Review of Institute of Medicine and National Research Council Recommendations for One Health Initiative

Human health is inextricably linked to the health of animals and the viability of ecosystems; this is a concept commonly known as One Health. Over the last 2 decades, the Institute of Medicine (IOM) and the National Research Council (NRC) have published consensus reports and workshop summaries addressing a variety of threats to animal, human, and ecosystem health. We reviewed a selection of these publications and identified recommendations from NRC and IOM/NRC consensus reports and from opinions expressed in workshop summaries that are relevant to implementation of the One Health paradigm shift. We grouped these recommendations and opinions into thematic categories to determine if sufficient attention has been given to various aspects of One Health. We conclude that although One Health themes have been included throughout numerous IOM and NRC publications, identified gaps remain that may warrant targeted studies related to the One Health approach.


Category
Abbreviated recommendations Improve understanding of cultural, infrastructure, and other issues affect improvement of surveillance, control and management of diseases Conduct training programs in food safety for public health officials, veterinarians and the animal health community in developing countries Support training of medical acarologists and tick biologists to ensure continuing progress on tick-borne diseases Research Needs Expand and coordinate NIH-supported research on agent, host, vector and environment factors leading to emergence of infectious diseases Increase funding for basic research on antibiotics, including development of more rapid and wide-screen diagnostics to improve tracking of emerging resistance and zoonotic diseases Climate change research should incorporate health issues associated with indoor environment Fund, sustainably, research in knowledge gaps in ecology, epidemiology, and pathogenesis of zoonotic diseases Investigate ecology of foodborne diseases to inform integration of animal and human health surveillance Define role of water as source of foodborne illness Provide evidence of economic benefit and value to investors to successfully solicit support for additional private or public research funding Integrate research efforts and findings on infectious diseases in humans, animals, and plants Develop comprehensive national databases that capture ecosystem, vector and patient data related to Lyme disease Develop bioeconomic models to assess economic impact of invasive species and evaluate prevention and mitigation Develop proof-of-concept prototypes for validation of One Health approach to food safety in developing world and to public-private partnerships Communication Needs

Develop trust and communication pathways between industry, public sector, academia, NGOs, smallholder farmers and community representatives to achieve bi-directional flow of formal and informal information needed for evidence-based decision making and coordinated actions
Educate public on complexities of antimicrobial resistance, especially related to use in food animals Develop public campaigns to address bush meat and exotic animal awareness Partnerships Develop/enhance EPA/CDC efforts to identify and mitigate health risks from degradation in indoor environmental quality associated with climate change Develop tripartite cooperative program within federal agencies to address infectious diseases in humans, domestic animals and wildlife, and to catalyze development of similar programs at state level that would network with the federal cooperative program Recognize the primacy of prevention and control of human disease, and improve collaboration between public health and agricultural agencies Establish prevention of invasive species spread as international public good and assist developing countries in establishing capacity for surveillance, detection and prevention of biologic (fungal) invasions Thematic group Reference(s) Examples of related activities surveillance/detection 1992 "The Environmental Protection Agency and other federal agencies should put into place a public-health surveillance system that uses existing environment and health survey instruments to gather information on how outdoor conditions, building characteristics, and indoor environmental conditions are affecting occupant health and on how these change over time."

IOM CR 2011
Strengthening links in human and animal surveillance: "Strengthening disease surveillance in humans and domestic animals. Priority areas include improving communication and information sharing between the medical and veterinary communities and designing integrated medical and veterinary disease surveillance systems at a regional level." 2001 and "…collaboration among practitioners of veterinary and human medicine, along with overlapping surveillance systems, would be highly beneficial to both people and animals" 2011 "Because many TBDs [tick borne diseases] are zoonotic, animal and human health experts urgently need to collaborate and to develop an integrated surveillance system that includes domestic animals, wildlife, ticks and people. Wider and more effective surveillance could allow animals to serve as sentinels and surrogates for human risk and exposure to TBDs.  Reference(s) Examples of related activities and sentinels and, therefore, a critical target for infectious disease surveillance and detection" "Increasing capacity for the early detection of, and rapid response to, biological invasions"

IOM WS 2011 (Fungal Diseases)
Global Early Warning and Detection System (GLEWS) a joint system that builds on the added value of combining and coordinating the alert and disease intelligence mechanisms of OIE, FAO and WHO for the international community and stakeholders to assist in prediction, prevention and control of animal disease threats, including zoonoses, through sharing of information, epidemiologic analysis and joint risk assessment. (17) Increased international exchange of molecular and epidemiologic data "to enable the sequence based linking of clusters of viral enteric disease, and thereby to track global food-borne outbreaks-outbreaks that threaten to produce more virulent viruses through recombination" Focusing efforts on markets (e.g., wildlife markets) to regulate, reduce, or eliminate trade that threatens the health of humans, domestic animals, wildlife, and ecosystems.

IOM WS 2011 (Fungal Diseases)
Laboratory Networks "The animal health laboratory network should be expanded and strengthened to ensure sufficient capability and capacity for both routine and emergency diagnostic needs and to ensure a robust linkage of all components (federal, state, university, and commercial laboratories) involved in the diagnosis of animal and zoonotic diseases."  Design "research prototypes for proof-ofconcept validation of One Health principles as applied to food safety in the developing world, and also to public-private partnerships between government and the food industry"

IOM WS 2012
Communication Needs "In its work on zoonotic disease surveillance and response, USAIDin collaboration with WHO, FAO, and OIEshould convene representatives from industry, the public sector, academia, nongovernmental organizations (NGOs), as well as smallholder farmers and community representatives to determine how best to build trust and communication pathways among these communities in order to achieve the efficient bi-directional flow of both formal and informal information needed to support effective, evidence-based decision making and coordinated actions."

IOM CR 2009
Need to educate public on complexities of antimicrobial resistance, especially given "polarized environment surrounding the issue of antimicrobial use in food animals" IOM WS 2010 (Antibiotic Resistance) Public campaigns to address awareness of risks associated with bushmeat practices and with exotic animal importation IOM WS 2010 (Infectious Disease Movement)

Partnerships
The EPA should collaborate with CDC "to assist state, territorial, and local health and emergency-management agencies in efforts…to identify populations at risk for health problems resulting from alterations in indoor environmental quality induced by climate change and to implement measures to prevent or lessen the problems."

IOM CR 2011
"Federal agencies should develop a tripartite cooperative program to address infectious diseases in humans, in domestic animals, and in wildlife. This program should serve as a focus for regular communications through working groups to address information transfer; to improve response to disease emergencies; to establish priorities for collaborative, focused investigations; and to pursue other areas of mutual interest. The program also should serve as a model and catalyst to stimulate the development of Thematic group Reference(s) Examples of related activities similar cooperative programs between state agencies that would network with the federal program." "Collaboration can be improved at the internal level as well. Although many international activities have succeeded, often via WHO, difficult circumstances have required the involvement of institutions outside the usual public health agency loop, such as agricultural agencies. This was true when the West Nile virus emerged in the United States in 1999, when the H5N1 influenza virus emerged in Hong Kong in 1997, and when the Hendra virus emerged in Australia in 1994. In each case, turf issues arose, and in some instances efforts to protect agricultural markets seemed to be deemed more important than efforts to protect the public health… The next step in solving such turf issues will involve recognizing the primacy of prevention and control of human disease."

IOM WS 2002
Dedicated One Health Offices at CDC and USDA (39). Multi-Agency Federal Inter-Agency One Health Working Group The national One Health Commission (40) "Establishing the prevention of the spread of invasive species as an international public good, which requires coordination among nation states... Because such a system is only as strong as the "weakest link," efforts are also needed to assist developing nations in establishing capacity for surveillance, detection, and prevention of biologic invasions" IOM WS 2011 (Fungal Diseases) *Bolded and shaded rows indicate recommendations from consensus reports;; IOM, Institute of Medicine; NRC, National Research Council; WS, workshop summary; WR, workshop report; CR, IOM consensus report; CmR = NRC committee report.