>> From the Library of Congress in Washington, D.C. ^M00:00:04 ^M00:00:23 >> Tomoko Steen: Welcome, everyone. I'm Tomoko Steen here at the Library of Congress Research Specialists. And today's event is sponsored by Science, Technology, and Business Division here at the Library of Congress. Today's topic is One Health. How many of you know about One Health? ^M00:00:43 ^M00:00:46 That's pretty good. I thought it's a new concept, but it's actually not new. So the speaker is going to explain that it's actually not a new concept. We are very, very lucky to have today's speaker. She's an expert, not only the One Health, but she's a director of the FDA as well as the advisor still right now for the George Washington University's Milken Institute of Public Health. And she'll go back, but this year she wants to share with you her knowledge on One Health. I think it's nice to connect between public and federal government. So I'm sure that you know what FDA is, right, this audience I guess. ^M00:01:45 [ Laughter ] ^M00:01:47 Yeah, it's Food and Drug Administration. So she'll go back and serve as a director again. But it's nice to have this public and government, and also maybe company private sector communication. That's a very important thing. And President Obama has been really pushing this concept. Today's speaker -- actually, you have the name here. I actually knew her name from her work before I met her. So Bernadette Dunham. Dr. Bernadette Dunham has done her veterinarian degree from Canada and came here and did a Ph.D. at Boston University. And she has served at the university as well as government. And she has been bridging academic and the public sectors. So she's such a catalyst in communicating very well, and very, very friendly person. So with her approach, she will explain exactly what One Health is today. So without further ado, please join me in welcoming our speaker, Dr. Dunham. ^M00:03:23 [ Applause ] ^M00:03:29 >> Bernadette Dunham: Well, good morning. Thank you, Dr. Steen, very much. And thank you for the invitation to be here at the Library of Congress. It's really an honor and I'm thrilled to see so many in the audience. So with no further ado, I am thrilled to be able to address a number of aspects of what we now call One Health. I'm going to cover a number of examples and wrap it up at the very end with an exciting opportunity to address an annual One Health Day event. So the concept of One Health, it isn't new, as you just heard from Dr. Steen. Considering the fact that over 2,500 years ago, it was actually Hippocrates who urged physicians to consider where their patients lived, the foods they ate, the waters they drank, their lifestyles, and the seasons of the year. And then Dr. Virchow, father of pathology, stated that, "Between animal and human medicine, there are no dividing lines nor should there be." And then Dr. Schwab, also coined the term "one medicine" in his textbook of "Veterinary Medicine and Human Health" in 1965. The American Veterinary Medical Association had a task force in 2008 which really started to set the framework for how we can really start to embrace One Health. By definition, One Health is the collaborative effort of multiple disciplines working locally, nationally, and globally to obtain optimal health for people, animals, and the environment. Why do we want to look at One Health? Worldwide, about 75 percent of all emerging infectious diseases in the past three decades have originated in animals. Environmental health can affect human and animal health through contamination, pollution, and poor conditions that often lead to new infectious agents. And the world population is projected to grow from a current 7.4 billion to 9 billion in 2050. We have to be aware of how we provide adequate healthcare, food and water for this growing population. Our health professions and related disciplines, and institutions must work together. And there's always that benefit that we experience from the human/animal bond to help impact the health of people and animals. Three groups that I'm going to highlight have evolved over time. One is the One Health Initiative, it started in 2006. And it basically is that forte of recognizing that human health, animal health, and ecosystem health are inextricably linked. And One Health does seek to promote and prove and defend the health and well-being of all species by enhancing cooperation and collaboration between physicians, veterinarians, and other scientific health and environmental professionals; and promoting strength in leadership and management to achieve these goals. And they have the umbrella, as we say, for One Health, of which here are a number of examples -- and I'm going to touch on a few of them today -- that come to mind when you say, "Well, what exactly are we talking about?" And you can have anything from zoonotic threats to comparative medicine and translational medicine to looking at the environment as well as our public issues. Another group that has evolved, starting in 2009, is the One Health Commission. And they really focus with their charter to educate and create networks that can help improve our health outcomes and well-being for humans, animals, and plants, promoting an environmental resilience through a collaborative global One Health approach. And then most recently in 2011, the One Health platform, also a global group, has been formed to try to further the forum of stakeholders that we have in really looking at potential future outbreaks of zoonoses, emerging infectious diseases in animals and people, and antimicrobial resistance, and the ecological factors surrounding them. Right now, this map that was generated by Dr. Monith [assumed spelling], displays the potential initial numbers that we're looking at that are both arthropod-borne, rodent-borne, as others, to give us zoonotic infections. And as you well know, Zika is certainly rolling off of everybody's tongues today. It is the next one to be added as an arthropod-borne infection. Put this up because in fact, we really do now live in a global village. So if I look at Zika virus, it absolutely exemplifies One Health so well. It really does need and showcase how we bring together entomologists, physicians, veterinarians, virologists, wildlife biologists, environmental experts, universities, governments, public health organizations, world health organizations. Why? Because we have so much to do to address this very important issue. Zika virus infection is often asymptomatic, and it can cause mild illnesses such as just a fever or a rash, or some joint pain. But most recently, and what has been in the newspaper and caught everybody's attention, is the fact that now -- and CDC just recently concluded -- Zika virus infection during pregnancy can cause microcephaly and other severe fetal brain defects. It's possibly also associated with autoimmune illnesses like Guillain-Barre Syndrome. And that's under investigation as well. But as of today, there isn't a commercial vaccine, nor a specific antiviral agent to treat Zika virus infection, so our basic research and vaccine development needs to continue. There's also no approved yet diagnostic test cleared by FDA to help us detect Zika virus, be it for blood, urine, or saliva samples. And the mosquito, Ades genus, the vector needs to be controlled. And what are the ways that we can do that? Some are looking at removal of water-containing sources: insecticide sprays. And now we have the potential for genetic engineering of these mosquitos to suppress mosquito population. And society has to take a look at all of these potential technologies. And then how do we enhance the risk communication and education to help the public avoid mosquito exposure? We do need enhanced surveillance systems collecting, analyzing the data to assist in whatever our public health strategies will be. We also still have yet to determine the non-human reservoirs for Zika virus. Originally, in the Zika forest in Africa was where a monkey had been looked at that did have access and was detected to having positive Zika virus. But now if you come over to South America, we don't know yet for sure what the animal potential reservoir is, so this is why we need further research. And most importantly, because of the devastation of what this virus can do with newborn infants -- ^M00:10:00 -- those that have microcephaly, they're going to need potential medical care for their lives. And that really means we have to have infrastructure local, at national levels, the financial commitments, and the government engagement in policy development that takes place in order to address this real challenge that we're facing. That's just one. There's a number of the other mosquito-borne diseases that I know you're very familiar with. If we talk about transmitting Dengue, Chikungunya, Yellow fever, Zika viruses from the Aedes specimen of the mosquitos; the one thing that we're not aware of -- you may not be aware of -- is Yellow fever internationally is actually potentially rising. And the one thing that is occurring is we don't always maintain sufficient of our vaccine stockpiles. So if Yellow fever was to take off in an urban area right about now in certain parts of the globe, are we really prepared to be able to address that? So those are the questions that are surfacing on a global level that we need to be aware of as we hear and track and see what diseases are surfacing. You're also familiar with West Nile virus, equine encephalitis virus. We also have Japanese encephalitis virus being transmitted. And of course, we have an [inaudible] transmitting malaria. And that's a constant struggle still; we have not yet overcome malaria. And then for a lot of folks that may have some cats and dogs, we have a mosquito transmission of dirofilaria immitis, which causes heartworm. And a quick aside, we have a number of products that you can treat your dog with, for example, to prevent heartworm. What's interesting is certain dogs have a genetic propensity to carry mutation in a very important protein that prevents them from metabolizing correctly the Ivermectin type of drugs that we use. And a quick analogy, if Tommy and Mary come into a veterinary clinic with their Collie/Collie-cross dogs and you want to treat both those dogs to prevent heartworm, there's a potential if you don't screen, that you might end up causing the loss of Tommy's dog. Well, that'll be heartbreaking. Well now, we can test, and again, bringing back in the idea of understanding from genomics, the fact that we have personalized medicine for people and we can have personalized medicine for animals. So now with screening, we can say Tommy's dog cannot receive an Ivermectin-based product, we'll use something else and he'll be fine, and he will be protected against heartworm. So medicine is touching both sides right now. And of course, emerging diseases of global health and agricultural concerns. You're certainly very aware that we've had numerous links over the years. Certainly, H1N1 has been a crisis. Back in 2009, we had a major outbreak. And we're looking at influenza from birds, from swine, and [inaudible] a potential for them again to jump from species to species and potentially then hit humans and cause some major important issues. SARS occurred in 2003, the severe acute respiratory syndrome, with people in direct transmission back and forth. Ebola. We had another major outbreak, as you saw in 2014. We're still addressing those issues right now. And again, how do we intervene? How do we track? How do we respond quickly enough? MERS also surfaced, and that again was your Middle East respiratory syndrome. The potential there is even looking at camels -- is there a source that can go back as a zoonotic entity? And I mentioned West Nile virus earlier. Certainly when that hit New York, that was an eye-opener. Again, we've had Zika, so how do you handle these vectors such as mosquitos? And then we had bovine spongiform encephalitis, also called mad cow disease, outbreak in '86 from Europe. And then what have we taken for policy steps to prevent that? And E.coli O157:H7 has had devastating results when it first broke out when we had the issue with the [inaudible]. We've come a long way, but we're still facing these issues. They're with us and they're challenging. So how about something local? Lyme disease. I think many of us, certainly in the eastern coast, but it crosses so many areas, have heard and maybe have even had Lyme disease. It's caused by a spirochete, it's called bacteria, Borrelia burgdorferi, and it's transmitted by ticks. Well, you think about where we live, we move into so many of the wooded areas anymore where deer hang out. But you know what, they're also capable then of transmitting diseases back. And the ticks that are there, very quickly will be able to pick up some of these problems. And they can touch people, they can touch dogs, horses -- cats rarely -- cattle and mice are known to be able to succumb to Lyme disease just like you and I can. Many times, you'll just have nothing more than flu-like symptoms, but it also forms both in early and a chronic form. And if any of you have had it or if you've had friends that have had it, it's very, very, very difficult. It's constantly being treated. And people are not happy when they have Lyme disease. And it can touch all of us: children and adults. With dogs and horses, very similar, you'll have shifting leg lamenesses, swollen joints, lethargy, fever, and [inaudible]. We do fortunately have a vaccine for dogs. And people say, "Well, what about me? Why don't you have a vaccine for me?" And this gets back again to the research and working with our companies to say we do have a need for a specific drug or a vaccine to be developed. And I believe there is still work to try to get us there, but we're not there yet. So your dogs, at least you can protect them. And when it comes to treatment, it's an antibiotic, and one that's very typical and used in horses, dogs, or people: Doxycycline. Well now, what about white-nose syndrome in bats? Why would I want to talk about bats? Because it's an example of how we do live in a global world. And it actually was humans that brought particularly this fungus over from Eurasia. And the bats that we have in North America had never been exposed to this before. And when they did, it really hit in 2006. This particular fungus impacts the bats when they're hibernating, and literally will lead to their death. And we've lost a lot of bats. So you may say, "Well, they're just bats. Why are you bothering with that?" Because they're very important. People often don't realize. They help with pest control. They night fly, so they'll take a lot of insects that can often damage agricultural crops. And they're very important in pollination, from deserts to rainforests. The nectar-feeding bats are really critical in helping pollinate, and then also for seed dispersion. There, they can help scatter seeds. And often times, if you've had deforestation in a forest, they can be the ones to help restore it again. So knowing we've lost so many, now going forward, I still think we're going to see some significant ecosystem impacts because of the loss of a very important pollinator that we have. And once again, it's bringing together your scientists, managers, lawmakers, and the public at large to try to address this issue, identify where we're seeing it, and hopefully see if the bats can themselves develop immunity, which often they can and have in other countries. But when you first get hit with something, often it's decimated to that particular species. And everybody also has heard a lot about honeybees. Bee colonies -- they continue to fall. There was a report just this month both by the -- University of Maryland released the survey and USDA released a survey. And here in the United States, the beekeepers have lost 44 percent of their colonies just the last year. Once again, why are we concerned? They're bees and you don't want to get stung, right? But it's more than that. Not only do they make the honey that you like, but they're tremendous for pollinating so many crops for the foods that we need. And I think once again, it's being aware of this, because we need to help make a difference identifying the problem and come up with solutions. There's been a variety of factors that people have looked at because we haven't pinned everything down specifically under what we call colony collapse disorder where typically you'll see a loss of the worker bees. Very few are dead, but the hives are basically empty other than the queen bee and any of the brood that remains. But if the worker bees aren't there to bring back in and continue to take care of them, then of course you have nothing. The other aspect has been the varroa mite. This particular mite has been devastating. It will continue to weaken the bee, and again, fungus and infections can come in and further decimate the bee colony. But again, they're so important for pollination that we may not see them actually doing everything they do every day, but we really see the impact when all of a sudden you don't have a crop. And therefore, when you think about feeding the world, it also becomes very important to sustain and address these issues. So a lot of research is ongoing right now. And then finally, if you take a look at monarch butterflies, once again, what do they do for us? They're a sentinel. They're one more example of how things are changing over time. And when we change the habitat, when we use insecticides, many times we can see how the impact is to a certain species. And monarch butterflies have one major source of food: the milkweed. Well, you think about weeds and you say, "Let's cut the area. Let's clear up the fields," but you're also taking away one of their key sources of food. Also, the extreme weather changes that we've seen have impacted. So as we can watch sentinels, it's important because it can open our eyes, we may be able to intervene sooner before ramifications come up on major impact to us and other animals. I'm going to shift into the oceans. We also have a number of marine environmental sentinels there. For those of you that love to go down and see coral reefs and scuba dive and appreciate the beauty as you see it all the time, or even in aquariums, you like to look at a healthy coral reef. But as you've heard and as you're seeing, many of these reefs are now really succumbing to oceanic acidification. And what are we as society doing? When you think about the impacts we have from water and how we have -- traveling back and forth through the oceans with some of these huge transport vehicles -- sometimes you have horrible ocean spills of oil. What is happening as we continue around our coastal areas that can further add to the acidification and impact these coral reefs? ^M00:20:03 We're the ones that can help make a difference. And together, bringing in the experts and potentially new research and scientific technologies, hopefully intervene to turn this around. One piece of news, when I talk about environment, is even today in the newspaper, there was a very good note that for the Chesapeake Bay -- in fact, from last year, they've managed to reduce some of the land runoff on agriculture, and in fact, the Bay is starting to now improve as they're monitoring different aspects. And that's encouraging. So where there's a will, there's a way. We can make a difference. Healthy green sea turtles. They've been around for centuries and they're beautiful. But you know what, they're also succumbing to a number of new issues. Fibropapillomatosis is a very devastating disease in a green sea turtle. You and I are familiar with the papilloma virus. Typically you'll get a wart, but more importantly, you can get cervical cancer. So we have developed vaccines which I think is very important. But for the sea turtle, it's because they're seeing so much stress now because of the impact on the environment of the coastal habitat, when they develop this particular papilloma virus, it's herpes five virus, then you'll see -- as you can see in this particular picture -- it looks like growths, and they are. But they end up obstructing swimming, feeding, buoyancy, and sometimes they can actually lead to the death of the animal, and also blind them if it grows over their eye. So once again, it's a sentinel. And yes, we can individually intervene and treat some of these animals, but it's awareness that as the environment is being stressed and polluted, we're impacting so many animals. And I think it's important that we take a look at the oceans as well as what we're doing here on the land or in the air. So climate change. Everybody has a different view on climate change. I think there's a lot of good evidence out there that we are certainly seeing some major changes. Most recently, we've seen an awful lot of change, certainly across the United States, with hurricanes, tornadoes, in areas that normally we didn't, or frequency that's increased. It's absolutely amazing. Flooding has occurred. The devastation that occurs to society when we deal with major floods. Yes, we're seeing rising sea levels because there's evidence that in fact we have melting glaciers and ice fields impacting polar bears, sentinels. What's happening? Who's measuring this? What's the documentation? And what, if anything, can we do about it? And I think we need to be concerned because even though sometimes you getting overwhelmed by thinking, "What can I possibly do?" In fact, there's a lot that together we can do as we become aware of some of these opportunities. We've seen increases of wildfires, too. And that's devastating not only for the environment and the wildlife, but as you've seen, certainly like California, it's touching where people want to live. And we love the wildlife, we want to live out there. These are beautiful, beautiful -- it's a country -- and yet, there's a lot that can happen that can turn this into devastating situation. And we've seen increased dryness and drought. So we as we see this, an example with drought would be well, you need to have crops, you need to have food. Today, more and more we're seeing genetically engineered crops, some of which now can withstand the drought; some can withstand certain pests. So are we ready to accept that? What's the science behind that? The modification behind that? The policies? And more importantly, how do we monitor all of this? So as we are moving -- sometimes science can move much quicker than what we're ready to adopt -- but I think it's important that we sit and look at that science and the policies that should be developed to handle this. And more importantly, to do it together in a global venue. Most recently, the White House just released in April their report on some of the health risks that come from climate change. And they did this because they're focusing again on how individuals, communities, organizations, and governments can proactively manage some of the health risks that we see with climate change. The first one that comes to mind is absolutely air pollution and all of the allergens that we see. So how can we take technologies and still provide and develop -- clean fuel, for example -- and not have to have air pollution? Concentration in cities. You take a look at some countries and people have masks on every day just to walk around because the pollution can be so severe. So people in countries want to evolve, you want to have economic change, but sometimes that brings with it some very big important challenges to the health. So how do we continue to advance the economy but also minimize the negative impact to our health? Yes, the extremes of heat and cold come into play, and how well do we handle that, and what does that do to your health. We just highlighted a minute ago just some of the intense extreme events that we've talked about. How do prepare? How do you handle some of those? That's going to be a challenge for all of us. And yes, with this, we see increase of some vectors that can survive in countries that they hadn't before. Or as usual, we travel, animals travel, and microbes travel. And as I showed you already, introduction of new species that can challenge our health and animals' health, and are we ready for it. Water-related illnesses. Nothing more than mentioning Flint, Michigan and lead in the water. We've seen the reaction of that. And how do we do and monitor the infrastructure. And infrastructure takes dollars, it's old, it's breaking down. How can we intervene to make sure we can keep things safe so people can have access to safe water? Threats to food safety/nutrition. Even just looking at the pollinators I mentioned to you can minimize. Will we still have the food supply we need? And all of this really stresses our mental health. People have a lot of angst when they're being stressed, and that's going to impact your health. And I think it's always been true: there are certain populations that are going to suffer a lot more than others, and there are certain countries where if they're not well off, they will be the ones to suffer the most than those of us that are very fortunate and can possibly handle this. Another good report -- this came out this year -- preventing disease through healthy environments. This is the World Health Organization that just released this. And again, taking a look at, in this global world, how much can we potentially turn around through the environment, some of the risk factors that we have evolved, that we have actually been part and parcel of causing. And the good news is that even though 23 percent of global debts and 26 percent among children under five, they're related to modifiable environmental factors. So if we can reduce air pollution, if we can assure access to safe water, if we can have the basic sanitation that, again, we often take for granted but in other countries they don't have that, and access to clean fuel. The pictures here and in the report can really highlight how we can make a difference, but it's at a cost, and it's going to take society working together. It's going to take us helping and lowering the pillars so that internationally, we can learn from each other, we can assist, and we can get to a sustainable level and minimize some of those factors and get the benefits that we want from today's technology. Switching gears. Translational biology. Now, very close to my heart, how do we advance One Health here? Well, many of you may have pets. Many of you may have had friends, or yourself, who might have been touched by cancer, and many of your pets may also have been touched by cancer. The Institute of Medicine, last year, held a workshop entitled The Role of Clinical Studies for Pets with Naturally Occurring Tumors in Translational Cancer Research. The National Cancer Institute has what we call comparative oncology trials consortium. And this has been set up solely for the infrastructure to take a look at and investigate clinical trials for our pets that have the naturally occurring tumors. And how learning from them -- and I'm going to show you in a minute some similarities that can easily be translated to and help in fact address human cancers. And there's a benefit because it's a win on both sides when we can have interventions through drugs, surgery for pets as well as for people. And right now we have over 20 academic comparative oncology centers. So maybe you've had a Scottie dog. Well, in this day and age of genomics and understanding the sequencing of the genome, we learned an awful lot. Well, Scottish Terriers are 19 times more likely to develop bladder cancer [inaudible] the transitional cell, carcinoma, it's a BRAF gene mutation. And in people with the same tumor, it's a BRAF gene mutation. And at the meeting, it was just so thrilling to see your board-certified human oncologists, your board-certified veterinary oncologists looking and talking to each other and saying, "Really? I had no idea." "Fabulous, because now we can talk and work together." At the same time, Dr. Rod Page, who I have here, he's with the Flint Cancer Center at Colorado State. He was one of the key folks to work and encourage the Institute of Medicine to put this workshop on. And he's also been fabulous in highlighting where we can learn from our pets that have spontaneous tumors. Take a look at osteosarcomas. Devastating on both cases. And many times limbs are amputated to try to treat an osteosarcoma. Once again, at this particular study, when you take a look at the clinical trials and the tissues from dogs or from people, you'll find again that gnomically, they're very, very similar. So the venue there would be could we take a look and develop a drug? And you could be using this literally for your dog to be able to hopefully extend their life as well as their quality of life, and then glean from that information that can move forward to hopefully attain and get successful drug approval on the human side. ^M00:30:00 So this is a very exciting opportunity. Our pets don't live as long as us, so therefore, you can have information gathered in a much shorter time period. So there's a win there. And then curiosity. Are you aware of the fact that elephants rarely develop cancer? Well, actually, taking a look at potentially some evolutionary-based medicine, a number of researchers have looked at this. And one thing that was very curious, they found that elephants have about 20 copies of what we call TP53. This encodes for a protein, p53, that's a very crucial tumor suppressor gene. Well, they have 20 copies. But guess what? You and I only have one. Is that possibly why? It's most interesting to see that. So once again, understanding different scenarios. And as genomics opens up the door more and more, we can take a look at what's behind some of the tumors that we're looking at and how cancer is evolving, and how can we intervene and hopefully come up with better ways of potentially addressing cancer, which touches so many of our lives. That just showcases a number of the trial consortiums that we have. Another example, cranial facial reconstruction through regenerative technology can benefit animals and people. So for the dog side. Often, dogs will get malignant and sometimes even benign tumors of the mandible, and they'll undergo surgery. This little diagram on the bottom shows a dog's skull. And if you can look there, you'll see it looks like just a regular plate, but there's a mark that shows you the section of the jaw that's trying to say, fuse. So if it had just been a clean break of a bone, you could do that. You plate -when your bone is broken, you can just plate it and it'll heal. Sometimes, whole sections of the jaw are removed. And when that happens, they've often gone and used bone grafts in the past, but the results really weren't ideal. Now you fast forward with today's technology and understanding of science, and in fact, on the human side, FDA has approved two spinal fusion products for use in people, and it consists of what we now call recombinant human bone morphogenetic proteins, for short, RHBMPs. What they really are, they're special growth factors, and they can absolutely help induce formation of bone and cartilage. So now, we can treat people and dogs similarly. And you'll be able to take, in this case, if there had been a tumor and you took it out, the two pictures on the bottom show if you'd just use a collagen matrix, you can see it's still kind of bluey/purple in the middle. It has really got all of the bone forming very nicely. But if you do the collagen and you then also add the RHBMPs, you can see it looks like bone all the way through. Much quicker, you get a really good reconstruction, and the benefits are fantastic. So again, One Health advances both. I can't resist. We see this, and we often times are guilty of it. I for one do have a slightly overweight pussycat. It's too easy, with our treats, to have our little pets become obese. And we're just about as bad sometimes if we're not careful. But the issue then is the health. And the health that really comes from obesity or being overweight really is type 2 diabetes, because that's one we can change through exercise, through eating healthy, we can improve and minimize that. But it also can stress us across the board from cardio respiratory disease, you can have hip problems and knee problems, and of course cancer is a potential as well. So as you can see from the diagram, sometimes nothing more than just get up and take your dog for a walk, go for a walk yourself, exercise. And even though it's so nice to stop by and get these fast food sometimes that are processed, trying to focus on healthy dieting is something we can all embrace. And that'll be good because that'll help us all. So after talking about One Health, how are we starting to bridge this back into academic curriculums? And I'm very, very thrilled that just this past year, the Association of American Veterinary Medical Colleges with the Association of Preventive Teaching and Research under the Healthy People Curriculum Task Force has developed 15 case studies to showcase literally how One Health can be brought into the academic situation. They're available online. They're fabulous case studies for you to take a look at. But the whole goal there is to really help our students be able to get the knowledge and skills needed to really address potentials for transmission of human and animal disease, how to prevent it, how to address the health issues once they've surfaced, and what policies need to happen. And then under that One Health principle, recognizing who needs to be invited to the table so we can drop the pillars and work together. And that's really the biggest challenge in how One Health can hopefully minimize that. So the 15 case studies, I've listed them there. Do take advantage of taking a look. They're very enlightening and interesting, and anybody can read them and appreciate some of these examples. They really are good. And the wrapping up, we always thought, when we had discovery of penicillin, that we had the magic bullet and we were not going to have to deal with any kind of infections again; but that's not true. Because even Sir Alexander Fleming -- discovery of penicillin also receiving the Nobel Prize, cautioned resistance is a natural counterpart to antibiotics. Welcome to the world of microbes. And this now, once again, is an international global issue. Over the past decade, I think we've seen some major concerns. Nothing could be more heartbreaking than to have an infection and to have the physician tell you, "I'm so sorry, I have nothing to treat you or your family with." And even more heartbreaking to see that member of the family die. So this is not to be taken lightly; it's very serious. And we all have to be involved. Are we capable of developing some new antibiotics? For the longest time after this development, we didn't think we needed them. They focused on virology and vaccines. Now come fast forward, we don't have in the armamentarium of drugs a lot of new antibiotics. So as we understand the genome of the microbe, are there ways that we can come up with new development of procedures to treat these particular microbes? This brings us all together: public health, agriculture, research, national security. I mentioned it earlier, it's so true, international travel has really opened up the capability of having these microbes and the resistance that they carry come over here. You could have an injury when you're walking in India and get an infection, and come back home here and all of a sudden, boom, you have an infection. And guess what? It's a microbe and we don't have that particular to treat it with. That's devastating, and that has actually happened. So we do need to be very cautious and we all have to be stewards -- when I say stewards -- of how we use these products, be it for our own health, taking care of our kids, taking care of our animals. And more importantly, major changes that I'm very proud of at FDA is we really [inaudible] in the case of how historically, some very important antimicrobials were being used in production agriculture. Way back when, some of our food animals received these products and they seemed to do very well. They grew, they stayed healthy -- well, that's nice. But that definition is not good enough today. You need to know why are you using an antibiotic, what species is it being used in, what dose range, how long, and what pathogen are you treating. And it really needs to be properly handled through physicians for people and for veterinarians for animals. And so now we have made those changes and we're seeing all of that happen with a proper label. And by January 2017 on the food animal side, any of these medically important antibiotics will in fact have proper labels. And the idea of thinking they could have been used for growth promotion, feed efficiency will not happen anymore. So again, there needs to be very cautious use of these very important products. Along those lines, we did have an executive order to try to come up with a game plan of combatting antibiotic-resistant bacteria. And it pleased me again to see that in fact number two is strengthen the national One Health surveillance effort to combat resistance. Again, we do need to study this, we need to be surveilling this, and we need to be able to accelerate the research to give us the tools that we need. Potentially even vaccines can help as well here. But it's also going to improve international collaboration and sharing of information that we see. Center picture says it all. No words are needed. When we have the benefits of the human/animal interactions, via from service dogs to our service animals, to the love and companionship that our animals give us. They really don't ask for very much, but they give so much. Really, really does help all of us with our mental health, and I think so important, companionship all the way through. They are jewels, and therefore, we want to make sure that we take care of them. But also, we need to be aware of when they can be the ones to transmit some potential harmful diseases to us. So wrapping up, politics has to get involved. If we're going to have these pillars drop down, we need people to help at the level of the government. Most recently, there was the One Health Act of 2016 that was introduced by Congress. And if this happens, it's sole focus is to do just that. So how do we get federal agencies to work together to try to address some of these infectious diseases? How do we prevent them? Could we get grants so that instead of just a silo of I'm going to get a grant from this one agency, and I'm going to go over here for a separate grant for a different agency, but yet, we want to work together. We need to have the granting agencies be able to acknowledge and say it's OK for different backgrounds to apply for a grant and work together, and most importantly, to publish together and to make that easier. ^M00:40:03 When I think about where do I go for a competitive grant for a disease in a cat or a dog, pretty hard to find that. ONH is really going to focus on the human side. USDA is really going to focus on more so the food/animal side. So there's areas. And EPA will be doing your environmental side. But when something crosses and it's a health issue for both sides, then hopefully we can encourage the granting agencies and Congress to open up the doors. And then of course, internationally, how do you deal with the World Bank/World Health organization? Because we do need to take a look at sharing data, working together, and learning from each other. So this morning I took advantage in a very short moment to give you examples of so many opportunities that come under that wonderful umbrella of One Health. And these have highlighted through the talk examples. There's many more that I'm sure each one of you could add do an entire presentation on. But I think it's heightening that awareness, and bringing this together is really the goal. And most recently, to let you know, there is going to be an international symposium on One Health in Mongolia in June. There is going to be a second global conference on One Health in Japan in November. And then in December, Melbourne is going to host the convention on One Health EcoHealth. So I'm really pleased to see this being embraced in so many broad brushstrokes. And finally, there is a desire to see that we can maybe have even annually a One Health Day. So the very first one we've chosen is November 4th, and it's an international campaign which has been coordinated by the three groups I highlighted at the start of the talk -- the One Health Commission, One Health Initiative, and One Health Platform Foundation -- to really bring attention around the world for how these interactions are so crucial, and that we benefit by working together. And this campaign is going to highlight literally around the world a number of projects ongoing, they can be small, they can be large. But it's the idea to show with inspiration so many ways that we can work together. And by working together, I truthfully believe that we can make a difference and we can attain health for people, animals, and for our environment. And I thank you so very much for the opportunity to speak with you today. ^M00:42:23 [ Applause ] ^M00:42:28 >> Tomoko Steen: [Inaudible] ask questions and the speaker is going to [inaudible]. >> I wondered what you thought of the Olympics in Brazil and what -- but I know that the low end has got our people in short shorts, where the Japanese have the parachute long clothes. Do you think it's safe for people to -- and the Olympics. >> Bernadette Dunham: So the question what do we think about attending the Olympics to be held this year in Brazil knowing that Zika virus is a concern. And the clothing that various members of the Olympic teams coming internationally should or should not wear. This is definitely a major issue of concern. And I think aspects of how one can protect oneself courtesy of yes, you know, various insecticide sprays. Clothing certainly is true. So if I was going to have shorts, I'd definitely want to make sure I had some repellant on my skin, for example. I think is Brazil is doing a tremendous job on communicating to enhance awareness of what people can do. They're really, really focusing, I think right now, heavily on both the insecticide spray, they actually have some potentials for reducing the population of mosquitos. But it's still something that you have to take responsibility for your own health and be very cautious. And I do think there's a number of entities that allows us to ensure that. So each person should be aware and then make a decision as to how they want to go forward. And I think all of the Olympic teams in the countries around the world are paying attention to this to try to minimize the problem. And by far, if we did have the capability, as I said, for diagnostics to be able to fine tune, it would help a tremendous amount to reassure someone, you know, having been exposed or not. So in the meantime, Zika has been around for a little while, but most recently it's been the major, major scare for the potential for this transmission of the microcephaly in pregnant women. And many times, as I mentioned, if we did we get exposed, you will develop some antibodies towards it, so you'll probably be fine. But it's the pregnancy that becomes the biggest issue of all. And then as you know, the potential sexual transmission of this becomes an issue. So education, education, education is needed right now, and then having people make informed and safe decisions. Does that help? >> Great. Thanks. >> Bernadette Dunham: You're welcome. Yes, sir. >> So there's been a lot of emphasis in recent years on using viruses to treat certain illnesses like [inaudible] with brain cancer. So can you talk a little bit about a One Health perspective on the future of that type of treatment? Can using a virus to treat a disease cross species in a way that some of these other things can [inaudible]? >> Bernadette Dunham: So the question is, moving back into the medical side, can we use some of the various viruses that we looked at and can they be used to prevent and treat certain diseases. And I think that is one area that is becoming very exciting because we are using many times a virus vector to transfer in a treatment modality. We have to be very careful that some of the viruses that we use are not going to cause illness. And that perfection of the dose needs to be and is being looked at right now. So it's a very good tool, but coordination and still the research is exciting opportunities which I think the future is going to unfold more and more as we go forward. So yes, it's a good question and it's definitely being looked at with potentials that could be very beneficial. Yes, sir. >> How do you relate One Health to [inaudible] you have lots of people [inaudible] nowadays, like, basically refugees and just for the climate reasons, and this has affected disease around the world? Does this tie in to this also? >> Bernadette Dunham: So the question is how do we look at the population of people in different countries and refugees -- >> Population [inaudible]. >> Bernadette Dunham: And then where they're concentrated, and we're looking at potentials for climate change, how does that overall fall under the One Health umbrella? >> More or less having basically people coming from one country to another without being screened for diseases. >> Bernadette Dunham: OK. Having people travel from one country to another without being -- >> Particularly refugees. >> Bernadette Dunham: Without being screened. And that is definitely the challenge that we're facing. When I mentioned the concern even with Yellow virus and where that could go, the scenario is just that -- what's the screening capability that we have? People do travel back and forth. You may not even get sick but be exposed, and then go back home to your country and be able to be potentially transmitting this infection. I think more importantly, it's just that heightened awareness of what are the various diseases that are in certain countries that we're aware of. And through that type of surveillance, be able to caution if someone is then traveling to another country where that disease is not known, then are setting them up to have that new disease nestle in and challenge our health or potential health of animals. This is the whole idea behind One Health which is surveillance is a major, major important part of that, and are we aware of what is happening in various countries. How do we assimilate that information? The more that we can, the more that we can advise or be on the lookout when someone is traveling that we can hopefully follow them. People often times may not want to say, "Well, I have been exposed to said disease, therefore I can't travel. Many times, they may stay silent, and that can do a lot of harm. So it's turning it around to be supportive and to showcase how together we need to protect your health and the health of other people. It's really back to can we afford infrastructure wise for these diagnostic tests if that's what it's going to be. So the surveillance is one that information that we have, if we can find ways of sharing that and minimizing the cost, that's another one that will open up the doors for being aware and hopefully taking advantage of One Health. Does that help? >> Then to follow up, what sort of related -- where you have say Dengue in the low lying areas of the country, but the internal parts [inaudible] the same set of diseases. Are things changes whereas there's more interactions so the highlands will get the lowland diseases and vice versa [inaudible]? >> Bernadette Dunham: So the question is with Dengue, which you see typically around your coastal areas if you come inland or higher elevations, would you therefore see the transmission. Part of that goes into the vector itself in the transmission capabilities. So right now, the mosquito is very happy all on the coastal areas, but how far north can it go or survive? That would be an issue to track and see just where that mosquito is basically surviving. But then if you have been exposed to Dengue and you travel into the Colorado Mountains, your potential is for you and probably you alone. Then whether or not -- ^M00:50:00 -- another mosquito is capable of picking that up and then surviving and transmitting it in Colorado, this is where you need the surveillance and understanding of the various vectors such as mosquitos and what they will or will not transmit. They don't always transmit each one of these diseases; that needs to be looked into. Same with the ticks. Different ticks will transmit certain diseases or not. But this again is opening up everybody's eyes to an awareness that we probably didn't have before, and with that awareness, what are potential new tools that we need to have to be able to track and see what's happening. Or does there need to be a specific host that can sustain that particular disease so that then a vector can come along and continue to transmit it. Aedes is in Asia, but in fact, we haven't had Yellow fever breakout in a major way. So potential is there. And you say, "Well, why hasn't it?" And I think it's very important that we look at areas where Aedes is surviving, yet you don't have specific diseases. And yet it's a great transmitter of that, and you have to say why. So this is I think that awareness of surveillance, and these questions need to be asked, and then bring our researchers and our entomologists together to understand more about this. Because if we can learn from certain locations or environments, maybe we can modify those and have them as interventions in other countries. Thank you. Yes, ma'am. >> What impact can One Health have on bioterrorism and agroterrorism, is it just raising awareness of the issue or bringing together governments to make sure that they don't utilize those tactics; what does One Health do? >> Bernadette Dunham: So the question is One Health and how that would handle bioterrorism across the board. So many of the biological entities that are used in bioterrorism are those exactly, the zoonotic entities that we talked about. Anthrax was used here up on the Hill. The potential for some of these viruses is huge. It's that awareness again of why nations need to understand the devastation that would occur through a biological agent that if that transmission, especially being transmitted from people to people for example, is huge, then in this global world, it doesn't take much to have that spread. And that annihilation is horrific to even think about it. So it think it's more important, and this is why as even with the nuclear weapon discussion, the devastation is so huge, everybody needs to do everything they can to prevent that. So the education of what these biological viruses and agents can do is one that we would hope would be forefront and the government agencies to say we're not going to go there. A lot of good can come from so much of the research that we have, and the understanding of so many of these important entities. But you're right. You flip the coin and they can suddenly become the most horrific agents that we've ever seen if we don't have a way to intervene. For some of these agents, we may or may not have a treatment or a vaccine, and how long does it take to develop those interventions, is it a challenge? And then how do you stockpile so that you're prepared? So I agree with you. I would hope that our nations internationally can work together and avoid going there, but it's only through that heightened awareness. And that gets back again to then how do you do the surveillance to track and see what's happening, and only through us acknowledging that we do live together in this world. So what's going to happen just across the ocean can still impact us. That mindset, I think is starting to change more and more. That's a good question. Thank you. Yes, ma'am. >> Does FDA have any cooperative programs where they assist developing countries with developing processes for drug approvals or for diagnostic test approvals? I mean, there are a lot of neglected [inaudible] diseases out there that we don't have here, therefore, there's no incentive for a lot of [inaudible] activity here. But certainly FDA has expertise that could be shared by helping out countries that do have these problems. >> Bernadette Dunham: The question is does FDA have programs whereby the staff that has this knowledgebase of the drug approval process, can they assist other countries where in fact they do have diseases that we might not have here, and can they assist in developing programs for drug approval in the other countries. And there's a number of groups where we look at international harmonization literally for human drugs and animal drugs on how countries can share information and work together and have the pharmaceutical companies literally be able to go through the process of bringing to fruition approved products in different countries, taking advantage of that knowledgebase. Many times, we have workshops and sessions to go to other countries to showcase examples of how they can develop their own regulatory program for drug approval. And the companies themselves often participate to enhance that awareness. Wherever we can, I think the part that's so critical -- and we see this even with HIV -- so we have potential products that can be used to treat people, but then how do we make those available and affordable when you're looking across the world? And that's going to bring the countries together to address these issues as well. So there is that capability. And a number of governments will come here and visit with us and learn how do you do A, B, C, D, E. And if we can show them different venues at different levels -- so what exactly do you need? It may not be the same as a different country over here. You may want the full monty; you may not. And we can help, and other countries can help that have full regulatory programs onboard to work with countries that are coming forward and developing their own. Thank you. >> Tomoko Steen: Please join me to thank again for Dr. Dunham. >> Bernadette Dunham: Thank you very much. ^M00:55:59 [ Applause ] ^M00:56:02 >> This has been a presentation of the Library of Congress. Visit us at loc.gov. ^E00:56:09