Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 1
Summary
Infectious disease surveillance systems play an important role in safe-
guarding human and animal health. By systematically collecting data on the
occurrence of infectious diseases in humans and animals, investigators can
identify new outbreaks, track the spread of disease, and provide an early
warning to human and animal health officials nationally and internationally
for follow-up and response. Unfortunately, for several reasons, the disease
surveillance systems operating around the world are not very effective or
timely in alerting officials to newly emerging zoonotic diseases—diseases
transmitted between humans and animals.
Emerging zoonoses are a growing concern given multiple factors. First,
zoonoses are often novel diseases that society is medically unprepared to
treat, as was the case with HIV/AIDS and variant Creutzfeldt-Jakob disease
(vCJD), better known as mad cow disease. Second, zoonoses are unpredict-
able and have variable impacts on human and animal health. For example,
different strains of influenza A virus—such as highly pathogenic avian
influenza (HPAI) H5N1 and pandemic H1N1 2009—have different host
ranges and cause illnesses of different degrees of severity. Third, zoonotic
diseases outbreaks are increasing in number: At least 65 percent of recent
major disease outbreaks have zoonotic origins. Fourth, because of increas-
ing international trade, travel, and movement of animals, zoonotic diseases
can emerge anywhere and spread rapidly around the globe, as demonstrated
by the recent outbreak of severe acute respiratory syndrome (SARS) and the
ongoing 2009 influenza pandemic. Fifth, the spread of zoonotic diseases can
take a major economic toll on many disparate industries, including those
in the agricultural, manufacturing, travel, and hospitality sectors, and can
OCR for page 2
GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
threaten the peace and economic stability of communities both directly
and indirectly connected to disease outbreaks. The economic cost of HPAI
H5N1 between 2003 and 2006 was estimated to equal nearly 2 percent of
the regional gross domestic product of China, Taiwan, Hong Kong, and
Singapore.
In response to concern about the global spread of zoonotic diseases,
the U.S. Agency for International Development (USAID) approached the
Institute of Medicine and the National Research Council for advice on how
to achieve more sustainable global capacity for surveillance and response to
emerging zoonotic diseases. A study committee was formed to review global
responses to zoonotic diseases over the past several decades and to examine
the current state of global zoonotic disease surveillance systems in light of
the underlying causes of disease emergence and spread. The committee was
asked to examine how an investment in global disease surveillance should
be considered relative to funding emergency (critical situation) responses,
and to make recommendations for improving coordination between differ-
ent surveillance systems, different governments, and different international
organizations.
After its review,1 the committee found that, in the United States and
elsewhere, traditional systems of infectious disease surveillance in humans
operate separately from those for animals. This separation impedes com-
munication between human and animal health officials on zoonotic disease
occurrences that can threaten human health. For example, during the 1999
West Nile virus outbreak in the United States, a veterinarian tried to notify
human health authorities about the possible connection between bird die-
offs in a New York zoo and human outbreaks of febrile illness occurring in
the same area. However, human health officials did not act upon the alert
to investigate the potential threat to humans in a timely manner. Another
problem is the mismatch of surveillance capabilities in locations where
diseases are most likely to emerge. The industrialized world has the most
robust surveillance systems for both human and animal health; however,
most recent zoonotic diseases have emerged in the developing world, where
surveillance systems are weaker.
Disease surveillance is essential to ensure that information is passed on
to authorities to implement an efficient, early response, averting the need
for a large emergency response after the disease has spread. A previous as-
sessment estimated that an investment of $800 million per year is needed
for global disease surveillance and early response capabilities; however, the
1 The
committee’s review was based on its data-gathering sessions, survey data, expertise
of committee members, and Achieving Sustainable Global Capacity for Surveillance and
Response to Emerging Diseases of zoonotic Origin: Workshop Summary (IOM and NRC,
2008).
OCR for page 3
SUMMARY
economic losses from emerging, highly contagious zoonotic diseases have
reached more than $200 billion over the past decade. Therefore, a global
zoonotic disease surveillance system to reduce the emergence of zoonotic
diseases in humans and to help detect other livestock diseases early could
help to prevent the staggering economic losses associated with zoonotic dis-
ease outbreaks. It was beyond the committee’s charge to comprehensively
assess how best to implement appropriate evidence-based responses to an
emerging zoonotic disease in human and animal populations; therefore,
significant further review and study of integrated emergency response sys-
tems is needed.
Detecting and responding to zoonotic diseases is challenging, the com-
mittee found, because the underlying drivers of zoonotic disease emer-
gence and spread result from an evolving complex of biological, genetic,
ecological, political, economic, and social factors. One catalyst for disease
emergence is the increasing demand for meat in developing countries where
there are also many challenges in proper animal production management.
In those countries, human populations and urban centers are expanding,
with housing and agriculture competing with existing wildlife habitat.
The movement of goods and people across borders—such as trade in food
animals and exotic pets, international travel, and the movement of refu-
gees into compromised living conditions—has increased the risk of disease
spread. Climate change models suggest that wildlife migration patterns
could change and that precipitation increases could lead to an expansion
of insect- and water-borne diseases. The convergence of these diverse and
nuanced drivers can create zoonotic disease “hotspots.”
However, effective surveillance systems rely on local and national par-
ticipants’ ability and willingness to accurately report disease outbreaks, and
their capability to implement local and national responses. Early identifica-
tion of zoonotic disease emergence is essential to rapidly contain outbreaks,
yet many local and national authorities lack the human and technical
capability, capacity, and supporting financial resources to do so. Tensions
increase when reporting can lead to international health and economic
consequences, such as trade sanctions, travel warnings, animal culling,
and declining public confidence in products, as was the case with pork
products during the influenza A(H1N1) 2009 outbreak. Local and national
incentives for reporting disease outbreaks help alleviate an individual or a
country’s fears about bearing such consequences alone and can diminish the
temptation to conceal or withhold information.
The drivers of zoonotic disease emergence and the measures to prevent
their emergence and spread are global in nature. The issues are important to
the international community and cannot be addressed by individual coun-
tries acting alone. Confronting the threat of zoonotic disease emergence
benefits governments and people of all states, thus the committee concluded
OCR for page 4
GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
that a global zoonotic disease surveillance system2 is a global public good.3
While disease surveillance and response are the responsibility of every na-
tion, a system providing sustainable global coverage will only be possible
with the efforts of nearly all nations and will require active national and
international collaboration with relevant private and public stakeholders.
The committee concluded that because the U.S. government is among
the world leaders in disease surveillance and has a considerable stake in
preventing the emergence and limiting the spread of zoonotic diseases,
it should lead efforts to coordinate a globally integrated and sustainable
zoonotic disease surveillance system. However, improving global zoonotic
disease surveillance cannot be achieved without the proactive engagement
of the World Health Organization (WHO) and the World Organization
for Animal Health (Office International des Epizooties, OIE), the global
standard-setting bodies for human and animal health, respectively. It is im-
perative for the Food and Agriculture Organization of the United Nations
(FAO), the World Trade Organization, and private industry to be involved
because of their roles in global food safety and security through trade
agreements among their member countries, and because of their roles in
implementing disease surveillance to meet respective goals and missions.
RECOMMENDATIONS
Achieving an effective zoonotic disease surveillance system that is global,
sustainable in funding and capacity, and integrated across disciplines and
sectors will require technical, economic, and political improvements (see
Table S-1). Recommendations assigned as high priority are foundational for
a global, integrated, zoonotic disease surveillance and response system. The
remaining recommendations are considered priority, although not listed in
rank order. While resources and leadership sufficient for carrying out these
recommendations may result in different implementation timetables, each
of the 12 recommendations is essential to achieve and sustain a successful
global system.
2 The committee defines “zoonotic disease surveillance” as the ongoing systematic and timely
collection, analysis, interpretation, and dissemination of information about the occurrence,
distribution, and determinants of diseases transmitted between humans and animals. Zoonotic
disease surveillance reaches its full potential when it is used to plan, implement, and evaluate
responses to reduce infectious disease morbidity and mortality through a functionally inte-
grated human and animal health system.
3 The International Task Force on Global Public Goods defines “global public goods” as
“issues that are broadly conceived as important to the international community, that for the
most part cannot or will not be adequately addressed by individual countries acting alone and
that are defined through a broad international consensus or a legitimate process of decision-
making” (2006, p. 13).
OCR for page 5
SUMMARY
TABLE S-1 Recommendations by Priority and Category
Technical Economic Political
Governance of Global
Financing and Incentives Efforts to Improve
Strengthen Surveillance for Surveillance and Surveillance and Response
and Response Capacity Response Capabilities
High Establish surveillance Establish sustainable Create a coordinating body
priority and response strategies funding strategies for global zoonotic disease
(Recommendation -) (Recommendation -) surveillance and response
(Recommendation -)
Priority Improve use of Create an audit and Deepen the engagement
information technology rating framework of stakeholders
to support surveillance for surveillance and (Recommendation -)
and response activities response systems
(Recommendation -) (Recommendation -)
Strengthen the Strengthen incentives Revise OIE
laboratory network to for country and governance strategies
support surveillance local reporting (Recommendation -)
and response activities (Recommendation -)
(Recommendation -)
Build human resources Mitigate disease threats
capacity to support from wildlife and trade
surveillance and response (Recommendation -)
efforts
(Recommendation -)
Establish a zoonotic
disease drivers panel
(Recommendation -)
NOTE: OIE = World Organization for Animal Health.
High-Priority Recommendations
The committee examined several infectious disease surveillance systems
already in operation to identify some effective systems, uncover gaps in ef-
forts, and examine improvements to existing systems to achieve the desired
global disease surveillance system. Table 4-2 in the report presents a sum-
mary of current system gaps and challenges.
Technical: Strengthen Surveillance and Response Capacity
The committee found that the United States and Europe are greatly
overrepresented in reports of emerging disease outbreaks, which is cer-
tainly related to disease surveillance and laboratory capacity. However,
OCR for page 6
GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
irrespective of resource availability, the committee was unable to identify
a single example of a well-functioning, integrated zoonotic disease surveil-
lance system across human and animal health sectors. The committee found
large gaps in existing disease surveillance networks, including coverage
across species and across geographic space. Of concern is that the cause for
90 percent of human infectious disease cases could not be identified, even
in developed countries.
Recommendation 1-1: The U.S. Departments of Health and Human
Services, Agriculture, Homeland Security, and the Interior should col-
laborate with one another and with the private sector and nongovern-
mental organizations to achieve an integrated surveillance and response
system for emerging zoonotic diseases in the United States. In addition,
these government agencies, including the U.S. Department of State and
USAID, should collaborate with WHO, FAO, and OIE to spearhead
efforts to achieve a more effective global surveillance and response sys-
tem, learning from and informing the experiences of other nations.
Given finite resources and the complexity of the challenge, an integrated
zoonotic disease surveillance and response system can succeed only if the U.S.
government and its partners, informed by best practices documented to date,
develop strategic approaches and strengthen the needed capacities at both the
national and global levels. Such strategic approaches would include
(a) Work with researchers to develop science-based criteria to determine
the magnitude and distribution of disease drivers.
(b) Immediately strengthen surveillance in human populations at high-
risk for zoonotic diseases (for example, livestock and poultry workers) in
countries where disease surveillance in animal populations is weak.
(c) Develop and strengthen surveillance systems in animal populations
so that outbreaks are detected early in animal populations rather than dis-
covered later through secondary human outbreaks.
(d) Synchronize and share surveillance information from both human
and animal populations in an integrated system, in as close to real time as
is possible.
(e) Engage science-based nongovernmental organizations as valuable
partners that provide the wide geographic reach and field-expertise needed
for more comprehensive surveillance and response activities.
Economic: Financing and Incentives for Surveillance and Response
Funding needs will be significant to develop and sustain a global disease
surveillance system for emerging and reemerging zoonotic diseases. Existing
OCR for page 7
SUMMARY
international aid architecture is fragmented and donor funding is unpredict-
able, especially during a global economic crisis. The committee concluded
that the long-term infrastructure for disease surveillance and response has
been underfunded in part due to the historical practice of time-limited do-
nor funding for specific diseases.
Recommendation 2-1: USAID—in partnership with international fi-
nance institutions and other bilateral assistance agencies—should lead
an effort to generate sustainable financial resources to adequately sup-
port the development, implementation, and operation of integrated zoo-
notic disease surveillance and response systems. An in-depth study of
the nature and scope of a funding mechanism should be commissioned
by these agencies, and the study should specifically consider a tax on
traded meat and meat products as a potential source of revenue.
Given the benefits the international community derives from early de-
tection of a potential health or economic (trade) risk, countries with greater
resources need to show leadership by supporting low-income countries and
international organizations. Whatever the source for sustainable financing,
it should be tied to activities that can increase the risk of zoonotic disease
emergence and spread, such as trade. The proposed levy on traded meat and
meat products places the burden on the wealthier importing countries. Ac-
cess to funding could be dependent on the recipient country’s commitment
to and development of national surveillance capabilities.
Political: Governance of Global Efforts to Improve Surveillance and
Response Capabilities
Recent concerns about a potential highly virulent human influenza
pandemic have resulted in coordinated international action to help coun-
tries improve their ability to detect disease outbreaks. In 2006, the UN
appointed a System Influenza Coordinator (UNSIC), which has been a key
factor in the development of strong partnerships among technical agencies
such as WHO, FAO, OIE, and other bilateral and multilateral partners, in-
cluding the World Bank. UNSIC provides a useful model for the governance
of a global zoonotic disease surveillance system.
Recommendation 3-1: USAID, in cooperation with the UN and other
stakeholders from human and animal health sectors, should promote
the establishment of a coordinating body to ensure progress toward
development and implementation of harmonized, long-term strategies
for integrated surveillance and response for zoonotic diseases.
OCR for page 8
GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
A streamlined architecture for global health governance on zoonoses
would benefit from structured coordination of critical intergovernmental
bodies. Establishing a permanent zoonotic disease coordinating body with
the authority and means to bring together technical agencies, including
WHO, FAO, and OIE, will ensure that all relevant stakeholders are con-
sulted and involved. The mechanism could also draw attention to problems
and challenges faced in implementation of the International Health Regula-
tions (IHR) 2005, OIE agreements, and OIE/FAO strategies, and identify
additional funding streams for zoonotic disease control.
Priority Recommendations
Technical: Strengthen Surveillance and Response Capacity
Improve Use of Information Technology Information technology is es-
sential for early disease detection, monitoring, and surveillance by enabling
real-time collection and sharing of detailed information about outbreaks.
Technological breakthroughs have led to new ways to collect and transmit
epidemiological, clinical, demographical, and other information in the field.
These include the use of handheld computers, cell phones, remote sensing,
and web-based data streams, which are used to capture and disseminate in-
formation from even the most remote and resource-challenged countries.
Recommendation 1-2: With the support of USAID, international or-
ganizations (such as WHO, FAO, OIE, and the World Bank) and
public- and private-sector partners should assist nations in developing,
adapting for local conditions, and implementing information and com-
munication technologies for integrated zoonotic disease surveillance.
Effective use of such technologies facilitates acquisition, integration,
management, analysis, and visualization of data sources across hu-
man and animal health sectors and empowers information sharing
across local, national, and international levels. To establish, sustain,
and maintain this technologically sophisticated system, both leadership
and investment are critically needed.
Technology development should focus on bidirectional information
sharing with specific attention to data aggregation technology, open source
development, transparency, privacy, and standards to facilitate improved
communication within and between human and animal health sectors
and across borders. Leadership and investment is needed within each
country and will require partnership with key nongovernmental actors
such as private philanthropies, industry partners, and nongovernmental
organizations.
OCR for page 9
SUMMARY
Strengthen Laboratory Network Identifying the cause of emerging out-
breaks is a vital part of any disease surveillance system. Existing reference
laboratories lack broad capabilities in disease diagnosis because they often
have only agent-specific expertise and may lack a specific mandate for zoo-
notic disease surveillance. The committee found that no resource exists to
provide data on existing global zoonotic disease diagnostic laboratory capa-
bility and capacity for both human and animal health sectors. Moreover, no
model is available for a workable global laboratory network infrastructure
for integrated zoonotic disease diagnosis and reporting. What is clear is the
overall geographic mismatch between reference laboratory and collaborat-
ing center locations and hotspot regions (Figure S-1).
Recommendation 1-3: USAID should promote and initially fund the
establishment of an international laboratory working group charged
with designing a global laboratory network plan for zoonotic dis-
ease surveillance. The working group’s objective would be to design
a laboratory network that supports more efficient, effective, reliable,
and timely diagnosis, reporting, information sharing, disease response
capacity, and integration of human and animal health components. In
addition, a long-term coordinating body for zoonotic diseases, perhaps
modeled after the UN System Influenza Coordinator’s office (see Rec-
ommendation 3-1), should implement the global laboratory network
plan, manage it, and assess its performance in consultation with the
international laboratory working group.
Local and advanced reference technical laboratory capacity needs to be
organized into national, regional, and global networks. An international
working group—with representation from national human and animal
health laboratories from the public, private, and military sectors, interna-
tional nongovernmental organizations, professional associations, and wild-
life health—should be tasked to strategically outline steps to assess, plan,
and fund the needed global network laboratory capacity. Implementation
of the plan can be modeled on the U.S. Integrated Consortium of Labora-
tory Networks.
Build Human Resources Capacity To produce and retain a skilled mul-
tidisciplinary workforce capable of conducting integrated surveillance and
response, new and existing personnel need to be trained in field-based,
integrated emerging zoonotic disease surveillance and response.
Recommendation 1-4: Given the need for increased human capacity to
plan, conduct, and evaluate integrated zoonotic disease surveillance and
response, U.S. government agencies should take the lead in developing
OCR for page 10
0
FIGURE S-1 Zoonotic disease hotspots and selected reference laboratories by location.
NOTE: The white dots signify the location of identified World Health Organization, Food and Agriculture Organization of the
United Nations, World Organization for Animal Health, and U.S. Department of Defense reference laboratories and collaborating
centers, many of which have a single disease or other focus mandate. Green dots are laboratories that have a broader function in
zoonotic and emerging diseases. Locations shaded in red and orange represent hotspot regions. The map does not include univer-
sity-based research and other laboratories working in the area of emerging disease detection and characterization. Numerous other
private-sector and national laboratories may be able to provide laboratory support capability (e.g., those of the Institute Pasteur
and Meriux Alliance), but were not included on this map.
New S-1 and 4-3 Color
SOURCE: Hotspot location data derived from Jones et al., 2008. Reference laboratory data received from committee’s communica-
tion with Stephane de La Rocque, Tracy DuVernoy, Cassel Nutter, Alejandro Thiermann, and Chris Thorns (2008).
OCR for page 11
SUMMARY
new interdisciplinary educational and training programs that integrate
human and animal health and allied fields. Existing national and re-
gional training programs in field epidemiology, clinical, and laboratory
diagnosis supported by the U.S. Departments of Health and Human
Services, Agriculture, and the Interior should be improved to include
a better balance of human and animal health concerns, incorporate
contributions from laboratory and social science professionals, and
connect with one another where appropriate.
The National Institutes of Health’s Fogarty International Center—in
partnership with the Centers for Disease Control and Prevention (CDC),
U.S. Department of Agriculture (USDA) Agricultural Research Service,
USDA Animal and Plant Health Inspection Services, USDA National In-
stitute of Food and Agriculture (the former Cooperative State Research,
Education, and Extension Service), and U.S. Geological Survey—should
be funded to provide leadership and partner with educational institutions
and relevant ministries to develop these programs. The new curricula and
training programs need to include human and animal health profession-
als, paraprofessionals, and community and public health professionals for
maximal opportunities to improve interdisciplinary communication.
Establish a Zoonotic Disease Drivers Panel The drivers of zoonotic disease
are individually and collectively complex, and the measures for controlling
them are transnational in nature. Although some of these drivers are under-
stood in isolation or in simpler, temporal interactions with each other (e.g.,
food-insecure people resorting to hunting wild animals for bushmeat, which
in turn exposes them to HIV), the complex ways in which they change and
interact over time are not well understood. This is a serious and noticeable
gap in current global zoonotic disease surveillance and response efforts.
Recommendation 1-5: The U.S. Department of State, in collabora-
tion with WHO, FAO, OIE, and other international partners, should
impanel a multidisciplinary group of technical experts to regularly
review state-of-the-science information on the underlying drivers of
zoonotic disease emergence and propose policy and governance strate-
gies to modify and curb practices that contribute to zoonotic disease
emergence and spread.
The zoonotic disease drivers panel would regularly review scientific
information to inform national and global policymakers of strategic ac-
tions to mitigate consequences of driver interaction that can lead to disease
emergence. The group should be composed of the recommended coordi-
nating body for zoonotic diseases and international representatives with
OCR for page 12
GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
demonstrated technical expertise to examine the broad set of drivers. It
could be modeled after the Intergovernmental Panel on Climate Change.
The Science and Technology Advisor to the President and the Department
of State’s Science and Technology Advisor to the Secretary could co-lead
the effort and bring the results of the panel’s findings to the attention of
important stakeholders and diplomatic forums, including the UN, Group
of Eight (G8), Group of Twenty (G20), and regional intergovernmental
organizations.
Economic: Financing and Incentives for Surveillance and Response
Create an Audit and Rating Framework Countries participate in assess-
ments of national human and animal health systems under the IHR 2005
and OIE programs, respectively. At present, there is no independent mecha-
nism to review progress towards achieving integrated surveillance and
response system capabilities, increasing the likelihood of uneven or incom-
plete progress.
Recommendation 2-2: USAID should convene a technical working
group to design and implement, by the end of 2012, an independent
mechanism to audit and rate national surveillance system capacities
for detecting and responding to emerging zoonotic disease outbreaks
in humans and animals.
The technical working group needs representation from WHO, FAO,
OIE, academia, nongovernmental organizations, national governments, and
private-sector partners. The 2012 deadline coincides with the target date
for full implementation of IHR 2005. Assessing both country risk and reli-
ability of reporting disease outbreak can help stakeholders identify barriers
to improve national and global capabilities. National surveillance capacity
information should be made publicly available by each country and such
information should be subject to independent audit and verification by the
audit framework. Because information on national risk is a public good,
resources to support this activity should be sourced through the global
funding mechanism described in Recommendation 2-1. This audit and rat-
ing framework would be housed within an independent global technical
consortium.
Strengthen Incentives for Country and Local Reporting An important
lesson from disease outbreaks such as HPAI H5N1 is that the ability of the
global human and animal health systems to respond is only as good as the
ability and willingness of local and national systems to detect and report
outbreaks. Bilateral aid agencies and international organizations have not
yet paid enough attention to reducing the tendencies of countries to conceal
OCR for page 13
SUMMARY
outbreaks. Such measures would include designing economic incentives for
reporting outbreaks, providing adequate compensation to cover economic
impacts of response, and assuring that implemented control measures are
based on scientific evidence.
Recommendation 2-3: To reduce incentives to conceal outbreaks and
mitigate the negative social and economic repercussions of early dis-
ease reporting (e.g., stigma of disease, food safety concerns, culling,
and trade and travel disruptions), financial incentives at the following
levels are needed through partnerships among bilateral aid agencies, the
international community, and national governments:
(a) Country level: USAID—in partnership with international finance
institutions and other bilateral assistance agencies—should im-
plement economic incentives to encourage middle- and low-
income countries to report human, animal, and zoonotic disease
outbreaks.
(b) Local level: National governments, with added support from the
international community, should identify and provide the resources
needed for financial incentives to promote early disease reporting
and to engage in effective responses at the local level.
The international community can also minimize the unnecessary cost
of sanctions at both levels by using existing regulatory mechanisms, like
zoning and compartmentalization, where appropriate. International com-
munity application and acceptance of these initiatives allow for continued
trade of safe products from countries or zones that have reported a disease.
In addition to funding for upgrading surveillance capacity, guaranteed assis-
tance with outbreak containment needs emphasis, including the availability
of diagnostic kits and vaccines for humans or animals. Without such sup-
port, countries have fewer incentives to report disease outbreaks, regardless
of international legal obligations.
National governments need to make explicit plans to increase incen-
tives by allocating financial resources for adequate reparation to those who
stand to lose from reporting, while decreasing disincentives by reviewing
and reducing the unwarranted use of outbreak control measures such as
travel restrictions, quarantines, and culling.
Political: Governance of Global Efforts to Improve Surveillance and
Response Capabilities
Deepen Engagement of Stakeholders The complexity of achieving sustain-
able, integrated national and global surveillance and response systems for
zoonotic diseases requires deliberate and intensified efforts to engage and
connect all relevant stakeholders at each governance level—local, national,
OCR for page 14
GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
and global. Moreover, high stakes for trade or industry groups—as illus-
trated by the detection of bovine spongiform encephalopathy (BSE) in three
cows in the United States between 2003 and 2006, causing great economic
harm to that industry with a total loss of $11 billion—necessitate their
involvement as well.
Recommendation 3-2: In its work on zoonotic disease surveillance and
response, USAID—in collaboration with WHO, FAO, and OIE—should
convene representatives from industry, the public sector, academia,
nongovernmental organizations (NGOs), as well as smallholder farmers
and community representatives to determine how best to build trust and
communication pathways among these communities in order to achieve
the efficient bi-directional flow of both formal and informal informa-
tion needed to support effective, evidence-based decisionmaking and
coordinated actions.
The public desires higher levels of health and less risk of disease; gov-
ernments have a political interest in the trade-off between improving the
levels of sanitary health on behalf of citizens and the freedom of interna-
tional commerce; and industry has an economic interest in the trade-off
between quality and yield. Despite these often mutually beneficial interests,
different sectors can still be resistant to working together. To overcome such
barriers, it is critical to engage relevant stakeholders from all levels to help
build transparency and trust.
Revise OIE Governance Strategies The committee analyzed similarities
and differences in the governance strategies and legal obligations embed-
ded within WHO’s IHR 2005 and OIE’s approaches, rules, and resolutions.
Although they have more similarities than some comparative analyses have
recognized, the committee concluded that the OIE rules lack important
provisions found in IHR 2005 that should be operative to promote animal
health.
Recommendation 3-3: To protect animal health and international trade,
and to contribute significantly to the reduction of human and animal
health impacts from zoonotic diseases, OIE members states should take
the necessary steps to:
(a) Adhere to Resolution 17 (adopted on May 28, 2009), which re-
minds OIE member states of their obligation to make available to
OIE all information on relevant animal diseases, including those
that are of zoonotic potential.
(b) Create legally binding obligations for OIE members to develop and
OCR for page 15
SUMMARY
maintain minimum core surveillance and response capabilities for
animal health risks, including zoonotic diseases.
(c) Authorize OIE to publicly disseminate information received from
nongovernmental sources, in the event OIE member states fail to
confirm or deny such information in a timely manner, or when de-
nials of such information run counter to persuasive evidence that
OIE has obtained from other sources.
(d) Empower the OIE Director-General to declare animal health emer-
gencies of international concern with respect to emerging or re-
emerging zoonotic diseases that constitute a serious animal or
public health risk to other countries and issue recommendations
about how countries should address such emergencies.
Adopting these four outlined principles will strengthen OIE’s ability
to ensure that its member nations have the minimal capacity for effective
surveillance and response to animal diseases, enabling them to control ani-
mal diseases before they decimate animal populations and impact human
health. These four recommendations provide a stronger foundation for
coordinating and collaborating among human and animal health organiza-
tions, ministries, and experts.
Mitigate Disease Threats from Wildlife and Trade The legal and illegal
trade in wildlife and wildlife products is an often ignored conduit for zoo-
notic pathogens, and it is apparent that the ability to monitor and control
this trade is limited. There is also a noted lack of coordination, even within
the United States, for disease detection in livestock and animal product
imports and in wildlife.
Recommendation 3-4: To mitigate and decrease the threat of zoonotic
diseases emerging from wildlife, U.S. government entities and their
international partners, especially OIE, should proactively take the fol-
lowing initiatives:
(a) Conduct a comprehensive review of federal and state laws on
trade in wildlife as a prelude to optimizing the policy and regula-
tory options to identify gaps and weaknesses in such laws, and to
enact new legislation, regulations, or administrative rule changes to
strengthen the government’s ability to protect human and animal
health from diseases carried by wildlife traded through foreign or
interstate commerce.
(b) Incorporate efforts and initiatives that support actions to prevent,
prepare for, protect against, and respond to threats to human and
animal health into current and new international negotiations and
cooperative processes that address drivers of zoonotic diseases
OCR for page 16
GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
(e.g., exotic pet trade, food safety and security, environmental
degradation, and climate change).
(c) Pursue negotiations for a new international agreement on trade
in wildlife species that improves international collaboration on
reducing the threat that such trade presents to human and animal
health. The objectives of the negotiations and the agreement would
be to make wildlife-related zoonotic disease prevention and control
a higher priority in the international management and control of
legal and illicit trade in wildlife species, the production and distri-
bution of food and animals, and environmental protection.
(d) Incorporate wildlife diseases and zoonoses into the OIE World Ani-
mal Health Information System and integrate reporting on wildlife
diseases and zoonoses in the Global Early Warning System. OIE
should also expand the role and capability of its Working Group
on Wildlife Diseases in order to more effectively meet the growing
zoonotic threat that wildlife diseases represent.
U.S. government entities including the Departments of Agriculture,
Commerce, Health and Human Services, Homeland Security, and the Inte-
rior should take the lead for these recommendations. Other relevant enti-
ties include the U.S. Postal Service and the U.S. Trade and Development
Agency. To overcome the current fragmentation of responsibility in the
United States, a first step would be establishing an inter-agency working
group to recommend a collaborative strategy for improved oversight and
action. Internationally, OIE should adopt a broader view of its remit by
forming an ad hoc committee to assess the most significant disease risks in
the international trade in wildlife, including those of potential impact to
human, livestock, and environmental health.
CONCLUSION
Minimizing morbidity and mortality in human and animal popula-
tions and protecting national and global security, international trade, and
individual livelihoods through a sustainable and integrated zoonotic disease
surveillance system is both a global public good and in the self-interest of
all nations. Steadfast global dedication of attention and resources from
multiple collaborating sectors is needed to achieve such a system, and it
will also require unprecedented collaboration across all levels, sectors, and
professional disciplines. Implementing all of the committee’s recommen-
dations would also strengthen the global implementation of IHR 2005,
WHO’s legal mechanism for improving disease surveillance and response
capacities for its member countries. The committee’s recommendations re-
flect elements and resources needed to strengthen global efforts to improve
zoonotic disease surveillance and response.
