How did international agencies perceive the avian influenza problem? The adoption and manufacture of the ‘One World, One Health’ framework
Abstract
Over the past few years, a ‘One World, One Health’ (OWOH) policy framework has become the guiding principle for international responses to avian influenza and other zoonotic infectious diseases. Several specialised inter‐governmental agencies, including the World Health Organization, the Food and Agricultural Organization and World Organization for Animal Health, jointly endorsed and promoted this framework. This article attempts to explain why international agencies advocated OWOH despite its vagueness. By examining how these international agencies gradually reframed avian flu problems, this article illustrates the crucial roles of international agencies in constructing disease knowledge and relevant policy responses. It shows that the three agencies adopted an all‐inclusive approach to reduce conflicts, defend their legitimacy, and facilitate commitment for collaboration. Not only has this new framework reduced tensions between agencies, it has also reshaped the interests and interactions of other global actors. The case thus illustrates how these organisational actors actively manufacture new cognitive frames and policy regimes that advance their own legitimacy and influence.
The emergence of ‘One World One Health’
Since late 2003 worldwide outbreaks of highly pathogenic avian influenza (HPAI) in poultry have attracted global concerns over a possible pandemic. Scientists warned that the avian flu virus posed great pandemic threats because it might evolve into a new viral type capable of human‐to‐human transmission. Many inter‐governmental organisations rushed to develop control and prevention policies against H5N1 avian influenza. Three international agencies are most closely associated with the tracking and control of avian flu, the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE). As a disease that infects both animals and humans, HPAI has challenged pre‐existing specialised international governance institutions and professions.
The distinct mandated responsibilities, interests and perspectives of these international agencies soon resulted in inter‐agency conflicts and tensions. The WHO, FAO and OIE are responsible for public health, food safety and animal health, respectively. They tended to govern specific domains and seldom share jurisdiction. Contradictions regarding policy prioritisation immediately appeared. For example, the WHO prioritised the necessity to strengthen pandemic preparedness for a potential outbreak, while the OIE and FAO were more concerned with eradicating viruses in poultry, a problem they considered to be imminent. FAO official Phil Harris, for example, stated that ‘it is clear that avian influenza remains a potential risk to humans but a real risk to animals’ (emphasis in the original).11
Harris (2006) was an information officer of FAO’s Emergency Centre for Transboundary Animal Diseases.
In addition, tensions often escalated due to the divergent professional expertise of these agencies. For instance, public health experts at WHO and agricultural economists at FAO and OIE disagreed on large‐scale culling of potentially infected birds. While WHO encouraged this strategy to avoid human infection, FAO and OIE became less willing to do so due to its impact on the food system and market. OIE’s Director‐General, Dr Vallat, challenged WHO’s position by stating:
Let us not forget that the WHO defines human health as not merely the absence of disease or infirmity but a state of complete physical, mental and social well‐being. Thousands of farmers, firms and employees in the poultry industry all over the world are going to disappear pointlessly. Who is going to compensate them for their distress? How long before we can say ‘never again’? (Vallat 2005)
Despite tensions and disagreements, international agencies frequently expressed the need for global collaboration. The WHO, FAO and OIE developed a few collaborative platforms, such as the Global early warning system for major animal diseases, including zoonoses (GLEWS), the OIE/FAO Network of expertise on avian influenza (OFFLU),22
OFFLU was renamed the OIE/FAO Network of Expertise on Animal Influenza after the H1N1 influenza pandemic in 2009.
and the FAO/OIE Crisis management centre for animal health (CMC‐AH). In late 2008 a significant policy shift took place, when WHO, FAO and OIE, along with the United Nations Children’s Fund (UNICEF), United Nations System Influenza Coordination (UNSIC), and the World Bank, jointly endorsed a ‘One World, One Health’ (OWOH) policy framework. Taking this concept from the Wildlife Conservation Society (WCS),33
‘One World One Health’ was also called the 12 Manhattan Principles. Its primary goal was to prevent epidemic and epizootic disease and to maintain ecosystem integrity holistically (Wildlife Conservation Society n.d.)
these agencies (re)defined OWOH as a cross‐sectoral and interdisciplinary approach that recognises risks at human‐animal‐ecosystems interfaces. OWOH, later officially called ‘One Health,’ has now become a shared guiding principle for global disease prevention and control. Since then, the WHO, FAO and OIE have held and supported numerous meetings, conferences and training sessions to contemplate and promote One Health. As a European Commission officer Alain Vandermissen stated at the first One Health Congress in Melbourne, Australia, in 2011, ‘One Health is now more infectious than the disease’ (avian influenza).
Many experts and international officials regarded the adoption of OWOH as unprecedented and paradigm‐shifting in global governance, since it demonstrated the commitment for closer organisational collaboration. In their tripartite concept note, the three agencies state that they ‘realize that managing and responding to risks related to zoonoses and some high impact diseases is complex and requires multi‐sectoral and multi‐institutional cooperation’ (FAO, OIE and WHO 2010a). However, OWOH was not clearly conceptualised when it was adopted and it is still evolving. A series of conferences and meetings have been subsequently organised to elucidate its implementation. This article attempts to explain why the WHO, FAO and OIE settled on and advocated OWOH, despite its vagueness. It traces the evolution of global avian flu policies to clarify the emergence, consolidation and shared appreciation of this policy frame. I argue that this global policy shift cannot be understood without examining the role of key organisational actors, who actively manufactured a new frame that reduced their conflicts and strengthened their legitimacy in a complex globalised world.
Theoretical backgrounds and methods
My research draws from and contributes to the literature on international bureaucracy, global governance, the sociology of knowledge and science and technology studies (STS). I take a constructivist approach, considering that knowledge and scientific facts are socially constructed. Gaining insights from organisational research, I focus on the roles of international agencies that connect, mobilise, empower or marginalise actors and stakeholders in crafting global norms, knowledge and policies. Scholarship that explains the formation of global models often centres upon distinct actors or forces, such as states, interest groups, civil society groups and epistemic experts. For example, the realist international relations literature considers nation‐states to be the main actors in international politics; neo‐institutionalism emphasises the cultural diffusion of science and modernisation; the neoliberal school of thought highlights the overwhelming force of an increasingly integrated global market and the epistemic community theory and STS scholars focus on the networks and/or conflicts among scientists. These theories tend to treat international organisations as passive actors or simply forums. I diverge from this theoretical tendency by recognising the relative autonomy of international agencies in crafting global policies (see Barnett and Finnemore 2004, Goldman 2005).
I incorporate the international bureaucracy literature with these other lines of scholarship, revealing how international agencies actively mediate the actions and interactions of other agencies, states, experts and further stakeholders to construct knowledge of disease and global policies. This article argues that the OWOH policy frame gained its prominence mostly due to the increasing interaction among international agencies in a globalised world. They are key actors who constantly seek to secure their own resources, establish their legitimacy, deploy technical scientific and technological expertise and craft global responses and norms.
Specifically, by showing the conflicts, debates, and coordination among the WHO, FAO and OIE, this article demonstrates that the agencies are relatively autonomous actors with their own logic, interests and practices. On the one hand they have striven to reduce tensions between themselves. On the other, by advocating new policy frameworks, they have affected and reshaped the interests and behaviour of other external actors. This research illustrates the dynamic relationships between the international agencies and other global actors. It provides an important alternative organisational perspective to more structural, political economic and epistemic analyses of global policy formation and change.
In the following sections I first elucidate how the agencies utilised three competing policy frames in the early stage between 2003 and 2008, and how an OWOH framework blended these three frames to create a functional consensus. Further, I explain how officials of these agencies perceived the change and the potential and limits of the new policy frame. The findings reported here are primarily based on an analysis of policy documents from these three agencies and interviews with 34 officials at these agencies, conducted between 2008 and mid 2010.44
I focus on the WHO, FAO and OIE while leaving out the UNSIC, UNCEF and World Bank because the former agencies are considered as having technical expertise on avian influenza. Due to institutional review board requirements, I have maintained the confidentiality of my informants. Interview quotes are thus presented by their code numbers.
Documents include updates on the disease situation, technical guidelines, standards, recommendations, reports of organisational activities and meeting minutes. The interview questions inquired into officials’ responsibilities, opinions and experiences during policymaking for avian flu control.
Competition between the fragmented frames: 2003–2008
Between 2003 and 2008 the WHO, FAO and OIE drew from three competing frames to prescribe the solutions for avian flu outbreaks – the technical/biomedical intervention, a societal intervention and ecological conservation frames. These three fragmented frames, as I will call them, are often proposed and supported by distinct types of professionals. I identified these frames through document analysis and interviews based on the epidemiological assumptions and proposed control strategies entailed in policy arguments (see Table 1).
| Fragmented frames | One World One Health | |||
|---|---|---|---|---|
| Biomedical/technical Frame | Societal frame | Ecological conservation frame | ||
| Norms | Modernity Development | Equality Empowerment | Environmentalism Sustainability | Modernity Equality Environmentalism |
| Knowledge | Virus behaviour Artefacts (antivirals, vaccines) | Human behaviour and cultures | Ecosystem Disease ecology | Interface of animal, human and ecosystems |
Technical/biomedical intervention frame
The first frame, a technical/biomedical intervention frame, saliently dominated the policy deliberations of these agencies in the early stage. Its rationality is deeply rooted in science and technical progress. Experts in virology, microbiology and veterinarian epidemiology and medicine constituted this frame’s knowledge foundation. They assume that modern science, technologies and pharmaceuticals are the basis for disease control and prevention. Using this frame, international agencies often portrayed H5N1 viruses as invisible and ever‐changing entities that threaten global health and security. They therefore prioritised studies on the pathogen’s features, such as its molecular or genomic compositions, its infection and replication mechanisms and the development of efficient vaccines and antiviral drugs. The frame also assumes unidirectional disease transmission, in which viruses infect wild birds and wild birds transmit the viruses to poultry, through which the viruses reach humans. Proposed strategies aim at either eradicating the virus directly or impeding its transmission by applying modern medicines.
Initially, the technical/biomedical frame prevailed in global policy deliberations. The WHO, FAO and OIE advocated dissimilar technical interventions supported by each agency’s specific technical expertise. For example, the FAO and OIE recommended biosecurity measures in poultry farms and markets. They urged farmers to build fences, disinfect poultry premises, adopt centralised slaughter of the birds and avoid unhygienic practices to prevent the spread of the viruses. The WHO also encouraged pharmaceutical development and stockpiling of drugs, in line with its public health expertise. This technical/biomedical frame is fundamentally expert‐dominated, because only experts, particularly those with biomedical expertise, can fill current knowledge gaps and develop a magic bullet to defeat the viruses. Overall, the WHO, FAO and OIE’s strategies have centred on fighting the pathogen, and their initial consensus was to ‘Find it fast – kill it quickly – stop it spreading’ (FAO 2008: 13).
Societal intervention frame
Although they shared the technical/biomedical frame, the three agencies still experienced great conflict when they competed for limited funding resources. Dissatisfied with the dominance of WHO’s pandemic preparedness campaign, the FAO and OIE claimed that it was more efficient to control the disease at the animal source. Around 2004 and 2005 these two agencies also began to utilise a different frame – the societal intervention frame – to legitimise the agencies’ significance and to distinguish themselves from the WHO.
The societal intervention frame, mostly advocated by economists and social scientists, highlights how social and cultural factors complicate disease transmission and the implementation of control strategies. Instead of exclusively focusing on the pathogen, it emphasises the need for changing human activities. Humans, in this frame, are not merely passive victims of H5N1 viruses but social actors influenced by broader structures, such as economic conditions, social trends and cultural beliefs and practices.
The societal intervention frame highlights how human activities affect disease transmission or the effectiveness of interventions. For example, some experts argued that the women and children who are often responsible for raising poultry may be at higher risk; legal or illegal trade of birds and bird products may facilitate virus transmission and certain husbandry practices such as backyard farming or intensive farming may cause threats. This frame thus recommends tailoring control strategies to particular cultures or societies. Diverse diagnostic explanations and control strategies co‐exist in this model due to the diversity of socioeconomic conditions around the world. While some intervention strategies are less radical, such as promoting health education and compensating farmers for their loss, some are more radical, such as condemning and banning modern factory farming. Generally, the frame advocates more bottom‐up strategies and promotes community‐based programmes.
FAO and OIE’s advocacy of the societal frame could be seen as an organisational strategy to enhance their political legitimacy. Firstly, by increasingly emphasising poverty alleviation, they challenged WHO’s insistence on stamping out the disease by killing poultry and legitimised their policy stances. The two agencies argued that economic concerns resulted in farmers’ reluctance to report suspicious outbreaks. They also noted that the mass culling of poultry often results in the poor losing their main cheap source of protein. Bringing in the societal frame therefore strengthened the FAO and OIE’s legitimacy in seeking to address the problem at the agricultural level. Since 2005 the FAO and OIE have started to recommend compensating farmers to encourage disease reporting and the acceptance of culling. The FAO further proposed pro‐poor risk reduction strategies to protect and enhance smallholders’ livelihoods in developing countries.
Ecological conservation frame
A third frame, proposed mostly by ecological biologists, conservationists and ornithologists, focuses on wildlife and ecosystem protection. This frame emerged in 2005, when the role of wild birds in disease transmission became increasingly controversial after an outbreak in China’s remote Qinghai Lake. No scientific research has yet drawn convincing conclusions on whether wild birds carry HPAI viruses during long‐distance migration, due to the difficulties of large‐scale wildlife surveillance research. Despite this scientific uncertainty, this frame argues that the emergence and spread of infectious diseases was mostly due to ecosystem degradation. The frame is thus more sympathetic to wild birds, compared with the other two frames. While the technical/biomedical frame assumes that wild birds are dangerous vectors that spread viruses to poultry and humans, advocates of this frame suggest that wild birds might be victims of outbreaks from intensive poultry farms.
Specifically, some wildlife experts criticised the global policy priority that has been given to short‐term technical strategies, ‘namely on fixing the problem rather than preventing the factors that first led to its emergence’ (Rapport et al. 2006: 2–3). For example, a report published by the United Nations Environmental Programme identifies ecosystem degradation and ecological imbalance as root causes of emerging diseases (Rapport et al. 2006). This frame argues that some farming practices may exacerbate disease spread, such as the crowded conditions of factory farms, waste run off from farms to wetlands where migratory birds gather and the inadequate use of antiviral drugs that drives the mutation of influenza viruses. Proposed strategies thus seek to protect ecosystem health and wild birds.
The FAO and OIE soon responded to criticisms from wildlife experts by adopting this ecological conservation frame. They periodically and increasingly stated the necessity for investigating the role of wild birds in disease transmission. For example, one FAO’s press release states:
FAO has been calling for such research [on wild birds] since early 2004, but insufficient resources have been allocated to be able to study the question properly ... As an international agency which has invested considerable resources in numerous aspects of biodiversity preservation and conservation, FAO would be the last to pinpoint wildlife as the sole source of virus dissemination. (FAO 2006)
FAO and OIE thus organised an international scientific conference on avian influenza and wild birds to review the latest scientific knowledge in 2006. In addition, the FAO initiated a working group to address wildlife disease surveillance. Evidently, the ecological conservation frame strengthened these two agencies’ legitimacy in advocating policies that represented their priorities, interests and technical expertise. They promoted interventions that required the specific veterinary expertise they were qualified to offer.
Between 2003 and 2008 the WHO, FAO and OIE often picked up different pieces of arguments from the three frames depending on the occasion. Among the three agencies, the WHO has tended to favour one‐size‐fits‐all biomedical interventions, while FAO’s policy arguments and programmes have been more diverse and fractured. The variety of FAO’s arguments may be due to the relatively broad composition of its bureaucratic expertise. In addition to veterinarians, the FAO’s avian flu working group also consisted of a few social scientists, communication experts and wildlife experts because of the agency’s concern with food production chains. Dissimilar underlying assumptions made the FAO, OIE and WHO seem incoherent, sometimes even contradicting themselves. Tensions between these agencies clearly demonstrated their competition and conflicts. Generally, the societal and ecological conservation frames have been more peripheral than the technical/biomedical frame.
The convergence on the OWOH policy framework: 2008 to the present
Experiencing inter‐agency conflicts, the WHO, FAO and OIE gradually recognised that divisions and tensions jeopardised global health governance and the organisations’ legitimacy. The WHO, FAO and OIE began to recognise that the lack of cooperation between the sectors hampered cross‐species disease surveillance and efficient global responses. In 2005 they started to initiate collaboration and reduce antagonisms. Specifically, cross‐agency coordination first commenced to strengthen disease surveillance by sharing information on outbreaks among agencies. The WHO, FAO and OIE established working relationships through the GLEWS, OFFLU, and CMC‐AH. The GLEWS, for example, tracks potential pandemic threats by exchanging outbreak information, and the OFFLU promotes the exchange of scientific information and biological materials among scientists. The three agencies also began to organise joint technical meetings and the international ministerial conferences on avian and pandemic influenza. They acknowledged that physicians, veterinarians and other health and environmental professionals should work more closely with each other to strengthen the knowledge foundation for global health governance.
The OWOH slogan, first coined by the WCS in 2004, initially did not receive much political attention. During the fifth International Ministerial Conference on Avian and Pandemic Influenza in 2007, the conference background paper, ‘the New Delhi Road Map’, highlighted the need for convergence between the animal health and public health sectors. The OWOH principle was recognised, and participating national delegates requested that these international agencies prepare a strategic frame to guide country responses. The FAO, WHO, OIE, UNICEF, UNSIC and the World Bank thus jointly produced and endorsed the ‘Contributing to “One World, One Health” strategic framework’ during the following International Ministerial Conference on Avian and Pandemic Influenza in 2008. This document was exclusively drafted and discussed among six officials from these six agencies, without consulting external experts. It laid out five main strategies55
The five strategies in the OWOH policy framework include: (i) building robust public and animal health systems that comply with the WHO’s international health regulations and OIE standards, (ii) preventing and controlling disease outbreaks by improving national and international response capacities, (iii) addressing the needs of poor populations by shifting focuses to developing economies and locally important diseases, (iv) promoting collaboration across sectors and disciplines and (v) conducting research that guides the development of targeted disease control programmes.
geared to reducing risk at the animal‐human‐ecosystems interfaces. Specifically, the framework highlights a cross‐sectoral and multidisciplinary approach that recognises the intricate relationships between human, animal and ecosystem health. After this conference, the OWOH policy framework became the guiding principle for global health governance, which proposes that managing novel pathogens requires collaboration between different professions and international agencies.
In principle, OWOH is a frame that seeks to combine the three competing fragmented frames discussed above, acknowledging that various multiple factors all contribute to disease transmission. It also seems to merge all values emphasised by the three fragmented frames, including modernity, social empowerment and sustainability. Seemingly holistic, the frame was primarily conceptual and not clearly defined when it was released. Most officials at the three agencies recognised that the OWOH slogan is catchy and appropriate. However, until 2009, when I interviewed most officials, they could not articulate its meaning and practical steps. To most of them, OWOH is more of an abstract concept than a set of concrete policies.
To translate this abstract framework into action, the WHO, FAO and OIE subsequently organised several consultation and technical meetings. For example, in 2009 the Public Health Agency of Canada hosted a consultation meeting in Winnipeg. In May 2010 the Centers for Disease Control and Prevention in the US hosted another consultation meeting to operationalise the concept. In February 2011 Australia’s Commonwealth Scientific and Industrial Research Organisation hosted the first One Health Congress to showcase relevant research and policy implementation. In 2011 the Mexican government hosted another high level technical meeting to address health risks at human‐animal‐ecosystems interfaces. The participants of these meetings were mostly invited international experts with medical or veterinarian backgrounds, officials of international agencies and national delegates from both the public health and agricultural sectors. Since 2008 the three agencies have frequently expressed their enthusiasm for OWOH. In 2010 the WHO, FAO and OIE (2010a) jointly published a ‘Tripartite concept note’ to reiterate their commitment to inter‐agency collaboration. They also changed OWOH to ‘One Health’ to recognise the WCS’ possession of the original phrase.
In the meetings to conceptualise One Health, nonetheless, participants struggled to give it a clear definition. After an FAO‐OIE‐WHO joint technical consultation in 2008, meeting participants agreed that ‘it became clear that this concept [One Health] was not new; however, the roles and strategies of all the players globally are not fully understood nor effectively integrated’ (FAO, OIE and WHO 2010b: 13). Some meetings ended with a conclusion that clear definitions and consistency of One Health are necessary. Most of the time, the scope of OWOH was left open or carried to the next appropriate meeting. One OIE officer summarised what she observed at the Winnipeg 2009 meeting:
For some people [at the meeting], this [OWOH] means to investigate the animal‐and‐human interface, while others believed that food security is more important. Still other experts thought that health issues should be more broadly defined, including not only disease prevention but also healthy life styles. The final consensus of the meeting was that One World, One Health could mean whatever people want to. Each country can emphasise any aspect relevant to the animal‐human‐ecosystem interfaces. (09–2009, interview)
This vagueness of One Health persists. Two years later, during the first One Health Congress in early 2011, experts and public officials still struggled to come up with a consensual definition. For example, in the opening plenary speech, one senior FAO official commented:
One Health means different things to different people. If you ask 10 people here, you may get 10 different ideas. We may not eventually obtain an agreement on One Health in this room. However, all of us believe that it is important ... During the next three days, we will discuss and conceptualise One Health in order to put our words to practice. (Field notes, 2011)
Experts participating in the congress continued to debate the scope and definition of One Health. Some insisted on focusing on infectious diseases, while others believed that One Health should include promoting healthy lifestyles and securing nutrients. Several participants and speakers recognised that having a clear definition of One Health was difficult and that stakeholders were still free to prioritise tasks differently.
Interestingly, despite One Health’s vagueness, policymakers, experts, and international agencies all welcomed the concept. The endorsement of One Health clearly did not result from a solid scientific understanding of the complex epidemiological dynamics – international agencies and experts repeatedly acknowledged the existing knowledge gaps in disease transmission mechanisms. Neither could the policy shift be entirely attributed to international politics, because most powerful nation–states and donors were more interested in efficiently preventing diseases from threatening the West by containing them.
The endorsement of OWOH, I argue, was mostly driven by the tensions and growing interactions between specialised international agencies in an increasingly globalised world that challenged the legitimacy of specialised governance institutions. It became a step toward appeasing cross‐agency contradictions and forging consensus among them and with other global actors, such as divided professionals, self‐interested nation–states and development‐oriented donors. By merging different normative claims, knowledge foundations and policies from fragmented frames, the WHO, FAO and OIE attempted to reduce cross‐agency conflicts, avoid criticisms and create a global consensus that facilitated coordination.
Functional consensus despite diverse interpretations
The political function of OWOH was illustrated by officials’ diverse and sometimes contradictory interpretations of this concept. My interviews disclosed three distinct perspectives regarding OWOH: those who bought into the idea, others who were content with current technical cooperation and yet others who considered OWOH a strategic response. Yet international officials all welcomed One Health no matter what perspective they held.
First, some officials wholeheartedly embraced One Health, praising it as a momentous paradigm shift in global governance. For instance, a WHO official commented that OWOH was ‘a new perspective that international organisations embrace’. She elaborated, ‘We’ve learned the importance of cooperation over the years’ (W10–2008, interview). Another FAO official said:
One Health is to broaden the veterinary approach. In the past, you wait for the disease to emerge; you respond to it, you get rid of it. In One Health, you try to understand the factors that lead diseases to emerge. You try to broaden the spectrum of professionals: use communication specialists, socio‐economists, bring doctors and vets together. (F9–2010, interview)
These officials were enthusiastic about capturing a big picture of disease epidemiology.
Other officials believed that OWOH just consolidated ongoing inter‐agency cooperation in global disease surveillance. One WHO official commented, ‘Some people consider OWOH a new idea, but actually we have being doing this for a long time. We just didn’t use this phrase’ (W8–2009, interview). He, along with other officials, considered that One Health was a reaffirmation of their ongoing technical collaboration rather than a paradigm shift. Another WHO officer held a similar opinion, arguing that OWOH just crystallised what had already happened:
It gives it a name. An expectation of a name seems to make sense. It helps us to capitalise what we have achieved and show that we can do more ... It’s just a concept, a vision. Hopefully it will underline the work we do.
This interviewee continued, ‘I don’t want to see a new programme that diverts the attention to the animal and human interface, because it’s already been there’ (W7–2009, interview). Some argue that the principle only ‘put what the organisations had been doing in words’ (W10–2009, interview).
Lastly, several officials considered OWOH beneficial for sustaining donors’ interests and investments in avian flu. For them, the adoption of OWOH was, at least partially, a strategic move. It was advocated primarily for reigniting global attention to avian flu prevention and control. During my fieldwork in 2009, several officials expressed an anxiety about ‘avian flu fatigue,’ that is, fading global attention to avian flu because the expected pandemic had not occurred. To them, the OWOH frame helped refocus global attention, particularly the financial commitment of donors such as the European Commission, the United States Agency for International Development and the World Bank. Many officials noted, ‘We have to let the funding agencies understand that the investment is beneficial’ (F9–2010). Another WHO official added, ‘Each organisation has its own agenda. We find the collaboration beneficial. But we need political support to make it happen’ (W6–2008, interview). Another consultant similarly commented that One Health is a:
repackaging of what has been happening for the past 30 years to make it more attractive to donors – there is a need for cross‐disciplinary coordination, but it has always been this way. (E17–2010, survey response)
Noticeably, no matter how these bureaucrats interpreted One Health, they recognised its significance. The three agencies also attempted to redefine the meanings and strategies of One Health by initiating discussions among international agencies, experts, and donors through organised meetings and conferences. Their shared enthusiasm but dissimilar interpretations of One Health illustrate the framework’s function as a boundary object strategically used by the WHO, FAO and OIE to transform tensions and encourage coordination (Star and Griesemer 1989).
Star and Griesemer (1989) state that a boundary object is ‘plastic enough to adapt to local needs and the constraints of the several parties employing them, yet robust enough to maintain a common identity across sites’ (1989: 393). One Health comprises characteristics of a boundary object for being both robust and flexible. On one hand, specialised organisational actors and experts supported One Health due to their common objective in promoting heath. By recognising that human, animal and ecosystem health are intertwined, One Health legitimised participation by all agencies in knowledge and policy construction. On the other hand, One Health also allows dissimilar interpretations, as it includes all the essentials of fragmented frames, recognises every possible epidemiological factor, and affirms different values. As an all‐you‐can‐eat type of framework, OWOH allows users to identify with different pieces of the frame. The ‘productive vagueness’ of One Health as a result facilitates communication among previously independent social worlds.
Consequently, OWOH created a sense of harmony across agencies and stakeholders with dissimilar interests and focuses. They may not necessarily interpret and implement OWOH in the same way, yet they now share a common vision and a commitment to ‘get along’ (Halfon 2006). Under the big umbrella of OWOH, individual bureaucrats, organisations, and experts downplay their conflicts and competition and reach the consensus that they are in fact complementary. Disputes over prioritisation were somewhat alleviated, as they no longer needed to choose one over another. Their growing collaboration also established the collective legitimacy of the three agencies.
A double‐edged policy framework
The evolution of OWOH in response to avian flu outbreaks demonstrates the influence of international agencies on global policymaking and policy change. The globalisation of pathogens has not only penetrated national boundaries, but it also challenged existing specialised bureaucratic governance systems and professionalised production of disease knowledge. The political endorsement of One Health was not simply driven by the advance of science, politics between influential nations and stakeholders, or advocacy networks of experts. Rather, competition and coordination between the WHO, FAO and OIE essentially shaped and promoted this new global health governance regime, which has now gone beyond avian flu and extended to other infectious diseases and pandemic threats. Ongoing institutional promotion and articulation of One Health illustrates that international agencies, though limited by their mandates and technical expertise, are not static. They can proactively respond to challenges, conflicts, and criticisms by adjusting policy claims and frames.
This research therefore contributes to the international bureaucracy literature by showing how world organisations shape disease knowledge and political policies by interacting, mobilising and networking with other global actors. The WHO, FAO and OIE strategically borrowed the concept OWOH from the WCS, transformed it into an overarching political principle, and consistently reconstructed its meanings and implementations. The emergence and popularity of OWOH can be attributed to negotiations and compromises between these principal organisational actors. It became appealing and widely appreciated before a clear definition and agreement on practical strategies was achieved. By adopting OWOH, the WHO, FAO and OIE not only reduced tensions among themselves and advanced their own legitimacy, but they also reshaped the institutional environment and interests of other stakeholders. For instance, these agencies began to encourage scientific investigations on the complexity at the animal‐human‐ecosystem interfaces. They advocated for multi‐disciplinary collaboration between medical, veterinary, wildlife and other professionals. The WHO, FAO and OIE also began to cultivate expert networks of One Health through organised consultation and technical meetings. Some experts and public officials have now identified themselves as One Health advocates and practitioners. In addition, these agencies sought to motivate donors and member states to continue investing in disease control and pandemic preparedness. Several officials emphasised the importance of ‘educating’ donors and of encouraging nation states to promote One Health. As one FAO official commented, ‘It is very important to convince donors to support OWOH. Because donors are like politicians, they are usually more interested in emergency responses rather than long‐term programmes’ (F4–2010, interview).
Moreover, this research complements the neo‐institutional approach by illustrating how new global norms and models come about. Neo‐institutionalism elucidates how broader cultural beliefs structure organisational cognition and guide decision‐making (Schofer et al. 2012). However, how these norms and rules emerge and how they become crystallised has not been adequately explained. Neither has much work explored how organisations respond to multiple, and sometimes competing, logics. This study shows that integration and abstraction could be one organisational strategy in response to norm contradictions. The WHO, FAO and OIE have shrewdly merged dissimilar values and knowledge claims to avoid tensions and criticisms. They incorporated distinct norms, including scientific advancement, social justice and ecological sustainability, into an all‐inclusive framework by means of numerous technical, consultation and political meetings. OWOH’s meaning has been fluid, varying with contexts and users.
This flexibility has both potential and limits. Although OWOH provides functional consensus due to its versatility, this very characteristic could prevent fundamental cognitive and behaviour changes. Its vagueness allows different, or even conflicting, interpretations and strategies to coexist. Yet, without shared concrete strategies except consensus on the need for collaboration, it could be little more than ceremonial. The earlier interventions of the WHO, FAO, and OIE have been criticised for advocating top‐down and technocratic approaches (Scoones and Forster 2008), for ignoring key factors of disease transmission such as intensive commercial farming (Davis 2005, Wallace 2009) and for representing certain farming practices as backward or problematic (Bingham and Hinchliffe 2008).
Although OWOH incorporates the fragmented frames, it does not always promise policy changes. For example, officials and experts who accept the technical/biomedical frame can embrace OWOH without shifting their perspectives. Rather, OWOH may downplay tensions and essential differences between frames. Most international officials have quickly learned to speak and apply the new pattern of reasoning by developing optimistic statements and abstract blueprints. If officials perceive One Health only as a strategy to avoid tensions or to refocus political attention, they can still practise the dominant technical/biomedical frame without converting to the seemingly holistic One Health perspective.
Officials, in addition, tend to resist change. During my interviews in 2009 and early 2010, some officials recognised that the political endorsement of OWOH had not considerably changed their work despite the fact that cross‐agency technical cooperative programmes had already been established. Several officials confirmed that ‘We are doing the same work, whether we have this phrase OWOH or not’ (F14–2010, interview). Another WHO official insisted that OWOH is only a concept. He said
Don’t think that it [OWOH] is something that’s too concrete. It’s a new concept. We are not aiming at producing new programmes ... There are partnerships to advocate the new concept, to use the concept. But those are partnerships, not new programmes. (W8–2009, interview)
These officials’ perception of the continuity of previous work suggests that international agencies tend to maintain their governance territories and resist the changes in bureaucratic structures that One Health demands.
In the age of globalisation, a framework like OWOH with a more sophisticated understanding of disease causality and management is certainly welcomed by many actors. Undoubtedly, improved cross‐sectoral surveillance platforms such as the GLEWS have facilitated quick detection and contingency responses to disease outbreaks. Despite these improvements in technical cooperation and strategies, whether the WHO, FAO and OIE will overcome barriers of bureaucratic divisions, professional specialisation, and international politics to realise One Health is still up in the air. The evolution of One Health, nevertheless, demonstrates that global problems and solutions are products of policy negotiations, in which international agencies can mediate and direct global policy formation and change. Motivated by resource interests and a desire for legitimacy, they have not only shaped knowledge of infectious diseases but also constructed policy responses to associated pandemic threats.
Footnotes
Acknowledgements
The author thanks Joachim J. Savelsberg, Elizabeth H. Boyle, Sarah Barker and anonymous reviewers for valuable advice. Research funding was provided by the Social Science Research Council; and the University of Minnesota Consortium on Law and Values in Health, Environment & the Life Sciences, Office of International Programs, Graduate School, Center for German and European Studies, and Department of Sociology.
