[MUSIC] Welcome everyone to module seven of this One Health MOOC. Today we are having a recap module where we will go through the key findings of the separate modules from KI and FEAM. So we the creators of this MOOC are gathered here today to discuss a bit and to kind of summarize what you might have been going through but also what we have been going through when creating this MOOC. So we're happy to be here today. So we're going to have a short person intro. So I am kind of being somewhat of a moderator today. So my name is Elin Pollanen. I'm affiliated with Karolinska Institute in Stockholm Sweden. And my background is in public health and political science. And with me today I have my colleague Walter Osika. >> Yeah, thank you Elin for this introduction. My name is Walter Osika and I'm a researcher and physician also affiliated at Karolinska institute. And over to FEAM and Claudia Granaldi. >> Yeah I'm Claudia and I'm a junior policy officer at the Federation of European Academies of Medicine. And as Ellen also have a political science background. And with me there is also Emma. >> Hello, good morning everybody. My name is Emma Martinez. And I am also working together with Claudia in the Federation of the European Academies of Medicine and I am there the senior scientific policy officer. My background is molecular biology. I'm a scientist turned science policy. >> Okay, so the point of this module is to go through the key findings. For you who have gone through the whole course but maybe also for you who are just checking out what this might mean and want to skip straight to the key findings. So we will try to summarize it for you and also discuss a bit, what are the take home messages and the most important ones for us. And so this way of going about that we're doing today might seem a little bit counterintuitive due to the MOOC structure. So in the actual MOOC, KI have the first modules and then FEAM have theirs. But today we're actually doing the inverted order. So FEAM is starting to present their key findings and then KI is following that. And the reasons for this is because when we discuss this, pre recording, we realized that there were some unforeseen events happening which can be when humans are involved. And so when we went through our key findings, we realized that the FEAM and the KIs lectures are aligning a bit. But KI is kind of zooming in and discussing a bit more, some of the aspects of FEAM is bringing up. So that is why we're doing it inverted order today. So hopefully that will become more clear once we are presenting and also when we are discussing. So FEAM, what were according to the key findings in your in your modules? Yeah, So we decided to group our findings in two groups that we are now going to present to you, me and Emma and the first one as a group is called 'One Health and health crisis' prevention and management'. And the first key message that I would like to highlight today is that a One Health that integrates environmental health and especially its philosophy of 'prevention is better than cure' is essential for a sustainable future. And, more in general, One health has a strong prevention potential. It is important to prevent pandemics, not only to learn how to respond to them. And the second main message in that lesson has been that the COVID-19 pandemic emphasized the importance of implementing antimicrobial stewardship programs that are adapted to a crisis context. The second group of key messages regards the 'Integrated and cross-sectoral vision'. An integrated vision is crucial to respond to nowadays global challenges and also system approaches are required. Then cross-sectoral information sharing is key for the implementation of one health and particularly in surveillance systems. Finally, concrete specific action, for instance research projects, integrative activities, promote cross sectoral and cross border cooperation and collaboration. And finally, we grouped some other key messages in the final group which is called 'Next steps' and investigate what role is for the international community. And the first key message here is that global scale diseases diversity is controlled by factors that we affect but we do not control. And also the liberalization of world trade, while offers many benefits and opportunities, it also poses new risks. Finally, the last key message from the FEAM side is that the world needs strong legally binding rules with strong compliance mechanisms to confront future pandemics. Okay. And the key findings from KI: We are aligned in many ways with your findings from FEAM with the systems thinking approach etcetera. So we have chosen to bring up some of the points that might be more unique for for our modules. So what I am what we're not presenting should also be considered that we we emphasize some of your points as well and we will get into that more in the discussion of course. But here are some of our key findings. So the first one is concerning Prevention and creeping crisis. So, from our lectures it is becoming evident that there's a need to further explore initiate preventive efforts. As today's ways of handling pandemics are still too high extent reactive, which means that we act once disease has occurred instead of minimalizing spillover risks and also creating buffer zones and systems. So we emphasize or the lectures emphasize the need to create buffer zones and systems. And also we explore the problems with an anthropocentric framing of One Health. So we explore how One Health is still adopted in anthropocentric terms which means human-centric bias which means to elevate human interest at the expense of animals and the environment, where the definition of animal and environmental health largely depends on their perceived function to humans. Exactly. And we see also that One Health is still focused heavily on zoonotic diseases and surveillance, quite reactive and other aspects are excluded. For instance, the interconnection between human and animal rights. We talk about 'One Rights', the mental health of animals and the connection between high meat consumption and noncommunicable diseases, environmental degradation like habitat destruction and climate change, but also pandemics. Mhm. And kind of tapping into that is as the last category about One Health potential normative role which remains largely unexplored and where lecturers emphasize that. Whilst One Health acknowledges the interdependence between humans, animals and the environment, it still lacks a normative framework which hinders action and implementation. Also, this is of course connected with the legal restraints where this interconnectedness between human, animals and environment is not acknowledged yet to that extent that might be needed. >> Exactly, so One Health could play a role in advancing public health ethics, by for instance, including animal interests in public health ethics. And combating epistemological oppression by including all the other perspectives of interest in decision making processes and prevention, especially local and marginalized voices and communities. >> Yes. So, these are our key findings. So, now the question is kind of a discussion point for us to talk about is: what did we learn and do our perspectives and key messages align? So we were diving a bit into that with the systems thinking and also the need for One Health to have a preventive aspect. And that is kind of something that I personally would like more to explore. So this preventive aspect of One Health, how - I might turn this to FEAM now - How do you see One Health preventive efforts as today and what might be needed for? How did your lecturers go on about preventive efforts and the preventive approach? >> So if I can say what I think about it, one lesson that I enjoyed the most was the one on the Environmental health. And what emerged from that is that, according to the lecturer at least, the environmental pillar of One Health as a strong prevention dimension. She was referring to the prevention, to the philosophy that 'prevention is better than cure'. They strongly connected to the environmental pillar of one health. So, I think that One Health has a strong prevention potential at least. So this was one of our key messages and I think this is one of the different aspects that emerged from our key messages and yours. But I think at the same time it's kind of complementary because from our side we're talking about the potential of the concept while you're talking more on on the current stages which is still far from been oriented toward the active prevention of pandemics. >> And if I might elaborate a little bit further on that, I would like to bring the role of surveillance systems into the prevention part of future possible pandemics. So we do have a lot of surveillance systems. But to what level are those interconnected between the different pillars is not so straightforward. So I think a closer integration and data sharing between different agencies and bodies is what we are lacking at the moment and what the community is probably pointing towards. >> I love that your lecture, I think it might have been the case also for us that we are quite focused on the obstacles and the blind spots that we currently see not only in the One Health concept, but maybe that seeps into the One Health concept due to the normative frameworks that we live in today. That we might be so focused on human, the human mind in this that it might be easy to forget that for instance from environmental health, this interconnected way of seeing is quite normal. It's quite the way that environmental health observes the world because if you look at the environment, most things are interconnected ecosystems, etc. So, hearing somebody from environmental health might make it make more sense. And of course from our lectures, it also was emphasized that the sectors, the animal and environmental sectors need to be more heard and the interests need to be made more complex and not just human function-related. So, it becomes less anthropocentric. But also when one of the things that I learned from our lectures were the, to make to make prevention a more complex word. And that's also kind of why maybe we switch the order of our key findings because we look at prevention, but we also look at it from different angles and also different stages of prevention where surveillance is one step. But there are also other steps before that that could minimize spiller effects by, for instance, creating these buffer zones or systems that are resilient by other measures. For instance, combating deforestation is one preventive measure that is kind of more deep preventive that looks at the upstream factors of why disease emerge. And Walter, I think you and I discussed a bit about relating to the prevention with the creeping crisis concept and and things that we learned from there about the difference between a classical crisis and a creeping crisis that demands a lot of more long term thinking from us. >> Yeah, I totally agree what you said there that the creeping crisis concept was really educative for me too. And also maybe the surveillance system that you Emma talk about that it also could create feedback loop up streams so that you really change the way we relate and treat nonhuman, animals. So that is, I think, one area of quite promising future action that is needed at least. >> And if I might contribute a little bit here in this discussion. Another of the things that I have learned throughout the development of this MOOC is the understanding on the concept itself, on the one hand, so not everybody understands One Health the same way to start with. And we're talking not only among the scientific community, but also in science policies, communities, and that's first. Second, the understanding of the general public, of the citizens. Do they know about it? Do they don't know about it? Because at the end of the day, our policies have guided by the needs of our citizens and if they are not aware of what's going on and that we need a balanced approach to health, they are not going to demand it and therefore it's not going to be met in policies. And finally, in the concept of understanding One Health is the institutionalization of One Health, I've learned throughout the development of the MOOC, is very different across member states. So one country is doing one thing in a way to approach One Health, but the other one is not. And therefore, how do you communicate with each other? And how do we make these international surveillance systems work if we don't understand the same concept or the concept the same way? >> I totally agree on that. >> And also, by making even more complex and continuing what Emma is saying, which is a brilliant point, is, if we include other voices and perspectives as well, to juggle all of these ways of seeing One Health, and if we include law for instance, which we have done in our lectures and in law, and social sciences and the normative framework, which is quite a challenge, but so it's very interesting where One Health is going. Because from what we could find there is an increasing interest in this concept from different institutions and angles and disciplines. So it feels like the concept is on a journey, and yeah, where it will go from here. >> Indeed, and also for me it was very important to understand how, in this phase of this journey, so, during the pandemic, the concept evolved, and it was striking as a feature that the implementation of One Health wasn't that easy to describe it during the pandemic. Even if we're in a pandemic that has likely a zoonotic origin, it's not easy to talk about implementing One Health, especially during, and since the start of this pandemic. Because of the urgency, the focus has been more anthropocentric as you on the KI side, noticed that already earlier. >> Yeah, 100% and also that it is very hard to implement something during a time of crisis, and that then it's always the kind of response, acute response that is needed to show that we are doing what we can to try to handle this. And that is also a kind of, something that the creeping crisis concept describes that when one of these signaling events as they call it happen, as a manifestation of underlying crisis that is happening. When a signaling event manifests itself, the focus is usually to deal with that crisis, but most likely there will be an insufficient way of addressing the underlying issues. So, going forward, one of the most important questions might be what is the potential within One Health to make us address these underlying issues. And how. And maybe, relating to what Emma said, how many people are aware of the One Health concept and might that be important as well? Did we maybe miss this in our MOOC that try to raise this kind of educative aspect, how could professionals working with One Health turn towards the public? Is that something they're doing. What is your take on this? I don't know, I feel like one health is still very much amongst professionals. Except for AMR of course, antimicrobial resistance, because that has a outward and educative focus. But when it comes to pandemics and preventing pandemics, One Health hasn't been working towards the public, maybe it needs to, what are you thinking? >> Yeah, maybe we should try to raise the awareness of this topic and I think, we hope at least, that this course made a little bit, it's part in this joint effort to raise awareness on the topic of course. And I think that, what makes easier is that at least there is like an agreed, as were saying before, an agreed definition of the concept. That is directed toward this operationalization so that, everybody can easily understand first of all what are we talking about here. And you were mentioning AMR, before for instance and, AMR has really like a lot of consequences that impact on the life of everybody and, we had this patients' perspective in our lesson AMR. So, everybody while taking medicines really can make for instance the difference in that, with his own role, with his own life, I dare say. >> And I would like just to mention a little bit on the international cooperation aspect of the One Health because, in some of the lessons that we have covered from FEAM part and modules, We have seen a very good cooperation between international players in developing surveillance systems, and collaborating in data sharing and so on. We have brought examples from the Americas but also from Oceania. So, I think I would like to put this into the perspective of the, latest development of where Europe is heading to after the pandemic, to recover from the pandemic. And I think we're taking the steps in the very right direction. We're starting to have a closer data integration in Europe in many different ways and shapes and mechanisms. And yeah, I think we're giving steps in the very right direction, and we're putting the mechanisms needed there to do a proper closer international collaboration. So, how we bring out the perspectives of those other pillars that have been perhaps, a bit underrepresented in the past, and some other topics beyond zoonoses. >> That's a really good point there and I'm also thinking of the international blame gaming regarding for instance the course of this pandemic, COVID-19 pandemic. And I think one thing that I learned and was reminded of working with this One Health thing was that we are so prone to pointing fingers at. Like for instance wet markers, and how other countries are treating non-human, animals not so well but, we ourselves have like large factories whereas a lot of suffering is hidden from the consumers. So I was really struck by that time of the time when we are pointing finger towards others. >> And, I mean the pandemic, it can be kind of seen as if we again relate to the Cuban crisis concept. It can be seen as a kind of signal event for something, a problem hidden under the radar. And it kind of reminded us of our interconnection with other animals and nature. But it also reminded us of our global interconnectedness, and it usually is the international community that responds the quickest to crisis. And how do we keep on working on this global solidarity? Which should include responsibility taking with the countries that have resources especially to respond, and tackle these underlying issues driving disease. So how can, maybe One Health have an impact on international but also other levels of governance. That would be very interesting to see how we can as Walter said, not just point fingers, but also look at every one of us and also not nations. How can we address these underlying issues where the pandemic can be a signaling event for something else. Unfortunately, something bigger that we're not looking into, that we should address and how can we address this. And I think one of the things that we might have been missing or that I would have wanted to see in our MOOC that we wanted to further explore but we couldn't due to several restraints is to kind of also make the different interests embedded in the concept more nuanced. And the power dynamics within the concept, so whose health and whose interests are represented and why? And also that it's not always about elevating animal interests above humans, etc and an environment versus humans or whatever. It can also be within the sector that there are different human interests represented. And how can the One Health concept become more democratic or a representation of reality in the different interests in local communities that are experiencing One Health interventions on a daily basis. And that is something that we would have liked to explore more. And of course bring in different voices. But hopefully that is something that we will bring with us. That this MOOC is just the beginning of hopefully a bigger conversation, a wider conversation that involves different people and interests. >> I was thinking that maybe another aspect that I would have liked to see more covered in our MOOC - but, I mean, we tried our best but it was not easy - is really to have the best geographical representation. Because One Health is such a complete concept that affect everybody in every corner of the world. And we tried to reach out to lecturers from all over the world. We try to have people from all continents but it wasn't easy because of course it's not easy to be in contact with people that are quite far. So I am still curious about how it's perceived One Health and how it is perceived locally: what are the differences in the conceptualization in different parts of the world. And this is something that I still am curious about and I think next steps will be also to understand better how this differentiates around the world. >> And I want to think in this regard which links with everything we have been saying that one of the lectures that we covered in our modules regarding the pandemic treaty might well help in this remarks that you made Claudia. How do we all understand a pandemic? How does it spread? How does it appear and then how what factors contribute to an appearance in the pandemic, and then we will all get to the conclusion of One Health is necessary. >> Okay, so what are the next steps, Emma and we have all been talking about this but if we could choose some of the most important next steps for for us that we we are taking with us. And that we perhaps wish that people who have been taking part of this course also can take with us with them. What would we like, what we like to be the kind of embodiment of this course? >> Thank you very much. I really like the question and I have two possible answers. So, on the one hand, I would like for continue the good path that we have started into closer collaboration and data integration between different countries, particularly in the sense of surveillance systems. So, I think we have the right agencies, the right mechanisms, we now need to invest a little bit more funding in order to make those IT systems work for everybody. That allow and support these data integration because how data is collected in different countries might be different. So this is a step one and the other answer to your question, Elin, will be multidisciplinary research projects. Because at the end of the day, policies have to be evidence-based and we need the views from all the different disciplines in order to have robust policies that are resilient that can fit for purpose for the future, this uncertain future. So I think as many of our lecturers pointed is multidisciplinary projects. >> And for my side, if I can contribute also, what I think that for next steps, what I noticed that of course we are struggling both from the theoretical point of view. So from the conceptualization of One Health. And also from the operationalization of it, so how to implement it. And what I'm afraid of sometimes is that the operationalization is just a little bit lagging behind the speed at which is proceeding the struggle to define it. So I really hope that in the future the struggle to implement One Health is going to just proceeding hand in hand with the struggle to define it, in order to have both processes going at the same speed. >> Yeah, we have discussed this a lot and I think I already mentioned that we should include animals and the environment in public health. And acknowledge the interconnection between human animal health and the environment like 'One Right' and also acting on what we know and not just treating the symptoms. But address and act to combat the conditions that create creeping crisis and signaling events and also more than just pandemic efforts that is effort to protect animal and environmental health. That can bring positive impacts beyond pandemic prevention, such as combating deforestation, decreasing animal putting conceptions and so on and so forth. Do you remember that Elin? >> Yeah, and just looking at the kind of One Health issues that might also be taken into consideration. There are so many that interact with pandemics and also with the probable underlying causes of deceased emergence. That might create so many vast benefits beyond pandemic prevention, but also prevention. So, I think, and we think, and from the modules that we have also listened to and participated in: there is much to gain from fixing the current imbalance in One Health. So trying to elevate and just emphasize the importance of animal and environmental health as an intrinsic value in itself and not just for human societies. Because as we say in the mini MOOC, for those who have listened to that one, there isn't really something that is a human world that excludes animals in the environment. There is a very interconnected world and we if we live by that, some problems will be solved on the way quite naturally. Which is something that the One Health concept beautifully reminds us about and that the kind of win-win situations that we can create from this work. So that is a hopeful message, maybe one that we need to be able to to face what we are facing today. And then also a kind of fun final question that we can just quickly go around is if we have personally experienced a One health 'wow' moment during our creation of the MOOC and or if One Health has been on our mind a lot, which had probably had, but which is one example of this. And we would also love for some of you participants if you want to to leave comments on this. Also, if you want to share this with us that we will share with you and so have we experienced a One Health moment during the course and if so, how, who wants to start? >> Maybe this is the most difficult question so far. But I don't know, I mean for me at least this is quite personal, but I'm always have some kind of distance, I have to keep some kind of distance from the animals sphere, let's say because I'm allergic person. So sometimes I've always been this tricky relation, but lately I just had to take care of the dog because it was, it's called I think hypoallergenic breed. And so it really didn't brought me anyway, but it was nice because for the first time I really had the chance to to feel like closer to the animal sphere. It is something that I could never experience before. It was nice and it was exactly in the same period in which we're realizing this course. So I really felt like that kind of closeness that everybody should feel, they say during his life. >> That's lovely. Emma? So I think the course developing this course, helping collaborating with you and developing the contents have helped me to be even more mindful with those other two pillars. I am a pet owner, I enjoy my work in the nature, but now I am even more careful to how I treat those other species. And this is a very personal level, no we are in the MOOC discussing other levels such as the scientific and the political level. But I think a good One Health moment for me has been seeing those other part as equal parts of life. That perhaps before I was still already aware and respectful with them, but now I realize that it's not only about the respect, but it is also about including them in my approach to life. And how do you like extrapolate this to higher levels. >> That's beautiful. Walter? >> Yeah, sure. No, but the pandemic made us so many of us like who are able to work on distance and I had opportunity to work both with supervision but also larger research meetings during my walks in the nature and that was quite powerful. So that is what's one of the One Health moment that it was really beneficial for me to be out in nature. But also skipping the last animal proteins in my diet was also encouraged by the pandemic and when you look at the systemic like, not so good things of eating for instance meat and fish. And so if you look how that is done. So that's my take-home. >> Okay. And I have been into the One Health concept for quite some time and I think that it actually helped me. It's regarding to the MOOC, but it's also regarding the PERISCOPE project at large, that when we started talking about One Health, what is it? And I had to step outside from that One Health box for minutes and sessions talk with people who might not be as used to the concept, and having to explain it, and to kind of re-explore it all the time. That helped me to realize the importance of, to look at it with a fresh eye and to maybe realize, okay, what are the questions that we might need to involve, that there are these kind of fresh eye questions. So it also made me realize that most people are quite interested in this interconnection. So when we started talking about this, people were leaning forward, and it's something that we carry with us on a daily basis, whether we acknowledge it or not, if we look at a wild animal or if we see a tree or it can be a lot of things that make us experience One Health on a daily basis. And then it is very nice to see how people want to engage in these conversations and maybe realize the importance of making One Health more accessible. And listening to those voices that have questions about the concept and those kind of questions that are fundamental. What is it, what does it mean? How does it work? What could it mean? What risks are there? What opportunities are there? So, just those very basic questions that I had to constantly re-explore in our meetings. And also, when creating this movie, was were very useful to me to kind of refreshing everything that is something I'm definitely taking with me. Yeah, after this. So mine was not about cats surprisingly, but it also mentioned I'm a cat lady, but you know, that's every meeting. So, >> [LAUGH] great, well, hopefully you who are watching this enjoyed this session and if you have any questions for us or comments, you can comment in Coursera, we would love to hear about your journey throughout this course. And also maybe some fundamental questions that you want to ask us that we didn't raise. So feel free to engage with us and thank you for going on this journey with us and for sitting in with us on this module seven recap session and I hope you have a great day.
