PHWR Public Health Weekly Report

Approximately 75% of emerging infectious diseases in humans originate in animals [1]. Rapidly expanding human habitations shrink wildlife habitats and increase human-animal interactions. This leads to a steady rise in the interspecies transmission of infectious diseases. Moreover, expanding cross-border exchange and contact further accelerates the opportunities and speed of the introduction of emerging infectious disease to humans [2]. In addition to zoonotic diseases, other complex and diverse public health issues such as health threats due to climate change and antimicrobial resistance (AMR) have become global concerns. An in-depth examination of these issues reveals the extent of interconnectedness among human, animal, and environmental health. To effectively prevent and respond to these threats, we should consider the health of the natural environment and animals rather than relying solely on traditional human-centric approaches [3]. In this context, the “One Health approach” is relevant. This approach emphasizes the importance of these connections and aims to provide optimal health outcomes through collaborative strategies [4]. Recently, there has been global consensus on the emergent need to effectively implement the One Health approach to enhance public health crisis preparedness and sustainable health promotion, and many countries have started incorporating this approach in their national policies.

International organizations have acknowledged the significance of the One Health approach and actively support policy development through various initiatives. Notably, in 2022, the World Health Organization (WHO), Food and Agriculture Organization (FAO), the World Organisation for Animal Health (WOAH), and United Nations Environment Programme (UNEP) formed the Quadripartite Alliance and published the One Health Joint Plan of Action (2022–2026) which outlines detailed implementation plans for six key action areas that significantly aid countries in formulating One Health strategy [4].

In the Republic of Korea (ROK), the Korea Disease Control and Prevention Agency (KDCA) has recognized the necessity of a one-health approach as an effective infectious disease response strategy for new health threats. The One Health Council and a dedicated task force within the KDCA have been established (as of February 2024). However, the agency has yet to establish a comprehensive and integrated national strategy or a specific joint action plan for One Health.

This report examines major cases of the One health approach in Germany, which has been playing a crucial role in global health through the formulation and execution of health policies, and to explore strategies to promote and develop One Health in ROK.

As a member state of the European Union (EU), Germany actively collaborates with other EU member states to implement joint policies across various sectors. Regarding One Health, all member states including Germany strive to introduce and establish policy environments, designate relevant organizations and stakeholders, establish laws, policies, guidelines, and action plans, and propose improvement measures to adopt and institutionalize One Health policy [5]. Germany works on these initiatives through its federal ministries.

1. Primary Ministries Responsible for One Health

In 2021, the German Cabinet established an informal health network through an inter-ministerial strategic workshop and has since actively utilized the network to collaborate with other ministries in the country to implement the One Health approach [6]. Additionally, under the leadership of the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung [BMBF]), Germany has spearheaded research agreements to enhance health policy implementation. These agreements enable a more rapid and effective response to emerging research challenges in the One Health field, while linking various national capabilities and resources to improve global health, and implement the federal government’s health research programs. The organization (Figure 1) illustrates the key ministries responsible for One Health in Germany and their roles, as outlined in the aforementioned research agreement. The Federal Ministry of Health (Bundesministerium für Gesundheit [BMG]) and the Federal Ministry of Food and Agriculture (Bundesministerium für Ernährung und Landwirtschaft [BMEL]) manage One Health-related policies for human health. The Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection (Bundesministerium für Umwelt, Naturschutz, nukleare Sicherheit und Verbraucherschutz [BMUV]) is responsible for environmental policies. Notably, strong and integrated cooperation exists across all areas rather than focusing on a single domain. The roles and functions of the key ministries responsible for policies related to the One Health approach in Germany are as follows [7].

Figure 1. Organization chart of One Health implementation in Germany
BMBF=Bundesministerium für Bildung und Forschung; HIOH=Helmholtz Institute for One Health; BMZ=Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung; BMG=Bundesministerium für Gesundheit; DART 2030=Deutsche Antibiotika-Resistenzstrategie 2030; BMEL=Bundesministerium für Ernährung und Landwirtschaft; BMUV=Bundesministerium für Umwelt, Naturschutz, nukleare Sicherheit und Verbraucherschutz; BMVg=Bundesministerium der Verteidigung.

1) Federal Ministry of Education and Research (BMBF) in Germany

The BMBF oversees policies related to education and research in Germany, including various health-related research initiatives. Over a five-year period since 2017, €40 million was allocated to establish a zoonosis research network, which enabled collaboration among researchers and practitioners from various fields, such as virology, medicine, and biology. This network ensures that research findings are swiftly translated into practical applications, contributing to the operationalization of the One Health approach. Such support has significantly contributed to the success of multidisciplinary infectious disease research encompassing medicine, veterinary medicine, and the humanities [8]. In October 2022, BMBF—together with BMG, BMEL, BMUV, The Federal Ministry of Defense (Bundesministerium der Verteidigung [BMVg]), and The Federal Ministry for Economic Cooperation and Development (Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung [BMZ])—signed a research agreement to further strengthen the One Health approach. Through this initiative, the BMBF is advancing the development of Germany’s national zoonosis research platform into a broader One Health research platform, enabling a more rapid and effective response to evolving research challenges. In addition, an optimal environment for conducting multidisciplinary research was facilitated, such as strengthening the One Health approach between the German Infection Research Center and other federal research institutions. Based on the outcomes of these efforts, the Helmholtz Institute for One Health was established [9].

2) Federal Ministry of Health (BMG) in Germany

The BMG is responsible for policies that focus on human health, promoting various initiatives and programs to protect public health, and improving the efficiency of the healthcare system. The BMG is particularly involved in policies aligned with the One Health approach, notably addressing AMR issues through the German AMR Management Strategy (Deutsche Antibiotika-Resistenzstrategie 2030 [DART 2030]), which aims to reduce antibiotic use in humans and animals while strengthening international cooperation. The BMG also strengthens surveillance and early response systems for zoonotic diseases, and collaborates with the WHO to prevent global infectious disease outbreaks. In addition, the BMG addresses environmental and health issues in an integrated manner by developing policies that comprehensively consider the health impacts of climate change. Furthermore, the BMG actively supports research and innovation related to health and contributes to the development of sustainable health systems. The BMG continues to implement global health tasks through international and multilateral cooperation, supporting Germany’s position as a leading contributor in addressing global health challenges [10].

3) Federal Ministry of Food and Agriculture (BMEL) in Germany

The BMEL is responsible for agricultural policies, food security, animal welfare, consumer protection, and environmental preservation. In particular, the BMEL plays an active role in addressing global food issues, reducing trade barriers, developing new markets, and strengthening bilateral relationships with countries. To improve global food security, BMEL collaborates with international organizations such as the FAO, Group of 7 (G7), Group of 20 (G20), and the UN to promote multifaceted policies aimed at ending hunger, improving nutrition, and promoting sustainable agriculture. In August 2023, the BMEL introduced a mandatory animal-rearing labeling system to enhance animal welfare and food transparency. This system empowers consumers to make informed purchasing decisions based on animal-rearing conditions and supports the transition to sustainable agriculture (or livestock rearing).

In the organic agriculture sector, the BMEL supports the establishment of eco-friendly agricultural systems that conserve resources and protect the environment. The ministry also plays a leading role in biodiversity protection, promotes various strategies for biodiversity conservation in the agricultural and forestry sectors, and emphasizes the critical role of insects, including honeybees and wild bees, in ecosystems. Further, BMEL encourages all citizens to choose healthy and sustainable diets through its ‘Good Food for Germnay’ food and nutrition strategy. This strategy aims to improve public health, respond to climate change, protect the environment, and preserve biodiversity, with initial measures to be implemented by 2025.

In addition, the BMEL promotes various measures to mitigate climate change and enhance climate resilience. The Ministry aims to reduce greenhouse gas emissions from the agricultural sector by 65% by 2030 compared to the levels reported in 1990. To achieve this goal, the BMEL is strengthening agricultural sustainability, conserving forests and soils as carbon sinks, expanding organic farming, and implementing programs to promote sustainable food consumption and reduce food waste [11].

4) Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection (BMUV) in Germany

The BMUV is responsible for policies addressing environmental and wildlife safety, nuclear safety, and consumer protection. In particular, the BMUV aims to promote human and animal health by addressing environmental issues such as climate change, biodiversity loss, environmental pollution, and the protection of wildlife habitats. In this respect, the BMUV assesses the impact of environmental pollution on human and animal health, with an emphasis on the link between environmental protection and public health and promotes policies to mitigate these impacts.

To prevent health threats from wildlife trade, the BMUV has established an international coalition to strengthen both international and national policies to substantially reduce the risk of zoonotic transmission trade of wildlife and related products. Furthermore, the BMUV initiated a Nature-based Solutions (NbS) action plan that aims to conserve biodiversity, mitigate climate change, adapt to climate crises, and foster harmonious coexistence between humans and nature by restoring ecosystems, improving water and air quality, and addressing floods and droughts. The BMUV also addresses specific aspects of health-related environmental protection, particularly consumer protection, and provides additional guidance on health and food safety for the general public. These efforts demonstrate the BMUV’s significant contribution to promoting the integrated management of environmental and public health from a One Health perspective [12].

5) Other main ministries

The BMVg, which is responsible for formulating defense policies and ensuring national security and military defense, plays a role in One Health, as it pertains to national security and military health, although it is not the primary ministry directly involved in this approach. BMVg also contributes significantly to broader interdisciplinary and integrated research through its internal initiatives and promotes the European Healthcare Cooperation 2.0 project to enhance pandemic response capabilities [13]. The BMZ promotes sustainable development policies based on the One Health approach at the international level. It strengthens global cooperation through various projects, such as the Global Food Security Alliance, the “One World – No Hunger” initiative, migration partnerships, climate initiatives, and global health efforts. These initiatives aim to improve food security, promote sustainable agriculture, address migration challenges, respond to climate change, and enhance global health [14]. Additionally, several other ministries and organizations, such as the German Epidemic Preparedness Team and the Think Tank Gruppe, support and implement One Health policies. Through inter-ministerial collaboration, these bodies continue to strengthen the One Health approach and develop concrete measures related to the adaptation of the health system.

2. Main One Health Strategies and Programs

1) DART 2030

DART 2030 is Germany’s national strategy to address the issue of AMR by strengthening surveillance, prevention, monitoring of antibiotic use, and presenting comprehensive solutions that consider environmental factors. It was developed in collaboration with multiple German ministries, including the BMG, BMEL, BMBF, BMZ, and BMUV. As AMR not only affects humans but also animals and the environment, DART 2030 recognizes the interconnected health of humans, animals, and the environment and adopts an integrated One Health approach to address the issue. DART 2030 outlines six strategies, starting with prevention. This strategy aims to prevent infectious diseases, reduce the need for antibiotics, and minimize the incidence of infections. It implements various preventive measures across multiple areas including human healthcare, animal health, environmental management, and food chain management. The second strategy, surveillance and monitoring, focuses on establishing an effective national response strategy and developing appropriate measures through comprehensive surveillance and data-based analysis of antibiotic use and AMR. The third strategy involves the appropriate use of antimicrobials and laboratory diagnostics. Its goal is ensure appropriate and responsible use of antibiotics while optimizing antibiotic treatments through the use of laboratory diagnostics to prevent the spread of AMR. Through the fourth strategy, communication and collaboration, public awareness of AMR among stakeholders is enhanced and collaborative efforts are promoted. It focuses on disseminating information on infectious diseases, the association between non-targeted antibiotic treatment and AMR, and the connection between infectious diseases and the occurrence of sepsis, thereby fostering fact-based understanding. The fifth strategy targets enhancing international collaboration and emphasizes the need for a unified global response to AMR, recognizing it as a cross-border, multidimensional challenge. This strategy advocates the establishment of regulatory and surveillance systems to strengthen AMR prevention efforts at the national level, with a particular focus on vulnerable regions. The sixth strategy is support for the development of new diagnostic tools, antibiotics and alternative therapies, and vaccines. Based on the One Health approach, this initiative aims to support a broad range of research areas, including basic and clinical research, public health, environmental and climate studies, the health and food sectors, agriculture, construction, media, and communication. The goal is to generate practical measures for AMR prevention and intervention as a result of these efforts [15].

2) Federal Action Plan on Nature-based Solutions for Climate and Biodiversity

The German government seeks to improve the overall health of ecosystems and address climate change through the “Federal Action Plan on Nature-based Solutions for Climate and Biodiversity,” based on the One Health approach. The NbS Action Plan strives to increase the adaptive capacity to climate change and biodiversity crises and promote sustainable responses to these crises by protecting ecosystems and strengthening their role as natural carbon sinks. It also promotes greater stakeholder collaboration through integrated policies and action plans by involving local governments, and agriculture and forestry personnel.

The NbS Action Plan targets a wide range of ecosystems across Germany and is organized into ten key areas, each with specific objectives. First, it establishes the right of first refusal for the public sector to purchase peatlands (wetlands rich in organic matter formed by the accumulation of undecomposed vegetation) to protect and restore them. The plan also included measures to protect government-owned peatlands. Second, it focuses on restoring rivers and floodplains (low, flat areas surrounding rivers) to their natural states and enhancing water circulation for better water resource management. This initiative aims to develop regional water balance guidelines and strengthen cooperation with various stakeholders to respond effectively to floods and droughts. Third, it promotes the sustainable use of oceans and coasts through marine and coastal protection, thereby enhancing their natural functions and resilience to climate change. Fourth, it seeks to preserve wildlife habitats by establishing maintenance plans and improving the management of wild and protected areas, an essential component of biodiversity conservation. The fifth goal is to expand Germany’s forest area to strengthen forest ecosystems, thereby enhancing the long-term carbon sink capacity of forests and creating climate-resilient forest ecosystems. Sixth, as soil is a major carbon sink and an important factor in strengthening an ecosystem’s resilience to climate change, the focus is on improving agricultural and forest management practices to promote healthy soils, enhance carbon storage, and support sustainable food production. The seventh objective seeks to widen the ecological corridors linked to urban green spaces to enhance biodiversity, mitigate the urban heat island effect, and minimize the ecosystem impacts of infrastructure development. Eighth, it aims to strengthen the existing ecosystem data network in Germany and integrate monitoring data from various fields to improve our understanding of environmental correlations. The ninth objective centers on strengthening research capacities by expanding studies and data networks, thereby facilitating the development of more advanced strategies for ecosystem restoration. Finally, as NbS can succeed only through close cooperation with the EU and the international community, the German government advocates strong policy support for NbS at the G7 and the EU, and actively engages in global initiatives such as the Convention on Biological Diversity, the Paris Climate Agreement, and the UN Decade on Ecosystem Restoration [16].

Germany has made significant progress in incorporating the One Health approach into its public policies. It promotes global health research and innovation by focusing on preventing infectious diseases, managing AMR, and responding to climate change. Germany also conducts research to assess the impact of climate change on public health and develop preventive and responsive measures. Through wider international collaboration, the German government supports research efforts to prevent the transmission of pathogens, and enhances the capacity of low-income countries to respond to public health threats. In addition to inter-ministerial collaboration to establish a foundation of universal health, based on the One Health approach, which recognizes the interconnectedness of human health with all sectors. Germany strongly advocates the One Health approach which fosters cross-sectoral and inter-ministerial collaboration in establishing a strong foundation for universal health targeted at optimal outcomes. It has established relevant systems for expanding research through result sharing and provides long-term funding to sustain such efforts. These German policies are significant as they provide guidance to global late adopters of the One Health approach, helping them develop strategies to prevent health risks and maintain sustainable environments.

In 2017, ROK formally adopted the One Health concept and incorporated it into its first and second zoonotic disease management plans. Although no dedicated ministry or organization currently oversees the One Health Initiative, the KDCA has established and promoted avaian influenza preparedeness and response measures, AMR measures, and zoonosis management plans following the One Health framwork. The KDCA is in the process of developing the necessary infrastructure (budget, organization, laws, etc.) to promote health, but coordinating cross-sectoral and inter-ministerial collaboration remains a challenge. This requires investments in Research and Development, and the fostering of a greater sense of shared responsibility and interdisciplinary cooperation through higher-level governance, interinstitutional collaboration and measures to strengthen the same can be achieved through awareness programs on the One Health approach among ministries. Although ministries in ROK currently advance various policies and programs related to human, animal, and environmental health, many of these are not recognized as part of the One Health approach. Creating a systematic mechanism for ministries to collaborate by consolidating fragmented One Health-related policies and initiatives into a unified package could serve as a crucial starting point for a national One Health approach. Promoting consistent and integrated action requires recognizing the interdependencies between policies in various sectors and mobilizing relevant policy actors. To achieve this, policymakers from different ministries and researchers from different institutions must collaborate more closely to develop relevant policy strategies using standardized terminology.

In addition, a comprehensive and unified Korean One Health Action Plan should be established at the national level to identify similar policies across ministries and implement them in a coordinated manner, thereby achieving greater synergy.

To build stronger momentum, revising the legal framework and institutions that specifically stipulate the One Health approach and creating a permanent and inclusive governance system that can facilitate coordination across ministries and disciplines, including central and local governments, are crucial. Additionally, fostering public support for the effective implementation of One Health policies is essential, which can be achieved by raising awareness of the approach’s importance through active public engagement initiatives.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: JAO, JHK. Data curation: JAO, SEL. Formal analysis: JAO, SEL. Writing – original draft: JAO, SEL, MRS. Writing – review & editing: JAO, JHK, MRS.