Spring 2021, The Oath Magazine

Oath

The

TEACH • HEAL • DISCOVER

Spring 2021

World Impact Our Role as a WHO Collaborating Center and More page 5

Malawi: Antimicrobial Resistance page 11

Helping in the Fight Against COVID-19 page 16

Meet the Class of 2024 page 21

Global Health

Building a Stronger World

FROM THE DEAN

The Good Fight

After a year like no other, we begin 2021 facing huge challenges, but with the hope that we now have a path to controlling the COVID-19 pandemic. We all understand that this is not the first pandemic that humanity has experienced, but it is by far the most devastating outbreak that our modern connected world has had to face. Our students, faculty and staff have overcome enormous challenges and done an amazing job sustaining our teaching, research and service work.

The uncertainty and anxiety have taken their toll, and the burden on clinical educators has been especially challenging.

One big milestone was graduating the class of 2020 on schedule in May, and our next target is achieving the same for the class of 2021. I really cannot thank everyone enough for their hard work, their spirit of cooperation and their dedication to sustaining our work for our students and patients.

The past year brought other overwhelming challenges, and most importantly our society had to confront the devastating and ongoing impact of systemic racism. A series of tragic and violent killings of Black people led to a broad revolt against this injustice. In our own profession and college we increasingly recognize that we must do different if we truly want to change and help create an equitable society.

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Our college community has started the hard work to make change, and we have benefitted from the inspirational leadership of Dr. Allen Cannedy and many others and especially from our students. While this past year has been marked by tragedy, we have an opportunity to create lasting change if we can commit to actions that are truly anti-racist.

This issue of The Oath focuses on the remarkable accomplishments of the CVM’s global health program. For several years now we have worked to expand our impact in this area. Many people have contributed significantly, but I want to say a special thanks to Dr. Sid Thakur, director of global health, Dr. Andy Stringer, who leads our global health education program, and to Dr. Greer Arthur, who helps organize all of our global health efforts.

There is much to read in this edition about how our global health program impacts our students, and the world. Looking to the future, the role and even the meaning of global health may see many changes in a post-pandemic world. The impact of COVID-19 demonstrated many things. First and foremost, the catastrophic spread of infection around the world proved impossible to check. Surveillance, early detection and a coordinated global response were our best hope, but we essentially failed. The impact on our world has already changed our society forever, and it is ongoing.

The importance of global health has never been more evident, and the years ahead must surely bring a renewed understanding and investment in pandemic preparedness if we are to control this outbreak and prevent the next one.

The pandemic has already demonstrated the fragility of supply chains, for everything from N-95 masks to household appliances.

This next year will see the greatest global health effort since the eradication of smallpox, as we strive to vaccinate much of our planet. I wonder what we will say about our performance and the humanity of our actions at the end of 2021. Many countries are likely to change their dependence on global supply chains in the future, “reshoring� manufacturing and services to ensure greater resilience. For emerging economies that are increasingly dependent on manufacturing exports, this could have a devastating impact, which will erode their ability to sustain population health and food security, and to be an effective part of global health alliances.

While we have a lot to learn about how the world will be changed by the pandemic, it is vital that we sustain our global engagement. It has never been more apparent that global health collaborations are essential for our future. Allowing isolationism to replace cooperation would be a disaster. No national health policy can control a global pandemic.

I hope you enjoy reading how our college is working to be a global health leader. The initiatives described in this edition of The Oath are a vital part of our work. As we look to the future we are committed to expanding our efforts and partnerships around the world.

D. Paul Lunn Dean, College of Veterinary Medicine NC State University

"While we have a lot to learn about how the world will be changed by the pandemic, it is vital that we sustain our global engagement."

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THINK AND DO

Extraordinary Leadership Paula Cray, head of the Department of Population Health and Pathobiology, received an Outstanding Global Engagement Award from NC State University. The award recognizes accomplishments in globally engaged teaching, research, student support and program development. Cray, a worldleading scientist in antimicrobial resistance research and prevention, is one of three NC State professors honored this year by the Office of Global Engagement. She was the driving force in having the CVM designated as a World Health Organization Collaborating Center on One Health and Antimicrobial Resistance.

Shivaramu Keelara, a research assistant professor in the Department of Population Health and Pathobiology, received a Young Investigator Award in Antimicrobial Resistance from the International Association for Food Protection. Antimicrobial resistance is a major research focus of the CVM’s global health program. Trained in veterinary medicine and veterinary public health, Keelara has dedicated his career to investigating the spread of antimicrobial resistance in foodborne pathogens impacting humans, animals and the environment.

Monique Pairis-Garcia, associate professor of global production animal welfare, was awarded a Veterinary Pharmacology Research Grant from the American Veterinary Medical Foundation and the Veterinary Pharmacology Research Foundation. Pairis-Garcia was recognized for her work identifying practical pharmaceutical approaches to easing castration pain on commercial animal farms. The grants support investigations into new or recently approved medications to protect food safety and fight disease in companion and food animals.

SPOTLIGHT: Greer Arthur’s title as the CVM’s global health program specialist merely hints at her true impact. Arthur plays a critical role in every facet of global health at the college, from working closely with faculty on research proposals to mentoring students both on campus and while they work abroad. “Greer always goes above and beyond and is amazing in terms of what she brings to the table,” says Sid Thakur, director of global health at the CVM and NC State. “She looks at the big picture with fresh ideas and a unique perspective that is vital to our program.”

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Top-bottom: Paula Cray, Shivaramu Keelara, Monique Pairis-Garcia and Greer Arthur 3

As a Global Virus Rages, CVM Graduate Focuses on Disease Research

2020 CVM graduate Keli Gerken conducts field research in Ethiopia while earning her certificate in global health from the college. Photo courtesy of Keli Gerken.

When Keli Gerken first entered the NC State College of Veterinary Medicine, she didn’t know much about the role veterinarians play in addressing global health challenges.

That changed quickly. Gerken, who graduated from the CVM in May, has recently begun a research project in Kenya as part of the prestigious Global Health Equity Scholars Program.

For her fellowship through the Stanford University School of Medicine, Gerken joined a research team in October to investigate the risk factors of Rift Valley fever virus (RVFV).

Gerken is the first veterinarian the research team has worked with full time.

During her training at the CVM, she studied pathogens and human behavior related to dairy animal source foods in Ethiopia while earning a certificate in global health from the CVM under the mentorship of Andy Stringer, assistant professor of veterinary global and public health.

Why were you interested in the program?

When I started veterinary school, I knew I wanted to work in global public health. This fellowship program was a perfect fit for me. During previous research in Ethiopia, I felt connected to this region of the world.

How did your time at the CVM prepare you for this

None of this would have been possible without Dr. Stringer giving me an opportunity to work with his research group in Ethiopia. I traveled to East Africa over every summer break and a winter break to see what I was learning about firsthand.

What is it about your fellowship’s research project that particularly interests you?

The project explores the specific risks of animal exposure for Rift Valley fever virus and acute infections in humans in Kenya.

Rift Valley fever is a zoonotic disease with high mortality in ruminants and can cause hemorrhagic syndromes in humans.

I want to dive deeper into what specific animal exposures contribute to the risks. Understanding this is important for those living in these areas who rely on animals to support their family, but also important for policy makers in the United States to develop plans for containment if the virus came here.

As someone who is pursuing a career in global health epidemiology, what has it been like watching the COVID-19 pandemic unfold?

In a way, it is not surprising. We always talk about how globalization contributes to the spread of infectious disease and here it is happening around us. As a junior researcher, it really is an exciting time to begin a career as more and more people discover the interconnectedness of animal, human and environmental health. — Jordan Bartel/NC State Veterinary Medicine

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EXTRAORDINARY IMPACT

The World In Our Hands

The CVM's global health program targets some of the 21st century's most pressing challenges.

Sid Thakur, director of global health at the CVM and NC State.

Photo by John Joyner/NC State Veterinary Medicine 5

Over the past 30 years, the NC State College of Veterinary Medicine has changed — and saved — countless lives. More recently, the college’s work in global health has drastically extended its reach, in everything from understanding infectious disease and tracking outbreaks to training a new generation who are redefining the role veterinarians play in an interconnected world.

Two years ago, the CVM bolstered its impact by combining its global health education and global health research programs under one dynamic umbrella. Led by director Sid Thakur, the program raises NC State’s profile in the global health realm by conducting groundbreaking international research, collaborating with peer institutions and training scientists around the world.

It’s just the beginning. Thakur talked to us about the importance of veterinarians to global health, the program’s plans for the future and why he’s optimistic that NC State can make a real difference in addressing the world’s most pressing health challenges.

In the two years since we announced our new vision of the global health program, there have been stark reminders of the importance of the world coming together to improve health. How is the college making strong impacts on global health?

Our mission statement defines our mandate — bringing everybody together to address global challenges. The college tackled many global health issues before the formal establishment of the program, but we wanted to encourage collaboration. We know how to solve global problems, and we have a tremendous amount of expertise, but we have to work together.

The result of our efforts in the past two years is clear with the multidisciplinary approach that we are taking. We’re building collaborations across the university and outside the university. Students are very enthusiastic about earning certificates in global health. It's a concerted effort.

How would you define global health in the context of veterinary medicine?

The classic definition of global health is health for all and health equity for all. And when we say health equity, we're not just focusing on human health. Our role is primarily for animal health, but animal and human health are interrelated because we also share the environment. You cannot help human health and ignore animal health.

Look at the world’s growing population —10 billion people in a couple of decades. We have to increase our current agricultural production by 70% or more to feed that ever-growing world.

We can't do that without having healthy animals. Food security is an integral aspect of what we are doing now and how we are doing it, especially in terms of controlling the pathogens that impact these animals and also humans.

We can target these issues of hunger and nutrition and animal health all together. A key aspect of that work is our students.

We are training our veterinarians to really understand these global challenges from a holistic point of view, not just by working in a clinical setting, but going to different parts of the world and gaining cultural competency. They see different cases that they will never see here in the United States. The COVID-19 pandemic has shown us how important it is to have that perspective.

What are some current projects that showcase that important role?

We are deeply involved in addressing these challenges. A new project with UNC-Chapel Hill in Malawi is focused on infectious disease and antimicrobial resistance training. We are working on food production and issues with wastewater that animals and humans get exposed to in Senegal. Those are all very important and they are also very large, complex problems to solve. There is no silver bullet.

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What is it like leading such a dynamic team?

When we tackle these global problems, we look at who has the expertise to solve them, and we don’t have to really look far.

They’re here at the CVM. The experience of Andy Stringer, assistant professor of veterinary global and public health, is exceptional, having worked for many years at a nonprofit, the Health and Livelihoods group, and chairing the Triangle Global Health Consortium. The global health education program grows stronger under his leadership every year.

Greer Arthur, our global health program specialist, acts as such a vital connection between the program and our faculty and students. We work on ideas together, and we’re also always open to ideas.

We also work closely with Associate Dean for Research and Graduate Studies Kate Meurs, who has been a strong supporter of our efforts.

What are the areas you see as us making the strongest difference so far?

Becoming a World Health Organization Collaborating Center focusing on drug resistance and one health is a big one. That has to do with the leadership shown by the head of the CVM’s Department of Population Health and Pathobiology Dr. Paula Cray. We are home to three national pathogen surveillance programs. That has been noticed by these global agencies, like WHO. Now, we are one of just 18 collaborating centers in the world working on antimicrobial resistance.

We are leading efforts across the world in terms of training for antimicrobial surveillance. Overall, we’re expanding the perception of what we do. There are faculty working across the globe — India, China, Brazil, the Galápagos Islands. There's a very clear understanding, not just within the college or at NC state but outside as well, that the CVM is emerging as a strong leader in global health.

What have been some of the other areas of focus?

The CVM has been working in the areas of antimicrobial resistance and food security for many years; they are two of our real strengths. Mathematical modeling of pathogenic transmission is another important aspect for us.

Gastrointestinal biology is very important for us, especially when considering nutrition and food security, especially in lowand middle-income countries.

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We have expanded our ability to attract world scholars for training at the CVM. Just over the last five years, we have been able to train more than 30 visiting scholars. The training aspect is so important for us because we are building this group of NC State-trained leaders.

How does the training aspect of the program elevate equity in global health?

Even though we have made so many advances across the world, there are still many countries that don't have access to technology that can really help them tackle some of these global challenges in their own countries.

What we are really doing is taking skills to the next level.

Scholars come over here, are trained and then go back to their countries and use what they’ve learned. Dr. Mabel Aworh is a good example. She came over here from Nigeria for four months and that partnership has led to two publications. A third one is about to be published, and we are on track to submit a National Institutes of Health proposal.

And then we also have our own students. We offer our own certificate in global health and there’s the master's of public health with a global health program that’s a collaboration with UNC-Chapel Hill.

Thakur, center, works with students focusing on swine health management.

There are many DVM courses with a global health focus.

What can students interested in global health expect when they come to the CVM?

"There are really

Many students come here to focus on companion animal medicine, but I’ve been here for 13 years and I've started to see students get more and more interested in public health and global health.

CVM’s global health

We have dual DVM/Ph.D. students who have done research in Sri Lanka, students who have goals to become epidemiologists with the Centers for Disease Control, who want to do public global health work through the United States military.

There are really exciting opportunities. CVM’s global health education program gives students a deep understanding of global health that leads to them coming up with new approaches to solving problems.

We see how these students after they come back from long, on-the-ground research in different countries, return with new perspectives and new passions that they may not have had when they joined our DVM program.

exciting opportunities. education program gives students a deep understanding of global health that leads to them coming up with new approaches to solving problems."

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Almaz, an Ethiopian livestock owner, feeds one of her dairy cows. Photo by Andy Stringer.

What led you to start your own global health research?

Why were you interested in it?

When I started pursuing my degree in veterinary science in India, I was exploring different areas to focus on. I wanted to be a clinician, but research was always interesting and important to me. I got into the Indian Veterinary Research Institute, and that’s where I really started to blend the concepts of veterinary and public health. Once I got into antimicrobial resistance research, I said, this is it. This is for me.

What clicked for you?

I just felt comfortable. I felt like this was something that allowed me to focus on the veterinary side, but the human side also. For me, that has been a driving force: If I can improve animal health and if I can improve human health, I want to do both.

What helps you stay positive about the future of global health? What keeps you hopeful?

We have to stay positive, especially now as we face the COVID pandemic. History has shown the power of that. We have faced so many challenges that we thought were insurmountable, but we have overcome those.

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We once had no concept of what a vaccine is, but we are still here, right? We have gone through two world wars. When I look at the CVM global program, I see a lot of positives. I think we are creating momentum. We need to keep going forward now.

That really resonates in the time we’re currently living in.

We are not the answer to all of the problems. I think in some areas we are definitely strong players, and we can take our work to the next level. But it's a struggle now. More than 385,000 people within the United States have died from COVID-19, but researchers like us are continuing to work hard to find a solution. So we have to stay positive. You have to keep fighting, but we also have to work together.

I’m assuming that optimism is carried by our students and visiting scholars as well. They wouldn’t be coming to us if they weren’t optimistic about the difference they could make.

Yes, definitely. The reason the visiting scholars come over here is that they can see the challenges their countries are facing on a daily basis. When they return, they have a step-up to start really tackling these pressing issues.

Over the next five or 10 years, what do you see as the most pressing global health issues we need to tackle?

It circles back to the strengths we have in antimicrobial resistance and food security for us. COVID is here, but antimicrobial resistance is here to stay. The projection is that by 2050 deaths caused by AMR will overtake the number caused by cancer because we don't have good solutions for it. No new drugs are out because of the resistance problem.

I think that's where a lot of our focus has to be, not just in terms of research, but collaborating with, say, the chemistry of life program at NC State that’s looking at small molecule drug discoveries to target infectious pathogens. That is one area that I think we will definitely play a major role in.

Food security goes hand in hand with that. We are doing the surveillance work, and a lot of it is focused on the animal side.

You can't solve the AMR issue by not focusing on animal health. If animals are not doing well, the availability of food to the world is impacted and so is human health.

What do you think our global health program will look like in five or 10 years? What can we offer to the world that is unlike anywhere else?

The first question a lot of people ask me is, ‘Why do you want a global program at NC State?’ Well, we have a College of Veterinary Medicine for starters. We have a College of Textiles.

We have a robust College of Engineering. There are some very unique things within NC State. So I hope in the next five, 10, 15 years, we have a program within the university where we bring everybody together and then work together as a team, not as individual departments.

Is global health work personal for you?

With my food security and AMR research, yes, absolutely. At some level it has to be personal. I’m from India. There's a lot of challenges in India including the availability of antimicrobials without a prescription. Accessibility to drugs is a problem. So yes, it is. It is personal. You have to really believe in it.

You can't just do it because there's funding available or it looks good. You have to believe in it. And the key thing is that yes, you can make a difference. If you can save one life, I think that's a job well done. ~ Jordan Bartel/NC State Veterinary Medicine

I definitely look at us being even more of a leader in training and securing more training grants. I anticipate that our research program will have more faculty who are driven by earning those grants for international work. In terms of biomedical research, that's going to be very important.

CVM Research Assistant Professor Shivaramu Keelara (front row, second from left) at the National Institute of Communicable Diseases (NICD) in Johannesburg, South Africa. Keelara facilitated a World Health Organization training course on foodborne disease surveillance and outbreak detection in October 2018.

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EXTRAORDINARY RESEARCH

In Malawi, NC State Extends its Global Reach in Antimicrobial Resistance Fight The map tells the story.

There’s America — 50 states, 330 million people. Different colors on the map indicate levels of antibiotic use in humans and animals, and the United States, like many of the other countries, is dark to indicate heavy use.

Across an ocean is Africa — 54 countries, 1.2 billion people.

On the map, most of the continent is colored gray. That doesn’t mean antibiotic use is low. It means there is no information about antibiotic use at all.

Whenever Sid Thakur is asked about disparities in the global fight against antimicrobial resistance, he remembers this one map he once saw in a research paper.

In antimicrobial resistance, it’s the unknown that’s most dangerous.

“You have these big countries where antibiotics are clearly being used without prescription or regulation, and we do not know exactly what it’s doing to humans, animals and the environment,” says Thakur, director of global health at the NC State College of Veterinary Medicine and NC State University.

“That creates these hotspots of emergence of new genes in pathogens that are not impacted by lifesaving antibiotics.”

As part of a new research collaboration, the CVM aims to fill these gaps of knowledge to help stem the rising tide of resistance to antimicrobials around the world.

Thakur is the CVM’s lead investigator of a project based in Malawi to establish effective antimicrobial resistance identification protocols, train researchers and institute effective surveillance systems in southeast Africa.

A $4.5 million grant from the United Kingdom’s Fleming Fund was recently awarded to the University of North Carolina at Chapel Hill’s Project-Malawi to establish in-country human and animal health laboratories capable of systematic AMR surveillance.

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The CVM is leading the animal sector aspect of the project, filling in the blanks about use of antimicrobials within Malawi’s growing agribusiness of private farms and public marketplaces.

Work in Malawi slated to begin earlier this year has been delayed by the COVID-19 pandemic, and the current project is funded through August 2021.

Developing such protocols are especially important in countries such as Malawi where there is often no regulation of antimicrobials and little money spent on uniform health protocols for animals and people.

UNC Project-Malawi has spent more than 20 years addressing pressing human health issues in the country that’s about the size of North Carolina but has 8 million more people. For its part of the project, the CVM is partnering with the Lilongwe University of Agriculture and Natural Resources (LUANAR/NRC) in Malawi’s capital. In the country, UNC partners include the Malawian Ministry of health and the Kamuzu Central Hospital in Lilongwe under the UNC-founded Lilongwe Medical Relief Fund Trust (LMRFT).

The project, the first of its kind in Malawi, also marks the first time UNC Project-Malawi has joined forces with the CVM on global health work.

“Antimicrobial resistance surveillance in Malawi is nonexistent; there’s one main veterinary lab in the capital,” says Irving Hoffman, a professor of infectious diseases at UNC-Chapel Hill and the United States director of UNC Project-Malawi. “It’s really starting from the bottom up to create standard operating procedures. And when there’s an animal component to a project, we go to NC State.”

The World’s Health at Stake

1,200+ total applicants

The work in Malawi reflects the CVM’s status as a leader in antimicrobial resistance surveillance and its dedication to making tangible progress as the world fights back against the looming AMR threat.

CVM members of the Malawi project. Left to right: Sid Thakur, Megan Jacob, Lyndy Harden and Shivaramu Keelara.

Photo by John Joyner/NC State Veterinary Medicine.

Thakur’s molecular epidemiology lab at the CVM is home to two national monitoring systems that recently received more funding: GenomeTrakr, which maps genetic fingerprints of pathogens and catalogs them in a sharable worldwide database, and NARMS, the National Antimicrobial Resistance Monitoring System for Enteric Bacteria, which tracks emerging bacterial resistance in retail meats, food animals and ill people in the United States.

And in the past few years, the CVM’s global health program has been at the forefront of changing the worldwide antimicrobial resistance game. Researchers from countries such as Nigeria, India, Brazil and Ukraine have come to the CVM to receive training on antimicrobial resistance surveillance, and when they’ve returned home, they’ve brought back effective approaches to integrate.

Earlier this year, the CVM’s Department of Population Health and Pathobiology, led by Paula Cray, was designated a World Health Organization collaborating center to combat antimicrobial resistance worldwide, one of 18 centers worldwide focused on AMR. In its capacity as a collaborating center and in addition to faculty and staff research, the CVM is working on using artificial intelligence to collect antimicrobial resistance data to predict areas most likely to be impacted by resistant microorganisms, often dubbed “superbugs.”

Around the world, antimicrobial-resistant strains of bacteria found in chicken and pork commonly cause foodborne illnesses.

According to the WHO, in 2016 nearly 500,000 people around the world developed multi-drug resistant forms of tuberculosis. Resistance to drugs is hampering efforts to control HIV and malaria, which UNC Project-Malawi has spent two decades combating. By 2050, it’s estimated that deaths related to antimicrobial resistance will hit 10 million, higher than the 8.2 million deaths today caused by cancer.

Part of the complexity of the problem: Resistance can occur through natural genetic changes, through exposure to certain antimicrobials and can also be spontaneous or acquired.

“What COVID-19 has shown us is that pathogens don’t respect international boundaries,” says Thakur. “And it’s the same case with AMR genes.”

A Team Effort Stopping the advance requires a strategic battle plan.

The CVM combines the broad approach of harmonized surveillance training with focused looks at specific strains impacting animals and people in countries in unique ways.

Student engagement is a long-term goal. As part of the project, Andy Stringer, assistant professor of veterinary global and public health, will develop antimicrobial stewardship in the curricula for a diploma in animal health and bachelor of veterinary medicine under LUANAR. 112

Rocio Crespo, CVM professor of poultry health management, is a member of the CVM Malawi project team because of the growth of the poultry industry in the country. In addition to writing protocols, she will train Malawians on collection of field samples, how to ship samples to labs and assist with bacterial isolation and identification.

“Completely removing antimicrobial resistance from a population is a difficult task,” says Crespo. “What’s so important is educating individuals and providing tools to better take care of the animals. We need to make sure that farmers use better management practices to prevent infectious disease rather than rely on antimicrobials or other chemicals.”

As a collaborating center, the CVM is especially interested in E. coli strains that produce extended-spectrum beta lactamase (ESBL) enzymes which provide pathogenic resistance against such common medicines as penicillin.

A paper recently published in the Journal of Clinical Microbiology with co-authors including Cray and the CVM’s Megan Jacob and Shivaramu Keelara, outlined a new protocol screening protocol for ESBL-producing E. coli to be used in a global surveillance program guided by WHO and is a template of sorts for the type of work the CVM is doing in Malawi. Cray and Keelara are also part of the CVM’s Malawi team.

“This is so much bigger than us putting out a research publication or obtaining a grant,” says Jacob,” says Jacob, associate professor of clinical microbiology and director of Diagnostic Laboratories at the CVM. “Those have value. But what we’re ultimately creating is something that people can use across the globe to contribute data where we haven’t had it before so we can all make better decisions. That’s really powerful and humbling to be associated with.”

Prior to CVM’s involving in the Malawi project, Jacob and Keelara worked closely together to develop surveillance protocols for countries that need it the most — lower-to-middle income nations without regulations guiding judicious use of antimicrobials, often without any form of surveillance or refined knowledge about how to effectively identify pathogens in a laboratory.

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Malawi is roughly the size of North Carolina but is home to 8 million more people.

The goal has been to optimize the protocols to make them cost-effective, easy to understand and uniform. Jacob and Keelara studied available equipment and indicators used to uncover AMR in samples and developed protocols that were easy to teach and researchers in countries could easily obtain.

Malawi project management and protocol development are being coordinated by Greer Arthur and Lyndy Harden.

Through various workshops, Keelara and Jacob have trained scientists from more than 20 countries, including Senegal, India, Pakistan, Nepal, Sri Lanka, Ghana and Malaysia. Those scientists then go to their country’s health ministry to start implementing the protocol and identity laboratories and sites for sample collection.

“The project will establish a baseline for future studies and each country can develop their plan of action,” says Keelara, a research assistant professor in the CVM’s Department of Population Health and Pathobiology.

“It’s not a one- or two-year project. Bacteria are intelligent. They were here before human existence. They’re fighting. They’re adjusting.

“It’s not going to just stop suddenly at one point. We need to have a constant effort in combating these issues right now.”

To Thakur, the effort not only continues with the Malawi project — it roars forward.

“We are going to get a good picture of what is going on across the world,” says Thakur. “And then we will come up with solutions.”

— Jordan Bartel, NC State Veterinary Medicine

Keelara, left and Thakur confer in Thakur's CVM lab.

Photo by John Joyner/NC State Veterinary Medicine

What is antimicrobial resistance (AMR)?

The rising tide of drug-resistant bacterial pathogens around the world is widely viewed as one of today’s biggest global health concerns. Antimicrobial-resistant strains of bacteria, including E. coli, Campylobacter and Salmonella, in chicken and pork are common sources of foodborne illness. AMR research plays a critical role in maintaining healthy food animal and human populations.

Why is AMR happening?

Bacteria, fungi, parasites and viruses have developed new resistance mechanisms and those mechanisms are spreading in increasing numbers. Resistance can occur through natural genetic changes, exposure to antimicrobials and antivirals in animals and humans. Mutations can be spontaneous or acquired. Some bacteria are particularly effective as reservoirs for antimicrobial resistance, easily acquiring it and sharing it with other organisms.

How is the CVM helping?

The college is the only place in the United States that’s home to both the National Antimicrobial Resistance Monitoring System (NARMS) and the GenomeTrakr program. Both programs track bacterial pathogens and help to halt the spread of infectious disease outbreaks caused by resistant bacteria. Both monitoring systems are overseen by Sid Thakur, director of global health at the CVM and NC State. NARMS, established in 1996 by the Food and Drug Administration, monitors resistance trends in strains isolated from humans, food animals and retail meats. GenomeTrakr, launched by the FDA in 2012, is the first network of labs to use whole genome sequencing to identify pathogens.

What is a WHO Collaborating Center?

Early in 2020, the World Health Organization designated the CVM’s Department of Population Health and Pathobiology as an official Collaborating Center on One Health and Antimicrobial Resistance. Under the direction of department head Paula Cray, the center will help WHO improve global surveillance networks, train developing nations in the best ways to identify resistant bacteria and integrate AMR data through artificial intelligence tools. The AMR Collaborating Center at NC State is one of 18 globally focused on antimicrobial resistance.

AMR and the CVM 14

Tackling Global Health With Virtual Reality A screenshot from the CVM's virtual reality global health course showing milk production in Ethiopia.

An NC State DELTA Grant is defying distance and broadening perspectives for students in the NC State College of Veterinary Medicine.

Andy Stringer, assistant professor of veterinary global and public health at the CVM, calls global food security one of the grand challenges facing society.” Stringer wants to prepare veterinary students to tackle food insecurity in the field.

“Urbanization in Africa is a major factor influencing food security. The United Nations has estimated that by 2050 approximately 70% of the world’s population will be urban,” says Stringer.

Teaching food security at NC State comes with its own set of challenges. Photographs and videos fail to accurately convey the cultural and physical context within which food is being produced and consumed across the world. Stringer applied for an Exploratory DELTA Grant in 2019 to address these obstacles through virtual reality.

VMP 991-162: Global Health Challenges is a one-week selective course at the CVM for DVM students. The course provides students with an introduction to global health issues. This includes understanding the importance of animal source foods and food safety in tackling food security challenges. Stringer sought an immersive experience that would allow students to engage with a virtual environment in Ethiopia.

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Stringer wanted to help students understand the context within which milk is produced, stored and sold in Ethiopia, the risk factors leading to unsafe milk and the criteria that define food security according to the Food and Agriculture Organization, a United Nations agency.

“Using this VR experience, students will be able to see how milk production and distribution occurs in other parts of the world, including risks. They will be able to understand the layout of communities, the interactions between people who live there and how that impacts food safety,” says Rebecca Sanchez, lead instructional designer and project lead.

Stringer played a unique and important role in capturing content. He makes several trips a year to Addis Ababa, Ethiopia, and DELTA Creative Director Mike Cuales trained Stringer in the technology before his departure to capture footage for the project.

The final product allows students to explore three different farms — two urban and one rural — and two urban dairy cooperatives, where milk is tested and sold. They can move freely throughout the virtual environment with checkpoints.

“I think that immersive technology such as virtual reality and augmented reality has a big role to play in teaching and educational initiatives now and in the future,” says Stringer.

—Lily Theresa Scharrett Fandel, DELTA

CVM Student a Behind-the-Scenes Force In Coronavirus Fight In March, Elsa Sanabria was offered a job at the North Carolina State Laboratory of Public Health. A week later, she went to work testing nasal swabs for the coronavirus, samples sent by high-risk populations such as nursing care facilities or area hospitals.

Sanabria then calls with the results. By early April, she had dialed the number of a place she knew well.

Sanabria called the Henderson County Health Department to tell them about an outbreak of COVID-19 at a nursing home in Hendersonville, N.C. She noted 23 positive results.

Sanabria’s 85-year-old grandmother had once lived at that nursing home, about a mile from where her grandmother now lives with Sanabria’s father.

“I wouldn’t say it was a difficult call for me to make. I was just more concerned,” says Sanabria, who grew up in Hendersonville. “But then I called my dad and told him you really need to be careful now.”

Infectious disease research became become part of Sanabria's life as a future veterinarian focused on public health and epidemiology. She began her fourth year at the NC State College of Veterinary Medicine in August and completed her four-month job at the laboratory in July.

Sanabria and the team tested thousands of samples early in the pandemic, and the work steadily continued through the summer. She extracted genetic material to analyze. Then she triple checked the results. Then she made the phone calls.

“I guess, in maybe a weird way, this kind of work excites me,” says Sanabria. “I don’t know if I would call it a ‘duty.’ But if you have the experience and you have the training — there’s a reason why someone taught you those things.”

After earning a biology degree from Duke University, Sanabria arrived at the CVM focusing on small animal medicine.

The class of 2021's Elsa Sanabria at work in the testing laboratory in the spring. Photo by Elsa Sanabria.

Then, through the CVM’s global health program, she went on a trip to Uganda. There, she saw veterinarians working to save critically endangered mountain gorillas and engaging with local populations, addressing issues such as poverty and access to birth control.

Soon after, Sanabria became the first student from the CVM accepted into a master’s of public health with global health emphasis program, a collaboration between the CVM and the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health.

As part of that program, she worked 200 hours in the state lab’s serology unit, looking for antibodies to brucellosis, an infectious disease spread to people from infected animals through unpasteurized dairy products or close contact with feral swine.

The lab remembered Sanabria and reached out to her when it began coronavirus testing.

Sanabria was the only DVM student conducting coronavirus testing in the lab. Her goal after graduation in 2021 is joining the Centers of Disease Control’s Epidemic Intelligence Service, a two-year postdoctoral training program.

And through this year, she spent a lot of time reading about the pandemic in newspapers. She didn’t watch a lot of TV news.

What she did was go back to work.

— Jordan Bartel, NC State Veterinary Medicine 16

EXTRAORDINARY STUDENTS

On the Frontlines of Global Health Research

A poultry market in Ethiopia. Photo by Hannah Sather.

Five new research projects from NC State College of Veterinary Medicine students address some of today’s most pressing global health challenges. They also provide substantive hope for a healthier tomorrow.

The international research, a requirement to earn a CVM certificate in global health, focuses on topics as varied as tuberculosis transmission in South Africa and a particularly pernicious equine disease in Ethiopia.

Andy Stringer, assistant professor of veterinary global and public health, leads the global health certificate program. The first certificate was awarded this year.

The 10-week projects are head-first dives into global research itself. With help from mentors, students create detailed research plans, work directly with communities and conduct extensive fieldwork. In the end, all of the projects shed light on health issues this new generation of veterinarians must tackle.

The work: Exploring the attitudes of those practicing or using traditional medicine in rural and urban environments, Balch paid particular attention to Kenyan women who use traditional methods to treat livestock and children.

Study participants included both men and women who also practice more clinical forms of medicine. Though about 75% of all rural livestock keepers are women, little is known about their specific knowledge and contributions to traditional medicine.

The research project is ongoing, and future studies may help integrate legitimate traditional medicine techniques into clinical medical systems.

Marisa Hofmeister, DVM candidate, Class of 2021 Project: Examining antimicrobial resistance in E. coli Where: Dakar, Senegal The work: Working at the experimental microbiology department at the Institut Pasteur, a CVM research partner, Hofmeister analyzed samples from humans, poultry and waste water for E. coli. Those samples will then be compared to one another and used in conjunction with data on antimicrobial usage to pinpoint risk factors antimicrobial resistance rates.

Caroline Balch, DVM candidate, Class of 2022 Project: Kenyan custodians of indigenous medicine for humans and livestock Where: Kasigau, Taita, Kenya; Ongata Rongai, Kajiado County, Kenya

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In one of many examples of AMR’s threat, resistance to medicines widely used to treat urinary tract infections is now common in E. coli. Hofmeister’s work has the potential to reveal specific AMR risk factors in Senegal and produce data that can lead to more effective surveillance systems that quickly uncover outbreaks and analyze AMR trends.

Stephanie Krasteva

Caroline Balch

Hannah Sather

Stephanie Krasteva, Class of 2021 Project: Prevalence of Mycobacterium tuberculosis complex in cattle bordering Kruger National Park Where: Bushbackridge, Mpumalanga province, South Africa; Cape Town, Western province, South Africa The work: Through blood samples, Krasteva identified cattle impacted by Mycobacterium bovis, which causes bovine tuberculosis (bTB). The blood samples from animals who tested positive will then undergo a new type of test to determine the presence of multiple conditions within the Mycobacterium tuberculosis complex, a group of related species that cause tuberculosis.

In South Africa, M. bovis poses a large threat to livestock and human health. With multiple drug-resistant TB strains impacting countries around the world, more effective testing and prevention techniques are vital. That’s fueled by research such as Krasteva’s.

Ashlan Westbrook, Class of 2021 Project: Unraveling Epizootic Lymphangitis in horses Where: Central Ethiopia The work: Westbrook and a research team developed a comprehensive project that explores how epizootic lymphangitis, an infectious disease caused by the fungus Histoplasma capsulatum var. farciminosum, or HCF, is transmitted. Epizootic lymphangitis, or EZL, primarily affects horses, donkeys and mules. HCF can cause debilitating and life-threatening symptoms.

Westbrook’s work may help outline geographic, sociodemographic and environmental factors fueling the spread of EZL. The results may help identify other transmission routes, informing future studies on disease surveillance and advancing understanding of EZL.

Hannah Sather, Class of 2022 Project: Investigation of backyard poultry health and production constraints in rural Ethiopia Where: Debre Zeit, Central Ethiopia The work: Sather explored how improving backyard poultry production also means improving childhood nutrition in Ethiopia. Sather conducted interviews at the country’s veterinary and agriculture research institutes, private veterinary pharmacies and farmer training centers in rural villages.

Food insecurity has vast consequences. Sather noted a high rate of childhood stunting in Ethiopia: 33% of those between the ages of 6 to 24 months experience impaired growth due in part to poor nutrition.

Marisa Hofmeister 18

In Memoriam: Terry Curtin, Visionary NC State Veterinary Medicine Founding Dean, 1926-2020

Terrence Curtin (second from left), the NC State College of Veterinary Medicine's first dean, flanked by (from left) the CVM's third dean and current NC State University Executive Vice Chancellor and Provost Warwick Arden; Oscar Fletcher, the college's second dean and dean emeritus; and Paul Lunn, the college's current and fourth dean.

NC State College of Veterinary Medicine founding dean Terrence Curtin, whose unwavering, sterling vision laid a strong foundation for the world-leading institution the college would become, died Dec. 15 at his home in Fuquay-Varina.

Curtin’s commitment to extraordinary quality and exceptional leadership that, to this day, remains a core value of the college, now consistently ranked as a top veterinary school in the country.

He was 94.

“We are deeply saddened to hear about the passing of Terry Curtin,” says NC State University Chancellor Randy Woodson. “His leadership and vision were integral to the College of Veterinary Medicine’s inception and have guided the college’s work for decades.

Curtin, who often went by Terry, served as dean from 1981, when the college first opened its doors, through February 1992. When the CVM was officially created in 1978, it was the culmination of a tireless effort years in the making — and Curtin was at the center of it all.

“You cannot overestimate the incredible positive influence that Dr. Terry Curtin had on this college,” says CVM Dean Paul Lunn. “He made many of the fundamental decisions that laid the foundations for the incredible success that we have enjoyed.

“A series of remarkable innovations set us on a path for success and created a truly interdisciplinary institution. We will never be able to thank him enough. It was an incredible honor to know him.”

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“I know that his legacy will continue to shape the educational experiences and compassionate care that the CVM is recognized for.”

Curtin was a practical visionary. He pushed for full state funding for the CVM from the very beginning, rather than a phased approach. He was instrumental in attracting extraordinary talent to fill faculty and administrative roles in the new college.

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Oscar Fletcher, who succeeded Curtin as CVM dean and led the college until 2004, says Curtin’s skillful work shepherding the college in its earliest days led to it quickly becoming a leader in veterinary higher education.

Curtin was a skillful diplomat, says Fletcher, able to keep the many varying interests and personalities involved with the college at its inception focused on the same goal.

“He did a really good job of getting all the necessary resources together — funding, faculty and facilities,” says Fletcher. “He deserves a lot of credit for the work he did in that initial role.”

Born June 9, 1926, Curtin grew up on a farm in South Dakota, exposing him to the challenges of raising farm animals and the critical role of veterinary medicine in agriculture. He joined the United States Army during World War II and served a tour of duty in Europe.

Following the war, he received a bachelor’s degree and a DVM from the University of Minnesota. He returned to South Dakota in 1954 and opened a veterinary practice. He earned a master’s degree and then a Ph.D. from Purdue University in 1964 and then joined the Purdue faculty.

He was a professor and chairman of veterinary physiology and pharmacology at the University of Missouri in 1973 when he was recruited by NC State University to launch the nascent veterinary science department in the thennamed School of Agriculture and Life Sciences.

By the time of his arrival, sentiment had steadily grown in favor of developing a separate college of veterinary medicine in North Carolina, but the path was challenging.

It went through some growing pains as a department within SALS, which later became the NC State College of Agriculture and Life Sciences.

With minimal resources, Curtin put together funding, mapped out facilities and developed curriculum. He was named the CVM’s first dean on Feb. 1, 1979.

Six days later, the CVM’s groundbreaking ceremony was held next to the dairy pavilion, now part of the college’s Teaching Animal Unit. The road leading to the TAU behind the college is now named for Curtin.

Curtin (far right) with a group displaying an architects rendering of the CVM campus at its groundbreaking ceremony. University Archives Photograph Collection.

The first class of 40 students enrolled in 1981, and the college was formally dedicated in April 1983. Curtin often recalled the satisfaction he felt on May 10, 1985, when he sat in his office and opened a letter informing him that the college achieved full accreditation.

Curtin didn’t have time to rest — and didn’t want to. Through the length of his tenure, he continued to expand the student body, enlist and support faculty and oversee the evolution of the college’s programs and activities.

He was active even in retirement, providing invaluable input on the CVM’s path and offering counsel to subsequent CVM leaders. After stepping down as dean, he remained at the CVM as professor emeritus in the Department of Molecular Biomedical Sciences and continued to represent the college and advocate for its mission and future.

“When I came from the University of Illinois to be dean of the college in 2004, Terry was an invaluable resource to me,” says Warwick Arden, the CVM’s third dean and now NC State University’s executive vice chancellor and provost. “He was instrumental in helping me make connections to the veterinary community and the college’s supporters across North Carolina. He will be sorely missed, but his legacy lives on through the college and its outstanding graduates.”

It always will. ~Jordan Bartel and Steve Volstad/NC State Veterinary Medicine 20

MEET THE CVM

Class of 2024 These times are extraordinary, but so are the members of the NC State College of Veterinary Medicine’s Class of 2024.

Our 100 first-year DVM students came to NC State from throughout North Carolina, but also from Florida and Maine, Texas and New Hampshire, Ohio and Puerto Rico.

Twenty-six are first-generation college students, and 39 earned undergraduate degrees from NC State. They range in age from 20 to 48. Several have military experience and were student athletes. Some are following in the footsteps of family members who are alums. One is the son of a graduate and a nephew of another.

They came to the CVM to pursue their interest in small animal medicine, in food animals and critical care. Separately, they are budding pathologists and specialists in public health and zoological medicine. They want to work with horses, study infectious disease and become clinician-scientists.

Together, they are now part of the CVM family and the future generation of impactful veterinarians.

Here’s a closer look at the CVM Class of 2024.

1,156: The total number of applicants for 100 seats.

80: North Carolina residents 13: The number of other states represented in the class. One student is from Puerto Rico.

77-23: The ratio of women-tomen in the class. Last year’s ratio was 89-11.

23: The average age of the class.

39: Students who majored in animal science as undergraduates. The secondmost popular major: biology (36 students) 27: Students focusing on small animal medicine, the most popular interest area. Other popular focuses: mixed animal (17 students); zoological and food animal (both 14 students) and clinician-scientist (7).

3.67: The average overall GPA 1: Student whose daughter is a member of the Class of 2022.

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Think and Do the Extraordinary

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Visiting Scholars

Mabel Aworh, a visiting scholar from Nigeria.

Each year, the NC State College of Veterinary Medicine welcomes scholars from around the world to train with faculty in labs, clinics and classrooms. These training opportunities help with career development, build new collaborations with international institutions and address the unique health priorities of countries worldwide.

Valeriia Yustyniuk, Ukraine Yustyniuk is a senior researcher at the National University of Life and Environmental Sciences of Ukraine in Kyiv. In June 2019, she received a Fulbright Scholarship to study program development and research with Maria Correa, CVM professor of epidemiology and public health.

Yustyniuk and Correa are continuing to work together to advance veterinary education in epidemiology, public health and policy in the country.

Mohammad Obaidat, Jordan Obaidat is an associate professor of food safety and zoonotic diseases at the Jordan University of Science and Technology in Irbid, Jordan. In 2016, he started working with Andy Stringer, CVM assistant professor of veterinary global and public health, to investigate contamination of milk and meat by zoonotic and drug-resistant pathogens in Jordan. Obaidat traveled to the CVM in 2019 to collaborate on an additional food safety project. Today, they are working to build and advance their collaborative food safety research in Jordan.

Mabel Aworh, Nigeria Aworh is a Ph.D. student at Ahmadu Bello University in Zaria, Nigeria, and an assistant director in Nigeria’s Federal Ministry of Agriculture and Rural Development. In September 2019, she arrived at the CVM to train with Sid Thakur, CVM professor of molecular epidemiology and director of the college’s and NC State’s global health program. Aworh learned laboratory and analytical techniques needed to implement a national antimicrobial resistance surveillance program in Nigeria.

Luisa Schmidt, Germany Based in Allgäu, Germany, Schmidt was pursuing a master’s in biochemistry and oncology at the University of Würzburg when she reached out to Tobias Kaeser, CVM assistant professor of swine immunology, to ask about a study abroad experience. In 2018, she arrived in North Carolina to work with Kaeser on vaccine development for chlamydia infections. The experience helped her advance her training in both human and animal health research.

Shivasharanappa Nayakvadi, India Trained in veterinary pathology, Nayakvadi is based in Goa, India, where he works at the Central Coastal Agricultural Research Institute. In 2018, he received a one-year Fulbright postdoctoral fellowship to study with Paula Cray, head of the CVM’s Department of Population Health and Pathobiology. At the CVM, Nayakvadi used advanced gene editing technology CRISPR/Cas9 to combat antimicrobial resistance. He continues to collaborate with the Cray laboratory to reduce the threat of drug-resistant infections in India.

— Greer Arthur/NC State Veterinary Medicine 23

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International Partnerships Strengthen Global Health

Leaders from NC State, including Director of Global Health Sid Thakur (third from left), CALS Dean Richard Linton (fourth from left), Executive Vice Chancellor and Provost Warwick Arden (third from right) and CVM Dean Paul Lunn (second from right) traveled to West Africa in 2019 to foster collaboration.

In September 2019, NC State University leaders traveled to West Africa to promote increased international collaboration for the global health program. Warwick Arden, executive vice chancellor and provost; Richard Linton, dean of the College of Agriculture and Life Sciences; Paul Lunn, dean of the College of Veterinary Medicine; and Sid Thakur, director of the global health program, visited several locations in Senegal and Morocco.

This included the Institut Pasteur Dakar (IPD) and Université Cheikh Anta Diop in Dakar, Senegal, the Institut Agronomique et Vétérinaire Hassan II in Rabat, Morocco, and the SPANA center in Marrakech, Morocco, in addition to cultural sites and working farms. The purpose was to increase collaborative research efforts focused on infectious diseases. NC State leaders met with national ministers of agriculture and livestock to discuss increasing international collaboration.

The College of Veterinary Medicine’s partnership with IPD supports research projects led by faculty from both institutions, as well as training and professional development for IPD students. The research will focus on combating diarrheal disease, and antimicrobial resistance.

Activities within the IPD partnership have included a threeday workshop hosted by CVM last year to discuss infectious diseases and research goals with IPD faculty.

“The workshops were an opportunity for all of us to get to know each other and figure out how we can unite our strengths to maximize our impact,” said Thakur. “Through these workshops we have discovered that one of Senegal’s main priorities is diarrheal disease, which aligns perfectly with our strengths at the CVM. Diarrhea is one of the leading causes of child mortality today, and the burden is particularly high in sub-Saharan Africa.

Diarrhea affects almost 1.7 billion children worldwide each year, causing more than 2,000 childhood deaths per day.

Partnerships in West Africa represent a portion of the largescale research and teaching taking place through the global health program. The topic of global health remains an integral portion of NC State’s strategic plan, as the university seeks to lead in international partnerships to improve human and animal health.

“It is exciting to see the support that global health receives from the Provost’s offices and NC State in general, as there is much work to be done on so many health-related issues,” said Thakur. “We’re working to build a better, healthier society through collaboration with researchers and colleagues throughout the world.”

— Emily Packard and Greer Arthur/NC State University

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Campus In the Age of Coronavirus It has been a year unlike any other, but the CVM is a place unlike any other. With an unshakable drive, our community pulled together during the COVID-19 pandemic to continue providing critical care to patients, educating students and even donating supplies to our partners in human health care. It continues to be a challenging time, but it is a challenge that we will continue to tackle together.

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Stronger Together

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NC State Veterinary Medicine NC Veterinary Medical Foundation 1060 William Moore Drive • Raleigh, NC 27607 Give Now: Use the giving envelope enclosed, (checks payable to “NCVMF”), or give online at cvm.ncsu.edu/giving.

Contact Us: Giving Office: 919-513-6660 cvmfoundation@ncsu.edu The Oath is published by the NC State Veterinary Medicine Communications and Marketing office.

Contact us at CVMCommunications@ncsu.edu This magazine was printed for a total cost of $4,500, or $1.33 per copy. No state funds were used.

Help Us Heal the World "The beauty of the interconnection between people, animals and our environment has always astounded me. It gives life a rhythm that is as steady and comforting as a heartbeat. For me, investing in the future of the NC State College of Veterinary Medicine and its work in global health is a way I can ensure the important work they are doing to grow and maintain this interconnection continues."

— Cathy Maready, North Carolina Veterinary Medical Foundation board member and global health program supporter

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