http://cmlag.fgov.be/eng/JohnRyanEC.pdf

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john.ryan@veterinarius.com

FMD, Risk and Europe

John Ryan, veterinary consultant

on behalf of

EUFMD, FAO

Introduction

This paper introduces the European Commission for the Control of FMD (EUFMD) and reports on the recent history of Foot-and-Mouth Disease (FMD) in the world. It describes work done in EUFMD analysing the risk of FMD introduction and gives some perspectives on the future of

Risk Analysis and Risk Management in Europe.

EUFMD - what it is?

EUFMD was established in 1954 under the aegis of the Food and Agriculture Organisation of the United Nations (FAO), with the specific remit to combat Foot & Mouth Disease. Its initial goals were to combat and eradicate Foot & Mouth Disease in Europe because in the early 1950's FMD was a severe problem throughout all of Continental Europe with repeated large epidemics disrupting farming across the continent. EUFMD's mandate was to co-ordinate the national control programmes of the member states and to share information, and by the late 1980's FMD had been effectively controlled in all of Continental Europe.

After some discussions about disbanding EUFMD once the EU and the Eastern European countries moved to a non-vaccination policy in 1991, it was decided to maintain the Commission but that it would refocus on preventing the re-introduction of FMD and also to try and limit the risk of FMD spread from countries surrounding Europe.

The membership of EUFMD includes all of the EC countries, most Eastern European countries and others such as Cyprus, Iceland, Israel, Malta and Turkey..Page 2 of 7

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FMD and Risk

Risk in the common usage of the term can be defined as the probability of an event occurring and the magnitude of the undesirable consequences of that event. As we have witnessed in the outbreaks in Western Europe in 2001, the introduction of FMD to a European country can have dramatic undesirable social and economic consequences for the entire rural society and is indeed a significant risk. It is also worth noting that in other contexts such as developing countries with no export markets to protect and simpler control policies that FMD is not associated with the same dramatic consequences and thus is not perceived as being a significant risk.

Risk Analysis

Risk Analysis for International Trade is described by OIE as a process comprised of 4 components: Hazard Identification, Risk Assessment, Risk Management and Risk Communication. After accepting that FMD virus is the identified hazard, this paper deals with the risk of FMD under the remaining general headings.

Risk of Introduction

The FMD situation world-wide has deteriorated significantly over the period 2000-2001 with different types of virus spreading well beyond their traditional endemic areas.

Countries that had been free of the disease for long periods of time have had to cope with introductions of virus and the subsequent difficulties of disease eradication. Other countries that were considered to have improving situations with regard to FMD have experienced the reintroduction of the disease that abolished the advances made in recent years. The restrictions associated with the measures taken to control the disease have had severe societal and economic impacts.

Within serotype O, the PanAsia O strain has been particularly successful in spreading over long distances and affecting countries with a long history of freedom from FMD, such as Japan, Republic of Korea, Mongolia, South Africa, UK, Ireland, France and the Netherlands. This pandemic type O invaded the UK where the first cases were detected in February this year. From there the disease spread to France, the Netherlands and Ireland. Currently, all European countries with the exception of the UK have managed to fully eradicate the disease, either with (the Netherlands) or without (Ireland, France) emergency vaccination.

Source OIE.Page 3 of 7

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With regard to type A, very large outbreaks of disease caused by an A strain in South America have necessitated the return to mass prophylactic vaccination in Argentina and Uruguay. Type Asia 1 continues to be endemic in south and south-east Asia, it is persisting in Turkey and Iran after its recent re-invasion and it continues to spread into the Caucasian countries.

Type SAT 2 has spread from its traditional endemic zone in Africa and has caused outbreaks in Saudi Arabia and Kuwait for the first time.

Realising that the world-wide FMD situation was deteriorating, and that qualitatively the risk of FMD introduction was increasing the questions remained: How to analyse this risk? And how to respond to this increasing risk?

Expert Elicitation Workshop

In response to requests from the EUFMD Executive Committee, the Secretariat and Research Group of EUFMD in collaboration with the Veterinary Laboratories Agency, Weybridge, UK held an Expert Elicitation Workshop on the Risk of Introduction of FMD to Europe, in Borovets,

Bulgaria in Sept 2000.

This workshop expanded on work done by H.S. Horst, Wageningen University, The Netherlands where her analysis of risk had moved away from traditional reactive commodity-centric risk analysis to a proactive overall view of the risk of introduction and spread of FMD and its economic consequences. A key feature of her work was the successful use of expert elicitation.

Her work focussed on the Netherlands, so the goal of the EUFMD workshop was to test whether aspects of her methodology could be successfully applied in a wider European context and whether it could help with the overall risk management decisions facing EUFMD.

In particular, the workshop tried to answer the following key questions:

Where in Europe is most likely to be affected by FMD in the next 5 years?

From where will the virus most likely come?

How will it be transmitted?

What is the most likely number of introductions over the next 5 years?

The methodology had to be adapted significantly from Horst’s model given time and resource constraints, but was designed to use expert opinion to answer the key questions without consideration of models of spread. In order to reduce the complexity, European countries and

endemic countries were grouped and a limited list of routes of introduction considered. A pilot questionnaire in advance of the workshop sought agreement on the groupings and helped reduce the list of routes of introduction considered. The workshop itself used a modified Delphi Technique for the direct elicitation of probabilities from the experts.

The results did show good convergence in opinion among the experts, who considered that the region of Europe most at risk from an introduction of FMD was the Balkans, followed by Eastern Europe, Southern Europe, Western Europe and the ‘Islands’.

The experts considered that the most likely source for virus introduction was Turkey followed by Russia/Eastern Europe, Middle East, Caucasia/Central Asia, North Africa, Asia, Rest of Africa and South America..Page 4 of 7

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The experts considered that the most likely route of introduction was the illegal import of livestock followed by the illegal import of animal products and tourists/immigrants.

The experts estimated that over the next five years there would be 7 introductions to the Balkans, 4 to Eastern Europe, 3 to Southern Europe, 1 to Western Europe and 1 to the ‘Islands’ group.

As it was in essence a test of methodology, the workshop encountered a series of problems. There was a lack of hard data on animal populations and movements, tourist/immigrant travel links between countries, animal product markets and movements to help inform the answers to the questions. The experts considered the discussions on the results to be very valuable and helpful in the accuracy of their answers, but would have preferred to have a wider group to discuss the results with, particularly non-veterinarians such as trade and travel experts. The experts felt that the exercise was too long and difficult and that not enough discussions on the results took place.

In spite of the problems, the experts concluded that the workshop had been an interesting and useful exercise and that it should be repeated learning from the specific problems identified.

There were a lot of methodological lessons learnt, the results were surprisingly convergent, and as such represent an improvement on individual opinions alone.

Although the experts put a low probability on an introduction to the UK’s group, they did predict one introduction over the period to that group and one introduction to Western Europe. It must be noted that the workshop took place shortly after the summer 2000 outbreaks in Greece and this fact combined with the historical view of Turkey - Balkans as the main route of introduction of exotic viruses heavily biased the results in this direction. However, there is still 4 years to run on the remainder of the predictions.

Risk of Introduction post 2001

Looking at the experience of 2001 in Europe and particularly at the success of the PanAsia strain in breaching the sophisticated defences of free countries around the world, there may be an indication that our thinking on the risk of introduction of FMD to Europe needs to adapt. While the virus does still spread from one country to neighbouring countries, by ‘natural’ organic spread, FMD seems to be spreading quicker and further than ever before. This may be a reflection of globalisation, as increased trade in animals and animal products and increased movements of people increase the transport, trading and social links between previously remote communities and as a result increases the chance of FMD moving with them e.g. a new road allowed the introduction of FMD from West Africa to North Africa for the first time across the Sahara desert because cattle transport vehicles could finally make the crossing in a reasonable time.

In looking at the recent history of FMD introductions to Europe, illegal activity features highly e.g. smuggling, false certification etc. How does one quantify or respond to this risk? It is very tempting to lump all this unofficial activity into a ‘black-box’ labelled illegal introduction and concentrate on the control of legal trade. If prevention of FMD is a real objective, then this ‘black-box’ needs to be opened, to be studied and the risk managed. It may also call for senior veterinarians to start thinking more like risk managers than just legislators.

Managing the Risk of FMD

In the author’s opinion the most important single factor affecting the size and economic impact of an FMD outbreak is the quality of the decision-making. This applies all through the chain from the quality of the clinical decisions of veterinarians in the field to the strategic decisions taken by governments to invest in their veterinary services.

Control of FMD is not a technical challenge - many countries controlled and eradicated FMD in the first half of this century with pre-war technology

it is a resource management challenge,

it is a public relations challenge,

it is an information management challenge,

 it is an endurance challenge,

but most importantly, it is a challenge to a country’s emergency preparedness and the Key Decisions that determine the impact of FMD have already been taken long before the virus enters the country

The Key Decisions taken pre outbreak that have most impact on the consequences of an FMD outbreak are all those that determine how much time, money and effort has been invested in overall Emergency Preparedness. Emergency Preparedness includes disease prevention, contingency planning and other basic emergency preparation such as resources allocation, disease

awareness among farmers, vets, politicians, general public; training of veterinary and support staff; surveillance networks and veterinary infrastructure; administrative response systems; communications channels and infrastructure; Information Technology etc. Investment in emergency preparedness determines the speed of initial notification and diagnosis and the speed of national response to the disease.

In contrast, the Key Decisions taken after the outbreak starts are essentially tactical decisions

(e.g. whether to vaccinate or not? When & where to vaccinate? What preventive culling strategy to use? etc.) and these decisions are largely constrained by what is organisationally possible given the level of emergency preparedness. After an outbreak starts, these decisions are extremely difficult to make because information on the spread of the virus is always at least one incubation period (some commentators use a rule of thumb of 14 days) behind reality and the information has to gathered and processed and presented in a useable format for decision makers.

The uncertainty around such difficult decisions leaves gaps for political exploitation and sub-optimal decision-making. The only effective defence against such politicking is sound science, hard information, good communication and good emergency preparation where these issues have already been discussed with key stakeholders.

Improving the Quality of Decision Making

 The  Key Issue for the prevention and control of FMD is Improving the Quality of Decision Making, particularly pre-outbreak. The Solution is to provide accurate, timely relevant, hard information to the decision-makers.

The provision of hard information and good science not only makes decision making easier, but has a nice side effect of de-politicising the decision-making process. In this regard there is a critical role for Risk Assessment as a means of presenting information to the decision-makers, there is a critical role for underlying scientific research that is the foundation of risk assessments and there is a critical role for communicating the results of the risk assessments to all relevant stakeholders.

To achieve this goal of better information provision appropriate structures need to be put in place to support the key decision-making points, such as risk assessment units, scientific research units and communication channels to gather information on risk factors and communicate the results

As such risk analysis must become a normative activity of a country’s emergency preparedness.

Emergency Preparedness is an iterative normative process of preparation, testing, learning and preparation again. Emergency Preparedness to the author encompasses 2 Pillars:

Disease Prevention and Contingency Planning

and two Foundations:

Emergency Preparation and Quality Control.

Emergency Preparation refers to building organisational competence and structures (veterinary, administrative, IT, communications, decision-making), the building of adequate resources for emergency response, the development of disease awareness and co-operative consultation with other stakeholders concerned with the impact of exotic disease introduction.

Communicating the risk

Managing the risk requires changes in behaviour, mostly this is achieved through legislation and rules governing trade in animals and animal products, but it is less clear how to control the behaviour of tourists, emigrants and travellers who also pose a risk of importing disease with animal products for personal use.

Changing behaviour is notoriously difficult even with the weight of legislation behind it, but it is not impossible! Behaviour can be changed if the actors concerned are convinced of the merits of the change. It is here that communicating to a degree that the target audience really understands the risk, the science and the logic behind the risk management measures is most important.

Another important aspect of communication is its two-way nature, changing behaviour is easier if the target audience believes that its concerns have been heard and considered.

This highlights the need to develop channels and fora to discuss these issues in advance of an outbreak and become part of a normative ongoing consultative process.

Conclusions

It is safe to conclude, based on the history of outbreaks in Europe in 1993, 1995, 1996, 2000 and 2001, that FMD presents a permanent threat of reintroduction to Europe. It is also worth noting that 2000-2001 has been the worst period in many years for FMD. This is particularly apparent with the activities of the PanAsia type O strain that has been so capable of breaching the defences of countries previously free of the disease.

The author suggests that this deteriorating situation may be due to a combination of factors, unusual strain characteristics leading to increased survival of the PanAsia strain, or it may be due to globalisation through increased movements of animals, animal products and people. It may also be due to the persistent run down of veterinary services in both developed and developing countries.

In some developing countries privatisation of national veterinary services has resulted in dramatic reduction in their capability to deal with transboundary animal diseases. In many developed countries, the decreasing importance of agriculture has led to a long term decline in funding for veterinary staff and research leading to uncompetitive salaries, low morale and understaffing in the national veterinary services.

 In addition, it has been noted that veterinarians have very little power to influence the decision-making process in comparison with the agri-trade lobby.

It is sadly necessary to reiterate that veterinarians are indispensable in veterinary diagnostic laboratories and surveillance networks, that employment conditions must be enticing enough to retain and attract key expertise and that adequate numbers of veterinary personnel are essential pre-requisites for the prevention and control of infectious diseases.

An obvious solution is to tackle the problem of FMD at source in developing countries, but FMD is very difficult and expensive to control and many countries still do not have the necessary supporting infrastructure to implement an effective control programme. FAO continues to help any countries that it can in developing their control programmes for FMD, but the time is not yet right to discuss a global eradication programme.

There is a need to continue to develop risk analysis methodologies especially responses to new threats like PanAsia.

There is a need to improve Emergency Preparedness, its pillars: Disease Prevention and Contingency Planning and its foundations: Emergency Preparation and the Quality Control of all the above components.

There is a need to improve overall Decision Making by providing accurate, relevant timely information through better risk analysis, more research and better communications. There is a need to formalise this process of risk analysis by putting the necessary structures in place.

Recommendations

To continue to develop tools for risk analysis, and particularly the methodologies for the analysis of external events and a research programme to develop the underlying science that is the basis of risk analysis.

That Risk Analysis structures/units must be built fundamentally into the decision-making processes and become normative activities alongside other normative activities such as disease prevention, contingency planning and emergency preparation.

That the process of learning from disease events and the history of the disease must be institutionalised and genuinely acted upon.