Modeling policy decisions to mitigate the risk of emerging arboviral diseases under ecological changes in Uganda: Proposing a One Health in All Policies approach

Abstract

Land-use and ecological changes are major drivers of emerging arboviral diseases. Uganda, a biodiversity-rich country with high vulnerability to arboviruses, is experiencing intensifying ecological pressures. However, the potential of different policies to reduce the impact of ecological disruptions on arboviral risk remains insufficiently understood. In this study, we combined policy review and expert opinion elicitation within a Structured Decision Modeling framework to evaluate how different policy interventions may reduce arboviral disease risk in Uganda. During two workshops, 20 multidisciplinary experts reviewed existing policies and identified disease preventive interventions. Experts assessed the influence of 29 preventive actions on disease risk under four policy scenarios: 1) Do nothing (DN), 2) Increase biodiversity conservation (B), 3) Implement human and animal health measures (H), and 4) apply a One Health approach (OH)- combining biodiversity conservation and health measures. The OH scenario produced the highest probability of low arboviral risk (82%), compared to H (16%), B (14%), and DN (0.006%). Under OH, mosquito net use, vector site removal, and multi-level surveillance actions had high probabilities of implementation (>80%). When actions were clustered, the probability of implementation was highest for biodiversity protection actions (72%), compared to arbovirus surveillance actions (69%), interdisciplinary actions (59%), and vector control actions (55%). Mutual Information analysis identified interdisciplinary actions as most beneficial for reducing decision uncertainty. The OH scenario had the highest Expected Value of Perfect Information, indicating a 25% improvement in decision confidence given perfect evidence. This study demonstrates the added benefit of integrating socio-ecological and human health dimensions that were separately less effective. This calls for embedding One Health in All Policies to improve OH governance. We present a structured, participatory framework to prioritise multi-sectoral preventive actions and improve collaborative implementation. This strategic approach is pragmatic for arboviral threats in complex, ecologically sensitive settings like Uganda.