Nancy J. Cox, PhD: A One Health hero in influenza surveillance

Abstract Background : This program continues to provide human and animal health authorities with information on zoonotic human and swine influenza viruses and infections for their early detection, disease prevention and control, and pandemic preparedness. Aim : The aim is to examine Dr Nancy J. Cox’s contribution to the development of collaborative human-animal influenza surveillance and identify practical lessons for implementing One Health. Approach/Method : The article uses the development of the US national swine influenza surveillance program as a case study, drawing on published sources and the professional recollections of colleagues involved in cross-sectoral influenza work. Findings/Results : Cox helped to foster durable relationships among public health agencies, veterinary authorities, agricultural partners, diagnostic laboratories, academic institutions, and industry. The experience demonstrates that trust must precede data sharing; administrative and funding barriers can be overcome through persistent leadership; surveillance systems should be built before crises occur; and effective cross-sectoral surveillance depends on sustained professional relationships. Conclusion : Cox’s legacy shows that the essential infrastructure of operational One Health is not only organizational agreements and technical capacity but trusted relationships that permit institutions with different mandates to work toward shared human and animal health goals. By example, she has and continues to influence and shape generations of public health, veterinary health, and One Health practitioners. One Health impact statement This article demonstrates how One Health moves from an aspirational concept to an operational reality. While many publications describe the value of collaboration among human, animal, and environmental health sectors, this paper examines how sustainable One Health partnerships are actually built. Using the development of the US national swine influenza surveillance program as a case study, it shows that successful One Health initiatives depend not only on scientific expertise, organizational agreements, and shared resources but on trusted relationships among people. Institutions do not collaborate – individuals do. Enduring partnerships are built through mutual respect, transparency, persistence, and a shared commitment to protecting human and animal health. Dr Nancy J. Cox’s leadership demonstrates that overcoming institutional, legal, financial, and cultural barriers requires leaders who unite diverse disciplines around common goals. The lessons presented provide a practical road map for implementing resilient One Health collaborations that strengthen zoonotic disease surveillance, pandemic preparedness, and global health security.