A passion for public health

What conference topic would compel veterinary students to take leave of their classes at midterm last November and journey to the University of Pennsylvania?

The encouraging answer is an interest in veterinary public health. Veterinary students from eight North American schools and colleges came to Penn's international conference, Nov. 9-10. They were among the 134 veterinary and other students from 18 schools as distant as Nigeria and Puerto Rico.

Penn's conference underscored the pressing need for more public health professionals globally. The one-medicine concept was the theme at other recent events.

Dr. John Herrmann of the University of Illinois, who was involved in two of the events, said, "Physicians and veterinarians have conceded their traditional roles in public health, and public health is the whole basis for the one-medicine concept."

Another event was the one-medicine symposium held in North Carolina in December to foster communication between veterinarians and human medical professionals.

In January, the University of Illinois College of Veterinary Medicine hosted an intra-university colloquium on one medicine. At press time, Tuskegee University was about to hold its 42nd veterinary medical symposium, focused this year on "one world, one health, one medicine."

Academic initiatives

The Penn conference coordinator, Emeritus Dean Alan Kelly (1995-2005) from the School of Veterinary Medicine, commended the students in attendance, especially those who had to work around scheduled examinations and coursework to come.

"The fact that you young people, you bright young minds, are interested in this issue is hugely important," Dr. Kelly said, "and we in academia have to step up and provide the educational programs that you clearly want."

Organizers of the Penn conference and U of I colloquium have hopes that their events will help shape specific new programs that are on the drawing board.

Of Penn, Dr. Kelly said, "This conference will set the direction of educational and leadership programs for the veterinary school for a long time to come."

Recently, Dr. Kelly told JAVMA that the veterinary school is in the early stages of planning a program that would likely lead to a joint VMD/master's in global veterinary health. Funding for new initiatives, however, is admittedly difficult.

An interest in exploring the interface of human, animal, public, and ecosystem health led to the U of I colloquium. It was a forum for the College of Veterinary Medicine to explore increased collaboration among the three U of I campuses.

The colloquium drew invited faculty and staff from the U of I system along with people from other universities and federal agencies who are interested in one medicine.

Using the colloquium proceedings, the U of I will explore funding opportunities to create an Illinois Center for One Medicine. It is envisioned as a regional or national center that would produce a cadre of public health professionals educated in animal and human diseases, ecosystem health, and research and policy issues.

Funding is an issue, but there is support for the center concept from the university president all the way to Illinois Sen. Dick Durbin, whose staff Dr. Herrmann served on as a science adviser while he was an AVMA Congressional Science Fellow. At U of I, Dr. Hermann is a clinical assistant professor and chief of the Food Animal Reproduction, Medicine, and Surgery section. In April he will speak on the concept to the joint meeting of the Association of American Veterinary Medical Colleges and the Association of Schools of Public Health at the Centers for Disease Control and Prevention.

"What the University of Illinois is trying to do is explore ways to use all of our capacities to approach community health from a global perspective," he said. "We're incorporating veterinary medicine, human health, engineering, agriculture, and ecosystems."

Keynote speaker Laura Kahn, MD, MPH, MPP, of the Woodrow Wilson School of Public and International Affairs at Princeton University underscored the need for veterinarians and physicians to work together much more.

In North Carolina

Collaboration between veterinarians and human health professionals was also frontline at the North Carolina one-medicine symposium. In 2006 it was held Dec. 6-7 in Research Triangle Park, N.C. The event was hosted by the North Carolina Department of Health and Human Services and the North Carolina Department of Agriculture and Consumer Services, with involvement from the North Carolina State University College of Veterinary Medicine and the University of North Carolina School of Public Health.

One-medicine approaches to food defense and to homeland security were subjects of two of the four annual symposiums. The 2006 topic was "Public health, agriculture, and wildlife: the common thread." The second day highlighted avian influenza as a model for collaborative preparedness activities.

Dr. Kelly G. Jeffer, the project manager, is the public health liaison veterinarian for Emergency Programs in the NCDA&CS.

"It is exciting and important to see all sectors of government, veterinarians and physicians in private practice, wildlife professionals, educators, and researchers grouped together at a conference discussing ideas and learning from each other," Dr. Jeffer said.

"This is very important, since 75 percent of emerging infectious diseases are zoonotic."

Perfect microbial storm

Introducing the University of Pennsylvania conference, Provost Ronald Daniels said, "We have clearly reached a critical juncture in the history of public health." World population will grow by more than 50 percent over the next 40 years, mostly in urban centers of developing countries, he said.

The conference approached the growing challenges arising from wildlife-generated zoonotic diseases converging with a livestock industry that is intensifying but poorly regulated in developing countries.

Dr. David Harlan of Cargill believes that global poverty and hunger constitute the greatest public health challenge. His company created the position of director of global animal health and food safety for him to address diseases that threaten the meat trade.

"Many of you have heard of this 'perfect microbial storm' of emerging infectious diseases due to the convergence of social, economic, biological, and environmental factors. The food industry is starting to recognize this, and they're starting to catch on," Dr. Harlan said.

Dr. Gregg BeVier of AgGlobalVision noted that of the more than 1,400 pathogens that cause human disease, an estimated 800 crossed over from animals, and in the past 25 years, three-fourths of the 38 new human pathogens originated in animals. "This is why a lot of people are talking about this one-medicine concept," he said.

They and 25 other authorities at the Penn conference described the emergence of problems involving zoonotic and infectious diseases, the environment, and food safety as developing countries grow in population, become prosperous, and demand more animal protein.

"With your collective knowledge, the veterinary profession must lead the way," Daniels said.

Attendees availed themselves of a rare opportunity to interact with experts from global agencies such as the United Nations Food and Agriculture Organization, World Bank, World Health Organization, and World Organization for Animal Health (OIE).

What emerged was a picture of the dearth of veterinarians serving international agencies and the rich opportunities available to those who embrace a career in public health or international veterinary medicine. The FAO has only 15 veterinarians on its large workforce, for example, and the World Bank has just two. Cees de Haan of the World Bank said his organization needs epidemiologists with good economic backgrounds, more so than clinical skills.

Erin Maureen McDonald (COR '08) is enrolled in the DVM/PhD program at Cornell University. It is one of 13 U.S. and one Canadian veterinary school offering dual-degree programs in veterinary medicine and public health, according to the AAVMC.

"I learned a lot about the latest research on important zoonoses, the latest implementations of international bodies such as WHO and FAO for surveillance of emerging diseases, and also about some of the problems facing the developing world in terms of food production," McDonald said. She hopes to be active in issues concerning biodiversity conservation and sustainable livelihoods for people of developing nations.

Veterinary students contributed noticeably to the Penn conference dialogue. Many seemed eager for day two, which focused on emerging disease threats and global response mechanisms that are in place.

Discovering Disneyland

Dr. Ilaria Capua of the Instituto Zooprofilattico Sperimentale in Italy, who heads the FAO and OIE reference laboratories for AI and Newcastle disease, was one of three speakers at Penn on the emerging threat of avian influenza. "I think the virus has found Disneyland," she said. "It has found an enormous variety of hosts which it can infect and that it can adapt to."

For every human infected with H5N1 avian influenza virus, more than a million animals are infected, she said. "Avian influenza is a disease of animals. It must be managed in animals. The spillover in humans is just a spillover. Controlling AI is an enormous challenge for the veterinary community."

Nonetheless, Dr. Capua thanked another speaker, Dr. Lonnie King, for putting things in perspective. She said there is so much emphasis on avian influenza when diseases such as malaria kill so many.

Dr. King, director of the National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC, predicts major increases in waterborne zoonoses in this decade. Each year, there are 4 billion cases of diarrhea around the world, with 2 to 3 million deaths, he said. More than a billion people have unreliable water sources. "If you want to make a difference in public health, these are the kinds of things you need to tackle."

Carole Harbison (COR '10), another dual-degree student from Cornell, said, "It was heartening to see increased awareness about other widespread diseases usually labeled 'tropical' or 'exotic,' which are for the most part usually ignored in this country.

"I left this conference with excitement about working in the field, because certainly there will be lots to do, but also with a sobering awareness of what could happen if veterinarians do not step up and take a more active role in the public health field."

Dr. King likes to remind people that even through their routine work with parasite control, private practitioners also contribute immensely to public health.

Lauren Wrobel (ILL '09) is such a person. One of four U of I students in the DVM/MPH program who came to Penn, she wants to initially enter private practice.

"If you go into public health, it doesn't have to be a whole career," Wrobel said. "It can be private practice, and you can be on a local public health board and still make a difference."

Reinforcing that idea was Dr. Hugh Mainzer of the CDC, who noted that the promotion of public health is in the veterinarian's oath. Veterinarians have core public health competencies, and there are some great opportunities, he said. "I look forward to seeing more of you in applied public health."

Veterinary medicine the center point

The inspiration for the Penn conference was the late Dr. Martin Kaplan (UP '40), who created the Veterinary Division in the WHO and went on to become director of science and technology in the WHO Office of the Director General. His son Peter Kaplan, MBBS, of Johns Hopkins University School of Medicine, said the conference was arguably unique in assembling top-level experts to create a global view about how veterinarians can enrich their understanding of these issues to better help manage them.

Dr. Kaplan said, "Veterinary medicine, which involves 999.99 percent of the world's species, is really the center point of this."

Proceedings of the Penn conference are posted at www.vet.upenn.edu/