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UNPREPARED VETERINARY MANPOWER -
THE WEAKEST LINK IN THE CHAIN OF DANGEROUS DISEASE EMERGENCY
PREPAREDNESS (provisional text)
V. Kouba
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
Contents
1. Introduction
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
8. Conclusion
References
Annex
1. Introduction
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 1.4.1.1) 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.
Example: In
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
will enter
More information see in http://vaclavkouba.byl.cz/riskassessment.htm
and in http://vaclavkouba.byl.cz/globsurveillance.htm.
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.
Example: In
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
In former
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..
4.4 The
----------------------
*) “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).
4.5
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
4.6
The
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
“ 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.
Leading
“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
There
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
fiascos (
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
5.1
How it was possible that such country as the
5.2
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.
Examples:
“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. Conclusion
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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Annex 1.:
Letter of the author:
“
Dr Yves Leforban
Secretary
European Commission for the
Control
of
Foot-and-Mouth Disease (EUFMD)
Animal Production and Health
Division, FAO
Vialle
delle Terme di Caracalla
0010 Roma
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. “
Annex 2.
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.