Evidence gaps and diversity among potential win-win solutions for conservation and human infectious disease control

Abstract

As sustainable development practitioners have worked to "ensure healthy lives and promote well-being for all" and "conserve life on land and below water", what progress has been made with win-win interventions that reduce human infectious disease burdens while advancing conservation goals? Using a systematic literature review, we identified 46 proposed solutions, which we then investigated individually using targeted literature reviews. The proposed solutions addressed diverse conservation threats and human infectious diseases, and thus, the proposed interventions varied in scale, costs, and impacts. Some potential solutions had medium-quality to high-quality evidence for previous success in achieving proposed impacts in one or both sectors. However, there were notable evidence gaps within and among solutions, highlighting opportunities for further research and adaptive implementation. Stakeholders seeking win-win interventions can explore this Review and an online database to find and tailor a relevant solution or brainstorm new solutions.

Figure 1

Subject-wide evidence synthesis The PRISMA diagram is shown in the appendix (p 14).

Figure 2

A menu of 46 potential solutions for advancing conservation goals and controlling human infectious diseases N denotes none (defined as hypotheses and anecdotes), L denotes low (defined as some supporting studies with moderate to major gaps, inconsistency, or low applicability), M denotes medium (defined as several lines of evidence that are mostly consistent and applicable), and H denotes high (defined as diverse, consistent, and highly applicable evidence that leaves little to no uncertainty regarding the outcome).

Figure 4

Solutions are widespread and diverse (A) The solutions covered all continents (except Antarctica), including countries with high and low burdens of infectious diseases, as measured by total DALYs and reported by WHO in 2018. (B) The solutions covered most pathogen taxa (except fungi) and transmission modes. (C) Seven International Union for Conservation of Nature threat classes were considered the primary conservation threat addressed by at least one solution, whereas transportation, climate change, and energy and mining were only secondary conservation threats addressed by any solution. DALYs=disability-adjusted life-years.

Figure 3

Six lose–lose scenarios that could be improved with win–win solutions This figure was commissioned from artist Hiram Henriquez, and all photographs were used under creative commons licences or purchased with commercial licences (ie, iStockphoto). Photographs of palms and sap collection pots were used with permission from Fernando Garcia and Nazmun Nahar.

Figure 5

Viable solutions can be identified and evaluated by 11 criteria We evaluated five criteria to determine whether solutions were harmless, contained, consistent, feasible, and acceptable in predictable contexts given the currently available evidence or whether these evidence were data deficient for the specified criteria. Stakeholders can evaluate six other criteria on the basis of priorities and resource constraints (impactful, effective, affordable, scalable, sustainable, and cost-effective). *Three potential solutions had evidence for trade-offs that were unmitigable or unpredictable and were categorised as not harmless, not consistent, or both. All solutions were categorised as contained or data deficient for the contained criterion. †None of the potential solutions had evidence for unmediatable barriers to implementation (not feasible or not acceptable).

Figure 6

Most solutions had evidence gaps Each cell contains the number of solutions that had a given composite evidence quality score on the basis of evidence diversity, consistency, and applicability (none is defined as hypotheses and anecdotes; low quality evidence is defined as some supporting studies with moderate to major gaps, inconsistency, or low applicability; medium is defined as several lines of evidence that are mostly consistent and applicable; and high is defined as diverse, consistent, and highly applicable evidence that leaves little to no uncertainty regarding the outcome). The green colour is used to emphasise that most solutions were supported by low or medium evidence for conservation or health outcomes.