Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases (2009)

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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  

 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). 

 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 

 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). 

 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, 

 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 

 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. 

 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. 

 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 

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). 

 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 

 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 

 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, 

 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 

 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 

 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.