4.1. Developing the EMPRES programme
4.2. Developing the GREP
4.1.1. Follow up to the World Food Summit Commitment
4.1.2. Impact of epidemic diseases on food security and trade
4.1.3. The EMPRES global network
4.1.4. EMPRES transboundary animal disease information system
4.1.5. Objectives of EMPRES at the national level
4.1.6. EMPRES functions at the global level
4.1.7. EMPRES functions at the regional level
4.1.8. EMPRES functions at the national level
4.1.9. The role of the farming communities in EMPRES functions
4.1.10. Developing EMPRES units within national veterinary services
4.1.11. Donor support to national and regional EMPRES initiatives
The overall implications of the Declaration on World Food Security made at the World Food Summit, in November 1996, were examined in relation to EMPRES. The impact of rinderpest and other epidemic diseases upon development were discussed by the Expert Consultation as they influence both food security and trade. The diseases contribute to the instability of food supplies and to natural disasters in semi-arid pastoral areas, where livestock systems provide the major food component. The security of this food source could be assured by a more vigorous application of the EMPRES principles at country level
Outbreaks of the transboundary epidemic diseases have a negative influence on both food security and trade. They do this by causing direct and indirect losses of livestock and by inhibitory effects of these diseases on trade. The Expert Consultation considered that the extension of EMPRES activities to regional and national levels would have a positive effect upon disease control and eradication activities. The EMPRES initiative is a key programme which addresses these issues and its role is more closely examined in a concept paper (see appendix 5.).
The need to assess the risk of epidemic diseases to trade among countries was highlighted. Clearly risks of introducing disease from one country to another arise from trading and the possibility of this occurring must be reduced to a minimum. A systematic risk assessment approach needs to be adopted in livestock trading. The Expert Consultation considered these issues and identified particular problem areas for the developing countries. Structural adjustment has frequently dismantled the infrastructures responsible for the minimisation of the risks involved in trading. As a result, many countries are now unable to meet the international standards for trade designed to prevent the importation of epidemic disease.
The development of the systems for monitoring and surveillance necessary to prevent such incidents were considered by the Expert Consultation an integral part of FAO-EMPRES activities and the reason why implementation is needed. For this to happen a more direct association is required between FAO-EMPRES and the countries involved. The development of a regional presence to facilitate implementation, and the adoption of EMPRES principles at country level, are essential if incidents such as the FMD outbreak in Taiwan are to be prevented.
EMPRES activities will involve FAO member countries, regional structures and international agencies and organisations such as OIE and WHO. Examples of regional institutions are the Pan American Health Organisation (PAHO) and the Organisation of African Unity (OAU). Reference laboratories and collaborating centres are crucial to the successful operation of the GREP and other co-ordinated control programmes. They provide confirmatory diagnosis and analyse and map the viral genome to assist in the epidemiological evaluation of transmission patterns. They have facilitated research for the development and evaluation of pen-side diagnostic tests for rinderpest virus. The FAO/IAEA Joint Division assists member countries and GREP and FMD control programmes by standardising, validating and assisting in the quality control of vaccination programmes and surveys. The Expert Consultation examined problems which had arisen in collaborative activities and has made recommendations regarding these.
Official information announces what a country declares, but gives no indication of epidemiological features nor of what the country does not officially declare. It is strongly trade oriented.
The Expert Consultation defined the role, function and activity of the EMPRES information system. Information systems should assist in problem resolution and provide support for better and faster decision making. In contrast to only collecting and collating data, information systems should provide the analysis and presentation of information to provide rapid additional insight into a problem for rapid reaction.
The database concept which includes e-mail connections to regional and country contact points with Access input files, Arcview GIS, and Access output report files was considered technically sound. However, at this stage it did not provide detail beyond the headquarters.
The Expert Consultation defined the relative roles of EMPRES, the regional structures and the countries within the information system. The role for FAO was to verify and validate information provided by countries, to identify spatial and temporal patterns of disease, to warn countries of potential adverse developments and to assess the effectiveness of field surveillance.
The information system would focus on the GREP, with a similar design for all countries in the programme. The system would need to be capable of adding other EMPRES diseases when required. It was estimated that 4-6 years would be required to achieve the following objectives suggested by the expert consultation;
· develop work plans to establish objectives, design database schema and structure, decide on critical points (e.g. case/outbreak definition, geo-coding format) and develop reports and maps for country use and to publish in the bulletin,· standardise and facilitate the reporting of performance indicators of surveillance from country to regional level to enable comparative analysis of performance over time and between countries (it was suggested that this be conducted firstly in conjunction with the PARC regional epidemiologist with a few pilot countries in Africa and with India). Once the national liaison units are operational, EMPRES headquarters should audit their effectiveness, and assist in the improvement, of field surveillance. The emphasis for the countries on the OIE Pathway will be on information to assist with rapid responses to emergencies,
· analyse remote sensing satellite data (e.g. cold cloud density (CCD), normal differentiated vegetation index (NVDI)), animal movement, wildlife populations and indirect and 'surrogate' indicators of spread, using GIS for patterns with which to predict the potential spread of rinderpest. The output of these analyses could be in the form of contour maps of risk of outbreaks of disease (it was suggested that this be developed for the Afghanistan-Pakistan region),
· accumulate and analyse the evidence (disease occurrence, case-related epidemiological data) of past outbreaks. Make comparisons between outbreaks to develop predictions and strategies for management of new outbreaks. The historical data in FAO's rinderpest occurrence file should be summarised and indices of incidence with time and area be developed, and
· develop GIS and analytical skills within EMPRES headquarters unit. The production and distribution of pictorial displays using GIS will maintain enthusiasm while developing experience.
The Expert Consultation was presented with the proposal to establish national EMPRES Units in 'clusters' of countries where the risk of transboundary diseases, particularly rinderpest, is high. The principle was developed to select clusters of three to five countries. The approach to the countries by FAO to adopt EMPRES principles for epidemic diseases, was to be made at a ministerial level. The Chief Veterinary Officer would be asked to assign a senior officer to lead a national EMPRES Unit. The consultation endorsed the contents of the concept paper which gives details of the establishment and operational activities of national EMPRES Units (see Appendix 5.).
The promotion of EMPRES in these countries will improve their capacity to contain and control diseases like rinderpest. A regional EMPRES presence could provide assistance for early warning and rapid reaction to disease emergencies. Contingency planning, improving communication networks and surveillance would be high priorities. The Expert Consultation prioritised the 'cluster' groupings of countries to be targeted in the first and second phases of development (see Tables 1. and 2. in Appendix 6.).
The EMPRES functions at the global level were considered by the Expert Consultation to be those associated with the co-ordination and harmonisation of the national and regional activities in pursuit of the final goal of the GREP. EMPRES is involved in the quality assurance of vaccine used in the GREP by its association with the Pan African Veterinary Vaccine Center (PANVAC). The FAO/IAEA Joint Division has standardised serological test systems and supports training in the conduct of field surveys to assess vaccination coverage. EMPRES collaborates with regional organisations such as PARC in their rinderpest eradication programmes and with donors such as the EU and IFAD.
An important function of EMPRES at headquarters has been to develop a Global Early Warning System (GEWS) for the transboundary diseases. The consultation discussed the steps for development and indicated that a time scale of up to 6 years would be realistic for implementation.
EMPRES has been active in assisting countries to meet the emergency situations which they have faced following outbreaks of rinderpest or other epidemic disease. This assistance, provided through the Technical Co-operation Programme (TCP), enables national governments to meet the problems presented by disease emergencies. The Expert Consultation was concerned at the apparent lack of early reaction in many of the countries which have suffered recent outbreaks of epidemic diseases. They strongly supported the promotion of EMPRES principles at the country level.
The Expert Consultation supported proposals to establish a regional presence for EMPRES. Pilot 'clusters' of countries were defined in areas of the world where current foci of rinderpest were present and the phases of development were prioritised (see Table 1. in Appendix 6.).
These clusters of 3-5 countries were selected on the following criteria;
· the role of the livestock production systems in the agricultural economy and food security,· the interest among local, national and regional stake-holders to combat and prevent epidemic diseases,
· the socio-economic impact of transboundary diseases,
· the epidemiological situation in adjacent countries based upon epidemic risk and ecosystem,
· the technical feasibility to reduce and contain the disease problem,
· where there are existing regional organisations that can facilitate implementation.
The 'clusters' would co-operate with existing regional organisations such as OAU, ASEAN and SAARC. The regional EMPRES officers should concentrate initially upon the GREP activities. Their appointment was considered critical to the success of the national EMPRES programmes as they would facilitate the development of the capacity for early warning, reaction and emergency preparedness within the countries of the region. They would have co-ordinating and training roles and would promote the development of improved communication networks within and between the countries involved.
The Expert Consultation supported the development of a national EMPRES presence. A 'cluster' approach to the definition of countries for first phase of implementation was endorsed. Recommended priority activities were the establishment of a National Animal Disease Emergency Committee and the inclusion of disease emergencies in the country's Natural Disaster planning. EMPRES would also seek to improve communication networks in country by the use of e-mail and develop and test detailed contingency plans for disease emergencies. The national EMPRES unit would collaborate closely with the regional EMPRES office. The operational activities of the national units will be described in detail in a separate publication of the Guidelines paper presented at this Expert Consultation.
The Expert Consultation discussed the collaborative role of livestock owners, co-operatives, community based animal health workers, NGOs and other extension workers in EMPRES activities. All these groups have a role in the improvement of emergency preparedness within a country. Promoting the awareness of disease recognition, impact and control, together with clearly defined lines of communication to animal health staff could greatly improve disease reporting. This is especially the case in countries where structural adjustment changes have resulted in a decreased number of personnel and decentralised responsibility in the veterinary services. The outreach could be achieved by targeting the training at those with the most contact with livestock using visual training aids.
The detailed guidelines for the development of the national EMPRES units within the national veterinary services were not discussed by the expert consultation. However, support for the overall principles for their activities were clearly emphasised in their deliberations. A recommendation was made to encourage much wider publicity both nationally and internationally for EMPRES.
The major requirement was for improved communication facilities using e-mail and Internet connections together with the necessary hardware and software. These would be used in training activities at all levels for the improvement of the recognition of the serious transboundary diseases. The establishment of disease emergency committees and the development of contingency plans were considered essential. The national EMPRES unit was also charged with improving the surveillance systems for rinderpest in support of GREP. These would also be critically important once a declaration of freedom from disease was made. National EMPRES activities would be focused on improved early warning, reaction and emergency preparedness against transboundary diseases.
A suggestion was made that national EMPRES funding might in part be obtained by making it a component of debt relief. The Expert Consultation proposed that FAO bring this possibility to the notice of the World Bank, IFAD and the IMF. A further suggestion was made by the FAO ADG, Dr Sawadogo, that NGOs be made aware of the goal of GREP which is the major thrust of EMPRES at all levels. This is a high profile programme co-ordinating the eradication of the worst animal plague known to man. It was felt that many NGOs might wish to become associated with the eradication programme. The possibility of recruiting their assistance in establishing both regional and national EMPRES presence should be explored.
4.2.1. The Blueprint for Africa: progress towards eradication
4.2.2. The Blueprint for Asia: progress towards eradication
4.2.3. When to stop vaccinating
4.2.4. How to stop vaccinating
4.2.5. How to validate a rinderpest disease-free status when vaccination ends
4.2.6. How to validate a rinderpest infection-free status when vaccination ends
4.2.7. Performance indicators
4.2.8. Emergency preparedness
4.2.9. Risk analysis
4.2.10. Sanitary Cordons
The GREP Blueprint developed for the Expert Consultation of 1996 was reviewed. In west Africa, Gambia-which declared provisional freedom in 1993 - has not requested the recognition of its rinderpest disease-free status as was hoped would happen in January, 1997. However, there was no reported deterioration in its rinderpest-free situation. Côte d'Ivoire, Senegal, Togo, and Guinea have all made provisional declarations of freedom from rinderpest and are thus adhering to the Blueprint. On the other hand-Mauritania, Mali, Burkina Faso, Ghana, and Benin-are all behind schedule. It is not certain whether Niger and Nigeria will make their anticipated provisional declaration at the end of 1997.
In central Africa, only Chad and the Central African Republic are now included within the sanitary cordon. Thus, each of the remaining territories-namely Cameroon, Gabon, Congo, and Zaire-have fallen behind schedule, although there appears to be no technical reason why this should be so.
In eastern Africa, there has been a deterioration in the situation since July 1996 when the Blueprint was prepared. Rinderpest, which was detected in southern Kenya in late 1996, spread to the contiguous areas of northern Tanzania-a country which had not reported the disease for 14 years. Emergency action by the Kenya and Tanzania seems to have contained the epidemic. Disease continues to occur in southern Sudan with consequent high risks for northern Uganda, north-western Kenya and south-western Ethiopia. The situation in Somalia is at present unclear with cattle in the southern part possibly infected.
Djibouti, Eritrea, Rwanda and Burundi are most likely free from rinderpest. There has been no report of any rinderpest outbreak from Uganda since 1994. However, in response to developments in the countries on its northern and eastern borders, Uganda expressed a wish to vaccinate the whole of its cattle population. It was advised by FAO to restrict this to the high risk areas of northern Uganda. Rwanda also expressed a desire for complete vaccination.
According to the Blueprint schedule, Tanzania, which vaccinated during 1997, Burundi, Rwanda, Eritrea and Djibouti all should have declared themselves provisionally rinderpest free at the start of 1997, but failed to do so. There is no solution in sight for the complete elimination of infection from southern Sudan where, according to the Blueprint, all outbreaks should end by the close of 1998. On a more encouraging note, Egypt has declared provisional freedom from rinderpest and has stopped vaccinating. A steadily improving situation in Ethiopia offers the chance of a provisional declaration there in the near future.
In the South Asian group of countries, there is evidence to suggest that all of Sri Lanka is free of rinderpest and it is hoped that a declaration of provisional freedom will be forthcoming during 1997. In India, which adopted a zoning policy from the outset, it appears that the OIE may be requested to recognise the northern (A and B) and islands (D) zones as disease-free towards the end of 1997 although some areas continue with vaccination. Furthermore, southern India (zone C), although currently still vaccinating, appears likely to meet the conditions for a declaration of provisional freedom from rinderpest in the near future.
Bangladesh, Myanmar and Nepal have all experienced a long enough period without clinical rinderpest for each of them to be able to make a provisional declaration. They have not done so and all three (3) are falling behind the Blueprint schedule. Bhutan is currently eligible to request recognition as a rinderpest-free country but has failed to do so. Pakistan still harbours rinderpest virus and appears unlikely to be able to reduce the number of rinderpest outbreaks to zero by the end of 1998. This will seriously jeopardise its progress towards freedom by the year 2005. The situation in and events and timetables for Afghanistan are intimately linked with those of Pakistan.
In West Asia, Iran regards itself as being rinderpest-free. However, it continues to vaccinate in view of the threatening situation in Pakistan and Afghanistan and, therefore, was not in a position to declare provisional freedom as required by the Blueprint in January, 1997. Rinderpest appears to have died out of northern Iraq in the 1994/95 winter but, in the absence of an empowered veterinary authority, no advantage can be taken of the favourable situation in this zone. There is limited disease intelligence from southern Iraq-the information available suggests freedom from disease-but they are still vaccinating. The Blueprint timetable anticipates that after January, 1998 Iraq will have had more than two (2) outbreak- free years. The national disease reporting system must be good enough to accurately determine the field situation, and there is no certainty that this is the case.
Turkey has stated an intention to create an eastern and western zone for declaration purposes, but has not yet done so through a communication to the OIE. No outbreaks have been seen since early 1996 and it is intended that the western zone will declare provisional freedom at the end of 1997. The eastern zone will be maintained as a vaccinated zone for the immediate future. The Blueprint called for Syria, Lebanon, Jordan, Israel, Saudi Arabia, Kuwait, Bahrain, Qatar and Yemen to declare provisional freedom from rinderpest at the beginning of 1997. At present, only Jordan and Lebanon intend to follow the OIE Pathway by making such a declaration at the end of 1997. Worse still, there is persistent rinderpest infection in both Saudi Arabia and Yemen. Possibly the United Arab Emirates and Oman were both rinderpest-free during 1996 and, if the situation remains unchanged during 1997, they will be able to make provisional declarations ahead of schedule at the start of 1998.
In Central Asia, it was hoped that Turkmenistan, Tajikistan, Kyrgyzstan, Uzbekistan, Kazakhstan, Russia, Mongolia and China would all join the OIE Pathway in January, 1997 by declaring provisional freedom from rinderpest. This has not happened and it is unlikely they will do so without more effective contact between these countries and the co-ordinating structures of GREP, such as EMPRES. Indeed, all countries in GREP require a much higher level of counselling, and at a higher level of government, than is currently achievable with the available resources.
If global rinderpest eradication is to be achieved by 2005, it is essential for all countries to fulfil all conditions imposed by the OIE Pathway. The principal objective of this Pathway is the production of verifiable evidence that no endemic focus of rinderpest remains within any of the countries previously known to have been infected. The OIE Pathway is the only route by which to obtain an internationally recognised status as a rinderpest-free country for the purposes of trade.
The use of attenuated rinderpest vaccine will mask serological evidence of the absence of infection. Therefore, it is only possible for a country to move onto the Pathway if it is prepared to stop vaccinating. Furthermore, it is only possible for a country to remain on the Pathway provided it is prepared to avoid further use of this vaccine. It follows therefore, that the sooner a country wishing to prove itself free of rinderpest stops vaccinating, the more rapidly will it achieve its objective. In order to stand a reasonable chance of being successful, it is a requirement of the Pathway that, before stopping vaccination against rinderpest, it must have reduced the number of outbreaks to zero and have maintained this situation for twenty four (24) consecutive months. The widespread use of vaccine throughout the bovine population will obtain this reduction, but the point at which it has been successful is the point at which its use should be ended. Vaccination campaigns should not be institutionalised.
The most important criterion by which to determine the time at which vaccination can cease, is the total absence of disease for two years. The most difficult task facing the senior administrators responsible for deciding when to stop vaccinating, is to know that the lack of outbreak reports truly represents absence of infection. The disease reporting system must therefore be evaluated as a key issue in the process of abandoning vaccination. In theory, the incidence of outbreaks will have been driven to extinction by the massive application of vaccine and so a demonstration of high immunity levels in the cattle populations can assist in making the necessary decision. In practice, a variety of factors including zoosanitary controls are involved in reducing the number of outbreaks. It follows then, that even if sero-monitoring results are incomplete or are lower than required to immuno-sterilise a population, a decision can be made based on accurate outbreak returns.
Rinderpest generally discloses its presence by causing overt clinical disease. On the other hand, so called 'low profile' strains have been encountered which do not give rise to dramatic outbreaks of disease and which can remain masked within a population except in times of inter-current stress. Accordingly, the absence of rinderpest from a population of livestock should be determined by active disease surveillance for outbreaks of clinically apparent disease. It is estimated that if no outbreaks are detected for three years, then the chances of rinderpest persisting within a population would be negligible. It cannot be guaranteed that the virulence of the 'low profile' strains found in eastern Africa would increase in an unvaccinated population to show obvious disease. In such circumstances, the infection could remain cryptic for long inter-epidemic periods (the technique for resolving this problem is mentioned below).
Standard methods exist to determine the minimum number of livestock units that must be examined to confirm the absence of rinderpest. However, there is no upper limit to the sample size that may be examined if a veterinary service is enthusiastic and wishes to advertise its strength and level of competence.
Animals that have been infected with either classical or 'low profile' strains of rinderpest develop a specific immune response which is long-lived and can be measured by a variety of serological techniques. The competition ELISA test is currently recognised as the technique of choice. This test has been standardised and validated. Demonstrating the absence of rinderpest antibodies in an unvaccinated population, assures the non-existence, at the period in time during which the survey was conducted, of both classical and 'low profile' strains. For a country to be declared 'free of rinderpest infection', it must mount a two-year sero-surveillance programme in conjunction with a three-year disease surveillance programme. Standard techniques have been developed for defining survey sampling techniques and programmes. To minimise the time from 'declaration of provisional freedom' to 'freedom from infection', sero-surveillance will need to commence at the end of the second year after cessation of vaccination.
The success of all stages of the eradication process should be carefully evaluated using a variety of performance indicators. Such indicators will offer a quantifiable measure of whether or not achievements are real and on target. They may be combined with diagnostic indicators which will offer an explanation of why achievement levels are below target. Performance indicators should not be confused with workload or other indicators.
A comprehensive set of guidelines has been developed for African countries and will be published in a separate document.
The period of greatest need for risk assessment is during the change from a vaccination policy to one of purposive surveillance. Risk is not easy to quantify after abandoning the use of rinderpest vaccine, because socio-economic and political factors become of greater importance as well as the biological factors. However, risk factors which should be examined include the likelihood of pockets of infection in domestic or wildlife populations, livestock movements into the country and the existence of rinderpest in one or more neighbouring countries.
Risk management strategies should be devised to protect against re-infection by implementing emergency preparedness concepts before an emergency arises. Risk communication must be undertaken by ensuring that all involved sections of the community, including members of the livestock health service and stock owners understand that a new strategy is being followed and that rapid communication of occurrences will greatly reduce the risk of further spread.
A sanitary cordon is a belt of two zones - a buffer zone and a surveillance zone-separating a rinderpest infected area from a rinderpest free area. Cattle may move into the first belt of the buffer zone which consists of a tract of land, in which potentially rinderpest infected livestock must remain for 21 days-the longest possible incubation period for rinderpest. Animals entering such a zone must be under veterinary supervision. The resident cattle in this zone should be immunised at all times to prevent the occurrence of any secondary outbreaks, should the transiting animals develop rinderpest. The second belt of the sanitary cordon-the surveillance zone- is a similar zone in which cattle are not vaccinated, but in which a high level of surveillance for clinical disease is maintained. This is bordered by the rinderpest free zone.
