As the world continues to focus on the response to, and recovery from, the COVID-19 pandemic, groups of researchers are working to prevent the next pandemic. They do this because pandemics are increasing in frequency [1, 2]. Most emerging infectious diseases and pandemics are derived via spill-over at the human-animal-environment interface [1, 3]. There are an estimated 1.7 million currently-undiscovered viruses existing within mammalian and avian hosts, up to 850,000 of which could have the capacity to infect humans [4]. The links between emerging infectious diseases and anthropogenic environmental changes are becoming increasingly accepted [5, 6]. In particular, biodiversity loss, climate change, agricultural intensification and the trade of wildlife have all been linked to various diseases and pandemics because these processes disrupt ecosystems, leading to (a) changes in how wildlife and microbes interact, and (b) increased contact among people, animals and pathogens. These processes lead to greater opportunities for pathogen spill-over (when a pathogen is passed from an animal to a human) and increased pandemic risk [7].

Despite these demonstrable links, policy, political discourse and research regarding responses to pandemics largely remain focused on reacting to immediate threats to public health. Typical public health responses include (but are not limited to) contact tracing, mandatory isolation, increasing hospital capacities, stockpiling, distribution and use of personal protective equipment, increased sanitation and sanitary practices, and rapid design, approval and distribution of vaccines [8]. Pandemic response mechanisms addressing the animal and environmental drivers of pandemics remain largely focused on monitoring and management of known zoonoses. That is to say, the governance of pandemics is focused on reactive pandemic response and not long-term pandemic prevention.

Most pandemic law and policy responses around the world remain tightly focused on monitoring reportable zoonotic diseases in wildlife, detecting spill-over events in production animals and humans, and preventing ongoing transmission among people. Although these are measures worthy of further attention and investment, they are passive and/or reactive and do not take action against the underlying drivers of emerging diseases that pose a pandemic risk. Prevention through environmental protection and conservation would require significant structural changes and financial investment, yet the economic and social costs of prevention are far less than the cost of pandemics [9], as evidenced by the COVID-19 outbreak and other recent pandemics such as HIV/AIDS. Pandemic prevention is also expressly part of the obligations of State parties to the International Covenant on Economic, Social and Cultural Rights (ICESCR), under Article 12, detailing the right to health [10]. Further, long term pandemic prevention interventions could, if designed correctly, bring about other social, ethical, environmental, and public health benefits.

The ‘One Health’ approach recognises the interdependence between human, animal, and environmental health and can provide a long-term pandemic prevention framework to instigate the transformative change required to ensure that pandemic risks are minimised [11]. One Health frameworks have been useful in responding to emerging infectious diseases in the past, but have not typically been used for ‘deep prevention’, that is, to instigate policy change on environmental and social issues such as land-use change, agricultural intensification, urbanization, climate change and the wildlife trade.

To address the multiple governance areas related to pandemic risk management, we formed a multidisciplinary research/practice group to analyse, synthesise, and harmonise the links between pandemic risk management approaches and issues in different disciplines to provide a holistic overview of current practice in Australia, and to examine the need for reform in Australian legislation and policy. We undertook initial mapping and synthesis over a series of online facilitated workshops in July–August 2020, with additional stakeholders from Government, non-Governmental organisations (NGOs) and research institutions.

We use our multidisciplinary perspectives to argue for a strengthened environmental dimension of One Health approaches to pandemic risk management by critically analysing existing systems in Australia, highlighting examples for transformative change. We begin by outlining the most critical existing pandemic risks in Australia. We then discuss the potential and the limitations of the One Health approach in pandemic risk management, and survey the state of One Health policy in Australia. We conclude with the argument for a holistic, First Nations-led, interdisciplinary One Health approach in Australia and make several specific recommendations that may help bridge the gap between environmental, animal, and public health in Australia, and provide best-practice One Health policy around the world.

Australia is not immune to emerging infectious diseases from either domestic or international sources; there are various risks associated with Australia’s wildlife and farm animals, biosecurity and international trade, and the drivers of pathogen spill-over such as environmental degradation. This section provides an overview of those risks and some of the governance areas relevant to addressing them.

Australia’s current pandemic risk management system is largely focused on established (i.e. known) biosecurity risks with pandemic potential. In the context of emerging infectious diseases, definitions of biosecurity can be narrowed to focus on ‘the protection of people, animals, ecological systems and the economy from the emergence, entry, establishment and spread of harmful infectious agents and diseases’ [12]. Biosecurity risks are both known and unknown, meaning that both targeted and non-specific policies and mitigation approaches are required. Known pathogen biosecurity risks within Australia include endemic domestic animal pathogens (e.g. Johne’s disease in cattle and sheep) as well as pathogens that emerge via sporadic spill-over from wildlife reservoirs (e.g. Avian influenza from wild birds or Australian bat lyssavirus or Hendra virus from flying foxes) [13]. Nine zoonotic diseases in Australia are categorised as national notifiable zoonotic diseases, according to the Federal Department of Health [14], and each State and Territory government drafts its own notifiable disease lists, which may also include diseases specific to the jurisdiction [15]. However, there is no formal list that identifies which notifiable or non-notifiable pathogens have pandemic potential, and assessments are instead undertaken on an ad-hoc basis.

Known biosecurity risks also arise from outside of Australia, particularly serious domestic animal diseases such as foot and mouth disease or African Swine Fever. Additionally, migratory animals can act as vectors of pathogens across international boundaries through island hopping (e.g. Torres Strait) and avian flyways. One key factor driving zoonotic risk in Australia is globalisation. For example, Northern Australia is deemed to be at ‘increased risk of infectious diseases’ found in South-East Asia, due to its proximity, high rates of trade and tourism activity, thus providing a gateway to the rest of Australia [16]. Recent biosecurity breaches of canine vector-borne diseases, canine hepatozoonosis and the canine monocytic ehrlichiosis [17, 18], while not explicitly of pandemic risk demonstrate the continuing zoonotic risks associated with companion animals [19]. Unknown biosecurity risks have received limited attention, and there are few policies to actively seek out, identify and assess future potential biosecurity risks from domestic or international sources. For example, spill-over of coronaviruses from bats to humans, either directly or via bridging hosts, has been previously recognised as a major pandemic risk [20]. Despite this, only three studies [21,22,23] have investigated the presence of coronaviruses in Australian bats, resulting in only a handful of Australia’s 81 bat species being sampled with sufficient depth to assess future coronavirus spill-over risk [23]. Prada and others found that 19% of 543 micro bats sampled in the south-west region of Western Australia tested positive for coronavirus infection, including viral species and strains that had never been found before [24].

There are also pandemic risks related to legal and illicit wildlife trade in Australia. Legal and illegal wildlife trade are common, due to Australia being home to an array of valuable reptilian, amphibian and avian species [25], and its proximity to established wildlife trade routes in South-East Asia [26]. Illegal (smuggled) imports of adults, eggs and seed can present direct pest and weed risks as well as transport numerous diseases [27].

A final source of risks for spill-over of pathogens with pandemic potential is the large animal agricultural production systems in Australia. Australia specialises in the large-scale production of livestock and is one of the world’s largest exporters of beef, lamb, mutton and goat [28]. Australian production systems involve animals that are, at times and for varying durations, confined in large numbers in single sites; increasingly, Australia is moving to confined housing arrangements for animal agriculture [29]. These characteristics increase the risk of animal-to-human virus spill-over [30]. These risks are further exacerbated by declining resources provided by the Australian government for on-farm advice and extension services, including support for veterinarians [31].

Other unknown risks continue to be under-investigated, particularly around changes to Australia’s ecosystems, through land clearing, mismanagement of waterways, bushfires and biodiversity decline [32], which increase contact between humans and animals harbouring pathogens and may increase rates of zoonotic disease spread [33]. Zoonotic emerging infectious disease risk is elevated in forested tropical regions experiencing land-use changes, and in environments of wildlife biodiversity. For example, New South Wales experienced high levels of rainfall following the Australian bushfires, dramatically increasing mosquito abundance and, in turn, increasing rates of Ross River Virus (RRV) [34]. Queensland also has been shown to have a high incidence of zoonotic vector-borne diseases, including RRV, Barmah Forest disease, and zoonotic faecal-oral parasitic diseases [35,35,36,37,38].

Australia continues to rank amongst the worst countries for its deforestation and land-clearing rates [39, 40]. The drivers of land-use change include unsustainable agricultural practices, land clearing and deforestation, the encroachment of urban populations into wildlife habitats, the development of new mining sites, and the consequent changes to the management of traditionally owned or ancestral Indigenous lands (where most Indigenous-owned land is managed by non-Indigenous people or companies for agriculture and/or mining) among others [41, 42]. Approximately 22% of infectious diseases in Australia have been associated with land use and native vegetation change, including Hendra virus [43,44,45].

The number of spill-overs directly related to climate change is expected to increase as the effects of climate change become more and more evident. Australia is one of the leading countries for greenhouse gas emissions per capita [46]. In Australia’s current policy setting, the Paris Agreement 2030 target will not be achieved and, even if fulfilled, emission rates would remain incompatible with a 2-degree emissions budget [47]. Research indicates that even a 1.5-degree temperature intensification in Australia will increase risks of biodiversity loss, natural disasters and species extinction, as well as cause significant social and economic implications [48]. As it stands, Australia is experiencing increasing temperature levels, decreasing rainfall levels, and, as a result, most severe and frequent weather events including drought and longer fire seasons [49, 50].

Also important is the disconnect between the different policies that address known and unknown risks. Syndromic surveillance and diagnostic exclusion testing are heavily relied upon for known biosecurity risks, with legislation and protocols to follow in the event of a positive detection. Lacking are policies and funding to follow up if an individual animal tests positive, and no clear guidelines on what to do in the event of a negative result, but where an unknown infection is suspected. The recent detection of a novel Hendra virus variant in a horse that died with clinical disease consistent with Hendra virus disease, but tested negative using routine diagnostic assays demonstrates the failing of ‘exclusion testing’ surveillance. We cannot truly advance pandemic preparedness without embedding routine investigation of unexplained causes of mortality in animal populations.

The ‘One Health’ approach to public health decision-making has been championed as the most appropriate policy framework to transform pandemic policies from response to prevention. One Health has been billed as a transformative framework that has the potential to ensure appropriate policies across the pandemic timeline, from environmental prevention to animal monitoring and public health response. The conceptual framework is centred on the recognition of the interdependence of human, animal and environmental health [51, 52], and stems from a recognition amongst the scientific and medical community that veterinary and medical professions could collaborate for mutual benefit, not just locally and nationally but on a global scale. Usage of the term ‘One Health’ originated in 2003 in response to Severe Acute Respiratory Syndrome (SARS) and the spread of highly pathogenic avian influenza H5N1 [53]. A series of strategic goals were developed in 2004, known as the ‘Manhattan principles,’ by the Wildlife Conservation Society [54], and updated to become the ‘Berlin Principles’ in 2019 (the Berlin Principles include stronger language around required actions and include acknowledgement of the climate crisis) [55]. These goals recognise the links between humans, wildlife, domesticated animals and plants, and all nature, and urge world leaders to take action to develop strong institutions to integrate these areas, eliminate or mitigate ecosystem alterations and associated impacts and enhance capacity for cross-sectoral and transdisciplinary collaborations, amongst others.

Despite these well-formulated principles, there is no one recognised definition of One Health, and so organisations and academics have formulated individual definitions with varying elements and principles [56]. These are often linked to the specific values, principles and interests of the respective organisation. A recent attempt has been made by the post-COVID established One Health High Level Expert Panel (OHHLEP) to consolidate various definitions, and while that consolidated definition has since been supported by the World Health Organization (WHO), The Food and Agriculture Organisation (FAO), the World Organisation for Animal Health (OIE) and the United Nations Environment Programme (UNEP), uptake at the ground level is yet to be seen [57].

The various definitions of One Health do have common themes. The ‘One Health’ approach is referenced as ‘integrated,’ ‘trans-disciplinary,’ ‘multi-sectoral’ and ‘holistic.’ The terms ‘interdependent’ and ‘interconnected’ are used when labelling the connection between multiple sectors and disciplines. Alternatively, when not referred to as an ‘approach’, One Health is described as a ‘paradigm’, ‘strategy’, and ‘concept.’ The terms ‘human’/‘animal’ or ‘human health’/‘animal health’ are present in all definitions, however, while the term ‘environment’ is present in nearly all definitions, it is often mentioned only in relation to the environments in which humans and animals operate. For example, the United States Centre for Disease Control (CDC) recognises the interconnection between people, animals, plants, and ‘their shared environment’ [58]. The OIE acknowledges that human and animal health are interdependent and bound to the ecosystems in which they exist [59]. The FAO iterates working together to tackle health threats to animals, humans, plants, and the environment, while WHO states the approach is critical in the animal, human and environment interface [60, 61]. Both FAO and WHO, for example, situate the environmental threats and health alongside human and animal health and potential threats.

There are strengths and weaknesses in the diversity of definitions of One Health. On the one hand, a lack of clear definition means that One Health may be misinterpreted or narrowly applied. On the other hand, the concept’s flexibility means it has received wide acceptance and adoption both regionally, nationally and internationally and can continue to be shaped into the future to match the quick pace of globalisation, technological progression, scientific understanding, and cultural norms. It has been critiqued for being too anthropocentric [62], neglecting environmental health in practice [63, 64], and universalising western science and knowledge acquisition [65, 66].

However, the utility of a well-designed and integrated One Health framework is yet to be really tested. We recognise the pros and cons of the various formulations of One Health and consider One Health not as a concept with one inflexible definition, but as a problem-solving framework and value proposition, under which more specific policies are defined and implemented. The framework, and any resulting actions and policies, can be guided by the values and principles arising out of the common definitions, such as the facilitation of open interdisciplinary, multi-sectoral, and cross-cultural strategies. We also acknowledge that One Health can, and should incorporate ‘deep prevention’ policies that focus on and reduce the environmental drivers of pandemics. It can incorporate policies that address the ‘three stages’ of pandemics, as demonstrated in Fig. 1.

Stages of pandemic risk management

Critically for the Australian context, One Health approaches should seek to understand current structural and systemic forces that have threatened the relationship that Indigenous people have to their land and animals. To enable this holistic approach, One Health strategies should be developed and implemented through collaborative and participatory means, with Indigenous knowledges, sciences, and experiences operating alongside and respected by western sciences. Underpinning the efficacy of One Health strategies is the need to secure adequate funding sources with the flexibility to meet identified community needs, collaborative and multidisciplinary research approaches, Aboriginal and Torres Strait Islander workforce and skills base development, and community capacity building, including leadership and self-governance. To this end, researchers have a responsibility to inform themselves about the past and current experiences of Aboriginal and Torres Strait Islander people with research and interventions, to ensure One Health responses in the future support the long-term goal of reconciliation. In the following sections, we describe and analyse the existing One Health policies in Australia, and then make suggestions on its improvement.

In this section we review the One Health framework as it relates to pandemic prevention and risk mitigation. While the term ‘One Health’ is mentioned in governmental policy documents in just about every State and Territory in Australia, there is no national multidisciplinary One Health body. Individual governmental departments and NGOs are leading One Health policy across the country. For example, the Federal Department of Foreign Affairs and Trade’s Indo-Pacific Centre for Health Security has One Health as a core principle and co-funds research with the Australian Centre for International Agricultural Research on One Health policies across the region. The Federal Department of Agriculture, Water and the Environment, and the Federal Department of Health, has prioritised a One Health approach in their joint ‘One Health Master Action Plan for Australia’s National Antimicrobial Resistance Strategy’ [67]. Wildlife Health Australia, Animal Health Australia, and the Australian Veterinary Association, all integrate One Health into their strategies to some extent. The Commonwealth Scientific and Industrial Research Organisation (CSIRO), is an Australian Government science agency which is developing an Infectious Disease Resilience Mission and an Anti-Microbial Resistance Mission under the guidance of a One Health framework [68].

In Queensland, the Department of Agriculture and Fisheries has a ‘Health and Food Sciences Precinct’, which positions itself as one of the nation’s leading initiatives working towards a One Health approach in health and disease research [69]. There is also a Memorandum of Understanding between Queensland Health, the Department of Agriculture and Fisheries and the Office of Industrial Relations to formalise management standards around an ‘emergency management approach to zoonotic incidents’ [70]. Victoria’s specific approach to Q-fever follows a One Health model that promotes collaboration among multiple stakeholders, including Worksafe Victoria, local governments, the Department of Health and Human Services, Agriculture Victoria and the Chief Veterinary Officer [71, 72]. South Australia Health commits to adopting a One Health approach in its strategic planning documentation [73]. Similarly, Western Australia’s Department of Primary Industry and Regional Development highlights support for a One Health concept through its core biosecurity activities [74].

These examples demonstrate that Australia is relatively advanced when it comes to acceptance of, and referral to the One Health approach. Collaborative initiatives such as the Australian Antimicrobial Resistance Strategy and Hendra Virus Interagency Technical Working Group are significant attempts to achieve collaboration between human and animal health sectors [75, 76]. Previous research also indicates high levels of support among Australian policymakers and practitioners for a One Health approach to zoonotic disease control and prevention [77, 78]. However, there are several key barriers to implementation that could limit One Health collaboration and its benefits [79].

In the first instance, On