One Health: Lessons Learned from East Africa.

Africa is faced with many of the most daunting challenges of our time. It comprises roughly 15% of the world's human population, and most of its countries are perpetually ranked "Low" on the United Nations' Human Development Index. On the other hand, Africa has arguably the largest proportion of intact natural ecosystems, biodiversity, and sociocultural capital and the lowest impact on global warming of any continent. Thus, African leaders are faced with competing demands and values among a multitude of complex issues, such as high human population growth, extreme poverty, food insecurity, land use policy, climate change, and biodiversity conservation. In this context, building sustainable national systems for human and/or animal health is one of the grand challenges of this generation. Today's complex global health and development challenges require long-term commitment and a range of approaches that are too broad for any one discipline, institution, or country to implement on its own. The One Health concept recognizes the interconnectedness of global health issues and, as such, promotes the importance of and need for international, interdisciplinary, and cross-sectoral communication and collaboration at local, national, and international levels. By taking advantage of natural cultural tendencies for shared leadership, resource allocation, and community values, African leaders are currently proactively demonstrating the principles of One Health, and thus becoming a model for this global vision. And by focusing on partnerships rather than donor-recipient relationships, they are fostering the development of shared priorities and are increasingly driving their own health agenda to fulfill their own needs.

BSE and variant CJD: emerging science, public pressure and the vagaries of policy-making.

Classical bovine spongiform encephalopathy (BSE) was first recognized in 1987 in the United Kingdom and ultimately spread to cattle across Europe and to the Middle East, North America and Japan through the movement of infected animals and contaminated meat and bone meal. The human expression of BSE, variant Creutzfeldt-Jakob Disease (vCJD), likewise was first identified in the UK and now has been observed in many countries due to human exposure to BSE contaminated products or to vCJD contaminated human tissues through transplantation and injection. BSE provides an example of an emerging infectious disease that demonstrates the challenges of policy-making in the face of rapidly changing science and public outrage pushing for action. Lessons learned through the BSE epidemic include: (1) beware of facts as new science continues to emerge; (2) complex issues rarely have simple solutions; (3) evaluate epidemics from a macro-epidemiologic perspective to understand their complexity and devise effective risk management strategies; (4) options always exist for prevention/control; (5) risk communications play a vital role before and during an emerging disease epidemic; and (6) risk management progress involves both science and politics. Adoption of One Health approaches involving systems thinking and shared leadership hold the most promise for effectively managing complex emergency global health issues like BSE.

Incorporating risk communication into highly pathogenic avian influenza preparedness and response efforts.

A highly pathogenic avian influenza (HPAI) outbreak in the United States will initiate a federal emergency response effort that will consist of disease control and eradication efforts, including quarantine and movement control measures. These movement control measures will not only apply to live animals but also to animal products. However, with current egg industry "just-in-time" production practices, limited storage is available to hold eggs. As a result, stop movement orders can have significant unintended negative consequences, including severe disruptions to the food supply chain. Because stakeholders' perceptions of risk vary, waiting to initiate communication efforts until an HPAI event occurs can hinder disease control efforts, including the willingness of producers to comply with the response, and also can affect consumers' demand for the product. A public-private-academic partnership was formed to assess actual risks involved in the movement of egg industry products during an HPAI event through product specific, proactive risk assessments. The risk analysis process engaged a broad representation of stakeholders and promoted effective risk management and communication strategies before an HPAI outbreak event. This multidisciplinary team used the risk assessments in the development of the United States Department of Agriculture, Highly Pathogenic Avian Influenza Secure Egg Supply Plan, a comprehensive response plan that strives to maintain continuity of business. The collaborative approach that was used demonstrates how a proactive risk communication strategy that involves many different stakeholders can be valuable in the development of a foreign animal disease response plan and build working relationships, trust, and understanding.

Joint degree programs in public health.

Public health and veterinary medicine share a focus on population health and primary prevention, along with a commitment to preparedness, response, and recovery in the event of disease outbreaks. Public-health and veterinary professional degree programs share commonalities in their educational accreditation requirements related to epidemiology and public-health practice. The initiation of a number of joint professional degree programs over the last five years, including the joint Doctor of Veterinary Medicine and Master of Public Health (DVM/MPH), represents an exciting development for inter-professional education for veterinarians interested in public health. Various models for joint DVM/MPH educational programs are discussed, including pre-veterinary public-health credentialing, integrated programs, and post-DVM executive programs. Collaborations between colleges of veterinary medicine and schools of public health show great promise in both educational and research innovation.

A flexible approach to training veterinarians in public health: an overview and early assessment of the DVM/MPH dual-degree program at the University of Minnesota.

As a result of the growing need for public-health veterinarians, novel educational programs are essential to train future public-health professionals. The University of Minnesota School of Public Health, in collaboration with the College of Veterinary Medicine, initiated a dual DVM/MPH program in 2002. This program provides flexibility by combining distance learning and on-campus courses offered through a summer public-health institute. MPH requirements are completed through core courses, elective courses in a focus area, and an MPH project and field experience. Currently, more than 100 students representing 13 veterinary schools are enrolled in the program. The majority of initial program graduates have pursued public-practice careers upon completion of the program. Strengths of the Minnesota program design include accessibility and an environment to support multidisciplinary training. Continued assessment of program graduates will allow for evaluation and adjustment of the program in the coming years.

The need for public-health veterinarians as seen by future employers.

Future employers of veterinarians working in public health see a fast-growing demand. Emerging zoonotic diseases, bio-security threats, and food-safety problems all require the expertise of veterinarians with a focus on complex, global problems that span both human and animal health. The Public Health Task Force of the Association of American Veterinary Medical Colleges convened a group of stakeholders representing various branches of the US federal government, state and local governments, and professional societies to discuss their needs for public-health veterinarians. This article discusses those needs, the broader societal needs that require veterinarians with public-health expertise, and the implications of these for educational programs to train DVMs in public-health issues.

The risk communication challenges of mass animal destruction.

Mass animal destruction strategies present a major risk communication challenge. While mass culling, stamping out, and depopulation may be scientifically and economically justified during emergency response to exotic disease incursions and eradication programmes, their use may be limited in the future due to public concerns over animal welfare, environmental contamination and unintended social consequences. To address this dilemma, official veterinary services must move from unidirectional communications strategies to active engagement of all potentially affected stakeholders. Case studies of recent disease outbreaks demonstrate the critical role that communications play in influencing public reaction to disease management strategies. An evaluation of these case studies provides support for the implementation of risk communication best practices: incorporating risk communications into the policy-development process, conducting pre-event planning, fostering partnerships with the public, collaborating with credible sources, meeting the needs of the media, listening to and addressing public concerns, communicating with compassion and empathy, demonstrating honesty and openness, acknowledging uncertainty and providing messages that give people meaningful things to do. Implementing the risk communication best practices requires veterinary services to move from a more technocratic approach to a participatory model where the potentially affected public play an active role in risk assessment and policy making.

Evaluation of veterinary public practice education programs.

OBJECTIVE: To describe the number and types of veterinary professional degree and certificate programs providing education in the area of public practice to veterinarians and determine the availability of these programs via distance learning. PROCEDURES: Web-based internet searches were performed for programs for veterinary public practice or public health, population medicine, or Master's degree in Epidemiology. The information reviewed was derived from individual school and program Web sites and from personal e-mail correspondence with school administrators. RESULTS: 17 professional degree and 4 certificate programs were available to provide education and training in the areas of public practice and population medicine to veterinarians. Twelve of these programs have begun since 1998. Of the 17 professional degree programs, 7 are located in the United States and 10 are located in other countries. Nine of the professional degree programs provide education through traditional teaching methods, and 8 provide education and training through distance learning. CONCLUSIONS: During the preceding 5 years, the number of programs available to educate and train veterinarians in the areas of public practice and population medicine has increased. Distance learning is being used to increase capacity and reach a broader audience of veterinarians. With the increase in programs has come an increase in capacity to educate and train veterinarians in the fields of population medicine and public practice. The impact and sustainability of this increased capacity have not been evaluated.

Evaluation of the use of an on-farm system for bacteriologic culture of milk from cows with low-grade mastitis.

OBJECTIVE: To determine factors associated with implementation and use of an on-farm system for bacteriologic culture of milk from cows with lowgrade mastitis, including information on how producers used the on-farm bacteriologic culture system to guide antimicrobial selection practices and the resulting impact on patterns of antimicrobial use. DESIGN: Retrospective cohort study. SAMPLE POPULATION: Producers of 81 dairy farms. PROCEDURE: Farms that used an on-farm system for bacteriologic culture of milk from January 2001 to July 2003 were surveyed. RESULTS: Over half of those producers continuing to use the on-farm culture delayed antimicrobial treatment pending results of bacteriologic culture. Most other producers initiated empirical antimicrobial treatment while bacteriologic culture results were pending. Several barriers to the use of an on-farm system were identified. Significant reductions in rates of antimicrobial use were detected when comparing antimicrobial use rates before and during use of the on-farm system. Most producers chose to treat cows with mastitis caused by gram-positive pathogens with antimicrobials, whereas treatment choices for cows with mastitis caused by gram-negative bacteria and in cases in which no growth was detected varied. CONCLUSIONS AND CLINICAL RELEVANCE: Readily available results permit antimicrobial selections to be made on the basis of the causative agent of mastitis. Adoption of an on-farm system for bacteriologic culture of milk may result in significant reductions in the percentage of cows treated with antimicrobials. Decreasing antimicrobial use may have several benefits including preventing unnecessary discarding of milk, decreasing the potential for drug residues in milk, and improving treatment outcomes as a result of targeted treatments.

The development of an exposure risk index as a rational guide for biosecurity programs.

Population disease risk can be ranked using an exposure risk index that uses quantitative data on exposure risk factors and the proximity of susceptible animals to disease reservoirs. The reservoir represents the available microbial load (a quantity), derived from the mass of the contaminant, the percentage available for dissemination, the initial microbial content of the contaminant, and its age and half-life. The proximity measurement uses distance from the reservoir to calculate an area over which the microbial exposure might be spread. Dividing the reservoir by the proximity measurement, one obtains an exposure risk measurement that is significantly correlated with veterinarians' perceptions of risk. This exposure risk ranking can be used to rank population disease transmission risks associated with events and practices in animal production. The advantages of the exposure risk index are that it derives an exposure risk measurement from available objective information, it provides a way to compare disparate sources of disease exposure risk, it can be modified for specific diseases, and it provides a foundation for developing and evaluating mitigation strategies. From the exposure risk measurement, mitigation strategies and available resources can be focused appropriately to prevent or control disease. Biosecurity programs and disease control measures can be directed at those areas of greatest risk for spreading disease.

Protecting US cattle. The role of national biosecurity programs.

The bovine practitioner has a critical role to play in promoting biosecurity at both the farm level and the national level. Successful exclusion of exotic diseases, biocontainment of endemic diseases, and emergency preparedness rest soundly on bovine practitioners as part of the national biosecurity team. Bovine practitioners must voice their opinions on the strengths and weaknesses of existing and proposed national biosecurity programs. Healthy debate about national biosecurity programs and consideration of biosecurity issues by national veterinary organizations provide valuable feedback for the continual improvement of the programs and enhance their credibility. The health and productivity of US agriculture depend on national biosecurity.