FAO-EuFMD-OIE Progressive Control Pathway for FMD - PowerPoint Presentation

1. FAO-EuFMD-OIEProgressive Control Pathway for FMDPresented by Keith Sumption – with acknowledgements to PCP team in FAO, EuFMD and OIE Regional Consultative Seminar on the preliminary work of the GF-TADS FMD Global Working Group on the FAO-OIE Global Strategy for the control of FMDNovember 2 – 4 2011, OIE Headquarters in Paris, France

2. The PCP for FMDBackground; the rationale Development, application and refinement Stage definitions and Criteria AssessmentAcknowledgementsThis is the work of MANY

3. Outlook of Southern Africa Regional Roadmap(FAO-OIE meeting in Gaborone, March 2011)1235467

4. SummaryPCP-FMD : In use since 2008Joint FAO-EuFMD-OIE Tool5 stagesOutcome oriented , evidence basedStrategy developmentGap analysisComparativeWork in progress:Tools for assessment linkages to PVSIS: a tool to assist strategy development - in an area of potential policy conflicts

5. Regional/National Reference Centres Reference Laboratories and Collaborating Centres Reference Centres(UK, Belgium, Italy, South Africa, India, Russian Fed – at 3/09) Intermediate, sporadic Endemic FMD - Free Free. Virus present in game parksFree with vaccination Countries with multiples zonesSource: Annual OIE/FAO FMD Reference Laboratory Network Report, 2007 Pool 1O, A, Asia 1Pool 2O, A, Asia 1Pool 3O, A, Asia 1Pool 6SAT 1, 2, 3Pool 4A, O, SAT 1, 2, 3Pool 5O, A, SAT 1, 2Pool 7O, ABackground – FMDV distribution across 7 virus “”pools””

6. Background – serotype distribution. But at animal level – what is the risk of infection?

7. 2%7%41%54%28%Age class <1 year2%Turkey Infection in first year of life (2007): similar seen in other endemic countriesSurvey at animal markets in Turkey (2008) - for exposure to FMD (NSP +ve)FAO-EUFMD/EC/GDPCBackground: the scale of infection: - FMD as a “”common childhood illness”” –newly recognised as serology becomes widely applied

8. Background: public-private policy issues affecting progresslack of incentives at national level lack of incentives at producer level to invest in preventionlack of opportunity to purchase vaccine (state controlled access, limited or no suppliers, cold-chain issue) lack of technical advice to guide vaccine purchasecommonplace high risk situations: open borders/ classical transboundary rangeland issues, and wildlife-domestic interface lack of confidence in the vaccination approach to area wide FMD controlFMD is common and damaging disease – but who benefits and who should pay for control?

9. Background : low reported use of FMD vaccination…and limited FMDV virus intelligence to select vaccines

10. Background – the behaviour challenge :FMD control –what’s in it for me?

11. Background – the market chain challenge“if I was vaccinated, I would be less risk when traded”

12. Critical control points.......or already too late in the infection chain?

13. Background – the scale of under-reportingWagging fingers does not change reporting behaviour

14. Faced with such challenges…the PCP –FMD needed to be :Simple – to communicate, and applyComprehensive – technically sound, critical factors for success are addressedCredible – progress must be validated with evidence Progressive – easy to enter, each stage a base for progressRisk based – with focus on optimising impact of limited resources, avoid prescriptionsRewarding – potential gains from every StageObjective – promoting and rewarding active monitoring and the use of evidenceEnvironmentally neutral – and part of the solution to develop integrated approaches involving wildlife

15. PCP concepts -1Focus of control – changes with Stage Implement risk-based control21Identify risk and control optionsMaintain zero circulation and incursions4Implement Control strategy to eliminate circulation3Maintain zero circulation; withdraw vaccination5Sector or herd level control Population level control Event based control(and population level)Objective Assessment of Progress of PCP for FMDFMDV Incidence

16. PCP Concept 2Monitoring (and at higher levels – Surveillance) - is a key principle of the PCP Implement risk-based control21Identify risk and control optionsMaintain zero circulation and incursions4Implement Control strategy to eliminate circulation3Maintain zero circulation; withdraw vaccination5Monitor FMD epidemics – and & risk as needed to develop risk-based control programMonitor implementation & impact of the control programEarly detection & response to incursionsConfirm FMD freeObjective Assessment of Progress of PCP for FMD

17. PCP Concept 3 – countries desire recognition of effective efforts and actions - PCP as an enabling tool for regional FMD control Regional Roadmaps chart Measured progress to 2020Forecast progress (Expert Opinion)Permits comparison between countriesW. Eurasia Roadmap to 2020measuredforecastObjective Assessment of Progress of PCP for FMD

18. The Progressive Control Pathway (PCP) for FMD controldeveloped by FAO/EuFMD in 2008pathway leading from “”endemic”” towards “free status”” applied in West Eurasia, and for developing Roadmap for subregions of Africa, South Asia ; enables assessment of country progress within a Regionbetween Regionsself-assessment at National levelIdentifies gap and assists project formulation provide progress indicators for donors/investmentSince 2011 a Joint FAO/EuFMD/OIE tool

19. PCP – stepwise along the roadCountry Stages - facilitate progress monitoringat national and regional levelGlobal scale -across Regional Roadmapsand at every stage generates information for risk assessment

20. Areas where PCP-FMD has been used- in assessment, and longer term planning

21. 5 stages that progressively increase the level of FMD controlDeveloped by FAO and EuFMD Intended to assist FMD-endemic countries to progressively reduce the impact and burden of FMDThe Progressive Control Pathway for Foot and Mouth Disease (PCP-FMD) : definitions and criteria for progress

22. PCP-FMD May be applied at national level ...OR targeted geographically &/or to specific husbandry system(s)Each stage has well-defined outcomes ...which may be achieved through a variety of activities (NON-prescriptive approach) Evidence based and transparent assessment of Stage of a country (or zone) Tools used in PCPMonitoring for impact - Repeated serological surveysReference laboratory services – vaccine matchingSocio-economic studies; identify options and approaches Auditing interventionsEvidence based decision supportObjective Assessment of Progress of PCP for FMD

23. PCP Stage 1 Focus: “To gain an understanding of the epidemiology of FMD in the country and develop a risk-based approach to reduce the impact of FMD ” Objective Assessment of Progress of PCP for FMDComparable with Risk Assessment

24. Stage 1 of the PCP: 8 outcomesHusbandry systems.......are described and understood ....a ‘working hypothesis’ of how FMD virus circulates in the country has been developedSocio-economic impact .........has been estimatedThe most common circulating strains of FMDV identified5. ........progress towards an enabling environment for control activities6. ..... transparency and commitment to .....regional FMD control7. Important risk hotspots for FMD transmission are identified

25. AND TO PROGRESS TO STAGE 2:A strategic FMD control plan that has the aim of reducing the impact of FMD in at least one zone or husbandry sector is developed

26. Stage 1 : Gain understanding of epidemiology and develop risk-based approach to reduce FMD impactComposition and distribution of FMD-susceptible species Livestock WildlifeHusbandry systemsMovements & marketingSocio-economic impact Strength of veterinary servicesPrevalenceCirculating viral strainsSpatial distribution FMDUnderstand EpidemiologyObjective Assessment of Progress of PCP for FMD

27. Stage 1 : Gain understanding of epidemiology and develop risk-based approach to reduce FMD impactDevelop a risk-based approach:Identify risks: key transmission pathways, based on understanding of epidemiologyA strategic FMD control plan that has the aim of reducing the impact of FMD in at least one zone or husbandry sector is developed Required to progress to Stage 2Objective Assessment of Progress of PCP for FMD

28. QomEffective control HERE can prevent spread downstreamUnderstanding animal movement patterns can be critical for planning effective FMD control Stage 1 examples: Value chain analysis in IranObjective Assessment of Progress of PCP for FMD

29. Baseline serosurveys - Corrected for known risk factorsUncorrectedCan be useful to target control Baseline for comparison after interventions introducedUsing NSP-ELISA to identify FMD prevalance Objective Assessment of Progress of PCP for FMD

30. PCP Stage 1 –developing national ownership of strategy

31. PCP Stage 1 – main focus is on FMD risk assessment - to identify options for revised control strategy Assess relevant aspects of EpidemiologyValue chain – drivers for animal productionDiagnostics Socio-economical impactStrength and capacity of Veterinary ServicesParticipation in Regional FMD meetings - cooperation and transparency in reportingObjective Assessment of Progress of PCP for FMD

32. PCP Stage 2 Focus: “To implement risk based control measures such that the impact of FMD is reduced in one or more livestock sectors and/or in one or more zones” Objective Assessment of Progress of PCP for FMDComparable with sector level Risk Management

33. Stage 2 of the PCP: 5 outcomesOngoing monitoring of circulating strains and risk in different husbandry systemsRisk-based control measures are implemented for the sector or zone targeted, based on the FMD strategic control plan developed in Stage 1It is clearly established that the impact of FMD is being reduced by the control measures in at least some livestock sectors and/or zonesThere is further development of an enabling environment for control activitiesAND TO PROGRESS TO STAGE 3:5. A revised, more aggressive control strategy that has the aim of eliminating FMD from at least a zone of the country has been developed

34. PCP Stage 2 - examples of national strategiesFMD as a private good:Private sector (stakeholders) can purchase quality vaccinesEmphasis on private sector action to protect themselvesPublic role is to monitor FMD risk in wider population, licensing vaccines, and communication (epidemics, encouragement to buy vaccination in risk situations)Example: Kenya - most FMD vaccination is paid by stakeholders. Transition issues: mix of partial state supply and private purchases leaves many gaps.

35. PCP Stage 2 : other examplesFMD as private and public good:Define sectors that can pay for their vaccination (smallholder dairy?)Define zones where public funded control is for public good: e.g along borders, around wildlife reservoirsReach stakeholder consensus, implement and monitor impact in each sector/zoneExamples:State funded buffer zone vaccination, private sector vaccination elsewhere FMD as a public goodState supported FMD control zones to protect the rest of the population (HIGH RISK areas)

36. Stage 2 : Implement risk based control measures such that the FMD impact is reducedDevelopment of measurable, objective indicators essential to Demonstrate reduction in FMD impactE.g. Repeated surveys to estimate prevalence, socio-economic studiesProve that reduced impact is related to the control measuresE.g. Vaccine quality assurance, inspections to measure compliance with biosecurity and/or movement restrictions, repeated KAP surveys (Knowledge Attitude & Practice)Objective Assessment of Progress of PCP for FMD

37. PCP Stage 2 have focus is on FMD risk management Or as stated by one CVO : “Surveillance activities in their own right do not reduce FMD impact. That needs decisions, actions and evaluation!”

38. Stage 2 : Organisational modelsCentral Task Force: defining goal and objectives, developing control strategy and implementation, assessing impact. Objective Assessment of Progress of PCP for FMD

39. Risk managementFMD controlLegislationKnowledge about FMD transmissionCommunicationStakeholder participationFMDVeterinary Services competenceFinancesObjective Assessment of Progress of PCP for FMD

40. AND TO PROGRESS TO STAGE 3: A revised, more aggressive control strategy that has the aim of eliminating FMD from at least a zone of the country has been developed Objective Assessment of Progress of PCP for FMD

41. PCP Stage 3 Focus: “Progressive reduction in outbreak incidence, followed by elimination of FMD virus circulation in domestic animals in at least one zone of the country” Objective Assessment of Progress of PCP for FMDComparable with population level Risk Management

42. Moving up means institutionalisation of FMD controlImplement risk-based control21Identify risk and control optionsMaintain zero circulation and incursions4Implement Control straegy to eliminate circulation3Maintain zero circulation; withdraw vaccination5Confirm FMD freeObjective Assessment of Progress of PCP for FMDStudies OrganisationInstitutionalisationIncidence

43. Stage 3: Progressive reduction in incidence, followed by elimination of FMD virus circulationAgain, measurable, objective indicators essential to demonstrate reduction, and eventual elimination, of FMD (E.g. Repeated surveys)Rapid detection and response for all FMD outbreaks Objective Assessment of Progress of PCP for FMD

44. Stage 3 of the PCP: 5 outcomesOngoing monitoring of circulating strains and risk in different husbandry systemsThe disease control plan developed at the end of Stage 2 is implemented, resulting in rapid detection of, and response to, all FMD outbreaks in at least one zone in the countryThere is further development of an enabling environment for control activities4. The incidence of clinical FMD is progressively eliminated in domestic animals in at least a zone in the country AND TO PROGRESS TO STAGE 4:There is a body of evidence that FMD virus is not circulating endemically in domestic animals within the country or zone

45. Stage 3 of the PCPNB: Once a country has entered the GF-TADs–supported PCP-Stage 3 and has decided it wants to continue along the pathway to Stage 4 and beyond, implicating the intention to eradicate FMD virus from the domestic animal population, it may ask for formal OIE-endorsement of its national FMD eradication programmeObjective Assessment of Progress of PCP for FMD

46. AND (TO Repeat) – to PROGRESS TO STAGE 4:There is a body of evidence that FMD virus is not circulating endemically in domestic animals within the country or zoneObjective Assessment of Progress of PCP for FMD

47. PCP Stage 4 Focus: “To maintain ‘zero tolerance’ of FMD within the country or zone and eventually achieve OIE recognition of FMD-free with vaccination” Objective Assessment of Progress of PCP for FMDEvent based (respond/eliminate) control - in addition to population level risk management

48. Stage 4 of the PCP: 6 outcomesContinued FMD surveillance and risk monitoringThe risk of FMD entering the country or zone is mitigated FMD incidence is very low: only occasional incursions from outside (which must eventually cease if successful application for recognition of “free with vaccination” is to be achieved)The environment enables the full implementation of control measuresA plan is developed to fulfil the requirements for OIE recognition of “FMD-free with vaccination” statusAND TO PROGRESS TO STAGE 5The OIE requirements for recognition of “free with vaccination” are fulfilled and a dossier is submitted to OIE for recognition of this status

49. PCP Stage 5 Focus: “To maintain ‘zero incidence’ of FMD within the country/zone and eventually achieve OIE recognition of FMD-free without vaccination” Objective Assessment of Progress of PCP for FMDEvent based (respond/eliminate) control - in non-vaccinated populations

50. Stage 5 of the PCP: 2 outcomesZero incidence of FMD outbreaks is maintained in domestic livestockAND TO EXIT STAGE 5 AND COMPLETE THE PATHWAY:2.The OIE requirements for recognition of “FMD-free without vaccination” are fulfilled and a dossier is submitted to OIE

51. Assessment of national PCP stageDon’t forget me when you make your paper strategies

52. Assessment of PCP Stages –West Eurasia FMD Roadmap 2008: self-assessment by countries with peer review (FAO)2009 (Istanbul): upon submission of evidence of actions required at each stagepresentation/review at Regional Meeting2 month period post-Meeting to supply information , if required2009: Roadmap progress on track 2010: second Progress Review . Used modified PCP following October 2010 review.

53.

54. West-Eurasia regional roadmap1235467

55. Virus pools and outlook and Regional Roadmap(South Asia - pool 2)1235467* Afghanistan and Pakistan are participating in the West Eurasia roadmap

56. Outlook of Southern Africa Regional Roadmap(FAO-OIE meeting in Gaborone, March 2011)1235467

57. Tool 1: Self AssessmentWritten questionnaire for veterinary services:Follows PCP Guidelines – Outcomes for each Stage Questions based on defined criteria and questions -each OutcomeYes/no answers explained by manualMinimum Requirements differ by outcomeYearly completion - to retain status, demonstrate commitment Enables PCP- Gap AnalysisEnables review/revision of forecast progressYearly completion recommendedObjective Assessment of Progress of PCP for FMD

58. Tool 2: External Assessment(work in progress to refine procedures)External assessment includesFAO (and OIE experts) reviewing national self-assessmentsExpert review with national authorities - FAO/OIE WorkshopsCountry visits – assessment with national representativesRegional Meetings with opportunities for countries to assess presented progress reports -peer-to-peer scrutinyComparison of progress on paper – with evidence from monitoring and surveillance reports Year to Year change -both “”paper”” and direct measures (incidence)Objective Assessment of Progress of PCP for FMD

59. Objective Assessment of Progress of PCP for FMDAssessment of PCP Stage 1:checklist for the 8 Outcomes

60. Assessment example - PCP Stage 1Objective Assessment of Progress of PCP for FMD

61. Assessment checklist –and output as spiderweb chartChecklist –Y/N-Not applicableTo enter Stage 11.1Is there a written plan in place to study the epidemiology and socioeconomic impact of FMD?11.2Does the plan include a study of the structure of livestock production throughout the country for all FMD susceptible species (cattle, sheep, goats)?0To have a comprehensive plan to study epidemiology and socio-economics of FMD1.3Does the plan include activities to estimate FMD prevalence?11.4Does the plan include a timeline for activities?11.5Does the plan include a budget estimate for each activity?11.6Does the plan describe the organisational structure to carry out the study (defined roles and responsibilities, nominated persons)11.7Have any of the activities described in the plan been initiated?1Stake holders include farmers/producers PLUS all of the main players (people,organizations,companies) involved in breeding, transport of animals, milk/meat processing, feeding and marketing of animals. There could be scoring for these questions: identified all, most, some, noneOutcome 11.8Have key stakeholders involved in cattle production been identified? 01.9Have key stakeholders involved in small ruminant production been identified? 0All husbandry systems, the livestock marketing network and associated socio-economic drivers are well described for FMD susceptible species1.1Have key stakeholders involved in swine production been identified? 0Information should be available about numbers, origin and destination, drivers or motives for the movement and any seasonal patterns there could be scoring based on how completely movements have been described (eg origin and destination known but not numbers, or for commercial farms only...)1.1Are movements of animals within the country well understood for cattle?01.1Are movements of animals within the country well understood for small ruminants?01.1Are movements of animals within the country well understood for swine?01.1Are movements of animals into the country well understood for cattle?01.2Are movements of animals into the country well understood for small ruminants?01.2Are movements of animals into the country well understood for swine?01.2If there is transhumance or nomadic peoples, are their movement patterns understood?0OutcomeCriteriaQuestionsPlan is comprehensiveQuality indicatorsstakeholdersmovements

62. Procedure of assessmentSelf assessmentfor Stage 1Year 1Self assessmentfor Stage 1Year 2Self assessmentfor Stage 1Year xExternal assessmentfor Stage 2 in year xSelf assessmentfor Stage 2 in year xSelf assessmentfor Stage 1Year ySelf assessmentfor Stage 2 in year ySTAGE 1STAGE 2

63. Objective Assessment of Progress of PCP for FMDRequired achievements(in blue) are meant to cover the minimum requirements (red)

64. Self assessment: output

65. Verifiable indicators: results from monitoring Sero-monitoring:Incidence (NSP serology, options)Year-on-year change Performance of vaccinationAuditing of vaccination implementationPerformance of movement control systemsSurveillance –performance of different componentsVirological – for indicators of incursions and internal movements

66. Objective Assessment of Progress of PCP for FMDAssessment of PCP Stage 3

67. PCP – Plenty to Chew over, Properly

68. SummaryPCP-FMDIn use since 2008Joint FAO-EuFMD-OIE Tool5 stagesOutcome oriented , evidence basedStrategy developmentGap analysisComparativeWork in progress:Tools for assessment linkages to PVS

69. Working together

70. AcknowledgementsGiancarlo Ferrari, Julio Pinto, Peter De LeeuwMelissa McLaws, Chris Bartels (EuFMD Epi-Team)Nadege Leboucq (FAO & OIE)EUFMD Commission member statesCVOs of West Eurasian countriesEC (DG-SANCO –Trust Fund; Alf Füssel)FAO (J. Domenech, J. Lubroth, G Ferrari, J Pinto)OIE (G. Bruckner, J Domenech)FAO World Reference Laboratory (WRL) Pirbright (D Paton, Jef Hammond)Supporting centres: EUFMD Secretariat staff (Nadia Rumich)RAHCs in Beirut, Tunis, FAO Ankara and Cairo