Role of the Veterinarians and One Health in the Fight Against Zoonoses
PRERIT KUMAR SINGH *, R.P.DIWAKAR1
Present Address- pratap clinic of veterinary and veterinary medicine court road mainpuri (U.P.) Pin No.-205001
*Corresponding author M.V.Sc Scholar/incharge of pratap clinic of veterinary and veterinary medicine,mainpuri.
1Assistant Prof. Department of Veterinary Microbiology COVAS, Kumarganj Faizabad(U.P.)
Veterinarians play an essential role in the animal-based food chain. They are professionally responsible for the health of farm animals to secure food safety and public health. In the last decades, food scandals and zoonotic disease outbreaks have shown how much animal and human health are entangled. Therefore, the concept of One Health is broadly promoted within veterinary medicine. The profession embraces this idea that the health of humans, animals and the environment is inextricably linked and supports the related call for transdisciplinary collaboration. Especially in zoonotic disease control, the benefits of the cooperation between veterinarians and human doctors seem evident. However, applying a One Health approach also makes moral problems explicit. For instance, how should veterinarians deal with situations in which measures to protect public health negatively affect animal health? This creates a conflict of professional responsibilities. To deal with such moral problems and to strengthen the veterinarian’s position, the starting point is a holistic perspective on One Health. We will argue for an ‘encapsulated health’ argument: the best way to safeguard human health is to promote the health of animals and the environment. This also holds for the responsibility of the veterinary profession: to serve public health, the central responsibility of veterinarians should be to be experts in animal health and welfare.
INTRODUCTION
ONE HEALTH
One health is a concept that was officially adopted by international organizations and scholarly bodies in 1984. It is the notion of combining human, animal, and environmental components to address global health challenges that have an ecological interconnectedness.One Health is an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment. One Health is not new, but it has become more important in recent years. This is because many factors have changed interactions between people, animals, plants, and our environment. Human populations are growing and expanding into new geographic areas. As a result, more people live in close contact with wild and domestic animals, both livestock and pets. Animals play an important role in our lives, whether for food, fiber, livelihoods, travel, sport, education, or companionship. Close contact with animals and their environments provides more opportunities for diseases to pass between animals and people.The earth has experienced changes in climate and land use, such as deforestation and intensive farming practices. Disruptions in environmental conditions and habitats can provide new opportunities for diseases to pass to animals.The movement of people, animals, and animal products has increased from international travel and trade. As a result, diseases can spread quickly across borders and around the globe. Animals also share our susceptibility to some diseases and environmental hazards. Because of this, they can sometimes serve as early warning signs of potential human illness. For example, birds often die of West Nile virus before people in the same area get sick with West Nile virus infection.These changes have led to the spread of existing or known (endemic) and new or emerging zoonotic diseases, which are diseases that can spread between animals and people. Examples of zoonotic diseases include:
- Rabies
- Salmonella infection
- West Nile virus infection
- Q Fever (Coxiella burnetii)
- Anthrax
- Brucellosis
- Lyme disease
- Ringworm
- Ebola
COMMON ONE HEALTH ISSUES
One Health issues include zoonotic diseases, antimicrobial resistance, food safety and food security, vector-borne diseases, environmental contamination, and other health threats shared by people, animals, and the environment. Even the fields of chronic disease, mental health, injury, occupational health, and noncommunicable diseases can benefit from a One Health approach involving collaboration across disciplines and sectors.
ONE HEALTH APPROACH WORK
One Health is gaining recognition in the United States and globally as an effective way to fight health issues at the human-animal-environment interface, including zoonotic diseases. CDC uses a One Health approach by involving experts in human, animal, environmental health, and other relevant disciplines and sectors in monitoring and controlling public health threats and to learn about how diseases spread among people, animals, plants, and the environment. Successful public health interventions require the cooperation of human, animal, and environmental health partners. Professionals in human health (doctors, nurses, public health practitioners, epidemiologists), animal health (veterinarians, paraprofessionals, agricultural workers), environment (ecologists, wildlife experts), and other areas of expertise need to communicate, collaborate on, and coordinate activities. Other relevant players in a One Health approach could include law enforcement, policymakers, agriculture, communities, and even pet owners. No one person, organization, or sector can address issues at the animal-human-environment interface alone.
ROLE OF VETERINARIANS
The work of veterinarians is no longer restricted to curative medicine in the interest of individual animals and their owners. A modern veterinarian must also have the competence to take collective and global perspectives into account and has responsibilities to care for animal welfare and public health as well (Meijboom 2018). According to Rollin, the most fundamental question of veterinary ethics is whether a veterinarian morally owes primary allegiance towards the owner or the animal (Rollin 2006). Nowadays, veterinarians in animal food production also have to consider the interests of the food companies, retail, consumers and society. Mostly, neither veterinary legislation nor professional codes offer veterinarians much support in case of conflicting values or interests. For instance, the Dutch Animal Law states that veterinarians have a duty of care towards animals (Ministry of Agriculture, Nature and Food Quality 2011). However, how they should act when this duty of care conflicts with other responsibilities, that society imposes on veterinarians, is not clear from the legal text. In their Code of Conduct, the Federation of Veterinarians of Europe (FVE) acknowledge that on occasions, obligations may conflict with each other and therefore the veterinarian may be presented with a dilemma. In such situations, FVE indicates that it is the individual veterinarian’s responsibility to balance these obligations (Federation of Veterinarians in Europe 2009). In reality, many veterinarians are struggling with this plethora of responsibilities. In daily practice veterinarians often have to deal with situations where human and animal interests are in conflict and no easy solutions are available.
Within the profession this has opened the discussion on veterinary responsibilities and how to deal with expectations from society. In the Netherlands, for instance, an open letter of a group of veterinarians organised in “The Caring Vets” led to an intense internal debate about the role of the profession in the transition towards a more sustainable type of animal husbandry (Caring Vets 2017). The Caring Vets claim that a veterinarian’s main interest should be animal welfare. Many Dutch farm animal veterinarians do not deny the importance of animal welfare, but consider themselves to be also responsible for food safety, public health and increasing the economic profit of farmers. The tendency towards a stronger emphasis on the veterinary responsibility for animal welfare is also reflected by a position paper of the British Veterinary Association (BVA), in which the authors argue that neither emotions nor economic factors may trump animal welfare considerations (British Veterinary Association 2016). For instance, when a dog owner has emotional problems to euthanize his/her companion who is suffering an incurable disease, this should not withhold a veterinarian to do what is best for the animal. If emotions of animal owners and societal expectations of the profession result in a conflict of professional responsibilities, this can be a source for moral dilemmas. The BVA argues that improving animal welfare should be the profession’s primary aim and motivation. The profession’s increased concern for animal welfare seems one of the answers to deal with the complex of societal expectations regarding veterinary responsibilities. However, if this would turn into a one-dimensional focus on either animal welfare or economics, it would do no justice to the broader spectrum of public expectations towards the veterinarian. Veterinarians are expected to promote public health and the health of the environment too. This is not only a public expectation, it is also acknowledged as a professional responsibility by the profession. It is broadly recognized that with their cross-species pathobiological expertise, veterinarians can make an essential contribution to public health.
However, to make all these veterinary responsibilities operational if concerns for health of humans, animals and nature are in conflict, is not easy. For example, in the case of antimicrobial resistance this becomes apparent when vets prescribe colistin to cure post-weaning diarrhoea (PWD) in piglets. PWD is an important economic problem in the swine industry, associated with a proliferation of enterotoxigenic E. coli bacteria in the pig intestine. Although treatment with colistin is effective, its use has also led to the development of (multi)resistant E. coli strains in swine. Moreover, in human medicine colistin is considered a ‘last resort’ therapy for certain bacterial infections. The discovery of new resistance genes, which can be easily transferred to other bacteria, has therefore raised concerns about the use in animal husbandry. However, alternative strategies to control PWD are complex, costly and depend on the competence, possibilities and willingness of farmers. For this reason, alternative strategies to control PWD are not as effective as antimicrobials (Rhouma et al. 2017). Despite the risks for public health, veterinarians therefore still treat PWD with antimicrobials like colistin to safeguard the health and welfare of piglets. Many veterinarians are aware of this dilemma but feel that, when they are not able to change the circumstances responsible for the disease, they have a strong duty to ensure the health of the piglets. Therefore, they often do not see other options on the short term than to treat the piglets with antimicrobials.
This example shows that veterinarians are constantly struggling to balance all these different professional responsibilities. Many veterinarians have great difficulty weighing all the interests in play. Without bad intent, this sometimes leads to unintended (but foreseeable) negative consequences for either public or animal health. Decisions become even more complicated when other interests join in as well. Veterinarians working in the context of the food industry, for instance, also have to deal with the economic interests of farmers and other parties in the food chain. At first glance, it seems that One Health only adds up to this complexity. The One Health framework requires veterinarians to cooperate with other health professionals to combat zoonotic diseases in order to protect public health. Within a narrow interpretation of the One Health concept this could imply that veterinarians should prevail human interests over animal health and welfare. However, we argue that these conflicts and difficulties are not the result of the One Health approach. It only makes the existing complexity explicit. In our view, the One Health concept can provide answers to mitigate these moral problems that veterinarians are facing.
ONE HEALTH AND VETERINARY ORGANIZATIONS
With its specific expertise, the veterinary profession is qualified to guide this transition towards a sustainable animal husbandry in which antimicrobial use can be minimized further. For individual veterinarians starting this process can be problematic. This is not rooted in moral indifference. For most veterinarians the main concern is the health and welfare of the animals under their care. However, the influence of farm animal veterinarians is sometimes limited because of their role as service-provider: they provide veterinary care on request of farmers. Farmers primarily expect veterinarians to do what they are consulted for. Therefore, interventions are sometimes only directed at solving disease problems in the short-term. Of course, veterinarians will advise farmers how to prevent diseases and have healthier animals in the long-term as well. However, this can be difficult because in this context veterinarians are dependent on the will and the (financial) possibilities of farmers to change circumstances for the better of their animals. Moreover, public health problems like antimicrobial resistance are of global concern and go beyond the sphere of influence of individual veterinarians. On such a scale their impact is limited. Although the commitment of individual veterinarians is essential in national reduction policies, to effectively address the issue of antimicrobial resistance on a global level a more collective approach in necessary.
Therefore, we propose to start this change at the level of professional organisations of veterinarians. They have a different position. They can translate veterinary concerns into position papers that transcend the problems on individual farms. Veterinary organisations should publicly address structural underlying causes in the food production chain that precede diseases in animals, like the transport of veal calves or growth rate in broilers. They should call on all responsible parties in the food production chain (farmers organisations, food producers, banks and retail) as well as the government and consumers to take action. By doing so, veterinary associations will support individual veterinarians in their daily work to improve animal health and welfare on the farm level. Veterinarians truly contribute to the idea of One Health if they collectively promote livestock systems that are not primarily focussed on production results and cost-reduction but on animal health and welfare.
However, not many veterinary organizations publicly address the problems of intensive animal husbandry in the name of One Health. Just like many individual farm animal veterinarians, national veterinary professional organizations seem reticent to take an explicit stand for animal health and welfare. In 2017, the World Veterinary Association (WVA) adopted the so-called declaration of Incheon that described the role of the veterinary profession in One Health and Eco Health initiatives. The WVA emphasizes the importance of policy engagement and professional leadership to address One Health issues. Moreover, the veterinary profession should “assertively advocate for and protect the welfare of all animals living in all environments. Veterinarians are educated to skilfully evaluate animal health and welfare, which are dependent upon proper housing, management, nutrition, disease prevention and treatment, responsible care and humane handling” (World Veterinary Association 2017). In relation to antimicrobial resistance, the FVE endorse the idea of ‘prevention is better than cure’ by stating that “animals that are well cared for and appropriately housed, will experience better welfare, be less prone to infections and will need fewer antimicrobials” (Federation of Veterinarians in Europe 2016). FVE acknowledges the need to improve biosecurity and hygiene in animal husbandry to reduce bacterial infections and corresponding treatments with antimicrobials. Moreover, FVE recommends to promote positive welfare steps to reduce stress and therefore susceptibility to infections. Besides productivity, farm animal breeders should incorporate breeding goals on health and longevity, including disease resistance, to decrease the need for antimicrobial treatments (Federation of Veterinarians in Europe 2016).
Despite these clear and urgent calls from international veterinary organizations, it seems that on a national level not much progress has been made. A small desktop researchFootnote 2 on websites of national veterinary organizations did not reveal publications that addressed the negative externalities of livestock production systems and the need to change for the benefit of human, animal and environmental health. Up till now, we don’t know of a successful campaign from the veterinary profession that advocates radical change of animal production systems. Currently in the Netherlands, a relatively small group of veterinarians organised in the ‘Caring Vets’ has taken a stand on several animal welfare issues like calf-cow seperation, tail docking in pigs and mega-farms (Nalon 2017). However, they focus primarily on animal welfare and leave public or environmental health out of the discussion. In Germany, a comparable veterinary organization, Tierärztliche Vereinigung für Tierschutz, mainly criticizes livestock farming because of the related animal welfare issues, like castration of piglets, animal transport and dehorning of cattle. In a recent position paper on disease surveillance the BVA acknowledges the importance of animal health and welfare for public health and trade in animal products. In line with OIE, they advocate the important role of veterinarians in monitoring diseases by acting as sentinel for wider human and animal health, underpinned by a common ‘One Health’ rationale to minimise harm (British Veterinary Association 2018). Although improvement of veterinary surveillance will certainly contribute to animal as well as public health, unfortunately in this paper the BVA did not point out the underlying reasons for many public health threats coming from intensive livestock farming. In our opinion, a missed opportunity to fundamentally apply One Health thinking. Of course occasionally individual veterinarians have spoken out for preventive population health to reduce the need for curative interference, like the prescription of antimicrobials (Davies 2017). However, on the level of national veterinary organizations there seems to be a relative silence about the need to change livestock production in the context of One Health. One of the reasons for this could be that just like veterinarians, who are financially dependent on their clients, veterinary organizations are equally dependent on their members. Without a considerable representation of the veterinary profession, veterinary organizations are often not successful in influencing policy making and contributing to public debate. Furthermore, because of differentiation and specialisation in the profession, veterinary organizations have a very diverse membership. For instance, companion animal veterinarians often have totally different views about the ethical acceptability of livestock production systems than their colleagues in farm animal medicine. This moral plurality sometimes makes it difficult to publish very pronounced statements.
CONCLUSION
To tackle zoonotic disease threats from intensive livestock farming, like antimicrobial resistance, One Health strategies are indispensable. However, the One Health concept does not yet prescribe exactly how the relation between human, animal and ecosystem health should then be shaped to fundamentally address zoonotic diseases. We argue that these health issues require a system level approach. Furthermore, it is essential to use an integrated view on health, rather than focussing solely on human health. Such a perspective forces us to address the underlying health risks of intensive livestock production instead of treating only the symptoms. Veterinarians can play an important role in this context.
In our opinion, to optimally promote One Health the primary interest of veterinarians should be: to promote animal health. We call this the ‘encapsulated health’ argument. Instead of the current curative and control focussed perspective in zoonotic disease control, veterinarians should advocate that healthy animals are an essential precondition of any type of livestock production system. If these systems are constructed to secure animal health this will eventually benefit human and environmental health. Interpreted as such, One Health offers a way out of the dichotomy between public and animal health that is at the basis of many moral dilemmas in zoonotic disease control.
REFRENCES
American Veterinary Medical Association (AVMA). 2008. One health: A new professional imperative, one health initiative task force final report. Washington, DC. https://www.avma.org/KB/Resources/Reference/Pages/One-Health94.aspx. Accessed 8 Feb 2019.
Boorse, C. 1977. Health as a theoretical concept. Philosophy of Science 44 (4): 542–573. https://doi.org/10.1086/288768.
British Veterinary Association (BVA). 2016. Animal welfare policy position. London. https://www.bva.co.uk/News-campaigns-and-policy/Policy/Ethics-and-welfare/Animal-welfare/. Accessed 28 Jan 2019.
British Veterinary Association (BVA). 2018. BVA position on veterinary scanning surveillance (animal health and disease monitoring). London. https://www.bva.co.uk/uploadedFiles/Content/News_campaigns_and_policy/Policy/Animal_disease_surveillance/BVA%20position%20on%20veterinary%20scanning%20surveillance.pdf. Accessed 28 Jan 2019.
Caring Vets. 2017. “Come in opposition veterinarians. This is not animal welfare.” Open letter in NRC newspaper. https://www.nrc.nl/nieuws/2017/06/26/kom-in-verzet-dierenarts-dit-is-geen-dierenwelzijn-11289973-a1564575. Accessed 28 Jan 2019.
Central Bureau of Statistics, PBL Netherlands Environmental Assessment Agency, and Wageningen University & Research. 2016. Development of Livestock on Farms in the Netherlands, 1980-2015. 2016. Wageningen https://www.clo.nl/indicatoren/nl2124-ontwikkeling-veestapel-op-landbouwbedrijven-.Costanza. Accessed 28 Jan 2019.
Costanza, R. 2012. Ecosystem health and ecological engineering. Ecological Engineering 45 (August): 24–29. https://doi.org/10.1016/j.ecoleng.2012.03.023.
Council on Animal Affairs. 2016. Antibiotic policy in animal husbandry. The Hague. https://english.rda.nl/publications/publications/2016/03/01/antibiotic-policy-in-animal-husbandry-effects-and-perspectives. Accessed 24 Aug 2018.
Davies, P. 2017. Balancing responsibilities when prescribing antimicrobials for farm animals. Veterinary Record 180 (15): 374–375. https://doi.org/10.1136/vr.j1708.
Degeling, C., Z. Lederman, and M. Rock. 2016. Culling and the common good: Re-evaluating harms and benefits under the one health paradigm. Public Health Ethics 9 (3): 244–254. https://doi.org/10.1093/phe/phw019.
Döring, T.F., A. Vieweger, M. Pautasso, M. Vaarst, M.R. Finckh, and M.S. Wolfe. 2015. Resilience as a universal criterion of health. Journal of the Science of Food and Agriculture 95 (3): 455–465. https://doi.org/10.1002/jsfa.6539.
Federation of Veterinarians in Europe (FVE). 2009. European veterinary code of conduct. https://www.fve.org/cms/wp-content/uploads/bro_fve_2009_final-1.pdf. Accessed 8 Feb 2019.
Federation of Veterinarians in Europe (FVE). 2016. Relationship between animal welfare and the use of antibiotics in food animals. http://www.fve.org/uploads/publications/docs/063_fve_aww_position_on_resistance_and_animal_welfare_final2.pdf. Accessed 8 Feb 2019.
Food and Veterinary Office. 2017. Final Report Prudent Use of Antimicrobials in the Netherlands. DG(SANTE) 2016–8889-MR. http://ec.europa.eu/food/audits-analysis/audit_reports/details.cfm?rep_id=3753. Accessed 28 Jan 2019.
Ge, L., N.P.R. Anten, I.D.E. van Dixhoorn, P.H. Feindt, K. Kramer, R. Leemans, M.P.M. Meuwissen, H. Spoolder, and W. Sukkel. 2016. Why we need resilience thinking to meet societal challenges in bio-based production systems. Current Opinion in Environmental Sustainability 23 (December): 17–27. https://doi.org/10.1016/j.cosust.2016.11.009.
Grave, K., J. Torren-Edo, and D. Mackay. 2010. Comparison of the sales of veterinary antibacterial agents between 10 European countries. Journal of Antimicrobial Chemotherapy 65 (9): 2037–2040. https://doi.org/10.1093/jac/dkq247.
Gunnarsson, S. 2006. The conceptualisation of health and disease in veterinary medicine. Acta Veterinaria Scandinavica 48 (1). https://doi.org/10.1186/1751-0147-48-20.
Haalboom, A.F. 2017. Negotiating Zoonoses: Dealings with infectious diseases shared by humans and livestock in the Netherlands (1898–2001). Utrecht University. https://dspace.library.uu.nl/handle/1874/354208. Accessed 8 Feb 2019.
Holling, C.S. 1973. Resilience and stability of ecological systems. Annual Review of Ecology and Systematics 4 (1): 1–23. https://doi.org/10.1146/annurev.es.04.110173.000245.
Huber, M. 2011. Health: How should we define it? British Medical Journal 343 (July): 4.
Kimman, T., M. Hoek, and M.C.M. de Jong. 2013. Assessing and controlling health risks from animal husbandry. NJAS – Wageningen Journal of Life Sciences 66 (November): 7–14. https://doi.org/10.1016/j.njas.2013.05.003.
Lerner, H., and C. Berg. 2015. The concept of health in one health and some practical implications for research and education: What is one health? Infection Ecology & Epidemiology 5 (1): 25300. https://doi.org/10.3402/iee.v5.25300.
May, S.A. 2018. Protecting society: The value of the professional regulatory model. In Professionals in food chains, 25–29. Vienna: Wageningen Academic Publishers. https://doi.org/10.3920/978-90-8686-869-8_1.
Meijboom, F.L.B. 2018. More than just a vet? Professional integrity as an answer to the ethical challenges facing veterinarians in animal food production. Food Ethics 1 (3): 209–220. https://doi.org/10.1007/s41055-017-0019-z.
Meijboom, F.L.B., and J. Nieuwland. 2018. Manifold health: The need to specify one health and the importance of cooperation in (bio)ethics. In Professionals in food chains, 266–271. Vienna: Wageningen Academic Publishers. https://doi.org/10.3920/978-90-8686-869-8_41.
Ministry of Agriculture, Nature and Food Quality. 2011. “Animal Law.” Dutch government. 2011. https://wetten.overheid.nl/BWBR0030250/2019-01-01#Hoofdstuk4_Artikel4.2. Accessed 28 Jan 2019.
Ministry of Agriculture, Nature and Food Quality. 2019. Policy documents zoonotic and animal diseases. Official website ministry of Agriculture, Nature and Food Quality. 2019. https://www.rijksoverheid.nl/onderwerpen/dierziekten/bestrijding-dierziekten/beleidsdraaiboeken-dierziekten. Accessed 28 Jan 2019.
Ministry of Agriculture, Nature and Food Quality, and Ministry of Health, Welfare and Sport. 2016. Letter to the parliament on forthcoming policy on antimicobial use in livestock. July 8, 2016. https://www.rijksoverheid.nl/documenten/kamerstukken/2016/07/08/kamerbrief-over-vervolgbeleid-antibiotica-in-de-veehouderij. Accessed 28 Jan 2019.
Nalon, E. 2017. Veterinarians speak out against systematic abuse of farm animals. June 27, 2017. https://www.linkedin.com/pulse/veterinarians-speak-up-against-systematic-abuse-farm-animals-nalon. Accessed 11 Feb 2019.
National Institute for Public Health and the Environment. 2019a. One Health: about One Health. 2019. https://onehealth.nl/over-one-health. Accessed 28 Jan 2019.
National Institute for Public Health and the Environment. 2019b. Q Fever. 2019. https://www.rivm.nl/q-koorts. Accessed 28 Jan 2019.
Netherlands Veterinary Medicine Institute. 2018. Usage of antibiotics in agricultural livestock in the Netherlands in 2017 trends and benchmarking of livestock farms and veterinarians. http://www.autoriteitdiergeneesmiddelen.nl/Userfiles/AB%20gebruik%202017/engels-def-rapportage-2017.pdf. Accessed 8 Feb 2019.
Ohl, F., and F.J. van der Staay. 2012. Animal welfare: At the Interface between science and society. The Veterinary Journal 192 (1): 13–19. https://doi.org/10.1016/j.tvjl.2011.05.019.
Pinillos, R. García, M.C. Appleby, X. Manteca, F. Scott-Park, C. Smith, and A. Velarde. 2016. One welfare – A platform for improving human and animal welfare. Veterinary Record 179 (16): 412–413. https://doi.org/10.1136/vr.i5470.
Rauw, W.M., E. Kanis, E.N. Noordhuizen-Stassen, and F.J. Grommers. 1998. Undesirable side effects of selection for high production efficiency in farm animals: A review. Livestock Production Science 56 (1): 15–33. https://doi.org/10.1016/S0301-6226(98)00147-X.
Rhouma, M., J.M. Fairbrother, F. Beaudry, and A. Letellier. 2017. Post weaning diarrhea in pigs: Risk factors and non-Colistin-based control strategies. Acta Veterinaria Scandinavica 59 (1) https://doi.org/10.1186/s13028-017-0299-7.
Roest, H.I.J., J.J.H.C. Tilburg, W. Van Der Hoek, P. Vellema, F.G. Van Zijderveld, C.H.W. Klaassen, and D. Raoult. 2011. The Q fever epidemic in the Netherlands: History, onset, response and reflection. Epidemiology and Infection 139 (01): 1–12. https://doi.org/10.1017/S0950268810002268.
Rollin, B.E. 2002. The use and abuse of Aesculapian authority in veterinary medicine. JAVMA 22 (8): 1144–1149.
Rollin, B.E. 2006. An introduction to veterinary medical ethics: Theory and cases. 2nd ed. Ames: Iowa State University Press.
Seinfeld, H., Gerber, P., Wassenaar, T., Gastel, V., Rosales, M. and De Haan C. 2006. Livestock’s long shadow. Food and Agricultural Organization of the United Nations. http://www.fao.org/docrep/010/a0701e/a0701e00.HTM. Accessed 26 Nov 2018.
Sheldon, T. 2016. Saving antibiotics for when they are really needed: The Dutch example. BMJ, August, i4192. https://doi.org/10.1136/bmj.i4192.
Speksnijder, D.C., D.A.C. Jaarsma, T.J.M. Verheij, and J.A. Wagenaar. 2015. Attitudes and perceptions of Dutch veterinarians on their role in the reduction of antimicrobial use in farm animals. Preventive Veterinary Medicine 121 (3–4): 365–373. https://doi.org/10.1016/j.prevetmed.2015.08.014.
Stephen, C., and W. Karesh. 2014. Introduction: Is one health delivering results? Revue Scientifique Et Technique (International Office of Epizootics) 33 (2): 375–379.
Tang, K.L., N.P. Caffrey, D.B. Nóbrega, S.C. Cork, P.E. Ronksley, H.W. Barkema, A.J. Polachek, et al. 2017. Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: A systematic review and meta-analysis. The Lancet Planetary Health 1 (8): e316–e327. https://doi.org/10.1016/S2542-5196(17)30141-9.
Van Dijk et al. 2010. Q-fever policy in the Netherlands 2005–2010. The Hague. http://library.wur.nl/WebQuery/edepot/156237. Accessed 19 Sep 2018.
van Herten, J., and F.L.B. Meijboom. 2018. Veterinary responsibilities within the one health framework. In Professionals in food chains, 281–286. Vienna: Wageningen Academic Publishers. https://doi.org/10.3920/978-90-8686-869-8_43.
van Herten, J., B. Bovenkerk, and M. Verweij. 2019. One health as a moral dilemma: Towards a socially responsible zoonotic disease control. Zoonoses and Public Health 66 (1): 26–34. https://doi.org/10.1111/zph.12536.
World Health Organization (WHO). 2017. WHO guidelines on use of medically important antimicrobials in food-producing animals. Geneva, Switzerland. https://apps.who.int/iris/bitstream/handle/10665/258970/9789241550130-eng.pdf;jsessionid=BB593A9387A91DA1A7326C5DCD7D2D4A?sequence=1. Accessed 28 Jan 2019.
World Veterinary Association (WVA). 2017. WVA declaration of Incheon. South Korea. http://www.worldvet.org/uploads/news/docs/wva_declaration_of_incheon_final.pdf. Accessed 29 Sep 2018.
Wright, N., F.L.B. Meijboom, and P. Sandøe. 2010. Thoughts on the ethics of preventing and controlling epizootic diseases. The Veterinary Journal 186: 127–128.
