ALICOM 99/14  |
| ALICOM 99/14 |
Conference on International Food Trade
|
Prospects for the Future: Emerging Problems - Chemical/Biological |
by |
Dr T. Van de Venter, Department of Health, South Africa |
II. Emerging foodborne problems
III. Emerging biological or chemical agents
1. Foodborne diseases are one of the most widespread global public health problems of recent times, and their implications for health and economy are increasingly recognized. These diseases are attributable to a wide range of agents. Only a small proportion of foodborne diseases actually come to the notice of health services and even fewer are investigated. It is estimated that the reported incidence of foodborne disease represents less than 10%, or maybe less than 1%, of the real incidence. There is reason to believe that in developing countries an even lower proportion of cases comes to the notice of health services, primarily because of poverty and lack of resources for food safety management and food control services.
2. In spite of this under-reporting, it has been possible to identify certain trends, such as an increase in foodborne diseases in many parts of the world, as well as the emergence of new or newly recognized foodborne problems. These emerging problems may be biological or chemical by nature.
3. The term "emerging" implies that this is largely a matter of perception, which is linked to any array of subjective factors. Emerging, or in some cases re-emerging, foodborne problems are however most commonly considered to be those problems which:
4. The following factors play a role in the epidemiology of emerging foodborne problems:
i) Changes in the pathogens themselves. Microbial adaptation through natural selection is a key process in the emergence of pathogens, while the therapeutic use of an antimicrobial agent, in human or animal populations, creates a selective pressure that favours survival of bacterial strains resistant to the agent.
ii) Development, industrialization, urbanization and changing life-styles. Economic and technologic development have introduced new foods and food preparations and have changed dietary habits. The food chain has become longer and more complex, thus increasing opportunities for contamination. Higher standards of living have led to an increase in the consumption of food of animal origin. There is an increase in the consumption of prepacked "convenience" foods as well as street-vended foods, while meals are consumed more often in food service establishments. Dietary habits also change as a result of nutritional recommendations and campaigns or may be influenced by food policy, production systems, or environmental changes that lead to increased access to certain foods.
iii) Changes in health and social environments. Many countries are under increasing pressure to down-size, decentralize and privatize their health systems. Such rapid changes and public sector austerity create immediate, dramatic health impacts. Food safety education is replaced by the emphasis on other important health concerns. Urbanization creates its own social changes which in turn influence dietary habits.
iv) Knowledge, beliefs and practices of food handlers and consumers. Lack of knowledge or negligence on the part of food handlers, coupled with an increase in mass catering are important factors, as are dietary preferences (such as those for raw or hazardous foods) and practices as well as some cultural beliefs and rituals.
v) Demographic changes. The proportion of the population susceptible to foodborne problems is increasing. In more affluent domains the population is growing older as life expectancy increases. Elsewhere a very high birthrate often goes hand in hand with poverty and malnutrition. Immunocompromisation because of HIV infection, malignancy and immunosuppressive treatment has also increased.
vi) International travel and migration. The hundreds of millions of tourists and other travellers that cross international borders every year are at a high risk of being affected by foodborne borne disease and can carry them rapidly to new and distant environments. Immigrants introduce new foods, food preparations and dietary habits into new regions.
vii) International trade in food, animal feed and in animals. The globalization of the food and feed supply, facilitated by the liberalization of world trade, has led to an increasing number of cases where the rapid movement of food and animal feed of animal as well as plant origin has contributed to the spread of foodborne problems to new areas. Healthy animals may act as reservoirs of foodborne pathogens.
viii) Polluted environment, poverty and lack of safe food preparation facilities. These are interrelated factors that play an important role in social settings of poverty.
ix) New food vehicles of transmission. An array of new food vehicles of transmission have been identified in recent years, including street foods. While undercooked foods of animal or marine origin were traditionally implicated in outbreaks of foodborne illnesses, increasing attention is now being focussed on items such as fruit, vegetables and apple cider.
5. Control measures in respect of emerging foodborne problems necessitate a thorough understanding of the causative agents. While the most prominent emerging foodborne problems are of microbial origin, other biological as well as chemical agents are also a cause for concern.
Bacteria
Eschericia coli O157
6. Referred to as enterohemorrhagic E. coli (EHEC), this pathogen produces toxins known as verotoxins. Cattle appear to be the main reservoir. Transmission to humans is principally through the consumption of contaminated foods, such as raw or undercooked meat products and raw milk. Fresh-pressed apple juice or cider, yogurt, cheese, salad vegetable and cooked corn have also been implicated. Faecal contamination of water and other foods, as well as cross-contamination during food preparation, can lead to infection, as can person-to-person contact. It is a major cause of bloody and non-bloody diarrhoea and often leads to complications such as haemolytic uraemic syndrome and other long-term complications.
Enteroaggregative Escherichia coli
7. Enteroaggregative E. coli (EAEC) have been increasingly recognized as agents of a watery mucoid diarrhoea - especially in children - in developing countries, and recently in industrialized countries. They are particularly associated with persistent diarrhoea (more than 14 days), a major cause of illness and death. It is thought that EAEC adhere to the intestinal mucosa and elaborate enterotoxins and cytotoxins, which result in secretory diarrhoea and mucosal damage. Recent studies support the association of EAEC with malnutrition and growth retardation in the absence of diarrhoea.
Listeria monocytogenes
8. This ubiquitous microorganism has been isolated from various environments, including decaying vegetation, soil, animal feed, sewage and water. It is resistant to diverse environmental conditions and can grow at temperatures as low as 3oC. It is found in a wide variety of foods, both raw and processed, where it can survive and multiply rapidly during storage. These foods include milk and cheeses, meat (including poultry) and meat products, as well as seafood and fish products. Listeria monocytogenes is responsible for opportunistic infections, preferentially affecting individuals whose immune system is perturbed, including pregnant women, newborns and the elderly. It primarily causes meningitis, encephalitis or septicaemia, and when pregnant women are infected it can lead to abortion, stillbirth or premature birth.
Multidrug-resistant Salmonella typhimurium DT 104
9. This microorganism has been isolated from cattle, poultry, sheep, pigs and horses. Antimicrobial therapy is used extensively to combat S. typhimurium infection in animals, and the evolution of a strain resistant to the commonly-used antibiotics has made infections with S. typhimurium in food animals difficult to control. The primary route by which humans acquire infection is by the consumption of a large range of contaminated foods of animal origin.
Salmonella enteritidis
10. This bacterium is the dominant cause of human salmonellosis in many parts of the world. Poultry, eggs and egg products in particular are contaminated, but this microorganism has also been found in other foodstuffs such as ice cream. Cross-contamination, undercooking and inadequate cooling procedures promote the spread and growth of salmonella during processing and handling. One important characteristic of S. enteritidis is its ability to contaminate the contents of intact shell eggs. Manifestation of illness include invasive disease and reactive arthritis.
Campylobacter jejuni
11. Most sporadic infections are associated with improper preparation or consumption of mishandled poultry products. Most C. jejuni outbreaks, which are far less common than sporadic illnesses, are associated with the consumption of raw milk or unchlorinated water. Campylobacteriosis may lead to Guillain-Barré Syndrome, a cause of flacid paralysis. The reservoirs of this organism include poultry, cattle, swine, sheep, rodents and birds.
Vibrio vulnificus
12. The consumption of raw mulluscan shellfish that is contaminated with this microorganism, which is a normal inhabitant of some marine environments, often leads to primary septicaemia and death. Individuals most susceptible to infection with this agent include those having chronic liver disease, or chronic alcoholism, or those who are immunosuppressed in some way.
Streptococcus parasanguinis
13. Pure isolates of this bacterium were recovered from two sheep in Spain during a recent bacteriological survey for determining the prevalence of subclinical mastitis. As this bacterium has been associated with the development of experimental endocarditis, its presence at relatively high concentrations in apparently healthy sheep milk may pose a health risk in persons with predisposing heart lesions.
Viruses
Hepatitis E
14. This virus usually enters the body through water or food, especially raw shellfish, that has been contaminated by sewage. Anti-HEV activity has been determined in the serum of a number of domestic animals in areas with a high endemicity of human infection, indicating that this may be an emerging zoonosis.
Norwalk virus and Norwalk-like viruses
15. These agents cause mild to moderate disease with gastrointestinal symptoms. Outbreaks have been associated with the consumption of contaminated drinking water and food, especially raw or undercooked shellfish.
Protozoa
Cyclospora cayetanensis
16. This coccidian parasite occurs in tropical waters worldwide and causes a watery and sometimes explosive diarrhoea in humans. It was initially associated with waterborne transmission but has also been linked to the consumption of raspberries, lettuce and fresh basil. The incubation period is one week after the ingestion of the contaminated food and the agent is shed in the faeces for more than three weeks.
Toxoplasma gondi
17. The primary hosts are cats, and human infection takes place when contact is made with their faeces. This can also take place by the ingestion of raw or undercooked meat from intermediate hosts, such as rodents, swine, cattle, goats, chicken and birds. Toxoplasmosis in humans often produces mononucleosis-type symptoms, but transplacental infection can result in foetal death if it occurs early in pregnancy. In immunocompromised individuals it can cause pneumonitis, myocarditis, meningoencephalitis, hepatitis or chorioretinitis or combinations of these. Cerebral toxoplasmosis is often seen in AIDS patients.
Cryptosporidium parvum
18. The mode of transmission of this coccidian protozoan is faecal to oral, including waterborne and foodborne means. The reservoirs include man and domestic animals, including cattle. Oocysts can survive in the environment for long periods of time, where they remain infective and are capable of resisting chemicals used to purify drinking water. They can however be removed from water supplies by filtration. Symptoms of cryptosporosis in man include fever, diarrhoea, abdominal pain and anorexia. The disease usually subsides in less than 30 days but may be prolonged in immunodeficient individuals and continue to death.
Helminths
The genus Anisakis
19. Anisakiasis is an infection of the human intestinal tract caused by the ingestion of raw or undercooked fish containing larval stages of the nematodes Anasakis simplexi or Pseudoterranova decipiens. Infections caused by the latter roundworm are not a serious threat to human health, but those caused by A. simplex are more serious in that this agent penetrates the gastrointestinal tissue and causes disease that is difficult to diagnose. The primary hosts are warm blooded marine mammals such as seals, walruses and porpoises. Their larvae pass via krill to fish such as cod, pollack, halibut, rockfish, flat fish, mackerel, salmon and herring.
Unconventional agents
Prion
20. Transmissible Spongiform Encephalopathies in animals and humans are caused by an unconventional virus or prion. These conditions include scrapie in sheep, bovine spongiform encephalopathy (mad cow disease) in cattle and Creutzveld Jacob Disease in humans. It is commonly accepted that BSE was first caused in Britain when cattle were fed carcase meal from scrapie-infected sheep. It is also accepted that humans contracted the non-classic form of CJD after consuming cattle meat, in particular nerve tissue.
Mycotoxins
21. Mycotoxins are the toxic products of certain microscopic fungi which, in some circumstances, develop on or in foodstuffs of plant or animal origin. They are ubiquitous and widespread at all levels of the food chain. Hundreds of mycotoxins have been identified and are produced by some 200 varieties of fungi. The most important ones from the food safety point of view are discussed individually below. In terms of their implications for human health and for economy, mycotoxins are by far the most important contaminants of the food chain.
22. Of particular importance in current toxicological studies is the combined and possible synergistic effects that some of the mycotoxins may have on human and animal life.
Fumonisins
23. Fumonisins are a group of Fusarium mycotoxins occurring worldwide in maize and maize-based products. Their causal role in several animal diseases have been established. Available epidemiological evidence has suggested a link between dietary fumonisin exposure and human oesophageal cancer in some locations with high disease rates. Fumonisins are mostly stable during food processing.
Zearalenone
24. This fungal metabolite is mainly produced by Fusarium graminearium and F. culmorum, which are known to colonize maize, barley, wheat, oats and sorghum. These compounds can cause hyperoestrogenism and severe reproductive and infertility problems in animals, especially in swine, but their impact on public health is hard to evaluate.
Trichothecenes
25. These mycotoxins are produces by many species of the genus Fusarium. They occur worldwide and infect many different plants, notable of which are the cereal grains, especially wheat, barley and maize. There are over 40 different trichothecenes but the most well known are deoxynivalenol and nivalenol. In animals they cause vomiting and feed refusal but also affect the immune system. In humans they cause vomiting, headache, fever and nausea.
Ochratoxins
26. These compounds are produced by Penicillium verrucosum and by several species of Aspergillus. The major dietary sources are cereals but significant levels of contamination may be found in grape juice and red wine, coffee, cocoa, nuts, spices and dried fruits. Contamination may also carry over into pork and pig blood products and into beer. Ochratoxin is potentially nephrotoxic and carcinogenic, the potency varying markedly between species and sexes. It is also teratogenic and immunotoxic.
Pesticide residues
27. Restrictions are now being placed on some of the older organochlorine pesticides because of their environmental persistence and their potential accumulation in the fatty tissues. Although exposure to these pesticides is below the ADIs, breast milk in both developed and developing countries has on occasion found to contain relatively high levels of organochlorine pesticides. It has also been found that although there may be a high variability in residue levels of pesticides in individual units of commodities, this was unlikely to cause any direct adverse health effects.
Veterinary drugs
28. The intake of the residues of veterinary drug residues in food at levels below the ADI is also considered to be safe. In recent years, however, growing concern has been expressed about the development of antimicrobial drug resistance. Some important contributing factors to the development of this resistance are the widespread use of veterinary drugs, the misuse of such drugs and the feeding of such drugs to animals at low doses in order to promote weight gain and improve feed efficiency. Some of these resistant microorganisms may be passed on to humans when they consume food that originates from the animals that harboured them. In addition, the development of resistance may also lead to the application of larger and larger therapeutic doses to food-producing animals.
Environmental contaminants
29. Chemicals such as dioxins, chlorinated biphenyls, furans and heavy metals may contaminate the environment as a result of industrial activities. From the environment these chemicals may enter the food chain via plants or animals and cause a variety of health problems. These are considered as emerging problems in countries in early stages of industrialization.
Biotechnology
30. The production of genetically modified foodstuffs presents tremendous opportunities and benefits as far as future food production is concerned. However, the emergence of this new technology has also presented a number of problems, although in many quarters these problems are regarded as potential or perceived, rather than real. The concerns that have been expressed mainly relate to changes in the nutritional quality of food, an increase in toxicity or hazards in respect of food intolerances or food allergies and the development of antimicrobial resistance. Real problems that will be carried into the next century include the lack of consensus amongst governments on many issues relating to food produced by means of biotechnology - including the labelling thereof - as well as the struggle to gain general consumer acceptance.
General
31. Other food-related problems or agents, such as cholera, "aeromonas" and rotavirus may be added to the list, but differences of opinion as to what is regarded as emerging will not have any impact on the basic issues at stake.
32. Some emerging problems have been known for twenty years or more, and within another twenty years may no longer be regarded as "emerging". With the progress of science, some may even no longer be regarded as problems. However, most will continue to place huge demands on industry, governments as well as on research and other organisations that have the responsibility of ensuring the safety of consumers. In many cases, the full impact of the newly-recognized problems are yet to be realized.
33. The likelihood is that new emerging foodborne problems will present further challenges to mankind and that their importance will increase, rather than diminish. Virtually all the factors that have contributed to the current emerging foodborne problems are still present, and many are in fact increasing in intensity. Populations will continue to grow and the movement of people, food and animals across international borders will continue to increase. Development, industrialization and urbanization will continue to facilitate changed life styles and changes in health and social environments. The proportion of the global population that can be regarded as immunocompromized is steadily rising.
34. Foodborne problems that are well-recognized in many areas of the world may become "emerging" in others. An increase in the consumption of seafoods may lead to a greater awareness of marine toxins. Biological, chemical or nuclear warfare or nuclear accidents may necessitate increased food control measures in this regard. Further mutations of microorganisms and the emergence of new biological hazards - including foodborne zoonoses - are expected by many.
35. Emerging foodborne problems will therefore not only have implications for the health status and economies of individual countries over the coming years, but also for international trade, and the agreements that govern these issues.
36. Foodborne illnesses are widespread and have an impact on communities in both the developing and developed world. Developing countries however, bear the brunt of the annual incidence of some 1,5 billion episodes of diarrhoea in children under three years of age. The more than three million resultant deaths are an indication of the magnitude of the problem, as a significant proportion of the diarrhoeal cases are foodborne in origin. The 1992 FAO/WHO International Conference on Nutrition recognized that hundreds of millions of people worldwide suffer from communicable and non-communicable diseases caused by contaminated food. These diseases take a heavy toll in human life and suffering, particularly among infants and children, the elderly and other susceptible persons. They also create an enormous social, cultural and economic burden on communities and their health systems.
37. Where many developing countries face problems such as poor education, poverty, poor environmental hygiene, high birth rates, food shortages and a variety of health problems, it is especially infants and young children that are trapped in the vicious circle of malnutrition and infection. In many of these countries HIV/AIDS is particularly prevalent, rendering millions of consumers more susceptible to foodborne illnesses and their consequences.
38. In developing countries scarce financial resources are often directed to what the governments perceive to be more urgent national priorities, e.g., other health problems, education, housing, sanitation, food procurement and defense. Food control issues are not well appreciated and usually receive low priority in public health programmes because foodborne illnesses are perceived as mild, self-limiting diseases. Their severe and chronic health consequences are often overlooked, as are their consequences for trade and for the economy. In such countries a lack of information leads to a lack of appreciation of the health significance of unsafe food and this in turn leads to low priority and and sometimes no resources at all being assigned to food safety. The latter causes a neglect in food control measures and even more so in foodborne disease investigation and surveillance. As no data on foodborne illnesses or other health and economic effects of unsafe food are generated, the policy makers continue to give the subject low priority, and so the cycle repeats itself. Food control matters do not get the same attention except for a few days when there is a serious foodborne disease outbreak and the matter highlighted by the press. It is soon forgotten as the emergency is over and status quo resumed. The experience gained is not translated into management decisions.
39. In many developing countries foodborne problems have their origin in the methods of farming. Many farmers are uneducated and follow methods of production that are centuries old. Their farms are very small or they share communal property. They live in very close contact with their animals, thereby increasing the likelihood of foodborne zoonoses. There are few if any animal disease control or eradication programs. Methods of harvesting and storage of grain increase the likelihood of problems due to toxic seeds and mycotoxins. When veterinary drugs and pesticides are available, there may be scant control over their sale and use. Irrigation water is often polluted. Distances to markets or processing centres are often long and transport is inefficient. The technology to prevent the contamination of agricultural products is absent, thereby also rendering these products unsuitable for export.
40. It is especially in developing countries that the food industry includes many small concerns that are not well informed of food safety issues or their responsibilities in this regard. Knowledge of modern technologies, good manufacturing practices, hygiene, HACCP and quality control is often limited or absent. Storage, including cold storage, facilities may be inadequate and the quality of water used in food processing facilities may not be suitable for this purpose. Vast numbers of labourers that handle food in factories, as well as on farms, are illiterate and untrained.
41. In some societies, diarrhoea is not perceived as a symptom of disease and may even be considered as a normal or natural occurrence. Many consumers may be carriers of foodborne pathogens, which they take with them to their places of work. In many countries food fermentation is a common household food technology, but the inherent hazards are not understood. Poor household food handling and storage practices do not directly affect international trade, but the economic effects of foodborne illness creates a drain of funds that could have been used for development.
42. Many foodborne illnesses have their origin in the household kitchen, and it is at this level that the most effective controls can often be applied. This emphasizes the importance of consumer education and the communication of information on emerging foodborne hazards to consumers.
Consumer associations, where they exist, may not have the necessary knowledge or experience in scientific aspects of food science, food safety and foodborne illnesses to adequately provide consumers with the information and advice they rquire.
43. Many developing countries - as well as some developed countries - do not have an optimum infrastructure to effectively recognize or deal with foodborne problems, including new or emerging problems. This lack of infrastructure includes a lack of human and monetary resources, as well as a lack of laboratory and training facilities. The consequences may include the following:
44. Paragraph 3 of Article 2 (Basic Rights and Obligations) of the SPS Agreement states that "Members shall ensure that any sanitary and phytosanitary measure is applied only to the extent necessary to protect human, animal or plant life or health, is based on scientific principles and is not maintained without sufficient scientific evidence......"
45. Article 3 encourages the harmonization of food safety measures on as wide a basis as possible. It implies that food safety measures which conform to Codex standards and related texts are deemed necessary to protect human life or health and are presumed to be consistent with the relevant provisions of the SPS Agreement. All countries need to develop the necessary capacities to conduct risk assessments and implement appropriate risk management activities, particularly regarding emerging biological or chemical problems.
46. Article 4 inter alia refers to the conclusion of bilateral or multilateral agreements on the recognition of the equivalence of the level of protection of specified food safety measures. Failure to conclude equivalence agreements with major trading partners can have serious economic consequences. The development of such agreements is however facilitated through the use of Codex standards, guidelines and recommendations as a basis for the food control legislation of individual countries. Such countries however need to develop the capacities to ensure adherence to the harmonized legislation.
47. The objectives of Codex are to protect human health and to facilitate international trade. The SPS Agreement recognises the right of governments to take food safety measures, but stipulates that they must be based on science and where possible should be based on international standards, guidelines and recommendations where they exist. This Conference addresses science-based decisions, harmonization, equivalence and mutual recognition. All of these issues are relevant to emerging foodborne problems. Such problems will however not be solved by individual countries acting in isolation, no matter how high their levels of expertise and food control. Emerging foodborne problems are a global issue. A unified and joint approach by all the countries of the world, together with the relevant international organizations, is a prerequisite for the identification and control of all emerging foodborne problems which threaten human health as well as the smooth flow of international trade. The following recommendations are based on this philosophy.
· That a global information system be elaborated and implemented in respect of emerging foodborne problems.
48. "Surveillance" refers to the systematic collection and use of epidemiological information for the planning, implementation and assessment of disease control. It therefore implies "information for action". The objectives of foodborne illness surveillance - which are also applicable at the global level - are to:
49. With the exception of cholera (which is subject to the International Health Regulations), there is no obligation to report foodborne diseases internationally. Attempts to provide a global picture of foodborne diseases are usually hampered by differences in national surveillance systems, where such systems exist. In addition, the reported diseases are not presented in a uniform manner.2
50. Global surveillance of emerging foodborne problems can play a very important role in the early detection, early warning, rapid investigation and control of such problems. It can also help limit the extent and distribution of the problem, thereby preventing many cases of illness and minimising the negative impact on trade and the economies of individual countries. It is therefore in the global interest that serious consideration be given to the establishment of an international emerging foodborne problem information system. The functions of such a system would include the elaboration of uniform international methods of surveillance, assistance to developing countries in the establishment of national focal points for surveillance and the collection of relevant data from across the globe. In this regard, cognisance must be taken of the existing activities of the Joint FAO/WHO Collaborating Centre in Berlin, and consideration should be given to the strengthening of its capabilities, especially as regards epidemiological surveillance and information so that it may be able to manage and operate the related information system.
51. The results of such an information system would also be of value to Codex in consideration of needs to elaborate standards and for countries in the early identification and control of emerging problems.
52. Consideration should also be given to the submission of food monitoring data, as this could provide most useful information on specific emerging foodborne agents, even in the absence of actual cases of illness.
· That international research into emerging foodborne problems be promoted and coordinated.
53. One of the most critical needs in food safety research is for techniques to more rapidly and accurately identify and characterize foodborne hazards. Many emerging foodborne pathogens cannot easily be detected, or be detected at all in foods. Other microorganisms, previously thought to be innocuous, have emerged as more virulent. Food control interventions ideally are guided by risk assessment, in respect of which data is often insufficient. Some areas that require research are:
54. Individual governments should recognize the importance of the matter and find means to provide the necessary resources and funds for such research. The international emerging foodborne problem information system could be used in coordinating such research, and also ensure the global dissemination of research results.
· That methods of sampling and analysis in respect of emerging foodborne problems be established and communicated, and that developing countries be assisted in their efforts to detect such problems.
55. The early detection of emerging foodborne problems is an important factor in the control thereof. Although many countries may be aware of problems that have occurred elsewhere, they may not possess the knowledge which is necessary for the correct sampling of foodstuffs and the laboratory analysis to determine the agent. This not only mitigates against efforts to curb the introduction or spread of the problem, but also prevents the country from playing a meaningful role in international control efforts.
56. The FAO and WHO should be asked to determine which methods of sampling and analysis need to be elaborated in order to identify specific emerging problems - chemical as well as biological. They must then elaborate methods for global application, for example for the detection of Cyclospora. This important information could then be globally distributed through the proposed international information system. FAO, WHO and other relevant bodies should continue and strengthen the dissemination of information, manuals and training on methods of sampling and analysis.
· That measures which will encourage and assist all countries in designing and implementing efficient national food control systems be qualified/quantified, coordinated and intensified.
57. Recent years have seen a number of countries react to national and international needs and obligations by announcing their intention to design and implement new and modern national food control systems. The exact nature of these measures differs from country to country, in accordance with individual circumstances, but all are aimed at achieving a high level of protection which is at least equivalent to that of their trading partners. A number of others, mostly developing countries, have made some progress in this regard, but much work still remains to be done.
58. Apart from facilitating the export of food, all countries need an efficient national food control system to enable them to fulfil their roles in identifying and controlling emerging foodborne problems. This cannot be done by a few major powers on their own. Although some countries may not succeed in concluding equivalence agreements and subsequently have little or no food exports, this may not prevent foodborne problems, especially pathogens, from spreading beyond their borders. Such countries may become reservoirs that constitute a threat to global food safety.
59. Articles 9 and 10 of the SPS Agreement make provision for technical assistance and for special and differential treatment of developing countries, especially least developed countries. The technical assistance can be bilateral or through appropriate international organizations. This issue has been discussed by the Codex Committee on General Principles, while FAO and WHO also offer technical advice and assistance through bilateral activities. Some major powers have also launched initiatives in this regard.
60. However, current efforts seem to be uncoordinated, and there is no indication of time frames for obtaining equivalence. For trade purposes the latter is largely a bilateral issue between individual countries. For global food safety control it is necessary that the appropriate international organizations, with the assistance of their members, elaborate a methodical plan of action to encourage and assist countries in developing acceptable and efficient food control systems, while simultaneously indicating the minimum or basic parameters or requirements for such purpose. These should include the ability to apply the three elements of risk analysis.
· That capacities for risk assessment be strengthened both at the national and international levels.
61. Risk assessments provide information for identifying and characterizing food hazards. In this regard, national governments should utilize the information developed by the Joint FAO/WHO Expert Committee on Food Additives, by the Joint FAO/WHO Meeting on Pesticide Residues and that developed by FAO and WHO on microbiological risk assessment. Risk assessment information is useful in determining what hazards are of such a nature that their prevention, elimination, or reduction to acceptable levels is necessary. The information is also useful in determining the most effective intervention strategies.
· That the application of General Principles of Hygiene as well as of the Hazard Analysis Critical Control Point system be promoted as a key element to enhance the control of emerging foodborne problems.
62. There are many causes of emerging foodborne problems, many points at which food can be contaminated, and numerous factors that make some groups of people more susceptible than others. Needless to say, no single preventative measure will ensure the safety of all foods. An initiative designed to improve the safety of the food supply should focus on the hazards and foods that present the greatest risks to public health, should emphasize development and implementation of preventative control of those risks, and should seek opportunities for such controls through a collaborative process with the responsible sectors of the food industry and all other stakeholders. The "farm to fork" concept should be enhanced by building safety into the production, handling, processing and storage of food.
63. Basic hygiene, good agricultural practices and good manufacturing practices should be adhered to by operating in accordance with the provisions of the Codex Principles of Food Hygiene, as well as other appropriate Codes of Practice and appropriate legislation. This must be supported by the application of HACCP in those sectors where it will enhance food safety.
· That the use of information, education and communication (IEC) be encouraged as a tool for the control of emerging problems.
64. Governments, industry and academia must all share in the responsibility of devising and applying risk analysis with emphasis being placed on risk communication. Consumers should not be passive but should be encouraged to make use of the many efforts that are normally made by governments and educational institutions to increase their knowledge of food safety issues. This is especially so in the case of emerging problems where hygienic household practices or other measures may play an important role in the prevention of foodborne illness.