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Extract from

Royal Society Infectious Disease Inquiry Follow-Up review (pdf file)

Vaccination

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Further action to ensure that emergency vaccination is a viable option for pre-emptive action, including the validation of Non Structural Protein (NSP) tests and a better understanding of the implications of vaccination by all stakeholders. (4, 5)

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"...the IDL report also stressed that the term biosecurity should encompass wider issues such as controls on all movements within specified risk areas, prudent sourcing of stock, quarantine, vaccination and testing in order to move away from the thinking that disinfection is the only barrier' that should be considered....."

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"....b. Decision making during outbreak While many of the individual components within the contingency plans are in place, concern remains about some of the decision-making processes within Defra during an outbreak of an exotic infectious disease; in particular about testing the robustness of the criteria that would be used in the decision tree to determine whether to employ extended pre-emptive action and if so whether this should involve emergency vaccination or slaughter {7.2}...."

5. Emergency vaccination

Although the IDL report recognised that rapid culling of infected premises and of epidemiologically determined dangerous contacts was the appropriate approach for the control of exotic diseases, it stressed that it was becoming increasingly unacceptable across Europe to cull and destroy large number of animals, as occurred in the 2001 outbreak, either as part of wider pre-emptive disease control or for welfare purposes. It is therefore imperative to find approaches whereby emergency vaccination can be employed in situations where pre-emptive action is required. Use of such vaccination procedures must be coupled with arrangements to ensure that the animals subsequently enter the food chain {7.7}. If there are problems associated with a nonslaughter approach then these need to be resolved.

Defra has put a great deal of effort into putting in place contingency arrangements for securing and delivering emergency vaccination in the event of an outbreak of FMD. These include securing derogations within the EU Directive {7.7} that will ease the exit strategies after the use of emergency vaccination. More work is required to promulgate to stakeholders and the general public the exit strategies. In addition clear explanations of meat treatments required in a FMD outbreak must be provided. The drafting of Defra's recent publication 'The role of vaccination in a future outbreak of FMD' (Defra2004d) was not sufficiently clear in this respect {7.7}. Failure to clarify both the exit strategies and meat treatment protocols will undermine Defra's sterling work in securing these derogations when the Directive was being drafted.

The contingency arrangements outline the scale of the delivery of emergency vaccination. Further information is required to assess whether the arrangements for scaling up vaccination capacity would meet the EU Directive requirements for a worse case scenario {7.5}. A consultation by Defra on the use of lay vaccinators was completed at the end of March (Defra2004j) resulting in two orders recently being laid before Parliament to allow trained personnel to handle and administer vaccine during an outbreak (Defra2004l).

The delay in obtaining validation of the NSP tests required to secure regaining of disease free status under a vaccination to live strategy remains a concern {8.2}. However, the recent Defra publication 'The role of vaccination in a future outbreak of FMD' (Defra2004d) states that "the absence of an internationally validated test would not prevent the use of vaccination in the event of a future outbreak".

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The provision of emergency vaccination during an outbreak is contracted out to Genus Plc, but the processes involved in provision of qualified teams still requires further planning. The amendment of the Veterinary Surgeons Act (1966) to allow the use of lay vaccinators will help resource any large scale emergency vaccination programme, but the overall veterinary management of the process will require careful planning {7.6}. The resources required for culling of animals also need to be considered carefully to ensure culling can take place within the guideline times.