Characterizing the One Health workforce to promote interdisciplinary, multisectoral approaches in global health problem-solving.

BACKGROUND: In recognition of the interconnected nature of complex challenges such as COVID-19, a collaborative, multisectoral, and transdisciplinary approach, referred to as One Health, has been employed to address sustainable development and strengthen global health security. Although significant investments have been made to build global health capacity, characterization of the One Health is absent from the literature. METHODS AND FINDINGS: We collected and analyzed perspectives from students, graduates, workers, and employers in One Health through a multinational online survey across health disciplines and sectors. Respondents were recruited through professional networks. A total of 828 respondents from 66 countries participated, representing governmental and academic institutions and students, among others; 57% were female, and 56% had completed professional health degrees. Interpersonal communication, communication with non-scientific audiences, and the ability to work in transdisciplinary teams were valued in the workplace and were considered essential competencies to build an interdisciplinary health workforce. Employers indicated difficulty recruiting workers, while workers indicated limited availability of positions. Employers identified limited funding and ill-defined career pathways as prominent challenges for retaining One Health workers. CONCLUSIONS: Successful One Health workers use interpersonal skills and scientific knowledge to address complex health challenges. Aligning the definition of One Health will likely improve the matching of job seekers and employers. Encouraging the employment of the One Health approach for a diverse range of positions, even if they do not explicitly include "One Health" in the job title, and clarifying the expectations, roles and responsibilities within a transdisciplinary team will lead to building a stronger workforce. As One Health has evolved to address food insecurity, emerging diseases, and antimicrobial resistance, it holds promise for supporting an interdisciplinary global health workforce that can make substantial progress on Sustainable Development Goals and improve global health security for all.

Prioritizing a One Health Approach in the Immediate Fight Against Antimicrobial Resistance.

Antimicrobial resistance is a major threat to global health security. While the global community has made recent advances to mitigate the threat of antimicrobial resistance, we continue to face challenges in creating solutions and concrete actions that will yield the greatest immediate impact. To examine the critical areas in human, animal and environmental health that contribute to the emergence and spread of antimicrobial resistance, the Forum on Microbial Threats of the U.S. National Academies of Sciences, Engineering and Medicine hosted a public workshop on June 20-21, 2017 in Washington, DC. This article summarizes the final synthesis discussion that took place at the workshop on suggestions for immediate actions and implementation that are feasible and cost-effective for combating antimicrobial resistance across the One Health domains. The priorities that emerged from the participants' discussions addressed the following topics: (1) Surveillance; (2) Stewardship, Infection Prevention and Behavior Modification; (3) Basic and Applied Research and Development; and (4) Global Policy and Coordination.

The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings.

Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec) Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011) and the second congress (Porto de Galinhas, Brazil, 2013) were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1) development of adequate science-based risk management policies, (2) skilled-personnel capacity building, (3) accredited veterinary and public health diagnostic laboratories with a shared database, and (4) improved use of existing natural resources and implementation. The aim of this review is to highlight advances in key zoonotic disease areas and the One Health capacity needs.

Combating the Triple Threat: The Need for a One Health Approach.

We live in a world that is rapidly changing, complex, and progressively interconnected. The convergence of people, animals, and their products embedded in an ever-changing environment has created a new dynamic. This dynamic is characterized by new threats to the health of humans, animals, and the environment. In addition, the health of each of these three domains is profoundly and inextricably linked and elaborately connected. Our interconnectedness strongly suggests that our future success in improving health will be based on a new integrative, holistic, and collaborative approach termed One Health. One Health demands that we work across professions, disciplines, and old boundaries. The challenges to our health are unique and profound, and old solutions to our new "wicked" problems are no longer as relevant or effective as in the past. The concept of One Health is not new but has reemerged as a concept to both better understand the triple threats to health and to better address these contemporary challenges using new approaches. This article discusses the health threats to each domain and calls for a new model to confront these challenges by shifting strategies and interventions upstream, closer to the origins of the threats. One Health is a new paradigm that can be used to improve the health of people, animals, and our environment as a collective rather than restricting our actions to any single domain.

Developing veterinary colleges and leaders: a whole-system approach.

The current environment in higher education calls for increasingly progressive leadership and management. This report describes the efforts of the College of Veterinary Medicine (CVM) at Michigan State University (MSU) to strengthen its leadership using a whole-system approach. Developing a leadership culture is the responsibility of leaders, and the pursuit of such a culture requires considerable and justifiable investment of time, energy, and resources. The volatile and changing environment in which colleges of veterinary medicine exist makes creating such a culture imperative if society's needs are to be successfully met. Noteworthy cultural change has occurred within the MSU CVM because of the efforts described here.

Veterinary medicine and public health at CDC.

People readily associate the role of veterinarians with private veterinary practice focused on pets and farm animals, but the true dimensions and contributions of veterinary medicine are much broader and reflect expanding societal needs and contemporary challenges to animal and human health and to the environment. Veterinary medicine has responsibilities in biomedical research; ecosystem management; public health; food and agricultural systems; and care of companion animals, wildlife, exotic animals, and food animals. The expanding role of veterinarians at CDC reflects an appreciation for this variety of contributions. Veterinarians' educational background in basic biomedical and clinical sciences compare with that of physicians. However, unlike their counterparts in human medicine, veterinarians must be familiar with multiple species, and their training emphasizes comparative medicine. Veterinarians are competent in preventive medicine, population health, parasitology, zoonoses, and epidemiology, which serve them well for careers in public health. The history and tradition of the profession always have focused on protecting and improving both animal health and human health.

The concept of rural community practice (RCP).

The need to devote more human resources to veterinary public practice to cope with escalating threats to biological security, public health, and economic prosperity, while also addressing societal value changes, has been widely recognized and supported. Most envisage increasing the numbers of veterinarians in government employment. Why not at least combine this initiative, wherever possible, with far greater involvement of rural practitioners to deliver contractual public-practice services and provide an enhanced community interface? This could make the difference between having a local practice in a community or none at all, as well as promising to be more cost effective. The concept of rural community practice (RCP) envisages combining traditional services provided in a "mixed-animal" veterinary practice with an expanded portfolio of public-practice and communication services that meet the emerging animal, public, and ecosystem health needs of the collective community, not just those of animal owners. These services could include those involving active sentinel surveillance programs for both domestic animal and wildlife diseases; on-farm food safety; bio-security; traceability and export certification and audit programs; disease investigation, including foreign animal diseases; surge capacity emergency response; managing for ecosystem health; and client and community education. An expanded practice team of animal-health professionals and technologists, led by veterinarians, would deliver these services. This RCP approach should have the potential to make rural practice more attractive from economic, lifestyle, and job-satisfaction perspectives; to enhance the visibility and recognition of the profession; and to respond to changing and new societal needs. It also promises to maintain a stable network of veterinary practices in rural communities. In addition, the recognition of veterinary medicine as a public good should provide for consideration of increased investment by levels of government. At the same time, this new model could help meet the demands of animal and public-health government agencies that face expanding responsibilities during a sustained climate of reduced budgetary resources.

Skills, knowledge, aptitudes, and attitudes colloquium.

Three projects recently funded by the American Veterinary Medical Association (AVMA) through the National Commission on Veterinary Economic Issues (NCVEI) focused on the veterinary school applicant pool, leadership skills in the veterinary profession, and a veterinary teaching hospital business model, respectively. The Skills, Knowledge, Aptitude, and Attitude (SKAs) Colloquium was designed to present the results of these three projects, to discuss their importance for the future of the veterinary profession, and to develop action plans accordingly. In all, 24 veterinary colleges were represented at the workshop and a total of 72 attendees participated, achieving a broad representation of the veterinary profession ( both academic and non-academic). Through an orchestrated combination of general sessions and facilitated small group discussions, recommendations for implementation and initial action plans for next steps were developed. From these, a list of potential AAVMC follow-up activities was developed, including advocating and facilitating programs across schools to engage and educate faculty regarding the results of these projects; developing realistic information on careers in veterinary medicine; organizing an AAVMC leadership consortium; working toward further development and implementation of the veterinary teaching hospital (VTH) business model; coordinating and sponsoring a national forum on the future of the VTH; reviewing admissions processes; integrating leadership into veterinary curricula; and organizing opportunities for faculty development in leadership.

What are the veterinary schools and colleges doing to improve the nontechnical skills, knowledge, aptitudes, and attitudes of veterinary students?

The KPMG study signaled the need for change in the veterinary profession, and the NCVEI was formed to follow up on the study's findings. As founding organizations, the AVMA, American Animal Hospital Association, and the Association of American Veterinary Medical Colleges remain committed to the cause, as do the NCVEI's corporate sponsors. In addition, it is clear that substantial change is also underway within the individual veterinary schools and colleges. The programs compiled should not be considered exhaustive because of the possibility that not all schools replied to the survey and because of ongoing changes. Widespread programmatic changes are being implemented in the veterinary schools and colleges, with short- and long-term implications for the veterinary profession. Such changes are not taken lightly in academia, and the schools and colleges are to be commended for their leadership and initiative. The momentum that is apparent can be expected to yield benefits for the veterinary profession well into the future.

National workshop on core competencies for success in the veterinary profession.

A workshop was designed to (1) present results of the Core Competencies for Veterinary Medicine project conducted by Personnel Decisions International (PDI); (2) discuss and analyze the implications of the PDI study results for academia, private practice, and industry; (3) identify actionable items-discuss opportunities and barriers; and (4) develop appropriate recommendations-devise specific actions for implementation as next steps. In total, 25 veterinary colleges were represented at the workshop and a total of 110 attendees participated, a broad cross-section of the veterinary profession (both academic and non-academic). Through an orchestrated combination of general sessions and facilitated, small group discussions, prioritized recommendations for implementation and initial action plans for next steps were developed. Recommendations included publicizing results of the PDI study, reconsidering current admissions policies and processes, evaluating the applicant pool and current recruitment programs, developing structured mentoring programs, enhancing DVM/VMD training programs, coordinating the development of continuing education programs, and overcoming existing barriers to change. Next steps should involve collaborative efforts across all sectors of the veterinary profession to develop plans for implementing the workshop's recommendations. Leadership for follow-up might reasonably come from the Association of American Veterinary Medical Colleges (AAVMC), the American Veterinary Medical Association (AVMA), and the American Animal Hospital Association (AAHA), either individually or collectively, through the National Commission on Veterinary Economic Issues (NCVEI). Partnerships with industry are also possible and should be strongly considered.