Wubshet Mamo, DVM, MVSc, PhDClinical Associate Professor- Global Health

Global Health DepartmentUniversity of Washington, USA

1st IGAD International Scientific Conference on Health3-6 December, 2014, Addis Ababa, Ethiopia

The Integration of Human Medicine, Veterinary Medicine and Environmental Science:

A model for Africa

++ = ONE HEALTH

Outline of The Presentation

Human - Animal Interface

Threats to the health of both animals and humans

Veterinary Public Health

What can we learn from animals?

Are we seeing more outbreaks of disease between animals and humans?

Are these outbreaks increasing?

One Health

The integration of human medicine, animal medicine and environmental science through a One Health concept

The One Health approach

One Health and Zoonoses Activities at 17 Select International locations, April 2012-May 2013

Some of the factors for the increasing number and significance of zoonotic diseases

Collaboration between human and veterinary medicine

Successful public health interventions

Building a national capacity in Africa

Animal health and human health are closely intertwined, and the health of the environment and ecosystem is fundamental to both human and animal health

The link between human and animal populations, and with the surrounding environment, is particularly close in developing countries like Africa where animals provide transportation, draught power and clothing as well as proteins (meat, eggs and milk)

However, in both developing and industrialized countries, this close link can lead to a serious risk to public health with severe economic consequences. Reduction of these risks require communication and collaboration among the sectors responsible for human health, animal health, and the environment

Many emerging health issues are linked to increasing contact between human and animals

Human - Animal Interface

The rapid human population growth and environmental changes have resulted in increased numbers of people living in close contact with wild and domestic animals

This increased contact together with changes in land use, including livestock grazing and crop production, have altered the inherent ecological balance between pathogens and their human and animal hosts

This attributed to the emergence of diseases or infections that are naturally transmissible from animals to humans and vice-versa, classified as a zoonosis

Zoonoses are common to human and animals

Human - Animal Interface…………cnt’d

Over 200 zoonoses have been described and they are caused by all types of agents; bacteria (e.g., salmonellosis and campylobacteriosis), parasites (e.g., cysticercosis/taeniasis), fungi (e.g., dermatophytoses), viruses (e.g., rabies, Ebola) and unconventional agents such as the agent of bovine spongiform encephalopathy

There are about 1,415 microbes that are known to infect humans, of which about 61% come from animals

About 75% of the new diseases that have affected humans over the past 10 years have been caused by pathogens originating from an animal or from products of animal origin

Zoonoses still represent significant public health threats, but many of them are neglected, i.e. they are not prioritized by health systems at national and international levels.

Human - Animal Interface…………cnt’d

For example, rodents transmit plague (is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis that circulates in animal reservoirs, particularly in rodents ) and typhus to humans, and domestic livestock are the original source of crowd diseases such as measles, mumps and pertussis

Example: In 1997 the avian influenza (HPAI H5N1) epidemic that began in Hong Kong affected 18 people, killed 6 and provoked the culling of 1.5 million birds and this outbreak forced the global community to recognize that animal health and human health are linked.

Zoonoses affect hundreds of thousands of people especially in developing countries, like Africa, although most of them can be prevented

Human - Animal Interface…………cnt’d

Organisms circulating in domestic and wild animal populations can potentially pose a threat to both animal and human health

As humans increasingly move into areas that are only sparsely populated, the risk of exposure to previously unknown agents is increased

The changes in eco-systems resulting from human activity such as significant changes in land use, expansion of large and intensified animal-production units, microbial and chemical pollution of land and water sources may result in the emergence and spread of novel pathogens

Both the animal health and human health sectors have an interest in, and responsibility for, monitoring and controlling these pathogens.

Example: deforestation for agriculture contributes to the emergence of zoonotic, vector-borne diseases and populations living within or near these fragmented forests are at a much higher risk of contracting zoonotic diseases because of increased contact with vectors at forest edges and the reduced biodiversity of the area.

Threats to the health of both animals and humans

Veterinary public health is an essential part of public health and includes various types of cooperation between the disciplines that link the health triad, people-animals-environment, and all of its interactions.

Veterinary public health is a component of public health that focuses on the application of veterinary science to protect and improve the physical, mental and social well-being of humans (Wikipedia)

Veterinary public health concerns the surveillance and control of zoonoses at many different levels, via disease control programs at farm level or wild animals or in the abattoir.

Veterinary Public Health

Animals share human environment, food, and water, they are effective sentinels for environmental, human, and public health problems

Animals tend to have greater exposures to particular environments and are more susceptible than humans

Because of shorter life spans, they are quicker to show the effects of exposure to some diseases and environmental hazards

They can serve as early warning signs of potential human illness.

Example: birds often die of West Nile Virus (the virus carried from infected birds to people by mosquitoes) before humans get sick with West Nile virus fever.

Another example: a dog exposed to asbestos develops cancer 20-30 years sooner than a human. At the same time, humans can sometimes be sentinels for disease risk in animals - it works both ways. Therefore, Human health professionals and veterinarians have a lot to learn from each other.

What can we learn from animals?

Diseases between animals and humans are not new. Ever since we became an agricultural society living closely with domestic animals, we've been sharing diseases with animals

About 70 percent of the emerging infectious diseases over the last few decades have come from animal sources.

Example: Severe acute respiratory syndrome (SARS), bird flu, Nipah virus outbreak in 1999 in Malaysia, West Nile virus, and now Ebola.

Are we seeing more outbreaks of disease between animals and humans?

Outbreaks increase because of changing ecology, changing climate and changing ways we raise animals

Habitat destruction, such as agricultural intensification brings us into closer contact with animals hosting these viruses.

Example: Per capita, we're eating more meat as the global standard of living goes up. In 1960, there were about the same number of people as chickens on the earth. Since then, the number of chickens in the world has quadrupled (increased by 4 times) to more than 20 billion while the number of people has only doubled. This has required raising food animals in more crowded environments, which amplifies the risk of certain infectious diseases such as influenza.

Are these outbreaks increasing?

Since the 1800s, scientists have noted the similarity in disease processes among animals and humans

The human and animal medicine were practiced separately until the 20th century

In recent years, through the support of key individuals and vital events, the One Health concept has gained more recognition in the public health and animal health communities

One Health is the idea that since human, animal, and environmental health are so interrelated; we need to break down the traditional silos between animal health and human health.

One Health

One Health through the integration of human medicine, animal medicine and environmental science is dedicated to attain optimal health for people, animals and our environment

The One Health concept has become more important in recent years, because many factors have been changed the interactions among humans, animals and the environment

These changes have caused the emergence and re-emergence of pathogens, and particularly zoonotic agents and these changes occur at unpredictable rates in animal and human populations

as the global environment changes rapidly, animals share many environmental risks with humans, and we need to find ways to coexist

One Health is about what we can learn from those shared risks, and it's about protecting the environment in order to optimize the health of the animals as well as humans.

The integration of human medicine, animal medicine and environmental science through

a One Health concept

The One Health approach is now being endorsed by international health agencies including the World Health Organization, the World Animal Health Organization (OIE), and the UN Food and Agriculture Organization (FAO) and the US Centers for Disease Control (CDC)

On a national level, countries as diverse as Sweden and Kenya have developed national One Health strategies

In addition, the Emerging Pandemic Threat (EPT) program of the US Agency for International Development (USAID) has created a One Health Central and Eastern Africa network of public health and veterinary universities (OHCEA) that is developing academic capacity in a number of African countries including Rwanda, Uganda, Tanzania, DRC, and Ethiopia

Example, in Ethiopia, member institutions of this network include the College of Veterinary Medicine at Mekelle University, University of Gondar as well as the Jimma University College of Public Health and Medical Sciences and more.

One Health approach

One Health Office Division of High-Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention (CDC)

One Health and Zoonoses Activities at 17 Select

International locations - April 2012-May 2013

The growing human populations and expanding into new geographic areas results more people live in close contact with wild and domestic animals and this close contact provides more opportunities for diseases to pass between animals and people

The changes in climate and land use, such as deforestation and intensive farming practices, and these disruptions in environmental conditions and habitats provide new opportunities for diseases to pass to animals and people

Global travel and trade have increased, and as a result, diseases can spread quickly across the globe

Increasing human intimacy with companion animals.

Some of the factors for the increasing number and significance of zoonotic diseases

Veterinary medicine has a long and distinguished history of contributing to the maintenance and promotion of public health and therefore considerable communication and collaboration between medical and animal health (veterinary) professionals is vital

Traditionally when an outbreak of disease occurs, public health and veterinary services respond as separate entities – no coordinated response occurs between services and the redundancy of efforts delays diagnosis and response, in which lives and economically important resources may be lost

It is advantageous to bring together veterinary professionals and the medical community for public health response to insure better preparedness and more effective surveillance systems for diseases

This can involve obtaining and sharing data about the health of the human populations, the animal populations, and the ecosystem of a region, that would lead to a better understanding of current health status as well as shared environmental health risks across species.

Collaboration between human and veterinary medicine

Among others, require the cooperation of human health, veterinary health and environmental health communities

Require a wide reaching strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment

Require the integration of human medicine, animal medicine and environmental science as One Health concept

Joint educational efforts between human medical, veterinary medical schools, and schools of public health and the environment

Joint cross-species disease surveillance and control efforts in public health

Successful public health interventions

Joint efforts in clinical care through the assessment, treatment and prevention of cross-species disease transmission,

Joint efforts in better understanding of cross-species disease transmission through comparative medicine and environmental research,

Joint efforts in the development and evaluation of new diagnostic methods, medicines and vaccines for the prevention and control of diseases across species

Joint communication efforts in journals, at conferences, and via allied health networks,

Joint efforts to inform and educate the public sector and political leaders through accurate media publications.

Successful public health interventions……cnt’d

Different countries of Africa are facing health challenges, including population growth, poverty and dependence on small scale livestock production for nutrition,The close contact between humans and livestock, there are a number of zoonotic diseases shared between animals and humans that could be of concern,Environmental changes including drought, overgrazing, and deforestation are commonIt is advantageous to bring together veterinary professionals and the medical community for public health response to insure better preparedness and more effective surveillance systems for diseases.

Building a national capacity in Africa on the integration of human medicine, animal medicine

and environmental science, why?

One Health provides a model for considering ways to maximize and monitor the health of human populations living in close proximity with domestic animals in a sensitive ecosystem. It provides a platform for transdisciplinary cooperation and collaboration between government and professional organizations that may have separate missions involving one or more of the sectors of human, animal, or environmental health.

Example, the Ministry of Agriculture typically deals with livestock health and disease issues, while the Ministry of Health manages human health affairs; the Ministry of the Environment manages conservation of natural resources. On the health services level, physicians and other human health care providers not often coordinate activities with veterinarians or other animal health professionals including livestock agriculture or vector control experts.

Building a national capacity in Africa………cnt’d

In Africa, where the human animal contact is intense and in the face of the growing human and animal populations and rapid environmental change, the linkages between human, animal, and environmental health through integration of human medicine, veterinary medicine and environmental science should be a concern and the One Health approach is a feasible approach.

Considering the integration of human medicine, veterinary medicine and environmental science, under the umbrella of One Health related agencies, institutions and human, animal and environmental health professionals would work together to develop mutually beneficial strategies for moving forward to encourage healthy humans, animals, and ecosystems.

Building a national capacity in Africa………cnt’d

Thank you for your attention!