This theme synthesizes roundtable content on The Competencies for One Health Field Epidemiology (COHFE) Framework, cross-sector training pipelines [Field Epidemiology Training Program (FETP), Field Epidemiology Training Programs for Veterinarians (FETPV) / In-Service Applied Veterinary Epidemiology Training (ISAVET)], and mentorship models. The One Health approach, aligned with the SDGs, addresses challenges like poverty, climate change, and health inequities through collaboration across public health, veterinary medicine, environmental sciences, and related fields (10–13). Workforce development is hindered by siloed policies, professional segregation, and limited inclusion of environmental and social sciences; curricula often overlook WASH and environmental degradation, weakening the response to drivers such as deforestation and unsustainable agriculture (10, 12, 14).

The One Health Joint Plan of Action (2022–2026) emphasizes competency-based training, mentorship, and data-sharing tools to enhance interdisciplinary collaboration. Core competencies include leadership, communication, systems thinking, and technical skills in outbreak management and disease surveillance. To build a sustainable workforce, it is essential to address gaps in teamwork, improve gender balance, recruit younger professionals, and provide career incentives (12, 14–16).

The FETP, initiated by the U.S. Centers for Disease Control and Prevention (CDC) in 1951 and modeled on the Epidemic Intelligence Service (EIS), has trained over 22,000 public health professionals worldwide (13–15). By December 2023, 98 FETPs operated in more than 200 countries and territories, equipping participants with skills in field epidemiology, outbreak response, surveillance, and evidence-based policymaking (17). Since 2009, veterinarians have been included in FETPs to address human-animal-environment health challenges through One Health principles (18).

The FETP-Frontline 3.0 iteration broadens participation (e.g., laboratorians, para-veterinarians, animal husbandry and WASH personnel) and emphasizes cross-sector collaboration to strengthen outbreak management (19). A 2023 multi-country pilot reinforced mentorship and collaborative practice; persistent challenges include funding dependency, political instability, and limited inclusion of veterinary and environmental sectors, highlighting the need for sustained national support and broader recruitment (20).

Veterinary epidemiology capacity is being advanced through specialized programs. Countries have expanded FETPs to include veterinarians or launched FETPVs in several regions (21, 22).

In 2018, the FAO developed 13 core competencies for field veterinary epidemiology provide a common scaffold, while ISAVET has trained over 1,000 veterinary paraprofessionals and uses tools such as TOM and VLCs to extend reach; future priorities include integrating IT, disease intelligence, and AMR surveillance within nationally led, sustainable implementation (22).

The COHFE Framework, launched in 2024 by FAO, WHO, and WOAH, provides an internationally aligned approach to workforce capacity at the human–animal–environment interface, linking to the Quadripartite Joint Plan of Action, IHR (2005), and the PVS Pathway; it outlines 14 technical and functional domains across training levels, including surveillance, outbreak response, laboratory capacity, leadership, communication, and ecosystem health, and is designed to complement FETPs, FETPVs, FELTPs, ISAVET, FTP-WEBE, and Nature for Health. COHFE supports harmonized curricula, mentorship, certification, and continuing education, aiming to strengthen surveillance and enable coordinated responses to complex threats, thereby contributing to resilient, One Health–oriented systems (23).

Next, steps include implementation evaluation, tool refinement (e.g., a budgeting tool), and a Community of Practice to embed One Health principles, strengthen networks, and prepare graduates for multisector leadership.

Robust training pipelines need enabling structures; the next theme addresses governance and multisectoral coordination.

Participants emphasized that implementation at scale in the EMR depends on defined roles, formal coordination arrangements, and aligned policies. Despite years of collaboration efforts, One Health practice still faces major barriers: fragmented surveillance, scarce resources, weak cross-sector coordination, and inconsistent legal frameworks. Uneven institutional capacity and the absence of integrated data platforms further limit action. Donor-driven initiatives have also struggled to endure, which points to the need for context-specific, nationally owned solutions aligned with global strategies such as the One Health Joint Plan of Action (2022–2026) (3, 24–26).

Advancing One Health in the EMR requires tackling linked technical, institutional, economic, and educational issues. Priority technical gaps include limited understanding of integrated health systems, weak disease prioritization, and fractured surveillance and data sharing, which argues for investment in shared frameworks and coordination mechanisms. On the institutional side, advocacy is thin, policies are misaligned, and the roles of One Health professionals are unclear, so governance arrangements and policy alignment must be clarified. Coordination should ultimately produce interoperable surveillance and routine joint risk assessment.

The roundtable emphasized interoperable surveillance, joint risk assessment (JRA), and cross-sector rapid response as the operational links between sectors. Minimum integration steps discussed included aligning priority case definitions across human and animal health, adopting a small shared line-list template, and producing a periodic integrated epidemiological summary that combines human, animal, and relevant environmental signals (5, 24, 27, 28). Triggers for action were also highlighted (thresholds to initiate a JRA, criteria for activating cross-sector rapid response teams, and environmental indicators that prompt risk communication). Data governance focused on timeliness, reciprocal access for contributing sectors, and feedback to subnational reporters so that integration leads to decisions and field support. As an illustrative example, management of Rift Valley Fever shows how linking local environmental observations to targeted interventions can strengthen response (10, 29, 30).

As a national illustration, Egypt’s strategy embeds surveillance, JRA, preparedness, and risk communication as core technical pillars supporting early warning and response (31). Specific implementation steps are summarized in Box 1. Sustaining these functions requires predictable resources and aligned budgets; the next theme addresses financing and sustainability.

Discussions linked sustainability challenges to donor dependency, fragmented funding lines, and limited budget authority for cross-sector activities. In the EMR, economic constraints, particularly in LMICs, highlight the need to embed One Health activities in routine planning and budgeting cycles, assign budget holders for joint tasks (e.g., joint risk assessments, joint exercises, risk communication), and align external support to a single government-led workplan. Educational limitations, such as minimal public awareness, lack of interdisciplinary training, and inadequate curricular integration, further restrict progress (12, 14). Simple process indicators can track whether financing is enabling coordinated action: regular coordination meetings with published minutes, completion of joint risk assessments with action items logged, maintenance of a cross-sector rapid response roster with at least one exercise, and production of a periodic integrated early-warning bulletin (32). With financing aligned, countries are better positioned to act on climate and environmental determinants.

Participants noted that financing remains a persistent bottleneck. In practice, fragmented budget lines across ministries, donor-driven projectization with short time horizons, and procurement rules that limit joint exercises were identified as key barriers. Some participated reported that assigning a designated budget holder for joint risk assessments and pre-authorizing modest cross-sector operating funds have helped sustain coordination.

This theme integrates the climate–health discussion, focusing on heat, air quality, extreme events, and biodiversity-linked risks that should trigger prevention and risk communication across sectors. Climate change, deemed the most significant health threat by WHO (33), exacerbates existing health issues and introduces new risks, including worsening noncommunicable diseases, mental health conditions, altered disease transmission, and disruptions to maternal and child health. Rising healthcare costs and environmental shifts increase pandemic risks, disproportionately affecting vulnerable populations like low-income groups, women, and Indigenous communities (34, 35).

Frequent extreme weather events strain infrastructure and disrupt essential services, reducing health system capacity, particularly in low-resource settings. WHO projects a global shortfall of around 10 million health workers by 2030; this global context underscores the urgency of strengthening One Health workforce pipelines in the EMR (35).

The EMR, with its arid climate and socio-economic disparities, is especially vulnerable (36–38). Although the region contributes only 8.25% of global greenhouse gas emissions, its temperatures rise nearly twice as fast as the global average (39).

Climate shifts exacerbate biodiversity loss, displacement, and health risks, including heat-related illness, air pollution, and waterborne diseases. Vulnerable groups, such as women, children, and refugees, bear the greatest burden (39).

WHO estimates 1 million annual deaths in the EMR are linked to preventable environmental causes, with air pollution accounting for 56% (39). Challenges include limited resources, poor stakeholder coordination, reliance on curative care, and low awareness of climate-health links, compounded by conflicts and emergencies that strain health systems (39).

The “Climate Change, Health and Environment: Regional Framework for Action (2023–2029)” emphasizes building resilient health systems, integrating health into climate policies, improving access to climate funding, and promoting evidence-based policies (39). Its threefold strategy aims to safeguard health, enhance resilience, and reduce emissions while improving outcomes. Collaboration across health ministries, NGOs, and sectors like energy and water is key, with civil society and youth engagement central to driving inclusive solutions (39).

Investments in renewable energy, surveillance systems, and climate-resilient infrastructure are essential. For instance, targeted climate actions in Pakistan could cut emissions by 27.5% by 2030, preventing 65,000 annual deaths from air pollution (39). Through mitigation and adaptation, the EMR can address interconnected health and climate challenges effectively and equitably (39).

The EMPHNET roundtable on advancing One Health in the EMR highlighted how shared regional challenges can be translated into practical steps. Participants emphasized that effective implementation depends on sustained workforce investment, clear and accountable governance, interoperable surveillance with joint risk assessment, predictable financing, and integration of climate and environmental determinants into health planning. Egypt’s national experience illustrated how One Health can move from concept to structured governance and practice. By embedding One Health in national strategies while fostering regional collaboration, countries in the EMR can strengthen preparedness and build resilient, inclusive, and sustainable health systems.

Key recommendations emerging from the roundtable include:

Establish a regular coordination mechanism with documented agendas and minutes (25, 26).

This Perspective is based on a single EMPHNET-convened roundtable and may be subject to convenor bias. Rapporteurs used a structured template, findings were reported in aggregate, and non-EMPHNET co-authors reviewed the synthesis. Attendance was not registered at the room level; the figure of ~68 reflects contemporaneous observation and should be interpreted qualitatively. No triangulation, inter-rater statistics, or participant validation were performed, so findings should be viewed as practice-informed signals rather than definitive estimatses. Some themes received less discussion time and are therefore supported more by secondary literature, though illustrative roundtable examples were retained where possible.