Evaluation of One Health practices to tackle zoonoses: the example of the integrated WNV surveillance in Northern Italy

Multi-sectorial surveillance strategies, with enhanced cooperation of human, animal and environmental health sectors, are seen as key to improve the management of health threats. In particular, it is commonly believed that One Health (OH) practices are crucial to tackle the complexity of emerging zoonoses. In spite of this, evaluations of such practices and their associated benefits are largely lacking. To assess the strengths of the One Health approach, an evaluation framework is being developed by the Trans-Domain COST (European cooperation in science and technology) Action TD1404 'Network for Evaluation of One Health' (NEOH). The NEOH tool foresees the evaluation of different aspects of One Health initiatives (OH-thinking, -planning, -sharing, -working, -learning), which are scored from zero (= no OH approach) to one (= perfect OH approach). We applied the NEOH framework to evaluate the integrated surveillance system on West Nile Virus (WNV) as implemented in three North Italian regions (Emilia-Romagna, Lombardy, Piedmont) in 2016. WNV is endemic in this area, and the WNV surveillance plans are based on the transdisciplinary and trans-sectoral collaboration between regional institutions involved in public, human, animal, and environmental health. Such integrated surveillance, targeting mosquitoes, wild birds, humans, and horses, aims at early detecting the viral circulation, to reduce the risk of infection. To improve the surveillance sensitivity, data sharing mechanisms have been established among the three regions. After describing the OH initiative (drivers, outcomes) and its system (boundaries, aim, dimensions, actors, stakeholders), we obtained a mean score for each OH aspect evaluated. We reached high scores for OH thinking (0.90) and OH planning (0.89). Lower scores were attributed to OH sharing (0.83), OH working (0.77) and OH learning (0.69), highlighting some critical issues related to communication and learning gaps. The application of the quantitative evaluation framework successfully identified critical points of the implementation of WNV surveillance in Northern Italy. An ongoing (qualitative) process evaluation will provide a more profound and detailed analysis of strengths and weaknesses of the system. The evaluation results will be the basis for developing shared recommendations to fine-tune the initiative in a more One Health-oriented perspective. In conclusion, the NEOH framework addresses the need for a common tool to evaluate One Health practices. Such assessment is cardinal to demonstrate the added value of One Health, and to better inform policy makers on the importance of implementing integrated policies for zoonoses surveillance.