In over 85 countries, US-trained DOs have unlimited practice rights. In 2005, after one year of deliberations, the General Medical Council announced that US-trained DOs will be accepted for full medical practice rights in the United Kingdom. According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an osteopathic physician and an osteopath." The American Medical Student Association strongly advocates for US-trained DO international practice rights "equal to that" of MD-qualified physicians. The International Labor Organization (ILO), an agency of the United Nations, issued a letter affirming that U.S.-trained osteopathic physicians are fully licensed physicians who prescribe medication and perform surgery. The acknowledgment draws a clear separation between American DOs, who are medical doctors, and non-physician osteopaths trained outside of the United States. Within the international standards that classify jobs to promote international comparability across occupations, U.S.-trained DOs are now categorized with all other physicians as medical doctors. This event took place in June 2018 and started a relay of events and opened doors for DO's as more countries started to understand and give full recognition to US trained medical doctors with the D.O. degree, e.g. the Association of Medical Councils of Africa (AMCOA) approved a resolution in 2019 granting the AOA's request that AMCOA recognize U.S.-trained DOs as fully licensed physicians with practice rights equivalent to MDs, opening its 20 member countries, which include Botswana, Gambia, Ghana, Kenya, Lesotho, Liberia, Malawi, Mauritius, Namibia, Nigeria, Rwanda, Seychelles, Sierra Leone, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe to DO's.