Global and regional governance of One Health and implications for global health security

Introduction: The apparent failure of global health security to prevent or prepare for the COVID-19 pandemic has highlighted the need for closer cooperation between human, animal and environmental health sectors. However, the vast number of institutions, processes, regulatory frameworks and legal instruments with a direct and indirect role in the global governance of One Health, has led to a fragmented global multilateral health security architecture. Methods: We used a grounded theory approach to identify and evaluate the structures and processes underpinning the global and regional governance of One Health, with a focus on legal and financial frameworks. Results: We explore four challenges: first, the sectoral, professional and institutional silos and tensions existing between human, animal and environmental health; second, the challenge which the international legal system, state sovereignty and existing legal instruments pose for the governance of One Health; third, the power dynamics, and asymmetry in power, between countries represented in multi-lateral institutions and its impact on priority-setting; fourth, the current financing mechanisms which predominantly focus on response to crises, and the chronic underinvestment for epidemic and emergency prevention, mitigation and preparedness activities. We illustrate the global and regional dimensions to these challenges and how they relate to national needs and priorities, through three case studies on compulsory licensing, the governance of water resources in the Lake Chad basin and the desert locust infestation in East Africa. Finally, we propose 12 recommendations for the global community to address these challenges. Conclusion: Despite its broad and holistic agenda, One Health continues to be dominated by human and domestic animal health experts. Significant efforts must be made to address the socioecological drivers of health emergencies. These drivers include climate change, biodiversity loss and land use change and therefore require investment, capacity building and integration of other sectors and professionals beyond health.