One-health wonders

Thomas P. Monath, MD, was a natural fit on the AVMA One Health Initiative Task Force.

 

The Harvard-trained physician served in the Army and U.S. Public Health Service for 24 years prior to retiring as a colonel in 1992. From 1973-1988, Dr. Monath headed up the Centers for Disease Control and Prevention's Division of Vector-Borne Viral Diseases. For three years beginning in 1989, he was chief of the virology division at the U.S. Army Medical Research Institute of Infectious Diseases.

Later, he was chief scientific officer and executive director of a biopharmaceutical company where he directed vaccine research and development on dengue, Japanese encephalitis, yellow fever, Clostridium difficile, smallpox, and other infectious diseases. He also developed a vaccine for West Nile virus that is approved for horses and is in clinical trials for humans.

Throughout his career, Dr. Monath has served on numerous government and international committees on infectious diseases and biosecurity, World Health Organization expert committees, and the National Vaccines Advisory Committee. Between 1998 and 2000, he was senior science adviser to the director of the Central Intelligence Agency.

Today, Dr. Monath is an adjunct professor in the Harvard School of Public Health while also continuing his work in private industry.

Why did you participate on the AVMA One Health Initiative Task Force, and what do you hope to see the new joint steering committee achieve?

The one-health initiative and the task force resonated with me personally as overdue and highly worthy endeavors. My entire career in medicine has been focused on zoonotic and emerging diseases, and in my various positions at CDC, USAMRIID, and later, in my position in industry, I had administrative responsibility to integrate multidisciplinary teams of veterinarians, wildlife ecologists, and physicians to undertake field and experimental investigations, and to build bridges across government agencies, including the Department of Agriculture, U.S. Public Health Service, and the Environmental Protection Agency. I thought that this experience could be of value to the task force and the steering committee.

In my position in industry, I had developed a platform technology for developing commercial vaccines for both horses and humans, and I strongly believed that the application of one-health principles within the biopharmaceutical industry was a critical need. I am very optimistic that the steering committee will increase public and private sector awareness of the need for one health; will establish a permanent national commission as an engine for change; will set a research agenda that can draw funding for one-health projects; will identify key implementation steps for integrating veterinary, medical, and environmental sciences; and will ultimately lead to selected restructuring of government agencies, academia, industry, and other institutions to improve public health education and practice, and to develop new ways to diagnose, treat, and prevent infectious and chronic diseases.

Veterinarians are involved in food safety as well as disease and biomedical research. Do you as a physician see an expanded role for veterinarians in promoting public health?

Veterinarians should be considered as integral specialists under the broad umbrella of allied public health professionals. This starts at the top, with agencies of local, state, and national government—as well as international agencies—veterinary and medical schools, and industry ensuring that these institutions have visionary leadership that is inclusive and drives programs that ensure seamless application of one-health principles to public health. We need to develop metrics that will measure and demonstrate the value of integrated approaches to specific problems in public health, so that the value of one health will be clearly defined and, therefore, be sustainable in the long run.

Many of the infectious diseases you worked with are zoonoses. What does this say about the connections between human and animal health?

I was fortunate to have been in a leadership position in an enlightened organization—the CDC—where one-health principles have been broadly accepted for many, many years. The diseases we had responsibility for—arboviruses, viral hemorrhagic fevers, bubonic plague—were all zoonotic, and our team was truly interdisciplinary, and most important, viewed across the organization as having no fractures or barriers based on specialty or core competencies. It was impossible to discuss or work on any of the diseases without considering the role of insect, wild and domestic animal host, human host, and environment. The connections across members of the multidisciplinary team were deep and the complexities of the disease ecology so enormous that success depended on working closely together.

Will it take a lot of convincing to get physicians, veterinarians, and other health care professionals to buy into the one-health concept?

It has taken over a hundred years for the separation and stovepiping across these health disciplines to develop, and it will take some time to reverse the process, but it can be done relatively quickly with sufficient focus and effort. We are off to a good start; the initiative has gathered considerable steam. The public, as well as leadership in many professional societies, some government agencies, and some university campuses, is much more aware of one health than they were three years ago. The repeated lessons from nature such as severe acute respiratory syndrome and avian and swine flu demonstrate the need to deal with cross-species disease transmission in a more effective way. The specific, actionable implementation steps to improve public health through one-health principles are, however, not fully fleshed out, and this is a challenge that must be met soon.

Aside from zoonotic and emerging infections, there are many other critical areas, including research on common chronic diseases affecting animals and humans; the development of improved diagnostics, drugs, and vaccines; food safety; biosecurity; and others where the benefit of, and steps toward, integration of different professional groups are less clearly defined. It will take some time to achieve approved approaches to ensure that funding streams require application of one-health principles and to embody the principles into medical and veterinary education.

You led the business plan team on the task force. Are corporations and other donors seeing the potential in the one-health initiative?

We were successful in getting funding from the Rockefeller Foundation, which, in fact, had already seen the value of one health and was funding some field projects overseas. The professional societies and some government agencies are helping with both funding and in-kind services directed at furthering the goals of one health. The fundraising efforts will be facilitated when the national commission is formed and we have, through various means currently under way, boiled down the initiative into a road map for change with clear implementation steps and deliverables. We are working toward doing that with the National Academy of Sciences and the Institute of Medicine.