The one-health initiative was front-and-center at the 144th AVMA Annual Convention as veterinarians, physicians, and public health officials spoke at a number of sessions about the importance of the two health care professions working together for the betterment of human and animal lives. Also, Julie L. Gerberding, MD, director of the Centers for Disease Control and Prevention, headlined the convention's Opening Session.
Under the leadership of Dr. Roger K. Mahr, 2006-2007 AVMA president, the AVMA One Health Initiative Task Force was established. In addition, the American Medical Association recently adopted a policy calling for greater collaboration with veterinarians as well as dialogue with the AVMA (see JAVMA, Aug. 1, 2007, page 357.)
One health is not a new concept. It has long been known that cancer research in dogs can have human health benefits. After a veterinarian reported in the 1980s that muramyl tripeptide increased the longevity of dogs with osteosarcoma, the National Cancer Institute began drug trials in people. Late last year, IDM Pharma filed for approval with the Food and Drug Administration to market the medication, Junovan, for human cancer patients.
There are even earlier examples of the human-animal health connection, according to Laura Kahn, MD, who has written extensively about one health. In the late 1700s, British physician Edward Jenner inoculated a young boy with cowpox virus after observing that milkmaids were immune to the deadlier smallpox strain. As a result, the child developed immunity to smallpox—the first smallpox vaccination.
"(One health) is a holistic systems approach to understanding health across all species," explained Dr. Lonnie J. King, director of the CDC's National Center for Zoonotic, Vector-Borne, and Enteric Diseases and chair of the AVMA One Health Initiative Task Force.
"It's a recognition that human and animal health are inextricably linked, and one health is about how to promote, improve, and defend the health and well-being of all species, with the cooperation of physicians and veterinarians," Dr. King said.
At the AVMA convention in Washington, D.C., three educational tracks focusing on one health were held.
Global animal health threats
U.S. Ambassador John E. Lange led off a daylong one-medicine track focusing on emerging global animal health threats, July 16. The track also featured a dozen other authorities.
Ambassador Lange is the nation's special representative on avian and pandemic influenza and also heads the State Department's Avian Influenza Action Group.
Lange said that the potential for a human pandemic persists.
"To be frank ... this animal disease may result in a mutation someday and cause a human pandemic," he said.
"This is why collaboration is necessary—because what's going on in the animal health area has great importance for us all."
In September 2005, President Bush announced the International Partnership on Avian and Pandemic Influenza. Its goal is to elevate the issue on national agendas and to coordinate efforts among donor and affected nations. All partners have endorsed a core set of principles focused on enhancing preparedness, prevention, response, and containment activities.
The partnership first convened in Washington, D.C., in October 2005. In June 2006, 93 countries attended the partnership meeting in Vienna, Austria.
"We've really reached out in many, many ways to countries around the world to deal with the animal health aspects (and human health)," Lange said.
In December 2006, the U.S. increased its international assistance to address the threat of avian and pandemic influenza by $100 million, for a total of $434 million.
The international partnership has supported the training of 129,000 animal health workers. That has required engagement with governments and regional and international organizations such as the United Nations Food and Agriculture Organization, World Health Organization, World Organization for Animal Health (OIE), and World Bank.
Enormous stakes are involved, Lange said. "We need to prepare for the worst, especially those who are veterinary officials. That would require an engagement not just of governments but of international organizations, nongovernmental organizations, and animal and public health professionals like yourselves, to resolve the challenges that remain."
In late June he attended an international technical meeting in Rome on highly pathogenic avian influenza and human H5N1 infection. Lange said it was clear that much progress has been made, but that the virus is spreading.
The ambassador said that more programs are under development to assist foreign countries in dealing with emerging and re-emerging threats.
Lange said, "The U.S. government and the U.N. Food and Agriculture Organization are looking to deploy veterinarians for temporary assignments abroad.
"I really congratulate you for your dedication to this and many other potential emerging diseases. I urge you to support all efforts to build a stronger bond between human and animal health professionals."
The U.S. Agency for International Development, for example, is seeking veterinarians and other animal health experts for its project Stamping Out Pandemic and Avian Influenza. An independent federal government agency, USAID receives foreign policy guidance from the secretary of state and arranges missions that are usually bilateral. The agency is funding the STOP AI Expert Resource Network to seek consultants with international expertise for short- and long-term assignments that may include providing technical assistance to national governments. The focus will be on the animal health aspects of highly pathogenic avian influenza, but the project will also address human health. Veterinarians interested in being considered should send their curriculum vitae to STOPAI@DAI.com.
The Department of Agriculture is the lead technical and regulatory agency for the U.S. government's international efforts to combat the spread of HPAI. The department's International Coordination Group for Highly Pathogenic Avian Influenza recruits and deploys veterinary emergency management subject matter experts for temporary assignments. Usually, these USDA specialists support activities directly implemented by the ICG and by host countries. In some cases, however, the ICG loans experts to the FAO to support its multilateral activities. Gordon Cleveland is designated as the initial point of contact for AVMA members who wish to participate in ICG activities; e-mail him at Gordon.S.Cleveland@aphis.usda.gov.
"One medicine: fly under one flag"
Speaking July 16 during the "One medicine: fly under one flag" session, Dr. Mahr noted that three-quarters of the emerging diseases during the past 25 years are zoonotic. Also, 38,000 animals cross U.S. borders every day, and 21 billion animals were used for food and fiber worldwide last year.
Three recent studies, including two by the National Academy of Sciences, stress society's need for more public health and food supply veterinarians. The top recommendation of these studies, Dr. Mahr said, was for improved communication, collaboration, and cooperation among professional associations, colleges, government agencies, and industry.
"I truly believe animal health is at a crossroads," Dr. Mahr said. "The convergence of human and ecosystem health dictates that the one world, one health, one medicine concept must be embraced."
Veterinarians have a responsibility to work with their counterparts in human medicine, public health, and environmental science, according to Dr. Mahr. "Together, we can certainly accomplish more to improve health worldwide than we can alone," he said.
Dr. Mahr believes the veterinary profession must assume a major leadership role in the one-health effort, which is why he proposed the One Health Initiative Task Force. This initiative will, he said, lead to an action plan for expanding the veterinary workforce as well as establishing a national commission on one health.
AMA President Ronald M. Davis, MD, also spoke during the session about other areas of veterinarian-physician collaboration. People and animals don't have just infectious diseases in common—they also are susceptible to the same chronic diseases. According to Dr. Davis, dogs whose owners smoke, for instance, are more likely to develop lung cancer and nasal sinus cancer, and cats are more likely to develop lymphoma.
Preliminary results from a national online survey suggest that informing pet owners who smoke about the risks of secondhand smoke to their animals would cause them to consider quitting, Dr. Davis said.
"This suggests that getting the word out could get a lot of smokers to quit or to at least not smoke around their pets," he said.
Public health practice
On July 17, a final track of one-health sessions was offered under the section Public Health Practice. Among the presenters were Rear Adm. William Stokes, chief professional officer for the Veterinary Category of the U.S. Public Health Service; Dr. Michael Blackwell, dean of the University of Tennessee College of Veterinary Medicine; and Dr. W. Ron DeHaven, who was stepping down as administrator for the USDA Animal and Plant Health Inspection Service to become AVMA executive vice president.