One Health, COVID-19, and vet med: Veterinary profession implications

Part 2

In part 1, we discussed the role of veterinarians in One Health as it pertains to the COVID-19 pandemic response. In part 2, we discuss general veterinary implications towards the One Health Framework.

What is One Health?

One Health is the cooperation that incorporates various disciplines and various stakeholders, from private, to public, academic among many. Together these entities intersect, working towards the common good of global health, encompassing human health and the overall health of animals and the environment, taken individually and together. Heavily intertwined, this intersection becomes pivotal moving forward in a One Health Framework. ^1–3

From the human-animal bond to vaccine development to scientific studies and research to vaccine administration to environmental risks associated with the connection of domestic and wildlife with the environment and humans alike, veterinarians can and should have a front-row seat in any discussions pertaining to One Health.

One Health, Covid-19 and vet med: How Covid-19 highlights vets’ role in public health (Read part 1 of the series here).

COVID-19 and emerging roles for veterinarians in public health

As discussed in Part I, veterinarians will be pivotal in preventing future pandemics, like COVID-19. This will require thinking outside the standard vet clinic box. Veterinarians don’t expect to be treating humans. In fact, it is the one species we legally cannot treat.

However, with our vast knowledge in infectious diseases and disease prevention and our skills as clinicians, researchers, scientists, and more, we can and are providing key resources to the global public health community. And the COVID-19 response helps show others how much we can bring to the table.

COVID-19 response, developing a vaccine, and using veterinarians to vaccinate humans – Why did it take so long?

Vaccine development

Regardless of if we are clinicians, educators, researchers, or a combination thereof, our job as a profession should be collectively to provide knowledge and examples when needed. COVID-19 is a prime example. Coronaviruses are not new to veterinarians. We’ve had successful vaccines against them for years and for various species.

Won et al. ⁴ discussed a systematic review and analysis that showed that the porcine epidemic diarrhea virus (PEDv), a well-studied coronavirus, responded well to vaccinations for control. These results were found regardless of the vaccine type utilized. Considered endemic in Europe and Asia for more than thirty years, it arrived in the U.S. in 2013.

By 2014, 7 million pigs were euthanized or died, and it reached 29 states. But it was successfully eradicated via a vigorous vaccine campaign. And as of March 6, 2018, fecal samples were no longer required federally.⁵

A variety of vaccination types already exist for coronaviruses. Extrapolation to humans and for COVID-19 seems like a logical step. Still, veterinarians were not initially consulted on vaccine strategy in the early stages of the pandemic.⁶

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mRNA vaccine technology is new. It allows more rapid development of a vaccine from start to clinical trials to delivery. But Liu et al. ⁷ discussed in 2019, before COVID-19, their work on coronavirus vaccines targeting the spike protein. So, while the technology was new in human medicine, it was already being worked on in the veterinary field. It may seem like the vaccines using mRNA technology were developed overnight. Still, veterinary medicine studies show the research started well before the human disease emerged.

In fact, Schlake et al.⁸ discuss the technological development of mRNA vaccines as early as 2012. So, while it seems like the concept was pulled out of thin air, research has been building for at least 8 years prior to the onset of the pandemic.

Human vaccine administration

Pharmacists, chiropractors, physicians, nurses all were considered at the beginning of those who could potentially vaccinate the human population against COVID.

It wasn’t until the veterinary community spoke out and the AVMA supported the efforts that the public health community thought, hmmm, veterinarians are trained to give vaccines.  In fact, veterinarians administer vaccines more regularly than most human physicians, save pediatricians.

It seemed logical to allow veterinarians to administer vaccines; after all, humans sit still. They tend not to bite you when you do something; they know what you intend to do and why. But it wasn’t an easy hurdle. Legal issues and liability concerns had to be addressed.⁹

Thankfully now, moving forward, there is a precedent already set. Suppose future pandemics or situations require the need for mass vaccination or similar health care needs. In that case, veterinarians can again be called upon to aid in similar One Health efforts.

Why, and how, to answer the dreaded question: What would you do if this were your pet?

Veterinary profession implications in a One Health framework

Why bother even discussing One Health? If you are a clinician practicing veterinary medicine in practice, your primary concern is the individual pet. Why should you care about the global picture?

Maybe you don’t need to. However, if you think about various concerns in veterinary medicine that also encompass public health matters, perhaps the answer may not be so simple. If you still believe that you don’t play a role in public health after reading these concerns, no worries, but prevalent topics currently include:

• The suicide rate within the profession; increased burnout and compassion fatigue
• The human-animal bond, a commonly discussed concept today, emphasizes the interconnectedness of the pet and pet parent relationship. The news, media, and various organizations highlight this bond and use it to promote multiple animal welfare benefits. As small animal veterinarians in practice, we strive to maintain the health of this bond.⁶
• Infectious diseases such as rabies, something we vaccinate for routinely. Rabies is a legal issue above and beyond our simple desire to protect our patients. It is a public health concern. Society fails to remember that we used to have the canine variant of rabies in the U.S. However, our countrywide vaccination program in dogs helped to eradicate it in 2007.
  • Yet because of poor surveillance, lapses in importation laws, and the state of the global pandemic, canine variant rabies entered the U.S. in 2021.
  • Aliza Simeone, VMD, Region 7 PA Veterinary Medical Field Officer, in her June rabies and regulatory update email (July 9, 2021), discussed concerns for the presence of the canine variant within the U.S. just this year. In June, a dog in Chester County, PA, imported from Azerbaijan 2 days before developing clinical signs, was infected with the canine rabies strain. The dog was purported to be vaccinated from the originating country. Traceback and surveillance were needed for all contact animals and humans associated with the shipment of dogs.
  • As a result of this and similar cases, The Centers for Disease Control and Prevention (CDC), on July 14, 2021, issued a ban on 100 countries with high endemic canine rabies rates in hopes of preventing the canine rabies variant from again entering the U.S.¹⁰
• Larval visceral migrans, cutaneous larval migrans, toxoplasmosis, tick-borne diseases, and many additional examples represent the intersection of humans, animals, and the environment.
  • Those in general clinical veterinary practice and human physicians see these diseases.
  • They must assess zoonotic and reverse zoonotic potentials and risks.
  • But our pets often act as sentinels. A zoonotic disease found in them means that the humans in the family are at risk as well. Education of owners is paramount, including preventative measures for the pets such as monthly parasite prevention go without saying. What we do with that information and how we approach each client can be taken from a public health perspective and a clinical one.

Covid-19

True, this is primarily a human pathogen that has reverse zoonotic potential. However, the virus produces variants that could lead to increased susceptibility among other species. Additionally, future mutations could more easily transmit from animals to people. Careful monitoring and studies are needed on the animal and human sides to understand how the disease progresses and the virus survives.^11,12

• Humans are the primary infected species, while several species, mink, most notably, the large cats and non-human primates, can develop significant illness.
• The transmission from dogs, domestic cats, and other domestic species does not appear to contribute to the reservoir status of the disease. Humans are the reservoirs at this time.
• However, mink and other species can transmit it within their own species very well. They could act as a reservoir if not controlled in the mink population in the U.S.
• Will this transmission cycle change as the disease mutates and new variants emerge is still in question. But to date, the primary animal of concern is mankind.
• Veterinary activities such as continued surveillance of zoo populations, domestic mink farms, and wildlife populations are ongoing. These efforts are critical to identifying spillover as well as at-risk species.
  • Chandler et al.¹³ conducted a surveillance study in MI, Il, NY, and PA on wild white-tailed deer populations. Their results show evidence suggestive of exposure to SARS-CoV-2 and sufficiently elevated neutralizing titers for them to suspect infection. However, more work is needed to confirm and determine the significance of the data.¹⁴
  • Additionally, zoo species’ exposure and clinical cases show potential breakdowns in hygiene practices, PPE use, and other factors and reinforce the reverse zoonotic transmission risks of COVID-19.
• The development of animal vaccinations against SARS-CoV-2 by companies such as Zoetis further suggests the One Health nature of this pandemic. The need for veterinarians to be involved in all stages of pandemic response and prevention planning moving forward is paramount. As of July 2021, over 11,000 vaccination doses have been donated to zoos and wildlife sanctuaries. Animals vaccinated include numerous non-human primate species, the large cats, bears, and other carnivores, to more obscure species countrywide. The vaccinations protect endangered or threatened species.^15,16

A veterinarian’s role in the future of One Health

A veterinarians’ role is increasingly recognized as more than just individualized pet care, from administering vaccinations to all species to joint research endeavors on vaccine development and disease surveillance and identification. The list of roles is long and beyond the scope of the article. However, know that the interdisciplinary nature of One Health is slowly being recognized by various organizations, professions, and key public health stakeholders.

As a profession, we have a place in both clinical practice and the realm of public health. Moving forward, veterinarians will be part of infectious disease surveillance and identification as well as disaster preparedness planning for natural and non-natural disasters, including the next pandemic.⁶

Erica Tramuta-Drobnis, VMD, MPH, CPH is the Founder & CEO ELTD of One Health Consulting, LLC, as well as a freelance writer, consultant, researcher, public health professional and small animal veterinarian.

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Results of the 2021 Covid-19 veterinary impact survey and what they mean for animal hospitals

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References

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2. Torres de Melo R, Rossi DA, Monteiro GP, Fernandez H. Veterinarians and One Health in the Fight Against Zoonoses Such as COVID-19. Front Vet Sci. 2020;7:756. doi:10.3389/fvets.2020.576262
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6. Nolan RS. Veterinary medicine and COVID-19: ‘A lot of lessons here.’ American Veterinary Medical Association. Published March 15, 2021. Accessed August 22, 2021. https://www.avma.org/javma-news/2021-03-15/veterinary-medicine-and-covid-19-lot-lessons-here
7. Liu X, Zhao D, Zhou P, Zhang Y, Wang Y. Evaluation of the Efficacy of a Recombinant Adenovirus Expressing the Spike Protein of Porcine Epidemic Diarrhea Virus in Pigs. BioMed Res Int. 2019;2019:e8530273. doi:10.1155/2019/8530273
8. Schlake T, Thess A, Fotin-Mleczek M, Kallen K-J. Developing mRNA-vaccine technologies. RNA Biol. 2012;9(11):1319-1330. doi:10.4161/rna.22269
9. Burns K. Veterinarians help with COVID-19 vaccine delivery. American Veterinary Medical Association. Published March 31, 2021. Accessed September 1, 2021. https://www.avma.org/javma-news/2021-04-15/veterinarians-help-covid-19-vaccine-delivery
10. The Centers for Disease Control and Prevention (CDC). Notice of Temporary Suspension of Dogs Entering the United States from Countries Classified as High Risk for Dog Rabies. The Centers for Disease Control and Prevention: Importation. Published July 16, 2021. Accessed September 2, 2021. https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/high-risk-dog-ban-frn.html
11. Ghai RR, Carpenter A, Liew AY, et al. Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses. Emerg Infect Dis. 2021;27(4). doi:10.3201/eid2704.203945
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13. Chandler JC, Bevins SN, Ellis JW, et al. SARS-CoV-2 Exposure in Wild White-Tailed Deer (Odocoileus Virginianus).; 2021:2021.07.29.454326. doi:10.1101/2021.07.29.454326
14. Yoo HS, Yoo D. COVID-19 and veterinarians for one health, zoonotic- and reverse-zoonotic transmissions. J Vet Sci. 2020;21(3):e51. doi:10.4142/jvs.2020.21.e51
15. Daly N. Bears, baboons, tigers are getting COVID vaccines at zoos across the U.S. National Geographic. Published August 20, 2021. Accessed August 25, 2021. https://www.nationalgeographic.com/animals/article/bears-baboons-tigers-are-getting-covid-vaccines-at-zoos-across-the-us
16. Greenberg A. Oakland Zoo vaccinates its animals against Covid-19. PBS. Published July 20, 2021. Accessed September 2, 2021. https://www.pbs.org/wgbh/nova/article/oakland-zoo-animal-covid-vaccine/