be directed towards reversing these trends. In relation to ‘de-intensifying’ animal agriculture, legislators need to increase regulation of agricultural operations. Measures could include removing subsidies, use of competition laws to de-concentrate industry, prohibiting additional intensive agricultural farms, requiring intensive animal agricultural operations to internalise the true costs of production including environmental, animal, and human health and welfare costs, removing animal welfare exemptions for farmed animals, and strengthening regulations.Footnote ¹³⁹

Where a zoonotic disease has emerged, the framework can be drawn upon to modify or at least prompt deep consideration of regulatory responses. Traditional approaches to control zoonotic diseases outbreaks include the culling of livestock and wildlife to limit their movement and their potential interaction with humans and other animals.Footnote ¹⁴⁰ However, as Degeling, Lederman, and Rock explain, these approaches are founded on a harm principle that excludes the interests of other animals.Footnote ¹⁴¹ If we judge the appropriateness of regulatory responses on the basis of consequences for the collective (humans and other animals, groups, and the Earth) different conclusions may be drawn. For example, Lederman, Magalhães-Sant’Ana, and Chuan Voo explain how the use of vaccine baits would be more effective in controlling rabies than culling, which remains a mainstream method of disease control.Footnote ¹⁴² As a minimum threshold, clear scientific, social, and ethical justification should be required in relation to any decision to cull.Footnote ¹⁴³

9.4.1 Preliminary Observations

The Regulation is part of a broader set of actions meant to address deforestation and forest degradation delineated in the European Green Deal:Footnote ⁶³ the Biodiversity Strategy,Footnote ⁶⁴ the Forest Strategy,Footnote ⁶⁵ the Farm to Fork Strategy,Footnote ⁶⁶ and the Commission’s Communication on stepping up EU action to protect and restore the world forests.Footnote ⁶⁷ Together with the provisional agreement on the Nature Restoration Law concluded at the end of 2023 and its adoption in 2024 (which also covers forest ecosystems in the EU),Footnote ⁶⁸ the Deforestation-free Products Regulation represents a significant step forward in the protection of the environment – forests in particular – both in the EU and in third countries.

The Regulation requires that the products it covers (products that contain, have been fed, or have been made with certain commodities, i.e. cattle, cocoa, coffee, oil palm, rubber, soya, and wood) are ‘deforestation-free’. This marks a bold difference from the EU Timber Regulation,Footnote ⁶⁹ which only focused on the legal provenance of timber products and which is repealed by this new Regulation. Indeed, a significant part of ongoing deforestation is legal according to the laws of the country of production,Footnote ⁷⁰ meaning that focusing only on the legality element has not been entirely effective.Footnote ⁷¹ The Regulation is meant to fill these gaps to minimise the connected risk of lowered environmental standards to obtain market access.Footnote ⁷²

9.4.2 The (Hidden) Link with the One Health Approach

The Regulation is, quite clearly, an environmental measure. Yet, it also has links to human and animal health. Indeed, addressing the link between land and health should be considered as belonging to a wider One Health strategy for disease emergence and spread, an environment-targeted operationalisation of the One Health approach as an integrated approach.Footnote ⁷³

As observed above, measures on nature and forest protection, conservation, and restoration, if sufficiently ambitious, may have positive One Health implications. Most notably, efforts to keep forests intact in the EU and outside the EU constitute an expression of the One Health approach in the form of preventative action. Targeting value chains and supply chains connected to deforestation and forest degradation, which is what the Regulation is set out to accomplish from the European Union’s side, may be considered one of these preventative actions.

The relevance of the Regulation and its measures would be higher in relation to the comprehensive nexus connecting humans, animals, and the environment, but it is also noticeable with respect to the individual nexuses of the One Health approach, especially the animal–environmental and environmental–human health nexuses.

That said, the protection of human and animal health in keeping with a One Health approach is not among the goals of the Regulation (Article 1). Preambular 20 of the Regulation, recalling the importance of measures against deforestation and forest degradation for achieving the Sustainable Development Goals (SDGs), does state that the Regulation should contribute to meeting the goals of SDG 3 – good health and well-being – among others,Footnote ⁷⁴ but this is not reflected in the Articles and Article 1 in particular, which only expressly considers the link of deforestation and forest degradation with climate change and biodiversity.

Considering the above, it can be wondered how effective the Regulation could be in tackling deforestation and forest degradation, and thus be instrumental from a One Health perspective.

While it is true that most commodities may be consumed at the local or regional level, it is crucial to account for the relevance of imports and exports. The EU consumption of products such as palm oil, cattle, soy, cocoa, coffee, timber, and rubber, also in their processed forms, accounts for 10 per cent of the global share of deforestation and forest degradation when considering the total final consumption (which is, then, deforestation embodied in the consumption).Footnote ⁷⁵ In this sense, tackling these commodities through Union policy intervention could bring the highest benefits for the unit value of trade,Footnote ⁷⁶ and demand-side action seemed to hold the most substantial potential to deliver the EU’s commitments and ensure increased sustainability in supply practices:Footnote ⁷⁷ indeed, the more significant the EU consumption and, thus, intra and extra EU imports, the larger the leverage can be expected from EU action targeting deforestation and forest degradation.Footnote ⁷⁸

Further, from the list of commodities covered (wood, cattle, cocoa, coffee, palm oil, rubber, and soya), it can immediately be noted how this instrument could be interesting to consider from a One Health perspective. First, forest activities and forest work, which could be associated with any commodity linked to deforestation, are among the epidemiological risk factors for certain zoonotic diseases,Footnote ⁷⁹ and a higher risk of deforestation for different commodities would likely be carried onto the epidemiological risk. A second relevant matter is the possibility of detrimental practices in the cultivation of these commodities. For example, palm oil plantations not only involve deforestation and biodiversity loss,Footnote ⁸⁰ but are also linked to respiratory illnesses and pollution.Footnote ⁸¹ Third, and this specifically concerns the rearing of cattle, not only would deforestation be carried out to make space for cattle with all the environmental issues that this would entail, but cattle rearing in deforested land could lead to increased contacts between wildlife or disease vectors, farm animals, and humans.Footnote ⁸²

Finally, the Regulation covers the supply chain of the concerned products deriving from these commodities (imports and exports), meaning that it can be considered as having some extraterritorial (extra-EU) effects, potentially making the Regulation a measure of global interest.Footnote ⁸³ Indeed, the responsibility in relation to ensuring deforestation-free or forest degradation-free supply chains is placed on EU-based companies, but the impact of complying with the due diligence requirements is likely to be felt also in third countries.Footnote ⁸⁴

What is more, the Regulation may encourage non-EU countries to take (similar) protective measures, which could be beneficial for forests and, in turn, for human and animal health: while the Regulation does not create obligations for non-EU countries (it does so only for operators and traders, EU member states, and competent authorities), it introduces facilitations for the tasks of companies under this Regulation if non-EU countries have undertaken actions to enhance deforestation-free supply chains and reinforce traceability systems on commodities.Footnote ⁸⁵

9.4.3 Structural Elements of the Regulation Having Relevance from a One Health Perspective

10.2.1 Historical Development

10.2.2 Conceptual Comparisons

10.2.3 Key Differentiating Elements

As interdisciplinary frameworks undergoing constant evolution, each of our three approaches lack ‘any generally, centrally agreed definitions, and are sometimes handled as almost synonymous, sometimes as overlapping and sometimes as quite distinctly separate’.Footnote ⁴¹ However, strictly for the purposes of this chapter, let us establish some key differentiating elements of each approach below, with an emphasis on conceptual differences that (although necessarily reductionist) will serve as useful premises for the remainder of this chapter’s analysis. These elements can be found in Table 10.1.

10.3.1 Direct Legal Reform

If we seek to discover what One Health can learn from other health frameworks (in the context of seeking the institutionalisation of One Health into legal and governance structures), we must begin by answering two questions. First, what is the current status of these health frameworks in law and governance? Second, what is their desired status?

Let us begin with the current legal status of these health frameworks. As outlined elsewhere in this book, explicit recognition of the One Health approach in binding federal or international law is comparatively limited.Footnote ⁴² Although One Health has clearly formed the basis of many international collaborations and policy guidelines – and is now championed in several United Nations resolutions – it is difficult to determine the extent of any direct causal role that One Health has played in effecting permanent legislative change. Where legal instruments are implicitly compatible with a One Health approach, it typically remains an open question as to how concretely One Health informed that legal instrument’s development (as opposed to being developed or popularised in tandem).

EcoHealth and Planetary Health currently possess even more limited, if any, overt recognition in federal or international legislation. This is naturally to be expected, given their relative youth as formalised frameworks, but similarly makes it difficult to assess their direct impact on legislative and governance structures. Assessments of international law from EcoHealth and Planetary Health perspectives tend to regard the landscape as ‘fragmented’ and ‘weak’,Footnote ⁴³ suggesting that the authors do not perceive the legal instruments considered as strongly aligned with EcoHealth or Planetary Health aspirations.

Let us secondly address the question of how these approaches aim to achieve legal reform. From a One Health perspective, this debate is still very much alive and this book will serve an important role in assessing potential routes forward. While Planetary Health explicitly aims to address legal and governance challenges and has broadly aligned with a rights-based approach to international environmental law,Footnote ⁴⁴ the movement has yet to directly notch a victory in ‘hard law’ (i.e. binding legislation) or completely reconcile its anthropocentric roots with the potential rights of nature. And where EcoHealth practitioners consider their ability to influence policy, they consider primarily indirect mechanisms such as producing effective research to pass on to policymakers.Footnote ⁴⁵

If One Health, EcoHealth, and Planetary Health so far have had ambiguous or limited success in achieving direct legal reform, and their aspirations for high-level integration into legal and governance structures continue to mature, what, then, can these approaches learn from each other? And how can they work together in overcoming legal and governance roadblocks in a way that does not privilege one of these approaches above the other (potentially hindering their ability to collaborate and co-evolve at the implementation level)?

EcoHealth and Planetary Health may have already stumbled upon the answer: legal reform does not only follow top-down consolidation of ideas and philosophies, but also often reflects bottom-up approaches that have already achieved success. It is this indirect approach to legal reform that we turn to now.

10.3.2 Indirect Legal Reform

This chapter recognises the value of a practical approach to legal reform. By more effectively delivering health outcomes to people, animals, and ecosystems in need, all three health frameworks dramatically increase the odds that supporting legal and institutional reforms will follow. We will examine several EcoHealth and Planetary Health case studies to assess both why the projects in question were successful, and how subsequent legal reforms emerged. By showing that effective health initiatives frequently precede related legal reforms, this chapter argues that a two-way causal link between the two likely exists; just as modernised legal structures could enable more effective health projects (a link that we will not explore in this chapter), so too can effective health projects lay the foundations for better legal structures to arise. These lessons can then inform One Health practitioners in seeking better health outcomes and effective reform of their own.

Such a bottom-up approach to legal reform recognises that substantial progress can still be made to improve health outcomes even within existing legal paradigms at national or international levels. Few countries strictly need a radically new legal conception of health or ecology to achieve better outcomes; for many problems, the solution can be as simple (in theory) as getting a local council to take a matter more seriously and finally implement basic but important regulations.

None of this is to imply that One Health practitioners can or should simply go about their business and rely on legal progress to occur purely incidentally to health work. Rather, this chapter suggests that One Health practitioners can consciously pursue methodologies that are conducive to legal reform through their projects even without a rigid preconception or expectation of what that reform may entail. Several projects that we will examine pursued methodologies, such as extensive community empowerment, which were conducive to subsequent legal or policy reform efforts. Engaging the public and relevant stakeholders in law reform processes habitually creates ‘strengthened democracy, more inclusive democracy, and efficacious law’.Footnote ⁴⁶

Legal instruments do not need to explicitly or entirely adopt a One Health approach in order to align with it more closely. Indeed, as any legal system ‘is continually engaged in carrying out the self-reproduction (autopoiesis) of the overall social system as well as its own’,Footnote ⁴⁷ those seeking to reform the system are bound to reflect and respect the social context within which each system functions. While attempts to homogenise the One Health framework for ease of practice (such as pushes towards a Global One Health Index weighting of factors)Footnote ⁴⁸ are admirable, a globally uniform approach to seeking legal reform may be unnecessary to make tangible progress.

We are now equipped to dive into our EcoHealth and Planetary Health case studies. This chapter will organise them as supporting evidence under two theses, both of which are oriented towards actionable suggestions for One Health practitioners to work towards better health outcomes and improved odds of compatible legal reform. One Health projects should:

1. (1) prioritise community engagement – and equip project stakeholders with the tools and confidence to pursue subsequent legislative change; and

2. (2) limit project scope creep – especially in situations where the full scope of One Health’s framework risks becoming cumbersome

10.4.1 Lesson #1: Prioritise Community Engagement

In our earlier table of key differentiating elements (Table 10.1), ‘community engagement’ was flagged as a distinct virtue of both the EcoHealth and Planetary Health frameworks. How can this be so, when there are many instances of One Health recognising the importance of community engagement and even elevating it as a ‘pillar’ of the approach?Footnote ⁴⁹

The rationale for this distinction lies in practice, rather than in theory. A 2018 systematic analysis of One Health Networks (OHNs) found that ‘activities such as communication and collaboration, data and information sharing, and human resource capacity building were reported by OHNs far more often than were other activities, such as community engagement and education or implementation research’.Footnote ⁵⁰ Moreover, the discrepancy is not a mild one: the analysis found that engagement with local populations to help adapt interventions to more specific socio-cultural contexts was ‘being done by less than 15% of OHNs’.Footnote ⁵¹ While certain OHNs do perform exceptional community outreach, they are so far the minority.Footnote ⁵² This discrepancy remains despite more recent attempts to by One Health institutions to recognise the importance of community engagement;Footnote ⁵³ One Health research (from 2015–2021) demonstrated a ‘a gap between advocacy and implementation, indicating a need for closer coordination’.Footnote ⁵⁴

This discrepancy is easily understood in the context of One Health’s empirical roots and rise to popularity. One Health draws primarily from scientific fields that are notoriously difficult to communicate as local knowledge: a rural village has little chance of independently formulating and producing a technical veterinary drug. Similarly, as a health approach geared particularly to the outbreak and spread of disease, One Health projects have likely uncovered greater attention and funding when addressing ‘outbreak narratives’ rather than fundamental and structural drivers like intensification of animal agriculture;Footnote ⁵⁵ biasing the approach further towards reactive, top-down responses less likely to require long-term community engagement.

This chapter will present several EcoHealth and Planetary Health case studies that successfully prioritised community engagement. They did so not only in a manner that contributed to desired health outcomes but also facilitated future legal reform and recognition.

10.4.2 Lesson #2: Limit Project Scope Creep

One Health’s determination to expand beyond its original veterinary and medicinal roots often left the framework in nebulous conceptual territory. As one public health practitioner put it, ‘we need to work a bit harder on defining what One Health actually is’.Footnote ⁹⁰ In 2022, the OHHELP published an updated definition of the framework, along with a Theory of Change and outcome targets. These high-level objectives state that One Health aims to ‘sustainably balance and optimize the health of people, animals, and ecosystems’, recognises the ‘intrinsic value of all living things’, and values ‘equity between sectors and disciplines’, while retaining One Health’s historical duties (from its medicinal and veterinary roots) such as identification and treatment of zoonoses.Footnote ⁹¹

While it now seems settled that One Health aspires to be much more than a public health framework for doctors and veterinarians, the OHHELP’s language persistently frames One Health as a kind of panacea; potentially applicable to anybody, anywhere, working on anything related to the health of any other thing. All three frameworks considered here are broad umbrellas in nature, but arguably One Health most of all.

This approach has its virtues: openness to a wide range of definitions and implementations makes room for interdisciplinarity, and One Health’s ubiquity has facilitated adoption by several United Nations bodies. However, this approach also risks ‘suboptimal strategic planning, coordination, and stakeholder engagement’ and has made ‘determining what would constitute improvements … challenging’.Footnote ⁹² One Health initiatives can be bogged down at the emphasised ‘collaboration’ phase, and begin to work against their own values.Footnote ⁹³ For instance, Degeling et al. (2017) note that ‘lack of evidence about how different sectors understand One Health, their roles and responsibilities, and how they pursue their priorities, could limit collaboration and its benefits.’Footnote ⁹⁴

This challenge may be surmountable with time and sufficient communication, but these are luxuries that not all health projects can afford. Sparsely staffed or funded projects often only have the resourcing to operate for a few years and are often situated in developing nations with language barriers to overcome and scarcely any nearby OHNs. Expectations for these One Health practitioners to carefully consider and communicate an increasingly far-reaching framework may take valuable time away from the fieldwork that counts most.

This chapter will present EcoHealth and Planetary Health projects that – although still complex at the implementation level – benefitted from a high level of clarity. By choosing their objectives carefully, these projects delivered stronger health outcomes to the communities affected and helped catalyse future legal reform.

11.3.1 Evolution of AMR Global Governance

To date, global action to address AMR has mostly relied on soft law instruments and political declarations led by different intergovernmental organisations. In 2011, the Food and Agriculture Organization (FAO), the World Health Organization (WHO), and the World Animal Health Organization (WOAH) recognised the significance of AMR as one of the three topics that require multisectoral collaboration to advance the One Health approach, alongside rabies and zoonotic influenza.Footnote ¹⁹

Following Resolution WHA68.7,Footnote ²⁰ 2015 was a crucial year for AMR, with the adoption of the GAP, the launching of the Global Antimicrobial Resistance and Use Surveillance System (GLASS),Footnote ²¹ and the establishment of the UK Fleming Fund to fight AMR. In May 2016 the landmark AMR report ‘Tackling Drug-resistant Infections Globally’ by Jim O’Neill was published. Commissioned by the UK government and the Wellcome Trust, this report illustrated the economic and social risks resulting from AMR and offered concrete actions to address the global AMR challenge.Footnote ²²

At the 71st Session of the United Nations General Assembly (hereinafter General Assembly) in September 2016, the High-level meeting on AMR adopted a Political Declaration on antimicrobial resistance included in Resolution 73/1. This Resolution emphasised the relevance of the One Health approach, recognising the interconnection between the animal, human, and environmental dimensions in combating AMR. It also called for the engagement of relevant government sectors in developing and implementing multisectoral national action plans, policies, and regulations, tailored to each country’s context and legal system. With this declaration, countries committed to developing multisectoral One Health national action plans for AMR and ensuring their implementation through appropriate regulatory frameworks. The Declaration also called for the establishment of an ‘Ad hoc inter-agency coordination group’ to provide practical guidance for sustained global AMR action. As a follow-up to this Political Declaration, the different intergovernmental organisations working on matters relevant to AMR joined forces within the Interagency Coordination Group on Antimicrobial Resistance (hereinafter Interagency Coordination Group) to identify shared solutions.

In its 2019 report, the Interagency Coordination Group on AMR resulting from this UN General Assembly Resolution proposed the creation of a One Health Global Leadership Group on Antimicrobial Resistance, supported by a Joint Secretariat managed by FAO, WHO, and WOAH (at the time, OIE).Footnote ²³ Additionally, the Interagency Coordination Group recommended the establishment of an Independent Panel on Evidence for Action against Antimicrobial Resistance for action against AMR in a One Health context.Footnote ²⁴

In response to the mandates from UN General Assembly and the Interagency Coordination Group, FAO, WHO and WOAH signed a Memorandum of Understanding (MoU) in 2018,Footnote ²⁵ which was later expanded to include UNEP in 2022, creating a quadripartite framework (the Quadripartite).Footnote ²⁶ The MoU provides a legal and formal framework for the four organisations to enhance integrated and coordinated efforts at the human, animal, plant, and ecosystem interface to reinforce national and regional health systems and services. AMR is precisely one of the major areas of cooperation.

Over time, these partner organisations have created governance structures for AMR, including a Joint Secretariat with rotating chairmanship, an Executive Committee composed of the Directors-General, and a Senior Management Group. They have also developed mechanisms to enhance consultation and coordination, including cooperation among technical experts, the organisation of annual executive coordination meetings, and the appointment of liaison officers at the global level. Under the quadripartite framework, the Quadripartite Joint Secretariat on AMR supports global, regional, and national AMR initiatives. This includes the development of a Joint Strategy on AMR, facilitating effective policy and legislative responses to AMR in countries.Footnote ²⁷

Established in November 2020, the Global Leaders Group on AMR (hereinafter Global Leaders Group) is composed of heads of state, regulators, and high-level public and private experts, including the principals of the Quadripartite. It collaborates with public and private stakeholders globally to prioritise AMR on international and national agendas. The Global Leaders Group has published several statements and guidance on topics such as AMR in food systems.Footnote ²⁸ It has also advocated for AMR’s inclusion in the Pandemics Treaty and the organisation of a UN General Assembly High-level meeting in 2024.

The AMR Multi-Stakeholder Partnership Platform (the Platform) serves as a neutral forum for discussion among the various sectors relevant to AMR, fostering coordinated actions and facilitating engagement among governments, academia, civil society, the private sector, and intergovernmental organisations. It also serves as space for developing specific coordinated joint actions through members-driven action groups. The Platform was launched on 15 November 2023.

Furthermore, AMR has been a recurrent topic in G7 and G20 ministers’ declarations. G20 ministers have addressed AMR in their declarations since 2016 (Hangzou Summit) and including the 2017 Hamburg Summit, the G20 Action Plan on AMR approved in Buenos Aires in 2018, and the Bali Summit in 2022, in which ministers committed to embracing a multi-sectoral One Health approach to AMR. In August 2023, G20 Health Ministers recalled their commitment to ‘tackle AMR comprehensively following the One Health approach’ and indicated multi-sectoral governance and coordination as a necessary step. Also, G7 Ministers have consistently addressed AMR in their declarations since 2014 (Brussels summit declaration), and more substantially in the Leader’s declarations of 2015, 2016, 2018 (recalling the One Health approach), 2021, and 2022.

At the time of writing this chapter, countries were preparing for a forthcoming UN General Assembly High-Level meeting on AMR scheduled for September 2024.

In summary, the global governance of AMR has been spearheaded by intergovernmental organisations such as the UN and the Quadripartite. The UN General Assembly played a pivotal role by issuing landmark Resolutions that laid the groundwork for subsequent intergovernmental efforts. The resulting governance framework incorporated various components, including policy-makers represented by the Global Leaders Group, scientific expertise to be facilitated by the forthcoming Independent Panel of Experts, and stakeholders’ participation through the AMR Multistakeholders platform. This structure fosters multidisciplinary and multilevel knowledge exchange, political involvement, and widespread public participation; three fundamental elements consistent with the principles of One Health.

11.3.2 International Law Instruments Applicable to AMR

Besides the legal instruments and policy structures mentioned earlier, the multifaceted nature of issues pertinent to AMR spans across various international instruments. These instruments play a crucial role in shaping the global governance of AMR.Footnote ²⁹

For instance, the International Health Regulations (IHR) provide a framework for cooperation among countries to prevent, protect against, control, and respond to the international spread of diseases, including those related to AMR. Some scholars have suggested that the emergence and spread of AMR bacteria,Footnote ³⁰ especially those for which there is no suitable treatment, may constitute a public health emergency of international concern under the terms of the International Health Regulations. Under these circumstances, countries would be required to notify the WHO under Article 6 of the IHR.Footnote ³¹ Under this view, applying the IHR to AMR could serve to strengthen global AMR surveillance and response, and to contain AMR. This opinion, however, is debatable to the extent that AMR does not meet the definitional requirements of a Public Health Emergency of International Concern.Footnote ³² Moreover, relying on a possible declaration of a Public Health Emergency of International Concern to address AMR globally would not put sufficient emphasis on the need for ‘deep prevention’ to effectively address the AMR ‘silent pandemic’.Footnote ³³

Beyond the IHR, several agreements under the World Trade Organization apply to AMR. The Agreement on Sanitary and Phytosanitary Measures (SPS Agreement) would be applicable for countries approving import restrictions to detect and stop the entrance of animals or animal products potentially contaminated with antimicrobial residues or resistant pathogens. In this respect, several international reference standards have approved detailed and granular guidance on antimicrobial use and AMR.Footnote ³⁴ Quality standards for antimicrobials could also be influenced by the Agreement on Technical Barriers to Trade (TBT Agreement).

Similarly, access and availability of safe and effective antimicrobials are influenced by the intellectual property rights provisions in the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS Agreement), which may have an impact on the equitable access to antimicrobials in all countries if the flexibilities granted under TRIPS are not taken into consideration.Footnote ³⁵ Other potentially relevant international agreements include the International Convention on the Harmonized Commodity Description and Coding System concerning customs procedures.Footnote ³⁶

The international trade of antimicrobials could be protected by the UN Convention of Contracts for the International Sale of Goods and, although soft law, the 2016 Principles of International Commercial Contracts of the International Institute for the Unification of Private Law (UNIDROIT). The UN Convention against Transnational Organized Crime could be also applicable to networks that trade in substandard, illegal, or counterfeit medicines, as long as they meet the definition of transnational crime. Finally, the illegal trade of animals, including wildlife, which could constitute an important avenue for the transmission of resistant pathogens across countries, is also influenced by the Convention on International Trade of Endangered Species of Wild Flora and Fauna (CITES).

The global governance of AMR is further shaped by international reference standards and guidance documents. The Quadripartite publication ‘International Instruments on the Use of Antimicrobials across the Human, Animal and Plant Sectors’ identifies key international guidance documents that may support the development of AMR policies and regulation across sectors.Footnote ³⁷ In addition to different guidance documents published by the WHO, these standards include the updated Codex Alimentarius Code of Practice to Minimize and Contain Foodborne AMR,Footnote ³⁸ the Guidelines for Risk Analysis of Foodborne AMR,Footnote ³⁹ and the Guidelines on Integrated Monitoring and Surveillance of Foodborne AMR.Footnote ⁴⁰ They also include the AMR-specific standards and articles introduced by the WOAH into the Terrestrial and the Aquatic Animal Health Codes,Footnote ⁴¹ which are periodically updated. These standards guide countries to apply a One Health approach to AMR governance and regulation and, while they are not legally binding in nature, the fact that both Codex and WOAH are nominated as reference international setting bodies in the SPS Agreement gives them a relevant regulatory role.

These international agreements and standards shape the regulatory framework for AMR at both the international and national levels. Conducting a mapping exercise of international obligations and the division of roles and functions at the national level helps identify the key actors and areas requiring coordination. Similarly, in the context of One Health, multisectoral governance mechanisms must consider existing international obligations across various sectors. This includes sectors such as health, agriculture, environment, trade, and intellectual property. Strengthening collaboration across these sectors is essential for addressing the complex challenges posed by One Health comprehensively.

11.3.3 From Soft Law to a Binding Global Framework for AMR

Global opinion has long debated the best international law instrument to address AMR. Some scholars advocate for flexible soft law instruments or a mix of binding and non-binding models.Footnote ⁴² These models propose progressively introducing new norms that create political momentum, fostering voluntary compliance and adaptive governance models,Footnote ⁴³ and granting AMR the flexibility that is needed for every area based on science and uncertainty. Other academics signal the limitations of soft law and propose a legally binding instrument that anchors concrete binding obligations and provides for accountability mechanisms.Footnote ⁴⁴ The Paris Agreement has been proposed as a model to develop a binding AMR instrument given the similarities between climate change and AMR and the challenges to be overcome.Footnote ⁴⁵ Any successful legal intervention must strive for a balance between access, conservation, and innovation.Footnote ⁴⁶ Measures must span across the human health, animal, agriculture, and environmental sectors and aim to preserve the efficacy of antimicrobials to achieve intergenerational justice, ensuring wins for present and future generations.Footnote ⁴⁷ In summary, the adoption of a One Health approach to regulating AMR at a global level is imperative. This approach ensures that AMR regulation aligns with principles of multisectoriality, equity across sectors and disciplines, and stakeholder participation.

The COVID-19 pandemic strongly influenced the discussions on a potential global level response to AMR, connecting this to the more specific topic of pandemic prevention, preparedness, and response (PPPR). The devastating impact of the pandemic placed pandemic prevention high on the international agenda and the possibility of crystalizing AMR as a silent pandemic within an international treaty gained scholarly support.Footnote ⁴⁸ At the time of writing this chapter, the negotiations for the drafting of a Pandemic Agreement by the Intergovernmental Negotiation Body have been further prolonged after the missed opportunity of reaching consensus at the 77th session of the World Health Assembly. That said, different countries, international and non-governmental organisations have strongly advocated for AMR to be considered as a silent pandemic. A strong recognition of AMR as part of the Agreement would offer an excellent opportunity to consolidate soft law rules that have been broadly accepted by countries. It would recognise the mandate of the Conference of Parties to develop intergovernmental and consensus-based implementation guidance and to negotiate complementary binding (including an additional protocol) or non-binding more granular instruments on AMR.Footnote ⁴⁹

11.4.1 Trends in the Development and Implementation of the GAP and NAPs

Both the Global Action Plan for AMR and the Interagency Coordination Group report recommended that countries establish multisectoral coordination mechanisms for AMR governance and approve multisectoral National Action Plans (NAPs) to consolidate their policy objectives. Over the past years, many countries have advanced in establishing both. In 2023,Footnote ⁵⁰ among the 175 countries responding to the Quadripartite Global Database for Tracking Antimicrobial Resistance Country Self-Assessment Survey (TraCSS), only eighteen declared not to have a multisectoral governance or coordination mechanism. A total of ninety-two countries reported having a formalised and functional multisectoral coordination mechanism, with thirty-five out of those countries utilizing these structures to implement integrated approaches to NAP implementation. This represents significant progress from the 2017 data, where forty-one countries declared lacking a multisectoral coordination mechanism, and only thirty-one reported having formal and functioning structures.

Regarding NAPs, a comparison between the TrACCS results of 2017 and 2023 under the topic ‘Country Progress with Development of a NAP’ reveals an observable increase in the number of countries incorporating a costed and budgeted operational plan and/or financial provisions for implementation.Footnote ⁵¹ Despite TrACSS being a voluntary self-assessment mechanism, the data indicates a positive shift towards more formalised governance structures such as joint work and integrated approaches. This positive movement is gradually followed by effective implementation, as reflected in financial allocations. This positive trend alleviates the pessimism regarding the implementation (or the lack thereof) of NAPs.Footnote ⁵² In 2018, FAO, WHO, and WOAH affirmed that despite countries declaring firm commitment, many countries had not implemented NAPs or aligned their domestic policies with global recommendations.Footnote ⁵³ Empirical analysis also revealed that, following an initial momentum for NAP development and the establishment of multisectoral structures, collaborations were challenging to sustain due to reliance on voluntary partnerships.Footnote ⁵⁴

The term ‘isomorfic mimicry’ was introduced to the AMR landscape to explain the differences between the content of the NAPs and their actual implementation.Footnote ⁵⁵ This phenomenon elucidates why low and middle-income countries tended to develop NAPs following the recommendations of the GAP but were unable to implement them due to financial constraints, as well as institutional and political challenges. In 2022, the WHO published an ‘Implementation Handbook for National Action Plans on Antimicrobial Resistance in the Human Health Sector’ targeting national and subnational stakeholders working on AMR to help them ‘guide and accelerate sustainable implementation’ of NAPs-AMR.Footnote ⁵⁶ This document includes concrete steps to set up a multisectoral governance mechanism promoting broad multisectoral engagement under the coordination of a higher-level authority.

TrACCS data allows for the conclusion that multisectoral AMR governance mechanisms have broadly been established with dissimilar success and standing challenges. However, informal mechanisms have shown signs of tiredness and weak accountability, compromising their long-term sustainability. Countries are facing challenges to setting up integrated mechanisms, such as integrated surveillance programs in the absence of a concrete framework for accountability and data sharing.

11.4.2 Elements and Principles of AMR National Governance and the Role of Legislation

Numerous authors have debated the best regulatory approach to establish a multisectoral governance mechanism for AMR at the national level. Some argue for flexible governance mechanisms to avoid the pitfalls of over-regulation. Rubin proposed a nuanced approach combining binding and non-binding instruments at multiple levels, emphasizing ‘glocalisation’, where global guidance adapts thoughtfully to local capacities and needs.Footnote ⁵⁷ This chapter argues that national AMR governance should be based on horizontal and decentralised collaboration reflecting the principle of subsidiarity, by ensuring that global recommendations are adjusted to national regulatory and enforcement capacities and needs.Footnote ⁵⁸ Birgand et al. suggested an AMR national governance model combining top-down power with ‘network governance’.Footnote ⁵⁹ In this decentralised approach, the central level shapes policies, and the local level, including beneficiaries and the private sector, defines bottom-up implementation mechanisms, enhancing democratisation and collaboration. Spruijt and Petersen advocated for flexible governance arrangements for scientific areas marked by constant evolution, uncertainty, and adaptiveness.Footnote ⁶⁰

However, flexible legal solutions must be coupled with clear roles and mandates and a functional accountability framework. In some legal systems, establishing a new interministerial group may require novel legislation that clarifies roles and responsibilities, introduces financial or reporting obligations, and sets up sustainable mechanisms for stakeholders’ participation. Such legislation can facilitate the transition from coordination to collaboration and integration, enabling joint interventions. The challenge is to ensure that legislation fosters an enabling environment, preserving its flexibility while building trust among all members, including the private sector.

Anderson, Schulze, and Cassini proposed a governance framework for AMR based on three core governance pillars:Footnote ⁶¹ policy, implementation, and monitoring and evaluation (M&E). Suggested indicators for policy include: multisectoral coordination, accountability, equity, transparency, and sustainability, among others. These indicators represent important foundational principles for the functioning of a multisectoral governance mechanism. Crucial for the implementation of AMR NAPs, accountability demands binding obligations for coordinating authorities and ensuring enforcement. This ties closely to sustainability, as accountability mechanisms influence long-term institutional engagement beyond the political momentum. Equity among countries and populations introduces a human rights dimension, ensuring equitable access to antimicrobials and sanitary care, particularly for vulnerable groups. This aligns with the One Health principle of equity,Footnote ⁶² emphasizing accessibility and affordability of healthcare for all, and considering gender and socio-economic factors affecting AMR exposure.

In addition to the proposed principles of accountability and equity, an effective AMR governance structure should embody the principles of good governance, solidarity, and subsidiarity.Footnote ⁶³ A well-established principle in public international law, solidarity safeguards human dignity amidst the reality of our shared vulnerabilities to the challenge of antimicrobial effectiveness reduction, an issue demanding integrated management. Subsidiarity directs the management to commence at the local level, acknowledging local communities’ better understanding of their specific AMR challenges.

For effective multisectoriality under the equity principle, all relevant ministries should be involved in AMR management. The Global Leaders Group ‘Pocket Guide for Ministers across Sectors’ identifies as potentially relevant for AMR governance not only the ministries of health, agriculture, and the environment, but also the ministries in charge of finance, industry, education, research, and innovation.Footnote ⁶⁴ Depending on a country’s constitutional structure, decentralised and local authorities might be directly responsible for certain elements of AMR management and deserve recognition of their roles and mandate. Collaborating with the diversity of actors that are part of the private sector (from the pharmaceutical industry to farmers) is also vital, as they can contribute significantly to NAP development and implementation and to AMR effective regulation, through co-regulation and self-regulation strategies.

A rapid check of national legislation using AMRLex,Footnote ⁶⁵ a FAO-based repository of AMR relevant policies and legislation in the food and agriculture sectors, reveals that, while most countries have adopted policies, strategies, or national action plans for AMR (155 are included in the WHO NAP Library), only a few have translated these commitments into specific legislation. Most of these instruments establish multisectoral governance mechanisms and define their composition and functions. Typically led by the Ministries of Health, these bodies vary widely in composition, with Ministries of Health, Agriculture, and Environment often included, alongside a diverse array of other entities, as exemplified by the national committees established in Guinea and Algeria.Footnote ⁶⁶ There are exceptions to this trend where members have a shared responsibility to lead coordination. For instance, in Ecuador’s Comité Nacional de Prevención y Control de la Resistencia Antimicrobiana,Footnote ⁶⁷ the Presidency alternates among members. The Executive Order issued by the President of the United States of America of 2014 provides another interesting example, by establishing a multisectoral task force and a Presidential Advisory Council.Footnote ⁶⁸ This global, albeit partial, overview emphasises the diverse strategies nations employ in translating AMR objectives into legislative action and highlights the importance of learning from innovative approaches across different jurisdictions.

11.4.3 The Role of Sector-Specific Legislation

In addition to a multisectoral governance mechanism backed by appropriate legislation, a conducive legal framework for AMR should encompass sector-specific laws that not only incorporate international guidance and best practices but also promote collaboration and coordination across various sectors and foster effective compliance and enforcement.

Sector-specific legislation is instrumental in shaping the availability and access to antimicrobials. It can introduce antimicrobial use requirements for products entering the food supply chain and regulate the disposal and release of antimicrobials into the environment. Jeleff’s empirical research underscores the need for a shift from non-binding to legally binding obligations, particularly in antimicrobial stewardship programs and consumption surveillance in hospitals.Footnote ⁶⁹ Legally binding individual responsibilities, as suggested by Munkholm and Rubin,Footnote ⁷⁰ can enhance implementation and enforcement. Hoffman, Bakshi and Van Katwyk argue that effective AMR strategies must extend beyond individual behaviour change and incorporate institutional-level action.Footnote ⁷¹

Relevant legal sectors for AMR include, among others, public health, animal health, food safety laws, and laws regulating the environment, waste, and pollution control. These sectors have traditionally been regulated in silos, with one sector usually regulated under specific legislation implemented by one Minister. While it is probably neither possible nor desirable to fully eliminate these silos, sector-specific legislation should incorporate appropriate mechanisms to enable multisectoral coordination across them.

The Quadripartite One Health Legislative Assessment Tool for AMR, launched in November 2023, warns against the risks of horizontal cross-sectoral AMR legal instruments that regulate fragments of different sectors. The Tool proposes a combination of horizontal AMR legislation addressing multisectoral issues, such as multisectoral governance, coupled with legal responses to be addressed in sector-specific laws.Footnote ⁷²

As results from this section, implementation of AMR under a One Health approach demands national mechanisms for coordination, collaboration, or integration of policies and strategies of common interest. While these mechanisms can take various shapes, it is important that they are accompanied by a substantive accountability mechanism that facilitates their long-term sustainability. Legislation can serve to provide legal basis to these mechanisms. This legislation should co-exist with sector-specific legal instruments incorporating international guidance into national law. Sector-specific legislation should preserve its internal consistency avoiding fragmentation. The solution is not to merge laws for AMR but to ensure that all sector-specific laws include the appropriate cross-references to work harmoniously, contributing to common goals.

11.5.1 Public Health Regulation in the European Union

The EU’s approach to public health has been shaped by its distinctive constitutional framework, regulatory nature, and its historical emphasis on internal market development.Footnote ⁷⁶ The delineation of competencies between the EU and its member states is meticulously outlined in its foundational treaties. These treaties have evolved over the years from an initial focus on the establishment of an internal market, to increased integration in areas of common interest. The Treaty of Lisbon of 2007 recognised public health as a shared competency between the EU institutions and the member states, unlike policies such as the agricultural policy, where sovereignty is largely transferred to the EU institutions. This acknowledgment underscores the EU’s commitment to a collaborative approach in addressing health challenges, achieving a nuanced balance between central coordination and member state autonomy.

EU member states have traditionally hesitated to transfer sovereignty powers in public health from the state to the EU level.Footnote ⁷⁷ This reluctance is attributed, in part, to the significance of the health budget and the nature of health systems, which gain legitimacy through a direct political process.Footnote ⁷⁸ For these reasons, despite the heightened attention to health policies prompted by the COVID-19 pandemic, with both global and EU health policies experiencing expansion, scholars caution that this focus might be ephemeral, drawing parallels with historical trends in the field.Footnote ⁷⁹

Before 1992, references to public health were primarily associated with the establishment of the internal market and were regulated as exceptions to free trade arrangements, echoing international trade law and the SPS agreement.Footnote ⁸⁰ The Cassis de Dijon case at the European Court of Justice exemplifies this, confirming that countries can only impose restrictions on the free movement of goods under certain exceptions, including the protection of public health and the defence of consumers.Footnote ⁸¹

Following the Maastricht Treaty in 1992, and more prominently with the revisions of the EU foundational treaties in Amsterdam (1997), Nice (2002), and finally in Lisbon (2007), the EU progressively gained the capacity to intervene in public health. Article 168 of the Lisbon Treaty recognises a high level of health protection as a core objective and principle for all EU policies and activities with EU action, complementing national policies and fostering cooperation between member states. The EU acquired the ability to initiate the establishment of common guidance and conduct periodic monitoring and evaluation (Article 168.2). Under this article, the regulatory capacity of the European Parliament and the Council over health matters is limited to the quality and safety of human tissues, veterinary, and phytosanitary fields, and the quality and safety of medicinal products and devices. Additionally, the EU Parliament and the Council may approve incentives to protect and improve human health (Article 168.4), with the Council empowered to adopt recommendations upon the Commission’s proposal (Article 168.5).

This background is essential to understand the evolution of AMR regulation in the EU. To dig into this topic, this section identifies some of the key elements of the EU regulatory framework for antimicrobial resistance, emphasizing its character as a shared policy marked by diverse and dissimilar responses across the EU member states. The intention is not to provide an exhaustive account of the very prolific legislative production and accompanying initiatives of the EU, but to show growth and evolution in the development of a robust AMR regulatory framework under a One Health approach.

11.5.2 EU Cross-Sectoral AMR Regulatory Instruments

The EU institutions have led the way in developing policies and regulatory frameworks to address antimicrobial resistance. The first Community Strategy to combat AMR was approved in 2001,Footnote ⁸² alongside Council Recommendations regarding the prudent use of antimicrobial agents in human medicine.Footnote ⁸³ Framed by the above-mentioned constitutional division of powers and responsibilities, the regulatory framework for AMR primarily comprises soft law instruments, including Council recommendations and Conclusions, the Commission Action Plan on AMR, and the monitoring reports approved by the Commission and its specialised agencies on AMR, AMR surveillance and other specific AMR aspects of cross-cutting nature. These soft law instruments have influenced the revision and update of various sector-specific AMR-relevant legislation across various domains such as food and veterinary controls, veterinary medicines, feed, waste, wastewater, and soon, the authorisation of pharmaceuticals for human use.

Early documents, such as the Community Action Plan 2001 and the Council Recommendations and Conclusions of 2001, 2002,Footnote ⁸⁴ and 2008,Footnote ⁸⁵ focused on both the human and animal sectors, addressing aspects related to the coordinated management of medicines, antimicrobial stewardship, and the development of new medicines.Footnote ⁸⁶ The slightly later second Commission Action Plan of 2011 and the Council Conclusions of 22 June 2012 introduce references to the One Health approach emphasizing the intersection between the human and the veterinary sectors.Footnote ⁸⁷ One Health is also expressly mentioned in the European Parliament Resolutions on AMR adopted in May,Footnote ⁸⁸ and October 2011,Footnote ⁸⁹ 2012,Footnote ⁹⁰ and 2015.Footnote ⁹¹

However, it was in 2017, with the introduction of the last EU One Health Action Plan Against AMR (the 2017 AMR Action Plan) that the role of the environment was highlighted, and thus better encompassing the overarching One Health approach to the AMR issue and challenges.Footnote ⁹² EU actions under the plan aimed at focusing on the areas with the highest added value for member states such as promoting the prudent use of antimicrobials, enhancing cross-sectorial work, improving infection prevention, consolidating surveillance of AMR and antimicrobial consumption, and reporting.

In the same vein, the 2023 Council Recommendations on stepping EU actions to combat AMR under a One Health approachFootnote ⁹³ encourages member states to implement One Health Action Plans for coordinated AMR response involving all sectors, including the environment, to ensure their full implementation. The recommendations further suggest concrete and measurable targets to reduce antimicrobial use, which consider national situations. Similarly, the European Parliament resolution of 1 June 2023 on EU action to combat AMR adopts a One Health approach and encourages members to foster multisectoral and sustainable AMR coordination and integrated surveillance addressing the environmental sector.Footnote ⁹⁴

The Commission’s overview report of member states’ One Health National Action Plans against AMR of November 2022 showed that while most member states have enacted NAPs under a One Health approach,Footnote ⁹⁵ these Action Plans varied considerably in terms of implementation, with measures related to the environment often missing. Furthermore, weaknesses in the areas of financing, monitoring, control, and evaluation were identified that could compromise the long-term sustainability of the NAPs.

11.5.3 Sector-Specific Legislation

In addition to the aforementioned cross-cutting AMR legal soft law instruments, the EU has undergone a comprehensive revision of sector-specific legislation across key legal areas crucial for AMR. This revision encompasses the regulation of antimicrobials, measures to prevent the contamination of food and the environment with antimicrobials, and initiatives related to disease prevention and animal welfare that minimise the need for antimicrobials.