Now, more than ever, scientists, policymakers, and all of us must recognize the interdependence of human, animal, and environmental health. Predicting, preparing for, and surviving an ever-changing menu of deadly health threats requires collaborations never seen in our siloed health systems. These fictional stories, based on true events, provide invaluable insights that will change the way we understand our place in the global ecosystem. Students, health professionals, scientists, and the public will recognize the characters of our interconnected world. The book, written by two scientists with decades of experience on the frontlines of animal and human medicine, who have witnessed countless examples of ever-evolving threats to life on our planet. These stories will expand awareness, change hearts and minds, and forge new ways of thinking about our shared existence. References to evidence-based scientific reports, help build a vivid picture of how transdisciplinary approaches can offer hope for the future.
Now, more than ever, scientists, policymakers, and all of us must recognize the interdependence of human, animal, and environmental health. Predicting, preparing for, and surviving an ever-changing menu of deadly health threats requires collaborations never seen in our siloed health systems. These fictional stories, based on true events, provide invaluable insights that will change the way we understand our place in the global ecosystem. Students, health professionals, scientists, and the public will recognize the characters of our interconnected world. The book, written by two scientists with decades of experience on the frontlines of animal and human medicine, who have witnessed countless examples of ever-evolving threats to life on our planet. These stories will expand awareness, change hearts and minds, and forge new ways of thinking about our shared existence. References to evidence-based scientific reports, help build a vivid picture of how transdisciplinary approaches can offer hope for the future.
“Tell me the facts and I’ll learn. Tell me the truth and I’ll believe. But tell me a story and it will live in my heart forever.” Native American Proverb
The Covid pandemic forced us to contemplate our interconnected world. Events in distant lands altered our everyday lives, and a tiny infectious agent had a lethal global impact. How could a virus from a faraway place impact the world so severely and so quickly? The pandemic, like a black cloud, enveloped us, ended our ability to travel to work, go on vacations, visit our neighbors, and even greet people with handshakes. It required those in the health professions to contemplate their commitment to caring for others when faced with a risk to themselves and their families. This microscopic organism brought death to the vulnerable and originated in some dark place in nature. We desperately yearned to find out where it came from and how to stop it, to end the nightmare. Public health systems worldwide struggled under the weight of uncertainty, evolving “best practices”, and managing misinformation and skepticism. Governments blamed each other as they tried to protect their own citizens before being willing to help a broader global population. New variants of the pathogen challenged the brightest virologists, immunologists, and physicians to develop novel methods of detecting and combating the insidious pathogen. Scientists and wildlife veterinarians searched hidden caves and wildlife markets, to identify how SARS-CoV2 spilled over from its natural ecosystems and throughout the world.
This was not the first time for disease detectives. While Covid provided unprecedented challenges to our health and planet, the pandemic was predicted years earlier. The history of humankind has countless examples of devastating plagues, some of which arguably changed the course of history. As human populations migrated and numbers expanded, we sought to tame the natural environment to meet our needs—for development, for economic gain, or simply for convenience. As a society some learned to be humble in the face of the vastness and power of a new disease that swept across the planet and quickly killed millions of people. Others did not change their behaviors. Infectious diseases are not the only threat facing humankind and the planet we share with all living things. Environmental threats, from toxic chemical spills to climate change, are in news headlines daily. As the dominant species in our world, humans have created threats to plants and animals that require a fundamental new way of finding solutions to the problems we have created.
By ignoring the benefits of biodiversity and exploiting natural resources that all animals, including humans, depend upon, we have set in motion events to poison our water, disrupt our climate, pollute our air and contaminate food supplies. The relationship between the health of the earth and all living things is deeply interconnected and rooted in cultural, social, economic, spiritual, and ecological dimensions. In many ways our advancement as a society has been remarkable but often at the expense of the land, its resources, and the ecosystems we inhabit. Indigenous peoples across the globe learned over the millennia to respect and appreciate nature. Earth and all its inhabitants are viewed as partners in a reciprocal relationship with human existence.
Indigenous people developed traditions, knowledge, and experience necessary for sustainable resource management. Yet modern cultures have chosen to ignore these lessons. As humans formed larger civilizations with new ideas of the nature of the world, their desire to conquer new territories and hoard the wealth overrode an appreciation of how they were part of a larger and more complex system of life. The Covid pandemic was one more example of what happens when humankind ignores nature’s warning signs.
The concept of learning from the natural world has been with us since antiquity. Through his writings Hippocrates (c.460-c.377 BCE) taught that wellbeing depended on the environment. Before the advent of medical specialization in the 1800’s, anatomists, scientists, biologists, and physicians recorded similarities in structural features, physiological processes, and pathologies between animals and people. In the 1960’s Calvin Schwabe, a veterinarian and public health scientist who studied zoonotic parasitic diseases coined the term, “One Medicine” to emphasize the similarities between human and veterinary medicine and the need for collaboration to effectively cure, prevent, and control illnesses that affect both humans and animals. In 2007, the American Veterinary Medical Association, the American Medical Association, and the American Public Health Association formed a One Health Initiative Task Force to create recommendations to bring together human and animal health in the context of the environment to address the problems at the interface of animals, people, and the environment.
The stories in this book demonstrate the links between these domains and the power of using a “One Health” approach to medicine and science. Uniquely trained people from multiple disciplines bring their skills to understand the complex connections between animal and human health. By sharing data, tools, and approaches in a transdisciplinary manner, today’s One Health practitioners are providing a window into the future to help preserve the health of the planet. The good news is that when working as synergistic networks, these disciplines can engage and think creatively beyond their specialty or policy focus and work towards solutions. This approach has gotten the attention of health organizations worldwide, as evidenced by the recent call to action led by the World Health Organization (WHO), and other international agencies involved in human, environmental, and animal health. In 2023 four international health organizations (the World Health Organization, Food and Agriculture Organization, the World Organization for Animal Health) issued a call to action emphasizing the need for collaboration and commitment from all countries and key stakeholders to prioritise and implement One Health policies. By promoting transdisciplinary and transnational collaboration, strengthening workforces, and investing in One Health, the “Quadripartite” organizations seek to establish a healthier planet and mitigate future health threats.
Threats to these three interdependent domains—people, animals, and the environment—go beyond new and re-emerging infectious diseases like Covid. While humans would like to think we can control our world, we face many threats brought on by our hubris, and frequently through conflicts including wars. Refugees displaced from their homelands face unprecedented challenges to survive. Our planet is heating up from climate change brought on by the overuse of fossil fuels. Unsustainable agricultural practices and deforestation have brought on the destruction of fragile ecosystems. Our overuse of toxic chemicals has led to the near extinction of insect pollinators we depend on to help us grow our food. By dumping plastics, chemicals, and our sewage into our waterways we have enhanced risks to water and food supplies. Rising water temperatures in our oceans and waterways have devastated coral reefs, created toxic algae blooms, and threatened aquatic species critical to the planet. These complex worldwide problems require integrated approaches to thwart the destruction of ecosystems, speed effective public responses, and eliminate barriers between public health sectors to combat emerging health issues. We must foster new collaborations between our siloed domains of science, medicine, ecosystems, and public health policy.
This book tells the stories and gives voice to those most directly affected when we ignore these warning signs. In telling these stories we show how scientists, veterinarians, physicians, environmental health experts, policymakers, and others work together to solve these complex threats. The telling of stories is as ancient as the need for us to live on our planet in peace with all the other animals and give reverence to the environment we all must share. The heroes of these stories require skills beyond a specific expertise—building team approaches, interpersonal skills, humility, communications, and strength of community. As indigenous peoples understood, we do not own the earth; we are privileged to occupy and share niches within the environments of our amazing planet. The following series of stories provide warnings, but we also hope that readers can listen, learn, and find ways to protect our interconnected world.
Chapter 1 -The Winged Threat
“Everyone likes birds. What wild creature is more accessible to our eyes and ears, as close to us and everyone in the world, as universal as a bird?” - David Attenborough
Juan rolled over in bed and reached clumsily for the alarm. Almost knocking it to the floor, he slapped it quietly while uttering a low moan. Getting up at 4:30 am was not easy, especially after a late-night church function the night before. He gathered the covers and sat up in bed, trying not to wake his wife, Maria, who stirred softly and rolled over, grabbing the sheet. The early fall weather was beginning to turn their rented trailer colder each morning. In some of his early morning dreams he envisioned that he was locked inside the large steel coolers from the poultry plant hanging with thousands of chicken carcasses.
Today as he awoke the chilled air rushed over him like a river, causing him to shiver. Peering out the frosted and stained window, Juan stared through the morning fog covering the blurry images outside- a gravel driveway, and a yard of dirt with dried yellow tufts of grass between rectangular boxed house trailers. Blinking his eyes, he focused on the rusted car and the old swing set, part of the “perks” his landlord told him that came along with the trailer. He did not have a driver’s license in the U.S. and had little need for the play equipment, as his children were grown and gone. More than that, everyday reminders of their youth made him feel that life was swiftly passing by. The stiffness in his back nagged him that he was not getting younger. He stumbled into the kitchen, fixed himself a quick breakfast burrito from last night's leftovers, and washed it down with black coffee. After rinsing his dishes in the sink, he methodically put together his lunch to take to work. He carefully made a sandwich of lunch meat with mustard and pickles wrapped in stale white bread, before placing it into his tin lunch box, along with a bag of tortilla chips.
"The breakfast of working champions", he thought, chuckling aloud.
Filling his thermos with the remainder of the leftover coffee, he sat down at the kitchen table, a plastic folding table his wife purchased at a thrift shop. Staring at the food-stained tabletop, he switched on the radio, to listen to the morning news. He grimaced upon hearing about the effects of climate change and melting of artic glaciers, turning the radio volume down and then completely off. He did not need to hear more bad news. He had to catch the bus to work, and his stop had moved further to the main highway, which took him an extra 20 minutes to walk. His arthritic knee did not help, as he grunted and pushed himself up to leave.Turning off the kitchen lights made the room shrink into darkness as Juan felt his way to the door of the trailer. Stepping down into his yard, he kept his head low to avoid the poop piles, courtesy of the feral dogs in his neighborhood. He made his way across the wet grass and began the walk on the gravel road towards the bus stop, with only the sound of crunching rocks and dirt.
The bus stopped, brakes hissing, in a small cloud of road dust. As he boarded, Juan muttered "buenos dĂas" to the driver, who mumbled a reply and reached to shut the door, avoiding eye contact. Inside the bus was dark and filled with the aroma of worn leather and motor oil. Juan could barely make out the outline of the other migrant workers, some greeting him, others nodding half asleep. His working day had started like most mornings, to the muffled rumbles and shaking of the aging city bus traveling down the road towards the poultry farm.
After being dropped off several hundred feet from the main gate, Juan and the other workers strolled towards the security gate of Horizon Farms, whispering their greetings in low Spanish tones. They walked past the familiar signs written in Spanish and English warning of the biosecurity measures needed before entering the gate. He showed his H2A visa identification card to a bored guard at the gate. Juan Alverez was born in 1982 outside of Mexico City. The dates on the card indicated his entry and expected exit dates covering his latest stay. This season, Maria and Juan came to harvest strawberries. Their plans changed when he was lucky enough to find a job at the poultry farm, which paid better wages, part of which he sent home to help take care of his ailing parents.
Today would be far from routine for Juan. He suited up in the anteroom outside his assigned work area, putting on footwear, a mask, and his clean coveralls, which hung on a hook under his name against the wall. The climate control panel gave a green glow to the room as it displayed the temperature, humidity, and ventilation status in the houses. The smell of chicken manure and damp feathers permeated the air. As he walked into the first of the layer houses, he immediately noticed something different about the "free range" layer chickens. These chickens were allowed several hours each afternoon in an outdoor yard with feeders. Some of the outdoor areas connected to small open grass-covered pastures adjacent to the sides of the layer house.
Inside the layer barn Juan noticed that the chickens were separating themselves into smaller groups, not their normal behavior. Some chickens held their heads outstretched with their necks extended, their beaks wide open gasping for air. A few of the chickens had puffy swollen heads with discolored, blotched, and red combs. To his horror, he found several dead chickens scattered among the flock. Their white, ruffled bodies lay in distorted heaps. The smell of fetid chicken droppings mixed with a stench unfamiliar to him, the smell of death and decomposing animals.
"Why is this happening?" he muttered to himself out loud, worried that his boss might blame him.
Juan immediately began to panic. He felt responsible for the chickens' health. He knew that, given their close living quarters, many things could go wrong. He went through his work checklistÂÂ: water was on, feed was available and unchanged, and the ventilation seemed fine. So, what could be causing the chickens to die? He remembered over the past days lots of activity at the farm. Local suppliers delivered new feed and contractors made repairs to the fans at the rear of the building. Could these visitors have brought the sickness into his flock? The side doors of the houses, which were open part of the day to allow the chickens to range into an open outside enclosed lot, were operational and working. Juan walked quickly to the attached office building to call the farm manager.
With his throat tightening and his voice cracking he forced his best English, "Señor Bill, this is Juan. Could you come over here quickly? Something's wrong with the chickens in Building 15!"
On the other end of the line, Bill could tell that Juan was distressed. He was one of his best new employees, and not one to panic easily. Bill Carter was a seasoned manager of the poultry operation, having worked in various roles on that farm since his teens. He also knew that a few dead chickens in one barn meant problems in other barns.
As soon as Bill arrived at Building 15, the magnitude of the problem was clear. Walking among the dead chicken bodies in his hazmat boots and mask, he almost gagged at the smell of decomposing animals. Bill's mind raced as he went through the many things that could go wrong in a confinement chicken operation, from mechanical ventilation failures to infectious agents. His thoughts went to his worst nightmare, avian influenza, or bird flu, which had been reported on several turkey production farms in the northern part of the state, and in wild birds throughout the county. He called Dr. Peterson, his consulting poultry veterinarian, to get an idea of what was happening. He then quickly called a meeting of his entire staff to go over the protocol for decontamination and biosafety.
Bill knew that if it was avian flu, it could devastate the farm, and his biosecurity measures might be too late to prevent the spread of the disease. The farm had experienced disease outbreaks in the past and he knew how disruptive shutting down production was to the entire community. Many of his neighbors worked at the poultry farm and the nearby production facility. Like him, their livelihood was linked to keeping operations open and running year around. He shivered as a cold bead of sweat ran down the back of his neck. In his mind, the loss of barn 15 was like the tip of a melting iceberg draining away profits and his year-end bonus.
*******
Arriving at his office that morning, Dr. Robert Peterson was reviewing his notes from yesterday’s visits and planning follow-up calls that included most of the poultry farms in the region. Peterson enjoyed his life as a poultry medicine specialist and had decided to be a “chicken vet” from as far back as he could remember, growing up on his family's midwestern poultry farm. He was proud of his efforts to help producers grow chickens in a healthy, sustainable manner.He paid close attention to the latest in animal welfare and biosafety concerns affecting the industry. Meat and eggs from commercial poultry are one of the fastest animal commodities in the world. He knew the business of poultry production and realized the intricate relationship between breeder companies, hatcheries, producers, processing plants, and feed mills. Dr. Peterson also understood the balancing act of disease control, animal biology, industry trends, public health, and of course, the politics of consumer demands, and government regulations.
“Bill how are you today," Dr. Peterson answered his long-term client in his folksy, yet professional, voice.
“Doc, please come as soon as possible, we have sick and dead birds, it might be bird flu or something similar,” Bill said, speaking quickly, partially out of breath.
Dr. Peterson asked a series of questions, aware that Horizon Farms would be his first call of the day.
“I assumed you checked the vents and temperature controls inside the building. How many barns are affected so far?”, Dr. Peterson rattled off the typical series of questions to try to gain some idea of the magnitude of what he was about to face.
Hanging up the phone, he sighed and slowly lowered his head, breathing slow, measure breaths as he stared at his laptop. A sense of dread made his chest tighten slightly. These types of calls were the reason he sometimes awoke at 3 am, his mind racing, preventing any sibilance of rest. He knew if Bill was correct the devastation that avian influenza would have on his clients would be enormous. Adding to his anxiety, he read the night before about avian influenza, the H5N1 strain, “spilling over” into dairy cattle in Texas. Cats drinking raw milk on these farms were dying, and dairy workers were sickened from the virus infection. Was this the start of a modern-day version of a plague spreading between animals to people?
*******
In Southwestern China, Wei Ming stood in her kitchen, stirring a pot of soup.The small stove held several pots of boiling chicken broth, wafting steam into the air in tight swirls. On the counter sat a mixture of chicken parts chopped and ready to add to the broth. She was well known in her village for her pork and chicken specialties. Wei lived with her two children and husband Xi. They were devoted farmers who lived their lives in quiet co-existence with the fields of rice and animals raised in their backyard in rural China. They prided themselves on their hard work and for raising enough pigs and chickens to feed themselves and still have some to sell at the local markets. As part of the community cooperative in their region of rural China, helping to feed their neighbors while earning a small profit would help them retire soon.
Xi came into the kitchen from the yard. His work clothes were covered in dirt and spots of chicken manure. He greeted his wife and tried to sample the soup before Wei shooed him away. Wei then scolded him for his appearance and asked him to change his clothes. As he turned, he felt dizzy and coughed violently. Sitting near the kitchen table he wiped his brow with his sleeve. Looking worried, Wei placed the palm of her hand on his forehead.
“You feel hot. Are you feeling, ok?”, Wei asked in a concerned tone.
Xi muttered his response in between more coughing. “I’m sure it’s just a cold or perhaps something I ate last night.”
Wei scoffed at his response and told him that her soup would help, but it would not be ready until their evening meal.
Xi said he had some sad news. He told Wei that several of their chickens were dead and some of the pigs were not eating when he did his morning check. He disposed of the chickens by throwing their bodies in the local common land fill. Wei remembered learning from her friends at the cooperative that agricultural officials has warned all rural farmers about the signs of avian influenza and to report it to local authorities if they observed the dreaded disease on their farm. They warned members of the cooperative that avian flu did not respect borders and may be transmitted by wild birds that migrated between countries. Xi did not think that throwing his dead chickens in the common trash pile could threaten the health of animals and people, only that it was the only way he knew to get rid of the rotting animals.
Over the next several days Xi’s cough worsened. Wei was more concerned about Xi than the loss of the chickens, and she was afraid to report the spreading disease among their own chickens. Xi developed a fever and body aches, but continued about his daily routine, even shopping for Wei at the local market. As he walked through the food stalls and shops, his forehead kept beading with sweat, and his shirt became wet, highlighting his thin body frame.
The next morning, he could not get out of bed without losing his balance due to coughing. Concerned for her husband, Wei made Xi visit the local medical clinic in the next village.
*******
Dr. Peterson finished collecting samples from the affected layer houses at the Horizon poultry farm, carefully labeling the tubes containing cotton swabs in plastic racks. The racks sat neatly in rows inside Styrofoam containers for shipment to the regional veterinary diagnostic laboratory. He completed the paperwork and removed his gloves with a snap before removing the rest of his personal protective equipment. There were several conditions he considered that may have caused the lethal poultry respiratory outbreak, including viruses, bacteria, and fungus. Some were less likely because their spread was typically slow and less lethal.
Amplifying his worst fears, more chickens were dying over the next several hours. Peterson had heard from his colleagues in the next county that they had a similar outbreak in a broiler operation (those bred and raised for meat production).
Fortunately, the regional veterinary diagnostic laboratory had rapid testing capabilities and was linked through the National Animal Health Laboratory Network, a federally funded program to control outbreaks of deadly diseases. By the next day, the collected samples confirmed the diagnosis of highly pathogenic avian influenza (HPAI). Subsequent genomic sequencing confirmed the virus to be the H5N1 strain.
Under the supervision of state and federal animal health officials, Dr. Peterson worked with Bill and his staff on a biosecurity plan to isolate and “depopulate” or “cull” the remaining chickens and begin decontamination procedures. This included instructions for the entire staff to thoroughly disinfect all equipment, clothes, etc., that may have come in contact with the affected birds or their droppings. The response included warnings for those workers in contact with the dead chickens, that H5N1 is considered a zoonotic disease and could be transmitted to humans. More tests would be available soon to understand the virus's origin and how it was related to pathogens across the globe.
Reports continued to accumulate from other states verifying that the H5N1 strain had crossed over to dairy cattle, cats on dairy farms, and a few workers in close contact. For Dr. Peterson the ability of influenza viruses to mutate and adapt to new species provided a constant reminder of a future pandemic. He knew that when multiple strains of the virus infected the same animal, they have the insidious ability to undergo “recombination”, or mixing of their genes, amplifying the threat.
He explained to Bill and his staff that avian influenza strain, like other forms of the virus, can be spread in wild birds worldwide during annual migration routes between countries and continents. In subsequent meetings with factory managers, Dr. Peterson tried to provide reassurance that current public health risk was low, and that federal agencies were monitoring the outbreak carefully and working with multiple states to monitor people with animal exposures.
*******
On the poultry farm Juan was tasked with the grim process of depopulating the chicken houses. As he followed the instructions to kill in mass the exposed chickens, he could not help but feel guilty. In his mind, like a recording on repeat, he kept revisiting the list of protocol breaks that could cause the deadly infection at the farm. After the culling was complete, he silently walked slowly through the chicken houses, as the rattle and whooshing noises of the large exhaust fans washed over him. Outside front-end loading tractors scooped up the tangled wet piles of dead chickens depositing them in trucks headed to the landfill, permitted to accept to infected waste. Juan turned away from the scene, pulling down his facemask to wipe the tears streaming down his face with the back of his gloved hands.
On the long bus ride home, the fear of losing his job began to seep over him like a shadowy cloud before a rainstorm. He did not know what to tell Maria, his wife. It was too late to look for a new job this late in the season. Dark thoughts began to haunt him, like a runaway car careening off a cliff. As if in a dream, he felt cold and sluggish the rest of the day. Without work they would need to return to Mexico. This would mean less money and more empty shelves in their home.
The sad memories of his youth enveloped and flooded over him. As he sat on the bus, he recalled the skinny boy in borrowed denim jeans and oversized boots he wore when he started work years ago. The endless hours in the fields picking vegetables for some other family far away. His back aches and sore hands and feet as he collapsed onto his cot each night, too exhausted to wash up. He also remembered the long nights of fighting through the cold river marsh when he first crossed the border with his uncle as illegal immigrants seeking a better life in the United States. He closed his eyes as the images and sounds of the pain, loneliness, and hunger tightened around his chest like a burial shroud.
*******
Walking along the levee in his wading boots, Dr. Chike Adebayo looked out across the marshland at the rising sun's red glow. The moist air was blowing in from the coast bringing with it the distant sounds of migratory birds honking overhead. As he looked up Dr. Adebayo squinted his eyes and tried to identify the species gathering and preparing to land in the rich waterways below.
Raising his binoculars to his face, he noticed a group of terns twisting in formation as they glided smoothly in, landing on the water producing expanding ripples around them. He took a pen from his backpack and methodically recorded the number and species of birds in his logbook before continuing his walk along the raised roadway bordering the flooded rice fields outside of Sacramento. Along with his backpack, he carried a small plastic utility box with partitions to hold specimens along with tubes, markers, labels, and sterile swabs.
His sampling routine was part of his regular duties as a wildlife biologist monitoring the animals of the wetlands for the California Department of Fish and Wildlife. Sometimes trying to discover causes of bird losses in the marshy landscape was like looking for a needle in a haystack. He was driven by a desire to help preserve the birds and wildlife that annually visited the Yolo Bypass wetlands. He followed the dirt and gravel road to a foot path that diverted down an embankment, allowing him to get better water access.
This was his third year on his job, and the Yolo wetlands had become familiar to him.The over 25,000-acre Yolo Bypass was engineered to protect Sacramento and surrounding communities from flooding. The wet winter season in this area can bring dramatic shifts in water management. In addition to growing rice, the wetlands support the Yolo Wildlife Area, considered the largest ecological restoration project west of the Everglades. This area of California is also under the Pacific Flyway, and it serves as an annual haven for millions of migratory birds seeking protection and sustenance during their long journeys north and south. The Pacific Flyway is like a river filled with massive numbers of migratory birds each year during their pilgrimage north and south across borders guided by their inherent drive to find food, better weather, and mates with which to breed and sustain their species.
Climbing down the embankment towards the water, Chike recognized that he had not sampled his area before. He scanned the horizon and noted the black dots of distant shorebirds floating out across the water. The sun produced a mirror-like reflection as it rose in the east. The outline of the city buildings of downtown Sacramento appeared like a distant wall holding back the city's people, cars, and noise. Looking down, he saw the white upturned carcasses of three dead birds floating in the black muck of decayed water plants.
He placed his sampling box and backpack on the shore. Reaching out with his gloved hands he raked the dead birds toward the shore so he could inspect and swab their bodies. Filling several tubes with coated swabs, he labeled the samples and put them in the plastic compartments of his sampling box. He carefully placed the dead birds in plastic bags for further examination back at the lab. He ran through the list of threats - botulism, bacterial or viral infections. There was no shortage of threats to migratory birds. He finished his regular sampling and trudged up the embankment to return to his university truck parked near the main road.
The morning sun rising in the distance that brought a warm breeze across the delta could not mask Chike’s feeling that he had stumbled across an emerging disaster for his beloved waterfowl. He had just read of the emerging threat of avian influenza spreading along migratory bird pathways all the way to the Southern Hemisphere, infecting birds, dairy cattle farms, and marine mammals. Could his samples contain avian influenza and be a harbinger of an impending health crisis? His tranquil morning and peaceful feelings were now replaced with a distant voice of suspicion and dread.
*******
In the nearby town hospital in their rural China province, Wei sat by Xi’s hospital bed. She held his hand hiding her fear behind the N95 mask that she was asked to wear. Xi’s condition had worsened. Local doctors voiced concern as they investigated a variety of respiratory pathogens including influenza. They knew that his condition may have implications for the health of the community. His test results came back within hours indicating that Xi was infected with an avian form of influenza. His age and the fact that he smoked cigarettes were making it more difficult for him to fend off the viral infection. Doctors sent off more tests to the provincial laboratory to clarify the nature of the virus invading Xi’s lower airways.
Even if Xi’s virus was a less serious type of influenza, local authorities would need to work with provincial authorities to call for a public health action plan to test animals and people in and around the village. Local public health officials understood that influenza A viruses are endemic in at least six animal species, including wild waterfowl, domestic poultry, and swine. Variants of influenza read like an alphabet soup of pathogens. They knew that avian flu infections among people are rare; they can happen when someone working closely with infected animals gets enough of the virus through contact via the eyes, nose, or mouth.
In Xi’s case, his close contact with his backyard birds was a likely source. But it was unclear how many of his neighbors may have also become infected. None of this was lost on local officials. Alarms and communications were already being sent to provincial and country authorities.
The virologist working on the outbreak understood that influenza viruses can easily reshuffle their genes when they infect a body’s cells. As a result, new strains can emerge, as they look for new victims to spread their progeny. Because of this nasty habit of creating new strains that could infect humans, these viruses are always at the top of the list of potentially zoonotic viral diseases, those transmitted between animals and people.
*******
In California, Dr Adebayo was aware of how, in 2014 and 2015, birds throughout the upper Midwest of the United States had succumbed to an outbreak of a “highly pathogenic” avian influenza strain that devastated wild birds and created major losses for the domestic poultry industry. In less than a month in 2015 approximately 40 million chickens and turkeys died or were culled due to a deadly outbreak of a highly pathogenic strain of avian influenza. Despite a coordinated response from federal and state agencies, the outbreak resulted in nearly $900 million in losses to the industry and disruptions to the nation’s food supply.
A few days later, while sitting in his office reviewing the laboratory results from the samples he collected earlier in the week, Dr. Adebayo’s pulse began to race. The results indicated “Samples positive for avian influenza type A.” Further testing would be required to classify the samples as high or low pathogenic. He immediately began to plan his next trip to the waterway. Warnings would need to be sent to local poultry farmers, veterinarians, and public health officials to prevent the potential seeds of a pandemic for birds and people alike. The public would certainly want to know if this new bird flu strain could bring back a human pandemic. A more troubling question that Chike did not know the answer to was, how do we stop the threat knowing that wild birds carry the pathogen through their normal migration patterns? He understood that the natural pattern of nature’s creatures could clash with mankind’s dominion over the planet.
Recent history was not on his side. Highly pathogenic avian influenza was detected again in 2022, and the outbreak continued. In this latest outbreak more than 50 million birds in 46 states had either died because of avian influenza infection or were killed out of fear of exposure to infected birds. Twice as many states were infected in the outbreak as compared to 2015. This is an enormous problem for food safety and security given the disruption of the food supply. In such a scenario, the potential for avian influenza A viruses to change enough through mutations or gene exchange to become human adapted is a constant fear for public health officials.
There are measures for poultry producers like Juan and Bill to stop avian flu pandemics. They knew that these included strict biosecurity measures on farms, rapid identification of the infection, and regulated culling requirements for commercial operations. For human medicine, vaccines and prevention are top of mind for public health officials. Bill had heard that mass vaccination of domestic poultry is being considered, but he dreaded the time and expense that this new practice would cost his company. Surveillance for circulating variants and quick public health responses are keys to stopping these types of pathogens in people. For people, these systems to be timely and effective must include public investments in diagnostic testing, coordinated policies and regulations, and public health communications.
Dr. Adebayo understood that without planning for these annual threats on wings, the migratory birds of his beloved wetlands were vulnerable to pathogens that spread easily as birds naturally gathered during their annual trips across borders. As he reflected in his office, he felt pride knowing the involvement of the many professionals and volunteers that understood the importance of systems to identify, communicate, and respond to zoonotic disease. Watching out his office window the evening sun created an orange glow across the skyline. He smiled and marveled at the gathering flock of birds flying overhead. Chike knew that infectious disease threats carried through the airways do not respect borders, but he believed that society could prepare for the outcomes when they arrive at our doorstep.
*******
Juan watched silently as twelve-layer houses on the farm were depopulated in a matter of days after his initial discovery of the dead chickens. He felt his job and his life were evaporating in front of his eyes. He felt the cold helpless fear of seeing so many animals being put to death. The images would not leave him as he rode the bus home each night and the thoughts followed him into his nightmares. The daily depopulation of the chicken houses reminded him of his family’s cross border journeys. He sometimes felt like a trapped animal in a migration center, crowded together by an uncaring enemy waiting for a decision as to whether he could work or sent home to Mexico. His night terrors were relentless, often finding him awake in a cold sweat. His clock with its blurry red numbers, reflexed back at him like an animal in the darkness.
Later that week reality hit hard. “I am sorry Juan, but I have no more work for you until next season.” Bill informed Juan who sat in front of him in his office, head hanging down as he stared at the floor.
Trying to avoid the inevitable, Juan’s thoughts drifted to his village when he was young. Happier memories of playing soccer with his brothers. Retelling himself stories in his mind helped him cope with the real world, transporting him briefly to happier times. His freedom was short lived, as Bill cleared his throat to awaken him. Juan jolted himself back sitting up in his chair to face Bill, a half-smile mask on his sunburnt face.
Thinking to himself, “How do I tell Maria that we need to go back this early? "He stared at the dirty tiles and felt like the room was spinning, and he was falling down a long dark tunnel. He suppressed the cough that started in his chest last night and wiped his brow covered with moisture from a developing fever. Juan rose and turned towards the door without mentioning his illness, more fears, reports, and paperwork. He had no health insurance and no access to medical care. What he did have was a long bus ride to his trailer and a long night of packing ahead of him.
*******
In their rural village in China, Wei and Xi, understood their livelihood depended on a close relationship with animals. They did not blame their chickens for causing his illness. The birds did not purposely bring sickness to their family. Fortunately, they did seek medical help for Xi in time to save him from the viral infection and subsequent complications. Soon they could return to their life as farmers, raising animals to eat and sell.
Meanwhile, lurking in the common trash dump in their village, the seeds (infected chicken carcasses) to another influenza outbreak were available for scavengers to find and continue to spread the infection to their offspring or throughout their travels. The cycle continued, winging away across the false geographic boundaries we pretend to separate us from the threats inherent in our interconnected natural world.
*******
Epilogue One Health – Protecting the Lives of People, Animals, and the Environment
We need fresh lenses, new tools, and better models for predicting and avoiding threats at the intersection of human, animal, and environmental health. From the tragic devastation of wars and displaced populations to individuals throughout the world going about their daily lives, the stories in this book reveal the unseen bonds between all living things. When their ecosystems are out of balance or facing threats, the results can be devastating.
Pressure from humans, often called anthropomorphic change, can alter or destroy ecosystems. Health experts and researchers ask themselves questions – some new and some routine - each time they confront unusual diseases or other emerging health threats. The solutions they seek often require a team of professionals from different fields coming together to help understand the origins of threats to our world that show up in seemingly divergent connections of ecosystems. Our characters depend on experts from fields as diverse as public health, engineering, agriculture, marine biology, veterinary medicine, social sciences, business, and forest ecology to name but a few. Equally important are new and emerging fields that include data scientists deploying novel tools that predict outcomes of complex systems to find ways to predict outcomes and prevent negative effects.
These stories illustrate our urgent need to change the way our siloed systems are funded, work together, and communicate with each other to produce optimal outcomes. They emphasize the resilience that individuals, animal systems, and ecosystems need when facing unprecedented threats, either manmade or by disruptions in nature’s balance.
*******
Infectious diseases transmitted between species know no geopolitical borders. As avian influenza outbreaks across our globe illustrate, they can devastate economies and disrupt lives when spillover events occur between reservoirs of the virus and domestic animals. For example, humans do not control the migrations of wild birds across the globe. However, we can develop measures to monitor and test for pathogens that may be seasonal or endemic threats. The story of highly pathogenic strains of disease spreading in unusual patterns and crossing between species is familiar to most readers. With diseases such as avian influenza we’ve seen the way viruses mutate and spread, first to animals in close contact and then to humans.
Less well recognized are the effects of these disruptions on the workers whose livelihoods are dependent on the commercial animal industry. Regulations that require culling of infected flocks can mean economic devastation for those working in the industry.But new ways to predict the impact of disease, toxins, animal migration patterns, and climate change provide reason for hope in combating the spread of deadly diseases and devastation of regional and global economies.
The expanding exploitation of land can lead to the transplantation of deadly organisms to new ecosystems. The more we learn about the origins of novel diseases the more we find they are often linked to environmental disruption – natural or human-made. Climate change results not only in rising global temperatures but also can change geographic distribution patterns of deadly microbes. Common among these stories is how protagonists seek solutions not from isolated expertise but through the collective power of working across disciplines to find new ways of thinking. The recent emergence of a fungal infection in the Pacific Northwest raises important questions related to how the pathogen made its way to freshwater, the ocean, to the region's topsoil, and into the air that marine mammals and people breath. These stories illustrate in sometimes surprising ways how ourecosystems are shared with the animals and plants.
The fictional story about mpox reflects a real event from a 2003 outbreak of monkeypox, now referred to as mpox. In the outbreak, forty-seven confirmed and probable cases of mpox in people were reported from six states—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. All people infected with the virus in that outbreak became ill after having contact with pet prairie dogs. The pets became infected from being placed near other small mammals from Ghana.This was the first time that human mpox was reported outside of Africa. The shipment contained approximately 800 small mammals representing nine distinct species, including six types of rodents. Laboratory testing at the time showed mpox viral infection in several exotic mammals being sold as pets. After importation into the United States, some of the infected animals were housed near prairie dogs at the facilities of an Illinois animal vendor. These prairie dogs were then sold as pets before they developed signs of infection.
This outbreak illustrates how the U.S. Centers for Disease Control and Prevention, and local public health departments, together with the U.S. Department of Agriculture, the U.S. Food and Drug Administration, and other agencies, worked to reduce the spread of mpox virus. Responses include extensive laboratory testing, development of guidance for patients, healthcare providers, veterinarians, and other animal handlers, tracking potentially infected animals, and investigation into possible human cases. In the outbreak rapid and clear communication between public health officials and medical and animal professionals were required to provide advice and recommendations on vaccines, treatments and prohibitions on the importation, interstate transportation, sale, and release into the environment of certain rodents, including prairie dogs. Raising awareness of risk factors and educating people about the measures they can take to reduce exposure to the virus remains the main prevention strategy for the infection, which still threatens global health.
*******
Our stories of human conflict shine a light on how the interface of people and animals can be altered when their environments are disrupted by human conflicts. Refugees who face war, famine, and climate disaster are ultimately displaced from their communities and ways of life. Their world is often tragically disordered and their relationships with their families, their domestic animals, and the environment they depend upon are often forever changed. In these circumstances, environmental threats affect the foods eaten by both humans and animals. Water contamination, social violence, and physical threats are today being repeated too often throughout war-torn countries. Less often recognized are disruptions in the intimate connections refugees have with their agriculturally essential animals, the basis for their livelihoods, cultural identity, and as food sources. Through compassion and ingenuity, the protagonists responded to these threats, seeking to regain balance in their lives and to survive their reality. Our refugee characters sought new technologies to understand environmental threats, growing new plant food sources capable of surviving harsh conditions, reconfiguring age-old socio-economic behaviors—these are just a few of the innovations that can arise in times of stress from an in depth understanding of human, animal, and environmental connections.
*******
Social science has demonstrated the role of gender in shaping cultures around the world. The best intentions of medical professionals in the field can backfire when they fail to understand and predict the interpersonal conflicts that are the unintended consequences of their interventions. While programs like Newcastle Disease vaccination efforts for poultry, can raise the income of people who own chickens in low- and middle-income countries, the results of increasing incomes within families may shift traditional relationships. If changes in incomes are too rapid and occur without social and cultural awareness, those who are most vulnerable may become the victims. Predicting outcomes of disease intervention requires an understanding of households, belief systems, and community norms. The skills of cultural anthropologists are needed in these situations. Universities, governments, and non-profit organizations that use a One Health approach engage with the community and closely examine the expected and unexpected outcomes, considering the relationships between people and animals. Programs that influence the health of agriculturally important animals can dramatically improve, or potentially negatively impact the incomes of people from low and middle-income countries. One Health approaches often must draw upon the knowledge of religious leaders, teachers, governmental leaders, and social scientists, to help anticipate the effects of interventions that maximize health outcomes.
Similarly, policymakers and scientists in the field must often weigh tradeoffs between maximizing benefits to people, urban environments, and natural ecosystems with economic profit. Ecotourism is not only about entertaining a privileged clientele. It can also have a lasting economic impact and improve the health of an entire region.The story of efforts to save mountain gorillas illustrates the complexity rural societies face with expanding urbanization. The story is based on established conservation programs in Africa, which have allowed expansion of mountain gorilla populations and provided needed economic stimulus to rural villages. Human population expansion, increased need for agricultural land, social instability, and cultural conflicts force governments and local communities to make decisions on how they balance nature and livelihoods. These decisions are not easy when resources are limited, and informed choices are required. Natural environments respond to change in a variety of ways. Animals whose ecosystems, food sources, and natural migrations are disturbed either adapt or perish depending on the speed and impact of the disruption. As human populations expand the choices we face have a real impact on the world around us and the survival of the planet. This story demonstrates that these conflicts require governments, health officials, environmental activists, and animal health specialists to work together to preserve their local communities with a vision that focuses on the future.
Around the world, struggling communities often have a difficult time balancing a desperate economic situation against promises and overtures from commercial entities that seek to maximize corporate profit often at the community’s expense. When mining is done without balanced enforceable regulations intended to protect people and the environment there is often great disappointment downstream.The story of Kwame, a miner turned environmental advocate, tries to protect his community from a global mining consortium, describes a common scenario. He is confronted by economic drivers of corporate greed and local corrupted politicians. This story demonstrates the devastation of short-term thinking when extracting the wealth of a region becomes more important than the long-term health effects of the people and animals in the area.
Practitioners of One Health seek long term outcomes, using the power of multiple disciplines and viewpoints so that science and values speak louder than money. Environmental protection laws mean little if the economic drivers favor short term gains and extend promises of personal wealth to a few. Kwame’s background, family values, and faith fueled his persistence, but he also needed the help of conservation groups to make a difference.
*******
Our warming planet indirectly and directly affects public health. News of the overgrowth of toxic algae has made headlines across the world, increasing in frequency over the past several decades. While, as individuals, we may not feel the danger of toxins in our water, the example in our story made clear the deadly outcomes that can occur to our pets and their pet parents. A day in the park can lead to deadly consequences. Toxic algal blooms are becoming more common and lethal for animals and people, and prevention again requires a multidisciplinary approach focused on education and community engagement. When farmers apply excess fertilizers to their fields, while well intended, these actions have consequences for the plants and microbes in ecosystems downstream of surface water or through aquifers that drain from those fields.
Another aspect of this story involves warning signs. In our daily lives, warning signs are all around us, and we may feel bombarded by massive amounts of information. Public health officials are often challenged to find the most effective and credible ways to communicate those warnings and link them with reasonable actions. These efforts require the knowledge and skills of social scientists to effectively educate and warn us of dangers. A better understanding of how people interpret warnings and act to protect themselves and their loved ones requires the knowledge and cooperation of social scientists and public health professionals.
As climate change and pollution contaminate our ecosystems, these threats may present as toxins in our water supplies or along our coastlines. Continued efforts to reduce these health risks require a range of technological solutions from measures to apply appropriate applications of agricultural fertilizers to monitoring our waterways from space. Our story provides a clear example of the ways a One Health approach can reduce environmental factors that set up the conditions fortoxic algae blooms. Important new technology is allowing satellite data to be incorporated into linked public health systems to warn communities of toxic blooms before they drink contaminated water or swim in murky ponds and lakes. Government agencies with divergent missions are learning to join their data together and use One Health approaches to protect us from hidden dangers in our environments.
*******
In our story about pollination, we connect the dots between insects, environment, and health. As we photograph flowers and bees, we may forget their impact on our food supply. Understanding the role that animals as small as bees have in human and environmental health can seem indirect and unrelated to more immediate problems in our daily experiences. If we ignore the lessons of indigenous peoples who have lived in harmony with nature for thousands of years, we risk our future.The misuse or overuse of pesticides has an impact beyond our fence rows and lawns. The lasting devastation of manmade toxins has a history of negatively impacting human, animal, and ecosystem health. From Agent Orange to DDT, the legacy of detrimental outcomes starts with promises and end with tragic results. In “Silent Spring”, Rachael Carson sounded a clarion call to warn us about the devastation of chemicals in our environment. We are still learning these lessons, and sometimes too late. This is where environmental policies require evidence-based science to help safeguard our environment and our health. We not only share the Earth with all its creatures and plants, but we must also be guardians to protect the Earth from ourselves and those that follow us.
*******
Microbes play both a beneficial and detrimental role in our health. Our story about antibiotic misuse shows what is required to harness the promise of modern medicines to combat pathogenic bacteria. Antimicrobial resistance is a complex issue with real impact on our ability to prevent bacterial infections across the globe. Antibiotic resistance is a severe public health threat that spans both human and veterinary medicine, as well as agriculture, plant biology, and other related fields.
The discovery of drugs that treat bacterial infections has revolutionized modern medicine and saved millions of lives over the past century. Unfortunately, in the arms race against infectious agents, bacteria quickly evolve ways to avoid their destruction.To combat antibiotic resistance takes a village of experts, policymakers, drug manufacturers, microbiologists, physicians, veterinarians, and educated citizens trained to use drugs appropriately. Only through a unified approach, do we stand a fighting chance.
In response to the global threat of antimicrobial resistance, many countries have adopted a One Health approach. In May of 2015 the World Health Assembly adopted a global action plan on antimicrobial resistance, which was founded on five major objectives, including improved awareness and understanding of antimicrobial resistance through effective communication, education, research, and training. The proposed plan emphasized effective sanitation, and infection prevention measures, as well as methods to optimize the use of antimicrobial medicines in human and animal health.
Preventing and treating disease is crucial, but so is feedinggrowing populations. Expanded need for food has strained sensitive environments, particularly in the Southwestern United States. Water overuse is often at the center of these issues, as is the need to feed large herds of animals. As agriculture in higher income countries evolved towards monocropping new environmental issues have arisen, including soil erosion, increased need for chemical fertilizers and herbicides, increased crop vulnerability to disease, and susceptibility to adverse events, such as flooding. The benefits of monocropping allowed farms to improve efficiency and transport products. As government policies shifted to more efficiently aligned with the short-term goals of improved crop production new problems have become evident. Technological fixes meant to solve one problem quickly can lead to other new unforeseen negative outcomes. For example, pesticides have been successful at reducing crop damage. However, the widespread use of pesticides has led to the development of pesticide-resistant insects and weeds. As a result, farmers use increasingly more potent chemicals, creating a cycle of escalating chemical use and resistance. These chemicals run off into streams and rivers and kill other types of plants that are required to feed animals, birds, and fish.
Monocropping and intensive farming are intended to produce maximum yields, but this can lead to soil degradation, loss of genetic diversity of crops, and vulnerability to large-scale disease outbreaks. The widespread use of antibiotics in animal agriculture cancontribute to the development of antibiotic-resistant bacteria, which creates risks for both animal and human health. All of these unintended consequences require better long-term planning and regulations to promote sustainability and resilience when implementing new technologies or practices.
Feeding a hungry world while maintaining and preserving the Earth requires recognizing the interdependence of its resources. These lessons are integrated into many indigenous people’s culture and belief systems. The ability to balance our interests in modern agriculture will require new technologies that seek harmony with our natural world.
*******
Service animals are just one example of the ways animals reduce human suffering, loneliness, or help people function with disabilities such as blind and post-traumatic stress syndrome (PDST). When we engage with animals as pets or in the wild there are proven benefits. Evidence-based studies have documented how intimate relationships between pets and people influence our hormonal and emotional responses and improve physical and mental health.
The exact dates that dogs were domesticated is controversial. Genetic evidence indicates that canine domestication occurred in northern Eurasia between 14,000 and 29,000 years ago. Unlike their wolf ancestors, dogs have evolved to align with our physical and emotional cues. We, in turn, have selected for traits by breeding dogs with characteristics that meet our specific jobs or support roles. As dogs evolved alongside humans it is believed that they took advantage of the hormone (oxytocin)-mediated positive feedback loop by gazing into the eyes of their human companions. They literally stole our hearts by looking into our eyes. This same hormone is critical in mother-infant bonding. In addition, by sharing our environment, pets, particularly dogs, mirror diseases in humans. Overweight humans are more likely to have overweight pets. Canine cancer studies provide clues to the origins of cancer in people and clinical trials in our domestic pets offer new pathways toward the discovery of cures for cancer and other chronic diseases.They are like furry canaries in the coal mine of our lives.
Psychological studies have documented the value of service dogs as an intervention for PTSD among military veterans and prisoners. In our story, having a therapy canine allowed Harold to find a path to nature to ease his triggered stress responses. Many people find psychological renewal by a walk through a city park or time spent hiking in the wilderness. Similarly, in this same chapter, Charles and his son bonded through trail rides and campus strolls, both facilitated by animals.Evidence suggests that spending time in nature can improve our attention span, lower stress, enhance our moods, and diminish our risk of psychiatric disorders. Animals can lead us toward a healthier lifestyle and concurrently help us appreciate the natural world around us.
Multiple interventions and a wide variety of resources may be required to heal from trauma, help those suffering from mental confusion and illness, or bring us back from the edge of an emotional abysses. We live in a world where information is readily available.Mobility is easy – we can reach far-off destinations within hours. Despite these conveniences or because of them, we may also suffer from social isolation and loneliness. This growing public health threat is particularly important for older individuals who may concurrently suffer from organic aging disorders such as dementia.Recent studies support the value of pet ownership and human-animal interaction for improving social support benefits and helping decrease loneliness and depression. As in the example of Joan, hospitals, some doctor’s offices, and healthcare facilities are increasingly incorporating animal therapy in treatment plans. As scientific evidence continues to document the value of the human-animal bond through a One Health approach, we all will benefit and grow to appreciate our connections with the world we all must share.
*******
In our expanding urban environments, the relationships between people and pets can present both opportunities and conflicts. When these animals share our environment conflicts arise.We also share different views depending on our belief systems, cultural bias, and previous experiences about the role of animals in our daily lives.
In our story about urban cat population control, conflicts arise between roommates who share a common scientific perspective, but different values pertaining to animals. When our pets carry infectious diseases that may threaten vulnerable populations, beliefs and policies are put to the test. Balancing how we feel or judge animals and their place in the community is often a composite of how those animals are valued or, in our story, controlled. Toxoplasmosis is a real disease with real-world consequences. Stray or feral cats can be carriers. The story contrasts different views as a community decides aboutregulations and animal population control methods, a conversation that has been repeated in communities across the world
Cats are natural predators of birds and small mammals.They were first domesticated centuries ago, in part, for their ability to hunt and kill rats and mice. Wildlife biologists and ecologists have different perspectives about how communities should face urban pet population controls.Conflicts between animals and people occur throughout the world and are dealt with in many ways. This story offers the perspective of how the protection of one species can conflict with the values and beliefs of individuals and their community. Globally there are many other examples of human-animal conflicts with species ranging from pigs and donkeys to wildlife like coyotes, bears, and lions. One Health approaches to urban environments need to consider all sides of these contentious issues to offer an evidence-based approach to conflicts and policy decisions. The problems illustrated in our chapter are emblematic of conflicts that benefit from an approach that considers the health of people, animals, and the environments they must share in our ever-compressed world.
*******
Almost three-quarters of the surface of our planet is covered by oceans and most of the Earth's water can be found in them. Across this vast ecosystem we see both tragic examples of environmental disruption andthreats arising from our use of marine resources. Our story begins with a boat that is swamped by a larger ship aggressively attempting to intimidate local fishermen. We see the complex tradeoffs of managing and sharing our ocean’s resources. One family’s disaster can inspire the next generation to make a strong stand against synthetic materials that break down into microplastics that are ubiquitously found in our environments and in most living creatures. Through their dedication and actions these characters in this chapter inspire hope for the future.
Reyna and her brother, Alain, face tough odds in life. Their family and cultural bonds allow them to use their skills as One Health-trained warriors to face the enemy in the seas around them. Increasing evidence indicates that plastics, while vital to our everyday lives, has widespread consequences for our future. As more disciplines focus on how to deal with non-biodegradable contaminants in our food, water, and air, more solutions are possible. Like a slow cancer, pollutants in our environment reveal themselves in subtle and sinister ways. The links between chronic diseases and pollution in our world can be hard to connect in the fog of data. This story illustrates the ways that epidemiologists, physicians, and public health workers, working with marine biologists, find hidden clues and disclose theslowly encroaching health risks we face throughout our interconnected world. This tale also has a foreboding end that illustrates how economic greed can threaten those who wish to speak the truth and expose those who seek money over public health.
*******
The world population is hungry for animal-sourced protein, and commercial fisheries are playing an increasingly important role in meeting that need. Our chapter focused on a salmon fishery in Chile shows the importance of the aquaculture industry for the local and regional economy and food security.Chile is renowned for its growing aquaculture industry, serving an expanding export market. While we have the technology to farm fish and distribute products across the globe, it has become clear that this form of farming requires careful management and a clear vision on how the environment may be altered. The story weaves together the values of those working on expanding the farm raised fish industry with local environmentalists seeking to preserve a natural ecosystem that attracts tourists.
This story also shows how dependent we are on international food sources and how vital supply chain quality controls are to protect the environment. Unexpected food contamination, whether residual antibiotics or toxins, can have a devastating impact on unprepared consumers. A backyard barbeque may end up with people in an emergency room if our food sources are tainted. As our expertise in raising farmed fish improves, so will trust in the safety of that food supply. Technology to improve food safety should be balanced against a respect for the local environment.New technology to trace the origin of our seafood and detect and prevent alterations in the food chain from toxic exposures will play an increasingly important One Health role in our future.
*******
The last chapter illustrates the importance of employing a broad One Health approach when confronting a novel health problem.Chronic kidney diseases with unclear causes have been described in the medical literature for decades, many named for the region where the condition was first described. This story involves a slowly progressing disease in Sri Lanka, often referred to as “Chronic Kidney Disease of Unknown Etiology” (CKDu). In this real-world problem, CKDu presents after a long lag time between an unknown exposure and the development of disease symptoms. While many theories have sought to explain the cause of CKDu, risk factors remain elusive.Some studies seeking a cause-and-effect answer to the origin of CKDu have implicated toxins (pesticides, heavy metals, silica, etc.) that may act independently or together with heat exposure, dehydration, and even infectious agents (Leptospira, hantavirus). But other studies suggest causes are not so easily identified.
No single branch of science has all the expertise needed to address an issue affecting multiple species in many affected areas. The devastating effects of CKDu provide a clarion call for communication across the medical profession to bring together toxicologists, public health professionals, health care workers, agricultural experts, veterinarians, physicians, and more to address the disorder. It will not be the last disease or disorder of unknown origin, as illustrated in the preceding examples. The knowledge of how people, animals, and the environment we must share is used in an integrated manner offers hope for the future of mankind and the planet we must preserve. There is no established cause of CKDu, although there are many suggestions. The disease occurs without diabetes, hypertension, snake bites, glomerulonephritis, other kidney diseases or other known risk factors for chronic kidney disease.CKDu is not evenly distributed in Sri Lanka but is limited to identifiable high-endemic areas within the dry zone. Over the past century, other CKDu hotspots have been in Central America and South Asia.Around the world, these have taken on several different names, including Chinese Herb Kidney Disease, Balkan Kidney disease, Itai-Itai disease, and lead kidney disease. Other outbreaks of similar diseases have been associated with toxin exposure.
Interestingly, chronic kidney disease (CKD) from a variety of causes has also been reported in animals, including domestic dogs and cats.These types of disorders in animals have many parallels to the human condition. In animals CKD is often progressive and difficult to treat. Many suggest that some types of chronic kidney disease in animals may have similar causes to those in people such as ingesting toxic substances, bacterial infections, chronic high blood pressure, diabetes and heat stress. Epidemiologic studies indicate that Sri Lankans with CKDu had significant associations with pet dog ownership and pests in the home. Further studies using a One Health approach seek to determine if pet ownership implies a zoonotic etiology for the disorder or is the result of chronic exposure to insecticides or other toxins in the homes of these individuals.
CKDu often occurs in warm, resource-poor countries where water can be scarce. This had led WHO to declare the disease a global epidemic, requiring more funding for research. Like many low-resourced countries farmers in Sri Lanka grow rice and use black market agrochemicals that work to reduce disease but are banned by the government.As the story implies, these chemicals may leach from shallow wells and contaminate water supplies meant for human consumption. This ongoing epidemic of CKDu in the dry zone of Sri Lanka is still affecting people and burdening the rural healthcare system. As CKDu is a terminal diagnosis, there is an urgent need to determine the CKDu risk factors at the interface of humans, animals, and their shared environments.
*******
Disease outbreaks, environmental disasters, climate change, and the myriad threats in our world reveal the importance of multiple disciplines working together to detect and mitigate health outcomes for creatures living on earth. There is a vital need for a network of health professionals who are trained and aware of global diseases, particularly given our mobile society. Because of the initial silent nature of diseases like Zika, avian flu (H5N1), dengue and mpox widespread infection can occur without obvious warning signs.
To address interconnected global health challenges, the World Health Organization (WHO), Food and Agriculture Organization (FAO)and World Organization for Animal Health established the One Health High-Level Expert Panel to foster interdisciplinary research, evidence-based policies, and global One Health approaches. Subsequently, a quadripartite agreement was formed among four important international agencies: WHO, FAO, United Nations Environment Programme, and the World Organization for Animal Health to enhanced global cooperation, emphasizing the urgency of collaboration and commitment to prioritize One Health policies in response to recent global health crises. By promoting collaboration, strengthening workforces, and investing in One Health initiatives, these organizations aim to create a healthier planet and mitigate future health threats, reinforcing the importance of a unified global effort toward One Health.
Effective One Health approaches offer great promise, but also many challenges associated with improving collaboration to tackle emerging global health threats. An urgent need to implement this critical approach to the world’s health needs is effective communication across disciplines to promote engagement and collaboration. These communication challenges will require new insights, tools, and strategies for effective cross-sector global partnerships. It takes a village to recognize the unusual signs of a pending disaster. Community-based awareness and surveillance for early detection are critical. Disease surveillance is no longer the domain of just health experts. School children, agricultural workers, park rangers, and many others need to be our early warning system, and they can use new smartphone technology to capture photos and report symptoms using GPS systems. We are ever closer to catastrophic consequences when our networks fail to pick up crucial warning signs or fail to notify authorities. Cutbacks in funding of public health departments across the U.S., have been cited as a contributing factor to the slow or uncoordinated responses to threats of diseases like Covid.
Demands on tax dollars sometimes mean governments make decisions that are “penny wise and pound foolish,” negating efforts to protect the public. The One Health paradigm is predicated on having our public health systems funded and interwoven to meet future challenges. Without investment in public health, communication about threats among vigilant health systems, we will have more days like those in this book. The lessons learned from these chapters can, if we pay attention, form the foundation for a more interconnected world that protects all of us.
Underfunded health departments create potential threats to human health. Right now, our public health care system is weak due to obsolete data systems that often do not communicate with each other or with hospital electronic medical records, inadequate laboratory equipment that would allow for quick testing of specimens, and an insufficient public health workforce. What all this means is that during a public health crisis we will be ill-prepared for a quick response, and the response may end up costing more than long-term investments in public health infrastructure. Over the past two decades, the U.S. Centers for Disease Control and Prevention’s budget, which serves as a major funder for state, tribal, and territorial health departments, has increased by just 6 percent after adjusting for inflation. These financial constraints have occurred at a time when there are new public health problems, including opiate overdoses, gun violence, climate change, new emerging infectious diseases, an aging population, and more. This insufficient funding can wreak havoc with our health. One Health experts point to the need for new investments to prepare for the future knowing very well that the next pandemic may occur at any time given the global connectedness of our mobile society.
We truly belong to the Earth and must learn from those that came before us, preserving the environment we all share and depend upon. This investment in the future through a One Health approach has benefits for mankind and all the creatures on the planet. If we ignore these connections or deny our interdependence on the natural world, we threaten the future of life on earth.
*******
Belonging to Earth: One Health Stories to Save our Planet and Ourselves is written with the premise that what's good for the planet is good for us too. It's a philosophy I already agreed with and live by, and this book just reinforced that belief.
Each chapter has a different focus: birds, refugees, education, agriculture, and more. Through the lens of each chapter, different stories are shared from all over the world to illustrate how interconnected things are. Not only are we in a global society where actions in one country have an effect on another, but education, industry, social justice issues, and more all combine to exacerbate negative effects of unhealthy situations.
I like the format of the book. Each chapter begins with a quote to set the stage for the chapter, then individual anecdotes are shared. Throughout each chapter, there are questions (with answers) that relate to the topic and show real-life applications - for example, how pets influence health. The epilogue at the end is a call to action for everyone, because everyone has a role to play in a global ecosystem and everyone matters.
The tone of the book strikes the perfect balance between academic and storytelling. It's believable, includes research-backed claims, yet it isn't too wordy or hard to understand. The length of the anecdotes and examples are long enough to provide a solid picture of the situation, but not too overly detailed. Each chapter has a good amount of examples, as well as an appropriate amount of the Q&A boxes to help readers reflect on how the global issue becomes personal.
This is a great book for anyone interested in the environment, community health, or social justice. Anyone working in any of those fields likely already knows how the different elements are connected. It's also a great book for anyone who is looking for reasons to actively work to make a difference.