Dr. Phaedra Henley

Background: Several sets of principles have been proposed to guide global health research partnerships and mitigate inequities inadvertently caused by them. The existence of multiple sets of principles poses a challenge for those seeking to critically engage with and develop their practice. Which of these is best to use, and why? To what extent, if any, is there agreement across proposed principles? Objective: The objectives of this review were to: (1) identify and consolidate existing docu ments and principles to guide global health research partnerships; (2) identify areas of overlapping consensus, if any, regarding which principles are fundamental in these partner ships; (3) identify any lack of consensus in the literature on core principles to support these partnerships. Methods: A scoping review was conducted to gather documents outlining ‘principles’ of good global health research partnerships. A broad search of academic databases to gather peerreviewed literature was conducted, complemented by a hand-search of key global health funding institutions for grey literature guidelines. Results: Our search yielded nine sets of principles designed to guide and support global health research partnerships. No single principle recurred across all documents reviewed. Most frequently cited were concerns with mutual benefits between partners (n = 6) and equity (n = 4). Despite a lack of consistency in the inclusion and definition of principles, all sources highlighted principles that identified attention to fairness, equity, or justice as an integral part of good global health research partnerships. Conclusions: Lack of consensus regarding how principles are defined suggests a need for further discussion on what global health researchers mean by ‘core’ principles. Research partnerships should seek to interpret the practical meanings and requirements of these principles through international consultation. Finally, a need exists for tools to assist with implementation of these principles to ensure their application in research practice.

Abstract Background Over the past decade, 70% of new and re-emerging infectious disease outbreaks in East Africa have originated from the Congo Basin where Rwanda is located. To respond to these increasing risks of disastrous outbreaks, the government began integrating One Health (OH) into its infectious disease response systems in 2011 to strengthen its preparedness and contain outbreaks. The strong performance of Rwanda in responding to the on-going COVID-19 pandemic makes it an excellent example to understand how the structure and principles of OH were applied during this unprecedented situation. Methods A rapid environmental scan of published and grey literature was conducted between August and December 2020, to assess Rwanda’s OH structure and its response to the COVID-19 pandemic. In total, 132 documents including official government documents, published research, newspaper articles, and policies were analysed using thematic analysis. Results Rwanda’s OH structure consists of multidisciplinary teams from sectors responsible for human, animal, and environmental health. The country has developed OH strategic plans and policies outlining its response to zoonotic infections, integrated OH into university curricula to develop a OH workforce, developed multidisciplinary rapid response teams, and created decentralized laboratories in the animal and human health sectors to strengthen surveillance. To address COVID-19, the country created a preparedness and response plan before its onset, and a multisectoral joint task force was set up to coordinate the response to the pandemic. By leveraging its OH structure, Rwanda was able to rapidly implement a OH-informed response to COVID-19. Conclusion Rwanda’s integration of OH into its response systems to infectious diseases and to COVID-19 demonstrates the importance of applying OH principles into the governance of infectious diseases at all levels. Rwanda exemplifies how preparedness and response to outbreaks and pandemics can be strengthened through multisectoral collaboration mechanisms. We do expect limitations in our findings due to the rapid nature of our environmental scan meant to inform the COVID-19 policy response and would encourage a full situational analysis of OH in Rwanda’s Coronavirus response.

Background: The rapid expansion of the cut flower industry in Africa has led to pervasive use and potential exposure of pesticides, raising concerns for local communities. Whether the risks associated with pesticide applications are localised or have broader implications remains unclear. Methods: We measured biomarkers of real and perceived pesticide exposure in two Kenyan communities: Naivasha, where the cut flower industry is present, and Mogotio, where the cut flower industry is absent. We measured real exposure by the percentage of acetylcholinesterase (AChE) inhibition and perceived exposure by assessing hair cortisol levels, a biomarker of stress. Additionally, we conducted a demographic survey to evaluate the health and socioeconomic status of participants, as well as their perceptions of pesticide risks associated with the cut flower industry. Results: Perceived pesticide exposure was more common in Naivasha (n=36, 56%) compared to Mogotio (n=0, 0%), according to community surveys. However, Mogotio residents had significantly higher mean hair cortisol levels (mean (xˉ) = 790 ng/g, standard deviation (SD) = 233) and percentage of AChE inhibition (xˉ = 28.5%, SD= 7.3) compared to Naivasha residents, who had lower mean hair cortisol levels (xˉ =548 ng/g, SD=187) and percentage of AChE inhibition (xˉ =14.5%, SD=10.1). Location (proximity to cut flower farms) and gender were significant factors influencing pesticide exposure, with individuals living outside the cut flower industrial complexes being at higher risk. Women in both communities were the most vulnerable demographic, showing significantly higher mean hair cortisol levels (xˉ =646 ng/g, SD=267.4) and percentage of AChE inhibition (xˉ =22.5%, SD=12.4) compared to men hair cortisol levels (xˉ =558.2 ng/g, SD=208.2) and percentage of AChE inhibition (xˉ =10.4%, SD=13.1). Conclusions: A heightened awareness of the potential risks of pesticide exposure was widespread within cut flower industrial complexes. This may have led to a reduction in exposure of both workers and non-workers living within or close to these complexes. In contrast, communities living outside these complexes showed higher levels of exposure, possibly due to limited chemical awareness and a lack of precautionary measures. Despite this contrast between communities, women remained the most vulnerable members, likely due to their socioeconomic roles in African society. Monitoring women’s pesticide expos

The Marburg virus disease (MVD) outbreak in Rwanda underscores the serious threat posed by zoonotic diseases. These pathogens, which are transmitted between animals and humans through direct contact or environmental factors, result in an estimated 2.4 billion infections and 2.2 million deaths annually1. MVD, which originates from bats, can spread rapidly to humans, with a fatality rate as high as 88%2. As of 10 October 2024, Rwanda has 58 confirmed cases of MVD, including 15 deaths3. This crisis highlights the urgent need for Rwanda to fully operationalize its One Health policy to address the interconnected risks of human, animal and environmental health. Outbreaks of MVD occur when humans are in contact with infected animals, including green monkeys, pigs and Egyptian fruit bats, which are known carriers of the virus2,4. After zoonotic spillover (when the virus transmits from animals to humans), it can spread between humans through bodily fluids or contaminated surfaces such as bedding2. While isolating cases and implementing public health measures are crucial, preventing future outbreaks requires an integrated One Health approach to mitigate the risks of MVD and other zoonotic diseases. One Health is more than just a buzzword — it is a strategic approach that links human, animal and environmental health to address interconnected challenges. It acknowledges that disease spread is not isolated; in cases like MVD, the health of animals directly affects human wellbeing. One Health emphasizes that no single sector (medical, veterinary or environmental) can effectively tackle the crisis alone.

The University of Global Health Equity‘s (UGHE) One Health Field School (OHFS) in Rwanda exemplifies an experiential approach to education that integrates human, animal, and environmental health. This field-based program engages students in real-world settings such as abattoirs, health centers, and mining sites to confront pressing public health issues, from zoonotic diseases and antimicrobial resistance to food safety and environmental health. Following Kolb's experiential learning model, OHFS equips graduate students to observe, analyze, and apply solutions to complex health challenges, fostering adaptability, resilience, and collaborative problem-solving skills. By bridging classroom theory with practical application, OHFS cultivates leadership and a holistic understanding of health, preparing graduates to navigate the interconnected global health landscape. Through this innovative approach, UGHE aims to train a generation of health professionals capable of addressing crises such as climate change, biodiversity loss, and emerging infectious diseases at the human–animal–environment interface. Paper Context Main findings: The University of Global Health Equity’s One Health Field School effectively integrates experiential learning with interdisciplinary collaboration to prepare students for complex global health challenges. By engaging students in real-world settings, the program fosters adaptability, resilience, and leadership in addressing interconnected health issues at the human-animal-environment interface. Added knowledge: The One Health Field School bridges the gap between theoretical knowledge and practical application, emphasizing interdisciplinary collaboration at the human–animal–environment interface. It builds capacity in future global health professionals to design and implement solutions for real-world health challenges, demonstrating the critical value of field-based, experiential learning in higher education. Global health impact for policy and action: The One Health Field School serves as a model for interdisciplinary education, promoting an integrated One Health approach. It informs global health policies by emphasizing the importance of equipping professionals with practical skills and holistic perspectives to address emerging health crises such as climate change, biodiversity loss, and food security.