These papers have been reproduced as submitted by the participants.
AGRIVET International Consultants, PO Box 178, Windhoek, Namibia
The emergence and re-emergence of zoonoses and their potentially disastrous impact on human health is a growing concern around the globe. The ease and speed of international travel, the rapid growth of international trade in animals and animal products due to globalization, urbanization of populations, and dramatic changes in livestock production systems and patterns are important factors in the spread of animal diseases and zoonoses. Surveillance and the early diagnosis and detection of pathogens are crucial components of disease control, eradication and prevention strategies.
Factors that drive the emergence and re-emergence of microbial threats are complex and a convergence of any number of these factors can create a suitable environment for disease emergence and maintenance in society. Such critical factors are: microbial adaptation and change (e.g. antimicrobial resistant pathogens); host susceptibility (e.g. due to being immunocompromised owing to HIV/AIDS, malnutrition); climate and weather (global warming expanding the distribution of vector-borne and water-borne diseases such as yellow fever or Hantavirus pulmonary syndrome); changing ecosystems; economic development and land use; international trade and travel; and reduction in animal health services, public services or infrastructure etc. (King, L.J., 2004). Public demands and societal needs in respect of public health and food safety place increasingly higher demands on the delivery of veterinary services. Compliance with international standards for veterinary services, such as those contained in the OIE Terrestrial Animal Health Code, and their evaluation for quality and equivalence, will increasingly be public demands at national, regional and international level on all bodies charged with veterinary service delivery.
The involvement of the private veterinary sector, as well as an increased role for veterinary paraprofessionals in surveillance, early disease detection and monitoring, and rapid response actions require capacity building activities on all levels. The same, however, also applies to official veterinary services and infrastructure, veterinary diagnostic and research laboratories as well as to veterinary training institutions and statutory bodies. The latter, especially as they are charged with the registration or licensing of veterinarians and veterinary paraprofessionals, require assistance and support to be able to fulfil their functions of legal control and maintenance of standards.
DEMANDS AND ACTIONS
In addressing the need for capacity building for veterinarians and veterinary paraprofessionals, it is necessary to take note of international developments in this respect. A number of international bodies and organizations have, in recent years, recognized the need for assistance and capacity building, specifically in developing countries, to facilitate and improve the international trade in animals and animal products.
Widespread human illnesses have been associated with a variety of food-borne microorganisms and with food products contaminated with toxic chemicals. Large-scale disruptions of food supplies involving illnesses in and contamination of farm animals have occurred. These outbreaks have resulted in the straining or overwhelming of public services, intense media coverage, and adverse economic, social, and political effects. These apparently inadvertent contaminations resulted in loss of public confidence in the safety of the food supply and regulations by governments to improve consumer protection (FAO/WHO, 2002). Adherence to dosages and withdrawal period instructions are very important elements of on-farm food safety management for animals and humans because the emergence of antimicrobial resistance in bacteria may be directly related to the use or misuse of antimicrobials in food-producing animals. The veterinarian has a most important role to play in restoring and maintaining consumer confidence in the safety of animal food products, based on knowledge obtained in the pregraduate veterinary curriculum addressing health issues of both human and animal.
Increased demands for food safety require an analysis of all potential risks present at the various stages of the "stable-to-table" food chain. Food-borne risks to human health can be reduced and minimized by the prevention, elimination and control of hazards arising at the preharvest stages of food of animal origin. At present, there is room for a significant improvement in many aspects of food-safety control in terms of cost and efficacy, especially during ante-mortem and post-mortem abattoir inspections and microbiological control processes. Measures should be tailor-made for the range and prevalence of hazards in a particular animal population. Management of all these hazards by the veterinary services needs to be carried out in a way that optimizes the use of available resources in both the public health and the animal health sector (OIE, 2003).
As part of a collaborative effort and resulting from a declaration made in Doha, the OIE, WHO, FAO, WTO and the World Bank have joined forces and developed the Standards and Trade Developments Facility. This aims to facilitate collaboration in enhancing the capacity of developing countries to meet the SPS standards. In the context of improving their trade prospects, the Facility will support information exchange and development of databases, toolkits and learning materials on trade-related SPS issues to better coordinate capacity-building projects. The Facility will also provide funding of seed capital for pilot projects on capacity building in individual countries or through regional initiatives in direct support of the Doha declaration, including, when appropriate, development activities involving both public and private sectors. The Facility will only address projects related to standards in food safety, plant, and animal health within the scope of SPS measures. These efforts are in direct support of the strengthening of veterinary infrastructures and thereby enhance the ability to detect and respond to disease incursions, while also enhancing the ability to trade internationally (OIE, 2005).
The implementation of the EU Hygiene Package of legislation as from 1 January 2006 will lead to a shift of the responsibility for safe food from the authorities to the producer, while the role of the official veterinarian will change from inspecting to auditing and the transfer of information (food chain information, feedback to producers etc.). Hence this demands integrated professional involvement at all stages, with a greater emphasis on the building of the required capacities for implementation in the official and private veterinary sector (especially veterinarians active in veterinary public health and food safety) and veterinary paraprofessionals (such as veterinary public health personnel, meat/food inspectors) involved in the food sector.
Recognizing this need, the Council of the EU, in responding to a conference on European Response to Public Health Risks from Emerging Zoonotic Diseases (Sept 2004, the Hague) called on all "Member States and the Commission to intensify the cooperation with the relevant international and intergovernmental organizations, in particular the WHO, the OIE, the FAO and the Codex Alimentarius, to ensure effective international coordination of activities in the area of zoonotic diseases, including, where appropriate, in the framework of the International Health Regulations". To this aim there should be more focus on technical and financial support for capacity building in developing countries for the control and eradication of zoonoses in animals (Council of the EU, 2004).
In the Evaluation of the Joint FAO/WHO Food Standards Programme by Codex (Codex, 2002) it is stated "Capacity building in developing countries was found to be essential for countries to protect their own citizens, to benefit from a globalizing market in food and to represent their interests effectively in Codex and WTO negotiations. Codex and FAO and WHO capacity building were found to be continuing to make a substantial contribution internationally and to individual countries", and "Capacity building for food safety and health systems for domestic consumers and for trade is a major priority of developing countries. In many of these countries, domestic food safety surveillance and controls tend to be very weak".
Public demands in respect of zoonoses are increasingly levelled on official veterinary services, nationally and internationally, placing additional financial and administrative burdens on already underfunded public services. A recent meeting of the World Bank (April 2005) acknowledged that emerging zoonoses and pathogens are a global public-good concern and that capacity building and strengthening of veterinary services in terms of surveillance, the development of rural networks of veterinarians and rapid response capabilities will provide a basis for improved crisis prevention. Increasingly the veterinary profession is becoming involved in creating awareness of the danger of the spread of zoonotic diseases from pet animals. Such public awareness campaigns address preventive as well as control measures through close liaison between the pet owner and veterinarian.
In recent years the threat regarding the deliberate misuse of pathogenic biological agents (bioterrorism) that could affect public health, and food and animal production has become a growing concern. Specific measures to counter such occurrences have to be developed by adapting existing methods of disease prevention and control and establishing rapid response mechanisms to manage and contain incidents of natural, accidental or deliberate disease introduction, whether animal diseases or zoonoses. The need for capacity building in this specific area is a particularly high priority.
THE ROLE PLAYERS
1. Official veterinarians
Official veterinarians at veterinary administrations are responsible for the implementation of sanitary standards related to animal health, veterinary public health and zoonoses and animal welfare.
The OIE Code (OIE, 2004a) definition of an official veterinarian is "a veterinarian authorised by the Veterinary Administration of the country to perform certain official tasks associated with animal health and/or public health and inspections of commodities and, when appropriate, to certify in conformity with the provisions of Section 1.2. of this Terrestrial Code", and veterinary administration "means the governmental Veterinary Service having authority in the whole country for implementing the animal health measures and international veterinary certification process which the OIE recommends, and supervising or auditing their application".
The standards of quality of veterinary services must be adhered to and maintained in order to enable their countries to benefit more fully from the WTO Agreement on the Application of the Sanitary and Phytosanitary Measures (SPS Agreement) while at the same time providing greater protection for animal health, animal welfare and public health. In all these sectors of animal health service delivery, particularly in terms of the ability of surveillance, monitoring, control, eradication and prevention of animal diseases and zoonoses, support and capacity building is of a high priority to enable developing countries to access international and regional animal/animal-product markets and make a meaningful contribution to poverty reduction and the improvement of living quality of rural communities.
2. Veterinarians in the private sector
The OIE was requested by its members to address the issue of the use of private veterinarians and veterinary paraprofessionals by national veterinary services and the conditions under which they may be used in order to comply with the OIE international standards on the quality of veterinary services and international certification of animals and their products. In response to these requests, an Ad Hoc Group was formed with the following terms of reference:
to define the functions and responsibilities of private veterinarians and paraprofessionals in the provision of animal health services; and
to provide guidelines on the roles, interrelationships and regulations required to link them with the relevant fields of activities of the veterinary services.
This work is also relevant to the commitment made by the major relevant international organizations at the Doha ministerial meeting regarding capacity building in developing countries, where veterinary services may be under organizational or financial pressure, to enhance their participation in regional or international trade in animals and their products (OIE, 2004d).
In terms of the OIE Code a veterinarian "means a person registered or licensed by the relevant Veterinary statutory body of a country to practise veterinary medicine/science in that country".
3. Veterinary paraprofessionals
The OIE Ad Hoc Group referred to above defined a veterinary paraprofessional as a person who is authorized to carry out certain veterinary tasks with authorization from a Veterinary Statutory Body, under the responsibility and direction of a registered or licensed veterinarian.
In the OIE Code a veterinary paraprofessional means a person who, for the purposes of the Code, is authorised to carry out certain tasks (dependent upon the category of veterinary paraprofessional) in a country through a licence from the veterinary satutry body, and delegated to them under the responsibility and direction of a registered or licensed veterinarian. The tasks authorized for each category of veterinary paraprofessional should be defined by the veterinary satutory body depending on qualifications and training, and according to need.
Examples of veterinary paraprofessionals would include veterinary nurses, veterinary technicians, community-based animal health workers, food inspectors, livestock inspectors etc. The modified definition of veterinary services emphasizes the important role of the private sector in the provision of these services, especially regarding animal disease surveillance and reporting, and the implementation of animal disease control measures.
4. Veterinary statutory body
To ensure adherence to ethical codes and standards by veterinarians and veterinary paraprofessionals, the Ad Hoc Group has recommended that a veterinary statutory body be established in each OIE member country. This body will be responsible for the licensing/registration of private veterinarians and veterinary paraprofessionals, the setting and monitoring of professional standards, and for discipline. Such a body will play a vital role in maintaining public and international confidence in veterinary services.
The Code definition of a veterinary statutory body is "an autonomous national authority regulating veterinarians and veterinary paraprofessionals".
All these professionals are part of the veterinary services of a country, which is defined by the OIE Code to mean the veterinary administration, all the veterinary authorities and all persons registered or licensed by the veterinary statutory body.
CAPACITY NEEDED FOR QUALITY VETERINARY SERVICES IN ACCORDANCE WITH THE PROVISION OF THE OIE CODE (OIE, 2004B)
The capacity for surveillance and the control of zoonoses by veterinarians and veterinary paraprofessionals is an integral part of the quality of veterinary services of a country. Hence it is prudent to note the requirements as specified in the OIE Code to assess and maintain quality veterinary services in a country. Competency in and capability to fulfil the provisions of the fundamental principles (see below) for assessing quality are thus equally applicable for successful control of zoonotic diseases.
The quality of the veterinary services of a country depends on a range of factors, which include fundamental principles of an ethical, organizational and technical nature, and veterinary services should conform to these fundamental principles, regardless of the political, economic or social situation in the country. Compliance with these fundamental principles by the veterinary services of a member country is important for the establishment and maintenance of confidence in its international veterinary certificates.
The Code definition of an international veterinary certificate is "a certificate, issued in conformity with the provisions of Chapter 1.2.2., describing the animal health and/or public health requirements which are fulfilled by the exported commodities".
The quality of veterinary services can be measured through an evaluation, the general principles of which are described in the Code. The following is a summary of the Code recommendations with which veterinary services should comply to ensure the quality of their activities.
Professional judgement - The personnel of veterinary services should have the relevant qualifications, scientific expertise and experience to give them the competence to make sound professional judgements.
Independence - Care shall be taken to ensure that veterinary services personnel are free from any commercial, financial, hierarchical, political or other pressures that might affect their judgement or decisions.
Impartiality - The veterinary services shall be impartial. All parties affected by their activities have a right to expect their services to be delivered under reasonable and non-discriminatory conditions.
Integrity - The veterinary services shall guarantee the integrity of the work of each of their personnel. Any fraud, corruption or falsification should be identified and corrected.
Objectivity - The veterinary services shall at all times act in an objective, transparent and non-discriminatory manner.
General organization - The veterinary services must be able to demonstrate by means of appropriate legislation, sufficient financial resources and effective organization that they are in a position to have control of the establishment and application of animal health measures, and of international veterinary certification activities. Legislation should be suitably flexible to allow changing situations to be addressed efficiently, including the incorporation of animal welfare and food safety measures. In particular, they shall define and document the responsibilities and structure of the organizations in charge of the animal identification system, control of animal movements, animal disease control and reporting systems, epidemiological surveillance and communication of epidemiological information.
A similar demonstration should be made by veterinary services when they are in charge of veterinary public health activities.
The veterinary services shall have at their disposal effective systems for animal disease surveillance and for notification of disease problems wherever they occur, in accordance with the provisions of the Terrestrial Code. Adequate coverage of animal populations should also be demonstrated. They shall at all times endeavour to improve their performance in terms of animal health information systems and animal disease control.
The veterinary services shall define and document the responsibilities and structure of the organization (in particular the chain of command) in charge of issuing international veterinary certificates.
Each position within the veterinary services, which has an impact on their quality, shall be described. These job descriptions shall include the requirements for education, training, technical knowledge and experience.
Quality policy - The veterinary services shall define and document their policy and objectives for, and commitment to, quality, and shall ensure that this policy is understood, implemented and maintained at all levels in the organization. The guidelines for the quality and evaluation of veterinary services propose a suitable reference system, which should be used if a member country chooses to adopt a quality system.
Procedures and standards - The veterinary services shall have appropriate procedures and standards for all their activities, including those for the registration of slaughter establishments.
Information, complaints and appeals - The veterinary services shall have effective internal and external systems of communication, ensuring that any requests for information, complaints or appeals are dealt with in a timely manner.
Documentation - The veterinary services shall have a reliable and up-to-date documentation system.
Self-evaluation - The veterinary services should undertake periodical self-evaluation especially by documenting achievements against goals, and demonstrating the efficiency of their organizational components and resource adequacy. The OIE can assist in the process.
Communication - The veterinary services should have effective internal and external systems of communication.
Human and financial resources - Responsible authorities should ensure that adequate resources are made available to implement effectively the above activities.
CAPACITY NEEDED FOR THE EVALUATION OF VETERINARY SERVICES IN ACCORDANCE WITH THE PROVISION OF THE OIE CODE (OIE, 2004C)
To be able to assess the quality of veterinary services of a country, it is necessary to evaluate such veterinary service provision, which includes the whole spectrum of animal diseases and zoonoses control.
The OIE recommends that any evaluation of veterinary services be based on the OIE Guidelines for the Evaluation of Veterinary Services contained in the Code. The Guidelines, which were adopted by all member countries in May 2002, are applicable to the evaluation of the veterinary services of another country and to the evaluation of a country's own veterinary services.
The purpose of evaluation may be:
to assist a national authority in the decision-making process regarding resources and priorities to be given to its own veterinary services (self evaluation); or
a part of a risk analysis process to determine the health measures which an importing country will use to protect human (in the case of zoonoses) or animal life or health from disease threats posed by imports.
Although quantitative data can be provided on veterinary services, the ultimate evaluation will be essentially qualitative. While it is appropriate to evaluate resources and infrastructure (organizational, administrative and legislative), emphasis should be placed on the evaluation of the quality of outputs and performance of veterinary services, thus the capacity for service delivery.
In an evaluation of veterinary services, the following criteria may be considered, depending on the purpose of the evaluation:
organizational structure of the veterinary services;
material (including financial) resources;
functional capabilities and legislative support; and
animal health and veterinary public health controls.
As regards veterinary public health controls, the national veterinary services should be able to demonstrate effective responsibility or controls, such as surveillance and monitoring programmes, concerning food hygiene, zoonoses, chemical residue testing programmes, veterinary medicines and the integration between animal health controls and veterinary public health.
These may include:
formal quality systems, including quality policy;
performance assessment and audit programmes; and
participation in OIE activities and compliance with OIE member countries' obligations.
To complement the evaluation of veterinary services, it is necessary to also consider the organization structure and functioning of the veterinary statutory body.
CAPACITY NEEDED TO MEET SPECIFIC DEMANDS OF VETERINARIANS AND VETERINARY PARAPROFESSIONALS
Urgent attention must be given to the training of future veterinarians, measured against the needs of the twenty-first-century society. This will necessitate examining entry requirements into veterinary schools, course contents and curricula, with attention to those fields of knowledge and expertise the veterinarian of the future will need. Veterinary pregraduate curricula, as well as postgraduate continuous professional development courses need to be assessed and, where necessary adapted, to be able to meet the demands for the control of TADs and zoonoses, the safeguarding of public health and food safety, application of animal welfare standards and sustainable and sound environmental practices in livestock-production systems (intensive or free-range). The next veterinary generation needs to be scientifically equipped to face up to these challenges brought about by habit destruction, overpopulation and intensive agricultural and marine farming systems.
There exists a general need to address the harmonization of registration/licensing requirements of veterinarians and veterinary paraprofessionals on a regional basis. This will also facilitate cross-border professional activities needed in the control, prevention and eradication of TADs and zoonoses. Such regional activities have been very successfully implemented in e.g. Australia and New Zealand, or within the EU. Many regional political groupings such as the Southern Africa Development Commission (SADC) would greatly benefit from such harmonization protocols, however there is an urgent need for capacity building in this respect.
The maintenance or establishment of veterinary statutory bodies is a prerequisite for the licensing/registration of veterinarians and veterinary paraprofessionals. Expertise and support is needed for the establishment of legal frameworks and administrative structures for these bodies.
The involvement of private veterinarians and veterinary paraprofessionals will greatly contribute to increased efficacy and service delivery of official veterinary services. Such improved quality of veterinary activities will enhance the animal health situation, improve control of zoonoses and contribute to the safety of international trade in animals and animal products and the access and opening up of regional and global markets.
New developments in intensive farming practices, be they on land or in the ocean, demand the veterinary profession's participation and active engagement in issues relating to e.g. environmental (land, sea and air) pollution, science-based welfare practices, and prevention of antimicrobial resistance caused by use of antimicrobials in non-human species.
SUMMARY AND RECOMMENDATIONS
The emergence and re-emergence of zoonoses and their potentially disastrous impact on human health has made food safety (including threats regarding the deliberate misuse of pathogenic biological agents) a priority issue for veterinary services, which includes all professional service providers and institutions, around the world. To be able to address effectively and efficiently the needed surveillance, monitoring, prevention, control and eradication of animal and zoonotic diseases, the professional capacities of all role players, including training institutions, laboratories etc., must meet the levels of the international standards prescribed or required (e.g. by OIE, CODEX) to be able to benefit from the SPS provisions and to access regional and international markets for animals and animal products.
Special attention should be paid to capacity building relating to:
the professional performance and capability of veterinary services in relation to the required quality of service provision;
pre- and postgraduate training in food safety and specifically control of zoonoses;
establishment, maintenance and performance of veterinary statutory bodies; and
harmonization of registration/licensing requirements for veterinarians and veterinary paraprofessionals on a regional level.
Codex. 2002. Evaluation of the Joint FAO/WHO Food Standards Programme. Codex Evaluation (available at www.foodlaw.rdg.ac.uk/fao-news.htm).
Council of the EU. 2004. Press Release, 25 November 2004.
King, L.J. 2004. Emerging and re-emerging zoonotic diseases: challenges and Opportunities. Technical Item. OIE.
FAO/WHO. 2002. Global Forum of Food Safety Regulators, 28-30 January 2002, Marrakech, Morocco. FAO.
OIE. 2003. The role of the veterinarian at the abattoir. Editorial, November 2003 (available at www.oie.int/eng/Edito/en_edito.htm).
OIE. 2004a. Chapter 1.1.1 Terrestrial Animal Health Code, 13th Edition. Paris, OIE.
OIE. 2004b. Chapter 18.104.22.168 Terrestrial Animal Health Code, 13th Edition. Paris, OIE.
OIE. 2004c. Chapter 1.3.4 Terrestrial Animal Health Code, 13th Edition. Paris, OIE.
OIE. 2004d. The role of private veterinarians and veterinary paraprofessionals in the provision of animal health services. Editorial February 2004 (available at www.oie.int/eng/Edito/en_edito.htm).
OIE. 2005. Current Programmes, Future Plans and Interactions for prevention, deterrence, emergency response, and mitigation of effects of accidental introduction or deliberate use of biological agents in food and agriculture. International Forum (available at http://intlforum.tamu.edu/Thiermann.htm).