Memorandum by Food and Agricultural Organisation
of the United Nations
1. The Food and Agriculture Organization
of the United Nations (FAO), together with the World Organisation
for Animal Health (OIE), has taken a prominent role in coordinating
the international response to the H5N1 highly pathogenic avian
influenza (HPAI) crisis in animals. FAO's global programme aims
to mitigate the risk of a human influenza pandemic by controlling
infection with HPAI at its source in birds and to safeguard smallholders'
livelihoods, food security and rural development in developing
countries through the support to the poultry sector thanks to
better control of HPAI and other major diseases. FAO works with
a range of international, regional and national partners and has
developed institutional structures to deal with the emergence
and spread of transboundary animal diseases (TADs) of which HPAI
is one. FAO works in close collaboration with the World Health
Organization (WHO) to mitigate the risks of human infection when
the TAD is zoonotic, as in the case of HPAI.
2. FAO's overall objective with respect
to HPAI is "to safeguard animal health and livelihoods
from the threat of HPAI and mitigate the risk of a human pandemic
through prevention and control of HPAI in the poultry sector at
three interconnected levels: global, regional and national".
3. The desired outcomes of FAO's approach
are threefold; a coordinated and efficient global response to
HPAI; development of disease control strategies and options that
are technically sound, economically sustainable, ecologically
appropriate and socially acceptable, which are available and communicated
to decision makers; and, regional and national capacities and
capabilities are developed for effective prevention and control
of HPAI in the animal population.
In response to the principle issues raised by
the Committee:
4. Question 1: Infectious diseases
remain a threat to human health, animal health and food security.
In animal populations they can have severe social implications,
including market shocks and disruption of orderly social structures,
which may be out of all proportion to their direct effect on animal
and human health. This is particularly so with zoonotic diseases.
The last couple of decades have seen the emergence, or re-emergence,
of a number of infectious diseases with potential global impact.
Of the newly emerging diseases, about 75% have originated from
non-human animal species. Failure to control TADs is often less
an issue of lack of technical knowledge than a lack of effective
animal health systems and particularly of strong Veterinary Services
able to detect and respond to diseases, and significant weaknesses
in communication strategies and planning. This is particularly
so in Africa. In general the situation remains critical because
currently recognized diseases threatening global spread are not
being adequately controlled and, regarding HPAI, it can reasonably
be expected that the virus will continue to circulate in the coming
years. Furthermore, from the perspective of affected communities
and the millions whose nutritional security and livelihoods are
dependent on poultry, HPAI is an unprecedented crisis.
5. Question 2: For human infections
with HPAI, the WHO official records show 351 reported human cases
of which 219 were fatal (22 January 2008). Almost all have occurred
in people who have close contact with infected birds.
6. Question 3: FAO's emergency
prevention system (EMPRES) addresses TADs by focusing on early
warning and early response, by enabling research and by coordination.
Its disease intelligence warning arm is the Global Early Warning
and Response System (GLEWS), which was a component of the FAO
EMPRES programme and which has become, in July 2006, a joint FAO,
OIE and WHO platform. GLEWS collects and analyses disease information
derived from field officers, mission reports, FAO country Offices/teams,
media, rumour tracking, etc, and distributes it to partner countries
to facilitate their accurate risk assessments and disease preparedness
plans. GLEWS is a growing system and, as international networks
continue to be strengthened its value, will continue to increase.
Furthermore, in 2007 FAO has established jointly with OIE and
in strong partnership with WHO a Crisis Management Centre for
Animal Health (CMC-AH) which can send a "fire-brigade"
type team when new outbreaks occur in countries. In mid-2007,
FAO established a Communication Unit within its Emergency Centre
for Transboundary Animal Diseases (ECTAD), which is partnering
with all other major agencies in analysing, developing, defining
and implementing effective communication responses to the crisis.
7. Question 4: Global eradication
of H5N1 HPAI in the immediate future is an unrealistic goal. It
is clear from current experience with HPAI that countries which
have well structured and resourced veterinary services are able
to detect incursions of disease rapidly and to eliminate them.
Therefore, while gaps in knowledge exist, it is possible with
current knowledge to eliminate infection if the resources are
available. A major component of the FAO/OIE strategy in combating
the global threat of HPAI is to support national governments,
within the framework of regional support and networking systems,
to build capacity for surveillance, disease diagnosis, communication
strategies, and response to disease incursion, and to have in
place integrated national preparedness and response plans. While
this is being done for HPAI, the structures and resources developed
contribute to the control of all TADs. Given the inadequate state
of the veterinary services in many of the countries that have
requested international assistance, this is a huge undertaking
that will require financial support and commitment for years to
come. In some countries the first indication that HPAI is present
in poultry was when human deaths occurred.
8. Question 5: Great progress
has been made with global and regional coordination and support
but the major constraint to controlling HPAI in birds is inadequate
national veterinary capacity and capability in many infected and
at risk countries. Additionally, much more focus and field-research
needs to be undertaken to better understand transmission pathways
in poultry production and marketing chains including the role
of wild birds to identify barriers/enablers to change for improving
interventions.
9. Question 6: In implementing
its Global Programme, FAO has forged strong partnerships with
OIE and WHO and works closely with the United Nations Children's
Fund (UNICEF), which has an important role in avian influenza
communication. FAO and other UN agencies work under the overall
coordination of the office of the United Nations System Influenza
Coordinator (UNSIC) in New York. Close working relationships are
established with other international institutions such as the
World Bank, the Asian Development Bank and the European Union,
as well as strategic donors and regional structures such as the
Association of Southeast Asian Nations (ASEAN) and the African
Union's Interafrican Bureau of Animal Resources (AU-IBAR).
10. Question 7: Many factors
contribute to the emergence of new diseases and international
disease spread. Globalization and intensification of agricultural
production systems and the international movement of animals,
animal derived products and associated commodities have the potential
to rapidly spread a disease that originates in one location across
the globe. The major safeguard against this occurring is the formulation
and implementation of sound biosecurity measures to control the
movement of risk products. This has not yet been achieved uniformly
and much of the spread of HPAI (and other TADs) can be attributed
to trade in poultry and poultry products, particularly the informal
trade. The role of wild birds still remains largely unknown. An
additional aspect, that needs deeper analysis, is the role of
incentives (financial as well as non-financial) that can catalyse
rapid uptake of biosecurity measures among small and medium-sized
poultry production enterprises, millions of which exist around
the world.
11. Questions 8, 9, 10 are not
applicable.
12. Question 11: FAO's support
to strengthening national surveillance systems for HPAI aims to
provide early recognition of disease in poultry so that Public
Health authorities can be alerted to the potential of human infections
before they occur. Also the OIE/FAO Network of Expertise on Avian
Influenza (OFFLU) interfaces with WHO and facilitates the exchange
and molecular characterization of avian isolates of HPAI to monitor
changes that might be consistent with mutations towards a pandemic
virus. FAO has also strongly advocated with communication partners
to prioritise interventions for the prevention of animal-to-animal
transmission of HPAI and the early reporting of suspect events
by communities. However, much more needs to be done in this domain,
given that this is critical for stopping the spread of the disease
at its source.
13. Questions 12, 13 not applicable
14. Question 14: Exchange of
current isolates of H5N1 HPAI is resisted by some developing countries
because they fear losing out on fair access to any vaccines or
new diagnostic tools that may be developed by commercial companies
in developed countries. This is a critical issue that needs to
be resolved and monitored to ensure good international access
to information on any changes that are occurring in the virus
towards pandemic potential.
15. Question 15: A major component
of FAO's Global Programme for the prevention and control of HPAI
is the development of technically sound control strategies and
options and their communication to decision makers in partner
countries. Activities conducted to strengthen national veterinary
capacity include training and regional networking to achieve harmonization
of approaches and sharing of experiences while still leaving room
for adapting those sound policies and tools to local conditions
and priorities.
16. Question 16: No comment
17. Question 17: The approach
taken by FAO in supporting countries to develop HPAI preparedness
and response plans is to ensure integration of the plans with
all other government authorities who may be called on to play
a role in response to a disease incursion. These plans are then
tested in simulation exercises to evaluate adequacy of the planning
and capability to respond. Surveillance and preparedness plans
usually have a trigger event, such as mortality above a certain
level in chickens, which initiates the response. There is scope
to explore further how valuable a syndromic approach, based on
a set of clinical signs, rather than a disease-specific approach,
might be in providing early warning, which can then be investigated
and further resolved. There is also evidence emerging that monitoring
changes in market patterns and flows of commodities can be used
to give early warning of possible disease events, whether or not
they are deliberately initiated. More work is needed, both in
respect of HPAI and in disease detection in general.
18. Communication strategies that raise
public awareness, gain community engagement, motivate poultry
producers to adopt the minimum set of biosecurity measures, and
promote early reporting of disease events are critical if outbreaks,
which may start in remote areas, are to be detected early enough
to prevent spread.
19. Question 18: Over the past
three decades there has been a steady stream of new infectious
diseases emerging, as well as old diseases re-emerging or gaining
new significance through greater prevalence or resistance to current
treatments. About 75% of the new diseases are derived from animals.
It can be reasonably expected that the rate of emergence of new
diseases will continue in response to ecological changes impacting
on human and domesticated animal populations, many of which will
be caused or exacerbated by climate change. Of particular concern
will be those infectious diseases transmitted by insect vectors.
While much community focus is on human diseases, the impact of
new diseases or diseases that move to new geographical locations
(such as West Nile Virus in the USA) may be felt in domestic and
wild animal populations also. Even those diseases that do not
directly affect human populations may affect food security by
their impact on food animal populations.
20. Question 19: The UK has pledged
US$10.17 million in support of FAO's global programme for prevention
and control of HPAI. Of this amount US$6.876 has been pledged
to the Special Fund for Emergency and Rehabilitation Activities
(SFERA). This latter pledge has added value in FAO's work because
it provides flexible funding to meet priority needs rather then
being earmarked to specific countries or regions defined by the
donor. To date US$5.579 million of the total pledged amount has
been received by FAO. Funds have been utilized to: support global
coordination activities; develop preparedness and response plans,
training and veterinary capacity building in Ethiopia; to provide
resources and expertise in Uganda; and to strengthen surveillance
and diagnostic capacity, communication and public awareness, emergency
preparedness plans and for socio-economic assessment in Kenya.
The development and implementation of these projects is carried
out with international and regional partners, and other donors
(USA in the case of Ethiopia). Parts of some projects have been
implemented by specialist institutions such as the Royal Veterinary
College, London, for epidemiology training.
21. Question 20: The important
role played by effective communication strategies and programmes
cannot be over emphasized in keeping the public informed, aware
and engaged in the detection and response to infectious diseases.
This is particularly so with diseases of livestock such as HPAI,
in which case an alert and engaged stock owner, who may be a villager
with no more that 10 or 20 chickens, can play a critical role
in early warning and response and instituting local biosecurity
measures to protect their own health and to prevent spread of
infection to other birds. Effective communication ahead of disease
events is also valuable in mitigating market shocks and distortion
of trading patterns that can follow disease identification. For
example the impact on tourism as a result of the SARS outbreak
was immense and reflected the public's fear of being exposed to
infection by air travel.
22. There is global agreement among all
partners that stopping the highly pathogenic avian influenza (HPAI)
H5N1 virus "at source" (ie, among poultry) is critical
in order to minimize the impact on agriculture and to prevent
the emergence of a human pandemic. However, to date, the overwhelming
majority of the communication interventions and discourse has
been biased towards the issue of human rather than animal health.
Much of this has been in the nature of an emergency response,
led by outbreak and risk communication from a human health perspective,
directed at the latter stages of the animal-to-human transmission,
rather than the earlier stages of the poultry-to-poultry transmission.
While these public health driven communication interventions may
help prevent animal-to-human transmission of the virus, and perhaps
human-to-human transmission in the future, they have done little
to help prevent the spread of the virus through biomechanical
transportation and animal-to-animal transmission. Factors that
strongly influence public response have often not been clearly
and consistently communicated. Emerging evidence from a wide array
of studies suggest that, while most people in affected countries
have heard and are aware of avian influenza, confusion still exists
about its transmissibility, and means of prevention. News reporting
has often tended to be sensational, confusing and inaccurate—fuelling
rumours and loss of public trust and confidence in national authorities.
This has generally precipitated large-scale negative consumer
reaction and poultry market shocks/disruptions during outbreaks.
Existing communication capacities, and resource allocations for
communication planning, especially for Ministries of Agriculture/Livestock,
have been less than optimal, and thus, in the event of an outbreak,
policy and decision-making within national governments still seem
to be reactive.
23. Socio-economic information on such things
as the impact of disease and control programmes on small holder
livelihoods and markets is important in developing control strategies
that are effective while avoiding negative impacts that will deter
stock owners from reporting disease or will endanger food security
for vulnerable members of society.
24. It has become clear that wildlife (primates,
other mammals and birds) play an important role as reservoirs
of infectious agents that, under suitable circumstances, spill
over into human populations with devastating effects. At present
the common approach has been to work back from finding a new human
infection to try to discover from which animal species it has
originated and the circumstances that may have led to its movement
across species. A prospective approach could be taken to increase
the study of infectious agents in wild life, focussing on targeted
species that come into contact with humans, often as a source
of food, and to ensure that tools are available to rapidly investigate
any emerging human diseases that appear to have a wildlife reservoir.
FAO is supporting major studies with partner organizations on
migrating wild birds to clarify their potential role as international
disseminators of H5N1 HPAI.
25. A comprehensive report on FAO's activities
in prevention and control of HPAI is available at http://www.fao.org/docs/eims/upload/236620/ah690e.pdf.
February 2008
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