Global Veterinary and Medical Perspectives on One Health

Increased population;

UrbanizationIntensified livestock production;

Ecosystem encroachment

Crisis in use of natural resources (Zinsstag et al., 2011)

M anA nimalP lants

Non-infectious

Bacteria & Rickettsia

Fungi

Helminth

Virus & Prion

Protozoan

538

307

287217

66

(Chugh,

T.D.

2008)

• 60.3 % of infectious diseases are zoonotic : 71.8 % originate in wild life.

(Jones et al., 2008)

• 75 % (132/175) of the emerging diseases are zoonotic. (Asokan et al., 2011)

• Direct loss of $20 billion with over $200 billion indirect losses in zoonosis.

(World Bank, 2010)

Pie diagram showing rate of death due to causes (Chugh T.D., 2008)

Wild life EID

Domestic

animal EIDHuman EID

Translocation

Agricultural

IntensificationGlobal travel;

Urbanization;

Biomedical

manipulationTechnology &

industry

Encroachment;

Introduction;

Spill over and

spill back

Human

encroachment;

Ex situ contact;

Ecological

manipulation

(Daszak et al., 2000)

HOST-PARASITE-ECOLOGICAL RELATIONSHIP

HISTORY • Ancient healers - priests : Slaughter sacrificial animals (Schwabe, 1984)

• Kahun Papyrus (1900 B.C.) : Chimeric animals & human in myths;

Vector borne diseases

(Driesch and Peters, 2003)

• King Adadapla- iddina (1068-1047 B.C.) : Constructed temple for

Goddess Gula - healer of Rabies (Day, 2011)

Chinese Zhou dynasty (11- 13th Century) :

– Integrated public health system

– Principles of yin-yang : Acupuncture in animals & man

“ The foundations of veterinary medicine are as comprehensive and subtle

as those of human medicine and it is not possible to place one above the

other.” (On the origin and development of Medicine: Xu Dachun)

(Driesch and Peters, 2003)

HISTORY (contd)…

• Arab : Kitab al Baytara ( )

• Greek scholars: Aristotle (384-322 B.C.) & Hippocrates (460-367 B.C.)

– Public health on clean environment

– Promoted comparative medicine

• Galen (130-200 A.D.) : extended idea of Hippocrates

• Leonardo da Vinci (1452-1519 A.D.) : Comparative anatomy

HISTORY (contd)…

• Giovani Maria Lancisi (1654-1720) :

Veterinarian

Use of mosquito nets for malaria control

Pioneer in RinderPest control

• John Hunter (1728-1793) : Comparative medicine

• Edward Jenner FRS (1749-1823) :

Small pox vaccination

HISTORY (contd)…

1761 January 2011 January

INCEPTION OF VETERINARY SCIENCES……

“Either medicine will mutually enlighten and perfect the other when we

discard a derisory, harmful prejudice.” (Claude Bourgelat)

(1712-1779)

HISTORY (contd)…

• Rudolf Virchow (1821-1902) :

Father of comparative medicine & cellular pathology

Coined “Zoonoses”

Regular meat inspection

“Between animal and human medicine there is

no dividing line, nor should there be. The object

is different, but the experience obtained

constitutes the basis of all medicine.” (Virchow)

HISTORY (contd)…

• William Osler (1849-1919) :

Father of Veterinary pathology in North America

• Louis Pasteur (1822-1895);

• Robert Koch (1843-1910);

• John McFadyean (1853-1941) :

Lab confirmation of Anthrax;

Zoonotic potential of bovine T.B.

“Veterinary medicine and human medicine

complement each other and should be considered as

one medicine” (Osler)

HISTORY (contd)…

• Calvin W Schwabe (1927-2006): One Health

“ …there is no difference of paradigm between human

and veterinary medicine , and is extension of notions

of comparative medicine. Both sciences share, as a

general medicine, a common body of knowledge in

anatomy, physiology, pathology and the origin of

diseases in all species.” (Schwabe, 1984)

(Veterinary Medicine and Human Health, Schwabe, 1984)

HISTORY (contd)…

• James H Steele (1913- 2013):

International doyen of VPH

Founder of CDC VPH

One World, One Medicine, One Health

(Monath et al., 2010)

• Frederick A. Murphy & Karl M. Johnson

(Kahn et al., 2009)

HISTORY (contd)…

• Stephen S Morse (1993) :

ProMED - Programme for Monitoring Emerging Diseases

“Global electronic reporting system for outbreaks of Emerging Infectious

Diseases and toxins” (Dell, 2010)

HISTORY (contd)…

Being admitted to the profession of veterinary medicine, I

solemnly swear to use my scientific knowledge and skills for

the benefit of society through the protection of animal

health and welfare, the prevention and relief of animal

suffering, the conservation of animal resources, the

promotion of public health, and the advancement of medical

knowledge........ (AVMA Veterinarian’s Oath , 2010)

• Wildlife Conservation Society (2004) at Rockefeller University

• Building interdisciplinary bridges to health in Globalised world

• ONE WORLD - ONE HEALTH

• Promote the impact of land use & wildlife health on human

• Holistic approach to prevent epidemic/epizootic disease and ecosystem

integrity.

MANHATTAN PRINCIPLES

• AMA (June 25, 2007) House of Delegates approved resolution

• AVMA (July, 2007) implemented One Health Concept

• To revive integration of human, animal or environmental health

(Klement et al., 2009)

• Inter-professional collaboration (Hristovski et al., 2010)

• To extend research on EIDs; surveillance (Atlas et al., 2010)

• Improve scientific knowledge & clinical care

ONE HEALTH INITIATIVE

Science (Vol. 316: June 15, 2007)

“One Health is the collaborative efforts of multiple disciplines working

locally, nationally, and globally to attain optimal health for people, animals,

plants and our environment”

(One Health Initiative Task Force, AVMA, 2008)

“You can’t tell the story of human health separate from animal health

or environmental health.” (William Foege)

CDC President to declare small pox eradication programme

• Improve animal & human health by interdisciplinary collaboration

• Meet new global challenges

• Develop new centres of excellence for education and training in specific

areas

• Increase professional opportunities

• Gain scientific knowledge to create innovative programmes to improve

health (One Health Initiative Task Force, AVMA, 2008)

BENEFITS OF ONE HEALTH

SCOPE OF ONE HEALTH

Antimicrobial resistance

Bioterrorism

Biomedical Research

Comparitive Medicine

Conservation Medicine

Zoonoses

Emerging Infectious

Disease; ecology

Food safety; security

Global water/ food system

Training

Creation of scientific

knowledge

Regulatory enforcement

Climate change

Land use pattern

Occupational health

Public health

Biodiversity

Wildlife promotion

Global trade &

commerce

(One Health Initiative Task Force, AVMA, 2008)

ADDRESSING PROBLEMS OF 21st CENTURY

Population Explosion

Food Security

Infectious Diseases Pollution

Climate Change

Poverty & Starvation

Human population increases by: 2.5 people/sec; 150people/min; 9000/hr; 2,14,000/day;

78 million/year

POPULATION EXPLOSION

(Courtesy: United Nations Population Division, World Population Prospects: 2006 Revision)

Pop

ula

tio

n (

bill

ion

s)

CLIMATE CHANGE

“Climate change is perhaps the most challenging collective action problem

the world has faced” (Tony Blair)

Temperature rise 2099

Indian subcontinent:

• Increase trends in annual mean temperature;

• 0.68oC increase in the temperature per century

• 8.7% increase of Carbon-di-oxide

• Increase in extreme rains in NE & SW monsoons

• Low number of rainy days in East coast

• Increased coastal water temperature in South Asia

• Water availability: 1820 cu.m/year (2001)

1140 cu.m/year (2050)

(Courtesy: IPCC Website)

EMERGING INFECTIOUS DISEASES

• Modern jet travel allows passengers to move less than the incubation period

of diseases: Notion of exotic diseases are meaningless. (Sherman, 2010)

• Rapid dissemination of disease occurrence: ProMED; OIE

• Initiate quickly the surveillance pattern

• Should be proper, responsible, effective risk communication

(Decker et al., 2010)

Consider 50,000 known vertebrates; each with 20 endemic viruses:

Total of 1 million vertebrate viruses.

Only 2000 viruses discovered

99.8% vertebrate viruses remain to be discovered

(Atlas et al., 2010)

• Global demand for foods of animal origin is steadily growing and is

apparent that livestock sector will continue to grow (FAO, 2009)

• Demand for food expected to increase by 50% before 2020 (Scott,2008)

• Reduction of tariff associated with market reforms

• Advances in shipping – growth of animal products trade (Speedy, 2003)

• Regulations for international trade

FOOD SAFETY

• Around 3 billion people live on less than $2 per day (World Bank, 2008)

• Professionals are unwilling to offer services

• Little or no access to prevent and cure veterinary medical services

• Serve as source of transmissible disease & spread (WHO, 2006)

• Food/ agri products faced average inflation rate of 9.9% over last half

decade in India (Moorthy et al., 2011)

POVERTY

Water

HumansFood

Animals

Soil

Wild Life

Meat

Effluents

Companion

Animals

Animal

Feed

Vegetation

Direct Contact

Sewage

ANTIMICROBIAL RESISTANCE

Irwin (2005) adapted from Linton (1977)

ONE HEALTH IN INDIAN PERSPECTIVE

Wild life Non- wild life

VectorsDrug resistant agents

(Jones et al., 2008)

To be kept in mind while propagating One Health programme

• 37 Veterinary Colleges V/s 251+ Medical colleges

• Lack of inter-sectorial collaboration

• Limited field epidemiology capacity

• Awareness of zoonoses is poor (Sekar et al., 2011)

One health in Indian perspective (Contd)…

Knowledge among Medical Graduates (Kakkar et al., 2011)

• Lack of national programme on Zoonoses managed by Dept of Animal

Husbandry, Ministry of Agriculture except for Rabies in few states

• Lack of authentic data on occurrence of the diseases

• No Public Health implementing agency (Asokan et al., 2011)

TO KNOW why 1,000 Indian children die of diarrhoeal sickness every day, take a

wary stroll along the Ganges in Varanasi. As it enters the city, Hinduism’s sacred

river contains 60,000 faecal coliform bacteria per 100 millilitres, 120 times more

than is considered safe for bathing. Four miles downstream, with inputs from 24

gushing sewers and 60,000 pilgrim-bathers, the concentration is 3,000 times over

the safety limit. In places, the Ganges becomes black and septic. Corpses, of semi-

cremated adults or enshrouded babies, drift slowly by.

(The Economist; 2008 Dec. 11)

One health in Indian perspective (Contd)…

• Consensus among stakeholders

• Collaboration among professionals,

• Cooperation among interdisciplinary groups,

• Coordination among partner agencies and

• Commitment (Political and financial) by donors, partners, regional

organizations and national governments

How to reach One Health??..

For low/ middle income nations : US$ 1.3 billion spend forOne Health per year till 2020

(Contributing to One World, One Health: A Strategic Framework for Reducing Risks of Infectious Diseases at the Animal-Human-Ecosystem Interface, 2008)

Opportunities for One Health partnerships

Solving today’s threats and tomorrow’s problems cannot be accomplished

with yesterday’s approaches…..

“It is not the strongest of the species who survive, nor the most intelligent;

rather it is those most responsive to change” (Charles Darwin)

THANK YOU……..

Your attitude determines your altitude..