One-health wonders

(V)eterinarians and physicians could do much to reduce the risk of zoonotic disease transmission if they worked more closely together.

– LAURA H. KAHN, MD, MPH, MPP

 

Laura H. Kahn, MD, MPH, MPP, is a general internist who began her career in health care as a registered nurse. She currently is part of the research staff of Princeton University's Program on Science and Global Security. Dr. Kahn's expertise is in public health, biodefense, and pandemics. From 2003-2005, she led a study that assessed the public health infrastructures of New Hampshire, New Jersey, New York, and Pennsylvania. Prior to joining Princeton, Dr. Kahn was a managing physician for the New Jersey Department of Health and Senior Services and a medical officer for the Food and Drug Administration. She spoke to JAVMA News about why veterinarians and physicians can, together, protect public health.

How does your work involve collaboration between human and veterinary medicine?

I began my work at Princeton University in the fall of 2002. The New York City West Nile virus outbreak of 1999 and the anthrax attacks of 2001 were fresh in my mind. When I designed my two-year biopreparedness study of four states' public health infrastructures (princeton.edu/~globsec/Macy/index.html), I was determined to include animal health. I surveyed both physicians and veterinarians, asking them a variety of questions, including their knowledge of their state and local public health infrastructures. I also asked them if they communicated with each other, and if not, would they be interested in doing so. Most of the veterinarians expressed an interest in working with physicians, but unfortunately, that sentiment was not mutual.

I befriended a veterinarian who had participated in the study, and she would send me articles from the veterinary medical literature. After reading what she sent me, I realized that there was considerable overlap between medicine and veterinary medicine, particularly in the realm of zoonotic diseases. I was convinced that the two professions needed to work more closely together, since the vast majority of emerging infectious diseases and bioterrorist agents were zoonotic. This was an issue that the general medical literature rarely, if ever, acknowledged.

Veterinarians aren't often thought of as promoters of public health. Why is that not the case?

An important article by veterinarians Sara Grant and Christopher Olsen (http://wwwnc.cdc.gov/eid/) provides a possible explanation to this question. In their paper on preventing zoonotic diseases in immunocompromised persons, they mentioned that HIV patients generally don't view veterinarians as a source of information for human health. If one extrapolates this to the population level, then the general public probably doesn't view veterinarians as a source of public health information. In reality, this is obviously not the case, but the public perception likely prevails.

They found that physicians wanted veterinarians more involved in zoonotic disease prevention. The issue typically falls through the cracks, since neither physicians nor veterinarians address it with their patients or patients' owners, respectively. Veterinarians need to educate the public about their very important role in promoting both animal and public health.

How are veterinarians and physicians working together today?

The One Health Initiative is a very important development in getting veterinarians and physicians working together to improve the lives of both animals and humans. Through the AVMA One Health Initiative Task Force, veterinarians and physicians are meeting and developing strategies to improve collaborative, cross-disciplinary efforts. It is important to note that veterinarians and physicians do work together in public health. One example is the international effort to control avian influenza. In addition, there are some collaborative efforts in research, but much more could be done. At the individual health level, veterinarians and physicians could do much to reduce the risk of zoonotic disease transmission if they worked more closely together.

What steps should be taken to strengthen ties between veterinarians and physicians?

There needs to be better communication and collaboration at the individual health, public health, and research levels. I think the first steps should be taken during medical and veterinary medical school with classes teaching about the importance of zoonotic diseases and the ecology of microbes. These topics are covered extensively in veterinary medical school, but not in medical school. Medical students would benefit from knowing what their veterinary medical student colleagues were learning so that they could understand why working collaboratively would be important. Postgraduate education—including joint conferences, seminars, and workshops that promote cross-disciplinary efforts and networking opportunities—would be another important step.