FAO/WHO Global Forum of Food Safety Regulators Marrakesh, Morocco, 28 - 30 January 2002 Improving Efficiency and Transparency in Food Safety Systems Sharing Experiences Appendix IV Introductory Remarks Food safety, an essential public health priority by Mr David Heymann Executive Director, Communicable Diseases World Health Organization Introduction Microbiological contamination and surveillance Chemical contamination and standard setting Global surveillance of infectious disease Risk assessment The WHO Global Food Safety Strategy Conclusion INTRODUCTION Food safety was in the past often but not always addressed as a public health issue. In recent years, because of a chain of events comprising large-scale food related crises of various degrees of severity, the public perception of the safety of our food supply has been shaken. However, the real burden of disease related to food presents an even more important reason why food safety has recently been increasingly identified as an essential public health priority. This is reflected in the acceptance of food safety as priority for WHO in the year 2000. MICROBIOLOGICAL CONTAMINATION AND SURVEILLANCE The estimated annual mortality of food and water-borne infectious diseases in developing countries amounts to the sad high of 2.1 million deaths, mainly of infants and children. In industrial countries microbiological food borne illnesses affect up to 30 percent of the population. Every year 20 out of each million inhabitants die from food borne disease. There are a number of examples of increased problems over the last decades. The increase in the incidence of Salmonella enteritidis infections in humans in the years between 1980 and 2000 amounts to a factor of 20 for many of the countries in Europe and North America. Another example of globally emerging problems is antimicrobial resistance. Data from the US show that the percentage of multi-drug resistant Salmonella Typhimurium, type (DT) 104 in cattle has risen from a mere 2 percent in 1982 to 43 percent in 1996, while at the same time the percentage in humans rose from 0 percent to 35 percent. The curves of both human and cattle percentages are almost similar, time-wise; suggesting transmission from cattle to humans through food. Our chains of food supply are often composed of many steps, and at each stage there are numerous possible occasions for contamination of the food. Many food production methods have been developed without adequate foresight into the possible consequences of the application of non-traditional techniques. This has for instance led to the spread of the BSE epidemic, an epidemic for which we cannot predict the expected course. Some examples of the economic impact of infectious food borne disease outbreaks show that the consequences of cost reduction measures can be grave. An outbreak of cholera in Peru in 1991 cost 770 million dollars, a similar outbreak in Tanzania in 1998 36 million dollars. The costs, or rather losses, are caused by for instance declining tourist revenues and exports of food commodities. Simple preventive measures and effective surveillance systems at a fraction of these costs might have prevented these outbreaks, or would have definitely reduced the impact thereof. From the outbreak in Tanzania a valuable lesson in risk analysis was learnt. Immediately after the notification of a human cholera outbreak in January 1998, various importing countries posed a ban on the importation of freshwater and marine fish imports. After a risk assessment undertaken by WHO on the actual transmission of human cholera, the ban was lifted. However, in the interim Tanzania had lost a lot of revenue through the halted export of fish. Had risk analysis been undertaken based on adequate information, the international response would have been more appropriate, and the ban would never have been posed. It is thus in the interest of all trading partners, be they the exporter, often developing countries, as well as developed countries, to have an adequate risk analysis performed. CHEMICAL CONTAMINATION AND STANDARD SETTING The human health effects of chemical contaminants of food, such as dioxins, range from various cancers, damage to the nervous system, diseases of the immune system, and reproductive disorders to interference of infant and child development. Various monitoring programmes have taught us that even in countries where the food supply is supposedly safe, chemical contamination remains a problem. Dietary exposure to dioxin and dioxin like PCB's in various Western countries is higher than the provisional tolerable monthly intake, the average level of DDT in human breast milk in all but one of the WHO Regions is well over the provisional tolerable monthly intake. Various similar or smaller scale studies regretfully complement this picture. WHO, through a number of food safety activities, has been contributing to food safety on a global level for a number of years. Much has been achieved in the areas of disease surveillance and response, risk assessment and surveillance of chemicals and chemical contamination, capacity strengthening, and standard setting. Most of these activities have been undertaken in collaboration with FAO. GLOBAL SURVEILLANCE OF INFECTIOUS DISEASE A network of networks: WHO has, through a network of networks, joined all presently existing networks that are active in the area of infectious disease surveillance. This task is undertaken by using important partners in the area of collection of information on disease incidence and outbreaks, such as the Ministries of Health, the UN sister agencies, NGOs, the media, epidemiology and military training networks. Examples of partners in this network of networks are described in the paragraph below. The Global Public Health Intelligence Network, GPHIN, is a web-based global network that automatically scans all news publications on the Internet for infectious disease outbreaks. This way, a number of important outbreaks have been identified, that would only have been discovered in a much later stage if the usual surveillance systems would have been the only mechanism of recognition. As an example, over a ten-day period in the year 2000, through screening for human infectious disease outbreaks related to food animals, GPHIN found a total of ten outbreaks. Of these outbreaks 5 affected less than 5 patients, three were in the range between 20 and 50, and two were large-scale. The rapid detection of these outbreaks allows for an early launch of control measures, and thus reduces the eventual size of the outbreaks. The global surveillance of human influenza, in which 84 countries are involved, through either collaborating laboratories or national networks, has led to the early detection of the Influenza A (H5N1) virus, or Hong Kong virus, which allowed for effective risk management and pandemic planning. The existence of a network, joining all collaborating laboratories and institutions, allowed for start of vaccine production as early as 4 months after the initial detection of the virus. The global surveillance of salmonella infections, a joint project of WHO, CDC and the Danish Veterinary Institute, which surveys salmonella infections in animals and humans is another global programme in which a network of laboratories has been set up to monitor the global incidence of salmonella infections. The programme is also active in expanding the network through technical assistance to laboratories in sero-typing analysis and quality assurance. In the area of monitoring and surveillance of chemical contaminants, WHO has been collecting data on chemical food contamination and human exposure for global evaluation through its Global Environment Monitoring System, or GEMS, for a number of years. The focus is on population based dietary exposure to major food contaminants, and presently more than 80 countries are participating in the system. RISK ASSESSMENT For many years, chemical risk assessment has been the first focus of activities. Through the work of the Joint FAO/WHO Expert Committee on Food Additives (JECFA) and the Joint FAO/WHO Meeting on Pesticide Residues (JMPR), risk assessments and advice have been provided to Codex Alimentarius and Member States. In the area of global risk assessment, the studies into potential exposure to Bovine Spongiform Encephalopathy through trade, which focussed on the spread of the actual sources of BSE contamination world wide, animal feed and live bovines, has allowed for the development of scenarios and projections on the incidence of BSE and human variant Creutzfeldt Jacob disease. Currently FAO and WHO are performing a number of microbiological risk assessments, the first ever to be performed at the international level. The food-pathogen combinations that have been identified through various expert consultations as deserving immediate attention are Listeria in ready to eat foods, Campylobacter in poultry, Vibrio cholera in seafood, and Salmonella in eggs and poultry. THE WHO GLOBAL FOOD SAFETY STRATEGY Through the adoption of food safety as one of WHO's priorities in the World Health Assembly in 2000, it became imperative for WHO to develop a global strategy on food safety. This strategy has recently been evaluated and approved by the Executive Board, and will serve as the basis for the WHO food safety activities in the medium and long term. In this strategy, technical capacity building and international cooperation are incorporated in the areas of food borne disease surveillance, risk assessment, the safety of new technologies, the public health role in the work of Codex Alimentarius, and risk communication. CONCLUSION The opportunities for partnership in food safety are presently good. In industrialised countries the present atmosphere creates wariness in consumers vis-à-vis food safety, and a severely compromised confidence of these consumers in the existing food control systems. This leads to a large willingness to put food safety on the political agenda. The hidden burden of food safety is still not fully understood, but present knowledge already alarms by mere facts. In developing countries the visible and endemic burden is large. Regretfully, mainly due to a lack of awareness both on the side of the consumers and on the side of politicians, there is often a low political will to address the issues adequately. There is at this precise moment in time a great opportunity to create the necessary partnerships between industralized and developing countries to benefit from current and past experience in strengthening national and global food safety. Let us grasp that opportunity as strive for safer food for all.