ONE HEALTH SUMMARIES CHAM 2021
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ONE HEALTH
CHAM 2021
SUMMARIES
October 1st – 2nd, 2021 - PARIS
CHAM 2021 – ONE HEALTHTABLE OF CONTENTS
ONE HEALTH: ONE WORLD, ONE HUMAN, ANIMAL AND ENVIRONMENTAL HEALTH 3
INTERVIEW OF OLIVIER VÉRAN 5
ONE HEALTH: THE INDISPENSABLE INTERDISCIPLINARITY 7
HOW TO FIGHT HUMAN AND ANIMAL ANTIBIOTIC RESISTANCE? 9
THE CHALLENGES OF BIOTERRORISM 11
STOP CATASTROPHISM 12
INTERVIEW OF JULIEN DENORMANDIE 13
ONE HEALTH: WHAT NEW ROLE FOR HEALTH INSTITUTIONS? 15
THE ROLE OF LOCAL AUTHORITIES IN PREVENTION 17
INTERVIEW OF STELLA KYRIAKIDES 19
INTERVIEW OF GÉRARD LARCHER 20
DRAW ME THE HEALTHCARE INDUSTRY OF TOMORROW 21
HOW TO ENSURE ONE HEALTH? 23
GET ACCESS TO HEALTH FOR ALL 25
INTERVIEW OF MARIYA GABRIEL 27
IS EUROPE OF RESEARCH UP TO THE CHALLENGE? 29
FROM THE HOSPITAL TO THE “HEALTH-CITY” 31
WHAT CARE FOR OUR ENVIRONMENT? 33
A LOW-CARBON HEALTHCARE SYSTEM 35
METAPHYSICS OF COVID 37
INTERVIEW OF EMMANUEL MACRON 38
CHAM 2021 – ONE HEALTHONE HEALTH: ONE WORLD, ONE HUMAN, ANIMAL AND ENVIRONMENTAL HEALTH
Full introduction
Speaker: Guy VALLANCIEN, President of CHAM | France
One Earth, a single earth,
One Heart, a single heart, a single global community,
One Health, a single health, human, animal, plant, and environmental health.
This is the major topic we are going to discuss during these two days:
If mankind represents only a tiny part of the terrestrial biomass, largely dominated by plants followed by
bacteria and fungi, we the questioning bipeds have nonetheless profoundly damage the planet that hosts
us through the massive use of harmful products and the accumulation of waste, well beyond our needs
simply because we wanted to satisfy our desire, crazy desires.
More than 60% of human infectious diseases have an animal origin. Pandemic such as, Covid-19, Zika,
Ebola viruses, by through arises a large variety animal. The number of major global pandemics has
increased over the past century as the world's population has grown, transportation has intensified, the
environment has deteriorated, and cities have developed.
Mankind produces more than 30 billion tons of objects for year, concrete, followed by gravel, bricks,
asphalt, metals, plastics, wood and glass which we can barely recycle or don’t know how.
In this mad race for ever more, healthcare professionals whose vocation it is to preserve and restore the
state of health, good health, of living beings, we must question our modes of production, transportation,
accommodation, organization, architecture in order to prevent or at any rate limit the occurrence of all
forms of excesses, deviation and ecologic maltreatment. Bearing in mind that the healthcare sector in
France employs 2 million people, we have medical and paramedical personnel, pharmacists,
veterinarians, administrative and technical professionals, and employees of the drug and medical device
industry, they will have to change their habits to waste less and pollute less. We have to add the 120,000
social jobs, the 650,000 farmers and fishermen so 10% of the jobs in France.
And if we do nothing to counteract these nuisances, we are exposing ourselves to future health crises
which are far more serious, and which will accompany the deepening climatic variations, pandemics and
agro-food and industrial pollution.
Noise and smoke from combustion engines, the industry processing plastic and chemical waste are no
worst then other dangers threatening us. The unhealthy increasing speed of our actions in all fields,
association with the loss of our nychthemeral cycles is very important. We have lost our 24hours cycles
induced by our screens and by the permanent lighting of urban concentrations and hiding the Milky way,
by the way.
And this requires a considerable expenditure of energy, but these new silent aggressions disrupt our
biological bodies and disrupt our cellular clocks. The profusion of pixels, lux and decibels could well prove
to be far more harmful to our health than the fine particles release by fossil fuels.
CHAM 2021 – ONE HEALTHShould we be pessimistics?
Scientific knowledge and progress and its technological applications, and medicine, have enabled us to
double our life expectancy in less than two centuries. Progress has lifted hundreds of millions of men,
women, and children out of extreme poverty and cured patients of previously incurable diseases. This
progress, of which vaccination is one of the most emblematic examples, should continue and grow. But
it also carries in its way, condemnable nuisances, like an army on a camping on trail with its slouting and
typhus. We condemn forest, we pollute and we disrupt Biodiversity and degrade our environment by
polluting seas, and the rivers and the oceans.
So what can we do?
There is no other policy, we don’t have to many options. We have to pursue and deepen our
understanding of the universe and its inhabitants by sharing the fruits of a fundamental and applied
research. With the human and financial resources which are needed to explore it and further.
At the same time, we need to adopt techniques and respect nature, not so much by promoting the return
to the scythe, the plow, and the horse-drawn carriage as Yves Cochet advocates, but by rethinking our
personal and communal lifestyle in a responsible economy that serves all.
We also need to improve our means of prevention and care while respecting the planet ecosystems to
which we are intimately linked.
This is our top priority, now it is huge, both huge and complex task, because it is not a matter of
decreasing but rather investing differently, so not decreasing our investments but investing differently in
new clean industries, in order to produce less polluting goods. Health must no longer be thought of in
terms of expenditure but in terms of investment. We have to think that it is the most beautiful economy
serving human beings, living beings, and we must invest in the long term. This a Copernic like revolution
and it is very dangerous that we measure the danger but do not try to evolve.
Let’s break down the walls that isolate the academic world from the business world, lets’ break down the
walls that separate the public and private sectors, let's strengthen the links between the medical and
paramedical industries working hand in hands with the veterinary and environmental worlds, as well as
with technology and medical device companies, just as with the pharmaceutical companies and let us not
listen to the false prophets who refuse these indispensable collaborations in order to defend their own
little backyard because they want to be independent.
No, much to the contrary, we have to work hand in hand to improve our destiny, there is no other priority.
We should work all together and change the way we think and the way we act. And we have to humbly
admit that we are any elements among others in a phenomenally powerful universe. Mere elements,
within the millions of species that inhabit the Earth, perhaps, but the most accomplished of living beings
in their complexity, fully aware of their responsibility, which is all the more overwhelming because we
are the only ones able to transform our environment for good or for evil.
Let us promote the spirit of a one health to respect everyone, this is what we are supposed to do.
CHAM 2021 – ONE HEALTHBACK TO THE FUTURE
Speaker: Olivier VÉRAN, Minister of Solidarities and Health | France
Interviewed by Guy VALLANCIEN, President of CHAM | France
Since March 2020, the unprecedented health crisis that the global population has had to face, has put a
lot of pressure on our health system.
In the wake of this crisis, several observations can be made
- The success of the vaccination campaign is linked to one of the major strengths of the
French health system: the centralisation of the insurance system ,
- There is an urgent need to improve public health ,
- Interactions and cooperation between professionals t o make progress on training and
research is essential,
- The concept of “One Health” should be spread and collaboration between human, animal
and environmental health enhanced ,
- The withdrawal of hospitals from the public procurement code was particularly eff ective
during the crisis.
The importance of restructuring public health to be able to deal more effectively future health crisis has
been particularly highlighted during the pandemic. As a result, three missions have been initiated to
promote the improvement of public health and convince medical interns to choose it in their studies as
main speciality:
First Mission - Public health organization (Pr of Franck Chauvin)
"When there is a crisis outbreak, it is because it could not be properly anticipated” Reflecting on France's
capacity to respond to a crisis is essential to strengthen its prevention and reaction tools. Through this
mission, Prof Franck Chauvin brings answers to the question of the reorganization of public health in all
its aspects: research, training, expertise.
Second Mission - Flash training for professionals ( Mr. Julien Delpech; Prof Eric Vibert)
This mission, supported by Mr. Julien Delpech and Prof Eric Vibert, aims at offering "flash" trainings to
health professionals, regardless of their profession. The objective is to provide new skills to be able to act
more effectively in the event of a health crisis, or any other emergency, and to keep on developing and
perfecting them over time.
Third Mission - Public health (Dr. Aude Nyadanu; Dr. Pauline Martinot)
Dr. Aude Nyadanu and Dr. Pauline Martinot are involved in developing and establishing a new concept
of "public health" for the whole population and more particularly for the youngest. The aim is to improve
public health’s perception and promote health.
Although those three missions participate in the improvement of public health, they do not however
encompass all the issues related to the subject, such as, for instance, the empowerment of hospitals.
CHAM 2021 – ONE HEALTHAccording to the health minister, two topics should be explored further
- To make an important part of the Public Health Code non -opposable regarding health
providers’ organization without impacting their status.
- Remove hospitals from the Public Health Code to give them more freedom and latitude. It
should be noted that the European law stipulates against such a measure.
CHAM 2021 – ONE HEALTHONE HEALTH: THE INDISPENSABLE INTERDISCIPLINARITY
Speakers: Delphine DESTOUMIEUX-GARZÓN, Deputy Director of the Laboratory IHPE – Host-Pathogen-
Environment Interactions at the CNRS | France, Monique ELOIT, Director General of OIE – World
organisation for animal health – OIE | France, Philippe MAUGUIN, President and CEO of INRAE | France,
Jean SCHEFTSIK de SZOLNOK, Member of the Board of Managing Directors, Global Head of the Animal
Health Business Unit of Boehringer Ingelheim | Germany, Philippe VERMESCH, Stomatologist; President
of the SML – Union of liberal practitioners | France
Discussion led by Antoine FLAHAULT, Director of the Institute of Global health at the Faculty of Medicine
at the University of Geneva | Switzerland
The difference between interdisciplinarity and transdisciplinarity has its origin in their definition.
Interdisciplinarity refers to the relationship between academic disciplines (medicine, sociology,
engineering, etc.) Transdisciplinarity goes beyond this concept and includes key actors of the One Health
discussions, such as the private sector, international organizations and the civil society, to develop jointly
thought-out solutions.
Contribution of the One Health approach to the management of the pandem ic
The pandemic represents a relevant example how to approach whole One Health concept while
considering its possible areas of improvement. Until now, the origin of the Covid-19 virus seems to be of
zoonotic cause. However, this pandemic has also highlighted our lack of understanding of how a
pathogenic virus ended up in large cities and was subjected to the hyper-mobility. In terms of risks and
mobility, it seems necessary to monitor and study pathogens, even if they have no impact on the animal
population. By monitoring the animal populations, we contribute to anticipate and manage the
protection of human health. Finally, this pandemic has shed light on the importance of cross-sectoral
work, particularly for the research which could take advantage of exchanging and sharing experiences
from different scientific fields.
One health: an environmental, animal and human interface
The health sector is aware of the close link between human and animal health. Indeed, recent studies
show that nearly 60% of human communicable infectious diseases have an animal origin. Although, this
link has been proven for several years, the connections among environmental health, animal health and
human health are now different. The increasing proximity (urbanization, deforestation, disruption of
ecosystems...) between humans, wild and domestic animals has impact on the food chain, thus causing
multilevel risks. The increasing proximity goes hand in hand with the evolution of zoonotic diseases in all
countries. Considering these elements, it is essential to better understand the ecology of pathogens to
trace epidemics from their genesis and to work on risk factors: mode of transmission from one species
to another, identification of environmental compartments in which the virus circulates, mode of
mutation... Considering ecological and evolutionary aspects seems significantly enlightening when it
comes to explain how human factors and environmental changes influence pathogens.
Global interdisciplinarity
For the One Health’s success in terms of global health policy, the collaboration between scientific,
medical and veterinary teams is essential. From now on, new actors intervene in the field of One Health
such as politicians, financial partners as well as countries that invest in this approach.
CHAM 2021 – ONE HEALTHConsequently, collaborative work seems to be part of the One Health operating model. However, such
an approach needs to be shared and enriched through an increasing governmental involvement, through
a local implementation. Moreover, One Health, in its local and collaborative approach, seems to be
essential for innovation in research, especially in studies of viruses.
Finally, the interdisciplinarity is reflected in the need building a sustainable health system based on public
and private partners’ network. Thanks to One Health approach in the period of a crisis, the active desire
to break down organizational models and to work together could be answered by the transdisciplinarity.
The economic and social impacts of t he one health approach
Zoonoses and epizootics have considerable economic and social consequences. The China’s example
facing the African swine fever was a perfect illustration of those consequences, sometimes disastrous,
and leading to drastic decisions taken to control the risk. Indeed, the latter led to the slaughter of 400
million animals, the number has to be put in perspective with the Chinese food culture based largely on
pork meet.
In general, the economic consequences are most often negative. However, the One Health approach is
not only built to estimate the global national losses but also to monitor the local impact. It shows, for
example, how animal diseases also cause losses to farmer’s families until decreasing their global welfare.
The importance of education and tr aining
One of the main issues raised by the One Health approach concerns education. Up to now, the public
health and the animal health are completely separated in the academic world. The One Health approach
is not very operational in medical schools, although the world of scientific research tends to promote the
transdisciplinarity. There is now a real challenge to create a dynamic between veterinary, public health
and human health training programs.
CHAM 2021 – ONE HEALTHHOW TO FIGHT HUMAN AND ANIMAL ANTIBIOTIC RESISTANCE?
Speakers: Thomas B. CUENI, Director General of the International Federation of Pharmaceutical
Manufacturers – IFPMA | Switzerland, Dame Sally DAVIES, UK Special Envoy on antimicrobial resistance
| United Kingdom, Jean-Louis HUNAULT, President of the SIMV – Association of the Veterinary medicine
and diagnostic industry | France, Alexandre MÉRIEUX, CEO of bioMérieux | France, Carmen PESSOA DA
SILVA, Unit Head, Antimicrobial resistance Division – GLASS at WHO | Switzerland
Debate led by Benoît GALLET, Advisor, Administrator of the IMEA – Institute of Medicine and applied
Epidemiology – IMEA | France
As of today, human and animal antibiotic resistance is considered a growing public health issue of major
importance. Scientific researchers estimate that more than 50 million deaths, representing a 4% impact
on GDP, will be caused by antibiotic resistance by 2050. There is an imminent need for global awareness
on antibiotic resistance to be raised as it constitutes a critical threat to global health. For this motive, the
United Nations and other institutions have set different action plans, described as follows:
A need for global awareness
The issues surrounding antimicrobial resistance are global and require a response at the international
level. Indeed, governments and institutions around worldwide expect global awareness to be raised and
international solidarity to be witnessed. Although several regulatory initiatives have been ratified and
signed, it seems that their implementation remains incomplete.
However, the current health situation has shed light on different issues. Indeed, the outbreak of the
pandemic has highlighted the importance we attribute to life and has shown the necessity of having
health infrastructures of sufficient capacity to prevent from saturation. Moreover, we have witnessed an
extremely quick circulation of the virus which has forced us to question our ability to respond quickly and
in an accurate manner to large-scale health problems.
Education on antibiotic resistance
Considering the sanitary situation, it is more than ever necessary to continue raising awareness among
governments, health and drugs professionals about antimicrobial resistance. The latter can be done, for
instance, by promoting and developing microbiological approaches in scientific programs at university.
More broadly, there is a need for our societies to develop a culture of pharmacovigilance by developing
and being equipped with tools allowing for early identification and diagnostic of antibiotic resistance.
Although well implemented in developed countries, this awareness on antibiotic resistance is still
unevenly achieved at the global level. It is therefore important for societies and institutions to launch
education programs aiming at using antibiotics, both for animals and humans, in a rational way. The
decrease by 70% in animal antibiotic prescriptions witnessed between 1999 and 2019, is a clear indicator
that change is underway and should be continued.
Monitoring the progress of antibiotics on the market
For the prevention of antibiotic resistance, surveillance remains a major issue in pharmacovigilance. As
of today, a system called “predict and prevent” allows to establish global surveillance. For an effective
surveillance system and an accurate monitoring, it is essential to be able to obtain exhaustive, reliable,
and relevant data. Political institutions need precise data to provide informed decision-making and the
implementation of rational regulations is only possible using evidence-based and objective data.
CHAM 2021 – ONE HEALTHHowever, due to the lack of resources in some countries, effective and efficient monitoring has not been
realized at a global scale yet. In addition, some governments are reluctant to share their surveillance
data. Therefore, the epidemiological surveillance aimed at mitigating antimicrobial resistance relies on
the pooling of means and resources and on the creation of dedicated and coordinated infrastructures.
Thus, in 2016, the WHO set up on a global scale the Global Antimicrobial Resistance and Use Surveillance
System (GLASS) that was ratified by more than 100 countries and that tries to integrate all the issues
regarding surveillance and information sharing.
Also, at the national level, the ESA France platform participates in surveillance and aims at assessing
health risks on animal and public health.
These initiatives should be pursued and generalized by raising awareness among governments, health
professionals and by promoting coordination between actors.
Market accessibility
The need to recreate a viable and sustainable market in the long term is a priority. To this end, policies
based on incentives, such as an innovation bonus for laboratories wanting to obtain market
authorization, are currently being studied.
Improving diagnostics and research
The marketing of new antibiotics is not a sufficient response to market accessibility. Data collected on
more than 8 million patients demonstrate a resistance rate of more than 40% to third generation
antibiotics. The implementation of a scientific innovation policy must precede the implementation of a
commercial strategy. Unfortunately, this point of view is not shared by all, and the situation remains
unchanged.
CHAM 2021 – ONE HEALTHTHE CHALLENGES OF BIOTERRORISM
Speaker: Eric VALADE, Professor; Chairman of the Scientific Council Biotox-Piratox Laboratory network |
France
Interviewed by Fabien GUEZ, Cardiologist; Consultant for BFMbusiness Santé | France
What is bioterrorism?
Bioterrorism is the occurrence, by a voluntary act, of an event linked to a biological agent (virus, bacteria,
prions, fungi) with an impact on human, animal, food or environmental health. Bioterrorism aims at
producing fear, generating a strong psychological impact on the populations exposed to it. Mass
bioterrorism, targeted attacks and the use of biological weapons represent a global threat to health and
the environment. Emergency departments, private practitioners and pharmacists play an important role
in the event of bioterrorism. They are responsible for the initial diagnosis by identifying several cases
presenting similar symptoms.
Bioterrorism involves one or more infectious or toxic biological agents. It is therefore crucial to be able
to determine the agent, the effects of being exposed to the latter, the timeframe for the appearance of
symptoms and the type of targeted population.
The role of the network and current issues
The national network of Biotox-Piratox laboratories is made up of the French National Institute of Health
and Medical Research (INSERM), of the Pasteur Institute, the French Agency for Food, Environmental and
Occupational Health & Safety (ANSES) and some hospital biology laboratories. This ecosystem,
constituted by very different actors from different fields is the reflect of the concept of One Health: it
understands that health problems must be considered not only at the human level, but also at the animal
and environmental one.
In case of a bioterrorism attack, the network plays an important role in identifying the pathogen agent.
It is responsible for organizing simulation exercises in order to verify that the set-up organization, in the
event of an attack, is in capacity of managing such an event. These exercises provide training to physicians
and pharmacists to raise their awareness on the challenges of bioterrorism and teach them how to deal
with it.
The future of the fight against bioterrorism
Biodefense is about the protection and preparation of all the elements necessary to provide an effective
crisis management. Although an exhaustive preparation is never possible, some exercises are useful in
improving our preparation and response to crises (Anthrax, Ebola, Covid-19). Indeed, the Covid-19 crisis
has shed light on new diagnostic capabilities at global scale that rely on coordinated platforms such as
screening and vaccination centers.
France, as well as other nations, will be led to use networks of actors, communication, information
control and new diagnostic methods to anticipate future crises. Thus, it is important to determine the
most appropriate ways to deliver messages. Indeed, communication on social networks is more than ever
an issue arising in crisis management. In this sense, the exchanges, on a European level as well as a global
scale, constitute real opportunities to take advantage of each government’s feedback, as we are all
confronted to similar issues and have responses that are varied and enriching.
CHAM 2021 – ONE HEALTHSTOP CATASTROPHISM
Speaker: Marc FONTECAVE, Professor at the Collège de France; Member of the French Académie des
sciences | France
Interviewed by Agnès AUDIER, CEO of Agnès Audier | France
The need to put forward scientific and rigorous statements about energy transition in order to fight
against misinformation is the main motivation that led Professor Marc Fontecave to write his book "Halte
au catastrophisme: les vérités de la transition énergétique". In the latter, he describes the lack of
knowledge we have in the energy field and our tendency to make risky public statements on the energy
transition.
An overdramatic atmosphere
The unfounded warnings on a possible end of the world and the feeling of inertia concerning the energy
transition have had disastrous effects on the population: identification of scapegoats, growing anxiety
about the future, loss of confidence in science.
Marc Fontecave wants to bring a sense of optimism and rationality. Indeed, although the energy
revolution can only take place over a long period of time due to scientific and technical constraints, we
must be confident in our ability to solve problems, including those we have created. This transition
requires continued efforts in knowledge production, research, and innovation.
Convincing French citizens, politicians, and administrations of the importance of research
The first difficulty when tackling problems is that the issues we deal with are often very complex. They
are often hastily dealt with by a part of the population claiming to have the capabilities to provide
solutions, even if incomplete. The second difficulty relates to the need to establish a common scientific
culture through education and training to approach the problems in a democratic manner and thus, limit
the appropriation of these issues by groups that proclaim themselves to be experts in the field.
In this sense, the scientific council formed around the President of the French Republic during the Covid-
19 crisis was an expression of a desire to educate and disseminate a democratic scientific culture. On the
other hand, the Citizens’ Climate Convention is considered as a counterexample. Indeed, it suggests that
an issue as technical and scientific as the energy transition can be dealt with only through a simple
consultation of 150 people randomly selected.
Change behaviours without resorting to catastrophism
The prevailing “doom and gloom” mood is ineffective. In fact, it only leads to decisions being taken on
measures that have not been evaluated based on relevant criteria but rather through the mobilization of
emotions and considerations with little scientific support.
CHAM 2021 – ONE HEALTHQUALITY AND FOOD SAFETY, A PRIORITY!
Speaker: Julien DENORMANDIE, Minister of Agriculture and Food | France
Interviewed by Vincent OLIVIER, President of Recto Verso | France
Quality and food safety: high expectations to articulate and reconcile.
Quality and food safety have different meanings depending on whether the perspective used is of
consumers, producers, or distributors. Although French people have not always shown a manifest
interest in food quality, it is subject to growing requirements from citizens, who are increasingly
demanding high food quality. Nowadays, the challenge is to identify how expectations on food quality
and safety are articulated and reconciled.
Food sovereignty
Alongside industrial and health sovereignty, two challenges at the heart of the CHAM 2021 debates, food
sovereignty is just as essential.
The Ministry of Agriculture and Food has observed that food has lost its meaning, including in the political
sphere, and that the concept of nutrition has unfortunately disappeared. However, although France is
currently dependent on certain areas, the key challenge is to ensure a national nutritional sovereignty.
For instance, seasonality is a major issue in France as approximately 30% of fruits and vegetables that are
currently imported into the country are produced with conditions inferior to French standards. This
situation has paved the way for initiatives like “territorial food projects” (PAT), as part of the ministerial
plan “France Relance” to emerge.
Nutritional sovereignty raises various issues. For example, the challenge of social equality in food is visible
in school canteens where the quality of nutrients is often questioned. Regarding food consumption places
such as canteens, the ministry is investing in the means of food production and food preparation sites.
One Health
The current pandemic and its zoonotic origin have highlighted the fact that animal, plant, and human
health no longer have borders. As certain local practices around the world encourage the outbreak of
pandemics, such as intensive pig farming China, a One Health approach is essential not only at the
national level but also at the international one. It is therefore fundamental to raise the standards of the
One Health policy internationally. Through the PREZODE initiative, launched during the One Planet
Summit, the Ministry of Agriculture and Food is supporting the policy. This initiative, which brings
together more than 1,000 research from dozens of different countries, aims at structuring the
international dialogue on the One Health policy.
In line with the One Health philosophy, Hippocrates advocated that "food is the first medicine". This
maxim has a strong resonance in France, as the country promotes close collaboration, through joint
projects, between the Ministry of Agriculture and Food and the Ministry of Solidarities and Health.
CHAM 2021 – ONE HEALTHAgriculture of tomorrow
As of today, France combines different models: from a small producer exploiting an old and exclusive
variety to a producer working on an industrial scale. These models are subject to consumers that
sometimes have contradictory requirements. It seems however difficult to maintain the combination of
a desire for short circuits and the requirement to benefit from efficient controls. It is therefore necessary,
although difficult, to provide answers aiming at reconciling these contradictions, such as the one existing
between environmentalists and farmers. Nevertheless, one of the main issues in France remains to be
the loss of food value mainly caused by a price war that contributes to the constant downward pricing of
food production. To reduce the sacrifice of our producers and better value their efforts in creating a
virtuous agriculture, it is fundamental to create correlations between quality and prices. Also, if we are
to limit the use of imports, although constantly increasing, it is crucial to tackle the problem of food value
in a collective manner. Finally, the role of the ministry in ensuring a better distribution of value, while
contributing to the implementation of a public support policy seeking to make valued food accessible to
all, is to be defined.
In essence, the characteristics and strengths of French agriculture are based on its quality. The third
agricultural revolution, which is already well underway, is based on knowledge (digital, robotics, genetics)
and on living organisms (biocontrol, microbiome, etc.). It will enable France to continue differentiating
itself internationally in the next ten years by relying, for instance, on investment plans such as the “Plan
France 2030”.
CHAM 2021 – ONE HEALTHONE HEALTH: WHAT NEW ROLE FOR HEALTH INSTITUTIONS?
Speakers: Sylvie BRIAND, Director of Global Infections Hazard Preparedness at the WHO | Switzerland,
Ivo CLAASSEN, Deputy Executive Director, Head of Veterinary Medicines division of the EMA | European
Union, Dominique LE GULUDEC, President of the HAS – French National Authority for Health | France,
Aurélien ROUSSEAU, Maître des requêtes at the Conseil d’État – State Council | France, Benoît VALLET,
General Manager of the Health Regional Agency of the Hauts-de-France; Chairman of the Board of
Directors of the ANSES | France
Debate led by Olivier MARIOTTE, President of nile | France
Institutions must strengthen the monitoring of emerging epidemics
Currently 75% of epidemics have a zoonotic origin. A large majority of them have considerable pandemic
potential due to the high mobility of populations and high human density in urban areas. To respond to
this growing risk, the WHO Department of Pandemics and Epidemics has set up a monitoring system
which, via a reporting and alert system, identifies, selects, investigates, and verifies signals of epidemics
onset. Thanks to the impowered system, it becomes easier to identify the beginnings of an epidemic and
act more rapidly. In this sense, the already existing monitoring efforts have to become permanent and
strengthened and cover all the scales concerned by pandemics, from the hyperlocal to the international
level, passing by the intermediate scales (regional, national, etc.).
Institutions must collaborate and build multidisciplinary coalitions on the national and
international levels
The Covid-19 crisis has revealed the importance of strong collaboration among all stakeholders in the
health sector but also among other sectors. Characterized by significant intersectionality, the concept of
One Health now seems to be a determining factor in the collective thinking about health issues. In France,
three institutions help implement the operational level of the One Health’s concept. The French Agency
for Food, Environmental and Occupational Health & Safety (ANSES) guarantees a collective action by
mobilizing the decision-makers from the Ministries of Health, Labour, Agriculture, Environment,
Consumer Affairs and Fraud Control. Also, the Agency Systems Coordination Committee (CASA) is a
collective working body, at the highest administrative level, among the Health General Direction and the
main national deciders of health prevention and safety policies. Finally, the Inter-ministerial Committee
for Health (CIS) participates in the development of the national health strategy. Furthermore, the French
National Authority for Health (HAS) contributes, through its various missions, to the implementation of
policies based on the One Health concept. The HAS is involved in the pandemic management (rapid
launch of tests, vaccines, and new drugs), in the antibiotic resistance (development of quality and safety
indicators for healthcare-related infections, good practice recommendations, etc.) and in the
environmental issues (participation in the 20-24 Health and Environment Plan, etc.).
At the European level, the European Medicines Agency (EMA) participates in the One Health policy
through two main initiatives: the development of collaborative programs for the risk reduction of
antimicrobial resistance and the creation of Member States’ coalition contributing to accelerate the
response to various emerging diseases.
.
CHAM 2021 – ONE HEALTHConsequently, it is important to note that the concept of One Health is conditioned by the
acknowledgment of agencies, a greater multidisciplinarity and coordination at both national and
international levels. It is high time for the stakeholders to share the awareness of a virtuous and efficient
collaboration.
Institutions must reduce social inequalities to promote prevention on the local level
Today, the health can no longer be separated from social issues and inequalities. It is no longer simply a
question of problems of communication, organization, and clarity of institutions. The main question is
how to create the right conditions for the One Health policy and its two goals: to reach the populations
outside of the health care system and to create more proximity with them by promoting the prevention
with new approaches adapted to local situations.
Institutions must sensibilize the next generation of decision -makers to the One Health
It seems essential to confront, educate and inform all current and future actors about the issues of One
Health policy. There are many stakeholders who should participate in One Health promotion: the Ecole
des Hautes Etudes en Santé Publique (EHESP) – school of public health; or the medical schools,
responsible for the education of future health professionals (doctors, dentists, physiotherapists,
pharmacists, and midwives). Also, as the subject is interdepartmental and intersectoral, it would be
beneficial to teach the implications of the One Health policy in other sectors and medical schools, such
as in the environmental sector, which is known to be closely linked to the health sector.
Institutions need to better inform people and promote more the reasons of the health
decisions
In general, the appearance of epidemics is a source of rumours and "infodemia", particularly through
social networks. Thus, a spreading of fake news (possibly contradictory and sometimes hardly based on
evidence) contributes to a general confusion and uncertainty. The role and duty of the WHO is therefore
to ensure better access to scientific information in order to inform and guide the public mindset.
CHAM 2021 – ONE HEALTHTHE ROLE OF LOCAL AUTHORITIES IN PREVENTION
Speakers: Marguerite BAYART, First Vice President of MG France | France, Jacques CHEYMOL, Founding
President of REPOP Île-de-France | France, Laurence ECKMANN, Physician coordinator of the MSA Grand
Est region at the Agricultural Social Insurance | France, Marc FILLATRE, President of the UNPS – National
union for the prevention of suicide – UNPS| France, Jacques GUÉRIN, President of the French national
order of veterinarians | France, Frédéric VALLETOUX, Mayor of Fontainebleau; President of the FHF –
French hospital federation – FHF | France
Debate led by Thomas LONDON, Partner at McKinsey & Company | France
Improving the management of chronic patients
The prevention is the central issue of the practice of general practitioners. Although the increase in
chronic diseases over the past few years has revealed that medicine should switch from being curative
to being preventive, it appears that doctors do not have more time to devote to patients to allow for this
switch to take place.
To answer that problem, the participation of other health professionals is even more important, such as
nurses who link the patient's needs with the local devices as well as the therapeutic education providers.
Similarly, medical assistants contribute to improve the quality of care by offering genuine support within
the patient pathway’s framework.
Mobilizing cooperation of actors to build appropriate solutions
Prevention includes a transformation from individuals centered models to a model which takes in
consideration the live environment. It is the role of local authorities to analyze the territory to adapt
public health responses and recommendations to population needs.
Some relevant responses and local solutions can emerge from the creation of a dedicated space for
collective discussion and the sensibilization of the local actors on specific health issues. Indeed, local
actors are often very familiar with the characteristics of the population and the existing or required health
care offer.
Unfortunately, the local initiatives struggle with the patient path’s coordination, which makes impression
that the outpatients care providers and the hospital teams belong to two different worlds. These cultural
differences often lead to a sort of misunderstandings and conflicts, and as a result to the approaches
which are not shared. Mutual acculturation seems necessary.
Knowledge of the actors and the development of a common culture
In order to respond to these shortcomings, the construction of a common culture is a key success factor.
It is based on mutual acculturation, sharing of information about the needs of defined territory and a
better knowledge of the professional network. Also, linking with local representatives seems important
to complete the territorial vision and to intervene on the different determinants, whether they are
related to health or social issues.
CHAM 2021 – ONE HEALTHIt is recommended to build a common language and to strengthen the Territorial Professional Health
Communities (CPTS) as they allow to have structured interlocutors and to start dialogues around
prevention missions. The Covid-19 crisis has catalyzed the possibility of establishing new ways of working
together and managing crises. It is now necessary to question the proper organization of a network of
human and non-human actors who share information and interact for the benefit of health. This
collaboration within a new socio-material ecosystem questions our ways of working together,
collaborating and exchanging in order to avoid the emergence of new crises.
What role for the State?
The State should play the regulatory role and be responsible for setting a normative framework and
encouraging policies in favor of objectives, linked to public health missions, while letting local actors to
define the way forward.
It would thus become a facilitator working to encourage experimentation, to support innovation, to
correct deviations and to reduce inequalities.
CHAM 2021 – ONE HEALTHINTERVIEW OF STELLA KYRIAKIDES
Speaker: Stella KYRIAKIDES, European Commissioner for Health and Food Safety | European Union
A health crisis revealing a need for improvement in the health system
"Collaboration and solidarity are the surest path to more resilient and accessible health systems and more
equal societies."
The pandemic has made it clear that our health security depends on collaboration, coordination of
actions and pooling of resources among the countries of the European Union. The benefits of
collaboration between EU countries have been greatly underlined by the establishment of a European
vaccine strategy.
However, the health crisis of the past 18 months has revealed shortcomings in the preparation and
management of the crisis. Thus, the Covid-19 pandemic has highlighted the need to employ structural
solutions in order to emerge from the crisis and prepare for future ones.
In November 2020, the European Commission then proposed structural changes in the EU health security
framework to lay the foundations for a strong EU health. These proposals focus on ways to improve
preparedness, surveillance and risk assessment so as to better address cross-border health threats while
protecting EU citizens.
Creation of the Health Emergency Preparedness and Response Authority (HERA)
To address these shortcomings, the Commission established in November 2020 the Health Emergency
Preparedness and Response Authority. This new authority, due to be operational in 2022, will be
responsible for preventing, detecting, and responding effectively to future health emergencies.
HERA will need to be able to prevent future crises quickly through close collaboration with other
European health agencies, intensive intelligence gathering, and the development of epidemic forecasting
models. It will also ensure preparedness for cross-border threats with serious health risks. Finally, it will
identify effective collective responses.
Thus, during Europe-wide health crisis, HERA will have the capacity to take decisions in a short period of
time and to put in place emergency measures.
This authority will have the function of addressing issues related to vulnerabilities in the development,
manufacture, supply and distribution of medical countermeasures in the EU and worldwide. These are
dimensions that are often missing in health crises. Ensuring a secure supply of countermeasures is a key
objective of the strategy to prevent and combat health crises.
It is now up to the EU to invest in the digital and ecological transition in order to strengthen its capacity
to produce, in a sustainable way, the most critical products in a such context. This will contribute to the
security of supply of the EU and the world and above all to the access of patients to the medicines and
medical devices they need.
The establishment of such a mechanism contributes to the development of a strengthened EU in the field
of health, able of acting quickly and deploying effective medical countermeasures during a health
emergency.
CHAM 2021 – ONE HEALTHINTERVIEW OF GÉRARD LARCHER
Speaker: Gérard LARCHER, President of Senate | France
Interviewed by Guy VALLANCIEN, President of CHAM | France
The situation at the end of the health crisis
The current crisis has made it possible to support the concept of "One health" and has shed light on the
importance of combining human, animal, and environmental health. This concept should allow us to go
beyond non efficient segmentations, to tend to a global approach of management and to encompass
these different health areas while mowing away from compartmentalization and divisions.
In the wake of the crisis, the French Senate noted several observations:
- A lack of consideration of the warnings made in the early 2000s ,
- An excessive centralization approach combined with a particularly fragmented
governance,
- A lack of a strategic vision during the crisis ,
- A communication of instructions that are not adapted to the current territorial realities ,
- Some inefficiencies in France’s research system .
The structural problems of the national research system were particularly highlighted during the
pandemic, and it has now become crucial to further develop the health industry. Indeed, France’s limited
resources and initiatives are often scattered, priorities are not clearly defined and the link between
academic research and the industry is broken. In order to evolve, the health industry should free itself
from purely budgetary rationale. In this sense, health should no longer be considered as a simple
expense, but rather as a long-term investment.
Strengthening the health industry means going beyond national borders and reinforcing the European
Union’s regulatory mechanisms. Although it is important to maintain national responsibility for health, it
is nevertheless necessary to reflect on a better distribution of the latter.
The regionalization of the health system: a subject for debate
The Senate has adopted the so-called “4D law” on decentralization, reconcentration, differentiation and
on reducing complexity. The latter aims at meeting local representatives’ expectations and offering
answers and tools to better implement public policies locally.
The regionalization of the health system is a real challenge in the context of the pursuit of
decentralization, whose proposed provisions are particularly weak.
The Law Commission thus wished, by entrusting the co-presidency of the supervisory board of the
Regional Health Agency (ARS) to the prefect and president of the region, to reinforce the application of
health policies at the local level.
Regionalization must not create asymmetries between territories. In this sense, experimentation remains
an adequate means of ensuring effective and efficient regionalization. Although France suffers from a
democratic deficit in health care, the adoption of the 4D law and its numerous measures proposed, are
supposed to provide concrete answers while allowing for a continuous improvement of the health care
system that is increasingly adapted to local realities.
CHAM 2021 – ONE HEALTHDRAW ME THE HEALTHCARE INDUSTRY OF TOMORROW
Speakers: Olivier BOGILLOT, President of Sanofi France | France, Anna Maria BRAUN, CEO of B.Braun |
Germany, Thomas COURBE, Director general of the DGE – Directorate general for enterprise of the
Ministry of economy and finance | France, Muriel DAHAN, Member of the CSIS – Strategic council on
health industries | France, John HACKETT, Divisional Vice President of Applied R&D of Abbott’s
diagnostics business | United States, Marc PRIKAZSKY, CEO of Ceva Santé Animale| France
Debate led by Marie BUSSON, Associate Partner at McKinsey & Company | France
The healthcare sector is constantly evolving. The healthcare industry has integrated itself into this rapid
development, particularly thanks to the springboard provided by the Covid-19 crisis and is at the same
time adapting to the healthcare system by bringing forward its holistic vision. Indeed, an integrated vision
of the patient is advocated: the movement starts with prevention, then diagnosis, then care and finally
prevention again. This vision is also true for health products.
A coalition of knowledge and skills: a key success factor
The industry is largely dependent on human health and its related research. However, fundamental
barriers exist, and it is mainly pre-existing collaborations that defined the ability to respond to the
pandemic. In this sense, the Covid-19 crisis revealed the importance of both the industry and strong
collaboration within the value chain. Indeed, the crisis has enabled public awareness to be raised
regarding the role of the industry in the future of health. From now on, all health sectors, especially
animal health, are expected to be mobilized, for innovation to be fostered and epidemics to be better
anticipated. In addition, digital technology is at the heart of advances in health. Tomorrow's
pharmaceutical industry should remain competitive by relying on efficient infrastructures: drug logistics
and pathways, research and clinical evaluation processes, etc. One of the key success factors is
collaboration between the research sector, the public health sector, and the industry.
A simplification of European and French processes, facilitating the industry of tomorrow
Europe has a crucial role to play in creating a market that is sufficiently favourable to development,
particularly in the field of data. It is fundamental that Europe finances industries in order to maintain its
common culture which promotes equal access to care. Collaboration is essential to ensure Europe’s
influence, the exploitation of know-how and expertise in favour of innovation and research. It also
requires allowing the expression of those with skills so that it fosters the sharing of their progress and of
their financing needs.
From now on, Europe is in charge of providing two major responses to the crisis through its industrial
drug policy and its ability to develop common and rapid responses.
The industry of tomorrow, synonymous with innovation and attraction strategies
In order to be relevant in its global approach, the industry will have to anticipate and react quickly on
research and treatment. The European Health Agency project is a significant lever in this global approach.
Observations tend to show a certain risk aversion in Europe, resulting in a sort of glass ceiling in terms of
funding. The precautionary principle therefore applies. As a response, France has taken on the task of
releasing new funding linked to calls for proposals. For instance, a plan to revive the health industry has
been adopted to finance 120 projects, most likely up to 700 million euros.
CHAM 2021 – ONE HEALTHOther plans have been implemented by mobilizing public research, to encourage start-ups, advances in
digital technology and even the fight against emerging and infectious diseases.
Tomorrow's industry will also be represented through important poles of attractiveness that make up
France's excellence in healthcare. This meeting of strengths and excellence will be attractive to young
talents and will create a territorial dynamic.
CHAM 2021 – ONE HEALTHHOW TO ENSURE ONE HEALTH?
Speakers: Rifat ATUN, Professor of Global Heath Systems at Harvard University | United States, Didier
BAZZOCCHI, President of Aetas | France, Thomas FATOME, Director of the CNAM – French National
Health Insurance Fund | France, Manuel MANDLER, CEO of Alley | Germany, Catherine TOUVREY,
General Manager of Harmonie Mutuelle | France
Debate led by Alix PRADÈRE, Managing Director Lead Health France of Opusline part of Accenture|
France
Economic paradigm shifts for efficiency
One Health’s policy raises several issues, including regarding its economic dimension and its insurability.
France made several recommendations at the G20 aiming at changing the models the health sector is
based on. Among these recommendations, France advised to recognize the economic interdependence
between health and the global economy and to acknowledge the need for investments in assessment
tools and their utilization for the development of public health policies. Finally, maintaining transparency
of these assessment tools for the public and for democratic countries’ parliaments is crucial in
guaranteeing neutrality and objectivity. The Covid-19 health crisis, along with the shock it provoked,
showed that many health systems, particularly international ones, failed to handle the interdependence
between health and economics. In this sense, the crisis has paved a way for a period of acknowledgment
of this dimension. However, it seems that the evolution towards new paradigms goes through the “5 I’s”:
Intention (moving from intention to action), Integration (promoting approaches integrated with other
sectors), Inclusion (partnerships with the private sector, the public sector and civil society for the
elaboration of national responses), Investment (no longer considering health as a cost but as an
investment), large scale Innovation. Indeed, the current economic tension should lead us, not only to
fully adopt the One Health approach, but also to consider making investments in prevention and keeping
in mind the long-term when supporting changes. This should be accomplished through a revived financial
sustainability.
Insurance and One Health
The health situation has reinforced the belief that it is necessary to reallocate value to health systems. In
particular, the crisis had a strong impact on insurers, who are now willing to expand their activities and
invest in supporting initiatives for a better health system, by being considered no longer as care providers
but rather as start-ups providing support on key areas such as artificial intelligence. Insurance companies
ought to change their institutional mindsets, since they are responsible for three key assets: data, money,
and beneficiaries, three assets that they do not seem to manage strategically. From passive payers
struggling to engage with assets, they must turn into buyers of the health system, rewarding value and
involving their beneficiaries.
Model developments
Among the development models, the imminent launch of the French national tool “Mon Espace Santé”
is a major one. It will enable to achieve the One Health concept and deploy, not only at the individual
level, a global vision, and a better data interoperability. To do so, it is important to control the use of
data. A regulatory framework such as a health data host certification for insurers could, for instance, be
implemented, to protect personal data use.
CHAM 2021 – ONE HEALTHThis control could also translate into a combination of personal data with other more factual data
(demonstration of correlation between data use and patient results), as is already the case in Germany.
A position open to competition with other players
The strong and growing competition from other players, such as GAFA, in providing medical consultations
or delivering drugs raises questions regarding the quality of services and offers, and the security in the
French digital health sector. However, the National Health Insurance seeks to be reassuring. It considers
data access as an issue of sovereignty and of sharing: the ambition is to ensure a stable balance between
security, through taxation on European soil where the RGPD applies, and service, for science and the
insured.
CHAM 2021 – ONE HEALTHGET ACCESS TO HEALTH FOR ALL
Speaker: Esther DUFLO, Nobel Prize in Economic Sciences 2019 – MIT | United States
Interviewed by Akram BOUCHENAKI, CEO of Abdul Latif Jameel Health | Monaco
JPAL, the Jameel Poverty Action Lab
In 2003, Esther Duflo founded the Jameel Poverty Action Lab (JPAL) a network of over 1,000 economic
researchers working in collaboration with field actors (NGOs, governments, etc.) They use large-scale
field experiment methods to evaluate social policies intended to fight poverty. These experiments use a
methodology similar to the one used in clinical trials. Indeed, JPAL randomly selects regions in which a
social policy will be implemented and monitors the results of both the regions that received the
experiment and those that did not. This allows for an evaluation of the results and the elaboration of a
potential link between the observed results and the policy implementation.
Governments should use social networks to communicat e their public policies
In one of their experiments, JPAL partnered up with Facebook. The latter agreed to run a major campaign
on its social media before Thanksgiving and Christmas Holidays. It consisted of doctors and nurses, from
different parts of the United States, recording videos to raise awareness regarding the risks of infection
from Covid-19 and to encourage people to stay home. The videos appeared as advertisements on the
Facebook accounts of approximately 30 million subscribers in randomly selected areas. JPAL later
observed a correlation between the exposure to the videos and the number of travelers. This was also
combined with a decrease in the number of cases two weeks following the videos’ release. The
experiment’s goal was to illustrate the impact of social media on individual behaviour. Indeed, social
media can be used wisely by governments to send powerful messages to populations that are increasingly
receptive to them.
Messages released using videos have a greater impact
At the beginning of the Covid-19 crisis, JPAL was interested in understanding how to encourage
individuals to adopt behaviours limiting the risk of contagion. To do so, it decided to conduct an
experiment in West Bengal, India. They divided the state into 1,200 zip codes, randomly selected 900 of
them, and sent short videos recorded by Abhijit Banerjee, the community health officer, to all subscribers
of a telephone operator. In these videos, Abhijit Banerjee reminded people of the importance of
reporting symptoms to the village nurse and adopting shielding measures. Six videos with different
messages were sent to approximately 30 million people. The aim was to assess the effectiveness of
receiving a video and whether or not the different messages reported in the videos had a different impact
on people’s behaviours. The control group did not receive a video but only a text message. The
experiment showed that receiving a video, rather than a simple written message, had a greater impact
of people’s behaviours. Such an experiment reinforced the idea that policy makers would benefit from
using social networks and more particularly videos as they are more striking than written messages.
Messages conveyed by celebrities are more compelling
JPAL has observed that the time separating the end of a successful experimentation of a public policy and
its generalization is often long and tedious. In order for a complex policy to be successful, numerous pilots
should be working on different scales and in close collaboration with governments.
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