Note: There have been quite a few thoughtful comments posted in response to the first half of this discussion, and although many of my replies spring from the interview below I will continue the exchange on the previous page to maintain its flow.

A little more than 150 years ago cellular pathologist and anthropologist Rudolf Ludwig Karl Virchow coined the term zoonosis.  Today, his assertion that “between animal and human medicine, there is no dividing line—nor should there be,” is a favorite quotation of One Health proponents.  With ideas of One Medicine targeting avenues of biosecurity as paths to implementation it appears high time for anthropology and One Health to reencounter and reassess each other.

While Dr. Laura Kahn notes in the interview to follow that most of the biosecurity applications of One Health have not been taken up by the security community at large, it is worth mentioning that the Deputy Assistant Secretary of Health Affairs at Homeland Security (under Bush at least, I can’t ascertain if this has changed under Obama), who is the head of the entire WMD & Biodefense wing, is a DVM (and not an MD) and has participated in One Medicine events.

I have divided the interview into four parts, added a little blurb on points of interest, and swung the bio-sketch down from the beginning to the end so the most relevant aspects are on top.

Contents
Of Biosensors and Sentinels- NNDSS and veterinary discrimination—potential models of animal sentinels— human valuations of animals and their utility in critter surveillance

Species of Flourishing and Animalia Biosecurity- Getting past animals as a tool for human health—how One Medicine is also grappling with Haraway’s question of “Which historically situated practices of multispecies living and dying should flourish?”

Natural Analogies and All Hazards Preparedness- How actually preparing for the risk depicted in powers law is tugged at by that of the bell curve and siphoned into cross cutting infrastructure.

Biographical Sketch – How institutions geared towards understanding and mitigating nuclear risks come to incorporate biological risks: more happenstance than strategy it seems.

THE TRANSCRIPT

Of Biosensors and Sentinels
NS: I am specifically interested in animals as biosensors, particularly the work of Tracey McNamara [Chapter 16], Peter Rabinowitz, and yourself.

LK: Have you read about the anthrax in Sverdlovsk? The animals were exposed to much lower doses of anthrax and they were dying.

NS: Yes, not too extensively though. I was wondering if you speak about how McNamara’s system functioned [which has ceased to be funded] and how ideally, One Health animal surveillance would function.

LK: Well, Tracey McNamara had set up this zoonotic surveillance system. They had gotten some funding from the CDC. [“This national zoo surveillance network detected positive West Nile virus cases several weeks before public health departments in three out of the four years of testing” wrote Kahn elsewhere].

We classify animals according to who owns them. It is either companion animals, if individuals own them, livestock if farmers own them, and then exotic animals when the zoos own them, or wild animals when nobody owns them.  When crows and other wild birds were dying nobody was really paying attention to them. A few people would bring the crows into a veterinarian. But they didn’t know what to do with them. They sent them to the state lab that didn’t have the facilities to adequately examine them.

It was the zoo birds that really where the key. The zoos could serve as a very important surveillance system for us. There are all of these animals that are outside. They get incredible attention, close supervision, expert veterinary care. If any thing goes wrong they get necropsied.

These are valuable animals.

For the most part people just ignore a dying animal. For example, during the monkey pox outbreak exotic pets such as prairie dogs in a large distribution center began dying. Nobody paid any attention to them. It wasn’t until humans started getting sick down the road … then they came back and said, “oh yeah, the prairie dogs have been dying.” But the animals had just been discarded, I mean maybe a couple were looked at but mostly discarded.

So we are very human centric. We are human. But when the animals start dying we don’t pay attention.

NS: How would animal sentinels be ideally deployed? Would it be a monitoring of solely zoos but on a larger scale?

LK: Right, well you could envision a couple different scenarios. You could have a national zoo, or even global zoo surveillance network, where the zoos are all sharing their data and sending them to a repository.

There have been some zoo animals that have gotten tuberculosis from humans. It goes back and forth. It is not just a one-way street. So that is one scenario. There is wildlife monitoring. It would take money and personnel to go and monitor them. And we see a little bit of that with the ArboNET surveillance, with the West Nile virus monitoring, where they’re monitoring birds and other animals. The animal positives usually predate the human cases. You can see the virus moving across the country with that surveillance system.

So there is monitoring of wildlife. There is monitoring of zoo animals. Pets also serve as important sentinels. There have been examples where pets would get lead posing before the owners would.  There is an example of mercury poisoning in animals that served as the key to uncovering mercury poising in Japan, the Minamata mercury case. I don’t know if you are familiar with that? [NS shakes his head] Factories were dumping toxic waste into a bay and people were getting sick, cats were getting sick as well, but people were not really paying attention to them. They brought some outside cats in and they started getting sick. So they served as an indicator that this was an environmental contamination. So there are many ways we can use animals as sensors. The canary in the coalmine is a classic example of this, where you bring in a canary, which is very sensitive to even low levels of carbon monoxide. It would fall off its perch, you would look in the cage and the bird is lying there dead, that is a great indicator to get out. So this isn’t a new concept.

[Recommended Soundtrack:  The Police-Canary in a Coalmine]

NS: Are veterinarians hooked into the National Notifiable Disease Surveillance System? Can they sound the alarm or is that the exact problem that McNamara was having?

LK: Well that is one of the problems. Public health is set up primarily to do surveillance of humans. There is no CDC for animals, and that is part of the problem. There is no Morbidity and Mortality Weekly Report for animals. And part of the problem is farmers don’t want it for there livestock. Its proprietary information: they don’t want people knowing that their livestock is sick; it’s their livelihood. There is a great disincentive for them to participate in this.

But there is not disincentive for the zookeepers, they should be happy to participate. It’s not a competition between the zoos. But from talking with some of the zoo people, it appears that they are protective of their data and not necessarily willing to share, so that will have to be overcome.

NS: What you were saying about agricultural animal health, livestock health, links into Nicholas Kristof’s Op-Ed the other day about animal health and MRSA. Did you see that?

LK: Yeah, my One Health colleagues Bruce Kaplan, Tom Monath, Jack Woodall, and I wrote a letter to the editor that was published.

NS: (laughs) Oh. I guess you did see it.

In response to the threat of novel pathogens, or less readily apparent epidemics, in human medicine they have developed the technique of syndromic surveillance to monitor the illness related behaviors of populations at large, and not using physicians as the gatekeepers of notification.

LK: Yeah, and than has not been that effective.

NS: Is an adaptation of syndromic surveillance at all on the agenda for potential animal surveillance techniques, for much of the bird migration tracking is analyzing aggregate flock data?

LK: The problem with syndromic surveillance is that you are so inundated with data it is very hard to pick up a signal in the mass of data that you collect from that. As far as I know syndromic surveillance just can’t hold a candle to an astute clinician, physician or veterinarian, who sees something strange and reports it. It is far more effective than doing surveillance of anti-diarrheal medication. Google has been doing surveillance of people doing searches on flu. And yeah, maybe that will give you an increase, but someone who is self diagnosing isn’t necessarily going to be accurate at to what they have.

With animals, they can’t tell you what their symptoms are, you can look at them and see what kinds signs they have. Animals don’t have symptoms, they have signs.

NS: In thinking about McNamara’s surveillance system I was wondering if you could maybe talk about why this hasn’t been taken up by the national security agencies as a technique for disease surveillance. Why is so much money being spent on syndromic surveillance systems and on the BioWatch program with $100,000 being spent on each autonomous pathogen detector and the scores of detectors needed in an urban area to make a reasonable detection grid. Why has One Health “languished” in this application?

LK: We are, for some reason, much more inclined to spend money on the magic bullet, on the next gizmo, than on something that is simple and relatively cost effective. People like spending money on building something tangible rather than reconceptualizing something we already have or investing in say someone’s salary. That’s not as exciting.
Syndromic surveillance has captured policy makers’ attention more than One Health.

We have “specieism”, we prefer to spend money on humans than on animals. Animals don’t vote.

NS: This sounds similar to McNamara’s talk on stopping using taxpayers as sentinels.

LK: It’s a beautiful line but its true. We use taxpayers as sentinels, basically. And I see a problem with that. It is much better to prevent disease in taxpayers, and monitor something beforehand but we don’t seem to think that way. That is the challenge of trying to change the mindset. It is hard. It is very hard and frustrating.

Species of Flourishing and Animalia Biosecurity

NS: This leads very well in to the next question. In your article on the ‘contiguous cull’ model of foot-and-mouth quelling you mention the wrestling of ethical and mathematical ideals for thwarting the spread of the virus, but you understandably steer clear of editorializing in your column. What I am wondering is what is the relationship between ethical engagements with animals and biosecurity?

LK: Well now you are starting to go into this whole murky realm of animal rights.

NS: Well it doesn’t have to be exactly animal rights, but what I am trying to get at is that in the One Health movement there seems to be a jockeying between animals as tools for human health and the idea that health is created from synergistic relationships between animals and humans.

LK: You have to walk a fine line. It’s hard because we certainly advocate for improving animal health, not just using animals as tools to improve human health, for that has been the traditional model. Particularly in research, biomedical research, where we genetically engineer rodents to mimic humans as closely as possible— that has been the direction that biomedical research as taken as opposed to trying to help animals that naturally develop diseases themselves. For example dogs get cancers and autoimmune diseases similar to humans. Its quite striking how many diseases animals get that are similar to human diseases.  But we don’t do clinical trials on dogs to improve their cancer treatments.

NS: There are not clinical trials for dogs, and why not?

LK: There is some. There is fascinating research going on developing a vaccine for dogs against melanoma that could potentially have some use for humans.  So this research could have the potential to benefit both species.

I don’t see that as an ethical problem. We are not doing anything to the animals, but rather, we are trying to treat their diseases.   In terms of monitoring animals in the environment, or pets, they are being monitored for their benefit and our own.

I don’t want to use the phrase ‘to kill two birds with one stone’ but we are trying to take advantage of the situation, whereas at this point we are not. So that is the whole ethical part of it, we are not using animals for only our needs but it would hopefully have mutual benefits for all species including ours.

It is a question of how do we live with the microbes? We need to live better with them. And we need to recognize the ecological context in which they exist.

Natural Analogies and All Hazards Preparedness

NS: In your article on animal biosensors you employ a meteorological analogy to describe the contemporary pathogenic landscape:
“Just as hurricanes are a part of life on this planet, so are infectious disease epidemics. We need to develop “biological” satellites that would identify epidemics at their earliest possible stages in order to prepare and warn populations.”
What do you think are the consequences of using a “natural” metaphor like hurricanes for the occurrence of all epidemics or the word terrorism in talking about non-intentional outbreaks such as in your piece on “Children: The bioterrorists we love”? Do you feel that maybe in not distinguishing between intentional terrorism and epidemics that arise without intent, human intent, is there a naturalization of terrorism, as terrorism becomes just part of this landscape where hurricanes happen so does terrorism. And simultaneously by putting them in the same stew are animals somehow vilified as terrorists in an un-parsed domain?

LK: Well you can’t accuse animals as being intentional terrorists… that’s a really tough question. We have harped on it so much now in the last decade at least. Terrorism. It has sort of become a new buzzword, for better or worse. Public health has been starved of funding for decades, and I guess we kind of have to jump on the bandwagon. Again as I said before we like to fund projects that build something. We also tend to like to fund things that are geared against manmade threats rather than natural occurring threats. For some reason we are much more concerned about an epidemic initiated by a human rather than one initiated by Mother Nature.

I don’t know why that is, because the naturally occurring epidemics are just as scary and can be just as devastating as something set by a human, but yet all of our energy is focused on the human side, the human element of terrorism. Mother Nature is our greatest bioterrorist. We use terrorism as this mantra of human induced disease.
So I think people have been taking advantage of that in order to get funding for basic public health, although many of the mandates stipulated by bioterrorism funding have to be focused just on these diseases. It’s ridiculous, a microbe is a microbe.

NS: The phrase ‘jumping on the bandwagon’ reminds me of the wording of the AMA resolution that was passed in regards to One Health, and that bioterrorism was in the first sentence. So One Health is largely using bioterrorism as a technique for raising awareness for an issue that has so many more cross-cutting effects.

LK: Yes. That’s the bottom line.

Biographical Sketch

NS: Could you briefly sketch out your entrance to the field of biosecurity, particularly in reference to its overlaps with One Medicine?

LK: My career has a long circuitous route.  Well, I’m originally a nurse, but I eventually pursued a medical career.  Yet, my interest was always public health, primary care prevention, with an interest in infectious disease. But when I trained [as an MD] it was at the peak of the AIDS epidemic in New York City. It was pretty traumatic just standing by helplessly watching one person die after another. You really couldn’t offer much.  There were no anti-retroviral drugs available at that time. I always wondered what it was like for the plague doctors, back during the 14th century Black Death, what would that experience have been like? I probably got an inkling of that. It was pretty scary helplessly watching people die. It was horrible.
So I already had an inclination toward public health with an interest in prevention. And I went into general medicine and public health with the goal to go into academic general medicine. This was just as managed care was coming into the form— there were no jobs. So I went more into public health then general medicine. I spend a year in the FDA followed by three years at the NJ dept of Health and Senior Services. The leadership there was lacking, so I decided to get a masters in public policy here [at Princeton].

This was in 2001, in the fall, when we had September 11th and then followed by the anthrax attacks. For the anthrax attacks this was like ground zero because the letters were mailed here. It was just a shocking experience, how could this be happening? It was a really weird surreal time when we were under attack!

I realized that the issue of bioterrorism needed to be addressed.

In the spring of 2002, I took Frank von Hippel’s course, “Prevention against Weapons of Mass Destruction.” Von Hippel is a physicist working on nuclear disarmaments issues although he did bring in a few lecturers on biological issues. I thought the course was really interesting and when it was over, I went to him and said, “you know you really need to have someone work on biological issues.” And he said “well okay, write your proposal and join my group.”

So that’s what I did. I joined this group [Science & Global security].   Right now, I’m the only biological person here, everyone else are physicists, so I’m kind of the odd man out. Chris Chyba, who is the new director, also works on biological issues even though he is a physicist but our work hasn’t really overlapped too much. We have had a couple of post docs who had just completed their doctorates in molecular biology come through. My interests are in public health leadership, preparedness, and prevention of bioterrorism.

I didn’t go into biosecurity with this concept of One Health at all. But what struck me was the West Nile virus outbreak in 1999.  The New York City West Nile outbreak was a real bellwether event to me because there were two simultaneous outbreaks going on at once, one in animals and one in humans. And there was no coordination, collaboration, or communication between them. An astute veterinarian at the Bronx Zoo, Dr. Tracey McNamara, recognized that the outbreak was due to a novel virus. Well, no one wanted to talk to her because she was a veterinarian. She contacted the CDC, they said, ‘we don’t deal with animal diseases.’

I was interested in studying leadership, public health, and agriculture preparedness, so I did a two-year study sponsored by the Josiah Macy, Jr. Foundation. I included Departments of Health and Agriculture because of the West Nile virus outbreak.  I surveyed public health officials, physicians, and veterinarians. … There had been some speculation that the West Nile virus outbreak could have been a bioterrorist attack. There was no evidence of that, but it could have been.

The key role of animal health and veterinary medicine was very much on my mind. In my survey, I asked physicians and veterinarians about communication and collaboration between them.  Since I had a very small physician response and a good veterinarian response, I couldn’t make any strong conclusions. However, many of the veterinarians indicated that they were eager to work with physicians but the feeling was not reciprocal. The physicians were not interested in working with the veterinarians. And the whole infrastructure was not set up for these different realms to work together.

One of the veterinarians who was one of my survey responders started sending me veterinarian medical literature on bioterrorism.  I had never read veterinarian medical literature before – its out of my area of expertise.

When I started reading what she sent me, it was like a hammer hitting me over the head. There is a tremendous overlap between medicine and veterinary medicine and the agents of bioterrorism. Many of them infect across species: they are zoonotic diseases. That was a  revelation to me. When you read medical literature, as opposed to the veterinary medical literature, you don’t see the connection. There was no mention of this cross species nature. It was very obvious to the veterinarian community but not at all to the medical community. The medical community has real blinders on and overtime they have become increasingly reductionistic to the point that they just focus on one organ. There are advantages to that but there are significant disadvantages to that when you try to think broadly to meet societal needs.

NS: Is this program here at Princeton (The Science and Global Security program) affiliated with the Bulletin [of the Atomic Scientists]? If not, how did you end up writing for them and have they always had a biological component?

A: Frank von Hipple happens to know a lot of people in the security community. He knew Kennette Benedict who is the Executive Director of the Bulletin. She had been, I believe, with the MacArthur Foundation and then moved to work at the Bulletin. She was interested in how the Bulletin could become more relevant or expand its scope, and I remember distinctly going to a meeting and saying, ‘I have absolutely nothing to offer you because I am dealing with biological issues and you are dealing with nuclear issues.’ These are different realms. But the Bulletin was interested in expanding the scope of its mission. They had published a piece on the need to do surveillance of humans, and I had written a letter in response to that saying that you really need to do surveillance of animals because once it gets to humans its late.
In response, they asked me write a piece called ‘The Zoonotic Connection’ in their Turn Back the Clock section.

About two years ago, they wanted a bigger online presence and asked people to write columns for them. And I guess they liked my ‘Zoonnotic Connections’ piece because they asked me to be a columnist. I was honored by that and thrilled to be given the opportunity to write what was on my mind online.