Towards integrated One Health surveillance: A systematic review and critical synthesis of infectious disease and antimicrobial resistance surveillance systems
This systematic review reveals that while multisectoral participation and technological advancements in One Health surveillance for infectious diseases and antimicrobial resistance have grown significantly, a critical gap persists between stakeholder engagement and true operational integration, necessitating a new framework to bridge the divide between collaborative involvement and effective, coordinated public health action.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Health does not respect the boundaries we draw on a map. A virus that starts in a forest can jump to a farm animal, then to a person, and finally spread through a city's water system. For decades, scientists and doctors have tried to track these threats by looking at just one piece of the puzzle at a time. Human doctors watched hospitals, veterinarians watched livestock, and environmental scientists watched rivers. But when a disease moves between these worlds, watching them separately leaves dangerous blind spots. To see the full picture, experts have developed a strategy called "One Health." This approach treats human, animal, and environmental health as a single, connected system. It is not just a theory; it is a practical way to catch outbreaks early, stop them from spreading, and understand how bacteria learn to resist the medicines we use to kill them. The question now is not whether we should connect these systems, but whether we actually have.
A team of researchers from Malawi and Norway recently set out to answer that question. They conducted a massive review of fifty-five different studies and reports published between 2000 and 2025. Their goal was to look at how countries and organizations are actually building these connected surveillance systems. They wanted to know if the different sectors were truly working together or if they were just sitting in the same room without talking. The researchers examined everything from the technology used to the rules that govern how data is shared, looking specifically at how well these systems track infectious diseases and the growing problem of drug-resistant bacteria.
What they found was a story of rapid technological progress that has outpaced human organization. The researchers discovered that the world is getting much better at collecting data. In recent years, there has been a huge surge in the use of advanced tools like genomic sequencing, which reads the genetic code of germs to see exactly what they are and how they are changing. There is also a growing use of wastewater surveillance, where scientists test sewage to see what diseases are circulating in a community before people even get sick. These tools are powerful. They allow scientists to see threats with a clarity that was impossible just a few years ago. However, the review revealed a significant gap. While many systems now collect data from humans, animals, and the environment, they often fail to connect that data in a useful way.
The researchers classified the systems they studied into three groups based on how well they worked together. Only about one-quarter of the systems they looked at were "highly integrated." In these rare cases, the different sectors shared a common plan, used compatible computer systems, and made decisions together. Most systems, about sixty-two percent, were "moderately integrated." This means they exchanged some information and had some coordination, but they still operated largely on their own. For example, a hospital might send data to a lab, and a farm might send data to a veterinary office, but the two groups might never compare notes to see if the same bacteria is moving between them. The remaining systems were "minimally integrated," where different sectors participated in surveillance but kept their data and decisions completely separate.
A key finding of the study is that having many different groups involved does not automatically mean the system is working well. The researchers found that while human, animal, and environmental sectors were represented in most of the studies, the actual integration of their data was often weak. There was a clear disconnect between participation and action. Just because a system includes a doctor, a vet, and an ecologist does not mean they are interpreting the evidence together or launching a coordinated response when a threat is found. The biggest bottleneck was not a lack of technology, but a lack of shared governance and data compatibility. Even when advanced tools were used, the systems often remained siloed, with data trapped in separate databases that could not talk to each other.
The review also highlighted that the world is not keeping up with these changes evenly. The studies included in the review came mostly from wealthy nations in North America and Europe. There was very little evidence from Africa, South-East Asia, or other regions that often face the highest risks of new diseases. This creates a dangerous imbalance. The countries that need these integrated systems the most often lack the funding, the laboratory infrastructure, and the trained workforce to build them. The researchers noted that while technology is advancing quickly, the institutions needed to manage it are lagging behind. In many places, the challenge is not just buying new equipment, but creating the rules and partnerships that allow different groups to share information freely and act on it together.
Despite the challenges, the researchers see a path forward. They suggest that the focus should shift from simply adding more sectors to a system to ensuring that the data those sectors produce is actually combined and used. They propose a framework where surveillance moves through five stages: getting different groups to engage, coordinating their activities, integrating their data, interpreting the information together, and finally taking coordinated action. The evidence suggests that we are good at the first two stages but struggle with the last three. The most successful systems are those that have formal agreements to share data, common standards for how to collect it, and clear plans for what to do when a threat is detected.
The study concludes that while the world has made impressive strides in building the tools for One Health surveillance, the real work is just beginning. The technology exists to see the connections between human, animal, and environmental health, but the systems to act on that knowledge are still being built. The researchers emphasize that the success of these efforts will not be measured by how many different groups are involved or how many new gadgets are used. Instead, it will be measured by whether these connected systems can actually detect a threat faster, understand it better, and stop it from causing harm. The future of global health security depends on closing the gap between having the data and using it together.
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