Appendix 3
THE BLUEPRINT FOR THE GLOBAL ERADICATION OF RINDERPEST
BY THE YEAR 2010

1. PROGRAMME DESCRIPTION

1.1 Background

1.1.1 History

Rinderpest is the world's most serious disease of cattle and domestic buffaloes. The morbillivirus responsible infects all cloven-hoofed animals. It can cause mild disease in sheep and goats and disease of varying severity in wild species. In earlier centuries, it was the scourage of domestic cattle populations throughout Asia and Europe. In Asia it continues to be a major problem whilst in Europe it was controlled through vigorous slaughter and quarantine. In the late 1880s the infection entered the Horn of Africa, and by 1896 had swept the continent killing millions of cattle en-route and locally exterminating some highly susceptible species of wildlife. South of the Zambezi alone, 2.5 million cattle are estimated to have died. The losses and stringent attempts to control the disease caused many instances of socio-political upheaval including the Matabele wars, urbanisation of impoverished Afrikaners which added impetus to the eventual Boer war, and political marginalisation of previously dominant pastoralists such as the Maasai in East Africa.

During the 20th century, control of rinderpest has been the main task of Asian and African veterinary services. The development of goat attenuated vaccine in India in the 1920s at last provided the tool by which cattle could be immunised and rinderpest controlled in areas where slaughter and quarantine could not be applied. The success of this and subsequent improved vaccines, especially the current cell-culture attenuated vaccine, led to the eradication of the disease from many areas where it had been widespread and endemic. This and other important technical aspects (including the absence of a carrier state and wildlife reservoirs, life-long immunity after vaccination and easily detectable antibody in exposed animals) encouraged an attempt to eradicate rinderpest in Africa. From 1962–1976 the JP-15 campaign successfully reduced the incidence and distribution of rinderpest throughout Africa restricting it to two foci, one in the west and one in the east of the continent. However, through complacency and false economies, the level of vaccination cover was not maintained and the virus emerged to cause disease across the continent from 1979–1984 resulting in losses of a magnitude (approximately 1 million) that it had been hoped would never be seen again. In the aftermath, the Pan African Rinderpest Campaign (PARC) was established in 1986 specifically to eradicate rinderpest from Africa. The concept of PARC was then extended to other regional projects in south and west Asia. At a meeting in Rome in 1992 it was recommended that the regional projects should be brought together within one overall programme. The Global Rinderpest Eradication Programme (GREP) was established within the Food and Agriculture Organisation of the United Nations.

1.1.2 Current situation

1.1.3 Prospects

The present situation offers a very favourable starting point for the global eradication of rinderpest. Recent mass vaccination programmes have confined the infection to a relatively small number of endemic foci. Some of these are already identified, but others might conceivably be masked by the immunity of surrounding populations. To complete the process of eradication, it will be necessary to concentrate efforts on the elimination of infection in known foci. Unidentified foci can be disclosed by the progressive withdrawal of vaccination, combined with purposeful disease surveillance. These can then be eliminated by limited but intensive ring vaccination.

If this opportunity for global eradication is missed, then the endemic foci will be a continuing threat to world cattle and buffalo populations. This will result in a continuing need for widespread vaccination programmes, and impediments to trade. The probability is that the infection will at some time spread from the endemic foci, and cause losses at least on the scale of the rinderpest pandemics of the early 1980s in Africa and the Middle East.

1.2 Strategy for the global eradication of rinderpest

The Global Rinderpest Eradicátion Programme (GREP) is a time-bound programme to eliminate rinderpest from the world by the year 2010. To do this it will devise strategies and implement programmes to reduce the clinical incidence of rinderpest to zero. The elimination of disease and infection will be confirmed by statistically valid active disease surveillance programmes.

Conventionally rinderpest control programmes have relied almost solely on mass vaccination campaigns. Indeed, it has been clearly established that such programmes can eradicate rinderpest if they achieve simultaneous population immunity levels to over 85% among very large bovine populations. More frequently however, they fail in their primary objective by not taking in large enough populations and by attaining considerably lower immunity levels than is required to prevent the circulation of virus. There is now evidence that in South Asian countries mass vaccination programmes have little impact on the occurrence of fresh outbreaks, and that these outbreaks are often brought about by the movement of milking animals in to, and out of urban dairies.

In GREP terms, mass vaccination is to be seen as the tool of choice initially in reducing outbreak levels to manageable proportions, and in the prevention of epidemics of disease. This can be accomplished most cost effectively by the development of rolling-front vaccination campaigns, together with sanitary cordons. In both instances zoosanitary controls, which must include movement orders, ring vaccination of identified foci and the safe disposal of dead animals, are seen as a preferable way of eliminating rinderpest from a situation in which a reasonable level of outbreak control has been established. Essentially in areas where endemic maintenance is a feature elimination must rely on the identification, containment and elimination of foci of endemic persistence.

Infected countries will have to use a combination of prophylactic vaccination and zoosanitary controls to bring the number of outbreaks down to zero. It may seem that at this point the task has been accomplished. On the other hand, in any country where vaccination has been extensively employed, there is a danger that foci of infection may have been masked and that the zero reported outbreaks figure may not reflect the real situation. It follows, therefore, that the zero reported outbreaks achievement has to be supplemented by a series of activities that confirm the absence of residual infection. Further, as the eradication of rinderpest may prompt new opportunities for livestock trade, a previously rinderpest infected country will have to produce internationally acceptable evidence that it no longer harbours the virus. These considerations lead to the conclusion that verification of a rinderpest-free status can only occur in a situation where prophylactic vaccination has ceased.

In 1989 the Office International des Epizooties included these concepts in a progressive series of time-bound actions which a country previously contaminated by rinderpest would have to take to receive international recognition as being free of both the disease and all evidence of infection. Starting from the zero outbreak point, the series of steps that could be identified are now refferred to as the OIE Pathway. GREP endorses the use of the pathway mechanism as the most appropriate means by which its purpose will be fulfilled.

A number of countries that have reduced the incidence of clinical rinderpest to zero are still reluctant to discontinue the use of rinderpest vaccine, which they feel is protecting them against a return to the ravages of epidemic disease, even though clinical outbreaks have ceased to occur. One of the immediate challenges facing GREP will be to counsel these countries in the elimination of vaccination, and the adoption of disease surveillance measures that prove that the virus has been eradicated. In approaching this issue it will probably be necessary to demonstrate the existence of safety nets such as regional vaccine banks, regional co-ordination and access to regional contingency funding. In addition it could be pointed out that national disease surveillance programmes such as village searches and clinical register searches accompanied by serosurveillance and by the open disease reporting channels, do in fact provide the best possible safety net against the emergence of disease from any residual foci.

It seems clear that there are three types areas of special concern requiring concerted action, namely Pakistan, Asia Minor and the Eastern African Infected Area. In none of these areas can it be said that adequate rinderpest control or eradication measures are in place. In looking at these, it is essential for GREP to sieze every opportunity to promote rinderpest eradication utilising, for instance, opportune periods when agencies complementary to the prime campaign can produce high immunity levels in cattle herds situated within hostile areas of the East African Infected Area, accompanied by a preparedness to do this repeatedly until outbreaks of rinderpest cease. In the case of Pakistan it is more important to absorb the experience of other regional campaigns, and avoid large mass vaccination campaigns, by developing a prior understanding of the epidemiology of the disease through improved disease investigation, diagnosis and reporting, in effect active disease surveillance. Elsewhere, any occurrence of rinderpest must be considered an international emergency.

From all these considerations, GREP will emerge as a series of concerted and co-ordinated actions by rinderpest infected (or recently infected) countries, promoting their achievement of verified rinderpest eradication within the defined time scale. Within this framework, it is expected that a Steering Committee mechanism will allow the merger of donor priorities and technical assessments, following which FAO-GREP will provide clear technical and strategy guidelines, that regional co-ordination offices will interpret these within the regional context and that national projects will be the implementing agents. It is expected that the objectives of co-ordination will best be fulfilled by invoking the services of regional bodies devoted to co-operation among neighbouring countries.

GREP will not directly control or finance country projects, and will fail to function unless such projects are in place.

1.3 GREP objectives

GREP recognises two categories of countries which need to fulfil the conditions of the OIE Pathway before they can be considered free from rinderpest. These are:

1. Countries which currently consider themselves to be rinderpest-free and which have not used rinderpest vaccine within the last 10 years. Such countries may be declared free from rinderpest if they can demonstrate that they have maintained an adequate disease reporting system during this period.

2. Countries which have vaccinated against rinderpest within the last 10 years, or have had clinical evidence of rinderpest. Such countries should follow in full, the various stages of the OIE Pathway.

1.4 GREP strategy and action plans

GREP-oriented tasks will be undertaken by individual State Veterinary Services, except in troubled areas where it is possible that international relief agencies and NGOs will provide an alternative service. It is not envisaged that there will be an international force created to undertake GREP objectives. Through its regional co-ordination system GREP will promote national action plans for:

1. ensuring the existence of an assured capability for immediate response to rinderpest outbreaks whether this be through using national resources or by preparedness to request rapidly assistance from international resources such as EMPRES;

2. the disclosure and elimination of all foci of disease;

3. terminating all prophylactic vaccination against rinderpest two years after the disappearance of the clinical disease;

4. ensuring the development of national disease surveillance systems capable of recognising the presence of rinderpest through the rapid detection of rinderpest outbreaks at a clinical level and a national laboratory investigation service capable of undertaking the differential diagnosis of rinderpest and rinderpest-like diseases;

5. ensuring the existence of a national reporting system, through which information on outbreaks of all OIE list A diseases moves from livestock owner to the head of the State Animal Health Service and thence to the relevant international authority;

6. improving the livestock owner-veterinary services interface to the point where the risk of under-reporting is no longer significant;

7. the maintenance of appropriate inter-country sanitary cordons until such time as there is regional concurrence that neighbouring countries no longer pose a risk of reinfection;

8. the promotion of regionally-oriented training systems in support of disease recognition, disease diagnosis, disease reporting and the promotion of self-help disease alleviation measures at village level;

9. the promotion of a policy of regional co-operation as a means of combatting all OIE list A diseases.

2. PROGRAMME BAR CHART

The programme bar chart, showing the projected progress of all countries and regions along the OIE Pathway to freedom from rinderpest infection is shown in Annex 1. The broad strategy is to eliminate the known foci of infection in the East African Infected Area, Asia Minor and Pakistan as an immediate priority. This is an essential pre-condition for global eradication. Until it is achieved, progress elsewhere will be constrained by the continuing risk of re-infection. A cordon sanitaire will be maintained in central Africa while the eastern African foci are being eliminated. Other countries are required to cease vaccination and proceed on the OIE Pathway to identify and eliminate any unsuspected foci of infection, and attain the status of freedom from disease, followed by freedom from infection.

The GREP strategy for global eradication is to encourage and assist countries to join and follow, on a regional basis, the existing. OIE recommended pathway to “Official Declaration of Freedom from Infection by Rinderpest Virus”. When all of the countries within the acknowledged infected regions in Africa and Asia have achieved this declaration, then Global Eradication of infection will have been achieved.

Countries within the infected regions can be grouped into three categories:

1. infected or possibly infected countries;

2. countries thought free of infection but still maintaining protective vaccination; and,

3. countries which have already stopped vaccination.

A country can only join the OIE Pathway when it has had no cases of disease for at least two years. Therefore the GREP strategy is to eradicate infection wherever it exists as soon as possible, while assisting disease-free countries to join and follow the Pathway. It is proposed that freedom from disease should be brought about by determined, well planned and co-ordinated, focused vaccination programmes to eradicate the virus from the currently known endemic foci. This is the first priority of GREP and a prerequisite for global eradication.

Other foci which may be detected in some countries after the cessation of vaccination will be eradicated in the same way.

Before entering each main step in the process towards declaration of freedom from infection, each country will need to establish, if necessary with the assistance of the regional co-ordination projects and international agencies, certain pre-requisites for achieving the aims of that step. These will include funds, vaccine and emergency management plans to cope with emergency outbreaks in unvaccinated populations; appropriate diagnostic and serological assay facilities or access to them, appropriate disease surveillance and reporting systems.

The main steps for the different categories of country to achieve freedom from infection are as follows:

2.1 Eradication of known foci of infection in infected countries and zones of country

2.1.1 Requirements

Each country should have:

1. sufficient trained staff for clinical and serological surveillance, sample collection and disease control, including vaccination;

2. established emergency preparedness procedures

3. sufficient funds and equipment for vaccination campaigns; and,

4. availability of diagnosis.

2.1.2 Identification and elimination of foci of infection

Define the population of cattle that maintain the virus and the factors which enable persistence of infection and dissemination to surrounding areas together with the most appropriate means of eliminating that infection. Prepare a detailed plan for effective immunisation of the population, taking into account the animal husbandry patterns and advice of the stockowners. Execute the vaccination programme in close association with the stockowners.

2.1.3 Surveillance

Carry out active surveillance for the disease supported by laboratory diagnosis and, if available serological investigation.

2.1.4 Join the OIE Pathway

After two years of freedom from disease, declare provisional freedom from disease and join the pathway.

2.2 Progress to “freedom from infection” after two years without cases of disease

2.2.1 Requirements

Each country must have:

• a national veterinary structure with appropriate legal powers and administrative authority plus resources capable of sustaining early warning and early reaction systems for rinderpest

• adequate surveillance and reporting systems to ensure early waring;

• a contingency management plan to contain and eliminate an unexpected outbreak (early reaction);

• access to contingency funds and resources for use in an emergency;

• stopped the use of rinderpest virus in laboratories and teaching establishments without containment facilities; and,

• access to appropriate laboratory diagnostic facilities.

2.2.2 Provisional freedom from disease

Demonstrate freedom of disease for at least two years and make declaration of provisional freedom from disease to OIE.

2.2.3 Active disease surveillance

Continue and enhance active surveillance for clinical disease, supported by appropriate reporting.

2.2.4 Cessation of vaccination

Stop vaccination against rinderpest of cattle, buffaloes and yaks so that the population of animals at risk becomes increasingly susceptible and unable to maintain rinderpest at a low prevalence.

2.2.5 OIE declaration of freedom from disease

After three years without rinderpest, and with disease surveillance, apply to OIE for country to be declared free of rinderpest disease.

2.2.6 Serological surveillance

Begin a two year period in which annual statistically meaningful serological surveys of younger animals are made in order to detect any antibody that might be due to circulating field virus.

2.2.7 OIE declaration of freedom from infection

If no serological evidence of rinderpest virus activity has been found after two years, apply to OIE for the country to be declared free of rinderpest infection.

2.3 Alternative method for countries which have had no disease or vaccination for at least five years

A small number of countries have not had rinderpest for many years and have already stopped vaccination. Provision is made within the OIE recommendations for such countries to be declared free of infection without having had to follow the strict procedures of the Pathway by demonstrating the lack of virus circulation by serological surveys.

For some countries that have not vaccinated for more than five years, this provision may allow them to proceed to Freedom from Infection more rapidly and more economically than if they followed the Pathway. GREP is an international community programme and all countries within a region should be encouraged to follow the Pathway together for their mutual benefit.

3. LOGICAL FRAMEWORK

The logical framework for GREP is shown as Annex 2.

3.1 Activities

3.1.1 GREP Apex Co-ordination Unit

The GREP co-ordination unit established within the EMPRES programme of the FAO Animal Health Service, will be responsible for the implementation of all coordination activities, including:

• the development and maintenance of the global blueprint for rinderpest eradication;

• monitoring global progress, and identifying problems;

• promoting the exchange of information on disease status between countries;

• identifying and co-ordinating the inputs of donors for regional and national projects;

• establishing an international contingency fund to finance responses to disease emergencies and approved verification procedures;

• providing technical support and advice to regional co-ordination units;

• the development of training materials and implementing “train the trainers” courses:

• designing, assembling and maintaining surveillance data systems

• setting standards for vaccine, vaccine manufacturing processes, diagnostics and diagnostic test (in collaboration with the Joint FAO/IAEA Division, Vienna)

• maintaining international commitment to the success of GREP

• developing a communications strategy

• establishing performance indicators for GREP

• assessing the need for research and development and enabling as required (in collaboration with the Joint FAO/IAEA Division, Vienna)

• sustaining the FAO World Reference Laboratory for Rinderpest and establishing a network of attested laboratories

• convening steering committee meetings as appropriate

• compiling a global historical' account of GREP

3.1.2 GREP Regional Coordination Units

• coordinate and monitor national programmes

• assistance to national laboratories within the regions

• assist countries in the design/implementation/monitoring of national programmes

• constant communication with the EMPRES GREP coordination unit

• capture, evaluation and auditing of surveillance and disease reporting data

• liaison with national vaccine licensing authorities (GMP/vaccine standards)

• harmonise and quantify cross-border livestock movement

• promote regional communications programmes with emphasis on farmer/livestock services

• establish early warning and early reaction systems at regional level including funding mechanism and simulation exercises

• maintain regional political intiatives and ensure effective relationships with regional sponsoring bodies

• convene annual meetings for strategy review and planning

• participate in GREP meetings

• administer and disburse compensation and incentive funds

• harmonisation of legislation between countries

• assistance for funding national programmes

• assist member countries in their submissions to OIE

3.1.3 Training package

In view of the delays in recognising, reporting and controlling some recent outbreaks of rinderpest, GREP should produce for global use a training package comprising the following units:

1. the concept of GREP and global eradication including the OIE pathway;

2. disease investigation and clinical diagnosis;

3. reporting, public awareness and communication;

4. the preparation of contingency plans to contain and eradicate rinderpest in countries that have stopped vaccination.

Guidelines on disease surveillance and serological surveillance, on vaccination campaigns, and on laboratory diagnosis already exist, and could be reformatted to conform with the style selected for the new manuals in order to produce one suite of manuals covering all aspects of rinderpest control leading to eradication. Wherever possible, training should also be given in the form of short seminars and refresher courses for veterinary officers and senior animal health assistants.

The manual on GREP and the OIE pathway will include:

• a brief introduction to rinderpest;
• the economic justification for eradication;
• the scientific justification for eradication;
• the principles of eradication;
• clear explanation of the recommended OIE pathway to eradication; and,
• the proposed time schedule to eradication.

The manual of disease investigation and clinical diagnosis will include:

• a resume of routine surveillance, including village searches, examination of clinical registers etc.
• advice on how to follow-up rumours and reports in a purposive manner;
• epidemiological patterns of rinderpest and their comparison with other rinderpest-like diseases;
• clinical signs in domestic animals;
• clinical signs in wildlife;
• differential diagnosis; and,
• sample collection and despatch to laboratories.

The manual on reporting will include:

• techniques for improved access to stockowners' information;
• examples of simple and concise reporting forms and schedules, and of the use to which these can be put;
• recommendations of the flow of information from farm to provincial and national authorities, and to regional co-ordination bodies and GREP; and,
• increased use of clinical registers and institution of rumour registers.

The manual on public awareness and communication will include explanations of how to:

• increase public knowledge of rinderpest and of the aims and activities of GREP;
• inform stockowners of the clinical signs of the disease, and of its seriousness and consequences if left uncontrolled;
• improve the farmer and animal health worker interface; and,
• introduce the concept of incentives for reporting suspected cases of rinderpest.

The manual on control will include:

• advice on the establishment of cold chains and their use where required;
• the need for quality assured vaccine;
• the preparation of diluent;
• reconstitution of vaccine;
• vaccination technique;
• ear notching/marking of vaccinates;
• recording of vaccinations;
• quarantine and movement restrictions;
• disposal of carcasses and disinfection;
• appropriate times for restocking;
• the advantages of thermostable vaccine; and,
• the potential of participatory approaches using community based animal health worker programmes.

3.1.4 Seminars and training tutorials.

These should be organised at a local level by national and sub-national level co-ordinators. They should be aimed at qualified veterinarians and senior animal health assistants who can then take the lessons learnt back to animal health workers working at the village level. The seminars should be short, supported by audiovisual aids and given by tutors sufficiently experienced in rinderpest to answer educated questions.

4. PROGRAMME MANAGEMENT

The organisational chart for the management of GREP is shown in Annex 3. FAO should establish through its EMPRES programme an international steering committee including representation from the donors concerned to direct the GREP. The objective of the GREP Co-ordination Unit, directed by the Steering Committee, will be to support and co-ordinate the individual country projects so as to ensure that their concerted efforts lead to regional and global eradication.

5. JUSTIFICATION

Rinderpest can be a devastating disease of cattle, buffaloes and wildlife species. It has caused pandemics that killed a high proportion of the host populations in many countries. However, due to the availability of an excellent vaccine, and concerted national and international effort, the disease has been confined to a few foci of residual infection in Africa and Asia. Nevertheless, rinderpest remains a serious cause of economic loss arising from:

1. Direct losses due to the disease itself. These are at present relatively small in global terms. However, serious outbreaks do occur from time to time, and these kill a high proportion of the cattle and buffalo population in areas where vaccination programmes have not been effective. All too often, the people most affected are among the most economically vulnerable groups in remote areas. The losses are not confined to cattle owners and livestock production. Cattle have important roles in farming systems, through draught power and acting as the capital reserve for the farm. Even where cattle production is not the dominant economic activity, typically many poorer people depend on cattle owners for their livelihood. Rinderpest also kills large numbers of wild animals, which cannot be protected by vaccination, but which are of great importance to the economy of some of the remote areas where rinderpest is most likely to occur. The disease is a serious threat to restricted populations of endangered wildlife and income from tourism.

2. Costs of control. Rinderpest vaccine is inexpensive, costing from US$ 3.00 to US$ 16.00 per hundred doses. However, the cost of delivering the vaccine from store to animal is generally very much higher. The vaccine must be stored in a deep-freeze and kept refrigerated until it is reconstituted, which requires a Acold chain@ network from store to vaccination point. Teams of vaccinators have to be supervised and supported by transport, subsistence allowances and other logistics. Serological monitoring should also be carried out to ensure that vaccinated animals are being immunised. Cattle owners face costs in bringing their animals to vaccination sites, which can have a high opportunity cost in terms of other farming activities, and through production loss caused by the disturbance to the animals. Gathering animals at vaccination sites also creates ideal conditions for the transmission of diseases such as rinderpest itself, CBPP, FMD and others. The overall cost of vaccination varies according to the situation, but the national average cost would rarely be less than US$ 0.50 per animal vaccinated. It is estimated that there are about 500 million bovines in the area subject to rinderpest control. To immunise all of these within a short time frame would cost not less than US$ 250 million and even if only 20% of these were vaccinated each year, an exercise which would have little effect on rinderpest persistence, the most conservative estimate of total annual costs would be US$ 50 million per year.

3. Effects on trade. While most of the countries affected by rinderpest would be excluded from world markets by other zoosanitary restrictions, there is important regional and within-country cattle trading, and this is periodically disrupted by rinderpest. Other trading opportunities, e.g. from India to the Middle East, are permanently restricted. This results in loss of economic welfare to both potential sellers and buyers. Moreover, the cost of enforcing movement control and quarantine procedures is significant, even where they are only partly effective.

In addition to these actual losses resulting from the continued existence of rinderpest, there remains a risk of major epidemics, which would result in much greater costs. In countries that have not experienced rinderpest for some time, there is constant pressure to reduce expenditures on vaccination. This trend was responsible for the major rinderpest epidemic in Africa in the early 1980s, which killed at least one million cattle. Until rinderpest is eradicated from the world, these costs will continue. It has been shown that the cost of completing eradication for most countries would be less than the costs of continuing vaccination and other control measures. When any individual country eradicated rinderpest from its own territory, it is in a position to replace mass-vaccination strategies with reliance on emergency preparedness, through ensured early-warning and early-reaction, applicable to all epidemic diseases. However, the tendency is to continue vaccination as long as the threat of re-introduction remains, and the potential cost-saving therefore fails to materialise. When such vaccination programmes fail to generate a sufficiently high level of herd immunity, experience has shown that it is nearly impossible to prevent the spread of rinderpest in susceptible cattle populations in most of the affected area. In the face of an outbreak, livestock owners either try to move their animals away from the threat, or sell cattle to reduce their exposure to loss. This results in the rapid distribution of infected animals through the area, and can cause epidemics.

GREP is designed to provide a mechanism by which countries can eradicate rinderpest in a concerted and co-ordinated programme, and thereafter benefit by saving the very considerable recurrent cost of present control programmes.

The importance of adherence to the OIE pathway is much more than symbolic. Countries will only have the confidence to stop vaccination if there is international verification of neighbouring countries freedom from disease and infection. The OIE pathway, which requires the cessation of vaccination combined with disease surveillance, provides the only practical approach to the disclosure and elimination of hidden foci of infection.

ANNEX 1: PROGRAMME BAR CHART

Africa

Asia

ANNEX 2: LOGICAL FRAMEWORK

ANNEX 3 : GREP ORGANISATION CHART

GREP ORGANISATIONAL STRUCTURE

GREP ORGANISATIONAL STRUCTURE