**5. One Health Approach and International Organizations**

Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals, and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist, and may spread to others.

Antibiotic resistance is one of the biggest threats to global health, food security, and development today, and can affect anyone, of any age, in any part of the world. Bacteria, not humans or animals, become antibiotic-resistant; the cause for this is mainly the way antibiotics are prescribed and used without sales supervision and medical or veterinarian control. Tackling antibiotic resistance is a high priority for the United Nations' agencies FAO, and OIE, and the WHO, who are leading multiple initiatives and global action plans.

The United Nations (UN) has become the foremost forum in addressing issues that transcend national boundaries and cannot be resolved by any single country acting alone. While conflict resolution and peacekeeping continue to be among its most visible efforts, the UN, along with its specialized agencies, is also engaged in a wide array of activities to improve people's lives around the world—from disaster relief, through education and advancement of women, to peaceful uses of atomic energy.

Despite great successes since 1953, the UN has, in the past and presently, experienced a number of catastrophic failures, such as the war on sustainable development, global energy goals, refugee and climate change policies, famine, poverty, war conflicts, drugs, diseases, security, terrorism, nuclear proliferation, and human rights issues, and it has suffered disappointing setbacks or complete failures in recent decades.

To improve sanitation and drinking water, the UN organizations FAO and OIE, and the WHO have assumed joint responsibility for addressing zoonotic and other diseases of potentially high socio-economic impact. These international UN organizations developed a Tripartite Concept Note (One Health) setting a course of action and proposing a long term framework for global partnerships which is oriented towards the coordination of global activities addressing health hazards and risks at the human-animal-ecosystems crossroads [122].

The One Health European Joint Program (OHEJP) is a European Commission co-funded scientific collaborative research program intended to help prevent and control food-borne and environmental contaminants that affect human health through joint actions on foodborne zoonoses, antimicrobial resistance, and emerging microbiological hazards [123].

Recognizing the health hazards and risks at the human–animal–ecosystems interface is a key element of their assessments, communication, and management. The One Health approach is

considered critical for the emergence of antimicrobial drug resistance and on attending prevalent public health concerns, which comprise emerging infectious, parasitic, and zoonotic diseases [124]. Some 60% of human infectious diseases are of animal origin (zoonoses can be caused by bacteria, fungi, mycobacteria, parasites, viruses, and prions); nearly 75% of emerging human infectious diseases in the past three decades originated in animal-borne (even aquatic) diseases/pathogens [125]. Some 80% of such agents can be used for potential bioterrorism and are also pathogens of animal origin [126].

Through strong partnerships with human, animal, environmental health and civil society organizations and professionals, it is considered possible to stimulate advances concerning a safe and secure world with fewer infectious disease threats to human security. But while this UN One Health initiative has proven to be successful from an emerging and infectious disease perspective, its value still needs to be proven in terms of the exchanges and interactions of different microbiomes and elements of microbial communities' transfer among humans, animals, and the environment [127].

#### **6. One Health, Ecosystems and Veterinary Sciences**

The development of new technologies to perform DNA sequencing has expanded studies on entire microbial communities in humans, animals, and in the environment. The term "microbiota" encompasses the entire complex ecosystem of gut microorganisms, the bulk of which reside mainly in the colon. The terms "microbiome" or the metagenome of the microbiota comprise all of the genetic material within a microbiota.

A complete understanding of human microbiomes in various body mucosa and surfaces requires an evolutionary perspective. The coevolution of humans and microbiota has generated host-specific microbiome structures and gut homeostasis of physiologic, metabolic, and antigenic diversity [128].

Population growth and economic development are leading to rapid changes in our global ecosystems [129]. Health risks are also a result of broader pressure on ecosystems, from the depletion and degradation of freshwater resources to the impacts of global climate change on natural disasters and agricultural production [130]. There is increased connectivity between humans, domestic pets, wildlife, farm animals, and real-world issues such as sanitation, economics, and food security. Ecosystems, landscapes, and a One Health paradigm, including social-ecological holistic approaches become increasingly important [131,132]. Such interactions require the integration of health science disciplines that span the spectrum from personalized care to public health [133].

At the national and international levels, these domains are organized in different Ministries, and there is an obstruction by professional corporatism which may impair the implementation of the One Health approach by not pursuing to unify health-related research. Furthermore, overcoming long-standing barriers of privacy and distrust among health professionals and political will are necessary to enable the integration of different health systems [134].

Fermentation, as a human ecological process, begins with the symbiotic human relationship with the microbial habitat [135]. Lifestyle, well-being, and even the survival of humans has been connected to single-celled microorganisms, i.e., fungi (yeasts) and bacteria on fermentation ecosystems [136]. The concept of a whole ecosystem is unpopular, and many have abandoned the idea that ecosystems have boundaries [137].

Gut microbes are extensively purged every one to two days and have the ability to double in number within the space of an hour [138]. In future the ecology of human nutrition may be studied on fermentation ecosystems models [139].

The One Health approach has been criticized for an excessive focus on emerging zoonotic diseases, inadequate incorporation of environmental concepts and expertise, and insufficient incorporation of social science and behavioral aspects of health and governance [140]. Barriers to implementing this strategy include competition over budgets, poor communication, and the need for improved technology [141].

At the national level, it is common to observe Veterinary Medicine, Animal and Veterinary Science, Colleges of Veterinary Medicine, and Veterinary Public Health within the Ministry of Agriculture

and not in the Ministry of Health; therefore the link between animal health and human health is very precarious. Veterinary medicine is considered an Agrarian profession which does not include the concerns of Health professionals on most criteria, including resources. Environmental health is under the Ministry of Environment, and overall, this partition of responsibilities results in practical difficulties in terms of implementing the collaboration of multiple disciplines and sectors working locally, nationally, and globally to attain optimal health for people, animals, and the environment.

At the international level, agencies such as The European Centre for Disease Prevention and Control (ECDC), The European Food Safety Authority (EFSA), the *forum* One Health European Joint Programme (OHEJP), and others, follow the developments on zoonoses with the mission of identifying, assessing and communicating current and emerging threats to human health posed by these diseases, as well as zoonotic agents, antimicrobial resistance, and food-borne outbreaks. However, the monitoring and surveillance schemes of most zoonotic agents are not harmonized between Member States, adding to existing complexity.

## **7. Concluding Remarks**

Fermented food microbiology is an excellent model that is deeply connected to the dynamics that shape the human microbiota in different body sites. Perceiving microbial community interactions, essential for the threat of global antimicrobial resistance, will help to reveal, via a holistic approach, the unknown secrets of the human microbiome and the interactions which greatly influence multiple forms of human health, nutrition, well-being.

The relevance and potential of fermented foods and beverages, with contrasting and inconclusive results, and advocacy for their inclusion into dietary guidelines, depend on future clinical research. The limitations and inconsistencies in the current body of evidence mean that, presently, no definitive conclusions can be drawn on the potential health benefits of fermented products.

It is not easy to apply trans-inter-multi-disciplinary research required by the One Health approach due to its complexity, but the associated human-animal-environmental microbiota and health threats and risks demand that many challenges and handicaps must be overcome. After two decades, One Health still needs to prove its use and its ability to be applicable in parallel with the present bold reforms which are underway among major United Nations departments in order to more effectively respond to global crises, streamline activities, increase accountability, and ensure effectiveness.

**Author Contributions:** V.B. & T.F. reviewed the literature and drafted the manuscript. J.F., L.P., M.P. read and revised the manuscript. T.F. responsible for the concept and preparation of final article.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflicts of interest.
