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Zinsstag, J., Schelling, E., Wyss, K. and Mahamat, M.B. (2005) Potential of cooperation between human and animal health to strengthen health systems. Lancet 366(9503), 2142–2145.
JAKOB ZINSSTAG,1,2* DAVID WALTNER-TOEWS3 AND MARCEL TANNER1,2
1 Swiss Tropical and Public Health Institute, Basel, Switzerland; 2 University of Basel, Basel, Switzerland; 3 Ontario Veterinary College, University of Guelph, Guelph, Canada
One Health: Benefits from Closer Cooperation
The convergence of interests in human and animal health, based on careful observation and scientific study, has a long history which has gained attention from medical historians in the last few years (Woods et al., 2018). Much of this convergence is based on inferences and analogies from empirical observations of specific diseases and comparative anatomy rather than on broader definitions of health (Bresalier et al., Chapter 1, this volume). Among the many proponents of a closer interaction of human and animal health (Zinsstag et al., 2015), two are particularly noteworthy: (i) Rudolf Virchow, the founder of cellular pathology in the late 19th century; and (ii) Calvin Schwabe (Box 2.1), an internationally renowned veterinary epidemiologist and pioneer of veterinary public health in the 20th century. Virchow and Schwabe were among the first to articulate key points that motivated elaboration of the premise of One Health. Discussing bovine tuberculosis (Tschopp and Yahyaoui, Chapter 22, this volume) at a hearing in the Prussian senate, Virchow stated: ‘There is no scientific barrier between veterinary and human medicine, nor should there be. The experiences of one must be used for the development of the other’1 (Bollinger, 1902; Saunders, 2000). Influenced by his experience of working with Dinka pastoralists in Sudan, Schwabe coined the term ‘one medicine’, to make the point that ‘There is no difference of paradigm between human and veterinary medicine. Both sciences share a common body of knowledge in anatomy, physiology, pathology, on the origins of diseases in all species’ (Schwabe, 1984).
Indeed the methods of comparative medicine used in both human and veterinary medicines are closely related and have produced – and continue to produce – enormous mutual benefits. Most therapeutic interventions in human medicine were developed and tested in animals. Under the increasing influence of specialization, however, human and veterinary medicine diverged, and too often fail to communicate, even when they share interests in the same disease. For example, during a recent outbreak of Q-fever in the Netherlands, public health authorities were not informed by veterinary authorities about a wave of abortions in goats (Enserink, 2010). Similarly, outbreaks of Rift Valley fever in humans in Mauritania were identified as yellow fever by mistake. The correct diagnosis was made only after public health services contacted livestock services and learned about the occurrence of abortions in cattle (Digoutte, 1999; Schelling et al., 2007a).
Box 2.1. Calvin Schwabe 15 March 1927–27 July 2006 (Zinsstag and Sackmann, 2007).
Calvin Schwabe graduated with a zoology degree in 1948 and obtained his doctorate in veterinary medicine in 1954. At Harvard, he obtained a master’s degree in public health and a PhD in parasitology and tropical medicine (1956). For 10 years, Schwabe worked at the American University in Beirut. His main interests were parasitic diseases, mainly echinococcosis. He initiated control programmes and led the WHO expert committee on veterinary public health in Geneva. In 1966, he became a full professor in veterinary epidemiology at UC Davis (California). Schwabe’s interests reached far beyond health issues towards more integrated approaches to science. His overarching views on health of all species influenced modern concepts of veterinary public health, One Health and ecosystem health. His vast bibliography is accessible at: https://oculus.nlm.nih.gov/cgi/f/findaid/findaid-idx?c=nlmfindaid;idno=schwabe (accessed 27 March 2020).
Collaborations between veterinarians and physicians should produce benefits that are broader than merely additive. The beyond-additive value-added benefits are related to direct positive outcomes not just in reduced risks and improved health and well-being of animals and humans, but also in financial savings, reduced time to detection of disease outbreaks and subsequent public health actions, as well as improved environmental services (Zinsstag et al., Chapter 31, this volume). For example, a mixed team of doctors and veterinarians examining human and animal health in mobile pastoralist communities in Chad found that more cattle were vaccinated than children. None of the children were fully vaccinated against childhood diseases. Recognition of this fact enabled subsequent joint human and animal vaccination campaigns providing preventive vaccination to children who would otherwise not have had access to health services. Clearly, a closer cooperation of veterinarians and doctors generated a better health status than what could have been achieved by working in isolation (Schelling et al., 2007a; Häsler et al., Chapter 10, this volume; Danielsen and Schelling, Chapter 14, this volume). Such joint services are scalable to national and regional level by adopting a systems strengthening perspective leading to an extension from Calvin Schwabe’s concept of ‘one medicine’ to One Health (Zinsstag et al., 2005). This has been clearly validated as a public health concept in different areas of the world, ranging from Africa to Asia (Zinsstag et al., 2011).
Today, One Health has become a broad international movement supported by the World Health Organization (WHO), the
