CASE NOTES

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FMD ERADICATION DREAMING

Peter Windsor DVSc, Specialist Veterinary Surgeon (Pathobiology, Small Ruminant Health Management), Professor of Livestock Health and Production (Faculty of Veterinary Science, University of Sydney, Camden, NSW)

Posted Flock & Herd April 2013

A GLOBAL FMD CONTROL STRATEGY HAS ARRIVED

FMD is by far the most significant biosecurity threat to Australia's livestock industries, with an outbreak potentially having devastating consequences to our community in lost production, trade, tourism and social impacts from movement restrictions and response activities during an outbreak. Our focus is rightly on disease prevention, yet we will remain at risk whilst the disease is endemic in many parts of the world, particularly in our own region. From a global perspective, FMD is more correctly considered a failure of the food security system, estimated to cost $US5billion pa in production and vaccination costs alone (J Rushton, pers. comm.). It affects over 20million cattle and 4million pigs per annum, severely compromises international trade in animals and animal products, causes considerable financial losses in affected countries, and provokes extremely emotive sociological and animal welfare debates when eradication strategies are invoked in FMD-free countries hit by an outbreak. However, the burden of FMD in developing countries is arguably the greatest. Such nations are comprised of mainly poor smallholder subsistence farmers (97% of global farms are under 10ha) and the impact of FMD has been either largely ignored or dismissed as a global priority, despite major losses through loss of animals (where cattle are the 'bank'), lowered production (especially through loss of draft power), threat to food security and the prevention of the economic development of livestock sectors in rural communities desperate to find pathways out of poverty.

FMD is a result of infection with one or more of the 7 serotypes of FMD virus (FMDV), being O, A, C, Asia 1, and SAT's 1, 2, and 3 (although there have been no outbreaks of C since 2005). FMD still exists in much of the world, particularly in Asia, Africa and the Middle East where currently over 100 countries are not FMD-free and multiple serotypes have been recorded. It is now considered more appropriate to invoke the regional context of virus pools, with 7 separate virus pools identified throughout the world, although able to be readily transferred between pools. Pool 1 is the SE Asian region where there are currently 3 topotypes of O, plus A and Asia 1 known to have been circulating in recent years. These endemic FMDV pools provide a permanent threat to FMD-free countries, particularly as the rapid expansion in global travel, trade and transport continues, inevitably increasing the risks of FMD spread.

Eradication of FMD from endemically infected countries is an emerging issue of global importance, fortunately increasingly being recognised as a 'global public good' policy. Following the recommendations of the first international FMD conference held in Asuncion in 2009, a Global FMD Control Strategy has been prepared under the FAO/OIE Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs). The strategy was endorsed by participating members at the second international FMD conference held in Bangkok in June 2012.

The three important components of the Global FMD Control Strategy are:

(i) Improving global FMD control, through the PCP, a 5 step progressive control pathway mechanism that provides a framework for FMD endemic countries to progress towards freedom,

(ii) Strengthening Veterinary Services, through PVS, an audit mechanism on the provision of veterinary services that aims to focus the attention of FMD endemic countries on resourcing FMD control, and

(iii) Improving the prevention and control of other major diseases of livestock, through expertise developed by enhancing disease management capacity in (i) and (ii) above.

Many developing countries do not have the financial resources to invest in FMD control, or of more concern, fail to see the cost-effectiveness of eliminating a disease of animals where in most scenarios, is not usually fatal. Sadly, the level of international investments has also been relatively low. At issue has been a systemic failure to understand the true costs of the disease, particularly in developing countries. This is an area attracting recent research priority, especially in the Mekong region (Rast et al., 2010; Young et al., 2012) where Pool 1 FMDV's circulate and a major epidemic of O (Mya98) emerged in 2010-2011. Other research areas of importance include molecular epidemiology to understand the changing FMDV pools and ensure reagents and vaccines are appropriate, plus movement of animals and product that results in FMD 'hotspots' where disease control including biosecurity education should be targeted (Nampanya et al., 2012a,b). Following the recent multi-lateral agreements in principle, a major sustained effort now needs to be made by the international community that involves partnerships between developing and developed countries.

REVIEW OF AUSTRALIAN PREPAREDNESS FOR FMD

Earlier this year, DAFF commissioned Ken Matthews to provide a qualitative assessment of Australia's readiness to respond to the threat of FMD. The Mathews Report is available at: www.daff.gov.au. The Report acknowledged the strength in Australia's biosecurity system and was positive on Australia's planning for FMD, but did highlight 11 areas for improvements in our managing the threat of this disease, as per:

1. Australia's national capability to anticipate an FMD outbreak & turn warning intelligence into action

2. Standards of assurances that exporting countries' Competent Authorities are operating to Australian biosecurity requirements

3. The possibility of illegal importation of animal products

4. The effectiveness of swill feeding prohibitions

5. Australia's capacity to sustain a large-scale FMD response

6. Traceability arrangements in the sheep industry

7. Policy on FMD vaccination and associated difficulties in preparing for a short-notice vaccination campaign

8. Preparation for the known challenges of carcass disposal

9. The possibility that FMD may not be detected readily and speedily

10. A lack of clarity about responsibility and accountability for national FMD planning processes

11. Planning for community recovery.

The Mathews four new policy directions

The report recommended the Australian Government pursue in its work on FMD, inclusion of:

1. Leadership for settling unresolved issues in AUSVETPLAN, including policies on vaccination, the absence of effective identification and traceability of sheep, & lack of clarity on responsibility & accountability for FMD preparedness planning.

2. Focusing resources and effort towards the 'earlier' elements of emergency management; prevention; and preparedness (as AUSVETPLAN has focused most on the post-incursion response), so prioritising border operations, initiatives to shorten decision making times, building disease response & management capacity, & facilitate early detection.

3. Institutionalising processes to refine & strengthen FMD preparedness & response arrangements, to ensure regular review & updating of plans that include advances in scientific understanding.

4. More rigorous application of the risk-return principle throughout the entire biosecurity continuum. The Beale Review (2008) recommended a risk-return approach to managing biosecurity risk and progress is being made by DAFF but more can be donee.g.preparing import risk profiles based on import interception data &/or the quarantine performance of overseas Competent Authorities, customs brokers and Quarantine Approved Premises.

Australian FMD vaccination strategy

Developments in vaccine technology and recent experiences of countries experiencing FMD outbreaks (eg UK versus Uruguay) have changed international attitudes to FMD vaccination. Australia no longer views vaccination as a measure of last resort. Australia and will consider the potential role of vaccination as part of the response strategy from the day an incursion of FMD is detected. The role of vaccination in an FMD response will depend upon the unique nature of each outbreak, and will vary depending on a wide range of factors (eg. where and when the disease has been introduced, the strain of virus, how long it may have been here, potential for spread,etc.). This requires a flexible policy that allows decision-makers to determine the role of vaccination appropriate for each specific outbreak scenario, but Australia will prepare as though vaccination will be used in the event of an FMD incursion, and the following policy considerations reproduced below, are available at: www.daff.gov.au

1. Vaccination will be considered as one of the potential strategies for disease control on the day an FMD incursion is detected.

2. The reestablishment of trade for affected industries will be one of the highest priorities of disease response efforts. It is acknowledged that in some scenarios, the decision to vaccinate may allow a return to trade sooner (by reducing the duration of the outbreak) than may have been possible without vaccination.

a. Protective vaccination: to protect groups of animal from infection or clinical signs of disease. This can include ring vaccination, targeted vaccination and buffer vaccination strategies.

b. Suppressive vaccination: to control the spread of FMD within and out of an infected area by vaccinating selected groups of animals

c. Mass (blanket) vaccination: to protect large numbers of animals over a wide area from infection and clinical signs of disease.

3. Vaccination may be useful for a range of purposes during FMD outbreaks including (but not limited to):

4. The decision of whether to vaccinate and how to apply vaccination is complex and will depend on many factors including: the nature of the outbreak, epidemiological considerations, logistical and resourcing issues, animal welfare considerations, industry and public attitudes, socio-economic considerations, trade implications, international standards and international experiences with the use of vaccination in previously free countries. Delays in implementing a vaccination strategy may impact on its ability to limit the spread of infection. The Consultative Committee on Emergency Animal Diseases (CCEAD) must consider the use of vaccination from day one of a FMD response.

5. CCEAD will provide the first meeting of the National Management Group (NMG) with advice on the potential role of vaccination as a control strategy, based on what is known about the unique epidemiology of the outbreak at the time. Decision-makers acknowledge that the decision to vaccinate will likely need to be taken in the absence of all desired information. This decision taken should be regularly reviewed.

6. In the event of a FMD outbreak, the outbreak strain should be typed to assess whether an appropriate antigen is held in the National FMD Vaccine Bank as a matter of urgency. If appropriate vaccine is available, CCEAD will advise NMG to order the constitution and delivery of the full supply of doses of appropriate vaccine from the National FMD Vaccine Bank. This is regardless of whether vaccination is included in the initial emergency response.

7. If the National FMD Vaccine Bank does not hold an appropriate antigen, or the number of doses of vaccine in the bank is considered insufficient, Animal Health Australia under direction from CCEAD and NMG will seek further supplies of vaccine from other manufacturers and/or international vaccine stockpiles.

8. Emergency response plans proposing the use of vaccination must include discussion of how vaccine is to be strategically used and how it will be administered to susceptible populations. In addition consideration should be given to how vaccinated animals are to be managed after the outbreak, including whether they are to be removed from the population or whether they are allowed to live out their commercial lives. Other issues to be addressed include identification and tracing of vaccinated animals, management of products from vaccinated animals, data management, and surveillance, resourcing, training and logistical requirements.

Conclusion

Australia has an envied global reputation for biosecurity and animal disease management, and the recent Mathews Report attests to the desire for continuing improvement that will very likely keep Australia FMD-free and ensure a more measured response should an outbreak occur here. However it is because of the endemic FMD in our region that we need to be continually investing in our biosecurity systems. There are very strong arguments in support of diverting a substantial portion of this investment into regional FMD control and potentially global eradication of FMDV. Australian governments and agencies have shown regional leadership in such endeavours. We assisted the eradication of FMD from Indonesia and more recently the Philippines (Windsor et al., 2011), with recent investments in the SEACFMD campaign in the Mekong now occurring. For the regional and global ambitions of the FAO/OIE Global FMD Control Strategy to progress beyond a dream that emerged in the wake of the successful Rinderpest eradication, an enormous financial commitment and effort is required. Many Australian livestock veterinarians have potentially important roles in this ambitious task.

References

1. Nampanya S., Sothoeun, S., Rast, L., Windsor, P.A. (2012a). Improvement of farmer knowledge of production, health and biosecurity between 2008 and 2010 in Cambodia. Transb. Emerg. Dis.: 59: 117-127
2. Nampanya, S., Richards, J., Khounsy, S., P. Inthavong, P., Yang, M., Rast, L., Windsor, P.A. (2012b). Investigation of Foot and Mouth Disease hotpsots in northern Lao PDR. Transb. Emerg. Dis. doi:10.1111/j.1865-1682.2012.01350.x
3. Rast, L., Windsor, P.A., Khounsy, S (2010). Limiting the impact of Foot and Mouth Disease in Northern Lao People's Democratic Republic by Vaccination: A Case Study. Transb. Emerg. Dis. 57:147-53
4. Young, J.R., Sothoeun, S., Andrews C.J., Henry, L.A., Windsor, P.A. (2012) Assessment of financial impact of Foot and Mouth Disease on smallholder cattle farmers in southern Cambodia. Transb. Emerg. Dis. doi:10.1111/j.1865-1682.2012.01330.x
5. Windsor, P.A., Freeman, P.G., Abila, R., Benigno, C., Nim, V., Cameron, A. (2011). Control and eradication of Foot and Mouth Disease in the Bicol surveillance buffer zone in the Philippines. Transb. Emerg. Dis.: 58: 421-433