Chronic wasting disease (CWD) is a transmissible prion disease seen in the deer family – including mule deer, whitetail deer, elk, and moose – in countries throughout the world. The prion affects nervous system tissue in infected animals. Eventually leading to erratic behavior and certain death. Currently, there is no evidence of direct transmission of CWD to humans. However, given the biological plausibility for transmission, equity/ecological concerns, and the spirit of a “One Health” approach, I believe the medical community needs to become a stakeholder in CWD management.
While CWD has not been shown to transmit to humans, there are concerns about potential zoonotic implications. This is not the first public health concern looking at prion transmission. Bovine spongiform encephalopathy (BSE), aka mad cow disease, began receiving attention as a public health concern in the late 1990s. In this paradigm, there was evidence of prion disease crossing species and causing human variant Creutzfeldt-Jakob disease (vCJD). vCJD presents clinically as a devastating and quickly fatal dementia with some characteristic diagnostic features.
The counterargument made to me during medical school is that CWD is not a medical concern because it has not crossed the species barrier from cervids to humans and may not. A similar line of reasoning would follow that novel coronaviruses currently only seen in bats are of no concern to the medical community. Recent data showing that monkeys can be infected with the prion disease by eating infected meat brings the idea of a species barrier into question. Given the precedent set by BSE and vCJD, comprehensive research is needed to evaluate the potential for zoonotic transmission and protect public health.
Equity and ecological issues arise when evaluating the diet of indigenous subsistence hunters in the Wyoming, Washington, Alaska, Montana, and Idaho (WWAMI) region. First Nation adults living in the region derive much of their diet from the hunting of game meat. Hunting cervids allows for the preservation of traditional cultures. The spread of CWD further into the Pacific Northwest, Canada, and Alaska poses an existential threat to the way of life for First Nation people. Further, CWD has the potential to disrupt entire ecosystems by impacting cervid populations as the animals play a vital role in maintaining ecological balance through seed dispersion, vegetation consumption, and overall habitat formation. The disease may also pose a threat to biodiversity and ecosystem stability. Thus, indicating the role that institutions involved with serving these populations must play.
The CDC defines the “One Health” approach as follows:
… is a collaborative, multisectoral, and transdisciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.
The current CWD paradigm seems to be a ripe environment to explore the issue with the aforementioned approach. Local game and fish agencies are already doing an incredible job with testing and surveillance of the spread of the disease. The veterinary medicine community has provided much of the research in understanding the mechanism of disease and its spread. Instead of simply giving lip service, the medical community has the opportunity to step up and partner with these institutions to enhance understanding and foster a One Health approach.
By partnering in the spirit of One Health, the medical community can aid the current work being done to understand CWD. Involvement is crucial due to the potential zoonotic risks and the subsequent equity and ecological concerns. By engaging cervid hunters from both the State Game and Fish front and from a medical perspective, CWD-related initiatives can contribute to safeguarding public health, preserving ecosystems and traditional ways of life, and supporting the sustainable management of affected cervids.
Jackson J. McCue is a medical student.
