One World, One Medicine, One Health

When you’re in the midst of a busy day in your clinic—running between exam rooms, taking calls from clients, trying to keep up with medical records—One Health might be the last thing on your mind. This interdisciplinary concept that examines the relationships among animals, human beings, and the environment might seem more a subject for philosophical opinion pieces in academic journals than anything relevant to your bustling veterinary practice. But according to experts, you as a veterinarian are likely already “doing” One Health—even if you’re not stopping to think about it.

Case in point: you are no doubt aware that tickborne disease is spreading in the U.S., thanks to climate change and other ways people are impacting the environment.¹ This means the local dog population, including your canine patients, may be at greater risk of Lyme disease. And as canine Lyme incidence reporting becomes more robust, experts are discovering that dogs are a sentinel of impending risk to humans in the same geographic areas.² People, the planet, and pets are all connected in this One Health scenario, and you as the veterinarian are right smack in the middle of it.

“Every veterinarian is a One Health practitioner by nature,” says Susan VandeWoude, DVM, PhD, DACLAM, director of the One Health Institute at Colorado State University. “I think it’s part of our veterinary psyche. We have the broadest training. We learn population medicine. We learn individual medicine. And we have to understand people—because no animal comes knocking on your door asking you to take a look.”

To that end, here are 5 ways you may already be practicing One Health—or ways to do so even more.

1. Right in your practice: Zoonotic disease, antimicrobials, and the bond

For many veterinarians, the first thing that comes to mind when someone says “One Health” is the prevention and management of zoonotic disease, whether that’s on a global level involving international health agencies or right in the exam room with your next patient. And with the COVID-19 pandemic gripping the world right now, zoonotic disease is in the spotlight like never before.

“It’s a classic One Health problem,” Dr. VandeWoude says. “People were going to a wildlife market, got exposed to a reservoir host, got the infection, and then for a variety of reasons it spread worldwide. Now it’s getting into big cats in zoos as well as domestic cats, and to solve this problem takes all kinds of interventions.”

While government officials do battle with the novel coronavirus in the name of public health, veterinarians are becoming alert to the possibilities of COVID-19 in cats or ferrets in their practices, Dr. VandeWoude says. But most veterinary practitioners have been on guard against zoonotic disease from the first day they set foot in practice, whether they’re vaccinating against rabies, educating pregnant clients about toxoplasmosis, or deworming to eliminate intestinal helminths. When they prevent and treat zoonotic disease in their patients, they’re also protecting the health of pet owners.

Another classic area where veterinary practitioners play a role in One Health is antimicrobial stewardship, especially in food animal medicine. The recently enacted Veterinary Feed Directive helps ensure that veterinarians stay central to the process so that these drugs stay efficacious in people for as long as possible.

“When we treat livestock with these compounds, are we promoting resistant bacteria? And what’s the role of the veterinarian in managing that?” Dr. VandeWoude says, adding that veterinarians need to be involved in the critical assessment of underlying assumptions. For example, she notes, studies show that the use of macrolides in feedlots presents a low risk of contributing to resistant infections and compromised human treatment.^3,4

Finally, when veterinarians facilitate and celebrate the human-animal bond, they promote wellbeing across species in a way that enhances the health of all. At Colorado State, researchers are providing veterinary care for homeless pet owners and assessing whether there’s a broader impact. “Improving the health of their pets could inadvertently help them improve their own health and wellbeing through the dynamics of the human-animal bond,” Dr. VandeWoude says.

2. Through advocacy: Supporting One Health legislation

A bill introduced in July 2019 in the U.S. House of Representatives — the One Health Act or H.R. 3771 — calls for collaboration among major U.S. health agencies to prepare for future zoonotic disease outbreaks.

If agencies such as the U.S. Department of Agriculture and the Centers for Disease Control and Prevention (CDC) worked together more closely, groups with the technological know-how could be utilized in a way that prevents illness and deaths and helps the U.S. avoid economic shutdown. For example, biotech firms could be called on to create the building blocks of potential vaccines based on emerging pathogens so they’re ready to deploy when needed.

The NAVC created an advocacy platform called Embrace to help inform veterinary professionals and allies on related issues and simplify the path to contacting local, state, and federal representatives (see “Embrace Your Veterinary Community,”).

3. In the community: Being a spokesperson

In situations such as the COVID-19 outbreak, veterinarians are excellent community spokespeople. “Veterinarians can tell people what roles we are playing in COVID,” Dr. VandeWoude says. “It’s everything from trying to develop vaccines to working in labs to donating respirators to determining whether dogs and cats might have the infection to worrying whether livestock might be impacted.”

She says veterinarians can understand disease outbreaks and offer perspective on news reports “just as effectively as MDs in their community.”

“I would encourage people to have more confidence and recognition of how important we are in society, not just on the individual level but on a global basis,” she says.

4. Through science: Participating in translational research

Many veterinarians who have embraced One Health and tried to engage medical doctors in their communities tell of receiving a less-than-enthusiastic response from their physician counterparts. But Dr. VandeWoude says that may be changing as more academic institutions find success in research collaborations that cross species.

She says more funding is available to medical institutions that partner with animal health researchers in order to accelerate translational discovery that leads to treatments for human health. To that end, Colorado State’s veterinary school is working with the University of Colorado Denver medical school in efforts focused on natural animal disease models of human conditions—what Dr. VandeWoude and her CSU colleagues label the “One Medicine” aspect of One Health.

Research is currently taking place regarding osteosarcoma in dogs, inflammatory bowel disease in cats, stem cell therapies in horses, and much more—all with the potential for human application. The more common these studies become, the more likely it is that veterinarians and physicians in training will embrace One Health as a natural aspect of their distinct healthcare professions, she speculates.

In the meantime, private veterinary practitioners can explore what types of translational studies are taking place in their geographic area and help recruit patients to participate—always a challenge for veterinary researchers—and make a direct contribution to One Health advancements.

5. In public health: Partner with organizations

The mission of the Pet Industry Joint Advisory Council (PIJAC) is based on a memorandum of understanding with the CDC and calls for the education of pet industry stakeholders about best practices for animal handling and management. The NAVC and other veterinary organizations, as well as individual veterinarians, serve on PIJAC’s Zoonosis Committee to shape these guidelines and best practices.

The committee’s goals are to provide educational materials for retailers and the public; to provide best management practices for retailers, breeders, and distributors; to develop web-based educational resources; and to improve communications during a zoonotic outbreak, says Savonne Caughey, director of governmental affairs for PIJAC.

When there is a zoonotic disease outbreak, the CDC contacts PIJAC, which works with the national organization of state veterinarians to get the word out. During a recent outbreak of Salmonella in pet turtles (not necessarily turtles sold in pet stores—more likely those obtained at a swap meet, flea market, or other unregulated channel, Caughey says), PIJAC put together an alert and shared it with the appropriate channels, including veterinarians.

“We are all responsible to communicate accurate information, whether individual veterinarians or associations or public health organizations,” Caughey says. “We should all be singing from the same hymnal.”

The free flow of information among these groups of experts is supremely important, Caughey says. “We all have a role to play in protecting human health, animal health, and public health,” she says. “The more communication we have between various stakeholder groups and public health partners, the better.”

The Future

Dr. VandeWoude is hopeful that one of the silver linings of the COVID-19 pandemic is more widespread recognition of One Health as an important issue. This may lead to more consideration of funding at the federal level and more support for legislation such as the One Health Act. “I’m an eternal optimist, but I’m semi-hopeful that these efforts will gain traction and there will be more resources available, which will strengthen our profession,” she says. “People will become more knowledgeable about our expertise, and veterinary medicine can move from the James Herriot era into the One Health era.”