We designed the study based on guidance and references of the One Health approach established in documents issued by FAO, OIE, WHO (6), and CDC (8); meeting reports (9,10); and policy documentation (11). A questionnaire was drafted to answer queries about policies and structures governing control of zoonotic diseases in general and MERS-CoV in particular (Table 1). We shared the questionnaire with public health and veterinary authorities in charge of surveillance and control of MERS-CoV in all GCC countries, Egypt, and Jordan 1 week before the workshop. The questionnaire also included open-ended questions permitting comments. Results were analyzed and interpreted using an Excel spreadsheet (Microsoft, https://www.microsoft.com). The core of the questions and the relevant results scores are shown in Table 2. Results were presented and discussed before the survey participants and audience of the workshop and approved by the joint scientific committee of the workshop. Decision for dissemination followed consent of all of the survey participants.

We surveyed 16 authorized government institutions representing 8 countries. Two countries did not respond. Seven (43%) institutions from 6 (75%) countries responded to the questionnaire. Six (85%) of 7 responding institutions were veterinary authorities. Except for 1 country, no public health authorities responded to the questionnaire.

Because of the global increase in zoonotic threats, the importance of the One Health approach has also increased, along with the need to establish effective mechanisms for collaboration to address threats at the human–animal–environment interface (6,8,12,13). Affected by the United Nations agencies, several countries, particularly those challenged by zoonotic events, began initiating their One Health platforms and programs to enhance their capacities to manage zoonotic diseases (10,11,14–16). However, these efforts always faced many challenges.

To enable sufficient internal deliberations and ensure One Health quality and consensus-based responses, we shared the survey questionnaire with the relevant authorized health and veterinary institutions. However, the first hindrance was the response by only 44% of surveyed institutions, a fact that limited a comprehensive analysis of the outcomes. This low response rate could be attributed to poor leadership and to limited conceptual awareness about the One Health approach (16,17). This finding is sustained by our observation that there was a discrepancy understanding the One Health approach. Although the term is familiar among veterinarians, it is not among their health counterparts, a considerable drawback to implementing the approach. A high-capacity endeavor is needed advocating the health sector to deal with the One Health approach in the future.

Most of the GCC countries, including those with high MERS-CoV incidence, have adopted an epidemic control policy, indicating that the One Health approach was either partially embraced or totally overlooked. This finding was demonstrated by the fact that only 2 responding countries reported veterinary health authorities partnership formulating national preparedness and response plans. As a result, the quality of data collected in response to an outbreak remains questionable.

The lack of budget to support MERS-CoV control programs revealed by the survey questionnaire and the consequent workshop discussions emphasizes crucial points in the implementation of a successful One Health approach. One explanation may be that the cost for a proper One Health response had been underestimated. However, the disproportionate distribution of the available budget raised by the delegates might further explain the lack of integrated response. For instance, although most surveyed countries had established MERS-CoV epidemiologic investigation teams, only 50% of these teams react jointly. At the level of diagnostics, national laboratories in 66% of the countries managing and diagnosing MERS-CoV outbreaks had collaboration between medical and veterinary response, and several teamed up with international reference laboratories, which was considered a positive step toward diagnostic efficiency and cooperation. However, because MERS-CoV is a GCC home-country infection, the in-country diagnostic capacity was expected to be adequate.

When discussing crisis communication and health education, the core persistent barrier to embracing One Health seemed to be the prevalent denial of the camel owners that camels could be a potential source of MERS-CoV. Because of the highly influential role of camel owners among the communal sectors of most of the surveyed countries, involvement of these sectors to combat emerging zoonotic diseases is essential (18,19). However, because most local communities tend to react forcibly toward emerging infectious diseases (20), the investigators could neither judge this factor nor its effect in curbing the policy makers bolstering the One Health approach (21). Anticipating such socioeconomic risk factors, involvement of social scientists to resolve this barrier might help (22) facilitate community buy-in of One Health.

The survey results appear to show that respondents did not benefit much from the lessons learned during the last influenza A(H1N1) outbreak (23). The variation in the nature of MERS-CoV epidemiology among the countries—handled as a human-associated infection in some, a human–camel infection in others, and an unnoticed inapparent camel infection in others (2)—has imbalanced the magnitude of response among healthcare and veterinary sector authorities, a situation negatively affecting the application goals.

Given that the One Health approach is increasingly recognized internationally as an effective trend for managing emerging diseases at the human–animal–environment interface (10,11,18), the key barrier fostering the One Health approach at the national level suggested by this study seems to be the relative lack of political will. Based on the experience gained in addressing MERS-CoV at the human–animal interface, this lack of will could further be responsible for the poor sectoral response to the surveillance questionnaire. Although in Qatar, MERS-CoV was addressed through a One Health approach from the start (24), much remains to be done nationally, particularly at policy-making level. The foundation of a permanent interministerial committee might be a key step to raise awareness of leaders and policy makers using the concept and to determine the importance of the One Health approach. Creation of a supreme coordinating crisis communication committee is an important element to build zoonosis control and prevention capacities. A unified funding policy is a good incentive encouraging alleviation of the financial obligations accompanying One Health, expected to ease launching of joint investigations, intensive health educational sessions, epidemiologic surveillance programs, and joint seminars and workshops. Sharing of laboratory diagnostic research facilities, diagnostic protocols, and application of proficiency testing would help build experience and improve quality results. Joint routine veterinary health services programs application and adoption of compensation policy with continuous health education and extension programs might turn animal owners and other social stakeholders onto One Health.

The ratification of establishing a regional GCC center for infection control (25) to help develop unified standard and integrative guidelines to control zoonoses might help sustain the One Health approach. However, whether the current political situation might compromise the hope created by the previously promised political commitment to collaborate and allocate funds after the recent emergence of avian influenza A(H5N1) (26) remains questionable.