One-health wonders
With all the attention of late on veterinarians and physicians collaborating for a more robust public health system, JAVMA News wants to spotlight a few of the veterinary and physician champions of the one-health concept with a new feature, "One-health wonders." We could think of no better champion to launch this series than Dr. James H. Steele. Among his many notable achievements, including surviving a bout of H7N7 A avian influenza virus—the "grandfather" of avian influenza viruses—in 1959, Dr. Steele started the Centers for Disease Control and Prevention's first veterinary public health program.
YOU CANNOT HAVE GOOD PUBLIC HEALTH UNLESS YOU HAVE GOOD ANIMAL HEALTH. AND YOU CAN'T HAVE GOOD ANIMAL HEALTH UNLESS YOU HAVE GOOD PUBLIC HEALTH!
– DR. JAMES H. STEELE
What do you make of the recent focus on one health?
This goes back to the origins of veterinary medicine. When the big rinderpest outbreak hit Europe in the 1700s, it devastated Western Europe by ruining farms. They had no draft animals, they had no agriculture production, and the pope called a meeting of his medical council to ask, "What can we do for animal health?" This resulted in the creation of the first veterinary school in Lyon, France. For the first 20 years, you had to have a medical degree to study veterinary medicine! Even in Louis Pasteur's time, he hired veterinarians and physicians to work side by side with him.
The same relationship between veterinary medicine and human medicine existed in this country for many, many years. Veterinarians were recruited into the American Public Health Association, organized in 1871, to bring a broad perspective to the association. The veterinary profession suffered a bit after World War I when horses were used less. But the decades following World War II saw the profession reinvigorated because the veterinarians in the U.S. Army had done a great job. I had that great opportunity of being challenged by the medics in the U.S. Public Health Service who said, "What are you veterinarians going to do for the public health now that the war is over?" You can see how this bridge between veterinary and human medicine has spanned over 200 years. So when you ask me what I think about the recent focus on one health, I think it's good!
What do you hope the result will be?
Respect for each other. That's the thing that's come to my attention most frequently over the years. The average veterinary clinician finds it difficult to go before a medical audience and talk about what their relationship should be. If you're a veterinary pathologist, or microbiologist, or virologist, it's easy, or if you've got professional training in public health, it's easy. The thing that I'm pushing personally, with support from the hierarchy of the PHS, is to build up a corps of inactive reserve veterinarians that can be called on when disasters occur. These people would be the ones encouraged to get an inactive reserve commission in the PHS, and then the service can call them together every one or two years to update them on what's going on in public health. This has been my mission.
How does veterinary medicine complement human medicine?
The first is in the area of infectious diseases. When I came into the PHS at the end of the war, we were probably having the biggest epidemic of rabies ever recorded. The reason for that is thousands of people were moving around the nation, and thousands of pets were abandoned. Across the southern United States and up the East Coast, rabies was raging. To answer that challenge—"What are you veterinarians going to do for the public health now that the war is over?"—I decided rabies control is the most important thing we could do. That's when we set up the studies on rabies vaccine duration. It took five years of testing, and at the end we knew we had a safe vaccine. Today, we as veterinarians can all proudly say we did our bit in eliminating rabies in dogs and cats.
The second area is more historical—the elimination of bovine tuberculosis. I wrote about the need for pasteurization and what pasteurization does in eliminating a lot of childhood TB. The disease is practically unknown today in the United States; you have to go to remote places to find where there's milk consumption from TB-infected cows.
The third area is the elimination of brucellosis in all our cattle. I constantly preach, "You cannot have good public health unless you have good animal health. And you can't have good animal health unless you have good public health." There are enough disease crossover to justify greater collaboration between the two professions. There's economic issues at play, too. Go to Mexico and see how much brucellosis has affected the goat population, and how that disease has kept millions of people in poverty because there's no profit in handling their goats—the goats are always sick or the people are sick.
How do you see veterinarians and physicians working together now?
The great thing going on today is joint meetings between our respective presidents. Ron Davis, president of the American Medical Association, and Roger Mahr (AVMA immediate past president)—there you had two people thinking in the same way, coming together. And now you have (AVMA President) Greg Hammer endorsing this, and that's good, too. One health requires constant exposure and dialogue between the two professions. The AVMA convention is going to be great this year because of the MDs and PhDs speaking at the meeting. Now that to me is the kind of thing that should be emulated at the state level. But unfortunately, it's not taken hold yet. The AMA, AVMA, and American Public Health Association, those are the three national associations that should be doing more interchanging of programs. Those kinds of exchanges matter in the long run.