1. INTRODUCTION
Foot-and-mouth disease (FMD) is the most important constraint on international trade in animals and animal products. It especially restricts world trade in a south-north direction. The endemically or sporadically infected countries - which are mainly in the south - generally face total embargoes on the export of their live animals and fresh meat to the FMD-free countries in the north. In those instances where endemically or sporadically infected countries have managed to gain acceptance for some of their products they have done so by agreeing to incorporate expensive safeguards such as the deboning of carcasses.
In addition to the trade restrictions resulting from FMD it also severely reduces the productivity of the meat and milk industries in the endemically and sporadically infected countries. It probably is also an under-diagnosed cause of juvenile livestock mortality.
Further costs of FMD results from the policing of borders by FMD-free countries and the costs of tests and quarantine for live animal imports. World-wide FMD vaccine remains at the top of the league in terms of volume and cost - the doses produced per year are in the order of 800–1,000 million, with commercial vaccine being sold for between US$ 0.20 and 1.00.
The eradication of FMD is feasible at both the national and regional i.e. international level, and examples of both can be provided. At the national level countries which have completed eradication programmes during recent times are: Indonesia; Chile and Uruguay. Examples of regional successes are the campaigns in Western and Eastern Europe and the former USSR, while in South America the so-called “Hemispheric Eradication Program” is progressing satisfactorily - the areas free of disease, particularly in the south of the sub-continent - have been progressively expanded.
The purposes of this discussion paper are: firstly, to outline the key points required to provide a framework for a programme of FMD eradication at the national and regional level, i.e to identify what is required; secondly, to review progress on the eradication of FMD at the regional level and make recommendations for establishing new ones, i.e. to identify where there are opportunities for new programmes; and thirdly, to put forward some initial thoughts on how the ultimate aim of global eradication might be achieved.
2. REQUIREMENTS FOR NATIONAL AND REGIONAL (INTERNATIONAL) FMD ERADICATION
2.1 Economic analyses and planning
Economic analyses with results which clearly indicate benefits to the nation or region are an essential first step before a campaign is begun. A clear indication of increased trading opportunity will be most persuasive for those countries which have a surplus of livestock or products but are constrained from export by the presence of the disease. An additional important benefit would be an increased availability of meat and milk for the inhabitants of the nation or region. The possibility of earning hard currency may be a particular attraction for some countries.
Financial support will be required to obtain the data for the cost-benefit analyses. The source could be either the national government or the regional body or a grant or loan from an international agency.
Data for the analyses will comprise: statistics on the current prevalence of disease, its economic impact on productivity, and the cost of the measures to control and eliminate it versus the benefits to be gained through achievement of successful eradication. Countries or regions with a high prevalence of disease may opt for a step-wise programme with the first goal being the establishment of disease free zones in order to open up some opportunities for export. The revenue from these could then be used to reinforce the programme and to secure and expand the free areas.
For regional programmes the cost-benefits will need to be considered at the super-state level and while the benefits may be considerable for some countries within the region they may not be so evident for others. For example, when the European Union implemented a policy of non-vaccination during 1990–91 the countries which subsequently gained the greatest economic benefit were those which had previously followed a policy of annual prophylactic vaccination since after the cessation of vaccination they were able to export live animals and products to FMD free countries such as the USA, Canada, Japan, New Zealand and Australia - trade which had either previously been denied to the formerly vaccinating countries or only allowed after expensive safeguards such as quarantine and testing. By contrast, trade between FMD-free third countries and the non-vaccinating countries in the EU had been going on for many years and the latter saw little change after the cessation of vaccination. However, the creation of the single market did bring some benefit to the previously non-vaccinating countries since there was an overall increase in intra-Community trade.
Economic planning should include budgetary allowance to allow for repeated cost-benefit analyses at intervals to monitor the progress of the campaign and re-evaluate the benefits. The possibility of a major increase in cost will need to be considered when a country or region decides to stop vaccination and instigate a policy of stamping out. This will require the establishment of a contingency fund so that in the event of an outbreak or outbreaks the affected farmers will be fully and speedily compensated. Otherwise the policy will not be sustained.
2.2 Farming Community
The support of the farming community is vital to achieve the success of a control and eradication programme. Farmers must be informed about the objectives of each stage of the campaign before it is implemented so they are prepared and willing to cooperate. They should be convinced of the long-term benefits. Adverse reactions are most likely at the beginning when farmers may be faced with unaccustomed restrictions and inconveniences. For example, there may be a requirement to disrupt trading routes and marketing practices and to ensure that vaccination is properly carried out. The success of the campaign will require the prompt reporting of suspected cases of disease and acceptance of control measures following disease outbreaks.
Publicity for campaigns, particularly when directed through schools in rural areas, has been shown in some countries to be valuable in creating a heightened awareness and sustaining support among farming communities.
2.3 National or Regional Authority
The sustained support of the national government or regional authority will be essential. The countries involved must have a national contingency plan for the control of the disease. Legislation is an essential component and must be enacted before the campaign begins so that the disease is notifiable and control and eradication measures are legally enforceable. Budgets will be required to support veterinary activities in the field, these may include the purchase and administration of prophylactic vaccine and contingency arrangements for provision of emergency vaccine. It will probably be necessary to expand and strengthen the central veterinary administration, the field services and their infrastructural support.
Funds will be required for training personnel at all levels of the veterinary and ancillary services and to support communication and publicity, for the investigation of suspected cases, for the collection and transport of specimens and for the application of control and eradication procedures. As mentioned previously, a contingency fund will be required if it is decided to adopt a policy of stamping out.
In the case of countries with land borders, FMD campaigns must be waged at the regional level. The co-operation of neighbouring countries will be essential for the dissemination of warnings about disease outbreaks and to mount effective control at frontiers. Border check-points will be required. These may need to be reinforced by facilities for holding animals during testing to ensure their freedom from infection. The flow of animals across frontiers will be driven by market forces and this should be considered when control measures are applied. It may be necessary to interfere with traditional trading patterns of animals and products to prevent the spread of disease.
Regular meetings should be held between representatives of the national control authorities of participating countries to harmonise disease control policies, to review progress and to discuss and resolve any problems.
As the campaign proceeds it should be possible to establish and progressively extend disease-free areas. Steps should be taken to reinforce the security of established areas and to progressively enlarge them, e.g. by adding further check points and carrying out more inspections to prevent the entry of potentially infected animals and products.
2.4 Veterinary Services
An effective control campaign will require good surveillance, a strong centralised veterinary service with a well organised infrastructure and sufficient resources of materials and personnel. Communication and transport networks must be rapid and efficient. Specialised groups must be available to administer vaccine, to investigate suspected cases, collect samples, carry out epidemiological investigations and apply zoo-sanitary measures if the presence of the disease is confirmed. Personnel must be properly trained and familiar with the legislation and codes of practice for disease control measures. Contingency plans should be harmonised for the region and in place before the campaign commences. Within each country the veterinary field staff must be responsible to and under the control of the central veterinary authority.
2.5 Laboratory diagnosis and vaccine
There should be sufficient technical support for the campaign whether it is at the national or regional level. There must be access to a diagnostic laboratory designated to handle FMD virus. This could be a national, a regional or the World Reference Laboratory. The chosen laboratory should provide a rapid and reliable serotyping diagnostic service and characterise isolates so as to advise on vaccine selection. The laboratory should assist with the provision of kits for sample collection from suspected cases.
The laboratory should collect and disseminate epidemiological information on disease outbreaks. Serological surveys, where required, should be planned in collaboration with the laboratory and the results analysed and made available to the central veterinary authority.
Whether vaccine will be required or not will depend on the prevalence of disease. In a highly endemic situation a prophylactic vaccination campaign will be necessary at the beginning of the campaign to reduce the prevalence of disease to a level at which it will be financially feasible to apply stamping out to achieve eradication. However, there are examples of some countries and regions which have succeeded in eradicating FMD by applying vaccination combined with zoosanitary measures over long periods rather than resorting to stamping out at an earlier stage.
If it is decided to adopt a vaccination programme it is essential that the vaccine is verified to be of good quality according to international standards, of suitable antigenic specificity and safe. There are very few vaccine production laboratories world-wide in the state sector which can satisfy those criteria so in the majority of cases countries and regions will be reliant on private vaccine producers for supplies of vaccine. Generally this will be as fully formulated vaccine but the possibility of importing concentrated frozen inactivated antigen for local formulation, bottling and labelling should be explored. This should be a cheaper option than importing fully formulated vaccine and offers the possibility of greater local involvement. Careful handling and thawing of the frozen antigen is critical to ensure optimal quality of formulated vaccine.
The vaccine used in the campaign should be regularly subjected to quality control tests by an independent vaccine control laboratory and licensed by a regulatory authority. The tests should include antigen specificity, antigen content, innocuity and potency. Records of the batches of vaccine passed/failed should be provided to the national/regional authority, as appropriate. Few regions world-wide, however, have an independent FMD vaccine control laboratory and quality control remains with the vaccine producers. This is a major deficiency which needs urgently to be addressed by the international animal health organisations.
2.6 Natural geographical barriers and husbandry systems
Campaigns will be more challenging in regions where the land borders between countries are poorly defined, or are long and in areas of remote and inhospitable terrain, or where transhumance is practised. Under such circumstances the movement of animals will be difficult, perhaps impossible to control, and so the areas incorporated in the campaign should be defined according to ecological and epidemiological conditions rather than by political boundaries.
By contrast, campaigns in regions comprised of island countries or of those whose border areas are comprised of high mountain chains or wide water-ways will be easier to administer since the natural barriers will prevent or hinder the entrance of animals from the surrounding areas. It is not surprising, therefore, that the majority of countries and regions which either have never had FMD or were among the earliest to achieve freedom fall into these categories.
The application of disease control measures will be easier in regions with well developed and specialised livestock husbandry systems. On the other hand, campaigns will be more difficult where the local movement of animals is not tightly controlled and where the marketing systems and abattoirs are not under veterinary supervision. Uncontrolled communal pasture and road-side grazing, the intermingling of animals at the village level, nomadic movement and the feeding of unheated waste food are activities which will have to be disrupted or prohibited if effective disease control is to be achieved during disease outbreaks. During emergency disease situations clear explanations, good communications and the support of the local authorities, the police, and perhaps the army, may be required to ensure the enforcement of unpopular control measures. The legislation to enforce compliance must be on the statute books.
Special actions may be required to ensure the separation of areas free from infection from those which pose a potential risk. This may be by the creation of either physical barriers by fences or of ‘immune’ barriers by vaccination or by a combination of both. For example, game animals in Africa, in particular the Cape buffalo, which can act as a reservoir of FMD infection for domestic species, are isolated in several southern African countries within game parks by fences - unless they are from stock which have been tested and demonstrated to be free of virus. An additional safeguard is to vaccinate the cattle immediately around the parks to establish an immune belt.
In similar fashion a buffer vaccination zone along the borders of Bulgaria, Greece and European Turkey (Thrace) provided effective protection of southeastern Europe against incursions of exotic strains of FMD from the Middle East from the time of its establishment in the mid-60's until its removal in 1989. It is noteworthy that since the buffer zone was eliminated there have been incursions of Middle Eastern strains of FMD into southeastern Europe in 1991, 1993, 1994, 1995 and 1996.
3. CURRENT FMD CONTROL AND ERADICATION PROGRAMMES
3.1 Hemispheric programme for the eradication of FMD
At the Vth Inter-American Meeting on Animal Health at the Ministerial Level (RIMSA V), in Washington, in 1987, a resolution was passed which called for the establishment of an Hemispheric Committee for the Eradication of FMD. The committee was to be comprised of a representative of the governments of each of the following subregions: Southern Cone; Andean Subregion; Amazonian Subregion; Mesoamerica and the Caribbean; North America; and representatives of the producers from each of these subregions.2 The division into subregions took account not only the existence of large ecological, cultural and socioeconomic macroregions but also the existence at the continental level of two large areas: one with FMD (South America) and the other without the disease (Middle America, North America and the Caribbean).
For the second area RIMSA V approved the establishment of a Commission of American and Caribbean Countries Free of FMD with a view to joining efforts to protect livestock in that area from the disease.
The plan which was subsequently developed and called the ‘Hemispheric Program For the Eradication of Foot-and-Mouth Disease in South America’ has the following objectives:
the eradication of FMD from the South American Hemisphere;
the prevention of its introduction into free areas;
the settlement of new livestock areas, especially the Amazonian Subregion, thereby preventing the introduction of FMD and other alien pathogenic agents and at the same time respecting the ecological integrity of these areas.
The intention is to attain these objectives through actions carried out in three different stages in order to gradually obtain consistent results. The time-table is: 1st stage 1989–1994; 2nd stage 1995– 2000; 3rd stage 2001–2009. The strategy for execution of the programme is directed on three levels: a regional plan; subregional projects; and national animal health programmes.
To-date the programme is making satisfactory progress particularly in the Southern Cone Subregion where Chile, Uruguay and the south of Argentina (Patagonia) are free without vaccination. Outbreaks have not been reported in the remainder of Argentina for over two years, in Paraguay for over 18 months, and the states of Rio Grande do Sul and Santa Catarina, Brazil for over 18 months. The regions in which the disease remains a problem are the Andean and Amazonian Subregions.
3.2 Campaign for the control of FMD in South-East Asia
In 1990, at Pattaya, Thailand during a symposium entitled “Control of major livestock diseases in Asia” held jointly between OIE and the Federation of Asian Veterinary Associations, a proposal by Dr L Blajan, Director-General, OIE that an OIE Sub-Commission for FMD Control in South-East Asia should be established and that meetings should take place at least once a year to discuss international cooperation, implementation of control programmes, vaccine control and use, animal movement controls and laboratory diagnosis was unanimously supported.3 It was further agreed and recommended that:
the member countries should, at the earliest possible convenience, meet and plan their approaches;
there would be a joint OIE-FAO support, but non-FAO members such as China should be encouraged to participate:
the OIE would establish a sub-commission in which the chief veterinary officers from the different countries in the region would meet once per year in order to analyse the status of the control programme, at both the legislative and technical levels;
support for the programme should be sought from the Asian Development Bank, in addition to other bodies such as APHCA.
A Coordinating Group for the Control of FMD in South-East Asia was created by Resolution No.X adopted by the International Committee of the OIE in 1991. Meetings of the Coordinating Group have been held annually since then, with the technical support of the OIE FMD Commission.
The OIE Regional Commission for Asia, the Far East and Oceania which met in Auckland, New Zealand in November 1993 recommended that:
The International Committee agree to create a Sub-Commission for FMD in South-East Asia for a period of six years which could be extended and adopt the text entitled “Terms of Reference and Internal Rules of the Sub-Commission for FMD in South-East Asia”.
The International Committee instruct the Director General to establish the necessary contacts with the governments and territories concerned and with international organisations in order to determine the composition of the Sub-commission and study with them the financing of a FMD control Programme in South-East Asia.
The International Committee give the Director General a mandate to determine the rules for the operation of the aforementioned programme, in particular the financial rules, and the conditions governing the recruitment and management of staff to be employed in the region.
These proposals were adopted by the International Committee at the 62nd General Session of OIE in 1994.
The Sub-Commission for FMD in South-East Asia, comprised of representatives from nine countries - Laos, Thailand, Malaysia, Vietnam, Singapore, Myanmar, Cambodia, Philippines and Hong Kong - and the OIE meets annually. The campaign for the control of FMD in South-East Asia will start in October 1996 with the establishment of a Regional Coordination Unit in Bangkok and the appointment of three or four coordinators. FAO and IAEA will be involved at both the regional and national levels.
The first objective is to improve the standards of the veterinary services in FMD-affected countries and to improve the productivity of animals by keeping FMD under control, and thereby to increase the income of livestock producers in Cambodia, Laos, Malaysia, Myanmar, Philippines, Thailand and Vietnam.
The long-term objective is to facilitate and promote the international trade of animals and animal products by creating FMD-free regions in South-East Asia. The campaign will last approximately 12 years, divided into three phases: (i) preparation; (ii) FMD control; and (iii) eradication and consolidation. An essential component will be the establishment of a Regional Reference Laboratory. The Government of Thailand has indicated its intention to establish such a laboratory at Pakchong.
3.3 FMD control programme in India
The National Dairy Development Board (NDDB) of India initiated a Pilot Scheme for the control of FMD in the Nilgris district of Tamil Nadu in 1982 with financial and technical assistance from the Overseas Development Administration of the UK.4. All cattle, buffaloes, sheep and goats were vaccinated at six-monthly intervals.
Encouraged by a decline in the incidence of disease the NDDB in 1984 extended the programme (the FMD Control Project - FMDCP) to the 23 districts of the southern peninsula covering Tamil Nadu, Kerala and Karnataka in a phased manner.5. Later 29 districts were involved. However, as project region was extended further north it encountered serious problems which subsequently impacted on the whole programme. These mainly were related to difficulties in controlling animal movement e.g. the transhumance of small ruminants, and a critical short-fall in the availability of vaccine. The Indian authorities have planned a new campaign which is expected to be launched in the near future.
4. PROPOSALS FOR SHORT-TERM FUTURE
4.1 South America
The objectives in the short-term should be to consolidate and secure the regions which have achieved freedom from FMD and where possible to expand and link these regions with neighbouring free regions. For example, the countries in the Southern Cone Sub-region of South America which have not yet stopped vaccination should soon decide whether they can afford to stop and move from a status of provisional freedom from infection to freedom from infection along the lines of the “OIE Pathway”. Greater effort should be made to increase vaccination coverage in the northern region of South America since this remains the main problem area in the Americas. If FMD could be eradicated from this region then all of the Americas would be free and this would dramatically increase south-north trading opportunities.
4.2 Europe
In the case of Europe there are two major threats. Firstly, to Bulgaria and Greece from the Middle East through European Turkey and secondly to The Russian Federation and The Ukraine from the Transcaucasian region. The price differentials in livestock between the free areas in Europe and the endemically infected Middle East and Transcaucasian regions make the likelihood of illegal animal movement between these regions very high. The strategy for disease prevention should be to strengthen the borders and to reinforce this with a belt of vaccination. The Russian authorities have done this by vaccinating along their southern borders but the so-called “Buffer Zone” between Europe and Asiatic Turkey was removed in 1989 and since then there have been repeated introductions of FMD into southeastern Europe from Asiatic Turkey. The patency of the border between Turkey and Greece/Bulgaria is also clearly evident from the regular introductions of sheep and goat-pox.
Obviously the freedom of Europe would be better protected by more effective control of disease in its endemically infected neighbours to the east and southeast but given the extent of animal movement throughout these regions, the proportion of small ruminants and the lack of resources and vaccine the effective control of FMD, as a first step towards eradication, must be regarded realistically as a very long-term objective.
4.3 South-East Asia
As stated in the previous section, the campaign for this region will commence in October 1996. The urgent requirements for the region are:
the need to increase the quantity of available vaccine and a system for independent assessment of its quality i.e. a vaccine control laboratory;
a Regional Reference Laboratory for virus diagnosis and vaccine selection;
legislation to increase the reporting of suspected disease outbreaks and to support the enforcement of disease control measures;
national contingency plans for the countries;
publicity for the campaign to increase awareness of the disease among the farming community to sensitise them to the consequences of the disease and the advantages of its control; and
training for personnel at all levels from the field through to the central administration.
5. INTERNATIONAL CONSIDERATIONS
Since future efforts will need to be directed towards countries which are lacking in resources, substantial technical and financial support from international animal health and donor organisations will be required if progress is to be made in extending existing FMD free areas and in creating new areas so that ultimately all the areas can be linked together to achieve the goal of global freedom. International support will be required to manage and coordinate the financial and operational elements.
There will also be a role for international bodies in promoting and harmonising disease control policies and encouraging trade. There is an urgent need to bring the recommendations for the OIE “Pathway” into line with the OIE International Animal Health Code Chapter on FMD. A first step in this direction will be a joint meeting between the OIE FMD and other Epizootics Commission and the OIE International Animal Health Code Commission to be held in January 1997.
Improvements in technology may assist countries which are free of FMD to maintain their status and also those countries in which the disease is sporadic or endemic by accelerating the progress of control and eradication programmes. Advances in tests for diagnosis and surveillance, in vaccinology, information technology, computing and networking, and their application to the improved control and eradication of FMD have recently been reviewed6.
