ANIMAL AND PUBLIC HEALTH ISSUES WHICH NEED GLOBAL RESPONSE STRATEGIES TO PROTECT POOR FARMERS
There are three key features of current developments which impact on the welfare of poor livestock farmers and which require effective and innovative responses:
KEY FEATURES OF THE REQUIRED RESPONSE
Each of these emerging dangers to the welfare and food security of poor farming families requires a targeted and carefully planned response. The proposed strategies are set out below.
A development strategy for the elements of the programme is given in the following paragraphs.
Detection, prevention and control of high-impact (epidemic) diseases
The first element of the proposed strategy to assist poor and marginalized farmers is to build more effective systems to reduce the risks of high-impact animal diseases spreading to new areas or intensifying their effects in regions least able to manage such problems.
Many of these high-risk regions of the world are areas where incomes, knowledge and resources to respond are extremely scarce. They are at trading crossroads of the world and hence exceptionally prone to disease outbreaks, because trade through these routes is increasing. What were once well established trade networks are becoming increasingly complex webs of movement, involving opportunities for exposure of large numbers of animals to serious and highly transmissible disease agents. Many of what are now the highest-risk situations were not of such concern when trading followed traditional patterns for which the risks were well understood by local people.
Clear examples of these issues can be seen for rinderpest and FMD (see Chapter 2).
The decline in strength, capacity and distribution of veterinary services over recent years means that the capability to respond has been substantially impaired.
It is therefore necessary to produce innovative approaches for global and regional management of these high-impact diseases, using novel techniques that will provide maximum benefit in relation to the inescapably limited resources available. A strategy for achieving this is outlined below.
Building a strategy to minimize risk of disease spread to new areas.Effective prevention of disease spread requires modern techniques of risk management, in which epidemiological skills and knowledge are combined with a structured process of identification of likely disease agents, assessment of the severity and nature of the risks and the areas of the country at highest risk for entry and spread of the disease. Appropriate strategies can then be developed and implemented to minimize the risks.
It will therefore be necessary to strengthen epidemiological expertise and approaches in national animal-health services to provide skills to enhance the effectiveness of disease detection and control in these countries.
Risk analysis. Only a few of the most advanced countries have well developed risk-analysis systems, and their efforts are mainly devoted to assessing risks in relation to import of high-value products from other countries.
There is a need to promote wider adoption of risk analysis and apply it to the problems of low-income countries, not just to the richest countries. This will require an investment in making risk analysis easier for such countries to conduct by developing suitable tools and adapting them to differing needs, training in the application of techniques and implementing pilot projects in which analytical templates can be developed and applied in data-sparse countries. The case studies are then written up and used to train other countries.
Risk-based animal disease surveillance and early warning systems.The core requirement for enhancing the effectiveness of control activities against high-impact diseases is to develop surveillance systems that focus on the greatest payoff in detecting disease and demonstrating freedom from specific diseases. Surveillance funds are always scarce, so the aim will be to take available funds and invest them in a portfolio of surveillance procedures that will provide the best possible benefit in relation to the funding available. The system will include scanning elements, which provide a broad assessment of the disease status of the country, and focused elements, which answer specific questions about national disease status. It will be risk-based, in that it will direct surveillance resources at activities and areas of the country in a way that is weighted according to the probability of adverse events and the likely consequences of such events.
In recent years, new and improved epidemiological methods have been developed to deliver disease surveillance. These include structured clinical and observational surveys of the population, serosurveillance, use of geographical information systems and remote sensing to provide information at lower cost than field data gathering, application of low-cost strain-differentiation methods using molecular epidemiological techniques delivered through kits to eliminate high processing costs and interview methods to gather information direct from livestock herders.
There is growing scope for gathering particularly valuable predictive information through image analysis of remotely collected data, such as vegetation mix and growth patterns, which can then be used to target field examination at sentinel sites most likely to yield representative information, such as the typical mix of herders, or indicator information such as areas subject to flooding or growing particular feed types. By using remote sensing to choose sites at which to conduct interviews and sampling, comprehensive data can be accumulated and used to develop statistically valid indicator variables that can be measured in place of the variable of interest, but provide a low-cost guide to disease developments.
Use of a portfolio of these techniques is making it progressively more practical to identify emerging patterns of disease early and put disease prevention and control measures in place, using economic methods to determine what mix of measures is most cost-effective.
Data from a structured mix of techniques can now be integrated through an information system and analysed to extract maximum value, using new epidemiological techniques that synthesize various types of data to yield the best assessment of the current situation and detect warning signals.
Such systems can be provided to low-income countries in a form that allows them to be implemented cheaply; resources can then be redirected to more productive uses. The systems can be used to provide reassurance about the current situation and early warning of unfavourable developments, which will then allow protective action to be taken.
Development of effective surveillance systems requires substantial investment in training of personnel, since the current level of skills in most countries is not yet adequate.
More accessible disease diagnosis
Major losses to disease-control effectiveness in recent years have been the decline through under-resourcing of veterinary diagnostic services and the slow development of alternative ways of providing reliable diagnostic capability. This situation can have serious effects on the speed and effectiveness of the national response to an emerging disease threat.
It seems unlikely that laboratory services will be fully restored, so there is a great need to take steps to restore the capability they provided. This can be achieved through a mix of new diagnostic technologies such as pen-side tests and kit-based strain typing and rebuilding core competence in national and regional laboratories. This will involve training in specific diagnostic techniques and application of these techniques to effective disease surveillance.
Early reaction and measured response to unfavourable disease trends. Surveillance and early-warning systems will only produce a payoff if prompt decisions are made about how to respond to information, followed by effective implementation. This means responding quickly and decisively to imminent threats but adopting a measured approach in which instinctive reactions are avoided and each response is appropriate to the scale and nature of the threat.
To achieve this, contingency planning for high-risk diseases and their control will need to be intensified and considerable effort devoted to assisting countries to plan and manage control programmes for diseases present in the country or threatening it. Such efforts benefit the recipient country and all its neighbours, who are likely to suffer if control measures are inadequate.
There is a need to strengthen the practical effectiveness of regional cooperation efforts in disease surveillance, early warning of emerging problems and coordinated response to potential disease incursions. This will require more effective contingency planning at regional level, joint training, effective liaison and sharing of access to scarce resources that will assist control efforts.
A key area on which animal-health services need to focus is ensuring that their actions are acceptable to and supported by the community, including how to build effective partnerships for action among public, private and NGO sectors involved in animal health. In many countries, this will require development of more effective and comprehensive stakeholder-consultation processes and creation of cooperative links among sectors contributing to animal-health delivery. This in turn requires consensus on the role of each sector and mutual recognition of value. If this is achieved, each sector can be empowered to fulfil its functions effectively.
Solving problems of vaccine and drug delivery systems for disease prevention and control measures. Although there is still scope for developing new vaccines and treatments for various diseases, the shortfall of greatest significance to poor livestock farmers is in low-cost, easy-to-use delivery systems. There is growing evidence of the potential of novel delivery systems for vaccines in food, water or by aerosol, for example, which can reduce costs and increase population coverage because of ease of administration. There also needs to be greater emphasis on achieving high immunogenicity of new and traditional vaccines at the point of administration, without the need for expensive cold chains from source to user; considerable progress has been made with this. There remains a problem of changing attitudes towards accepting these techniques as genuine, useful alternatives or complements to traditional vaccination technology.
There is a need to move from current disease control through routine mass vaccination towards more subtle approaches in which management changes, targeted vaccination and other techniques are combined in integrated low-cost strategies. Such control programmes can make effective disease control a realistic possibility in poor communities by bringing the costs within reach. The potential for this is greatly increased if the immune response to the vaccine is such that it is still possible to differentiate infected animals from vaccinated but uninfected ones. Vaccines with accompanying discriminating tests are becoming more readily available and seem likely to be an important tool in the future. Local strain variation in disease agents needs to be considered. Although it is much more cost-effective to use generic vaccines that can be used for different populations, this must not be allowed to override the need to ensure that each vaccine genuinely provides protection in the various populations, otherwise the confidence of low-income communities in vaccination will be undermined.
There is scope to achieve comparable delivery enhancements with a range of drugs used for treatment and prevention, although this is a long-term task.
Expanding access of low-income countries to international market opportunities
Many of the poorest countries and communities have little or no opportunity to enter the international market for animals and animal products, even at regional level, because they do not meet expectations for veterinary services or disease status. There is a danger that globalization trends will exacerbate this exclusion from markets. What is needed is a long-term strategy to build marketing opportunities for poor countries, without putting other countries at risk. This will provide encouragement to poor farmers to pursue market opportunities for their animals and products.
In the developed world, performance standards are increasingly applied that can assess the adequacy of veterinary services and hence identify elements that exceed or fall below the required range. Imposing the same standards on low-income countries excludes them from trade, so there is a need to develop a sequential approach whereby countries can move up by steps in animal-health services, as they do in disease status, and progressively gain access to market opportunities. This would provide poor countries with achievable goals and benchmarks of other countries against which to evaluate themselves. In comparison with areas such as medical care or education, animal-health services make less use of benchmarking as a tool and there is scope for it to help rather than disadvantage poor countries.
Developing effective partnerships for delivering animal-health care to low-income communities
In recent years, considerable experience has been gained in development of animal-health services for low-income groups through community-based animal-health workers. They receive simple training from people with formal veterinary skills and then offer standard packages of extension advice and treatment, deriving income from selling products. Such services have typically expanded from an initial pilot study to cover much larger areas and have generally been very successful. They have, however, depended for cohesion and continuity on the enthusiasm of the people leading the programme. Long-term viability rests too heavily on this leadership, so there is a need to link such services more closely with other delivery systems.
While this bottom-up approach has been growing in popularity, there is a top-down requirement for privatization of veterinary services in countries where they have been predominantly public. This process has operated successfully in countries with a commercial-farming sector, but has not expanded in countries where few people can pay private-sector fees for animal-health care. In such situations, poor farmers urgently need animal-health care, yet scarce veterinary resources are diverted to areas which generate income for the veterinarians but little benefit to the low-income communities.
It is proposed that a major strand of the proposed programme should focus on broadening coverage of effective animal-health services for low-income communities, integrating all personnel and delivery mechanisms into strategies that are flexible but targeted to the needs of particular mixes of animal species, spectra of important diseases and lifestyles of the communities. This will involve investigating successes and failures, then building on that experience to guide country studies to test integrated private/public approaches to meeting animal-health needs. Experience gained would then be applied on a larger scale by assisting other countries in the target group to develop approaches based on the results.
Best results are likely to be achieved where the distribution and marketing skills of commercial enterprises are combined with the local knowledge and community standing of NGOs, official veterinary services and community organizations to develop delivery models that are effective in the circumstances of the country. In many countries most needing to overcome the barriers, the relative infrastructure is weak to non-existent. Organizations are needed to ensure that mechanisms are in place throughout low-income countries, not just in limited areas where the drive exists locally, to meet this need and make such systems work in the long term. This will require a methodical process of identifying suitable organizational structures and assisting them to provide the services.
Opportunities for applying newer technologies to communicate with target groups
Village farmers have been prevented from adopting high-return investments in animal-health because it is difficult to distribute appropriately targeted information over large areas where travel is expensive and time-consuming. Experience in evaluating communication strategies for animal-health messages in such situations suggests that strong emphasis on traditional communication methods is important, but that many communities are strongly influenced by information received through technologies that are new and exciting to them. In view of the high cost of using traditional communications methods to reach remote communities, the benefit of disseminating disease-control messages through newer technologies, chosen according to local availability, should be evaluated.
Control of food-borne hazards and other zoonoses
Low-income farming communities are exposed to a range of zoonotic diseases; in some parts of the world these diseases are among the most serious health threats to the community. Some of these, such as Brucella melitensis and anthrax, are diseases traditionally associated with animal production and processing animal products for local consumption in traditional ways. They remain serious risks in many low-income communities. As human activity impinges more and more on natural ecosystems, increased interaction between rural communities and wildlife has apparently led to the emergence of new and in some cases devastating diseases. The link has not been fully proved, but AIDS, Ebola virus, Nipah virus and Hendra virus all appear to fit this description.
It is proposed that strategies be developed to improve protection of poor rural communities against zoonotic infections, using a risk-based approach to identify low-cost prevention methods for serious zoonoses, with special emphasis on food-borne diseases. In cases where a major risk is exposure to wildlife, approaches should be developed to widen separation between people and wild animals and protect the ecosystems against further degradation.
This could be done using about four case-study areas, each representing particular types of problem, to build experience in approaching these problems.
As food safety becomes a dominant issue in world trade in animal products, lowest-income countries are likely to be further disadvantaged by exclusion from favoured markets. The fact is, however, that traditional production methods provide natural protection against the food-borne diseases that mainly concern importing countries.
It is therefore proposed to develop food-safety protocols and procedures to demonstrate that products from these sources are low-risk. Very low-cost procedures in these countries can therefore provide protection matching that of sophisticated systems in developed countries. This will not be true of all products and all countries, but it offers market niches which can provide income to the poorest countries.
DEVELOPMENT STRATEGY FOR THE PROPOSALS
Each of the components outlined requires an organization to set direction and identify mechanisms for establishing the three major strands of the action plan.
Each strand requires a mix of infrastructure development, training, resource development, organizational management and operational research to provide the proposed elements and hence develop and apply an integrated strategy for achieving the anticipated results.
It would be best to take example countries for each of the strands and work through the development steps, then adapt the model for other countries, using the original sites as resources.
It is fully recognized that changing the situation at village level will be a major challenge - but that is exactly why the task needs to be done.