For a start, please tell us who you are. What is the focus of your work and research?

In my medical practice as an infectiologist, I am involved in direct patient care, whether on an ambulatory basis or in hospitals during several decades.
My research background is in the field of HIV. I am particularly interested in co-infections such as tuberculosis and viral hepatitis. But together with my team, I also deal with the great threat of resistance to antimicrobial agents. These are all silent pandemics that threaten humanity globally. I also focus on emerging infectious diseases, the most prominent recent example being the COVID-19 pandemic.
The third hat I wear is as the head of the department is that of public health of the University of Zurich. The focus is not on the individual, but on the health of the population on a national or, in the case of Global Health, global level.

So, you have your background in infectious diseases. How did you find your way to the Travel Clinic? What drew you here?

I came here because of the interesting mix. Bringing together different lines is something I've always found exciting. In my professional life, I mostly came to positions that were still relatively undefined. The prime example in 2017 was travel medicine and this department, which was then called "Public Health." I found people here who think ahead and also have a desire to take up topics "from the street", so to speak, know that you not only can create something new, but you must create it, and I saw great potential here to break new ground.

You said public health had been around as a concept for a long time. But you added the word "global" to the department. Why?

Exactly. When I took over the department, it was still called "Department of Public Health" and one of my first actions was to rename it "Department of Public & Global Health" in 2019. The reason for this is that we want to think outside the box and also actively take global responsibility in health.
This also fits well with the ZRM (Zentrum für Reisemedizin; Travel Clinic), where we have a focus on 'Health on the Move'. In the area of global health, however, we are involved in research projects beyond the ZRM with partners such as Makerere University. This partnership has been going on for more than 10 years. Recently, we have also been working with India and are planning a Schistosomiasis/Fasciola^[1] One Health project in Côte d'Ivoire.

Lately you hear more and more terms like: "Public Health", "Global Health", "One Health", "Planetary Health". Everything sounds somewhat similar. What does it all mean? Where are the differences?

There was a nice publication on this in the journal 'The Lancet Planetary Health' earlier this year. It looked at what topics and publications appeared as search results when the terms 'One Halth' and 'Planetary Health' were entered into PubMed^[2]. It was not surprising to see that there was a great deal of convergence. Antimicrobial resistance tends to appear heavily in the "One Health" concept, while climate change and related topics appear heavily in "Planetary Health." However, there is a lot of overlap, and in the end it doesn't matter so much anymore, because what matters is that all aspects are thought of in a systemic way.
In my opinion, "Global Health" emphasizes the social aspect even more, which can be summarized under the term 'equity' (justice/fairness). Equity in this context describes the basic idea that serious, good global health for as many people as possible only works if the SDGs (sustainable development goals) are taken as a starting point. This includes, for example, the right to clean water, education for all and access to good health care for all. The larger problems can only be solved if equity is always considered and worked towards.

"Global Health" thus has a greater focus on social aspects such as 'equity'. "One Health" and "Planetary Health" are broader. What exactly is "One Health"?

"One Health" recognizes that human health, animal health, and the environment are very much interrelated and form a complex system that cannot be separated. "One Health" is more than that, however. Because through this holistic thinking, one gives oneself the opportunity to create synergies, from which the added value ultimately arises. This means synergistically seizing opportunities and working together with all the "players". In the academy, this means working together in an interdisciplinary way.
A classic example of such synergy is, for example, global rabies control. The best results can be achieved when veterinarians and human doctors work together. In Chad, for example, the dog owners were also vaccinated as part of a nationwide dog vaccination campaign. This was done by mixed teams, which drove out together in the same jeep and vaccinated both animals and humans on the same day. So, there was no need for 2 teams and no need to drive out twice.

How can the Corona pandemic be analyzed from this perspective for example?

Relating a pandemic to "One Health" makes sense, because we have seen from Corona how complexly everything is connected. Starting with what was most likely the point of origin, a wild animal market in Wuhan, it describes exactly this species transition from one animal to another to humans.
Diseases such as corona are so-called zoonoses, i.e. infectious diseases that originate in the animal world and can then be transmitted to humans.
About 60% of all human infectious diseases originate in the animal world, which means that we have to be interested in what happens in the animal world. If we don't look at this, we give ourselves the chance to understand these connections and to be able to act.
And now the environment and the climate come into play again.

A study in Nature has calculated that with a global warming of 2°C until the year 2070 we will have about 4500 completely new disease transmissions between different species. This, of course, creates the potential risk of new transmissions to humans from minor outbreaks to pandemics.

How is that?

Climate and environmental changes mean that there will be places where certain species can no longer live and they will be forced to find a new habitat. This in turn means that they will come closer to other species, where they have never been before. These other animals are not prepared for the new pathogens they bring with them.
This is exactly what has happened to us. Humans - as mammals, so to speak - were not prepared for SARS-CoV2. Our immune system had never been in contact with this virus and was overrun by it. This can develop and spread like wildfires, as the Corona pandemic proved.

Does this mean that you should think about health on a larger scale than just the immediate surroundings if you want to stay one step ahead of infectious diseases?

Yes. "Public Health" and, indeed, "Global Health" have always meant thinking and acting outside the box. Considering the climate crisis, the pressure to follow this principle even more wholeheartedly is even greater. We are noticing more and more how globalization makes everything directly interconnected. For example, the trade in old car tires has likely led to the Asian tiger mosquito finding its way to Italy and subsequently to Switzerland. That was a direct consequence of international trade and there are many more such examples.
Everything is interrelated and we are all getting closer in that sense worldwide. I mentioned it in another Interview^[3] : Wuhan is virtually a suburb of Zurich. We must succeed in integrating this mindset into our everyday lives. For far too long, we just watched and watched as Covid advanced into Iran and on to northern Italy. Even when a state of emergency was declared there, we still had the feeling that this would not affect us. Perhaps because Gotthard lays in between. From that point of view, yes, you definitely have to think bigger, look ahead and act early.

What is going on at the University of Zurich regarding "One Health"?

The university is in the process of establishing a One Health Institute. The various faculties will come together in a multidisciplinary way. As head of the Department of Public & Global Health, I myself am involved in setting up the new institute. It is important to understand that "One Health" also means "Global Health" and vice versa. I hope that we can root this well, because if we don't succeed, we will only create "One Health" that takes place in Switzerland and the surrounding area, and that would be too short-sighted.
The university was also recently able to join the  Una Europa Alliance. There are currently 11 universities in the alliance. There are various self-steering committees, one of which deals with "One Health", where I represent UZH as a physician.

A somewhat casual question: what exactly is the output of all these bodies? Communication promotion? Guidelines? Services?

What I haven't mentioned yet: at UZH, of course, a lot is already being done about "One Health". The veterinarians have been living "One Health" much longer than the human doctors.

Then we are also involved with our department in various initiatives such as the E-Rabies project^[4] with Sonja Hartnack^[5] from veterinary medicine. The goal is to implement a web-based rabies monitoring system for humans and animals in Uganda. We are doing this together with our local partners.

Food safety is also a huge issue. This is the research area of the dean of the VetSuisse faculty, Prof. Roger Stephan^[6]. For example: He and his team are investigating antibiotic-resistant bacteria in the food chain and in wastewater.
So there are quite a lot of projects in the area of "One Health". But to come back to your question, the idea of all these initiatives is to bring everything together even more. It should be clear who is working on what, so that we can move forward in an even more coordinated, even more targeted and even more efficient way. That is the basic idea of One Health and that is our output.

Let's come back to the national level. What role does the relatively small country of Switzerland play in such global issues? Or to put it another way: what role can it play?

It is important that we are aware that we can do something. At the same time, the size of our country does not free us of any responsibility. We have to and can be active because we have a robust healthcare system overall and, above all, we are at a top level with research and teaching. These are extremely valuable resources. We are able to identify fundamental mechanisms in biology and medicine. Those who have made fundamental discoveries can share them with a research community, which in turn can create evidence for decision makers worldwide. In this way, a small spark can make a big difference. This is where I see our strength, Switzerland as a think tank.

Switzerland is no stranger to the pioneering role. The HIV cohort^[7] , for example, is world famous. We have CERN^[8], we have ETH^[9] and other world-renowned universities where UZH is one of them. These are big resources and we have to be careful in Switzerland not to maneuver ourselves into the off-side because, for example, we no longer have EU access (keyword Horizon^[10]). If we can no longer get grants (research funds) in the EU area, this will become a huge problem for us on the research side.

On the other hand, Switzerland has a long tradition of diplomacy. Major international organizations such as the WHO have their headquarters here. But a strong financial center with an international reach also gives us leverage. Just by being close to them and interacting with them, we have the chance to help shape and influence the world.

Switzerland as a scientific, economic and diplomatic hub with headquarters of many international organizations?

Exactly!

Interview: Cécile Rasi

In the second part we will talk about the emergence of travel medicine in Switzerland, about how the current world situation affects the health of the individuals and why Swiss people have to care about the effects of their own behavior on the other side of the world - because the tropics are coming to us!
Dive into the dynamic world of travel medicine and find out why doctors always have to be activists. The article will be published soon!

^[1] Schistosomiasis/Fasciola: parasites

^[2] PubMed is an English-language text-based meta-database of references to medical articles related to the entire field of biomedicine from the United States National Library of Medicine.

^[3] A yet unpublished interview with Primary And Hospital Care on the topic of "One Health."

^[4] eRabies surveillance - a way forward to rabies elimination in Uganda

^[5] PD Dr.med.vet. Sonja Hartnack: Scientific Collaborator at the Vetsuisse Faculty

^[6] Prof. Roger Stephan: Dean of the Vetsuisse Faculty

^[7] Swiss HIV Cohort Study

^[8] CERN: Europäische Organisation für Kernforschung

^[9] ETH: Eidgenössische Technische Hochschulen (Swiss Federal Institute of Technology).  ETH is ranked 7th in the world university rankings.

^[10] Horizon: 9. Rahmenprogramm der Europäischen Union für Forschung und Innovation (2021–2027)