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UNPREPARED VETERINARY MANPOWER - THE WEAKEST LINK IN THE CHAIN OF DANGEROUS DISEASE EMERGENCY PREPAREDNESS (provisional text)
Formerly: Chief, Animal Health Service, Food and Agriculture Organization of the United Nations; Czechoslovak Chief Epizootiologist and Professor of Epizootiology, University of Veterinary Sciences, Brno
2. Continuous risk
3. Late discovery of introduced disease
4. Evaluation of recent major FMD outbreaks
5. Lack of sufficient number of competent and well prepared veterinarians
6. Underestimation of field practice
7. Simulation exercises
1.1 I would like to express some comments on the preparedness against very dangerous animal diseases such as foot and mouth disease (FMD). The comments are applicable also on the diseases which could be abused as biological weapons.
1.2 Anti-epizootic control starts and ends at field level being supported by laboratory etiological investigations and by managerial structure identifying strategy and tactics, providing staff (including top level specialists), material, financial and logistic support, vertical and horizontal coordination as well as assuring necessary cooperation with other relevant professional, government and international organizations. All components of management and action pyramid should function effectively not underestimating any of them. All activities must at the end to be targeted at the decisive stratum, i.e. at field level practice where the key anti-epizootic problems to be solved.
1.3 In the majority of the countries there are quite good legal documents, such as particular laws, ministerial decrees, regulations for local government authorities and contingency plans against FMD and other very dangerous diseases as well as instructions for veterinary services. Regular updating of these documents is obviously a current practice. There are many useful manuals and models for emergency planning published by relevant international organizations such as FAO, WHO, OIE, PANAFTOSA, EUFMD, etc.. It seems that the management and administrative preparations at all levels are of relatively good standard.
1.4 However, the basic problem is how to transfer the provisions of these documents and methods for emergency situation into practical life. Their implementation depends firstly on veterinary manpower, mainly on the preparation of field veterinary staff. The same is valid for other persons coming in contact with animals susceptible to very dangerous diseases. Rich experience of anti-epizootic control indicates general very serious underestimation of the main component - irreplaceable field working veterinary personal.
1.5 The war against FMD and other very dangerous diseases is a very practical problem requiring immediate actions, first of all on the spot. It cannot be won by the paperwork or theoretical modelling using not always reliable data.
1.6 The management and action pyramid usually should have the strongest stratum at its basis, i.e. at grassroots’ level. This is not the case in actual animal disease emergency preparedness where the pyramid has the best prepared stratum at its “head” and the weakest at its basis. Evaluating available documents on contingency planning it can be stated that it exists deep unbalance between theoretical and practical preparation and between central management and field veterinary service preparedness.
1.7 Analytic documents on the lessons learned from the recent FMD outbreaks contain enormous number problems to be solved. Unfortunately, available analyses are not giving necessary attention to field veterinary manpower preparedness. This is the reason why I am trying to comment on this fundamental factor influencing animal disease emergency preparedness. I have used literature sources and documents of some national and international organizations considering also my experience of FMD research, prevention, control and eradication.
2. Continuous risk
2.1 It is logical that the main problem is to protect country territory against FMD virus introduction and thus to avoid extremely demanding and costly “fire brigade” eradication activities. Insufficiently controlled animal disease occurrence in exporting countries and extreme antisanitary liberalization of international trade facilitate spread of communicable diseases, not excluding the FMD (e.g. during 1996-2000 there were reported 22 cases of FMD import into FMD-free countries; in 2000 in Japan even after 92 years).
More information in http://vaclavkouba.byl.cz/globdisease.htm.
2.2 “New policy” of relevant international organizations supports “unimpeded flow of international trade in animals and animal products”(Main objectives of the OIE, 1999). It has been imposed the principle “import risk analysis is preferable to a zero risk approach” (OIE CODE 1997 Foreword and article 184.108.40.206) to facilitate trade instead of previous principle of zero risk trade “to avoid the risk of spreading animal diseases” (OIE CODE 1992 Foreword).
2.3 According to WTO/SPS and OIE Code, for the first time in the history, importing country cannot require sanitary innocuous healthy animals and animal products, i. e. to be “pathogen-free” without written “scientific justification of the risk assessment” for all transmissible diseases to convince exporting country !? Where is normal logic ? To facilitate trade the both documents do not know the terms such as “healthy animals” or “pathogen-free animal products” currently used in veterinary medicine as the expression of sanitary quality. These organizations de facto have legalized disease export.
2.4 The abused risk assessment requirements have become the main tool how to “facilitate export” of non-healthy animals and non-pathogen-free animal products, i.e. without guaranteeing full sanitary quality. In OIE “Handbook on Import Risk Analysis for Animals and Animal Products”, 2004, page 20 there is even a formulation threatening importing countries that “zero risk importation policy … would require the total exclusion of all imports” (!?). This is unprecedented perversity when fair international trade in all other commodities on the contrary requires zero risk export/import, i.e. the exclusion of exporting countries and organizations not guaranteeing required quality. According to above mentioned OIE antisanitary document, those countries requiring import of healthy animals and pathogen-free products of animal origin should be “excluded of all imports” of these commodities ?! This represents further evidence that the OIE (self-declared as World Organization for Animal Health) is applying a policy favouring only major exporting countries which are not able to guarantee the export of healthy animals and pathogen-free animal products, i.e. favouring disease export regardless of animal and human health consequences in importing countries. The OIE is not more applying basic medical principle of consequent protection of health - “Primum non nocere !” Even old Greeks applied hippocratean principle “better preventing than treating” which is not more respecting in 21st century by so called “World Organization for Animal Health”.
2.5 New WTO and OIE international trade policy has open a broad channel for export of also non-healthy animals and non-pathogen-free products and thus for gradual irreparable unpunished globalization of communicable diseases. The importing country must even pay also non-healthy animals and non pathogen-free products as being of full sanitary quality ! They cannot be refused without “scientific justification” !? Exporting countries are not obliged to cover the losses caused by disease export, as it is normal in cases of the export of damaging inanimate commodities !
2.6 New international documents for international trade in animals and animal products have been neglecting biosecurity requirements - unilaterally favouring to exporting countries at the expense of animal and human health in importing countries.
“International trade in live animals (livestock, exotic pets, game species, zoo animals) and of animal products in most regions of the world is increasing. This remains the primary risk for the spread of FMD particularly because there is a general neglect of biosecurity issues when driving trade liberalization measures forward” (European Commission for Control of Foot-and-Mouth Disease - EUFMD Research Group Report, 2003, Appendix 15).
This is extremely serious warning requiring reconsideration of actual international trade policy conducing to diseases’ spreading! The OIE instead of applying consistently animal health protection policy supports openly, consciously and irresponsibly only risky export, i.e. it must be expected import of animal diseases, including of the most dangerous ones.
More information in http://vaclavkouba.byl.cz/oiecode.htm.
2.7 Less demanding criteria for sanitary innocuousness of exported animals and their products facilitate the spread of communicable disease pathogens through international trade. Minimizing epizootiological surveillance and pre-export investigations of animals and their products represent steady risk of exporting dangerous disease pathogens. Therefore, any import of animals and animal products under actual circumstances is much more risky than before WTO/SPS and “new” OIE Code.
Note: The OIE Code doesn’t include any sanitary requirements for inanimate commodities (such as straw) which can be pathogen carriers representing other route of disease spreading through international trade.
2.8 On the other hand, there have been many intensive useful discussions on emergency planning, produced many relevant documents and papers, organized many meetings, consultations and disease emergency projects, etc. Unfortunately, these are usually not giving necessary attention to territorial protection avoiding disease introduction. Effective country protection is much more important and cheaper than to let the disease pathogens’ to be imported and than to “hunt” them trying to eradicate them.
2.9 Serious risk is linked with weak government veterinary services in exporting and importing countries being unable to control effectively epizootiological situation, supervise “accredited” veterinarians who test of and issue “official” attests for exporting commodities in the name of the government. Without effective supervision it cannot be avoided cheating and corruption, particularly due to lack of professional, financial, disciplinary and criminal responsibility of testing and attests issuing veterinarians (without effective supervision, including control retesting, and personal consequences they can certify what they want). The OIE international veterinary certificates are only of incomplete informative character and not quality guarantee documents as it is absolutely normal in all other commodities.
More information see in: http://vaclavkouba.byl.cz/vetmanpower.htm.
2.10 During natural conflicts of interest government veterinary officers have better chance than accredited private veterinarians to apply uncompromisingly sanitary measures against the resistance of profit-oriented producers and exporters. Health protective measures and requirements for exporting only healthy animals and pathogen-free animal products represent for the producers and exporters serious “complication of their life”. Even government veterinarians have difficulties with organizations and persons defending only trade interest regardless of sanitary requirements. Unfortunately, the OIE documents prefer trade interests at the expense of health in importing countries.
2.11 Risk minimization starts by thorough surveillance and eradication of relevant dangerous diseases in exporting countries, by demanding import conditions requiring pathogen-free commodities, strict border control, quarantine and by significant strengthening of postimport surveillance. Increasing national animal production towards self-sufficiency minimizes the need for problematic risky import. The animal import from countries which are unable to guarantee the export of healthy animals and pathogen-free animal products to be avoided. Unfortunately, these principles are very often not applied. Importing countries should require exporting countries for zero tolerance for communicable disease pathogens in importing commodities.
“Farmers were obviously vulnerable as far as FMD was concerned because policies to keep the virus out of country were not stringent enough; indeed import controls remain almost non-existent.” (!?) (CRISPIN and BINNS)
Note: In European Union are well prepared contingency
plans including against
African swine fever, the most dangerous disease in pigs; one
would expect that this disease imported in 1978 in the island
2.12 Importing countries have not enough or no information at all on epizootiological situation in exporting countries (e.g. in OIE World Animal Health reporting “disease occurrence” = “+” is almost without practical value and surveillance data are missing) and therefore objective assessment of introduction risk is impossible. There are much less information on the occurrence of a l l international reportable diseases in exporting countries than before WTO/SPS (1995).
The post-SPS OIE regular information system (OIW World Animal Health Yearbook) was reduced mainly as far as FMD reporting is concerned. OIE abolished also regular annual reporting system on the most important animal disease – foot-and-mouth disease - according to its types: FMD A, FMD O, FMD C , FMD Asia 1, FMD SAT 1, FMD SAT 2 and FMD SAT 3. Country reporting on each FMD type was before subdivided into six animal species (bov, buf, ovi, cap, sui, others) and on FMD occurrence when the type was not identified. OIE stopped requiring these 49 data on FMD occurrence as it was normal during past decades. If we consider also the abolition of previous disease occurrence epizootiological graduation, what was offering for each type and animal species more useful information, then the number of required FMD annual data was reduced from more than one hundred criteria to one line of very simple information ! This absurd reduction was done without any scientific justification or risk assessment ! Only exceptionally there are some countries providing more detailed information facilitating to assess disease introduction risk. International animal disease reporting system is much less informative and transparent than before WTO/SPS (1995).
2.13 Among the risk factors also belong problems with postvaccination FMD cases and with FMD virus escapes from laboratories.
Examples: “In regard to the 13 outbreaks attributed to origin within the
Community, the major sources are believed to have been residual live virus in
vaccines which had not been fully inactivated, and escapes from laboratories working
with the virus – especially where concentrated aerosols of virus may have been
produced, for example, by experimentally infected livestock or during
large-scale virus growth for vaccine production.” (DONALDSON, DOEL, 1992). : "On September 15, 1978, the Plum Island Animal Disease Research
Center, identified foot-and-mouth disease (type O) in cattle in a holding area
on the Island near the Laboratory Emergency precautions were taken to assure
that o virus escape from the island. All cattle, swine and sheep on the island
were incinerated and all areas cleaned and disinfected. Since intensive
surveillance found no infection within the
2.14 It is logical that the risk of FMD occurrence and spread is much higher in the territories without anti-FMD vaccinations, i.e. with fully FMD-susceptible animals, than in specifically vaccinated territories.
Note: ”The cessation of vaccination will result in higher proportion of fully
susceptible cattle and in the recent of outbreaks will increase the likelihood
of the rapid dissemination of virus and increase the risk that the infection
3. Late discovery of introduced disease
3.1 Important indicator of the preparedness to discover in time primary outbreaks of the FMD is the ratio primary/secondary outbreaks: Taiwan in 1977 = 1 : 6,147, UK in 1967/68 = 1 : 2,364; UK in 2001 = 1 : 2,030, Greece in 1994 = 1 : 94, Netherlands in 2001 = 1 : 26; European Union in 1977-1987 average = 1 : 54; Europe in 1991-2000 average = 1 : 10,5. (OIE, FAO, DAVIES). These examples document very late discovery and blockade of the primary outbreaks due to weak or not existing effective anti-epizootic surveillance at field level and due to lack of necessary number of well trained veterinary professionals.
UK FMD 2001 outbreak: “infection being present but unreported for at least three weeks
before the first case was identified” (SCUDAMORE and HARRIS) “during an antemortem inspection in an
abattoir“(STERNBERG and CHRAINE). “By the time 2001 outbreak was confirmed, it had spread to 57
locations across the
3.2 Above mentioned examples show enormous difficulties to detect in time introduced diseases in spite of the fact that the FMD belongs among diseases with clinical manifestation more expressed than in the majority of important communicable animal diseases. There are not two identical cases, i.e. every case is different ! The FMD has different forms: from sudden death, peracute, acute, subacute, chronic and subchronic course up to asymptomatic “virus carrier”.
Example: In Czechoslovakia during 1957-1960: in 1403 diseased cattle of 50 evaluated FMD outbreaks there were reported following clinical symptoms: anorexia in 99.86 %, fever in 75.41 %, mouth changes in 82.34 %, changes on muzzle in 45.76 %, changes on udder in 18.03 %, changes on extremities (interdigital space) in 12.47 % and other changes such as heart malfunction, changes at horn root, on conjunctiva, abortions, etc. in 1.42 %; in 243 diseased pigs of 21 evaluated FMD outbreaks there were reported following clinical symptoms: anorexia in 98.77 %, fever in 62.97 %, changes on the snout in 9.87 %, on the udder in 6.99 %, on the extremities (interdigital space and along of coronary bands) in 96.30 % and other such as sudden death, loss of the horny covering of the toe, agalactia, abortions, etc. in 11.12 %. (KOUBA, 1961).
3.3 Also when initial diagnosis of a FMD case is correct and isolation measures are immediately applied, several days pass from the moment of FMD virus introduction and first symptoms. The delay period is influenced by the type and grade of clinical manifestation, stage of disease spread as well as by initial reluctance of farmers to call veterinarian due to high cost of veterinary service (this was not the problem in the countries where veterinary service was free-of-charge) or not being conscious of FMD occurrence or due to fear of drastic measures. Not all veterinarians were able to recognize the FMD without hesitation or at all, particularly when disease course was atypical.
3.4 Also latest cases of FMD reconfirm the key role of early detection of the primary outbreak and then also of all secondary outbreaks what requires firstly good information/instruction of the farmers and availability of sufficient number properly trained veterinarians.
“The farmer awareness of the clinical signs of FMD and the consequences of the infection is critical to early identification of FMD. Farmers are the front line defence and the time it takes to notify a veterinarian about a suspect case will make a critical difference in whether the outbreak will be limited or widespread.” (RYAN).
Example: Hog cholera in the
3.5 The principal condition for any adequate anti-epizootic preparedness is to know thoroughly the “enemy”, i.e. to know well relevant disease, its distribution, etiological, clinical and epizootiological characteristics as well as to be able to recognise it in time and to block it.
3.6 Real FMD epizootiological situation changes every day and hour. Therefore, the measures must be flexible and applied on the spot immediately as the situation requires. They cannot wait for the decision based on data processing which are more for strategic solution than tactics and operational work. Under emergency there is no time for waiting for processed not always reliable data, often only of anamnesis values. Veterinary service must act immediately, also in suspect cases !
3.7 Late discovery of the FMD causes its further spread. One of the reason can be the confusion with similar diseases. Late discovery of the FMD was sometime caused also by incorrect initial diagnosis considering real FMD case as something else (looking for typical classical FMD symptoms not considering possibility of atypical course, e.g. without vesicles). In these cases increasing number of diseased animals, better expressed specific symptoms or further spread creating secondary outbreak(s) conduced finally to correct diagnosis and isolation measures.
Examples: “In cattle in
3.8 For the FMD diagnosis a particular role has specific epizootiological risk indicating the grade of possibility of FMD virus introduction and spreading under local conditions.
In former Czechoslovakia during 1957-1960 following ways of FMD virus transmission were reported (proved or supposed): by persons 46 x, by meat products and in connection with slaughterhouse operations 20 x, in the city with FMD vaccine production factory 13 x, by kitchen wastes 10 x, by animal transfer (movement) 7 x, by transport means and equipments 6 x, in connection with foreign countries 5 x, by milk 1 x and during common pasture 1 x. There were 6 cases of FMD recurrence in previously affected villages. (KOUBA, 1961).
3.9 Therefore, there is a need to be always very careful, i.e. first to consider the possibility of FMD occurrence and after rejecting it to continue finalizing the case diagnosis. There is much more responsible and acceptable to make mistake in expressing the suspicion of FMD occurrence, applying immediate provisional isolation measures and alarming the authorities, than vice versa ! First the application of provisional isolation measures and then consideration of other diagnoses !
4. Evaluation of recent major FMD outbreaks
4.1 The evaluation measures of any preparedness are practical results of dangerous disease prevention and control. Unfortunately, the recent disease introduction cases have demonstrated serious gaps in anti-epizootic preparedness. In order to avoid the repetition of disastrous consequences of disease introduction a lesson must be taken based on complex analysis of recent cases.
4.2 For this
purpose it can serve
4.3 The UK, one of the richest country, had been known as the "number one in the world” as far as anti-FMD conditions and preparedness *) were concerned: island country having natural barriers – seas; having excellent FAO/OIE World Reference Laboratory for the FMD – world leader in FMD research, diagnosis, virus typing and advise; having top level specialists influencing anti-FMD policy in the whole world; providing international experts advising organizations and countries how to diagnose and control the FMD; having veterinary service with above-average staff (in 2001 reported 12,251 government and private veterinarians), material, facilities, communication and transport means; having above-average financial, political (up to government and its prime minister) and armed forces support; having above-average competent and experienced farmers, above-average livestock industry, production and export; exploiting widely internet communication, using several bio-mathematical models for FMD introduction risk assessment, prediction and control, using navigation system satellites (GPS – Global Positioning System), etc..
*) “Preparedness and capacity of the UK Veterinary Service to control FMD, if introduced, was considered good in comparison with other countries in Europe”. (LEFORBAN, Secretary of the European Commission for the Control of Foot-and-Mouth disease - EUFMD).
In spite of having almost ideal conditions for anti-FMD action, the
- 1967/68 outbreak – 2,364 infected premises, 407,341 animals slaughtered and loss of 1.75 billion pounds sterling (SCUDOMORE);
- 2001 outbreak – 2,030 infected farms,
about 4 million animals sanitary culled (cattle – 594,000, sheep – 3,334,000,
pigs – 145,000 and other - 4,000) and loss of 3.1 billion pounds sterling (THOMPSON).
KITCHING et al. informed in 2006 about much higher numbers: “The official figure for the number of
animals slaughtered was approximately 6.5 million, but when the total number of
still-sucking lambs, calves and pigs that were slaughtered is included, the
total could be as high as ten million. The financial cost of the FMD epidemic in the
“This outbreak represented one of the worst
animal crises in living memory.” (STERNBERG and
CHORAINE). The 2001 FMD in
Note: It could be the consequences of “new”
antisanitary philosophy such as: "The need to remove technical obstacles
to the free circulation of animals and their products"; "It is
not longer possible to apply the old system under which animals and
animal products had to come from specific free zones, and were subjected to
isolation, quarantine, inspection and diagnostic testing before and
after export.". In: V. Caporale :
“Harmonization of activities of the veterinary services in
4.7 The catastrophic results proved that any anti-FMD programme cannot underestimate anti-FMD field activities consisting in clinical and epizootiological investigations and immediate measures.
4.8 Processed not reliable and not verified data, often only of anamnestic value, served more for confusing decision-makers, sitting in the offices isolated from the field reality, than for cost-effective problem solutions.
Example: “.. this amounted to a vast squandering of data on what was the world’ largest FMD outbreak.” “problems were exacerbated by the inadequacy of the information available…” “During the FMD outbreak it became apparent that DEFRA did not always have the quality of information needed to manage the disease control process. Even now, some of the official data produced on FMD is of debatable quality.” (DEFRA).
4.9 Obviously, no one theoretical mathematical software modelling FMD process and control had proved to be feasible and cost-effective under real field emergency UK FMD reality. This kinds of unrealistic models deviate the attention from the key measures for practical solution of acute anti-FMD problems wasting time and resources as well as confuse responsible decision makers.
Example: “EPIMAN software is
decision support tool to minimize the
impact of a disease incursion, using the example of FMD. The original
version of EPIMAN, developed in the early 1990s, was focused entirely on FMD.
All the data required is also needed for management of the epidemic, and in the
2001 epidemic in the UK, information was simply transferred daily by email
between London and New Zealand and results returned typically within 8 h. The
only integrated system for FMD control which contains spatial data and a
comprehensive suite of decision support tools is EPIMAN. Integrated
decision-support systems offer the best method of managing FMD outbreaks to minimize the cost and size of the epidemic.
Because the EPIMAN system developed in
The only usefulness criterion of any theoretical model is its practical impact, i.e. results.
4.10 The critical opinion of the author of this paper on mathematical modelling was again reconfirmed by R.P. Kitching, M.V. Thrustfield and N.M. Taylor who wrote in “Use and abuse of mathematical models: an illustration from the 2001 foot and mouth disease epidemic in the United Kingdom”, Rev.sci.tech.Off.int.Epiz., 2006, 25(1), 293-311:
“During the 2001 epidemic of FMD in the
“That is fine if you are
sitting in front of a computer screen in
“The consequences following the recommendations of these models were severe: economically, in terms of cost to the country; socially, in terms of misery and even suicides among those involved in the slaughter programme; and scientifically, in the abuse of predictive models, and their possible ultimate adverse effect on disease control policy in the future.” “The utility of predictive models as tactical decision support tools is limited by the innate unpredictability of disease spread..””A model constitutes a theory, and a predictive model is therefore only a theoretical projection.””It is not necessary to be mathematically literate to appreciate that no model will produce the right output when fed the wrong input.”
The authors support the opinion of the author of this web paper when criticizing the mathematical modellers: “..it was carnage by computer !” This graphically exemplifies the isolation and abstraction of ‘armchair epidemiology’ !” “Approximately three million healthy animals were slaughtered to control the epidemic.”!.
“The amount of slaughter that
took place is not longer likely to be tolerated by the public.” “..the public
memory of the mounds of dead animals, funeral pyres and burial pits cannot be
erased.” “The perceived merit of this action came from mathematical predictive
models… used as guides to control the 2001 epidemic in the
“Michal Osterholm, Director of the Center for Infectious Disease Research and Policy, University of Minnesota, has commented: ’In 30 years in public health, I’ve never seen any statistical modelling that had any impact on public health’.”
4.11 This example demonstrated very dangerous harmfulness of the “paper veterinary epidemiology” deviating the strategy and measures from the field reality and ignoring biological character of the epizootics and thus instead to help causing enormous losses. The mathematical modellers (working in four groups) share great deal of the responsibility for this disaster representing a shame for the veterinary medicine.
If practical results represent the main criteria
of any biological science, then catastrophic occurrence of the foot-and-mouth disease in
Note: During the international FMD simulation exercise in Czech Republic, 5-7 June 2001, organized by European Commission for the Control of the FMD, the UK representative-lecturer answered the question about actual UK FMD panzootic control that no country would be able to do it better (?!). It seems that self-criticism is an unknown term in veterinary services of those countries continuously demonstrating unjustified superiority (reminding colonial times). During 50th Anniversary Meeting of the European Commission for the Control of Foot and Mouth Disease, held on 11th June 2004 in Dublin, Ireland from almost fifty medals for the anti-FMD merits the majority were given to UK professionals; no one medal was given to professionals from Central and Eastern European countries participating also in FMD eradication in Europe and in anti-FMD protection of West European territories against FMD waves penetrating from South and East, thanks to effective FMD-eradication actions at home (not admitting any panzootics as e.g. in the UK in 1967 and 2001).
4.12 This example represents a very expensive experience with the application of the absurd “scientific ?” models for diseases control elaborated by the theoreticians having not idea about practical solution of complicated epizootiological problems. The tragedy is that this “armchair epidemiology” is taught by the majority of veterinary faculties and veterinary postgraduate training centres in the world only theoretically “preparing” incalculable thousands of veterinarians and “veterinary epidemiology specialists” for anti-epizootic actions and emergency preparedness. When considering this situation than it is understandable that the majority of veterinary manpower, in spite of its size and resources, is not properly prepared to be able to cope effectively with disease emergency.
“armchair epidemiology specialists” from some developed influential countries
(UK, USA, France, New Zealand, Italy, Canada, Australia, etc. ) are not only dominating
the OIE and the International Society for Veterinary Epidemiology and Economics
(ISVEE) but also imposing this dangerous concept (declaring their pure
theoretical approach as the only “scientific” one !?) on the majority of the
countries in the world. They even refuse to use the term of “epizootiology”,
the science for practical actions, in spite of its effectiveness, as “archaic term” !? The mentioned
“specialists” are historically responsible for international disease spreading
and globalization as well as for the failures
of many actions against emergency diseases as it happened for example in the
have been organized many international postgraduate training courses on
emergency diseases surveillance and control where the lessons have been given
by theoretical “experts” having not any
personal experience of successful programmes; the selection criterion for the
lecturers was their nationality (usually from the developed countries) and the friendship
with the staff of the organization financing the course. This policy reflects
the underestimation of the so called “non-developed countries” and super-estimation
of developed countries serving more as deterrent examples due to anti-epizootic
4.13 The only criterion of any theoretical model usefulness is its practical impact, i.e. the results which in this case proved to be not favourable. How control/eradication of a biological phenomenon such as FMD can be theoretically modelled for practical use under emergency when: every case is different requiring different measures, the situation is continuously rapidly changing requiring immediate actions, there is a great number of influencing factors (including human one) and available data depending on field investigations are usually incomplete and not reliable (garbage in, garbage out) ? There is difficult to understand why, instead to process FMD data “at home” for immediate actions, they were sent daily to be analysed in a very distant country on opposite side of our planet. This case serves as a deterrent example of the tendency to decide on emergency actions from a great distance (e.g. in comfortable offices without seeing animals and field conditions) instead to near the decision-making to field level where there is the most important stratum for FMD control and eradication.
4.14 The use of suitable software is desirable when it has proved as feasible and helpful for the solution of particular practical problems. This is valid also for mathematical models of epizootic processes and control measures.
4.15 The struggle against FMD cannot be won only from the offices in spite of having the most sophisticated computer software, theoretically trained “veterinary epidemiologists” for paper work and specialists for unquantifiable (= unreliable) “risk assessment”, etc.. It is not necessary to be mathematically literate to appreciate that no model will produce the right output when fed the wrong input.
4.16 There were many objective factors outside of veterinary services possibility influencing
negatively anti-FMD campaign in the
4.17 Above mentioned examples reflect enormous complexity, diversity and dynamics of the FMD as biological and social-economic phenomenon.
5. Lack of sufficient number of competent and well prepared veterinarians
How it was possible that such country as the
It is difficult to understand why from more than 12 thousand government
and private practice veterinarians in the
5.3 This case demonstrates very important experience that the majority of private veterinarians are usually not available for this type of emergency actions. These veterinarians were either not prepared for FMD emergency actions or were giving the priority to current curative practice providing them necessary personal profit and defending their “territory” against the concurrence. National emergency plan obviously didn’t calculated with them. To fill the staff gap there were imported foreigners not properly trained and not being properly acquainted with local conditions.
Example: ”The whole point of contingency plans is that
they should be in public domain and widely available and it is axiomatic that
they must be practiced to ensure that they are realistic.” “There were insufficient State Veterinary Service
(SVS) veterinary surgeons, many of whom were poorly trained, provided ineffectual leadership..” “There was very
poorly organized recruitment of additional veterinary surgeons to act as
temporary veterinary inspectors. There was no formal system for assessing the
ability of those recruited and for training those who needed training.” “.. inadequate numbers of trained staff”. “.. size
of the SVS was insufficient to cope with a major epidemic of foot and mouth
disease..” “ It is likely that FMD was present in the
5.4 One would expect
that after 2001 disaster the government service in the
Example: "A large rendering company in
5.5 For successful implementation of anti-FMD programmes is needed professional veterinary staff in terms of number, qualification and availability. To increase the number of government veterinarians is not easy due to ad absurdum underestimation of the role of public veterinary service. However, the improvement of the knowledge and skill needed for anti-FMD programme can be achieved soon and easier. The solution is undergraduate education and postgraduate practical training aimed at emergency situation.
5.6 The weakest link in the chain of anti-FMD preparedness was the underestimation of decisive role and preparation of veterinarians at grassroots’ level and of practical epizootiological surveillance of country animal populations. The prevention, timely detection and control of introduced dangerous disease require a complex of preparedness measures, where the key role play field activities. Any effective preparedness requires necessary number of thoroughly trained veterinarians to be able to detect relevant disease or its suspicion and apply immediate isolation measures.
5.7 Veterinary service privatization imposed by some international organizations, such as World Bank and International Monetary Fund (without any protest of global animal health organizations such as OIE), on the majority of the countries has seriously debilitated up to paralysed government service capacities for effective emergency programmes which cannot be replaced by any legislation, management, paperwork and computer use or contracts with individual profit-oriented private veterinarians. Chief Veterinary Officers (CVOs) are responsible for disease control in the country having not necessary staff and resources for its implementation. CVOs are often in the position of generals with their headquarters but without necessary number of properly trained “solders” to implement the strategy and tactic operations. Without sufficient number of well trained veterinarians and adequate chain of unified centralized command cannot be won any anti-FMD war without great losses.
“To cope with ever-increasing demand on Veterinary Services, … ,which currently only have a limited number of government personnel. There are increasing demand for the prevention and control of diseases…. Furthermore, consumers are becoming more and more interested and demanding in regard to the safety of livestock products. This means a heavier workload for the Veterinary Services. However, current veterinary manpower is inadequate to cope and the recruitment of additional workers is difficult in the light of the continued downsizing of the Government.” (OZAWA et. al.).
“DEFRA’s ability to implement its slaughter policy was seriously affected by a shortfall in the number of vets available. This situation was brought about partly by cuts to the State Veterinary Service during the 1980s.” (DEFRA).
“Dismemberment of the public sector. The Animal Virus Research Institute at Pirbright was depleted of its active scientists from a peak of some 300 in the 1970s to about 120 in the 1990s. In parallel with this decrease in public sector research and development, there was a similar run down of the personnel of the teams of field veterinarians who were in the employment of Ministry of Agriculture, Fisheries and Food (MAFF) and who was as part of their normal duties are required to engage in routine inspection and surveillance activities.” (SPIER).
5.8 We are witnesses of minimal or nil practical preparation of decisive staff - veterinarians of public and private services for emergency situation. Instead of strengthening field, slaughterhouses and laboratory staff of public services independent on private sector, these services during last two decades were significantly reduced and replaced by not always reliable private veterinarians. Debilitated public veterinary service has minimized its ability to protect country territory against the introduction of dangerous disease pathogens, to eradicate them, to surveille epizootiological situation and supervise/inspect private sector. Private veterinarians have naturally other interests (e.g. profitable curative or other practice), usually not compatible with defending all society interest, such as protection of country animal populations’ health.
5.9 Extreme reduction of government sector has conduced to global crisis of public veterinary services being not able to cope effectively with epizootics. As the consequence communicable animal diseases are spreading towards their globalization.
Example: “Since the mid-1980s structural adjustment programmes in developing countries have led to a demand for the privatization of veterinary services, thus aiming at drastically diminishing the role of the state in these activities. Surveillance, early warning, laboratory diagnostic services, planning, regulation and management of disease control programme, as well as ensuring the quality and safety of animal products were secondary considerations. The chain of veterinary command that required notification of disease outbreaks enabling a response to disease emergency and which also ensured the management of national disease control programme, was often dismantled.” (RWEYEMAMU and ASTUDILLO).
5.10 The tragedy is that among internationally influential veterinarians are those who publicly support government veterinary services dismantlement propagating further privatization of veterinary services. The irony is that this “idea” is being declared as the “strengthening of veterinary services” in spite of minimizing country capacity to cope with epizootics such as FMD. The propagators of this concept are usually veterinary theoreticians having no any responsibility for animal population health in their home countries.
Example: “Complying with the SPS agreement demands the strengthening of veterinary services..” Recommended alternative solution – “Privatization of services..” (ZEPEDA).
5.11 Similar contradictory and false is the statement of the WTO/SPS “Desiring to improve the human health, animal health…in all Members” while in the whole document is no one word for improving health. On the contrary, it serves only to conceal the facilitation of the trade at the expense of animal and human health in importing countries, i.e. facilitating disease propagation through international trade. ZEPEDA wrote openly: “Its main intent is to avoid the use of sanitary .. measures as unjustified barriers to trade.”, i.e. the main intent was “not improving health”. What are unjustified barriers to trade ? The requirements for the import of healthy animals and pathogen-free products are unjustified barriers to trade ?! The barriers are the diseases in exporting countries !
5.12 Exporting countries loosing previous motivation for disease-free export reduced or stopped demanding and costly disease eradication programmes and started risky export regardless health protection in importing countries, i.e. export of non-disease-free animals and non-pathogen-free animal products.
6. Underestimation of field practice
6.1 The anti-epizootic preparedness requires a sound pyramid of actions, i.e. giving necessary importance to the lowest level of actions at field conditions where the problem starts and must be resolved. Unfortunately, the current emergency preparedness pyramids are overestimating central level of management at the expense of grassroots’ actions.
6.2 “Coping with the outbreak of
FMD has stretched some State Veterinary Services to the limits of their
abilities. This confirms previous reports from the Food and Veterinary Office
of the European Commission that many Member States of the European Union
have inadequate veterinary manpower to deal with not only animal health but
also animal welfare and veterinary public health requirements imposed by the
European Union legislation.” “…in the
6.3 The above statement reflected the gap in veterinary service staff preparation for practical anti-epizootic actions. Unfortunately, the education and training in veterinary epidemiology was directed only to office work such as statistics, economics, use of computers, modelling, risk assessment, etc. (TOMA et al.) passing by practical field activities such as population investigations and anti-epizootic measures. The veterinary epidemiology was addressed to the officers of public services working mainly administratively in the offices isolated from daily animal population health problems solution. Very narrow concept of this subject was not preparing the students and postgraduate trainees for practical skill to be able to identify affected, suspect, threatened and specific disease-free animals and herds, limits of outbreaks and perifocal zones etc., i.e. to carry out very demanding epizootiological diagnosis based on anamnesis, clinical, laboratory and population investigations.
Note: Unfortunately, this theoretical concept had been imposed as a “international model” on many countries, e.g. to replace or significantly reduce practical-action-oriented epizootiology, strong undergraduate and postgraduate subject being taught during many decades in the universities of Central and Eastern Europe and of many other countries. Also in many international training courses on disease control during 1990s (e.g. on disease surveillance in Teramo 1992), organized by EU to give “lessons” to Central and Eastern European countries having rich practical experience and results, were as the lecturers Western Europe theoretical “veterinary epidemiologists” without any practical experience. Converting action-oriented practical subject into theoretical one conduced to significant reduction of anti-epizootic preparedness close to holey system of the EU.
6.4 The case of UK FMD 2001 demonstrated total failure of narrow theoretical “veterinary epidemiology” confused with veterinary statistics and economics as it has been taught in the UK and in many other universities applying the same concept.
Example: The degradation of veterinary epidemiology as very complex biological science into something else can be demonstrated by the WHO Consultation on Development and Training in Veterinary Epidemiology, Hanover, Germany, 9-11 October 1990: “The meeting demonstrated the gap between theory based on sometimes excessive use of mathematics and computer modelling without orientation to action and the need for cost-effective practical application in the field. The relative isolation of the sophisticated methodology represent one of the major obstacles for the wide use of epidemiological methodology in veterinary medicine, particularly in the developing world.” Among participating “teachers of veterinary epidemiology” from veterinary faculties of some so called “developed countries” were mathematicians and economists (!?).
More comments see in http://vaclavkouba.byl.cz/dictepid.htm.
6.5 Restricted theoretical "veterinary epidemiology" of relatively low practical importance has been unfortunately imposed upon international organizations, international postgraduate training, undergraduate education, research and publications in many countries, mainly developing ones. The “veterinary epidemiologists” have been trained to be able to collect, process and disseminate data, assess theoretically the risk, disease modelling, etc. but not to be able to monitor, investigate, detect, control, reduce and eradicate communicable diseases at animal herd and population levels. This clarifies the fact that many so called "veterinary epidemiologists" were not involved in field control programmes with professional responsibility for their results. (What a difference in comparison with clinicians who after case diagnosis must solve the problem on the spot!) This is obviously the reason why the majority of about 500 veterinary faculties existing in the world have not "veterinary epidemiology" or “epizootiology” in the list of undergraduate curriculum mandatory subjects (in spite of international recommendations to include in the curriculum the veterinary epidemiology or epizootiology as separate subjects - see Report of the Fourth FAO/WHO Expert Consultation on Veterinary Education, Uppsala, 1978). Unfortunately, education and training programmes are concentrated on lucrative curative medicine leaving very limited time to communicable disease prevention, diagnosis and control at animal populations’ level. In other words, the preparation of veterinary manpower for dangerous disease prevention, diagnosis, control and eradication under emergency situation has been in general absolutely insufficient. This fact is reflecting global crisis of veterinary education not respecting the priority needs of animal and human populations’ health protection against transmissible diseases.
6.6 If practical results represent the main criterion
of any applied biological science usefulness, then catastrophic occurrence of the FMD in
6.7 Required output of any animal population health activity are final practical results and not papers: deeds not words (acta non verba).
7. Simulation exercises
7.1 There are different forms of the preparedness against FMD. One of them is represented by simulation exercises. These exercises are very important components of any anti-FMD preparedness.
7.2 Examples of FMD simulation exercises:
- International organized by: FAO in Uruguay and Colombia in 1984, in Korea in 1986, in Thailand in 1986; FAO/EUFMD in Italy in 1990, in Poland in 1998, in Czech Republic in 2001, etc.; PANAFTOSA in Mexico in 1977, in Brazil in 1981, in Peru in 2005, etc.; by Mexico/ United States Commission for the Prevention of Foot and Mouth Disease along their common borders in 2003, etc.; (the relatively best FMD simulation exercises have been organized by PANAFTOSA which has produced several extremely useful and detailed manuals for FMD control).
- Organized by National Veterinary Services: Canada in 2000 and 2004, Cyprus in 2003, Russia in 2003, Australia in 2002 and 2004, , Scotland in 2003, Austria in 2004, Iceland in 2004, New Zealand in 2002, Canada/USA/Mexico in 2001, USA/Canada in 2005, Colombia in 2004, Ireland in 2004, Netherlands in 2004, UK in 2004, Germany in 2002 and 2003, Switzerland in 2003, France in 2003, Bulgaria in 2003, Panama in 2002, Lithuania in 2002, etc.
7.3 Today, there are very few veterinarians having personal experience of FMD and other very dangerous diseases. In this context it merits attention the statement of LEFORBAN and GERBIER that “the level of awareness of the different stakeholders plays a major role in the early detection of FMD. After little or no FMD in western Europe over the last twenty years, awareness of the disease has decreased dangerously. To improve the level of awareness, training and information are needed. Simulation exercises should be encouraged to verify that the different steps of contingency plans are really in place”. Unfortunately, as I know, the majority of FMD simulation exercises organized nationally and internationally for veterinarians have been more theoretical than practical, i.e. not applying the principle “learning by doing” under simulated field emergency conditions.
7.4 The majority of simulation exercises have had a character of workshops consisted in listening the instructors, watching slides, films, videos and using audio-visual means, reading documents, contingency planning, data processing, experience exchange and discussions combined with the visits of farm/ranches and different demonstrations (e.g. clinical investigation). This training with prevailing theory and paper work without individual involvement of the participants, sometimes even without seeing the animals, has often represented the main FMD simulation exercise form. These kinds of FMD simulation exercises have been lacking the most important component – practical training of individual participating veterinarians in clinical and epizootiological investigations targeted at FMD. This kind of theoretical exercises has usually low effectiveness and the acquired knowledge can be easily forgotten.
7.5 All forms of FMD simulation exercises have been important but not of same weight for anti-FMD actions.
7.6 Theoretical training cannot replace simulation exercise consisting in practical field activities – under simulated conditions to investigate and identify FMD suspect, affected, threatened and free animals, herds and zones what is the key for any cost-effective FMD control action. Under real emergency situation the results of these investigations serve as the main source for local and territorial analyses of FMD epizootiological situation and for identifying the most cost-effective strategy and measures at all managerial levels. Without good knowledge of FMD epizootiological situation, based on systematic herds and populations’ investigations and surveillance, the control measures must be made through guesswork (semi-blindly), i.e. not corresponding with real situation and needs.
7.7 Theoretical FMD simulation exercises are much cheaper and easier to organize than practical training at farm/ranch level simulated conditions when every participant must work individually, i.e. after clinical and epizootiological investigations to identify relevant isolation, eradication and sanitation intra-focal and perifocal measures. Theoretically is almost everything “clear”. However, the problem is practical application and results of the contingency plans and relevant regulations. Theoretically “everything” is evident and transparent but its transfer into practice is something else ! Paper can bear anything.
Example: On 15 October 1970 in a cattle farm I attended as an foreign observer a FMD simulation exercise guided by theoretically very well prepared „international FMD expert“ from a continental FMD centre. He started with one hour filling anamnesis form and then he tried to demonstrate to about thirty participants how to clinically investigate a cow. To my surprise, he was unable to pull out the tongue of the cow ! Filling paper forms is easier !
7.8 The simulation exercises have been organized mainly at the top of management pyramid, i.e. at national managerial level. For the success of any anti-epizootic action the decisive is the grassroots’ level where the epizootic processes start, develop and end. Without effective actions at field level the decisions at central level cannot be implemented to become cost-effective reality. Therefore, the anti-FMD practical training should be realized at all levels of management pyramid and all part of veterinary services.
7.9 The veterinarians must be trained to be able to react immediately to the worse FMD scenario. In spite of contingency plans and simulation training we must be prepared for practical solution of extreme FMD situations at all levels, first of all on-the-spot.
Note: In these days (September 2005) we are witnesses
of an extraordinary natural disaster in
7.10 The veterinarians must be able in case of suspicion to find out the diseased (including the eldest case for the estimation of the entry date and outbreak duration which is very important for FMD tracing), suspect, threatened and healthy animals of susceptible species, to identify the limits of the outbreak and the limits of perifocal area (including mapping) as well as to apply the isolation and intrafocal provisional measures. They must be able to find out the best possible samples for laboratory investigations. They must be able to trace the way of disease introduction and of its eventual further spreading – contact herds and animals.
7.11 Field simulation training should cover all levels of government and private services (private veterinarians can be the first to discover this disease).The practical simulation exercises should start with leading national and provincial veterinary officers who should be able to do the field work themselves, in spite of the fact that their role will be more of managing anti-FMD actions. FMD simulation exercise requires to respect different level of FMD control responsibility of the participants and must be adjusted correspondingly.
7.12 Results of clinical and epizootiological investigations are bases for any effective anti-FMD actions. After the field diagnosis starts the application of prepared scenarios in form of instructions and contingency plans at different managerial levels. Incorrect diagnosis = incorrect decision.
7.13 Detailed methodology of the practical FMD simulation field exercise see in http://vaclavkouba.byl.cz/simulation.htm .
8.1 The weakest link in the chain of anti-epizootic preparedness is critical lack of sufficient number of well practically trained veterinarians of public and private services.
8.2 The main problem of anti-epizootic preparedness, beside the insufficient anti-epizootic country protection, is the delay in discovering and isolating the outbreaks, first of all the primary outbreaks. Therefore much more attention must be given to the emergency simulation training in clinical and epizootiological investigations and in provisional measures’ application under field conditions.
8.3 The key problem for successful cost-effective anti-epizootic control is to detect in time any outbreak starting with the primary one! It depends firstly on the ability (preparedness) of all who are involved in livestock breeding, production, trade, animal products processing, etc., i.e. who are in the “first front line defence“. All of them should be properly instructed and practically trained to be able to recognize the suspect cases (not necessarily the disease itself which anyway must be confirmed by specialized laboratory), to apply immediate provisional isolation measures and to call immediately relevant public veterinary and other government authorities.
8.4 The veterinarians must be trained to be able to react immediately to the worse FMD scenario.
8.5 Public veterinary service staff and management structure must be strengthened as much as possible to be able to cope effectively with emergency situation.
8.6 The science will continue to bring new and much better diagnostic and control methods, emergency planning will continue to be further improved, economic, social and other society conditions will hopefully be more favourable for disease control etc. However, practical knowledge and skill needed for dangerous diseases detection and diagnosis and for prevention from spreading will be always the basis for any cost-effective anti-epizootic actions.
8.7 The investigations and measures in the field cannot be replaced by any distant observation of animals, any office work, any use of software, any modelling or even use of satellites. Therefore, the veterinary manpower must be prepared as best as possible for exigent anti-epizootic activities under emergency situation.
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More information on the principles of preventive and control/eradication measures applicable on FMD see in http://vaclavkouba.byl.cz/
Letter of the author:
Dr Yves Leforban
European Commission for the Control
of Foot-and-Mouth Disease (EUFMD)
Animal Production and Health Division, FAO
Vialle delle Terme di Caracalla
I t a l i a
Ref.: Recommendations for the improvement of the foot-and-mouth simulation training
Dear Dr Leforban,
Many thanks for prompt
sending of the documents I asked for when I met my friend Joan Raftery in
I wanted to discuss the FMD preparedness of veterinary services.
According to my experience the main problem is the delay in discovering and isolating the FMD outbreaks, first of all the primary outbreaks. Therefore much more attention must be given to the FMD simulation training in clinical and epizootiological investigations and in provisional measures application under field conditions. Anti-FMD action starts and ends at grass-root level, i.e. in the field. This cannot be replaced by paper simulation exercise in lecture halls which is relatively simple to organize but without necessary effect.
The veterinarians must be able in case of suspicion to find out the diseased (including the eldest case for estimation of the entry moment and outbreak duration which is very important for FMD tracing), suspect, threatened and healthy animals of susceptible species, to identify the limits of the outbreak and the limits of perifocal area (including mapping) as well as to apply the isolation and intrafocal provisional measures. Initial demonstration should be followed by practical work of all individual participants.
In my postgraduate simulation courses, based on the principles “teach teachers to teach” and “learning by doing”, I preferred to start with leading national and provincial veterinary officers (they must be able to do the field work themselves in spite of the fact that their role is more of managing and organizing anti-FMD actions according to their emergency plans). Field simulation training should cover all levels of government and private services (private veterinarians can be the first to discover this disease).
In my courses I tried that every participants must clinically investigate all “predilect” places of cattle, pigs, sheep and goats to look for natural (or artificially provoked – chemically) changes for differential diagnosis and sample collection (using also probang method). Every time when investigating herds of tens or hundred animals, it could be found natural pathological changes in mouth, lips, interdigital spaces, teats, etc. “Intrafocal and perifocal” clinical investigations were always complemented by epizootiological investigations (including mapping) and by elaboration of control measures tailored for the particular local situation.
With best personal regards to you and to Joan
Vaclav K o u b a
*) Chief Epizootiologist responsible for the eradication of FMD in Czechoslovakia during 1956-1975; Chief of successful international anti-FMD expedition in Mongolia in 1964; PhD thesis: epizootiology of the FMD; research and many publications on FMD investigation, diagnosis, control, eradication and economics; as professor of epizootiology in several universities in Europe and Latin America using FMD as the main model disease for under- and post-graduate courses (including simulation exercises); etc. “
Example of anti-epizootic emergency planning
1. From the exotic animal diseases the foot-and-mouth disease (FMD) was considered as the most dangerous one threatening the country. For immediate response to the FMD or other exotic disease suspicion were prepared at all managerial levels thorough anti-epizootic emergency plans. To have everything needed ready in advance and not to waste time in the emergency, at all managerial levels (i.e. national, provincial, district, municipal and large livestock units) there were elaborated “anti-FMD emergency plans” assured by staff, material and budget, regularly updated and usually verified through simulation exercises. The first emergency anti-epizootic plans were prepared in 1959 based on the experience with FMD control.
2. Among the main components of emergency plans belonged: very detailed procedures of clinical and epizootiological investigations, elaborated texts of intrafocal, perifocal and protective zones’ measures; pre-printed information texts, texts of public notices (quarantine orders), different questionnaires and forms to be filled (for specimen shipment to laboratory, for registration of and reporting on emergency disease situation, for vaccine provision order, etc.); lists of addresses and telephones of: veterinary service responsible officers and exotic disease emergency specialists (in the districts also of all veterinarians), members of anti-epizootic committee, Reference Laboratories, Chief Veterinary Officer, Chief Epizootiologist, facilities of local up to national importance (e.g. slaughterhouses, rendering plants, sources of and stores with material needed for anti-exotic disease actions); list of villages and large ranches with the numbers of animals according to their species and categories; local and territorial maps, etc.
3. “Model of Emergency Plan for the case of foot-and-mouth disease or other dangerous infections” issued by Czech State Veterinary Service for District Veterinary Directorates, 1974, 74 pp.: Contents: emergency plan – anti-epizootic alert measures, measures in case of infection suspicion, 24 hours preparedness; the most important addresses and telephones of district, provincial and national importance; principles of clinical investigations of animals suspect of being affected by the FMD; contents of emergency case; instructions for veterinary care in FMD outbreak; equipment of veterinarian detached to work inside the outbreak area; contents of emergency bag; instruction for the collection and sending of specimen for laboratory investigation on FMD , including special order form; model for recording FMD investigations; veterinary measures in FMD farm; model of final report on FMD at affected ranch (farm); model of diary recording FMD course in an outbreak; methods of clinical investigations in affected village; measures in affected village (including demands on medical service); model of final report on FMD course in affected village; text of an order of District Veterinary Service Chief for anti-FMD prophylactic vaccinations; model for recording ( list) of animal owners and number of anti-FMD vaccinated animals; emergency plan of Central of Veterinary Sanitation Institutes and its branches; abattoir certificates; instructions for meat processing industry; principles for meat treatment in FMD outbreak; and model for daily reporting of FMD course in the outbreak. Documents to be filled by the District Veterinary Service Chief: list of veterinarians of the district according to individual working places together with exact addresses and telephone numbers; list of district anti-epizootic commission members, including addresses and telephone numbers; list of provincial diagnostic groups including addresses and telephone numbers; list of villages in the district including numbers of animals according to species and categories; list of neighbouring District Veterinary Directorates, including addresses and telephones of District Veterinary Service Chiefs; list of mechanized equipments and technical facilities for DDD (disinfection, disinsectization and disinfestation) according to individual organizations; district map for plotting outbreaks and identification of I. and II. protection zones. Total: 26 components and 19 annexes.
4. All the above mentioned information and documents for the emergency there were deposited in “emergency envelopes” ready to be used immediately in case of need. They were submitted to regular revisions and updating. The plans were guarded in sealed envelopes being available at any moment.
5. Anti-epizootic emergency plans were interlinked vertically creating a pyramid system from district up to national levels.
6. Preparations for emergency situations were verified by simulation exercises at all managerial levels combining practical field and theoretical in-door components.
7. Permanent readiness (24 hours-a-day) was organized at FMD Reference Laboratory and at all levels of public veterinary service from local to national, i.e. to be at any moment available for immediate anti-FMD action at least one responsible officer whose address and telephone number were known to veterinary staff. Similar arrangement was made to reach in any time National Chief Veterinary Officer and the Chief Epizootiologist.