Priorities and opportunities for strengthening hygiene and One Health alignment in research, policy and practice

Hygiene plays a critical yet under-recognized role in addressing One Health (OH) challenges, including zoonotic disease prevention, antimicrobial resistance (AMR) control, food safety and protection of ecosystem health. Likewise, hygiene research and interventionsgenerally lack an OH perspective, resulting in siloed efforts that inadequately address the human-animal-environment interface. We convened three sessions at global conferences well attended by health professionals working in hygiene or OH. Participants identified gaps and opportunities for hygiene-OH alignment across research, policy and practice at community, national, regional and global levels. An evidence gap identified was research on hygiene approaches to protect ecosystems in programs otherwise focused upon human or animal health. Methodological priorities included harmonizing tools and protocols for pathogen detection, fecal contamination measurement and hygiene behavior assessment; strengthening cross-sectoral data sharing; and developing integrated study designs. Intervention opportunities included engaging local stakeholders, balancing infrastructure and behavior change, adapting existing programs for cross-sectoral relevance and broadening evaluation to include animal and environmental outcomes. Implementation priorities included localized program design and decision-making, regional cooperation for cross-border threats and leveraging surveillance and preparedness infrastructure. Policy priorities included reducing institutional fragmentation, harmonizing standards, and strengthening the roles of hygiene and OH within existing regulatory frameworks. From our synthesis, we present cross-cutting recommendations for strengthening hygiene and OH alignment. Aligning hygiene and OH offers a pathway to more comprehensive and upstream prevention of disease and AMR, supporting coordinated, system-level management of health risks across human, animal and environmental domains and building resilience to emerging health threats.