Volume 19, Number 12—December 2013
Perspective
Review of Institute of Medicine and National Research Council Recommendations for One Health Initiative
Suggested citation for this article
Abstract
Human health is inextricably linked to the health of animals and the viability of ecosystems; this is a concept commonly known as One Health. Over the last 2 decades, the Institute of Medicine (IOM) and the National Research Council (NRC) have published consensus reports and workshop summaries addressing a variety of threats to animal, human, and ecosystem health. We reviewed a selection of these publications and identified recommendations from NRC and IOM/NRC consensus reports and from opinions expressed in workshop summaries that are relevant to implementation of the One Health paradigm shift. We grouped these recommendations and opinions into thematic categories to determine if sufficient attention has been given to various aspects of One Health. We conclude that although One Health themes have been included throughout numerous IOM and NRC publications, identified gaps remain that may warrant targeted studies related to the One Health approach.A review of existing IOM publications for One Health–related consensus recommendations or individual opinions is a critical step in assessing whether to move forward with a general, or more refined, focus that will complement the existing body of IOM/NRC reports. We sought to complete such a review, and to fit the findings into a framework that would facilitate a data-driven assessment of how to move forward in possibly seeking an IOM/NRC review of One Health.
Methods
The National Academies and Their Reports
A primary function of the National Academies is to provide unbiased and timely expert advice to policy makers and the general public. The National Academies include the National Academy of Sciences, the IOM, the NRC, and the National Academy of Engineering. Their operations are independent from the US federal government and not funded by direct appropriation, although studies are often mandated by Congress in the interest of seeking expert counsel. Studies can be requested by federal agencies or by independent organizations.At the National Academies there is a vast difference in the weight ascribed to consensus committee recommendations, compared to the individual opinions that are collected in a workshop summary. A consensus committee, typically including 10–15 members, is carefully chosen to represent a range of specific disciplines and experiences. Consensus committees are carefully structured to ensure that all members are independent of the sponsoring agencies (3–5). The committees operate under a set of rigorous rules pertinent to Section 15 of the Federal Advisory Committee Act. Each committee member undergoes an extensive bias and conflict of interest review, and their names are posted online for public comment. The committee collects information from presentations, literature reviews, and other means; the committee’s recommendations are then designed in a very structured way. When a draft report is compiled, it is submitted to a review committee with a similar mix of disciplinary expertise. The entire process is overseen by the overarching National Academies Report Review Committee (RRC).
In strict contrast, a workshop summary is not allowed to contain anything that could be interpreted as a consensus conclusion or recommendation. It is not reflective of a Federal Advisory Committee Act process and the RRC is minimally involved in most instances. To separate the workshop summary from the report of the persons who designed the workshop, the summary is always written by an appointed reporter rather than a workshop planning committee member . The goal is to ensure that the workshop report is not seen as the product of a committee process, but as a collection of opinions expressed by workshop participants. The standard of peer review for a workshop is very different from that described above for a consensus study. A much smaller group of reviewers is involved, and the objective of the review is to ensure that the report is an accurate and clear description of what happened, not what should have happened. Because there is some overlap in content between the IOM/NRC consensus reports and IOM workshop summaries in terms of coverage of health-related issues, we included both types of reports in this review.
Selection of Reports for Review
Titles and objectives of NRC/IOM reports during 1991–2013 were reviewed to identify content addressing interactions among humans, animals, and the environment. By using this process, 20 reports (Table) (6–25) were judged most likely to contain multiple recommendations or opinions related to One Health concepts. Although it is likely that additional reports may contain One Health concepts, this review was constructed to provide a starting point to inform those considering how future studies of One Health by the National Academies could be constructed.Defining One Health Concepts
For the purposes of this review, a consensus recommendation or workshop opinion was deemed related to One Health concepts if it included any aspect of the relationships between humans, animals, and the ecosystems in which they coexist and interact. Although this definition may be viewed as broad, it was chosen intentionally to prevent bias for or against any particular component of One Health.Grouping of Recommendations
All consensus reports and some workshop summaries and workshop reports included summary or overview chapters containing an aggregated view of consensus report recommendations or themes emerging from the workshop. However, in cases in which reports lacked such an organized set of recommendations, the full report was reviewed to determine whether any pertinent information was conveyed within individual chapters. Recommendations or opinions found to be related to One Health were compiled for each individual report; then the aggregated list was reviewed to identify common themes. Finally, we sought to identify examples of completed or ongoing activities that address recommendations and opinions.Results
We grouped the recommendations and opinions into 7 topical categories: Surveillance and Response, Governance and Policy, Laboratory Networks, Training Needs, Research Needs, Communication Needs, and Partnerships. Technical Appendix Table 1 [PDF - 320 KB - 10 pages] displays a paraphrased listing of the recommendations by category. The list of recommendations was circulated among the authors and other subject matter experts in an attempt to identify ongoing activities or programs that appear to address gaps identified in the IOM and NRC reports. Technical Appendix Table 2 [PDF - 320 KB - 10 pages] lists all of the recommendations, the exact references that support each recommendation, and examples of activities that appear to respond to specific recommendations.
Discussion
The quantity of recommendations and workshop opinions related to One Health concepts suggests that a reasonable level of attention has been given to the One Health movement in the past 2 decades of IOM/NRC publications. However, level of coverage does not necessarily translate into sufficient consideration of all aspects of a One Health approach, nor does it indicate adequate consideration of current understandings of One Health concepts. Apportioning our findings into thematic categories let us create a framework for evaluation of breadth of coverage. We found that some categories have received more attention than others. For example, the Surveillance and Response category had 16 recommendations or opinions that originated from 14 individual reports; and the Governance and Policy category had 10 recommendations or opinions from 8 reports. By contrast, 4 recommendations or opinions were identified in the Partnership category, and 3 were identified in the category of Communication Needs.
Most of the examples of implementation of One Health concepts that are described in the Technical Appendix are not directly associated with specific IOM or NRC recommendation. In contrast, recommendations from the United States Agency for International Development (USAID)-supported IOM report “Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases” (2009) were translated into One Health activities under USAID’s Emerging Pandemic Threats (EPT) Program. Progress in One Health activities may be a result of explicit recommendations from IOM and NRC reports, or simply be occurring because of increasing awareness of One Health concepts.
Examples of Progress
In the Surveillance and Response category, there is good evidence that progress has been made in addressing some of the One Health–related recommendations generated from IOM and NRC studies. Several recommendations in this category address the need for integrated surveillance systems that capture information from multiple sectors. An excellent example of such integrated surveillance is the National Antimicrobial Resistance Monitoring System which became operational in 1996 as a collaborative effort of the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration, and the US Department of Agriculture. The National Antimicrobial Resistance Monitoring System tracks antimicrobial susceptibility among enteric bacteria from humans, retail meats, and food animals (26–28) and provides timely integrated surveillance information that has enhanced the effectiveness of response to outbreaks of enteric disease. Although many of the recommendations regarding surveillance and response have been addressed in part, this particular area may provide an opportunity for a more focused IOM study group to evaluate how existing systems could be linked or merged to provide a sustainable, integrated surveillance system that addresses the needs of multiple sectors.Recommendations in the Governance and Policy category appear to have not been specifically addressed and may represent a gap that needs to receive more attention. However, a One Health website, www.onehealthglobal.net, was released in mid-April 2012. The portal is intended to be a network-of-networks that speaks to One Health governance and that may serve as a mechanism that facilitates the recommendations within the Governance and Policy category (29). The portal is a product of the One Health Global Network Work Group that was formed as an outcome of the “Stone Mountain” meeting organized by CDC in collaboration with the World Organisation for Animal Health (OIE), the United Nations Food and Agriculture Organization (FAO), and the World Health Organization (WHO), titled Operationalizing “One Health”: A Policy Perspective—Taking Stock and Shaping an Implementation Roadmap (30).
Laboratory network recommendations have been addressed on several national fronts, including planning for a National Bio and Agro Defense Facility (31) and the flourishing National Animal Health Laboratory Network (32). Internationally, OIE, FAO, and WHO have received USAID EPT funds to improve networking among human and animal laboratories (33). As mentioned previously, this EPT funding occurred after a 2009 Consensus Report, demonstrating direct actions to enhance laboratory capabilities in response to recommendations made within an IOM report (18)
Within the Training category, some recommendations are being addressed by the Stone Mountain Meeting Training Workgroup, grantees from 1 of 4 EPT projects named RESPOND, and the University of Minnesota with Rockefeller Foundation funding (34). These 3 groups work independently and also collaboratively to define One Health Core Competencies for varying levels of practitioners. They also develop course catalogs that capture existing training opportunities and identify needed training materials. In April 2012, the University of Florida announced that it will offer 2 new One Health degree programs, including a PhD in Public Health with a One Health concentration. “The One Health concentration is a research-oriented health degree that emphasizes working across public health, veterinary health, and environmental health disciplines to tackle difficult health problems” (35).
Similar selected examples of programs and projects that address the IOM recommendations can be identified for the categories of Research Needs (e.g., National Institutes of Health [NIH] Centers of Excellence for Influenza Research and Surveillance program, EPT PREDICT projects and the NIH-NSF Ecology and Evolution of Infectious Diseases Program: A Joint Program for Multidisciplinary Research [36]), Communication Needs (e.g., formation of One Health Offices at USDA and CDC), and Partnerships (e.g., US Interagency One Health Working Group, inclusion of veterinarians in CDC Field Epidemiology and Laboratory Training Programs). Although these examples are excellent steps in the right direction, they do not respond to the majority of the recommendations. In particular, recommendations that point toward collaboration, resource sharing, coordinated research, and strengthened lines of communication deserve greater attention.
Conclusions
Acknowledgment
We acknowledge the valuable input provided by Patrick Kelley during all aspects of this project. His scientific insight and expertise concerning the National Academies’ publications was essential to the completion of this review.
References
- One Health Initiative Task Force. One Health: a new professional imperative. American Veterinary Medical Association; 2008 Jul 15 [cited 2013 Oct 21]. https://www.avma.org/KB/Resources/Reports/Documents/onehealth_final.pdf
- One Health Commission. One Health summit, 2009. Washington : Institute of Medicine [cited 2012 Jul 31]. http://iom.edu/Activities/Global/OneHealthCommissionSummit.aspx
- National Research Council. Policies and procedures. Washington : The National Academies [cited 2012 Jul 31]. http://www.nationalacademies.org/nrc/na_064188.html
- Institute of Medicine. Charter and bylaws, December 2006. Washington : The National Academies [cited 2012 Jul 31]. http://www.iom.edu/~/media/Files/About%20the%20IOM/charter-and-bylaws.pdf
- National Research Council. Washington: The National Academies; 2012 [cited 2012 Jul 31]. http://www.nationalacademies.org/nrc/index.html
- National Research Council. Animals as sentinels of environmental health hazards. Washington: National Academies Press; 1991. 7. Institute of Medicine. Emerging infectious diseases: Microbial threats to health in the United States. Washington: National Academies Press; 1992.
- National Research Council. The use of drugs in food animals: Benefits and risks. Committee report. Washington: National Academies Press; 1999.
- Institute of Medicine. Emerging infectious diseases from the global to the local perspective. Workshop summary. Washington: National Academies Press; 2001. 10. Institute of Medicine. The emergence of zoonotic diseases: Understanding the impact on animal and human health. Workshop summary. Washington: National Academies Press; 2002. 11. Institute of Medicine and the Board on Global Health. Microbial threats to health: Emergence, detection and response. Washington: National Academies Press; 2003.
- National Research Council. Animal health at the crossroads: Preventing, detecting, and diagnosing animal diseases. Committee report. Washington: e National Academies Press; 2005.
- National Research Council. Critical needs for research in veterinary science. Committee report. Washington: National Academies Press; 2005.
- Institute of Medicine. Addressing foodborne threats to health: policies, practice and global coordination. Workshop summary. Washington: National Academies Press; 2006.
- Institute of Medicine. The impact of globalization on infectious disease emergence and control. Workshop summary. Washington: National Academies Press; 2006.
- Institute of Medicine. Global infectious disease surveillance and detection: assessing the challenges—finding solutions. Workshop summary. Washington : National Academies Press; 2007.
- Institute of Medicine. Vector-borne diseases: understanding the environment, human health and ecological consequences. Workshop summary. Washington: National Academies Press; 2008.
- Institute of Medicine and National Research Council. Sustaining global surveillance and response to emerging and zoonotic infectious diseases. Washington: National Academies Press; 2009.
- Institute of Medicine. Infectious disease movement in a borderless world. Workshop summary. Washington: National Academies Press; 2010.
- Institute of Medicine. Antibiotic resistance: Implications for global health and novel intervention strategies. Washington: National Academies Press; 2010.
- Institute of Medicine and the Board on Population Health. Critical needs and gaps in understanding prevention, amelioration, and resolution of Lyme and other tick-borne diseases. Workshop report. Washington: National Academies Press; 2011.
- Institute of Medicine and the Board on Global Health. Fungal diseases: An emerging threat to animal, human and plant health. Workshop summary. Washington: National Academies Press; 2011.
- Institute of Medicine and the Board on Global Health. The causes and impacts of neglected tropical and zoonotic diseases: Opportunities for integrated intervention strategies. Workshop summary. Washington: National Academies Press; 2011.
- Institute of Medicine and the Board on Population Health and Public Health Practice. Climate change, the indoor environment, and health. Committee report. Washington: National Academies Press; 2011.
- Institute of Medicine and the Board on Global Health. Improving food safety through a One Health approach: Workshop summary. Washington: The National Academies Press.
- National Antimicrobial Resistance Monitoring System (NARMS). Enteric bacteria. Atlanta (GA): Centers for Disease Control and Prevention; 2005 [cited 2012 Jul 31]. About NARMS. http://www.cdc.gov/narms/about_narms.htm
- National Antimicrobial Resistance Monitoring System. Silver Spring (MD): US Food and Drug Administration [cited 2012 Jul 31]. Introduction to NARMS.http://www.fda.gov/AnimalVeterinary/SafetyHealth/AntimicrobialResistance/NationalAntimicrobialResistanceMonitoringSystem/default.htm
- Epidemiology B, Resistance A. NARMS—National Antimicrobial Resistance Monitoring System Animal Isolates. Washington: US Department of Agriculture [cited 2012 Jul 31]. http://ars.usda.gov/Main/docs.htm?docid=6750
- Expert Meeting on One Health Governance and Global Network. Atlanta Report 2011. Atlanta (GA): US Department of State, World Organization for Animal Health (OIE); 2011 [cited 2012 Jul 31]. http://www.eeas.europa.eu/health/docs/2011_report-experts-atlanta_en.pdf
- Operationalizing “One Health”: a policy perspective-taking stock and shaping an implementation road map. [cited 2013 Oct 21]. Atlanta (GA): Centers for Disease Control and Prevention/World Organisation for Animal Health; 2010. http://www.cdc.gov/onehealth/resources/archived-meetings/march2009-may2010.html#one
- National Biol and Agro-Defense Facility. Washington: US Department of Homeland Security [cited 2012 Jul 31]. National Biol and Agro-Defense Facility. http://www.dhs.gov/files/labs/editorial_0762.shtm
- National Animal Health Laboratory Network. About NAHLN. [cited 2013 Oct 30]. Washington: United States Department of Agriculture. http://www.aphis.usda.gov/animal_health/nahln/about_nahln.shtml
- US Agency for International Development. Emerging pandemic threats program overview, June 2010 [cited 2013 Oct 21]. http://avianflu.aed.org/eptprogram/pdf/ept_brochure.pdf
- One Health Competency Workshop 2012 Mar 12–13 meeting report [cited 2012 Jul 31]. http://www.onehealthtalk.org/1/assets/File/One%20Health%20Compentency%20Workshop.pdf
- College of Public Health and Health Professions Academic Programs. [cited 2013 Oct 21] Gainesville (FL): University of Florida Department of Environmental and Global Health. http://egh.phhp.ufl.edu/academic-programs/doctoral-programs/phd-in-one-health/
- National Institutes of Health/National Science Foundation. NIH-NSF Ecology and Evolution of Infectious Diseases Program: a joint program for multidisciplinary research, 2011 [cited 2013 Oct 21]. http://grants.nih.gov/grants/guide/notice-files/NOT-TW-12-001.html\
Table
Technical Appendix
Suggested citation for this article: Rubin C, Myers T, Stokes W, Dunham B, Harris S, Lautner B, et al. Review of Institute of Medicine and National Research Council recommendations for One Health initiative. Emerg Infect Dis. 2013 Dec [date cited]. http://dx.doi.org/10.3201/eid1912.121659
No hay comentarios:
Publicar un comentario