Coppoc One Health Updated

Text Transcript:

Coppoc Lecture      November, 2015    Dr. Gregory Gray

Thank you, Harm and Dr. Coppoc for sponsoring this event.  It’s a pleasure to be here and to meet so many talented faculty and students.

I’m going to try something here and I hope you won’t throw tomatoes at me but I’m going to throw some new material at you.  I’d appreciate any feedback, especially if I get something wrong.

First let me say that my background is a little different.  I’m trained as an infectious disease epidemiologist on the human side so I’m not a basic scientist, or an agricultural scientist, or a veterinary scientist. But I’ve learned a tremendous amount by working with those colleagues over the years and actually have some training opportunities where we actually learn from scholars like yourself who teach about One Health in their various courses.  So these comments are from me – they’re not from any of the institutions I represent so hopefully will get some good feedback from you.

I want to talk to you about where this concept of One Health is going – at least where we perceive it to be going, talk about some of the trends we’re seeing in production, particularly animal production, talk about the benefits and some of the drawbacks of those changes in animal production and then suggest some ways forward with One Health as the center.

I like to start off, particularly with my colleagues on the human side who are somewhat jaded with respect to new ideas, talk about wicked problems because wicked problems seem to register today.  You see here a number of books that are written about wicked problems.  The concept is easier to get your mind around in that with today’s globalization, because of modern transportation, because of international cooperation.  We have problems that we just didn’t have 50 years ago.  Now, wicked problems have been defined, in this case by the Australian Public Health Service, as things that are multi-causal.  They exist in complex systems that are somewhat unpredictable.  They have emergent kinds of behaviors.  They’re not stable.  There’s often no clear solution, and these problems cross governance boundaries so different agencies, different disciplines have responsibilities.  

In public health, some of these wicked problems, at least three themes of these I’ll talk about now.  Emerging infectious disease are a big one, and when you think about the emerging infectious diseases, 70% of which come from animals, the ones in particular that are frightening to the people on the human side are those that cause little or no problems in the animals, and we only know about their movement geographically when they cause severe disease in a person in another geographical area.  So, effectively, people are serving as sentinels.  This gets people in my world pretty excited.  You know, how do we stop this?  Well, we can’t stop this by sitting in the emergency room with the world’s best diagnostics.  You’ve got to reach out to people in the veterinary world and the animal production world.  So this is an example of a wicked problem that requires a One Health collaborative approach.

Another area, of course, is antimicrobial resistance.  We have tremendous pressure due to our successes in developing antimicrobials and their corresponding metabolites at selecting today for resistant organisms.  That pressure comes from lots of different places.  It certainly comes from the veterinary world, the animal production world.  It comes from the human world and, again, you can't just sit in a hospital ward and expect to do anything other than count the number of patients who have a very severe illness, for which your antibiotics are not working.  So this seems to also register with my medical and public health colleagues.

And, finally, food safety.  Food security is a huge issue today with globalization of the markets.  I know that the FDA has been so frustrated with their portion of the responsibility pie, but they stood up a crack unit to basically deal with this.  A CDC emergency response unit that they never had before because they have so many of these problems.  So this is an excellent example of a wicked problem that requires multi-disciplinary participation. 

 And the way our government is set up and classically we handle complex problems, is to divide the problems into different sectors.  In this case, four different government agencies have some sort of responsibility, some portion of the responsibility pie.  And they act a bit like a dysfunctional family.  “No, you can’t contact that agency, that’s my responsibility.”  “No, you can’t know what’s in the tomato sauce, that’s proprietary.”  “No, you cannot have my data, it’s top secret.”  And we end up having sort of a dysfunctional family with frustrations and poor cooperation because we divided the responsibility instead of working together.  Now it’s fortunate that the family comes together when there’s a family emergency.  A good example is highly pathogenic avian influenza – one of the finest examples of interagency cooperation – and I think we’ll see it again today if we any more occurrences here in the United States.  But what we need to think is a different paradigm where we have these collaborations set up before we’re met with another huge threat that’s going to cause a lot of morbidity, mortality in humans or animals and even large economic loss.

The foundational problem is that we don’t have a single discipline or a single institution that kind of manages these things.  They cross so many boundaries.  By nature, the wicked problem.  So we have to start thinking about new paradigms.  New approaches.  And that’s where One Health has gotten a lot of traction.  We’ve seen a number of examples of where we’re required to work together across disciplines.  Now, classically, we’ve talked about human health- that would be public and medical disciplines –veterinary health, and environmental health.  Now let me make it clear that the interdisciplinary nature does stop there.  Certainly there are big contributions from people in other disciplines – social sciences, which manage behavior or understand how to do behavioral interventions-, economics which can capture our data in a way that our policy makers can embrace it.  So One Health can be rather broad in its scope of involving different disciplines.

Now the thinking about doing interdisciplinary research is not totally new.  This is a paper that was written, or published, in 1981, by a medical colleague who was wrestling with how to do this for pulmonary medicine in a big hospital.  He was trying to bring together sort of a microcosm, if you will, of the disciplines in health care.  And it was complicated, it was a mess.  He faced some of the same problems.  His conclusion in this, I think, in this seminal paper, is that you’ve got to sit people at the same table, they have to work on their problem and define their problem jointly, not divided up into sectors, but jointly work on the problem.  And I think that’s one of the key things that we have to do in One Health is somehow teach the next generation to focus on problem areas in an interdisciplinary, problem-solving way.  And as, pretty much, equal partners.  Equal partners in the sense that your view counts, your data is very important – we have to work together.

Well, who’s embracing this?  This is a page, somewhat dated now because the number of agencies has increased greatly, from the One Health website showing the number of organizations and institutions who have written their support of the One Health approach.  And you can see that it’s mounting.  So if you want information on One Health, this is an excellent website.   It’s a volunteer supported website, where people have given their time and their energy-there’s no federal funding for this.  But they have a rich repository for data and they have a nice email distribution list if you’re interested.

Another really nice website is a little more formal.  They do have some funding and that’s the One Health Commission site that was stood up some 5,6,7,8 years ago.  They’re trying, basically, to have an organizational approach.  They have engaged lawmakers, they have webinars.  They have more sort of structured activities, a little more planning, if you will, and focused activities to try to effect change.

There’s also a student-run newsletter that’s actually distributed by these groups.  The University of Florida students, like many in this room, submit articles and manage the articles.  This has a wide distribution throughout the world.  If you have an idea of a One Health issue, or a report of One Health success, this is a great place to give it some visibility.  You can contact these folks and find out how to do so.

With respect to publications, there are quite a few that one could call one health oriented in the peer review literature.  But I asked one of our students just to search for terms that we know are very specific to one health so that one health initiative or the one health approach and look at the changes over time.  And I think you’ll agree with me that there is an increasing number of peer reviewed literature reports where one health terms are used.

We’re beginning to see new journals.  Some of these require no fee and they’re available online and I’ve heard of a fifth one focused in Romania.  People are saying we need to promote what we’re doing in one health.  We need to talk about examples of case reports, success stories, because we’re really excited about this concept and it’s working.  It’s interesting that a lot of these are coming from the developing world.  In some ways, people with the least resources see the biggest need because they work closely with animals and they are pulling together some pretty good success stories.

One Health conferences are becoming more and more frequent.  Sometimes these can be local, sometimes these can be statewide, regional, national and international.  We’ve recently organized one of these in China that brought people from across China.  We have another one coming in Mongolia.  There’s a very big one in December of 2016 in Australia.  So these bring together people from many countries who are embracing the one health concept and moving forward in policy and research.

What about funding?   Ten years ago, frankly, there wasn’t much funding for this kind of intercollaboration work, but it’s changing.  The Gates Foundation has come forward with at least two calls for proposals for $100,000 pilot projects.  I don’t know how many won the big money afterwards, but they’ve certainly embraced it.  USAID and their EPT-2 Program recently awarded three different contracts totaling somewhere, we think, in the term of $300 million- to use the one health approach to detect novel pathogens, to train people in the one health approach and to effect policy.   The World Bank, the US Department of Defense, the State Department, Homeland Security.  The NIH is funding, although there have been no specific calls, they are funding at least our grants with One Health in them.  The UK, and sometimes the EU, are funding One Health.  The big one that’s about to come out is the US defense threat agency that has a lot of the agencies that work across our government building consortiums who compete for $120 million dollars that has a One Health training and response theme for biosecurity in this country.

What about jobs?  Well, there aren’t that many people formally trained.  But, I’ll tell you, the folks who have come out under the programs we’ve created such as the Master’s program in One Health had no problem getting jobs or into graduate school.  Now here are four jobs we have that are One Health oriented and I’ll just say that I’ve seen a number of different professor positions – I understand there’s one here.  There was one recently at UNC or NC State, so the concept of having a champion for One Health at your university is getting some traction.

Let me tell you a little bit about our One Health research.  Now, remember I told you that I had no real formal training in this concept.  I mean, I went to medical school and you don’t classically learn a lot about zoonotic diseases.  You have no clue as to where the meat comes from.  All you know is that you buy it at the grocery store.   But my veterinary colleagues have educated me over the past dozen or so years and actually proposed a number of hypotheses that we have had the privilege to investigate and it’s been a lot of fun.  Because I don’t have to know all they know.  All I have to do is ask them “how do we do that?”  So you can see some of the pathogens, a lot of this has been focused on avian influenza because there’s funding for influenza.  But there are other pathogens out there for which we don’t know that much as far as crossing species that have been sort of pilot project things that students have engaged.

So my groups have worked where they have large groups of people and animals mixing.  And you can imagine where some of that has occurred.  We’ve done a bit of this in the United States, working with the US CDC and the Minnesota Veterinary College.  We were the first to detect the pandemic virus in pigs.  This was accidental.  We were just trying to do work in the pig shows, trying to understand why people who were visiting the pig shows were coming down with swine influenza and suddenly we found a pandemic virus. Secretary Vilsack announced this which wasn’t our intent and, basically, there was a problem in that the pork prices plummeted.  Now that wasn’t our ideal.  We didn’t come out with the paper til three years later.  But it just demonstrates that there are often things that we don’t know are going on at the human-animal nexus and, if you just have someone examining, you might be surprised.

We found in that study evidence of these crossover infections and they were replicated worldwide in just a matter of months.  We’ve also partnered with a number of people looking for subclinical infections with a number of avian viruses shown here.  A lot of this has recently been in China, but also in Nigeria, Cambodia and Thailand.  We found, for instance, H9N2 subclinical infections in Cambodia.  Recently evidence of subclinical infections in veterinarians in Iowa – and the veterinary workers with equine.  And we’ve worked with veterinary partners such as here in Romania setting up sentinel ducks and geese.  So I’ve had a pretty rich opportunity to see the veterinary world with respect to, at least, avian influenza.

Most recently we were working for the NIH, under one of their Centers of Excellence at St. Jude, surveying animals in Mongolia for viruses and basically found the first evidence that an H3N8 had crossed over to camels, so we’re adding camels to the ecology of equine influenza.

I’ll say that this kind of work is exciting to people in the developing world and other countries that are moderately developed such as China.  Here in the last year we’ve had success in collaborating with other institutions in China, looking often at the One Health realm.  Partners are pretty easy to find internationally.  Now we’ve been fortunate in that, despite not having a call for One Health proposals, we go ahead and put One Health in our descriptions in applications for various grants.  This is an R01 that we won in collaboration with a leading Institute in Beijing where we’re studying in a One Health way, people exposed to pigs and controls.  Pigs, in fact 300 throat swab specimens per month, and environmental swabs.  So this involves six different farms in China and we’re trying to understand how these viruses are being amplified and moving back and forth in a One Health way.

I’ll show you some of the field work, what it’s like working there.  Now when I first started out I said no way did I have the funding to pay for all the staff that would be necessary to do a prospective cohort study of this type, not with this amount of money.  But my colleagues said that, no, you don’t really have to plan for funding like we would in the United States.  You can leverage the interest of your partners.  So what you see here is just a small number of the people in the various – we have four or five Chinese CDCs – that are engaged because they want to know this information too.  And so I’m just trying to challenge you to go ahead and try to plan big in a One Health way and you’ll be surprised at what you can accomplish that you might have difficulty doing here considering some of the fiscal restraints.

So we have developed this network in some places developed and some not developed, promoting One Health and I’ve learned quite a bit about doing these studies a lot of the time from my veterinary colleagues.  We’ve done avian flu, as I mentioned, equine flu, canine influenza and, frankly, most of the studies are not too exciting because I think the species barrier between these animals and humans is really high.  It’s a difficult barrier.  But where we’ve had the action is looking at swine.  So I’m going to talk to you a little bit more in detail about what’s going on in pigs, at least from my perspective, and influenza.

I would argue that minimizing novel influenza generation risk in modern swine production should be considered a wicked problem.  Somebody might argue with me that that’s not true, but I think it’s immensely complex.  Let me talk to you about why I think that’s true by talking about some of the trends, and some of this is probably not new to you but some of it may be startling.  To our junior students here, the family farm that our ancestors came to enjoy has largely given way.  We just don’t have the family farms that my members came from because you cannot be effective, it’s not economically viable.  What’s viable today, and what we do perhaps better than anybody in the world, is intensive farming.  We can raise the least expensive meat and meat products in the world with some of the best biosecurity in the world.  And we are seen as leaders in these industries, largely by the dedication of scientists in these state veterinary schools and other people to do, for instance, food production.  Some people may argue that maybe the industry should be paying for some of this research that they’re sort of getting free, but that’s another debate.  Nonetheless, we’re being emulated in these production techniques and the number of swine farms has rapidly declined, but the scope of those farms are massively increasing.  So big change.

We also know that swine influenza viruses are enzootic or endemic where we have these modern production facilities.  You can understand where you have a small herd of pigs and you introduce a novel virus, it will burn right through them.  But if you’re continually introducing pigs that are immunologically naïve then the virus can become enzootic and can be sustained by replicating through generations of animals.  We know from some of these published studies that risk factors for sow herd swine influenza seropositivity have to do with pig densities.  Also, bringing in breeding pigs from external sources and the total number of animals on the site and proximity of the barns to each other.  We also know that SIV is associated with large herd size, high pig farm density, and so, if you want to find swine influenza, you don’t go to the back yard farm, sort of little producers; you go to the big industry.

As we’ve gone over time from the small farm to the larger farms, at least there is a loose association of increased variety of viruses in the farms.  Many people have talked about this.  These are largely veterinarians talking about swine being engaged in a generation of novel viruses.  Some of you students may not know, but swine have the receptors for all the kinds of viruses that are reservoired in aquatic birds and humans and, of course, can move those.  And so the diagram that some of our veterinary colleagues have put forth, indicating here that originally when we had small farms, the variety of viruses that were circulating were few.  But as these industrialized farms became more and more prevalent, the variety has increased.  Now this was before the pandemic hit in 2009 and the number of viruses now has greatly changed, has greatly increased.

So we’ve done a number of cross sectional studies and prospective studies and the veterinary world in avian and swine and also equine and canine, at least one study in canine exposures.  This is a middle range NIH funded study where in Iowa, who has arguably the largest number of adult pigs in the United States, we enroll people from 29 counties who had either chicken or pig exposures.  We drew their blood at 0, 12, and 24 months and sent them home with these kits; this wasn’t a lot of money so we couldn’t have nurses go contact them.  So we told them to put this little freeze pack in their freezer and, if you get influenza-like illness that meets this criteria, gargle in this cup and swab your nose and send it in this box to us and we’ll look for virus.  Not the best way relying on self-collection and the postal service, but it turns out that we picked up quite a few viruses this way and at least one of these was from a pig.  Most of the time, though, it was human viruses.  More importantly, we found evidence that was almost impossible to believe.

How many here are epidemiologists?  Ok, we have a number in here.  You see an odds ratio that is three or higher and there’s no inclusion of one in the confidence interval you get excited.  But when you see an odds ratio of 54 you say something’s wrong.  It’s too high.  Unbelievable.  In fact, some of the infectious disease docs, when they look at the titers we were seeing that generated these odds ratios quipped that it would take a boatload of antigen.  In other words, it would be a pretty good vaccine if you saw these odds ratios.  So the swine workers in Iowa who participated in the study had sky high titers against both the classical H1N1 virus that’s probably been circulating since the 1930s and a 3-year-old with H1N2 virus, pretty high titers compared with controls.  But more remarkable was we also found titers that were very high in their family members, 90% of which had no direct contact with pigs.  Which of course suggests that somehow the pig workers are bringing the virus home. So, anyway, this little project was pretty interesting and something that the students contributed a lot to.  Then we talked to another students.  We said, you know, you’re a mathematical modeler sitting in our infectious diseases epi class – why don’t you look at this question.  What role would modern industrialized farming play in amplifying a pandemic virus that would move back and forth like, perhaps, the 1918 H1N1 that was obviously infecting pigs.  What role would rural America see?  If you looked at both, say, the pigs and the people in rural communities?  And the first time he took this to his mentor, the mentor said “oh, bad ide-it’s not going to be worth anything.”  But I’ll tell you this guy rode this idea all the way to Cambridge for his postdoc, because what he showed was something we’d never thought about before.  He used a simple model like this, susceptible infection recovered, in the CAFO species, the CAFO workers and the community.  He had made many assumptions because we don’t know some of the rates of contact and things.  But for a mildly infectious virus, the R nought 1.1 to 1.5, these are sort of the range of the impact and, basically, he found for a low R nought, the workers played a huge role.  The workers were acting, basically, as a population to move the virus to the communities, because of the assumptions that it was being amplified in the pig reservoir – not making the pigs sick, but the probability of the workers taking that home was great, and so, suddenly, you have this concept that these people who live in rural areas may be economically and medically disenfranchised could be the source for bridging population.  If you think about where we have our tertiary care facilities, they’re not in rural Indiana or North Carolina.  Those people have to travel three or four hours.  So if you wanted to put a novel virus somewhere, and you wanted it not to be detected for some time, this would be a pretty good place – in rural America where we have a lot of industrialized farming.  The good news was that if you had a halfway decent vaccine -50-70% effectiveness- and you gave it to these workers, it would totally mitigate the problem.  And, yet, when you look at the national plans for influenza, do you see veterinarians or these workers listed?  They’re not a priority.  Instead, the guy changing the light bulb in the emergency room in the hospital is more likely to get a pandemic vaccine because he’s around patients who might be immunocompromised.

So, basically, we’ve argued that you veterinarians and veterinary technicians and the workers in these industries don’t get any respect.  (Those of you who are under 30 won’t get this)  Rodney Dangerfield was a comic who said “I don’t get no respect” and that was his whole thing.  You’re just not being thought of as players in the pandemic world, at least not yet.  And we’ve lobbied for this with veterinary partners and said “Why aren’t we thinking about veterinarians”?  Who was it that died from Hendra virus or H7 in the Netherlands?  Who are really the sentinel populations?  Well, the veterinarians – and, frankly, we’re not thinking about you enough- at least with pandemic influenza planning.

Let’s move over to industrialized farming.  We don’t know exactly where the 2009 pandemic came from but a number of people noticed, maybe a temporal association, when it occurred it was linked geographically to Smithfield Farms, a large pig producing facility in northern Mexico.  So some people have hypothesized that perhaps that’s where the mixing occurred to create the novel H1N1.  It’s important to know that that may not have been Smithfield’s fault, so much as it is the fault of humans being exposed to the pigs and bringing in new viruses.  And now there are mounting data to say that reverse zoonoses are contributing in ways that we didn’t expect; that is, pathogens moving from humans to large populations of animals.  This, I think, is one of the best examples.  A veterinary school up in Canada had a production facility largely for the trainees, veterinary students, and they had an incursion from a worker that was well documented.  And in that incursion, they saw an explosion of illness in the pigs, and secondary infections in waves in the workers.  And so – a good example of a reverse zoonosis that infected both populations.

But we’re seeing more and more of this.  This is a nice paper Martha Nelson, an NIH researcher at Fogarty who does a lot of modeling in swine influenza.  She has documented, by looking at the genetics, a number of incursions of human influenza in the pig population.  So this is becoming totally understood that we are contributing to the variety with our viruses, of human influenzas in the variety of viruses in the pigs.  We asked a group of my students to look at this risk of humans infecting animals.  What’s in the literature?  And they did this systematically and found, if you look here in the graph, at least an increased number of reports in the peer reviewed literature.  Some 43% of these are in livestock.  So we would argue that this is something we need to be looking at.  With modern production, how often are humans introducing novel pathogens in our production livestock?  So this is a paper I mentioned, in a joint product with the CDC and the University of Minnesota in the pig show.  As soon as we published that, people were finding the pandemic virus in pigs all over the world, in a number of different feline species and turkeys.  It was just amazing how much we were missing that we didn’t know about until people started looking.  This is a nice graphic a few months later showing that this was not unique to the United States, that the H1N1 virus had crossed to pigs in many countries.

So think about reverse zoonoses.  How can you capture it?  Who can you partner with on the human side to prove it?  As a result of this introduction of the pandemic virus in the pigs, people started seeing progeny viruses that had components of those pandemic strains that were recombined or reassorted with the enzootic viruses and the variety – and this is a number of years ago where I captured this – is only increasing.  The only one that a lot of people are concerned about, is H3N2 variant virus.  Now, close to 400 human cases of this strain, and there are some new ones, an H1N1 strain that we’re really holding our breath about because it turns out that about 90% of children less than 11 or 12 years of age are very susceptible to this H3N2 variant.  The NIH is so concerned that they have constructs already, and if they’ve not completed them, phase 1 trials.  Now it’s important to note that when you’re thinking about the ecology of the viruses in pigs, and you talk to colleagues in the pig industry, swine influenza is not an industry problem.  It doesn’t really cause – I mean, occasionally it does in combination with other viruses, but generally it’s pretty well tolerated.  They have vaccines and, correct me if I’m wrong, this is nothing like some of the other problems we’re worried about most recently that are emerging in pigs.  This is something we’ve learned to live with.  Now, with that in mind, and remember to talk about humans being sentinels, what we’re seeing now – and because we don’t really know what’s circulating in the pigs, either geographically or genetically, we’re being surprised quite a bit.  And that’s because the pigs, sometimes because of partial immunity – in this experiment done at the University of Minnesota, the pigs that they were challenging had some maternal antibodies to the virus they challenged with, and yet, the pigs were shedding virus that were picked up by aerosol, viable virus, and we’re knowing now that, sometimes by indications of novel viruses are when people visit the county fairs.  And so if you’ve watched the fairs as I have over the last few years, there were great restrictions this year, of course, with respect to poultry, but there have also been increasing numbers of hygienic, hand-washing stations-all kinds of warning signs because of these phenomena.  Basically, pigs that look perfectly healthy, show pigs that are screened by veterinarians, are shedding virus to the people who walk through those barns.

Now, on the human side and sometimes on the veterinary side, despite our best efforts to develop diagnostics, when a new virus emerges sometimes the diagnostics don’t work.  At least the rapid diagnostics.  So we have these physicians running these rapid monoclonal antibodies, you know like a urine pregnancy test, and “Oh, that person doesn’t have influenza”.  But what they really have is a novel virus and it’s being missed by these diagnostics so that’s something we need to consider in the ecology of this.  What can we do better to conduct surveillance of novel virus generations, particularly in the pig population?  We cover a lot of the human population through some really intense seasonal influenza surveillance.  So occasionally, because we don’t really know what’s going on, these healthy pigs cause big outbreaks.  This is a fair associated outbreak – 98 cases of the variant in Ohio.  And, as I mentioned, these cases continue to mount in the United States.  It’s scary.  People point to this influenza surveillance program that the USDA has stood up in partnership with the CDC, but it’s a passive system.  It depends upon the grower seeing enough illness that he calls a veterinarian who has to be convinced enough that he orders the test and then, in the case of this program, being willing to submit to this particular type of testing, which can basically lead to information that goes outside of their production system.  So it’s a very passive system I would argue and one that’s not going to give us a great handle on what’s going on.

So we have argued, having seen a number of these human cases, that we’re looking through a glass darkly.  We don’t really know what’s going on.  If you talk to our veterinary colleagues – Sam, correct me if I’m wrong – Sam is a molecular guy here – that the proportion of pigs that are sampled are very few.  The distribution is not always well characterized – and certainly not characterized everywhere – so we don’t have a good handle and the industry is not very excited about letting those public health tree huggers – you know, vegans come in to their facilities and interrupt their business operations.  So we have this sort of offensive confrontational paradigm and don’t know what’s going on very well.  So in this editorial, we basically said if we can’t do it here, let’s go to China.  Now I’ll just tell you that’s kind of frustrating in a lot of ways because we have a lot of talent in this country.  If we could figure out how to do it that’s not offensive to industry we could probably make a difference.  And so these cases continue to mount.  This is another variant, H1N1, just recently causing some severe illness.

So that’s sort of the framework we’re working in from my perspective.  It may be totally wrong so correct me later if you need to.  But what are some of the benefits?  There are some huge benefits in modern production that aren’t well recognized on the human side.  And I get some of this from the Pork Checkoff, from the Pork Board and I’ll say this.  Some of my family members were pig farmers that were kind of pushed out by big industry years ago.  But the bottom line is we’ve greatly reduce severe pig diseases in this country.  Food safety, I would argue, is some of the best in the world.  We have animal well-being at a lower cost that is very defensible.  We’ve reduced severe overt diseases – I don’t know if you read stories, but swine fever, foot and mouth disease, some of these that were considered foreign animal diseases were huge, huge problems until these systems were developed in a lot of developing countries.  You think about food related trichinosis, cysticercosis, all these things and due to the biosecurity – all of these things that people like the faculty here have developed over time.  Rodent control, physical barriers, safe water, feed etc.  I mean I understand that but I don’t know that everyone on the human side understands that.  We have really good training with respect to food safety now and, when I take my classes through the meat processing plants now, it’s like going to Mars.  They had no clue this is all going on.  Food safety – the food inspection folks – we just don’t get any appreciation for this fundamental thinking in the veterinary world and, frankly, we’ve got to have this.  People need to understand that if you’re going to fight infectious agents that are meat-related, the people on my side of the fence need to understand this.

Animal well being.  The Pork Checkoff argues rightly I think that better temperature control, better nutrition, fewer losses to trauma and disease.  And certainly the big motivator is reduction in pork production costs.  I mean that’s why people want to emulate us.  We have fewer workers, fewer losses of pigs, more efficient use of feed.  I say this because I want you to know that I recognize this and value it.

So what about the rest of the world?  Well, the rest of the world sees this tremendous success, and particularly China.  China has 54% of the pork production and they are quite envious.  They would like to not consume all their pork, but produce it to export.  There is a 65% higher cost of pork in China than in the U.S., despite having all the inexpensive labor costs.  And so what has happened?  Well, China, in 2013, bought Smithfield Farms, the premiere production facility in the United States and is now trying to move those sorts of production strategies to China.  To get rid of the small farms.  But the concern is maybe China will adapt the economically valuable modern production techniques, but because they don’t have the USDA, they don’t have the EPA, they don’t have some of the things that hold the bad parts of production in check, the concern is that we might increase, for instance, some of the influenza problems.  It’s interesting to see this and you guys know this better than me, now China’s beginning to accept imports from the United States.  Of course they own the company.  But it’s interesting to see the economic transition going on, and yet we increase our herd efficiency here.  We’re doing things better and better and they’re taking advantage of it.

What about some of the criticisms?  Some of you may know about this.  This is the Pew report, published in 2008, where people from the agricultural industry, from academia, public health, government, all basically got together and examined a lot of these questions.  And the report was, I think, fairly balanced.  It wasn’t terrible in the sense that it bashed farming.  But it said we need to make some changes, we can do better, we can improve some things.  They talked about the novel pathogen generation risk, nitrates in the intensive farming causing respiratory problems and neurobehavioral problems in people and, of course, animals.  Some of the problems in the environment etc.  So there were some negative things, but they recognized the value of farming.  The idea is not to destroy farming, it’s just how do we make it better?

One of the most alarming things is this constant cycling of swine influenza viruses in large herds causing increased opportunity for novel virus generation.  And I don’t know that we’ve made a lot of progress on that.  We’re also seeing some other pathogens that we haven’t thought about, such as MRSA associated with both morbidity in people and animals.  Some new problems coming.  And, of course, the coronaviruses.  Again, Martha Nelson Fogarty has done some remarkable studies of some of the sequences in some of the swine influenza viruses captured over time.  She has documented that we’re basically shooting ourselves in the foot.  A novel virus starts in Canada here and we just basically move it around the United States.  But we’re seeding our farms because of the way we do business.  The novel virus, in this case, began in North Carolina.  And we talked a lot about, at least my colleague did, about how good biosecurity was in the poultry industry and now all of a sudden we had this huge outbreak of H5N2.  Millions of dollars.  Millions of birds destroyed.  So maybe we need to go back and re-examine some of these assumptions we had about biosecurity.  In particular, I think, when you talk about bioaerosols.  We’re also seeing problems in other countries.  You know, we look at the United States and we like to point fingers at the United States, but when you go overseas, man the United States is great.  Because in China we have fecal effluent going right into waterways adjacent to living areas.  All sorts of resistant microbes being found and the richness of viral influenza variety being found in China is amazing.  This is a paper recently published in the Journal of Virology with some of the leading scientists, you know H1 through H11 is there and the industry just doesn’t recognize these problems.  

This is Guan Zhou live animal market.  My friend at South China Ag University – it’s a veterinary school said that somebody counted 128 different animal species, you know, animals you can take home and eat.  Guangdong is where SARS came from.  And this is tradition.  This is the culinary tradition, the Cantonese tradition that goes back thousands of years.  You can’t easily go in there and say don’t do that.  It would be like cancelling Thanksgiving here.  It’s not going to be very popular.

This is three weeks ago – we’re looking at biosecurity in the participating farm.  You see any problems here?  I mean this is open air, there’s no rodent control, fecal droppings in the food, we’ve got birds flying in and out, we’ve got a flock of ducks in between two barns, we’ve got geese at the far end of the same two barns, we’ve got people with no personal protection moving pigs.  They’ve got dogs adjacent to the farm because they’ll bark if somebody tries to steal the pigs and all these opportunities for cross species infections, reassortment, recombination.  It would discourage you, I’m sure, having the training you have, if you’ve never been to China and seen this.

Why should we care about generations of novel pathogens in China?  Let me show you one slide.  10% of the pigs in this country were destroyed by PED.  We can’t hide from this.  It gets over here, whether it’s PRRS or flu or whatever, we need to know what’s going on over there.  Now are they going to tell us?  Not likely.  But what they will do is they’ll emulate our production methods if you can show them that there’s a benefit to using a new technology or a new approach to animal husbandry in pork production for instance.  It’s likely that they’ll adopt them.  They care about their environment – they just don’t have all the regulations.  So what’s happening right now?  I’m far removed from this.  I can only sort of watch this from the bleachers.  Here’s what I see.  Huge attack.  The animal industry is under terrible attack.  This is the livelihood of a great number of Americans either directly or indirectly.  We have a really bad image of these industries.  I don’t know if you’ve seen these videos on YouTube.  A guy takes a quad copter and flies over Smithfield, says really disparaging things, and tells you at the end not to eat any meat.  But, anyway, it’s terrible.  It’s very one-sided.  We have celebrities doing this, we have groups of people with regimented and organized attacks, strategies to attack animal businesses.  This one is fighting CAFO pollution.  OK, some of it’s justified.  But I’m telling you, they’re organized and are they making a difference?  Well, look at what’s happening.  Not only are they doing it through social media, but they’re attacking the buyers.  They’re putting pressure on Costco and Target and Walmart.  And I would say that the problem is that the industry is in retreat.  It’s trying to hunker down and protect itself.  We’re also seeing increased regulations.  I was in Guangdong and the FDA came in and the USDA came in to explain the new – these are the data that are published and argued-80% of the U.S. antibiotic supply is used in animals (of course, the Pork Board says that’s wrong and I don’t really know what the truth is.  But there’s enough of a problem with using antibiotics in animal feed that it’s captured the President’s administration.  That’s pretty high up the food chain.  And they’ve come out basically saying that, like that Pew report, we have to take action here.

And so what did they do?  They created new regulations and basically eliminated growth enhancement use of antibiotics and prophylaxis.  Pretty much restricted.  As you probably know, you’ve got to have a veterinarian with appropriate credentials to write scripts.  And so at a meeting I attended, they were trying to say nice things but it’s obviously a new burden.  The small producer doesn’t have all the support and the big producers – it’s sort of restricting the farming.  And, tell me if I’m wrong, but I think regulations, while it’s one answer to putting pressure on and making changes in the industry, it may not be the most beneficial.  It might drive business outside of the United States.

So the possible way forward – we’ve got a lot of problems.  You can focus on influenza, but it’s certainly more complex.  We can see more regulations, we can see more pictures on flyers or we can think of new partnerships for solving the wicked problems.  And I would admonish you to help me advocate for these new partnerships.  And people say well “where are these examples?”  I just did a search today.  There are 1940 references in PubMed that had One Health in it.  We're seeing expert think tanks saying that this is the only way we’re going to make a difference.  This is their report on emerging viral diseases.  We’re seeing examples – and this one is in Denmark, perhaps an early example of cooperation.  I’ve listened to these talks and again, from the bleachers.  What they did was to bring everyone to the table to talk about antibiotic resistance.  We’re going to do multi- faceted interventions.  We’re going to have checks and we’re going to have penalties.  But they did it in a way that was not so destructive.  It was sort of gentle legislation – and they brought a lot of education and gradually, not everybody, but they brought the farmers around, as the story was told to me.  A lot of producers saw some advantages.  Now they can say antibiotic free, etc. and, basically, it’s a pretty good story where they took a multi-faceted approach and had some success in reducing antimicrobial resistance in animals and in pigs.  You can read about it.  Some of you know much more about this than I.

I’ve also been watching with great interest some of the CDC’s activities.  In the past the CDC was almost always stonewalled.  There was, for instance, a problem in a production farm that was crossing over to the people in the rural areas.  But we’re beginning to see some change.  A nice report that just came out this year of an investigation that involved the Minnesota Department of Health, the CDC, the veterinary college with an agreement from industry to investigate an association of human illness with novel influenza virus in a  group that was marketing live animals.  And basically in one study, in a short period of time, this wasn’t that terribly damaging in the sense that they lost sales, they shut down the market.  In a short period of time, they nailed it.  They found that the sequences in the animals correlated with the sequences in the environment, correlated with the sequences in the humans.  They found the problem.  They identified intervention and, boom, game over.  Here’s what you’ve got to do to clean this up.  I think this is a good example of how we need to do these partnerships.  Bring in people from different disciplines with the industry to try to look at the wicked problems and do something about them.  Now, of course, this is a small one and not nearly as complex.

Who should the agricultural industries partner with?  We know they partner with veterinary colleges and people in agricultural related industries.  But I would posit that they need to think bigger, especially with influenza.  They need to think about partnering with other groups that they might not have liked to partner with before.  And that’s because we don’t have a national institute of veterinary medicine.  Just talking to the faculty here today – the science that you’ve value the most, the funding comes from the NIH.  And it’s hard to get because you have to camouflage your science into something that is human health related.  It’s almost not fair.  Who could say that food security is not important to this country?  Is anybody on my side of the fence doing much about food security?  You guys are.  It’s a question I don’t have the answer for, but here’s the disparity.  OK – I was at the University of Florida about a year ago so I was privy to some of the research tallies.  And you can see here that the College of Medicine generated in excess of 300 million dollars in 2014 in external funding.  What did the veterinary college get?  Somewhere around $10-12 million.  But look at the ratio here.  Is that just the University of Florida?  I don’t think so.  This is data that I acquired from the web-how good is that I don’t know – but you take the College of Medicine for external research funding, said to be UCFS (San Francisco)- take their counterpart in the veterinary world (UC Davis) you’ve got more than $450 million in one year and UC Davis is bragging because they got $37 million. Probably half of it was the USAID contract.

So if you need money to look at these wicked problems, we’ve got to find a way for the industry to tap into all the resources that are available on my side of the fence.  Here’s an example.  I mentioned the H5N2 outbreak.  Remember, chickens don’t cough in the same way pigs do with avian flu.  So people aren’t thinking that it’s transmitted through aerosol, and yet these researchers in Minnesota, without a lot of funding, studied this looking for evidence of aerosol transmission and they found it.  People don’t know what to make of it – the USDA hedges on it – “On, no, how can that be?”  Maybe it’s high winds and feathers.  Who knows exactly?  But the fundamental thing is, if this is true, it undermines all the poultry biosecurity that I know about.  If a wind can blow in, you can wear all the personal protective gear you want.  If it can blow from your house into the next chicken house, all the hygiene you do is just not going to matter.  So we need people to tackle these problems with new technologies and, you know, the folks up in Minnesota don’t have the resources to do this.  They’ve got a company – and this is all second hand so I don’t know how completely accurate it is – a veterinary company that generated a new aerosol sampler.  Is it the best sampler in the world?  We don’t know, but they were picking up molecular signatures.  There are other technologies out there that folks in the industry could tap in to.  This is a new sampler that not only can find a molecular signature, but also viable virus.  If we could somehow get these aerosol scientists working together with the industry.

How do we make One Health happen?  How do we operationalize it?  Well, that’s the million dollar question.  Actually, there have been some meetings on this – the CDC Stone Mountain meeting- where they had sessions led often by veterinarians, including Lonnie King, to talk about it.  How do we make this part and parcel of our disciplines and training.  And I think they have some good ideas.  I think it needs to be examined again and continue to be honed and put into the curriculum of the medical schools.  Obviously, you have that here.  We need to do that on the other side of the fence and in public health.  I think once we do that, if we can figure out ways to work with, particularly with industry in a way through checks and balances, we’ll sign agreements or whatever – we’ll move through some of the rich resources we have on the human side of the fence to help them see that the humans are going to benefit, then we’ll have some progress, if we can do that in problem solving.  And let me say that in my generation it’s probably not going to happen.  A lot of us are very invested in our institutions, our silos if you will, and it’s going to take the young people in the room to reach across the fence and pull together new approaches to these very wicked problems.  And so, please, recognize that you’re the future for this change.  It’s not going to come by fiat in a short period of time.  It’s going to take dedication from you and others to make this almost a life’s work.

So that’s all I have to share.  I thank you for your kind attention and for inviting me here and it’s been a rich experience for me. Thank you.