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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases 2 State and Quality of the Current System INTRODUCTION The committee was charged to review, summarize, and evaluate the state and quality of the current animal health framework. This review is organized into the following categories: Components of the Animal Health Framework Technological Tools for Preventing, Detecting, and Diagnosing Animal Diseases Scientific Preparedness for Diagnosing Animal Diseases: Laboratory Capacity and Capability Animal Health Research International Issues Addressing Future Animal Disease Risks Education and Training Improving Awareness of the Economic, Social, and Human Health Effects of Animal Diseases. COMPONENTS OF THE ANIMAL HEALTH FRAMEWORK The animal health framework comprises organizations and participants in the public and private sectors directly responsible for maintaining the healthy status of all animals and those who are impacted by animal health or are influencers of forces affecting animal health. The essential components of the framework for addressing animal disease, beginning with the affected animal, are listed in Box 2-1.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases BOX 2-1 Components of the Animal Health Framework People on the front lines of the animal production unit, animal habitat, or companion animal owners Veterinarians and other sources of professional advice and care for health-related issues (such as universities and diagnostic laboratories) Federal, state, and local animal health and public health agencies International collaborations among agencies, organizations, and governments Supporting institutions, industries, and organizations (including educators and the public health and intelligence communities) Front Lines The front lines contain multifarious actors and components: from intensive, large-scale, highly technical food animal facilities, monitored by well-trained livestock managers and veterinarians, to disparate clusters of companion animals within individual homes observed with differing degrees of intensity by their owners, to wildlife populations without any kind of regular monitoring contact by humans. It is a sine qua non that the first signs of a disease outbreak are small abnormalities in behavior. The sooner a new disease is recognized, the greater the likelihood that it will be effectively controlled and cause minimal damage. In this context, an effective framework for animal health is most highly developed for agricultural animals. In today’s livestock industry, producers are encouraged to adopt herd health programs and focus on prevention rather than dealing with case-by-case problems (Gary Weber, National Cattlemen’s Beef Association, presentation to committee, April 6, 2004). As front-line responders, animal attendants and caretakers may have variable levels of training and motivation for recognizing and reporting abnormalities and sounding an alert when abnormalities are noted. Farm animals are also raised by individual “hobbyists” who might lack the training of paid animal attendants but who potentially have the luxury to be more observant of their animals than do large-scale animal producers. They might also have expendable income with which to seek out veterinary services when needed. Because the number of hobbyists is growing, a better picture of the animal care practices of this community is
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases needed to evaluate the knowledge of this group of owners and their likely motivation for reporting suspected disease outbreaks. For companion animals and wildlife, the situation is even more uncertain. With the exception of some large charismatic and commercially viable species, there is little economic incentive to survey animal health, and in some cases, an absence of financially remunerated attendants responsible for monitoring husbandry. In these cases, recognition of a disease abnormality by people not associated with the immediate habitat is due to both diligence and chance. An astute owner may seek advice on first blush of a disorder in a companion animal, or alternatively, a group of companion animals may become quite ill prior to any abnormality being reported outside of the immediate surrounding. For wildlife, especially wildlife outside the oversight of zoo veterinarians and handlers, the situation can be even more uneven. For large and charismatic species (e.g., chimpanzees, giraffes, dolphins), detection of anomalies may occur at the early stages of disease development; however, with the majority of wild species (e.g., rodents, small birds, reptiles), disease may become widespread before it is recognized by people not associated with the immediate habitat. Veterinary Medical Profession The goals of the veterinary profession in the United States, as embodied in the oath taken by its members, are to protect animal health, relieve animal suffering, conserve animal resources, promote public health, and advance medical knowledge. In 1994, 56,000 veterinarians were active in the profession. In 2004, that number had grown to 65,000, a 16 percent increase. The profession is expected to grow another 25 percent in the next 10 years. The Bureau of Labor Statistics expects 28,000 job openings by 2012 due to growth and net replacements—a turnover of nearly 38 percent (AAVMC, 2004). Present employment of veterinarians is described in Table 2-1. Each state is responsible for licensing veterinarians and for regulating private veterinary practice (AVMA, 2004a). The American Veterinary Medical Association (AVMA), established in 1863, serves as the lead professional body for veterinarians in the United States. It is an organization largely driven by private practitioners, the majority of whom are in companion animal practice and AVMA’s primary activities are a reflection of the membership. It has a significant influence on veterinary education through its accreditation process administered by the Council on Education (COE). The AVMA also promulgates many and varied policy statements and guidelines that bear on animal health and welfare and on public health. The United States Animal Health Association (USAHA) is another key organization dealing with agricultural animal health and disease is-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases sues. USAHA works with state and federal governments, universities, veterinarians, livestock producers, national livestock and poultry organizations, research scientists, the extension service, and seven foreign countries to control livestock diseases in the United States (USAHA, 2005). This coalition of government, academic, and industry animal health professionals has operated for more than 100 years and serves to discuss prominent issues and deliver resolutions to appropriate organizations and government for consideration. The nature of veterinary employment is changing (Table 2-1). Over the past 15 years, there has been a 35 percent increase in the number of veterinarians engaged in small animal practice, a 13 percent decrease in the number of veterinarians in food-animal and mixed practice, and a 47 percent decrease in the number of veterinarians in public practice (i.e., government employment). Currently over half the profession is employed in small animal practice and only about 16 percent serves the livestock industry and food system, assuming that all the work of government employees is related to this domain (AVMA, 2005b). The veterinary medical profession and its branches have been the subject of several in-depth assessments over the past 35 years (NRC, 1972, 1982, 2004b; Pritchard, 1988; Brown and Silverman, 1999). The KPMG megastudy conducted by Brown and Silverman (1999), entitled The Current and Future Market for Veterinarians and Veterinary Medical Services in the United States, examined the profession’s income disparities, the increasing demand of services in new areas, and the critical shortage of trained professionals, and concluded that a series of strategic and substantive changes are needed in the veterinary profession to meet evolving societal needs and demands. One of the most comprehensive reviews, the Pew Veterinary Education Program, concluded: “Veterinary medicine is being threatened as never before by powerful forces of change in society, rapid advances in science and technology, and by the changing needs and expectations of almost every constituency it serves. Decisive steps must be taken at this time to make corrections in the way that the profession is trying to fulfill its responsibilities, to bring them more in line with the changing needs of society. Although it can not yet be defined as a crisis, the veterinary profession is not adapting rapidly enough to changing needs and is encountering substantial problems” (Pritchard, 1988). More recently, a 2004 National Research Council report on the veterinary medical profession found, among other key factors negatively impacting the supply of comparative medicine veterinarians, a lack of qualified applicants for all types of postgraduate training programs and the lack of commitment by veterinary medical schools and institutions that offer postgraduate training programs to prepare and train veterinary students and postgraduates for veterinary careers other than private clinical practice
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases TABLE 2-1 Employment of U.S. Veterinarians Who Are AVMA Members Private Clinical Practice 2004 1986 Number Percentage Number Percentage Large animal exclusive 1,887 4.0 1,936 5.7 Large animal predominant 2,596 5.4 4,570 13.5 Mixed animal 3,868 8.2 3,397 10.1 Small animal predominant 5,507 11.7 4,722 14.0 Small animal exclusive 29,951 63.4 17,276 51.1 Equine 2,257 4.8 1,888 5.6 Other 1,198 2.5 Subtotal 47,264 100 33,789 100 Public and Corporate Employment 2004 1986 Number Percentage Number Percentage College or university 3,961 46.7 3,713 39.5 Federal government 641 7.6 2,212 23.5 State or local government 542 6.4 756 8.0 Uniformed services 474 5.6 586 6.2 Industrial 1,566 18.5 2,128 22.7 Other 1,294 15.2 Subtotal 8,478 100 9,395 100 Grand Total 64,867 43,184 SOURCE: Pritchard, 1988; AVMA, 2005b. (NRC, 2004b). While it is too early to tell whether the recommendations from the 2004 NRC report have had an effect, the employment demographics of veterinarians over the last 15 years (Table 2-1) suggest that many of the Pew report recommendations have not been realized, due largely to the limited amount of funding provided and the complete lack of follow-up and continuity. Private Veterinarians Veterinarians in private practices, generally supported by veterinary technicians, are among the front-line health professionals dealing with animal disease. They constitute about 80 percent of the veterinary workforce (ca. 47,000, as shown in Table 2-1). Fewer than 10,000 derive a significant portion of their income from food-animal practice, and the number is declining (AVMA, 2005b). Rural demographic changes, inten-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases sification and specialization in the livestock industry, lifestyle issues, veterinary college entrance selection, and perhaps shifts in gender balance have led to circumstances where fewer veterinary graduates opt for careers in rural food animal practice (AVMA, 2004b). Veterinarians working in small animal and exotic practice can also play key roles in the detection of emerging disease problems. Examples of successful recognition of early incursions include the diagnosis of West Nile virus by a veterinary pathologist at the Bronx Zoo and screw worm incursions halted by small animal and equine practitioners in two different states (Nolen, 1999; Thurmond and Brown, 2002). Federal and State Animal Health Agencies Federal Animal Health Agencies This section briefly summarizes the legal authorities and functions of the federal government for preventing, detecting, and diagnosing animal diseases. Appendix C contains a more detailed summary prepared by Nga L. Tran, entitled “Existing Federal System for Addressing Animal Diseases.” Figure 2-1 illustrates the large number of federal entities involved in addressing animal health issues. International, state, and private entities involved in animal health issues are not included in Figure 2-1. The USDA Animal and Plant Health Inspection Service (APHIS) plays the lead role in protecting the health of domestic animals. Within APHIS, the majority of the responsibility to protect animal health resides in Veterinary Services (VS). The USDA’s programs addressing animal health cover a wide range of functions, including deterrence (the elimination or reduction of factors conducive to the potential import, transport, or transmission of disease from suspected sources of pathogens) and prevention, detection and diagnosis, monitoring and surveillance, emergency response, research, education and training, and communication (see Table C-3). A summary of deterrence and prevention efforts as they relate to reducing a potential threat before it reaches U.S. borders are described later in this chapter in the section on International Issues. The APHIS-VS division shares responsibility for some animal health issues with the Food and Drug Administration’s (FDA) Center for Veterinary Medicine (CVM). The CVM regulates and approves the manufacture and distribution of food additives and drugs that will be given to animals. APHIS-VS’s Center for Veterinary Biologics (CVB) regulates veterinary biologics, including vaccines, bacterins, antisera, and diagnostic kits that are used to prevent, treat, or diagnose animal diseases and ensure that these products are pure, safe, potent, and effective,
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases FIGURE 2-1 Key federal agencies addressing animal diseases.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Glossary of Acronyms and Abbreviations for Figure 2-1 AFMIC – Armed Forces Medical Intelligence Center APHIS – Animal and Plant Health Inspection Service ARS – Agricultural Research Service BTS – Border and Transportation Security CBP – Customs and Border Protection Bureau CDC – Centers for Disease Control and Prevention CEAH – Centers for Epidemiology and Animal Health CFSAN – Center for Food Safety and Applied Nutrition CSREES – Cooperative State Research, Education, and Extension Service CVB – Center for Veterinary Biologics CVM – Center for Veterinary Medicine DHS – U.S. Department of Homeland Security DOC – U.S. Department of Commerce DoD - U.S. Department of Defense DOI - U.S. Department of the Interior EP – Emergency Programs FAS – Foreign Agricultural Service FDA – Food and Drug Administration FEMA – Federal Emergency Management Agency FSIS – Food Safety and Inspection Service FWS – Fish and Wildlife Service Bureau HHS – U.S. Department of Health and Human Services IAIP – Information Analysis and Infrastructure Protection Directorate IS – International Services LRN – Laboratory Response Network NBII – National Biological Information Infrastructure NBAAC – National Biodefense Analysis Countermeasure Center NCAHP – National Center for Animal Health Programs NCID – National Center for Infectious Diseases NCIE – National Center for Import and Export NIH – National Institutes of Health NMFS – National Marine Fisheries Service NOAA – National Oceanic and Atmospheric Administration NVSL – National Veterinary Services Laboratories NWHC – National Wildlife Health Center OIG – Office of the Inspector General S&T – Science and Technology Directorate USAMRIID – U.S. Army Medical Research Institute for Infectious Diseases USDA – U.S. Department of Agriculture USGS – U.S. Geological Survey VS – Veterinary Services WS – Wildlife Services
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases based on the Virus-Serum-Toxin Act (37 Stat. 832-833; as amended December 23, 1985, Pub. L. 99-198, 99 Stat. 1654-1655; 21 U.S.C. 151-159). The APHIS-VS division also administers the National Veterinary Accreditation Program (NVAP). This voluntary program certifies private veterinary practitioners to work cooperatively with federal and state animal health officials. Nationally, more than 60,000 active accredited veterinarians are in the NVAP database. These veterinarians are instrumental in performing examinations and issuing health certificates critical to the safe movement of animals, assisting in disease eradication campaigns, and maintaining extensive animal disease detection and surveillance functions. NVAP work must be consistent with international requirements to safeguard animal health. The USDA Food Safety and Inspection Service (FSIS) is responsible for ensuring the safe, wholesome, and correctly labeled and packaged commercial supply of meat, poultry, and egg products that move within interstate commerce, are imported into the United States, or exported to other countries. Over the years, FSIS has transitioned into a public health role and has especially focused on food safety and security. Through its inspection system, which involves inspection of individual animal carcasses at slaughter, FSIS plays an important disease detection function. For instance, FSIS assists APHIS in identifying tuberculous cattle carcasses for the national bovine TB eradication program. The FSIS inspection system is further enhanced through its use of toxicological, pathological, and microbiological analyses. In this capacity, the agency is able to help prevent the dissemination of pathogens and diseases to people and animals further along the commodity stream. FSIS employs approximately 7,600 inspectors and is the largest employer of veterinarians in the federal government. The Fish and Wildlife Service (FWS) of the U.S. Department of the Interior (DOI) is responsible for the protection and enhancement of wildlife populations, safeguarding habitat for wildlife, including endangered species, and the inspection of wildlife shipments imported into the United States to ensure compliance with laws and treaties and detect illegal trade (FWS, 2001). DOI’s National Wildlife Health Center (NWHC) was established in 1975 as a biomedical laboratory dedicated to assessing the impact of disease on wildlife and identifying the role of various pathogens contributing to wildlife losses (USGS, 2004). The center provides a multidisciplinary, integrated program of disease diagnosis, field investigation and disease management, research, and training. It also maintains extensive databases on disease findings in animals and on wildlife mortality events. Other DOI programs include the National Biological Information Infrastructure (NBII), a broad collaborative program providing
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases increased access to data and information on the nation’s biological resources. HSPD-9 On January 30, 2004, the White House issued a policy directive, Homeland Security Presidential Directive-9 (HSPD-9), which makes the U.S. Department of Homeland Security responsible for coordinating federal programs aimed at protecting U.S. agriculture and food from diseases, pests, and toxins. Veterinary medicine is a critical component of HSPD-9, which significantly expands federal animal health-related initiatives. For instance, the policy calls for creation of a national stockpile of animal drugs and vaccines to respond to serious animal diseases; grants to veterinary colleges for expanding training in exotic animal diseases, epidemiology, and public health; and inclusion of veterinary diagnostic laboratories in national networks of federal and state laboratories (The White House, 2004). Over the course of 2004, federal response to HSPD-9 and related Homeland Security presidential directives was initiated and included in a USDA Agriculture Emergency Response Training session targeting APHIS animal health personnel and a scientific conference targeting development and use of rapid detection technologies. In January 2005, the Department of Homeland Security released its National Response Plan in response to HSPD-5 (Management of Domestic Incidents), which includes elements supportive of HSPD-9 efforts. The National Response Plan serves to “align federal coordination structures, capabilities, and resources into a unified, all-discipline, and all-hazards approach for incident management” (DHS, 2004d) and includes notation that annexes specific to food and agriculture will be published in subsequent versions of the plan. State Animal Health Agencies With few exceptions, states have the greatest responsibilities for animal health, whether for agricultural animals, companion animals, or wildlife. Local authorities will quickly become involved in an animal health emergency, but as soon as resources are overwhelmed, the state will assume responsibility. The federal government oversees issues involving foreign animal and programmatic diseases, veterinary biologics, and national identification and surveillance systems. It also monitors animals at U.S. borders, serves as a reference laboratory, and regulates imported and exported animals and animal products. Most all other animal health issues are dealt with at the state level or as a part of a cooperative state-federal program.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases The state departments of agriculture play a vital role in the animal health framework. Through their departments of agriculture, each state assumes responsibility to provide services and regulations regarding the health of agricultural animals. States maintain a list of reportable diseases and require all veterinarians to report disease occurrences. State veterinarians spearhead and direct the efforts of state animal health officials who have intrastate authority for disease reporting, detection, and often, diagnosis. These same officials also serve as key cooperators with their federal government counterparts in the prevention, detection, and eradication of a number of foreign and domestic diseases associated with national animal disease programs. In addition to state veterinarians, a large majority of states also have state public health veterinarians, whose positions and offices are usually associated with departments of public or community health. These officials are responsible for dealing with zoonoses and many other dimensions of veterinary and human public health. State agencies license veterinarians, regulate the intrastate movement of animals, organize emergency response, and are responsible for wildlife. States typically provide regulatory, laboratory, epidemiological, and programmatic support to their livestock, companion animal, and wildlife industries by working through veterinary practitioners, directly with producers, with relevant industries, and with local and federal animal and public health agencies. A major contribution of the states is the maintenance of animal health diagnostic laboratories. In most states, animal health diagnostic laboratories are associated with state departments of agriculture and, depending on the state, are located at veterinary colleges, land grant university departments of veterinary science, or state agencies for public health. Some states have multiple laboratories. These facilities handle or forward the majority of specimens for diagnosis and monitoring of disease. Private laboratories also play an increasing role in the diagnosis of animal diseases, especially for companion animal species. More information about diagnostic laboratories is described in the section of this chapter entitled “Scientific Preparedness for Diagnosing Animal Diseases: Laboratory Capacity and Capability.” International Organizations Many international organizations are involved with issues related to animal disease. Given the increasingly global nature of disease outbreaks, these agencies, the most important of which are highlighted here, play a key role with respect to the animal health framework in the United States. The agencies involved in prevention, detection, and diagnosis of animal diseases consist of several multilateral groups that have different mandates and functions but do not have national regulatory authority.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases The nation’s animal and public health could benefit more fully from the potentially powerful analytic capabilities of risk analysis and risk assessment if there were more widespread understanding of and participation in the way in which mathematical models of disease incidence and spread are used to determine risk, and the assumptions inherent in those models. By formalizing and strengthening links and communication between risk assessment modelers, who understand risk modeling methodologies, and biologists, who understand the agents, animals, biology, and pathways of the disease, the biological accuracy of pathways being modeled could be improved. These interactions might help, for example, to clarify uncertainty in the prevailing knowledge of the disease and in the pathways being modeled, which are never known with absolute certainty, in order to understand the confidence that should be applied to reported risk estimates. In general, there is a need to promote the education of risk assessment methods for decision-makers, biologists, diagnosticians, and others who will be called upon to use, or to respond to, risk assessment reports. New ways to communicate key findings and conclusions of each of the four steps of risk assessment to those who are neither risk modelers nor experts in the disease are needed, so that those who must apply the results of risk assessments to policy or action can better interpret the bases for risk assessment results and can have confidence in their understanding of the strengths and weaknesses of the methods used. That goal might be accomplished, in part, by incorporating the specific goals and objectives of decision-makers and animal health planners into initial stages of risk assessment design so that risk assessments can be more focused and directed, and thus more precise, in addressing specific animal health issues. EDUCATION AND TRAINING Education and Training of Veterinarians Veterinary Schools Veterinary medicine comprises several distinct fields of practice, including the care of various species of food-animals, small animals, equids, general or rural practice (mixed domestic animals), ecosystem health (including wildlife disease and conservation biology), public health, and biomedical science. Not surprisingly, veterinary schools face a difficult challenge in producing sufficient graduates for all of these fields with the appropriate depth of competence across the full range of veterinary practices. The United States has 28 schools of veterinary medicine that graduate approximately 2,000 individuals each year with a Doctor of Veterinary
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Medicine (DVM) degree (AAVMC, 2003). Attaining this degree requires a minimum of 2–4 years of university preparation followed by a professional curriculum that normally extends over 4 years. This pattern of education emulates human medical education, with a key difference being that internship is not required prior to licensing for veterinarians. The system has served veterinary medicine reasonably well in the past, but it has not changed in about 50 years despite recent enormous changes in society that have generated markedly altered production systems and disease patterns. The students entering veterinary schools and their decisions to specialize are also changing. For example, veterinary students are increasingly from urban environments and are women. Another trend is that, with more disposable income and greater expectations for the level of care and services for their animals, companion animal owners have demanded greater sophistication and improved health care delivery that has resulted in specialization into services such as oncology, critical care, internal medicine, and ophthalmology. These dramatic increases in specialization in companion animal services and practices, and improved financial rewards, have influenced student decision making to enter these fields. DVM programs are uniformly subjected to accreditation by the American Veterinary Medical Association (AVMA), which sets “standard requirements of an accredited or approved college of veterinary medicine” (AVMA, 2004a). These standards include those relating to organization, finances, physical facilities and equipment, clinical resources, library and information resources, students, admission, faculty, curriculum, research programs, and outcomes assessments. The AVMA’s Council on Education reviews each veterinary school every 7 years. The Association of American Veterinary Medical Colleges (AAVMC) provides a collective voice for the veterinary schools (AAVMC, 2004). It publishes the Journal of Veterinary Medical Education, sponsors biennial symposia, manages a national veterinary student application process, and provides leadership in addressing current issues in veterinary education and research. Licensing State agencies license veterinarians. U.S graduates must be from an AVMA accredited school and have passed a standard North American Veterinary Licensing Examination (NAVLE) to enter private practice. While there is some opportunity for students to focus their undergraduate clinical training in one of the specific fields of veterinary medicine, accreditation requirements and the broad range of subject matter covered
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases by the NAVLE puts a limitation on the practical extent of such training. As a consequence, specialization in the various fields of veterinary medicine occurs at the postgraduate level. The relatively modest incomes that are the norm in veterinary medicine (with means that range from $84,000 to $92,000/year for different fields in 2002), together with high levels of student indebtedness (a mean of $71,000 in 2002) may deter new graduates from opting for postgraduate training. This has led to the suggestion that veterinary educators should consider an engineering model of undergraduate professional education in which veterinary students elect a curriculum track with the depth of study in different disciplines appropriate to the field of their choice (Eyre, 2002; Radostits, 2003; Nielsen, 2003). This would require a change in licensing policies, which has been advocated by some (Karg, 2000). Training in Population Health/Food Systems An adequate education in population health is essential for veterinarians on the first line of defense in dealing with animal diseases in the livestock industry as private practitioners and as employees of government agencies or commercial enterprises. It is also essential for those involved in the food system, public health, and ecosystem health. However, since the objective of about 75 percent of students is to enter companion animal practice or a related specialty, present curricula emphasize individual animal medicine. A symposium of U.S. veterinary educators (Hird et al., 2002) held in 2002 concluded that: A crisis in veterinary medicine exists that requires urgent action from veterinary educators, veterinary associations and organizations, and public and private practitioners. The convergence of animal, human, and environmental health issues has created the need for veterinarians with a level of knowledge and skills that is not being achieved by either new graduates or the current pool of veterinarians. Unprecedented changes in food animal production and health, human and animal demographics, diseases, concern for animal well-being and welfare, antibiotic resistance, and biotechnology are occurring. In addition increasing threats to animal populations from the introduction of exotic animal diseases, either accidentally or intentionally, require a much larger cadre of veterinarians with training in population health concepts if the US is to manage exotic disease outbreaks and maintain the security of the of the US food supply. The conclusions that emerged from this symposium echoed similar ones made in the 1972 NRC report New Horizons in Veterinary Medicine and the 1988 Pew National Veterinary Education Program (NRC, 1972; Pritchard, 1988).
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Training in Public Health A recent survey of education in public health in 27 (of the 28) U.S. veterinary schools found that the curricula of all 27 required at least one course in public health; when epidemiology was included, the contact hours assigned to these subjects ranged from 30 to 120 (mean of 67). Only four schools, however, have required clinical rotations in public health (Riddle et al., 2004). Twenty-four of the 27 schools offer from one to six elective courses varying from a total of 15 to 288 hours. Eight schools offer elective clinical rotations of 3–4 weeks in length. Twenty-three schools offer some form of advanced training in public health or epidemiology, four offering a dual DVM/Masters of Public Health program. Fifteen schools offer or are about to offer some form of DVM program combined with an advanced degree related to public health. Statistics describing first-year employment of new graduates (Table 2-3) indicate that few, if any, opt for careers in public health or have the opportunity without further education. Leaders in veterinary education have called for the profession and its educational establishment to give much more attention to meeting societal needs in this field (Hoblet et al., 2003). TABLE 2-3 First-Year Employment, 2004 Veterinary Graduates in Various Fields Percent Private Clinical Practice 68.2 Large animal exclusive 2.5 Large animal predominant 2.8 Mixed animal 9.0 Small animal exclusive 40.4 Small animal predominant 10.0 Equid 3.4 Public or Corporate Employment 1.9 College/university 0.1 Uniformed services 1.2 Federal government 0.1 State/local government 0.1 Industry/commercial 0.1 Not-for-profit 0.2 Other 0.6 Unknown 3.7 Advanced study programs 25.7 SOURCE: AVMA, 2004b
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Ecosystem Health Ecosystem health provides a broad context for veterinary education to address wildlife diseases and conservation biology at the level of multiple populations that share the same environment (Van Leeuwen et al., 1998; Deem, 2004). While some schools offer undergraduates the opportunity to choose elective courses or rotation in wildlife diseases or zoological medicine, most new graduates who wish to specialize in wildlife diseases undertake postgraduate studies to this end. Veterinary schools in Canada have jointly created an innovative elective undergraduate rotation in ecosystem health (Ribble et al., 1997). Veterinary Technology Programs Veterinary technicians are important members of veterinary practice teams, government agencies, biomedical research laboratories, diagnostic laboratories, and commercial enterprises. Opportunities to make rural practice more attractive could depend on having veterinary technicians who are better suited and empowered to provide appropriate support to veterinary practitioners. There are 104 programs in veterinary technology in the United States accredited by the AVMA; 15 offer baccalaureate degrees, 2 of which are at a veterinary college. Postgraduate Studies Although data on the total number of graduate students in the veterinary sciences are unknown, a 2004 AVMA survey indicated that of 2,225 College of Veterinary Medicine (CVM) graduates, roughly 25 percent responded they were entering graduate studies at CVMs and elsewhere (Shepherd, 2004). In 2002, 27.7 percent of all female graduates and 23 percent of all male graduates directly entered advanced studies, including internships, residencies, and graduate training programs (Wise and Shepherd, 2004). In order to encourage more veterinary students to opt for postgraduate training, at least 10 veterinary schools offer combined DVM/graduate degree programs, such as DVM/PhD and DVM/Master’s programs, not counting schools with joint MPH programs (Riddle et al., 2004). Several colleges have recently offered new DVM/MPH dual degree programs that can be completed in 4 years. Postgraduate training can be of several types: (1) clinical training, leading to certification as a specialist (or diplomate); (2) research training, to prepare the veterinarian to be an independent research scientist in a specific area, such as immunology, physiology, epidemiology, microbiol-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases ogy and toxicology; this training may or may not lead to a PhD, although individuals seriously interested in a research career typically pursue a PhD, followed by postdoctoral training; and (3) a combination of research and clinical training—for example, veterinary pathology or laboratory animal medicine. Clinical Training Many, if not most, new veterinary graduates seeking formal postgraduate education elect residency training (which may be in conjunction with a M.Sc. degree) and board certification in a medical discipline with a view to becoming a clinical specialist, often in the companion animal health discipline. In the United States, the AVMA guides and regulates the formal processes for clinical specialization in a veterinary medical discipline, a process that began in 1949 with the pathology specialty. There are now 20 specialty colleges (See Table 2-4). Veterinarians who wish to achieve the status of a specialist in a medical discipline must undertake an approved residency program and subsequently pass a rigorous examination set by a recognized specialty college. Those who successfully complete a program become registered “diplomates” in the college or board they choose. It normally requires about 3–5 years for a new graduate to achieve this goal. Specialization by species was resisted for many years, except in the case of laboratory animals, where the American College of Laboratory Animal Medicine has existed since 1957. The American College of Poultry Veterinarians was established in 1991. The American Board of Veterinary Practitioners (established in 1976) recently provided categories for specialization in avian practice, beef cattle practice, dairy practice, and swine health management. The number of diplomates in each of these categories is modest, ranging from 11 to 107. Diplomate status in a specialty college has become a required qualification for faculty in clinical departments of many of the nation’s faculties of veterinary medicine and has greatly enhanced the quality of clinical education. The diplomate status in one of several disciplines is the preferred qualification for section heads in diagnostic laboratories that opt for accreditation by the AAVLD. Increasing the strength of the nation’s animal diagnostic laboratory and field investigative network will depend in part on having adequate numbers of veterinarians with specialist qualifications in pathology, epidemiology, microbiology, toxicology, and wildlife diseases, as well as other laboratory professionals.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases TABLE 2-4 Active, Board-Certified Diplomates (as of December 2004) Field No. of Diplomates All Fields 7,970 Anesthesiologists 148 Animal Behaviorists 36 Dentistry 75 Dermatologists 158 Emergency and Critical Care 156 Internal Medicine 1,478 Cardiology 120 Internal Medicine, Small Animal 788 Internal Medicine, Large Animal 357 Neurology 126 Oncology 151 Laboratory Animal Medicine 677 Microbiologists 164 Bacteriology/Mycology 33 Immunology 43 Microbiology 85 Virology 50 Nutrition 47 Ophthalmologists 264 Pathologists 1,411 Anatomical Pathology 1,210 Clinical Pathology 255 Toxicological Pathology 38 Pharmacology 43 Poultry 247 Practitioners 740 Avian 107 Beef Cattle 11 Canine and Feline 408 Dairy 30 Equine 74 Feline Exclusive 71 Food Animal 20 Swine Health Management 18 Preventive Medicine 531 Epidemiology 64 Radiology 264 Radiation Oncology 34 Veterinary Surgeons 1,041 Small Animal 43 Large Animal 23 Theriogenologists 306 Toxicology 98 Zoological Medicine 83 SOURCE: AVMA, 2004c.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Research Training and Combination Training Currently, students who seek board certification are encouraged to pursue a PhD if they have an interest in research. Unlike MD equivalents, who often enter postdoctoral training in a research environment, opportunities for rigorous DVM postdoctoral research training are few. While it is not unusual for an MD involved in research not to hold a PhD, it is still expected by veterinary colleges that a veterinarian hold a PhD to undertake independent research. The extended period of time needed to become a biomedical investigator might significantly discourage students from pursuing this path. But despite the additional 4–5 years of effort, some DVMs pursue a PhD and postdoctoral training. Most typically, veterinarians entering the field of biomedical science and research do so through graduate degree(s) and postdoctoral training in a medical discipline. Some combine this with specialty training in clinical disciplines, such as laboratory animal medicine or veterinary pathology, leading to certification as a diplomate in the American College of Laboratory Animal Medicine (ACLAM) or the American College of Veterinary Pathologists (ACVP), respectively. Data compiled by the NRC study National Need and Priorities for Veterinarians in Biomedical Research in 2004 indicate a strong but unfilled demand for veterinarians with proven research skills. The NRC report documented the rising number of position announcements for laboratory animal medicine veterinarians, which increased from less than 20 in 1995 to 50 in 2001. At the same time, animal use in the NIH grant portfolio is at an all-time high, a reflection of the continuing importance of animal based research (NRC, 2004b). Nearly 5,500 grants, or about 40 percent of all NIH competing grants, involved the use of live vertebrate animals (NRC, 2004b). However, NIH grants usually do not support animal disease research except as models for human disease. Veterinarians need to be trained in biomedical research to take active roles as principal investigators on NIH grants related to animal models for human disease and other grants for animal disease research, including investigations of the role of animals in zoonoses. The NRC report’s review of Research Project (RO1) funded NIH grants in 2001 indicated that only 4.7 percent of NIH-funded competitive grants utilizing animals were awarded to veterinary principal investigators. The number of RO1s awarded to DVMs was small even during the period of doubling of the NIH budget (1997-2001): 76 RO1 awards to DVMs in 2001 (NRC, 2004b). The report concluded that the current number of veterinary investigators is not adequate to capitalize on the unique potential of comparative medicine to contribute to biomedical research.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases The ACVP has provided further evidence of the future shortfall in biomedical scientists (ACVP, 2002). It studied the national needs for veterinary pathologists by surveying potential employers for the period 2002–2007 and compared this estimate to the expected output of trainees from existing training programs for the same period. It concluded there would be a shortfall of 336 pathologists or 50 percent of the predicted demand. In summary, these facts point to a critical need for colleges of veterinary medicine to reexamine the nature of training provided to students relative to national needs. Although a more detailed examination of factors that impede veterinary students and veterinarians from pursuing research careers is beyond the scope of this report, these issues are the subject of a forthcoming NRC report entitled Critical Needs for Research in Veterinary Science (NRC, 2005). Continuing Veterinary Medical Education (CVME) In 2002, the AVMA Council on Education removed the Continuing Education Standard as essential for veterinary college accreditation. Hence this body no longer reviews college CVME programs. At present, no organization sets CVME national standards, as is the case for continuing medical education (Moore, 2003). CVME is delivered by schools of veterinary medicine, various professional associations and societies, employers, and government agencies. Forty-one states, in one form or another, have mandated requirements for CVME to maintain licensure (Moore et al., 2003). APHIS-VS administers the National Veterinary Accreditation Program (NVAP) (USDA-APHIS-VS, 2004) and plans to make regular CVME a mandatory requirement for the accreditation of private veterinary practitioners who wish to participate in federal and state regulatory programs (Torres and Bowman, 2002). It is anticipated that accreditation will be designated in two separate categories: one for companion animals and one for food-animals. Proposed rule changes are expected to be available for public comment in the winter of 2005 (Lawrence Miller, personal communication, June 2005). Currently, 80 percent of practicing veterinarians are accredited. The current accreditation program does not require veterinarians to maintain, through continuing education, their knowledge of foreign animal diseases. Under the proposed new program, foreign animal disease training will be available to complete CVME requirements to maintain accreditation status (Lawrence Miller, personal communication, June 2005).
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Education and Training of Others on the Front Lines Most animal handlers and others working and living with animals on a day-to-day basis are not health professionals and acquire their knowledge about animal disease through one or more means, such as from their veterinarian, employer, the Internet, industry magazines, commodity organizations, and extension programs offered by universities, government, or producer organizations. By definition, extension agencies are well positioned to take the initiative to provide appropriate training programs, but would probably require additional support to develop such instruction, given competing priorities and a challenging budgetary environment. Wildlife agencies are expected to keep staff biologists and technicians adequately informed about disease issues. Hunters and naturalists can get information from societies dedicated to their interest or hobby through print, meetings, and the Internet. AWARENESS OF THE ECONOMIC, SOCIAL, AND HUMAN HEALTH EFFECTS OF ANIMAL DISEASES An outbreak of animal disease can have significant economic, social, and human health effects, although these effects vary considerably depending on the nature of the disease and the specific outbreak. Some animal diseases can have significant effects on markets. These include direct impacts on lost production and farm income, unintended costs to adjust from lost output, sector and community losses in welfare, and impacts on markets (prices) and trade. Consumers may lose confidence in the safety of meat and other food products, and this loss of confidence can contribute to a decrease in prices as well as lack of trust in public authorities. The potential for market and other impacts of an actual or threatened animal disease outbreak points to the importance of accurate and ongoing communication with consumers, producers, and the general public. Increasing dependence on trade can increase the volatility of prices. With the confirmed cases BSE in Canada in May 2003 and the Canadian-U.S. border closed to live cattle trade and only limited meat trade, U.S. beef prices rose by over 26 percent in 2003. After discovery of a BSE case in the United States in December 2003, U.S. beef prices fell by nearly 11 percent. The world beef trade declined by an estimated 2.5 percent in 2004 (Beghin et al., 2004). A recent review of studies of the economic impact of transboundary animal diseases indicates significant losses caused by the perceived threat of transboundary animal disease and control efforts. The studies include losses to Uruguay of added trade revenue estimated up to $90 million per year from the presence of FMD (1996) and losses in the
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases United Kingdom in 2000 related to BSE (lost trade, production, and other financial costs) of €5 billion (Otte et al., 2004). USDA estimates losses to the U.K. economy of $3.6–11.6 billion for FMD and $5.8 billion for BSE (USDA ERS, 2001). BSE is linked to variant Creutzfeldt-Jakob disease (vCJD) known to have caused 147 human deaths in the United Kingdom as of December 2004 (CJD Statistics, 2004). In addition to known animal diseases from naturally occurring exposure is the added risk of disease that is spread with malicious intent (NRC, 2003a). Also, diseases associated with environmental disturbance or degradation are becoming more important. The effect of environmental contamination can affect domestic animal production, as well as the health of wildlife, and the value of hunting and fishing for recreation or livelihood.
Representative terms from entire chapter: