One medicine; in practice

The ‘One-medicine’ movement has been boosted by the launch of a new web site at http://www.onehealthinitiative.com. It aims to promote the idea of 'one medicine’ throughout the world and provide information on this initiative for the public, political and governmental leaders, news media, and all 'One Health' professionals, advocates, and supporters.

The concept of ‘one medicine’ is now well established having been adopted by both the American Veterinary Medical Association (AVMA) and the American Medical Association. It seeks to enhance collaboration between veterinarians and physicians, and other health professionals, to promote the health and well being of all species. More recently, the health of the environment has been included in the 'one medicine' concept reflecting the facts that all three are interlinked. The term one medicine was first used by the pioneering veterinary epidemiologist, Calvin Schwabe, who sought to break down the barriers between human and veterinary medicine. Professor Schwabe set up the Department of Epidemiology and Preventive Medicine at the University of California, Davis, in 1966, which was the first veterinary epidemiology department in the world. He developed his ideas from his experiences in researching into hydatid disease and other parasitic zoonoses while he was teaching at the American University in Beirut.

The idea of ‘one medicine’ sounds very worthy and laudable, but it is not always easy to envisage how in practice to impact on the lives humans and animals and the environment. If anyone wanted a really good example of how the ‘one medicine’ approach can benefit all three, they would have done well to have attended an excellent talk delivered by Dr Sarah Cleaveland on rabies control in Africa, given at the British Veterinary Association Congress in London on Friday 26 September. Those of us who were fortunate to be there heard how the health of livestock, wild animals and humans in the Serengeti are woven together in a dynamic relationship, and how measures to control infectious diseases affect the humans, livestock, wild animals and the environment. Dr Cleaveland has been based at the veterinary school in Edinburgh, was awarded the Trevor Blackburn Award in recognition of her work on zoonotic, livestock and wildlife diseases in East Africa and for her outstanding contributions to animal and human health, wildlife conservation and animal welfare in Africa and beyond. The talk covered the effects of disease and its control in the Serengeti region of Tanzania, known to viewers of wildlife programmes as the site of spectacular wildebeest migrations, followed by lions and other carnivores that live off them. Dr Cleaveland spoke about the control of a number of zoonotic diseases such as brucellosis, tuberculosis, and echinococcosis, but it was her account of the campaign to control rabies which really showed the value of the ‘one medicine’ approach. Rabies is a very serious problem in many parts of the world and it is estimated that 55,000 people die from the disease each year. Most of the victims are children, and poor children in remote areas are the most likely to die if infected, because the cost of the post-exposure vaccine and time taken to reach a clinic. We heard how epidemiological techniques were used to prove that dogs were the reservoir host (and not the wild carnivores that were also affected), and how a mass dog vaccination campaign that she directed and implemented, currently vaccinating 200,000 dogs annually, has prevented hundreds of human and animal rabies deaths. We also learnt that one of the most difficult parts of the control programme was persuading the Masai dog owners to wait in an orderly line to have their dogs vaccinated, and that the commonest pet names for their dogs were ‘Osama’ and ‘Bush’. As well as saving at least 50 human lives saved each year, at a fraction of the cost of post exposure vaccination, the measures have also protected endangered wildlife species, such as the African wild dog.

We also learned how the wildebeest numbers, a dominant feature of the ecology of the Serengeti, have grown since the control of rinderpest in cattle in the 1960s, and that as reservoirs of malignant catarrhal fever virus, the arrival of the wildebeest to the lush lowlands of the Serengeti drives the Masai to take their herds, to higher more marginal grazing, which can lead to environment problems from overgrazing.

A search of the CAB Abstracts database for information on ‘one medicine’ shows that not only is the concept helpful in improving the lives of pastoralists in developing countries, but can also help deal with global problems such as obesity and heart disease through the benefits of the animal human bond.

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