An interdisciplinary approach to tackling coronavirusOne Health Initiative?
The prospect of infection should be more than enough to persuade us that research and training in animal health, human health and environmental health need to be much better integrated. This is the core message of the One Health Initiative. Escaping from the silos, that is its project.
Launched in the United States in 2006, its scope is global, with a powerful focus on research, education and dissemination to policy-makers and the media.
In terms of its listed supporting bodies, it remains predominantly an American venture. But recent conferences in France and Poland have raised its profile in Europe. In 2018, professional and student bodies operating at European Union level met in Paris. They considered the increasingly globalised movements of people and animals in the context of climate change – and their consequences for healthcare provision.
This was not the first voicing of One Health aspirations in Europe. The European Commission published an EU One Health Action Plan in 2017, but its prime focus was on research into anti-microbial resistance.
As for education and training, it limited its proposals to the upskilling of staff in the competent authorities, notably those responsible for monitoring all aspects of food safety. Action was to be targeted at qualified professionals, presumably in the framework of continuing professional development.
A new undergraduate curriculum?
Current European proposals are no less urgent, but significantly more radical. Taking the outcomes of the Paris and Warsaw conferences together, One Health envisages an academic landscape in which healthcare students follow interdisciplinary programmes, both clinical and non-clinical.
Cohorts from the component disciplines will study together, while teaching staff will engage in interdisciplinary mobility. Stressing that their motivation is primarily ethical, the One Health conference delegates commit to designing a One Health competence-based curriculum at undergraduate level.
How far should the integration of discrete disciplines go? In Paris in 2018, participants were drawn from medicine, dentistry and veterinary science. In Warsaw in 2019 they were joined by pharmacists. The fact that nurses and midwives did not figure suggests either the expectation of a trickle-down in curriculum content, which some in those professions will find suspect, or an initial decision to maintain a tightly focused lobby campaign. Or both.
The lobby has begun
The lobby power of these disciplines is indeed formidable, ranging from the Standing Committee of European Doctors (CPME), the Council of European Dentists (CED) and the Federation of Veterinarians of Europe (FVE) to the Pharmaceutical Group of the European Union (PGEU). These are among the European Commission’s principal interlocutors in all matters relating to the management of professional qualifications in the Internal Market.
Backed by their four related student associations, the lobby has long-term persuasive force. It may well need it.
All of the professions active in One Health in Europe have successfully developed competence-based curricula. But recognition is the key to implementation. And the proposed One Health curriculum will somehow have to be enshrined in the consolidated Directive 2005/36/EC on the recognition of professional qualifications.
The text of the directive and its Annex V make little explicit concession to interdisciplinarity. Time and the experts will decide how much tweaking is necessary. But the wheels of EU comitology turn slowly. However urgent the public health considerations, the full flowering of One Health is not just around the corner.
Unlike general care nurses and midwives, who also fall within the scope of automatic recognition, the basic training required of medical doctors, dental practitioners, veterinary surgeons and pharmacists must last at least five years. This raises the possibility of a core One Health curriculum lodged in all four training programmes, perhaps in the first year.
More ambitious would be the programmes proposing full integration over the whole five-year period. They would face daunting obstacles. Even the most comprehensive universities are unlikely to have faculties of veterinary studies. Many healthcare training programmes take place in monodisciplinary institutions, structurally and perhaps geographically distant from their potential partners.
One Health – many challenges
Can clinical and laboratory facilities be easily combined only in brand new universities? What role might e-learning play in course delivery? What clinical and other work placements will have to be re-thought in a One Health curriculum? And how will they inform and satisfy the career progression needs of the students who undertake them?
In Europe, it is possible for institutional partnerships to operate on a cross-border basis. This may be desirable both on academic and geographic grounds. Likewise, it is possible for their programmes to be accredited at European level. But One Health encompasses regulated professions with high profiles and the most demanding benchmark – patient safety. National and regional regulatory bodies will have to have their say.
Ideally, the One Health Initiative can be presented as an opportunity for the greening of the European healthcare workforce, making it more versatile and more responsive to environmental crises foreseen and to epidemiological crises unforeseen.
As there are no suggestions that it will bring economies of scale, its proponents can look forward to the hard work of building the necessary consensus for effective curriculum design, intensive lobbying and winning public support.
Howard Davies is an independent consultant in European higher education and senior adviser to the European University Association.