Start the ‘One Health’ Concept to Fight Against Zoonotic Diseases
Saturday, 7 March 2009
The newest global development is heading towards the importance of widely and continuously introducing a new concept, ‘one world, one medicine, one health’. Experts in many countries demand a more integrated and synergized cooperation between veterinarians and doctors to anticipate the emergence of zoonotic diseases with epidemic potentials.
Until this day, human medicine and veterinary medicine are still seen as two separated sectors or entities almost in all countries. Obviously veterinarians by law are not allowed to treat humans and doctors almost never treat animals. But in reality, there are many overlapping between these two sectors, moreover on issues concerning public health and control of animal diseases that could be transmitted to human (zoonoses).
Start the ‘one health’ concept is a movement to build partnership between doctors and veterinarians. It should be approved by all parties, either medical, animal health, or public health organizations. The road towards ‘one health’ should be started by developing collaboration and reducing communication barriers between doctors and veterinarians.
The century of zoonotic diseases
We know that more than 35 new emerging diseases – including Ebola, monkeypox, BSE, West Nile virus, Nipah virus, SARS, HPAI – are known to be zoonotic. The ‘one health’ concept is an immediate response from the increasingly concern on the threat of new emerging diseases in the world and also threats right in front of us such as disease outbreaks that are hazardous to the health of humans and domestic animals. These threats could affect both regional and global economy.
Human behavior in the world widely contributes to the emergence of zoonotic disease, including population pressure, deforestation, agriculture intensification, global trade of wild animals, and over consumption of meat.
One target of the ‘one health’ concept is to integrate the education system within and between medical, veterinary, and public health schools. This is to encourage more communication between the disciplines, either through seminars, conferences, journals, classes, or networking in health and public welfare sectors. More over, the ‘one health’ concept promotes the importance of collaborative research on disease transmission between species, surveillance, and an integrated control system between humans, domestic animals, and wild animals. This concept will start and initiate comparative researches and it would umbrella all researches on diseases affecting human and animals, including diabetes, cancer, autoimmune disorders, and obesity.
The ‘one health’ concept will also encourage stronger partnership between academicians, industry and the government in developing and evaluating new diagnostic methods, medications, and vaccines to prevent and control interspecies diseases, along with the collaborative effort to inform and educate political and public leaders.
The ‘one health’ concept will encourage partnership between doctors and veterinarians towards better research and surveillance on zoonoses and emerging diseases. To reinforce defense with the ‘one health’ concept is a key goal that must be continuously stressed to achieve global health. There are many experiences that could be used by both parties; therefore communication between doctors and veterinarians must be improved. For example, previously SARS was not known as a virus from animals, but after the disease emerged, clinical and public health officers then had to learn more about corona virus infection in animals. Hence a clinician/doctor should realize that when he/she has a patient infected with a zoonotic disease, a veterinarian would know more about the disease then they would. While patients maybe haven’t noticed that veterinarians could provide information regarding their health.
Limits of Professions
Even though the limit between medical science and veterinary medicine is now clearer compared to previous centuries, actually separation between the two disciplines had started since the 20th century. There were a number of reasons for the separation. Geographically, medical schools and veterinary schools were never placed within the same academic scope and management. Another factor was social influence. Ecology and microbiology was not taught in medical school such as in veterinary school, thus medical students are not too aware of the importance of zoonoses. Also, focus of the veterinary school has shifted more to livestock and companion animals in response to the social needs of the public.
The following table illustrates existing barriers between the medical profession and the veterinary medical profession. Also included are ways to bridge these two professions.
hubungan yang tidak serasi (misalnya antara Departemen Kesehatan dan otoritas veteriner)
Kerjasama, integrasi dan kemitraan kegiatan pencegahan dan pengendalian
dokter: kesehatan manusia
dokter hewan: produksi ternak
Keuntungan bersama: manfaat untuk kesehatan hewan dan manusia
Persaingan (institutional dan profesional),
Training: Kurang memberikan penekanan terhadap penyakit zoonotik
Penguatan kapasitas: training umum tentang penyakit-penyakit zoonosis baik untuk pekerja kesehatan maupun veteriner
Lemahnya infrastruktur kesehatan masyarakat veteriner
Pengendalian penyakit-penyakit zoonotik hanya berdasarkan manajemen pemadam kebakaran/manajemen krisis
(Diadaptasi dari: WHO/FAO/OIE, Control of Neglected Zoonotic Diseases, 2005)
As a collaborative effort in 1967, the expert commission from FAO and WHO had identified and were concerned of the presence of more than 150 zoonotic diseases in the world. In 2000, it was known that more than 200 disease occurring both in human and animal could be transmitted from human to animal and from animal to human. All of this indicates that there was more than a 30 % increase in the emergence of zoonotic diseases for the last thirty years of the 20th century. The H5N1 virus, which has spread in Asia, Europe, and Africa in the 21st century, has provided a strong fact that animal health affects human health, and of course, the knowledge, which every should know, that almost all bioterrorism agents are zoonotic.
In response to the avian influenza outbreaks happening lately, many countries have formed an ‘ad hoc’ committee involving many sectors in the control and eradication program; some of the sectors involved are the Department of Agriculture, Department of Health, Department of Information and Communication, Department of Education, Department of Trade, etc. Indonesia followed in 2006 by establishing the National Committee on Avian Influenza Control and Influenza Pandemic Preparedness (Komisi Nasional Pengendalian Flu Burung dan Kesiapsiagaaan Menghadapi Pandemi Influenza / Komnas FBPI). For it to be effective, an inter sector cooperation such as this must be legalized with a clear and clarified method of operation and responsibility. Not only to response to crisis, but also to function as a tool for risk analysis, prevention, coordination, and integrated control.
Human, animal, and environment,
The ‘one health’ concept has existed since centuries ago, but such collaboration is becoming more imperative in the 21st century. Veterinary medicine has its root in human health. Slaughter of livestock to control Foot and Mouth Disease or Rinderpest, a very virulent disease in cattle, had started since the 18th century as a way to protect the food supply. The first veterinary school in Lyon, France, was established to ensure the health of livestock as food for the people. Louis Pasteur studied fowl cholera in 1880. After he injected chickens with weakened disease agents, he found that the chickens were able to develop immunity against the disease. His concept was then widened for anthrax and rabies. Many experts follow this hypothesis and then developed a frame to better understand yellow fever and equine encephalitis.
Lately, the ‘eco-health’ or ‘ecosystem health’ concept also emerged, with the concern that continuous development should be made for the benefit of human, animal, and environmental health, where all of these factors intertwine, and this extends the ‘one health’ concept to the whole ecosystem, including wildlife. Climate change is also a factor which might influence the emergence of zoonotic disease and is part of the ‘one health’ concept.
Vision to the future
The world’s dependency and complexity demands a new mindset and future vision about the ‘one health’ concept. This concept should be fought for so it could be understood better by both disciplines and also to convince all parties without exception. In the International Ministerial Conference on Avian and Pandemic Influenza in New Delhi, India, at the end of 2007, the ‘one health’ concept was once again brought up and analyzed, and it was concluded that the world must adopt this concept to overcome the crises of emerging and re-emerging zoonotic diseases.
Understanding the ‘one health’ concept does not mean just a close relationship, but it needs deeper thought at the operational strategy level. To exploit the synergism between human and animal health, a strong cooperation is needed at all levels, including international organizations, government, research and technology, health system, and education.
Of course our goal above should encourage the veterinary profession to take a role in the front line to ensure that both parties accept this concept and with a central goal to globally improve the health of human, animal, and the environment. Lonie J. King (2008), an expert in epidemiology said: “Animal health and public health is a continuum; we should not look at it as separated systems”.
Chairman of CIVAS Directive Board
Working at OIE Regional Coordination Unit
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