Prioritization of Zoonotic Diseases in Malawi Using a Multisectoral One Health Approach: Outcomes and Future Directions

Background Emerging and re-emerging zoonotic diseases pose significant public health, agricultural, and environmental threats in Malawi, a country characterized by extensive livestock production, human-wildlife interactions, and environmental changes. Recognizing the increasing risks of emerging and re-emerging zoonoses, Malawi conducted its first multisectoral One Health Zoonotic Disease Prioritization (OHZDP) workshop utilizing the OHZDP tool developed by the United States Centres for Disease Control and Prevention (US CDC). Prioritizing zoonotic diseases of national importance is essential for strengthening prevention, early detection, and control efforts, particularly in resource-limited settings like Malawi. This workshop aimed to prioritize zoonotic diseases of greatest concern to Malawi using a One Health approach and to develop corresponding action plans to enhance multisectoral preparedness and response. Methods Using the OHZDP tool, stakeholders from the environment, public health, and animal health sectors jointly identified 23 zoonotic diseases of national relevance. Participants at the OHZDP workshop collectively developed ranking criteria, which included disease severity, epidemic potential, presence and extent of disease spread in the country, environmental and socio-economic impact, and availability of capacity for prevention. Associated questions were developed for each criterion and weighted accordingly. A decision-tree analysis and normalized scoring system were used to generate the final list of ranked priority zoonotic diseases. Results Of the 23 zoonotic diseases evaluated, ten were selected as top priorities for Malawi. These include rabies, salmonellosis, zoonotic tuberculosis, anthrax, viral haemorrhagic fevers, schistosomiasis (haematobium), African trypanosomiasis, cysticercosis, zoonotic avian influenza and Mpox. Rabies received the highest weight, making it the disease with the highest priority. Key recommendations included strengthening One Health governance structures, enhancing zoonotic disease surveillance systems, expanding laboratory diagnostic capacity, improving outbreak preparedness and response mechanisms, and advancing workforce development and risk communication strategies across sectors. Conclusions This exercise represents the first nationally endorsed prioritization of zoonotic diseases in Malawi using a One Health, semi-quantitative, and participatory methodology. The outcomes provide a strategic framework to guide policymakers, relevant stakeholders, and development partners in formulating, implementing, and monitoring coordinated interventions for zoonotic disease control, thereby improving health security at the human-animal-environment interface in Malawi.