1.SUPPLEMENTARY TABLES

Table S1

Comments of Delphi participants who preferred option 1
Round / Participant / Comment
3 / DP#13 / My understanding is that the One Health philosophy is about the inter-relationship of these areas of health, rather than about integration/collaboration and/or communication between disciplines.
3 / DP#24 / It is not integration as One Health looks at the existing relationship between human, animal and environmental health.
It is not limited to research and government departments.
3 / DP#26 / It is not necessary to INTEGRATE the three areas - just look at how one relates to the other. One Health is a CONCEPT not a discipline. Statement 3 describes an outcome of following 1 or 2.
3 / DP#30 / I see 1 and 2 as very similar but 1 being wider in what it captures than just the integration, in that there may still be an inter-relationship without things necessarily being integrated. Re: 3, I think the concept of One Health, while it should include cross-disciplinary collaboration, should exist as a concept even without that collaboration actually occurring.
3 / DP#45 / This is the core and basis for collaboration and intervention as necessary
3 / DP#54 / It is the closest fit: recognising integrity of the sub-disciplinary fields while identifying the significant inter-relationships
Round / Participant / Comment
4 / DP#4 / The One Health approach is not a forcing of collaboration it is merging for the best outcome when required.
4 / DP#5 / I maintain my view that Description 3 reflects the practical, operational focus of working in OH but is too narrow, missing the social sciences and other disciplines that are (although not explicit in) are not excluded by description 1. To me, effective OH needs multidisciplinary teams that can work in a trans-disciplinary way, covering all of STEEEP (Social, Technical/scientific, Economic, Environmental, Ethical and Policy/political).
4 / DP#10 / This definition allows for information sharing between stakeholders and jurisdictions, but also for "harder" issues, such as assigning of tasks, responsibilities and authority, when necessary
4 / DP#11 / To me option 3 is not comprehensive enough. Integration may be a step further down the track, however opening up more discussion and developing the inter-relationships between the disciplines/ professions is an important first step
4 / DP#51 / One Health is a multidisciplinary initiative and does not carry with it implications of outcomes as suggested by some other commentators.
Comments of Delphi participants who preferred option 2
Round / Participant / Comment
3 / DP#9 / "Integration", to me, implies understanding of the interrelationships of human, animal and environmental health, working with the 3 components together and undertaking a collaborative, cross-disciplinary approach to zoonotic diseases. This also implies collaboration and communication among veterinary, medical and ecological scientists and practitioners, relevant government agencies and wider stakeholder groups.
3 / DP#10 / "Integration" is a stronger word than "inter-relationship", hinting at action, rather than maybe just awareness of each other's activities/existence.
3 / DP#33 / The concept of OneHealth is that the health of humans, animal and the environment is each affected by the other, so perturbations in one area affect the other areas. Understanding this requires integration of the concepts of health determinants across the OneHealth spectrum. Integration of theoretical approaches to each is a more comprehensive definition than only consideration of the inter-relationship between the three areas. Cross-disciplinary collaboration and communication are the responses to the concept of OneHealth, rather than a definition of it.
3 / DP#40 / Dismissed 1 because it implies only looking at the inter-relationship not achieving improved health outcomes through improved practices within the sectors but also across them (i.e. not one planet one health). 3 is closer but neglects an implementation aspect. To be honest I don't think 2 is perfect but at least it is closer than the other two
3 / DP#44 / One Health should exploit all the potential advantages of One Health by integrating knowledge, expertise and capacity.
3 / DP#50 / Although in effect is a collaboration between disciplines, ideally it would result in an integrated approach
Round / Participant / Comment
4 / DP#9 / I only chose option 2 because it contained comment 9, which best reflects my big-picture view of One Health. That is- it encompasses all three ideas; the inter-relationships, and an integrated and cross-disciplinary approach.
4 / DP#22 / We have an "inter-relationship" between the respective disciplines already - we need to move towards greater integration.
4 / DP#29 / Comment re first statement that background evenly distributed between vets and meds, ignores ecologist etc… who are missing and important if there is a wildlife or feral animal reservoir, not just domestic animals involved.
Comments of Delphi participants who preferred option 3
Round / Participant / Comment
3 / DP#11 / Initially I was going to choose 1 but on reflection and answering the previous surveys made me reflect on the importance of not just collaboration but a framework for communication and government
3 / DP#15 / Each respective component of the one health paradigm has a stand-alone purpose and function but it is the cross-disciplinary sharing of info and development of joint action described in 3 when required that really encapsulates how the community would best experience net impacts of one health
3 / DP#22 / All three statements are fine but I selected the last as it focuses on cross-disciplinary collaboration between various groups.
3 / DP#28 / One health I take to mean a unified approach, i.e. one joint approach.
3 / DP#33 / More inclusive of disciplines ie. govt agencies. Collaboration and communication best describe the interrelationships.
3 / DP#52 / This is a difficult question to answer well as all three options reflect my view of One Health (OH) to some degree and in different situations - but I have listed option 3 as it probably provides the most useful and effective answer to cover my overall view of the definition and the active involvement in OH responsiveness.
Round / Participant / Comment
4 / DP#4 / The One Health approach is not a forcing of collaboration it is merging for the best outcome when required. Agree with A and D
4 / DP#28 / Zoonotic disease is an ecological issue, it occurs on a landscape, on sets of interactions, and at each stage there needs to be effective communication among each of the specialist disciplines, including those with legislative responsibilities, ie government.
4 / DP#32 / I really feel that communication is the crux of an effective One Health approach, as this implies contact between the various sciences and sharing of relevant information to assist working towards a common goal.
4 / DP#43 / I think that the one health concept involves collaboration and communication, not just an appreciation of the different disciplines.
4 / DP#47 / It is more action-orientated and describes what One Health means in practice.
4 / DP#48 / I see OH as having pragmatic purpose, addressing animal and human health promotion and disease control - acknowledging the centrality of ecology (A) is just the start, and the outcomes extend beyond "integration" (B) of the sciences.
TABLE S2: Comparison in rankings allocated based on sector. Data collected in round 3. / Overall Ranking / Human Health Sector Ranking / Animal Health Sector
Ranking / Human Health Rankings in top Quartile / Animal Health Rankings in top Quartile / Human Health Rankings in 2nd Quartile / Animal Health Rankings in 2nd Quartile
Impacts on human health / 1 / 1 / 1 / 100% / 95% / 0% / 0%
Availability of human and health resources for plan implementation / 2 / 2 / 2 / 70% / 60% / 20% / 35%
Continuity of food supply and maintenance of essential services / 3 / 3 / 4 / 55% / 65% / 35% / 25%
Public education about the risks faced by individuals and communities / 4 / 4 / 6 / 60% / 60% / 25% / 25%
Economic impacts on individuals, businesses and governments / 5 / 6 / 3 / 20% / 40% / 50% / 50%
The financial cost of implementing the plan / 6 / 8 / 5 / 35% / 40% / 15% / 35%
Potential public reaction - including concerns about stigmatisation / 7 / 5 / 11 / 15% / 45% / 70% / 20%
Ease of tracking exposed persons / 8 / 7 / 9 / 45% / 30% / 20% / 35%
Welfare and health of animals / 9 / 12 / 7 / 10% / 10% / 35% / 35%
Emotional/psychological stress on individuals / 10 / 9 / 13 / 15% / 20% / 50% / 25%
The interests of other jurisdictions – [neighbouring states, WHO, etc.] / 11 / 13 / 13 / 25% / 5% / 25% / 45%
Confidentiality of those who are ill, being traced, decision makers… / 12 / 10 / 14 / 15% / 15% / 50% / 20%
Impacts on the environment / 13 / 16 / 10 / 5% / 5% / 10% / 25%
Australia's reputation / 14 / 15 / 12 / 10% / 5% / 25% / 30%
The potential for research to generate valuable new knowledge / 15 / 11 / 17 / 15% / 0% / 25% / 20%
Impacts on the freedom of individuals / 16 / 14 / 15 / 0% / 0% / 30% / 25%
Impacts on tourism and travel / 17 / 18 / 16 / 0% / 5% / 0% / 25%
Impacts on family cohesion / 18 / 17 / 18 / 5% / 0% / 10% / 10%
Impacts on public transport / 19 / 19 / 19 / 0% / 0% / 5% / 15%

2. ELEMENTS OF THE DELPHI SURVEY

ROUND 1:

1. General Questions about the definition of One Health

  1. Where, and in what context, have you heard about the concept of ‘One Health’?
  2. In your own words, what does the term ‘One Health’ mean to you?
  3. Where do you see ‘One Health’ being most useful for your job/practice/profession?

2. The 3 Scenarios assigned to expert participants

Scenario 1

A group of dead birds are found in the Hunter Wetland National Park with 7-10 relatively fresh carcasses. Rangers report that many birds are also ill with flu-like symptoms, with the Hunter New England Health District reporting a higher than usual rate of people turning up at GP surgeries with upper respiratory symptoms. Local hospitals have also noticed a spike in pneumonia cases. Several large Intensive poultry farms are in the Hunter region. There is a proposal to trace and quarantine all visitors to the National park area since the flu-like cases began, but that will be difficult as there is no way to track visitors and some visitors from overseas may have already left Australia. There are also proposals to attempt to control migratory birds who visit the reserve.

Scenario 2

A cache of young dogs intended for domestic ownership is found hidden on a private yacht in Darwin during a routine quarantine inspection. The boat had come from Bali. The dogs are taken to a quarantine facility where one is showing signs of rabies. On further investigation, it turns out that the boat had done a number of such trips and that dogs have already been delivered to customers in the Northern Territory.

Scenario 3

During a routine pest investigation of a Food Court not far from the Port of Melbourne, rats are found to be using the crawl space near the roof. The roof space links a number of restaurants and small business including food importers. The rats are tested and found to be carrying Hantavirus. Some owners and cleaners have severe respiratory problems. The cleaners are contract staff and are employed on an ad hoc basis through an independent contractor. The records of employees are incomplete, with crucial shift and contact details missing.

Questions put to the DELPHI Panel for each scenario

  1. How do you think this scenario will play out in present-day Australia?
  2. What practical steps do you think should be taken to prevent, control or contain an outbreak?
  3. What are the obstacles that might arise in implementing such a response?
  4. What are the social and moral implications of these interventions?
  5. Should the public be informed about the outbreak? How?
  6. General Comments

ROUND 2 - Likert scale based on data collected in responses to general questions in round 1.