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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases 5 Recommendations for Strenghtening the Animal Health Framework INTRODUCTION As the committee reviewed a group of contemporary zoonotic disease issues, it became apparent that the convergence of human and animal diseases has also produced a convergence of public health and animal health officials, experts, and organizations locally, nationally, and globally. The critical lesson identified from West Nile virus, severe acute respiratory syndrome, monkeypox, bovine spongiform encephalopathy, and other recent zoonotic events is the need for a new strategic partnership and relationship between the public and animal health communities. This critical need represents a significant gap that should be filled. In this era of emerging and reemerging zoonoses, there is a distinct lack of coordination and development of strategic partnerships between the human and animal health communities. It is also a reminder that veterinary medicine is one of the health professions and, as such, is committed by oath to the improvement of public health. It has been asserted that 11 of the last 12 significant human epidemics have been due to zoonotic pathogens (Torrey and Yolken, 2005). Considering the factors that have led to this new era, there is nothing to suggest that this trend of emerging and reemerging zoonoses will abate. Consequently, the animal health framework has new responsibilities and obligations to address the serious and profound occurrence of this group of diseases. The challenges and opportunities now faced by the animal health framework are described throughout this report and are reflected in the committee recommendations presented here. Future research, training,
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases laboratory linkages, global planning, diagnostics, and other features pertaining to the prevention, diagnosis, and detection of zoonoses now deserve urgent attention and should be part of the cornerstone and culture of the evolving animal health framework. Strategic partnerships in human health and animal health will likely be fundamental to the future success of both communities. COORDINATION OF FRAMEWORK COMPONENTS Recommendation 1: The nation should establish a high-level, centralized, authoritative, and accountable coordinating mechanism or focal point for engaging and enhancing partnerships among local, state, and federal agencies and the private sector. A centralized coordinating mechanism or focal point could help ensure flexibility and strong coordination at the federal, state, and local levels; help minimize duplication of effort; and maximize efficiency in both resource allocation and function. A few examples of possible means to accomplish this mechanism could be through a high-level individual or through a group embedded in an existing office or an interagency alliance. Alternatively, given the overlapping legislative mandates and competition for resource allocations that affect federal agencies and issues of state versus federal jurisdiction and authority, a third approach would be to establish a nongovernmental organization to serve as a central coordinating agency. Such an organization would function like a domestic version of the World Organization for Animal Health (OIE), which arbitrates between governments. Another example of an organization that has some of the properties and function that a central coordinating body should have is the Southeast Cooperative Wildlife Disease Study (SCWDS), a state-federal cooperative agency whose resources are supported and shared by the wildlife agencies of 15 states and Puerto Rico, the U.S. Department of the Interior, and U.S. Department of Agriculture (USDA). The SCWDS is a multiple-purpose program that carries out research, performs diagnostics and surveillance of wildlife diseases, and provides training and consultation to wildlife managers, farmers, landowners, veterinarians, physicians, and the agencies tasked with safeguarding animal health. In making these suggestions, however, the committee wishes to clarify that it was not tasked to analyze all possible mechanisms for implementing Recommendation 1. Furthermore, while there is compelling evidence of a need for improved coordination in prevention, detection, and diagnosis, the committee felt it is premature to recommend a specific systemwide mechanism prior to examining other parts of the animal health framework—that is, surveillance, monitoring, and response recovery. The
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases two planned successor phases of this study can potentially better address this issue following examination of the other aspects of the animal health framework. Regardless of how a central coordinating mechanism or focal point is implemented, it will need to promote effective communication among various stakeholders and with the public during and outside times of animal disease outbreaks. Opportunities for information sharing between agencies using electronic information systems should be developed. A methodical effort should be made to identify and link key databases and establish protocols for contributing data and for creating alerts. For example, subject matter experts in government, industry, and academia will sometimes need access to information gathered by the intelligence community. In addition, public-private partnerships are important in long-term strategic planning. The private sector will always be the beneficiary of effective animal disease prevention, detection, and diagnostic programs, but much of the success will depend on the level of private sector leadership, involvement, and investment. While the framework will promote effective communication and collaboration among different stakeholders, it will also need to ensure that those on the front lines of disease prevention and detection at the local level (e.g., field personnel and wildlife management) are fully integrated into the system of animal health communication and of disease prevention and detection. As was demonstrated during the exotic Newcastle disease outbreak, private industry, local and regional resources, and a willingness to capitalize on expertise located outside the centralized federal animal health system allowed a cost-effective and reliable assay to be rapidly developed, validated, and implemented for disease detection and control. Another specific example of broad-based local community involvement in animal disease prevention and detection is described in Box 5-1. TECHNOLOGICAL TOOLS FOR PREVENTING, DETECTING, AND DIAGNOSING ANIMAL DISEASES Recommendation 2: Agencies and institutions—including the U.S. Department of Agriculture (USDA) and the Department of Homeland Security (DHS)—responsible for protecting animal industries, wildlife, and associated economies should encourage and support rapid development, validation, and adoption of new technologies and scientific tools for the prevention, detection, and diagnosis of animal diseases and zoonoses. The current animal health framework has been slow to evaluate, validate, and implement new scientific tools and technologies that could sig-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases BOX 5-1 Example of Preparedness, Prevention, and Detection Plan of Action Wichita County, Kansas, provides an example of a broad-based, local community prepared to prevent or detect an animal disease outbreak (intentional or nonintentional). Social and public health professional representatives of law enforcement, fire, emergency medical services (EMS), county commission, chamber of commerce, county extension, and Farm Service Agency joined the animal health community of veterinarians, pharmaceutical representatives, livestock producers, and others interested and potentially impacted in the economy. Coordinating this widespread committee was first prompted by the threat of agroterrorism or a foreign animal disease outbreak. Many representatives had never met each other and were not aware of one another’s concerns and issues. Over 6 months, the committee developed and implemented a preparedness emergency plan for the county that subsequently became the model for all counties in the state. Major components of the plan are: List of vulnerable entities in each county such as feedlots and livestock markets with names and numbers to contact in case of an emergency. List of resources such as feedlots with loaders, cooperatives with fencing materials and feed, and volunteer agencies that would take care of feeding and housing of workers. All entities and agencies involved. All emergency team members’ names and contact information. nificantly enhance animal disease prevention, detection, and diagnostic capabilities for the United States. Despite a recent surge in activity related to post-September 11 homeland security efforts and associated focused funding, the active review and implementation of advancing technologies is inadequate to protect and enhance the health of the country’s animal populations and related economies. Existing technological advances, such as immune system modulators, animal-embedded monitoring (chips embedded underneath an animal’s skin to monitor temperature and other physiological indices), and differential vaccines as prevention strategies, as well as a range of rapid, automated, sensitive, and portable sampling and assay systems for early warning and reliable diagnosis, are not adequately exploited by the current animal health framework. Early biodefense warning systems, such as DHS’s BioWatch or private industry’s
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Notification procedures - courses of action to be taken and implemented on short notice. Procedure for emergencies. Strengths and Challenges of the Coordinated Local Emergency Preparedness Plan: Each community sector has knowledge of the diverse capacities and capabilities of the overall system. Each committee member is a liaison for his/her respective agency or entity and is empowered to speak for his/her organization. All committee representatives are holistically and responsibly involved with the coordination of the plan. Periodic review of the County Preparedness Plan and participating agency/entity meetings with “scenario” exercises are critical to keeping the plan fresh and current and in keeping the Plan updated. Dispersing prudent reliable information to the media and the public is extremely important. Education of county residents (particularly agricultural) is important, and should be an ongoing activity, with regard to the care and handling of livestock. Trained and educated livestock producers will utilize best management practices (BMPs) in the prevention, detection, and diagnoses of animal disease. Successful preparedness in the event of a foreign animal disease outbreak, intentional or nonintentional, can help eradicate disease and minimize adverse market reaction and economic impact. gene-based anthrax testing, are designed for rapid detection and identification of key pathogens by sampling air in public environments. These systems have been operating since early 2003 and are meant to assist public health experts in rapidly responding to the intentional release of a biological agent (DHS, 2004a). Early warning technologies have not yet been adequately evaluated by the animal health infrastructure. SCIENTIFIC PREPAREDNESS FOR DIAGNOSING ANIMAL DISEASES: LABORATORY CAPACITY AND CAPABILITY Recommendation 3: The animal health laboratory network should be expanded and strengthened to ensure sufficient capability and capacity for both routine and emergency diagnostic needs and to ensure a robust link-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases age of all components (federal, state, university, and commercial laboratories) involved in the diagnosis of animal and zoonotic diseases. A robust animal health laboratory network will utilize the resources and expertise located throughout the country for efficiency in routine, early detection of agents, and provision of surge capacity in the event of disease outbreaks, whether newly arising, accidental, or intentionally introduced. Federal laboratories should serve as reference laboratories of the highest caliber and should rely on linkages through the network for assistance in assay development, standardization, and validation. The committee has identified five high-priority elements critical to the success of implementing this recommendation. Based on the committee’s review of the current operational status of the National Animal Health Laboratory Network (NAHLN) and the need for a more robust, broad laboratory network for optimum detection and diagnosis, the first critical element is for the USDA, in collaboration with the American Association of Veterinary Laboratory Diagnosticians (AAVLD), to ensure that all accredited state/university diagnostic laboratories are members of the network, and that each of these laboratories is appropriately equipped and has trained staff to perform standardized assays developed and approved for diagnosis of high-consequence livestock and poultry pathogens and toxins. This would ensure that all states with accredited laboratories could actively participate in the NAHLN at the reference level for multiple diseases and multiple assay formats, and not just by virtue of performing contract surveillance work for USDA. It would also ensure that diagnostic assays and systems meet rigorous scientific standards. While the committee agrees with the concept of including contract laboratories in the NAHLN, the original concept of building the laboratory system in the United States that ensures appropriate staffing, equipment, training, and use of standardized assays should not be lost or abandoned in this redefinition. A second critical element is adequate quality assurance for network laboratories. There needs to be an independent process to plan, undertake, and evaluate proficiency testing for all laboratories involved in diagnosis and detection of animal diseases, including USDA, HHS, state, and other national laboratories. All network laboratories must meet standards for accreditation, verified by outside, independent review. In addition, USDA, in collaboration with its diagnostic partners, needs to develop and implement scientifically rigorous validation procedures for assessment of accuracy, precision, and utility of diagnostic assays and disease detection systems. An independent scientific review process should be utilized to evaluate and make recommendations for use and application of diagnostic and detection technologies and systems. A third critical element is formalization of linkages and operational relationships among veterinary diagnostic laboratories, the NAHLN, and the Laboratory
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Response Network for Bioterrorism (LRN). All fully accredited veterinary diagnostic laboratories that meet LRN membership requirements should be in the LRN. Membership of LRN reference laboratories that meet NAHLN membership requirements in the NAHLN also should be considered, though the committee did not examine this issue in sufficient depth to make a recommendation. The processes for laboratory membership in the NAHLN and the LRN are nearly identical, making joint membership nearly seamless. Joint membership could include sharing of assay protocols, proficiency testing programs, equipment, and staff as appropriate, and the networks could work toward standardized messaging for facile data exchange and mutually understood and approved reporting guidelines and requirements. The expected outcomes of this effort would include: an enhanced laboratory capability and capacity for detection and diagnosis of multiple agents (including zoonotic pathogens); standardized operating procedures for high-priority diseases that are shared and utilized by all laboratories in these networks; a common understanding and adherence to business practices and reporting procedures; and fluid electronic sharing of data in emergency and routine diagnostic scenarios. The committee recognizes that additional laboratory networks are under development, such as the Food Emergency Response Network, and encourages sharing of data with these laboratories as necessary and appropriate for prevention, detection, and diagnosis of animal diseases. The 2002–2003 exotic Newcastle disease outbreak in California and neighboring states clearly showed the advantage of having high containment facilities at animal laboratories for tissue sampling and laboratory workup close to the outbreak location. A fourth critical element of a strengthened laboratory infrastructure in the United States is expansion of BSL-3 laboratory and necropsy space in animal disease diagnostic laboratories for detection and diagnosis of agents requiring enhanced biological safety. A major paradigm shift from a focus on the pathology of individual animals or samples to a holistic diagnostic approach involving the population (herd or flock) is needed. Herd-flock diagnostics necessitate considering the multicausality of disease/health in animal populations, including the interactions among management practices, the environment, and infectious or toxic diseases. A fifth critical element of a robust diagnostic system in the United States is the development and application of population-based diagnostic and detection methodologies. It will be necessary to improve education and, through research, develop cost-effective, efficient laboratory and field-based diagnostic strategies to diagnose and detect diseases, infectious agents, and toxins affecting herd or flock health. Diagnosticians and clinical epidemiologists are in a unique position for communication and instruction and should be encouraged to enhance producer and practitioner awareness and under-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases standing of population-based approaches to diagnose and prevent disease, whether endemic or exotic. A broad diagnostic outlook for the herd or flock considering population health, rather than disease in only one or a few animals, and expanding diagnostic perspectives will increase the likelihood of early recognition of new or emerging diseases. These efforts will improve the overall chance of detecting a foreign animal disease through a broader accession base and increased interest at the farm level, in the wild, and in companion animals. Inherent in this new strategy of enhanced prevention and early detection is a means of funding routine diagnostic testing for indigenous diseases that mimic foreign or exotic animal diseases. ANIMAL HEALTH RESEARCH Recommendation 4: Federal agencies involved in biomedical research (both human and veterinary) should establish a method to jointly fund new, competitive, comprehensive, and integrated animal health research programs; ensure that veterinary and medical scientists can work as collaborators; and enhance research, both domestically and internationally, on the detection, diagnosis, and prevention of animal and zoonotic disease encompassing both animal and human hosts. This process might be modeled on the National Institutes of Health (NIH)-administered Interagency Comparative Medicine Research Program, an interagency task force model, or some comparable process that promotes this type of cooperative research agenda. This recommendation builds on a recommendation in the IOM report Microbial Threats to Health: Emergence, Detection, and Response, which states: “NIH should develop a comprehensive research agenda for infectious disease prevention and control in collaboration with other federal research institutions and laboratories (e.g., Centers for Disease Control and Prevention, Department of Defense, the U.S. Department of Energy, the National Science Foundation), academia, and industry” (IOM, 2003). The agenda should include collaborative research among veterinary and medical scientists to provide an integrated research approach to detect and prevent zoonotic diseases infecting both human and animal hosts. In addition, it should include integrated research on comparative medicine to address interspecies transmission, disease pathogenesis, and host responses in diverse species including wildlife. Zoonotic strains of avian influenza, concerted research efforts, and dialogue involving veterinary and medical scientists are needed to address the most applicable control measures to be implemented in avian species to block transmission to humans. Research would not be limited to domestic activities only but would include the international dimensions, such as developing preven-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases BOX 5-2 Government/Industry/University Research Partnership in Development of a Preclinical Test for Sheep Scrapie In 1998, scientists at USDA’s Agricultural Research Service, working in collaboration with researchers at the Washington State University College of Veterinary Medicine, the American sheep industry, and a private company, Veterinary Medical Research and Development, Inc., developed a preclinical, noninvasive test for scrapie. Scrapie is a degenerative and eventually fatal disease that targets the central nervous systems of sheep and goats. These researchers found that lymphoid tissue in the third eyelid of sheep collects prions, the unique protein that causes scrapie, bovine spongiform encephalopathy, chronic wasting disease, and other related diseases. They also designed a new antibody to identify prions in a sample of eyelid tissue (O’Rourke et al., 1998, 2000). There is no cure or treatment for scrapie and scientists do not fully understand how it is transmitted. Sheep can harbor the disease for up to 5 years before they show signs such as trembling, incoordination, or scraping against objects. Prior to development of the eyelid test, diagnosis required recognition of clinical signs and testing of a sample of brain tissue collected from a euthanized animal. Producers with confirmed cases of scrapie in their flock had to destroy clinically normal animals to obtain the appropriate sample for a diagnosis in an effort to eliminate the disease. The ability to diagnose the disease at a much earlier stage has greatly facilitated attempts to eradicate it. This partnership of government scientists, academia, a producer group, and private industry resulted in the first, and to date, the only validated preclinical test for a prion-induced disease. The test is approved by USDA APHIS and is being used in formal eradication programs in North America. tion, detection, and diagnosis methods closer to the point of infection, and approaches that invite collaboration with other countries and related organizations. One example of an effective research partnership between government, academia, and industry is described in Box 5-2. The committee considered two possible mechanisms or strategies for implementing this recommendation: the establishment of an independent advisory group and/or an incentive program. The advantages and disadvantages of these alternatives are discussed below. An independent scientific advisory group to the USDA (including ARS) with members from academia, industry, and state, federal, and in-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases ternational agencies and composed of scientists with infectious disease, animal health, and public health expertise could develop and regularly evaluate and modify a comprehensive, long-term research agenda for animal and zoonotic disease prevention and detection in collaboration with other federal research institutions and laboratories. The advantage of such a group would be to provide a forum for regular exchange of information, sharing of priorities, and possibilities for priority modification. Furthermore, an advisory group could assist federal grant administrators in developing requests for interagency funded proposals for important new areas of animal/zoonotic disease research and emerging animal and zoonotic disease problems. A distinct disadvantage could occur if this group were constructed in such a way as to create another layer of approval or review that would delay the development of new initiatives or implementations of programs. The comprehensive research agenda could also include an incentive program to encourage academic, government, and the private sectors to partner and to develop novel and effective technologies for the prevention and detection of animal disease both domestically and abroad. As a financial incentive, federal funding agencies could jointly fund new programs (such as program grants by multi-investigator teams from the above sectors) and national centers (integrated zoonotic and wildlife disease research centers and information centers for collecting, collating, and monitoring of diagnostic/disease information across species) to foster and promote collaborative research with the goal to provide an integrated research approach to the detection, diagnosis, and prevention of animal and zoonotic diseases encompassing human and multispecies animal hosts. The advantages of an incentive program would be to incorporate more researchers into the overall strategy to address and control animal diseases and to work and collaborate with other countries on issues of common concern. A disadvantage can arise if a federally funded program cannot exert sufficient control in the appropriate time period to obtain the needed results. The nature of the relationship between federal needs and academic or private industry contributions would have to be structured in such a way that there is continual dialogue and sharing of results in a real-time way. A more in-depth assessment of national needs for research in animal health is beyond the scope of this report and is being addressed by a forthcoming NRC report on Critical Needs for Research in Veterinary Science (NRC, 2005). Recommendation 5: To strengthen the animal health and zoonotic disease research infrastructure, the committee recommends that competitive grants be made available to scientists to upgrade equipment for
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases animal disease research and that the nation construct and maintain government and university biosafety level 3 (BSL-3 and BSL-3 Ag) facilities for livestock (including large animals), poultry, and wildlife. Biosafety level 3 facilities (including laboratories and animal rooms for large animals) are needed not only for basic animal disease research, but also for development and evaluation of vaccines and diagnostics for exotic, newly emerging, or highly contagious disease threats. Such facilities will also provide the necessary regional surge capacity for sample and tissue collection and testing from suspect infected animals needed for evaluation of sick or subclinical cases from multiple disease outbreaks. The facilities could in addition be used for BSL-3 vaccine production, storage, or evaluation in emergency outbreak situations. Prior to September 11, 2001, most animal disease research efforts in the United States were focused on existing indigenous infections of animals and zoonoses and methods for their detection, treatment, prevention, and control. Since then, scientists have begun to focus research efforts on both indigenous and exotic infectious agents of animals and zoonoses in order to develop potential measures against the inadvertent or bioterrorist introduction of potentially devastating diseases of animals, such as foot-and-mouth disease (FMD). Without appropriate countermeasures such as resistant animals, vaccines, or treatments, the U.S. animal and food production systems and related industries are especially vulnerable. The United States has an extensive system of land-grant universities with scientists having expertise in various arenas of animal diseases and zoonoses. Improving and enhancing the infrastructure of these institutions would be an excellent investment of federal dollars to create national networks of countermeasures for the prevention, detection, and diagnosis of emerging and reemerging animal diseases and zoonoses. The threats of these diseases and bioterror events will continue and likely be accentuated in future years. The December 2003 detection of the first case of BSE in the United States illustrates the continual threat of diseases and their economic impact on both agricultural industries and the national economy, as well as their importance to public health. Enhancement of our current infrastructure for animal disease research is essential to counter the threat of these diseases. INTERNATIONAL ISSUES International Interdependence and Collaboration Recommendation 6: The United States should commit resources and develop new shared leadership roles with other countries and international organizations in creating global systems for preventing, detect-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases ing, and diagnosing known and emerging diseases, disease agents, and disease threats as they relate to animal and public health. As the United States and the rest of the world become increasingly interdependent, it is essential to identify animal disease risk factors as they emerge and to focus more attention on the sources and precursors of infections, rather than wait for them to appear in a particular species in the United States. Taken collectively, the recent experience with SARS, West Nile virus, and monkeypox lead to the inescapable conclusion that globalization, population growth, and expansion of human activity into previously unoccupied habitats have essentially connected the United States to potential zoonotic pathogens residing throughout the world. This new reality necessitates coordinated international collaboration directed at identifying potential risks worldwide as well as regulatory mechanisms that minimize the threat of introducing emerging infectious agents into the United States. U.S. support of these efforts, and the cost of implementing them, should be evaluated relative to the potential risks of animal disease to disrupt international markets. By helping to strengthen other countries’ approaches to preventing, detecting, and diagnosing animal diseases, the United States has an opportunity to enhance its own animal health framework. Means to accomplish this include exchange of technology between nations where feasible, and providing training opportunities to international students and veterinarians to ensure self-sufficiency and sustainable surveillance. The United States can also encourage and support the enhancement of critical competencies within the national services, which includes active participation in the formulation of international standards and the timely reporting of zoonotic and exotic diseases. The charge to the committee explicitly states that it will “review the U.S. system and approach for dealing with animal diseases,” but the committee regards the international dimension as a critical component of the U.S. animal health framework. As globalization increases—with more movement of diseases, people, products, pathogens, and vectors—the United States cannot continue to impose a line between domestic and international issues. To operate interdependently means to invest time and resources in building and working through coalitions, formulating international standards that could require years for adoption, and building alliances at the technical level, as well as at the negotiation stages. This is not a short-term activity and requires that the United States make strategic investments to share expertise and better understand and appreciate other countries’ current infrastructures, levels of advancements, and greatest challenges and concerns. In determining priority areas, it is important for the United States to work through, support, and promote the leadership of other countries to advance issues and standards of importance in a manner
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases viewed as balanced rather than unilateral. The approach will require a significant investment of time to identify emerging and strategic issues, as well as active outreach and alliances in place to move the plans forward. Coalition building in international settings will require working more interdependently with other countries. Over the years, the United States has built strong ties with countries with comparable animal health infrastructures, including Canada, Australia, and New Zealand. Similar outreach with emerging countries that are now becoming or will be more active on the international stage should be an equal priority. Proactive approaches—including initiatives undertaken to encourage longer and more sustainable interchanges, sharing of expertise and technical assistance, and pursuing common themes—will build confidence and enable the sharing of data and information at the scientific as well as political levels. This approach is most timely for the early identification of issues associated with the importation, sale, and transport of animals and developing consensus actions to follow. Importation, Sale, and Transport of Exotic Animals Recommendation 7: Integrated and standardized regulations should be developed and implemented nationally to address the import, sale, movement, and health of exotic, non-domesticated, and wild-caught animals. Such a policy needs to include health professionals and laboratory-based analysis since many wild-caught and exotic animals may carry pathogens and pose a risk of transmitting disease without demonstrating clinical signs. As noted in Chapter 4, the monkeypox outbreak highlighted weaknesses in the animal health framework for addressing a newly emergent zoonotic disease. In particular, while several federal agencies (including the U.S. Department of Agriculture, the U.S. Department of the Interior’s bureau of Fish and Wildlife Service, and the U.S. Department of Health and Human Services) have roles in preventing, detecting, and diagnosing zoonotic and other animal diseases transmitted by exotic animals, there is a lack of coordinated federal oversight of the animal-centered aspects of diseases transmitted by exotic animals. Considering that the emergence of new disease agents occurs most frequently at species interfaces, monkeypox most likely will not be the last zoonotic microbial agent to emerge from an exotic animal in the United States. The expected beneficial result of this recommendation would be better traceability of exotic and wild companion animals and imported animals. It is essential that regulatory responsibilities for all imported, nonlivestock animals be clarified and that the health of these animals be ascertained by appropriate means at the point of origin before importation whenever possible, or at the time of importation when necessary.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases ADDRESSING FUTURE ANIMAL DISEASE RISKS Recommendation 8: The USDA, DHS, Department of Health and Human Services, and state animal and public health agencies and laboratories should improve, expand, and formalize the use of predictive, risk-based tools and models to develop prevention, detection, diagnostic, and biosecurity systems and strategies for indigenous, exotic, and emerging animal diseases. There has been increased recognition and use of well-structured and scientifically based mathematical, epidemiological, and risk analysis models and tools to define acceptable risks and mitigation strategies that can assist in policy and science-based decision making. Examples include models of the spread of FMD during the U.K. epidemic, and an assessment of the risk of BSE to U.S. agriculture, developed by Harvard University’s Center for Risk Analysis for the USDA (Cohen et al., 2003; Haydon et al., 2004). Risk analysis and modeling have been criticized, mainly on the basis of insufficient scientific data or inappropriate assumptions. Therefore, efforts to develop scientific data on disease transmission, effectiveness of control programs, economic evaluation, and quantitative assessment of all factors involved in making policies and regulations need to be priorities of the animal health infrastructure as it works in collaboration with academia, industry, and global trade partners. The World Trade Organization (WTO) Agreement on the Application of Sanitary and Phytosanitary Measures (the SPS Agreement) adopted in 1995 heightens the importance of science- and risk-based tools in evaluating animal disease risks. The SPS Agreement requires governments to adopt sanitary and phytosanitary regulations that facilitate trade in an open, nondiscriminatory, and scientific manner. The concept of risk assessment, which is new for many governments around the world, has risen to the level of an international obligation. Animal health authorities worldwide face a collective challenge in developing risk-based tools and practices that are consistent with their obligations under the SPS Agreement. Threats from bioterrorism, emerging diseases, and exotic animal disease introductions create an urgent dimension to preventing or minimizing catastrophic consequences to the United States and global economies. Risk-based approaches would proactively address disease threats, identify sources of infection, and respond to predisposing risk factors, including prediction of movement and transmission of disease. A risk-based approach also calls for committing additional resources to the assessment of risks and consequences of emerging issues. While some of this is occurring, it is currently more driven by the observed economic consequences in other countries and the perceived losses in the United States if a disease occurs than by a fundamental change in mindset
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases toward a risk-based approach. Taking an approach that builds risk profiles and continually monitors and channels intelligence into targeted initiatives or precise actions, long before the presence of disease is detected, is a departure from the past and more in line with what needs to occur in order to allocate resources and efforts effectively. Stakeholders require such information if they are to conduct business differently. Underscoring the risk-based approach is the importance of having professionals who have the education and training to assess, manage, and communicate risk in a manner that supports activities to protect animal health, human health, and the economy. Good communication and information to stakeholders, including producers and the public, are important aspects of an infrastructure that supports risk-based approaches. EDUCATION AND TRAINING Recommendation 9: Industry, producers, the American Veterinary Medical Association (AVMA), government agencies, and colleges of veterinary medicine should build veterinary capacity through both recruitment and preparation of additional veterinary graduates into careers in public health, food systems, biomedical research, diagnostic laboratory investigation, pathology, epidemiology, ecosystem health, and food animal practice. This can be achieved through the design and implementation of training and educational curricula to better address these areas and by ensuring that licensing agencies accommodate these new capacities. The Veterinary Workforce Expansion Act of 2005, which amends the Public Health Service Act, will be a useful first step by establishing a competitive grants program to build capacity in veterinary medical education and expand the workforce of veterinarians engaged in public health practice and biomedical research. A critical and fundamental component of this framework is an academic establishment that responds to the nation’s needs for educating veterinarians, veterinary specialists, veterinary scientists, and veterinary technologists with the knowledge and skills needed to address emerging zoonoses, changing food animal practices, and other challenges. As noted in Chapter 4, an inadequate veterinary workforce is a growing problem from the perspective of its distribution, total number, and range of competencies. Contemporary veterinary medicine and that necessary for the future essentially comprises several major and distinct fields dealing with such topics as various species of food-animals, small animals, equine, rural practice (mixed domestic animals), ecosystem health (including wildlife and conservation medicine), public health, and biomedical science. It is equally critical that the human medical and veteri-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases nary professions, including regulators, diagnosticians, veterinary practitioners, and owners, routinely have accurate and timely information in order to strengthen early detection capability in the animal health infrastructure. The committee also recognizes that too few veterinary biomedical scientists and discipline specialists like pathologists are being educated to meet the nation’s needs. Forty-three percent of veterinary pathology positions are unfilled, and many pathologists currently working are near retirement (AAVMC, 2004). A previous NRC report, National Need and Priorities for Veterinarians in Biomedical Research (NRC, 2004b), has already called attention to the paucity of veterinary researchers in biomedical research and provides a strategy for recruiting and preparing more veterinarians in careers in laboratory animal medicine, comparative medicine, and comparative pathology. This committee endorses the recommendations of that report: to acquaint students with opportunities in comparative medicine throughout veterinary school; increase veterinary school recruitment of applicants with interest or experience in comparative medicine; effect change in veterinary school curricula; address financial barriers to postgraduate training in comparative medicine; increase the number of veterinarians in roles supporting biomedical research; and increase the number of veterinarians serving as principal investigators. Undergraduate and graduate curricula developed by colleges of veterinary medicine and continuing veterinary education for private practitioners and public (government) service veterinarians must put more emphasis on the contemporary issues in infectious disease epidemiology, risk analysis and management, public health, foreign and emerging diseases, zoonoses, wildlife diseases, bioterrorism, and food safety. In addition, accrediting and licensing agencies and organizations need to be sufficiently flexible to assure that their policies are congruent with this imperative. While increasing veterinary capacity may require more veterinary graduates, the priority is to produce a professional cadre of veterinarians with new skills, knowledge, and abilities that are more responsive to the contemporary and future needs of a changing society. The committee recognizes the desirability of putting forward a comprehensive strategy to increase veterinary capacity, but developing a strategy is beyond the scope of this report. Recommendation 10: The USDA, state animal health agencies, the AVMA, and colleges and schools of veterinary medicine and departments of animal science should develop a national animal health education plan focusing on education and training of individuals from all sectors involved in disease prevention and early detection through day-to-day oversight of animals.
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases Responsibility for implementing the plan would be at the local level. As noted in Chapter 4, a strong and well-functioning front line of detection is the backbone of effectively controlling animal disease outbreaks. While different levels of education are required for the various tiers of employees and management, general education and awareness of those who make daily observations of animals should be promoted in order to improve skills in detecting infected or diseased animals. Prerequisite critical education and training, therefore, would include an awareness and recognition of clinical signs, as well as an elementary understanding of disease transmission and prevention. In addition, those with day-to-day oversight of animals need to understand the methods and responsibilities for reporting and the signs of exotic animal diseases. Basic multilingual education and training, with awareness and recognition of biosecurity and implications for breaches in biosecurity, are necessary for those with such direct oversight of animals, whereas managers and owners need more indepth education to promote greater depth and breadth of understanding of transmission and prevention. Education should be provided formally in English and Spanish, and other languages as necessary, perhaps through mobile education units or long-distance education efforts to minimize time off the job. IMPROVING PUBLIC AWARENESS OF THE ECONOMIC, SOCIAL, AND HUMAN HEALTH EFFECTS OF ANIMAL DISEASES Recommendation 11: The government, private sector, and professional and industry associations should collectively educate and raise the level of awareness of the general public about the importance of public and private investment to strengthen the animal health framework. Increased investment in this area will help reduce disease transmission, enhance public and animal health, ensure a secure, economical, and viable food supply, and improve trade and competitiveness. Increased public awareness will be critical in supporting and implementing transformations needed to strengthen the framework against animal disease risks. The lack of a cohesive national advocacy, such as supports public health, creates a much more difficult environment to increase attention and investment in the framework for preventing, detecting, and diagnosing animal diseases. These efforts should include food-animals, wildlife, and companion animals. In recent years, the news media has given much attention to the unprecedented spread of avian influenza in Asia in January 2004 that killed more than 30 people and led to the slaughter of tens of million of chickens and ducks, the introduction of BSE in the United States, the death of chil-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases dren from E. coli O157:H7 after they ate hamburgers at a fast-food restaurant, anthrax-laced letters passing through the U.S. postal service leading to the death of 5 people and infection of another 11, exposure of preschoolers to rabies at a petting zoo in Minnesota, the devastating slaughter of six million British animals in 2001 due to foot-and-mouth disease (Thompson et al., 2002; Haydon et al., 2004), the steady progress of an epidemic of West Nile virus encephalitis in humans and horses across the United States, and the emergence of a new zoonotic disease agent (SARS) in 2003 that sent shock waves around the world, affecting even countries with few cases, like the United States. Despite these news headlines, consumers are largely disconnected from animal agriculture and complacent about the potential costs and risks of animal disease events that lack relevance in their daily lives. Global disease events in recent years, such as FMD, avian influenza, and BSE, indicate that education and outreach to the consumer, as well as to animal industries, are critical for early detection, for acceptance and compliance with regulatory actions and disease control activities, and for social and economic recovery from catastrophic animal health events. Following detection of BSE in the United Kingdom, contradictory or vague statements from both government offices and the animal agriculture industry often unnerved and confused the general public, ultimately weakening public confidence in policymakers and federal regulators. Similar scenarios have played out with other animal health issues, notably FMD and chronic wasting disease. Therefore, improved information to the public is a critical component of ensuring appropriate levels of public investment in detection, diagnosis, and prevention activities. The nation’s framework for addressing animal disease must, of necessity, include a solid foundation in broad-reaching educational programs aimed at improving society’s understanding of animal diseases. This applies to all facets of society, including children, consumers, government officials, and health care professionals. SUMMARY Extraordinary changes present new threats to animal health, necessitating prompt action within an animal health framework that has not kept pace with science and technology or new global realities. Why is animal health at a critical crossroads? The explosion of human, domestic animal herds, and some wildlife populations—coupled with increased globalization and its industrial development, trade and travel, exploitation of natural resources, and application of modern technology—has greatly increased the degree of contact among humans, domestic animals, and wildlife, and with it, the threat of disease. The growing presence and con-
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases vergence of just some of these factors calls for a fundamental shift in how regulatory agencies, educators, livestock producers, and industry envision their roles. This report provides a starting point for addressing the needs for improved prevention, diagnosis, and detection. The two planned successor studies (the first one on surveillance and monitoring, the second on response and recovery) will build on the conclusions and recommendations presented in this report. In order to address and to begin building the infrastructure necessary to address critical needs for animal health, a new paradigm for strong leadership, vision, and transformational change will be key in developing dialogue and collaboration among stakeholders. Such collaboration will be important in establishing a mutual understanding that the country’s best interest is to be more visionary and strategic and to provide more direct support to efforts that focus on preventing disease rather than only combating disease. This involves: Improved development and use of science and technology for prevention and detection. Strengthened animal health laboratory networks. Comprehensive research with partnered government, academic, and private sectors. A coordinating mechanism for engaging partnerships among local, state, federal, and international agencies and the private sector. Enhanced global systems for preventing, detecting, and diagnosing diseases. A standardized approach for the import, sale, movement, and health of exotic and wild-caught animals. Increased use of risk-based tools and models. Increased veterinary capacity and capabilities. Improved education and training opportunities for individuals responsible for day-to-day oversight of animals. Increased awareness about the importance of maintaining animal health. The evidence discussed in this report provides compelling support for both fundamental changes in the framework related to prevention, detection, and diagnosis of animal diseases and for the urgency in making these changes. The dynamics and realities of today’s world require long-term planning and decision making that is well integrated among stakeholders, including international experts and partners. U.S. agencies and stakeholders will have to make significant improvements in their scientific and technological acumen in order to be competitive and to maximize U.S. abilities to sustain and protect animal and public health. The
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Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases committee is calling for regulatory and oversight agencies to break with the past and engage themselves in this expanded, interdependent role. This will require a large and formal shift away from the introspective mentality of many stakeholder groups and toward a multilateral, open, and transparent operational environment.
Representative terms from entire chapter: