V i P bli H l h i hVeterinary Public Health in theEpoch of “One Health”

Dra. Marguerite PappaioanouExecutive Director AAVMC

p

Executive Director, AAVMC

Dr. Primo Arambulo IIIDr. Primo Arambulo IIIInternational Consultant, AAVMC

PANVET 2010September 2, 2010

• Increasing human population• Increasing human protein and micronutrient g p

malnutrition• Extensive & rapid travel/mobility of humans

d land animals• Urbanization-: 50% in urban areas today,

increasingincreasing• Changes in land use, environment, climate• Changing patterns of wildlife populationsChanging patterns of wildlife populations• New information technology – rapid sharing of

information, information overload,

• Globalization of food industry, food safety• Increased trade of livestock, poultry, eggsIncreased trade of livestock, poultry, eggs

New agricultural superpowers (e.g., Brazil, China)Developing countriesp g

• New farming methods , production, healthAquaculture, game farmingGenetic engineering, transgenesisWaste disposal, environmentA ti i bi l i tAntimicrobial use, resistanceAnimal WelfarePopulation – based medicine system based controlPopulation – based medicine, system based control

• N t l d M d Di t• Natural and Manmade Disasters• Emerging and Re-emerging Zoonotic Diseases• H A i l B d d l f i • Human-Animal Bond and roles of companion

animals• R d d f bli t • Reduced resources from public sector,

increased privatization

Wild i d•Wild pigs suspected as cause of E. coli outbreak

•TranslocationOne Health

•Human encroachment•Encroachment

Wildlife•Ex situ contact•Ecological manipulation•Human behaviors

•Introduction•“Spill over” &•“Spill back”

DomesticAnimal

Human •Global travel•Urbanization•Biomedical•Agricultural

E t i P d ti •manipulation

•Food processing/distribution

•Extensive Production

•Technology and•Industry

•After Daszak P. et.al.•Science 2000 287:443

Health, Development, and Povertyand Poverty

Health DevelopmentLivestock/Poultry Reduce Poverty

Source:Source:UNDP

Goal 8: Develop a Global Partnership for Development

Exposure Animals HumansExposure

Clinical Signs

Animals

Veterinary

Symptoms

yCare

Care

Adapted from graph in “Sustaining global surveillance and response to emerging zoonotic diseases,”, IOM/NRC 2009

All i i All countries, in partnership with private and public stakeholders and public stakeholders, should develop, maintain, and globally coordinate g yintegrated surveillance and response capabilities to prevent, detect, and respond to the emergence of zoonotic diseases in of zoonotic diseases in order to limit loss of life and livelihoods.and livelihoods.

Food SecurityNutritionFoodborne

EmergingDiseases

Bio- Agro-Terrorism

EmergencyResponse Biomedical

Research

FoodborneDisease

AntibioticResistance

Disability

Mental HealthEnvironmentalHealth

Resistance

Injuries OccupationalHealth Health

Education

ObesityPhysical Activity

Is the Collaborative Effort of Multiple Disciplines Is the Collaborative Effort of Multiple Disciplines

working locally nationally and globally– working locally, nationally, and globally–

t tt i ti l h lth f l i l d to attain optimal health for people, animals, and our environment.

AVMA AMA One Health Task ForceAVMA-AMA One Health Task Force

The Future of Veterinary Medicine

• Nurses • Epidemiologists

• Physicians• Veterinarians

• Laboratory Scientists• Social Workers

H lth Ed t• Dentists• PhDs• Public health advisors

• Health Educators• Statisticians• Information • Public health advisors

• MPHs• Sanitary Engineers

Information Technology Specialists

• Entomologistsy g• Industrial Hygienists• Animal Scientists

• Lawyers• Other

• Environmental Specialists

• Ministries of agriculture, Departments of veterinary services (livestock, poultry)y ( p y)

• Ministries of natural resources, forestry, interior (wildlife, ecosystem health)

• Ministries of health, public health (human health)

• Ministries of tourism, commerce (trade, commerce)

• Ministries of finance• Ministry of state

• InternationalWHO (Human) / PAHOW O ( u a ) / OOIE FAOFAOWorld Trade OrganizationMultilateral development/assistance Multilateral development/assistance organizations, banks (World Bank, IADB)Bilateral development/ assistance Bilateral development/ assistance organizationsNGO’sNGO sOthers

“ I l l t i tifi “ I l l t i tifi “…. I solemnly swear to use my scientific “…. I solemnly swear to use my scientific knowledge and skills for the benefit of knowledge and skills for the benefit of society through the society through the protection of animal protection of animal society through the society through the protection of animal protection of animal health, the relief of animal suffering, the health, the relief of animal suffering, the conservation of livestock resources, conservation of livestock resources, the the promotion of public healthpromotion of public health and the and the advancement of medical knowledgeadvancement of medical knowledge..””

“ is what we, as a society, do “ is what we, as a society, do yycollectively to assure the collectively to assure the conditions in which people conditions in which people conditions in which people conditions in which people can be healthy.”can be healthy.”yy

Institute of Medicine, Institute of Medicine, The Future of Public HealthThe Future of Public Health, 1988, 1988

• “the sum of all contributions to the physical, the sum of all contributions to the physical, mental, and social well being of humans through an understanding and application of veterinary science”

• Is multidisciplinaryp y• Is a public good!

• Graduate of Veterinary Medical and Medical Medical and Medical School

• One of the world's most prodigious p ginvestigators in animal diseases and public

KF Meyerhealth

• Mentor to other leaders

“Human health “Human health Human health Human health provides the most provides the most logical unifying or logical unifying or logical unifying or logical unifying or apical cause in apical cause in

i di i ’ i di i ’ veterinary medicine’s veterinary medicine’s hierarchy of values”hierarchy of values”

Calvin Calvin SchwabeSchwabe, , V t i V t i

yyVeterinary Veterinary Medicine Medicine and Human and Human Health, 1984Health, 1984

Established Veterinary Category in the US Public Health Servicein the US Public Health Service

Integrated veterinary public g y phealth into public health programs at US CDC

Proposed VPH program – WHO Organizing Committeeg g

Raised visibility of zoonotic d l d h

James H. Steele

diseases to leaders in human health

“I would like to put forth the notion that the veterinary profession should serve humanityveterinary profession should serve humanity.

Those who are responsible for the professional education in the veterinary sciences should grasp this idea and begin to guide our training centers to the three g gprincipal services benefiting humankind:

agriculture biology and public healthP d agriculture, biology and public health.

I believe that if we were to do any less,

Pedro Acha

we would fail in our mission…”

• Policies – Resources• I l/I di i li R h• Intersectoral/Interdisciplinary Research• Multi/Inter Professional Education• Multisectoral Health programs – providers,

disease prevention, surveillance, response• N d k h i O H l h b • Need to make the case– is One Health better

than other approachesNeed monitor and evaluate progress on human Need monitor and evaluate progress on human, animal, environmental health indicatorsNeed buy-in and commitment from all professionsy p f

All i i All countries, in partnership with private and public stakeholders and public stakeholders, should develop, maintain, and globally coordinate g yintegrated surveillance and response capabilities to prevent, detect, and respond to the emergence of zoonotic diseases in of zoonotic diseases in order to limit loss of life and livelihoods.and livelihoods.

Recommendations by Priority & CategoryTECHNICAL ECONOMIC POLITICAL

Strengthen Surveillance and Response Capacity

Financing and Incentives for Surveillance

Governance of Global Efforts to Improve Surveillance and R C bilitiResponse Capabilities

High priority

Establish surveillance and response strategies (Recommendation 1-1)

Design sustainable funding strategies (Recommendation 2-1)

Create a coordinating body for global zoonotic disease surveillance and response( ) surveillance and response (Recommendation 3-1)

Priority Improve use of information technology to support surveillance and response activities (R d ti 1 2)

Create an audit and rating framework for surveillance and response systems(R d ti 2 2)

Deepen the engagement of stakeholders (Recommendation 3-2)

(Recommendation 1-2) (Recommendation 2-2)

Strengthen laboratory network to support surveillance and response activities (Recommendation 1-3)

Strengthen incentives for country and local reporting(Recommendation 2-3)

Revise OIE governance strategies (Recommendation 3-3)

( )

Build human resources capacity to support surveillance and response efforts (Recommendation 1-4)

Mitigate disease threats from wildlife and trade (Recommendation 3-4)

Establish a zoonotic disease drivers panel (Recommendation 1-5)

• Launched by CDC in 1980 – modeled after CDC Epidemic Intelligence Service (EIS)

• Goal to strengthen linkage between epidemiology and laboratory systems in surveillance & outbreak response

• 2 year full-time training and gov’t in-service program in applied epidemiology and public health

• MD’s DVM’s laboratory scientistsMD s, DVM s, laboratory scientists• 25% coursework and 75% field work • 12 active programs representing 22 countries12 active programs representing 22 countries• 18 self-sustaining programs representing 24

countries

• Brazil**Brazil• Argentina**• Colombia**Colombia• Peru• Central AmericaCentral America

** Accept veterinarians** Accept veterinarians

• Offer Courses in—Offer Courses inVeterinary epidemiology, population medicinePublic HealthUNAM, exploring relationship with medical UNAM, exploring relationship with medical school

• Understanding, respect, commitment di i li d tacross disciplines and sectors

Connections between humans, animals, environmentEducation, expertise, experience, roles, , p , p , ,contributionsHow to work togetherHow to work together

• Effective communication at all levelsInter-American Ministerial Level Meetings (Human and Agricultural Sectors)– RIMSAGlobal Early Warning System for Major Animal Diseases including Zoonoses (GLEWS): FAO, OIE, WHOInternational Ministerial Conference on A i l d P d i I fl (IMCAPI) Animal and Pandemic Influenza (IMCAPI)

• S ffi i t h d fi i l • Sufficient human and financial resources across sectors ($200 Billion last 20 years on emerging oonotic diseases)emerging zoonotic diseases)

• Reliable data : Dx, Lab confirmation• Transparency, Trust• Demonstrating (Cost) effectiveness of g ( )

One Health

• Drs. Pedro Acha and James Steele transformed the concept of VPH to programs – PAHO, US Public Health concept of VPH to programs PAHO, US Public Health Service

• Most countries in region free from canine transmitted rabies

• 80% of region free of FMD• Food safety protected• Food safety protected• Animal influenza viruses- tracked, increased efforts to

control• Control /eradication of bovine Tb, Brucellosis• Surveillance of emerging zoonotic diseases• World Bank adopting One Health approach to confront

zoonotic diseases; GLEWS

• One Health/One Medicine

• Salmonella enteriditis in eggs in US

• Food safety/Foodborne illness reduction

• Pandemic Influenza, H1N1, Avian Influenza , ,

• Counter-terrorism; biologic, agricultural, nuclear

• Natural / Intentional Emergencies/Preparedness and Natural / Intentional Emergencies/Preparedness and Response

• Antimicrobial use, antibiotic resistanceAntimicrobial use, antibiotic resistance

• Animal welfare