The term “shifting the goalposts" often carries a negative connotation, implying unfairly that someone is changing certain criteria to make success unattainable. But Dr. John Amuasi, executive director of the African Research Network for Neglected Tropical Diseases and co-chair of the Lancet One Health Commission, wants global health researchers to embrace shifting the goal post as fundamental to success.

Delivering the Commemorative Lecture Friday at #TropMed24, Amuasi, a member of the ASTMH Board, said the inherent complexity of the One Health paradigm — which emphasizes the extremely tight bonds between the health of humans, animals and the environment — demands that scientists constantly rethink the nature of global health threats along with the solutions required to overcome them. 

Amuasi believes that safeguarding the health of people and planet will require following a series of constantly moving targets and responding with “better research and better data.”

“We have to be willing to shift as we move along; otherwise, we will be stuck in our ways — and that could be injurious,” he said. 

Amuasi outlined several categories of “goal post-shifters” that have emerged in a One Health world. They include: 

• Climate change: He noted that rising temperatures, for example, are affecting the geography of mosquito-borne pathogens, and that demands a constant re-evaluation of global efforts to control diseases such as dengue and malaria.
  

• Intense pollution and biodiversity loss: Amuasi also pointed to the way illegal mining operations in sub-Saharan Africa are turning pristine water bodies into polluted lakes and rivers almost overnight, which he said will have “huge implications for health.” 
  

• The interaction between infectious and chronic diseases: Amuasi said the severity of COVID-19 infections often was determined by the presence of pre-existing conditions like diabetes and hypertension. He believes the global increase in chronic conditions now occurring in tandem with rising threats from emerging and re-emerging infectious diseases will require a constant rethinking of interventions in both categories.
  

• Artificial Intelligence: He said the rapidly growing capabilities of AI systems and the implications for health could make this technology the “fastest goalpost-shifter” of them all. 
  

Amuasi said in each of these areas and many more, following the pathway revealed by scientific evidence will inevitably disturb the status quo. He showed a cartoon of Dr. Anthony Fauci running down an American football field with a set of goalposts. He said that while the cartoon was meant to be critical of Fauci’s decision-making during the pandemic, it was inadvertently illustrating how he was following the science and changing his guidance in response to new scientific evidence. 

“The goalposts will shift when we are following the science, even though it will be uncomfortable and will come with risks,” he said.