One Health in two countries: The politics of transdisciplinary healthcare collaboration in Canada and the United States

Introduction

Proponents of the “One Health” approach to human, animal, and environmental well-being hold that people, plants, and animals are intrinsically interdependent and cannot be protected in isolation from each other. No country has done more to advance the One Health approach than Canada, where physicians and veterinarians lay the foundation of “comparative medicine” in the late 19^th century, and few countries would gain more from the approach today, when the growth of healthcare expenditures, pace of innovation, and risk of zoonotic spillovers place a premium on collaboration and efficiency in disease surveillance, healthcare delivery, education, and research. Much to the detriment of the country as a whole, however, Canada has forsaken its One Health heritage for a more or less disciplinary alternative.

The following article therefore makes the case for a more deliberate approach to One Health in Canada. First, I discuss the advance of One Health in the United States (US), and the likely social and economic returns on the investment. Second, I discuss the limits to One Health in Canada, and the opportunities that are being squandered. Finally, I offer policy recommendations that might encourage transdisciplinary healthcare cooperation in Canada. Only by fully embracing and exploiting its One Health heritage, I argue, can a country as large, diverse, and sparsely populated as Canada be fully prepared for the challenges of the new millennium.

One Health in the United States

What is today known as the One Health (OH) approach took off in the early 21^st century, when “the divide between veterinarians and doctors was seen as an obstacle to addressing the many new or re-emerging human diseases that come from animals.” ¹ It gained ground in the midst of the COVID-19 pandemic, when the risks and costs of disease spillover became self-evident. Experts have portrayed the pandemic as “a One Health issue” insofar as the virus originated in an animal reservoir and adapted to new hosts in the “absence of an efficient early warning system and early collaboration between stakeholders.” ² Given that more than 75% of emerging infectious diseases are zoonotic in origin, moreover, the payoffs to a One Health approach are likely to grow in the future.

Furthermore, the advantages to cross-disciplinary collaboration go beyond the surveillance and control of zoonotic diseases. They extend to the prevention of biological invasions that threaten water and forest health; the pursuit of efficiencies by co-locating research and training facilities; the prospects for Research and Development (R&D) at the interspecies boundary; the performance and monitoring of cross-species tissue or organ transplants, or “xenotransplants,” which raise the prospect of their own zoonotic spillovers; and the simultaneous protection of humans, non-human animals, and their environments. ³

Over the course of the past half-decade, therefore, the United States government has taken deliberate steps to embrace a One Health perspective. Multiple federal agencies joined forces to sponsor a One Health Zoonotic Disease Prioritization Workshop in 2017. The Centers for Disease Control (CDC) followed up by creating a One Health-Federal Interagency Network designed to bring “public health, animal health, and environment officials from more than 20 federal agencies” together on a regular basis. ⁴ Congress devoted millions of dollars to veterinary medicine in the COVID-19 relief bill, and the 2023 federal budget stipulated the development of a national “One Health Framework.” ⁵

Efforts to promote One Health in the United States have been backed by the American Veterinary Medical Association (AVMA) and the Congressional Veterinary Caucus and bolstered by complementary efforts to lure veterinarians into public service and rural practice with the promise of student loan relief. Insofar as they’re both generalists by training and orientation and less likely to worry about threats to their prestige and authority than higher-status physicians, veterinarians are likely to form the backbone of the One Health movement.^6,7,8 OH stalwarts therefore take comfort in the fact that the supply of veterinarians is expanding rapidly in the United States, due in part to the construction of new veterinary schools and expanded class sizes. ⁹ The result, they believe, is a potentially virtuous circle between a growing veterinary profession and a more powerful One Health campaign.

What are the likely consequences? Experts have already identified both the performance gains that derive from “collaboration between human and veterinary healthcare professionals” and the efficiencies that derive from their joint training and education, especially in small and/or sparsely populated territories. ⁶ While medical doctors have been treated as a caste apart since the Industrial Revolution, when human and non-human medicine diverged into distinct disciplines, they tend to be undersupplied in periods (and regions) of high demand, oversupplied in periods (and regions) of low demand, costly, and inflexible. ¹⁰ Canada’s problems in this regard are legion. Insofar as veterinarians hold “translatable clinical skills,” and are willing to undergo additional training, they could not only contribute to the fight against zoonotic disease—in both the field and the laboratory—but provide a flexible adjutant labour force in remote areas and/or times of duress.^{11, 12}

In fact, the veterinarians who champion the One Health approach are “versatile professionals with a wide array of skills” who are “accustomed to adjusting their assessment and treatment of patients based on species, size, and unique behavioural characteristics. ¹¹ Veterinarians administered COVID vaccines and tested samples in their laboratories during the recent pandemic, for instance, and have long been portrayed as potential backstops to physicians in the event of large-scale disasters that tax the existing medical infrastructure. ¹² Redundancies between veterinary and medical curricula have at times been exploited by cost-conscious students and administrators in the absence of crisis, and cross-disciplinary collaboration is likely to prove particularly rewarding in sparsely populated environments—where infrastructure and professionals of all types tend to be undersupplied in the best of times.^{13,14, 15}

One Health in Canada

Cross-disciplinary collaboration apparently made sense to physicians and veterinarians in late 19^th century Montreal. After all, the founder of the Montreal Veterinary College (MVC), Duncan McEachran, collaborated with medical doctors in their efforts to fight infectious disease and maintain public health. ¹⁶ His associate William Osler agreed that physicians and veterinarians should be cross-trained, and took great pride in his positions at both the Montreal Veterinary Medical Association and the Veterinary College itself, before departing Canada and going on to co-found the medical school at Johns Hopkins University.^{17,18,19, 20} Their successor, T. Wesley Mills, declared the boundaries between animal and human medicine obsolete. ²¹ Veterinary students at MVC therefore took classes, carried out laboratory work, and participated in post-mortem examinations with medical students at McGill University and were even eligible to become physicians with an extra year of study.^{16,22,14, 23} Post-Confederation Canada can thus claim to have pioneered the One Health approach to human, animal, and environmental well-being.

Nevertheless, McGill closed its Faculty of Comparative Medicine and Veterinary Science in 1903, when university-affiliated veterinary schools ran into trouble on both sides of the border, and Canadian One Health is still paying a price.^14,24 While there have several grassroots initiatives and episodes of cross-disciplinary collaboration in the provinces, “there is no obvious government entity responsible for coordinating or supporting One Health in Canada.” ²⁵ Nor is there a national framework like the one being developed in the United States and, insofar as animal scientists are indispensable practitioners and proponents of the One Health approach, the movement suffers from Canada’s profound shortage of veterinarians and lack of student loan relief. While Saskatchewan forgives the loans of veterinarians who agree to serve in rural areas, up to a point, neither the federal nor provincial governments beyond Regina have followed suit, and at least some key stakeholders have expressed doubts about the efficacy of loan forgiveness programs given the complexity of career decision-making and location choice in Canada.

Lurking in the background, however, is a distal cause of both the lack of a national One Health framework and the underinvestment in veterinary education: Where the AVMA is a powerful voice for veterinarians in the United States, and has been at the forefront of efforts to reignite cross-disciplinary collaboration in that country, the Canadian Veterinary Medicine Association (CVMA) is relatively weak for two reasons: First, the AVMA—formerly known as the “United States Veterinary Medical Association”—claims to represent all North American veterinarians, and has traditionally drawn members and resources away from the CVMA.^{26,27, 28} Second, Canadian veterinary regulations are largely determined at the provincial level, and many veterinarians are more involved in their provincial associations than the CVMA. ²⁹ Canadian veterinarians thus find themselves in a negative feedback loop of underrepresentation and underinvestment.

A final impediment to the consolidation of a One Health framework in Canada lies in the locations of the veterinary schools themselves. A substantial body of literature suggests that veterinary colleges are more likely to devote resources to R&D, in general, and to One Health initiatives, in particular, when they’re co-located with medical schools.^30,31,32 Of the 38 accredited veterinary schools in North America, for instance, approximately 75% have been identified “as actively working to further One Health” by the One Health Commission, a non-profit based in Washington. ³³ The aggregate figures nonetheless obscure a key distinction: almost 95% of the schools that are located in a city that also houses a medical school are working to promote One Health; less than two-thirds of the schools that aren’t co-located make the list; and only 2 of the 5 Canadian veterinary schools are co-located with medical schools. Where the United States anticipates a positive feedback loop of veterinary growth and transdisciplinary collaboration, therefore, Canada runs the risk of a negative feedback loop of disciplinary decline—or, at a minimum, misses out on opportunities for transdisciplinary collaboration.

The costs are likely to be enormous. After all, Canada boasts more food animals per capita than the United States and many more dogs. ³⁴ It’s no less—and arguably more—vulnerable to infectious disease. ²⁵ Finally, all 13 provinces and territories have been racked by fires and floods that speak to the interdependence of animal, human, and environmental health.^35,36

Furthermore, Canada is much smaller and less densely populated than the United States. In fact, it’s one of the least densely populated countries in the world, and the One Health approach is particularly salient in small countries that are likely to have trouble “combining training with treatment at scale” and low-density environments where high costs, low demand, and limited infrastructure impede the provision of human and animal health services. ³⁷ “In resource-limited settings where critical infrastructure and transport systems are lacking,” explain Catherine Machalaba and her colleagues, “personnel, programs and resources in animal and environmental sectors can potentially be leveraged for health research, implementation activities, and surge capacity during emergencies” like the COVID-19 pandemic, when veterinarians diagnosed and vaccinated humans among other things. ³⁸

Policy recommendations

Canada, in short, is stuck in a negative feedback loop. In the absence of a powerful community of veterinarians, it’s unlikely to fully embrace transdisciplinary collaboration; and in the absence of transdisciplinary collaboration, it’s unlikely to develop a powerful community of veterinarians. Furthermore, the impediments to collaboration are, if anything, reinforced by jurisdictional federalism, which not only inhibits policy coordination but fragments the very interest groups and stakeholders who might otherwise pressure the government to act. In the absence of a simple solution, however, medical doctors could explore the One Health approach and the federal and provincial governments could pursue several initiatives with an eye toward building a community of OH stakeholders in—and beyond—the country’s universities.

First, the federal government could appoint a One Health working group to be co-chaired by one federal and one provincial representative, like the Working Group on Adaptation and Climate Resilience established by Environment and Climate Change Canada. ³⁹ The group would be responsible for the development of a national One Health framework akin to the one developed in the United States but tailored to the Canadian context. While the diffuse interests at stake in Canada would pose a challenge to the development of consensus, they could be rendered tractable by the very flexibility and capaciousness of the One Health concept. In the prairie provinces, for instance, One Health might be interpreted through the lens of agricultural interests and livestock producers. In Ontario and Quebec, by contrast, human health might get priority. On the coasts, transdisciplinary collaboration might be oriented more toward environmental protection. The point is not to defend these specific examples, however; it’s to note that One Health is neither narrow in orientation nor a zero-sum game. When designed and administered by forward-looking professionals and politicians, it can redound to everyone’s benefit.

Second, and depending on the recommendations of the working group, the federal government might allocate matching or block grants designed to let different provinces put their own One Health initiatives into effect. In theory, grants could be conditioned on the development of different types of initiatives within the broad One Health framework: disease surveillance and control on farms or in communities; education and human resource development in schools and universities; research and development in firms and laboratories; and/or environmental protection where possible, to name a few. By letting different provinces develop different frameworks, Ottawa would encourage experimentation and adaptation in the best federal tradition.

And, finally, the government could try to combat the persistent shortage of veterinarians by enacting student loan forgiveness, underwritten with federal resources, and developing at least one new school veterinary school, in the medium run. ⁴⁰ Where might Canada build a new veterinary school? Ole Nielsen and his colleagues have emphasized the importance of both a bilingual location and the presence of nearby faculties in medicine, public health, and related fields that would allow for “the development of competence in One Health and policy,” and in that respect Ottawa seems ideal. ⁴¹

In late 19^th century Montreal, according to the former Dean of the Cornell University College of Veterinary Medicine, “novel strategic thinking about the health sciences was more prevalent than today.” ¹⁴ Physicians and veterinarians joined forces to prevent and treat disease, train human resources, and carry out research as a matter of course. If their efforts had become the global norm, instead of being derailed, the theoretical and applied health and environmental sciences would in all likelihood be further along than they are today, but it is not too late to learn their lessons, and in the new era of infectious disease, climate change, and accelerating demand for healthcare, we may have no choice.