Examination of Witnesses (Questions 1120
- 1139)
TUESDAY 20 MAY 2008
Dr Bernard Vallat, Dr Alain Dehove, Dr Sarah Kahn
and Dr Alex Thiermann
Q1120 Chairman:
Thank you. If there was one intergovernmental organisation that
could put most pressure on countries to develop the standards
in veterinary care that you seek to achieve, what would that organisation
be? Would it be the United Nations? Who would it be?
Dr Vallat: We think that the United Nations
could be one of the more efficient ways of convincing governments,
but, as you know, internationally there are a lot of different
bodies involved in health and we have to try to convince those
bodies. We have the WHO and the FAO, but a better way is the United
Nations in New York. It is difficult to have a statement made
by the General Secretary of the United Nations. We got a very
important statement three years ago during the avian influenza
crisis because of the risk of a pandemic, not because of the risk
to poultry. Thanks to that, the United Nations' General Secretary
nominated a co-ordinator in New York, Dr David Nabarro, and this
was useful for co-ordination between different United Nations
bodies. Thanks to this crisis, the outcome was that our organisation
had more influence on governments to convince them to make more
available for prevention and control of animal diseases but, unfortunately,
mainly for diseases transmissible to humans. We would like to
convince governments to address all animal diseases.
Chairman: Thank you. I would like to
bring Lord Desai in here because there is a crucial question about
the political will and the ability to carry it out.
Q1121 Lord Desai:
Thank you, my Lord Chairman. Dr Vallat, you say in your evidence:
"an important blockage to the effective control of serious
animal diseases ... is a lack of governance and limited effectiveness
of national veterinary services, particularly in some developing
countries where multiple government priorities ... compete for
scarce resources". Do you think it is your role to encourage
individual countries to prioritise animal health as against other
competing demands for resources? Secondly, do you think the World
Bank should do more to fund the priority for animal health in
their agenda of governance?
Dr Vallat: As soon as our member countries vote
a mandate to improve animal health worldwide, it is our duty to
provide the relevant information to all governments to convince
them that they have to address these threats mainly because the
world is changing and the globalisation of trade and the movement
of people is unprecedented. We need to provide this information
because we are convinced that the threats are increasing because
of the new factors of globalisation and climatic change. We provide
all information to governments as to why they have to invest more
than before in the field of animal diseases. Developing countries
cannot fund this by their own resources, they need external resources,
and it is in the interests of countries to have a disease-free
environment after investments over years and they now understand
it is more cost-efficient to invest in poor countries to protect
themselves than to invest it all in border protection. That is
why a specialised organisation, the World Bank, accepted working
with us and using our technical inputs to develop programmes in
several developing countries in the field of animal health. A
lot of developing countries are using funds from the World Bank
or the EC. The EC is a very active partner worldwide in the field
of animal health investment.
Q1122 Chairman:
Just before we go on to International Health Regulations, on the
World Bank issue we have heard a number of times that there is
a need for greater investment in the infrastructure of health
systems in countries, and I wonder if the World Bank does not
give sufficient attention to investment in veterinary systems
in countries. Would you welcome a much greater emphasis on that?
What could, and should, the World Bank do in relation to veterinary
services that it is not doing already?
Dr Vallat: It is true that for 30 years the
World Bank has considered priorities other than health and culture.
The Bank funded more infrastructures in industry and not in health,
but for the last five years the World Bank has been changing its
priorities. We think they have to do more because the issues of
sectoral investment have changed, but not sufficiently. We would
like the World Bank to take that more seriously.
Q1123 Chairman:
What would the investment be in veterinary services that you think
the World Bank could do?
Dr Vallat: We are promoting a concept directed
first at employment of governance. Governance includes appropriate
legislation and appropriate resources to implement the right legislation
to prevent and respond to sanitary events. First, any efficient
investment needs appropriate governance. For example, if you found
some material to address animal diseases in poor countries without
appropriate staff trained for that you will lose your money. That
is why we first need to be sure that governance is appropriate
before putting money into infrastructure. That is why we try to
convince governments first to adopt the right governance and then
to ask for loans or grants to carry out actions in the field.
Q1124 Chairman:
If any other members of your panel want to come in on these questions,
then please indicate.
Dr Thiermann: I would like to comment on the
first question regarding enforcement. As you know, the OIE does
not have the legal mandate to enforce adherence to the international
standards, but the legal basis for that is in the World Trade
Organisation. I think the World Trade Organisation, by having
recognised the OIE as the standard-setting organisation for issues
on animal health and zoonotic diseases, is where the obligations
come for countries that do not adhere and properly justify their
position in accordance with the standards of the OIE.
Q1125 Chairman:
In some respects the World Trade Organisation is more important
than the World Bank in terms of delivering the sort of structures
you want, is that right?
Dr Thiermann: Not so much the structures but
in terms of enforcement. The courthouse, if you will, for countries
that do not use the international standards coming from the OIE
to determine legislation in terms of international trade resides
in the WTO, and the WTO in a case would seek the expertise on
the international standards from the OIE to resolve that. The
legal aspect comes from the WTO while the financial support and
enforcement that Dr Vallat indicated will come from the World
Bank.
Dr Kahn: I will just make a quick comment. I
think the OIE is in quite a unique role because at the same time
we are responsible for standard setting, and the standards relate
to the control, management and reporting of diseases, and to trade.
The standard-setting activity, as you can imagine, has a strong
input from the developed countries. The reference laboratories
and collaborating centres are largely in the developed countries.
When you look at the membership, the 172 members of the OIE, two-thirds
or more are developing countries and least developed countries.
In a sense, if the standard-setting is driven by the more developed
countries, what about the implementation of the standards? This
is really the challenge for the developing countries. The OIE
has got a two-fold role. It is the standard-setting, certainly,
but it is also how to reinforce the capacities in the developing
countries and how to encourage them and help to give them the
tools to implement standards. Of course, there is the technical
side, the technical capacity, and also the administrative and
legislative, the governance aspects that Dr Vallat was talking
about. In our minds, there is always the standard-setting role
but, very importantly, how to support particularly the poor countries
in putting these standards into place and the ultimate goal, certainly,
to improve food security, to fight against poverty, but in a self-interested
way for many of the members it is about removing the threats to
their disease status, whether it is animal diseases or diseases
that affect humans.
Q1126 Lord Desai:
This leads me to the governance question. Dr Vallat, you have
criticised the International Health Regulations because they "do
not include specific measures, where zoonoses are concerned, that
would enable the appropriate synergies to be developed with other
international organisations". Could you expand on that comment.
How would you like other international health organisations to
be improved now that the IHR are in force? How do they achieve
the appropriate synergies between national and other international
organisations?
Dr Vallat: I am still very frustrated by the
content of the International Health Regulations because, if you
read them (and I think there are 60 or 70 pages), the words "zoonoses",
"veterinary", "veterinarian" do not appear.
This is very surprising because it means that the role of zoonoses
is not mentioned in this document. Why, because this document
introduced new obligations for members of WHO ignoring the fact
that the prevention of zoonoses is mentioned through different
tools, managed commonly by OIE, FAO and WTO. One of the more frustrating
parts of the IHR are that, under WTO obligations, the OIE provides
obligations to our members, with the support of the WTO, to give
certifications of safety of animal origin products regarding all
zoonoses. The IHR do not mention the existence of this safety
tool. It puts new obligations on the control of commodities which
are not described in our standards. During the negotiations we
tried to influence members and got the support of the staff of
the WHO but not the support of the member countries' representatives
which was surprising to us.
Q1127 Chairman:
Did they give a reason for that?
Dr Vallat: We think that the collaboration between
the medical services and veterinarians worldwide has to be improved.
We need to improve this collaboration and dialogue.
Q1128 Chairman:
It suggests that they just saw it, for whatever reason, as two
totally separate compartments. Is that how you see it?
Dr Vallat: Yes.
Q1129 Lord Avebury:
Immediately to follow that point up, what opportunities do you
see in the future of influencing the IHR so that they would incorporate
some of your concerns? Are you lobbying member countries of the
OIE to raise this when they have the opportunity? At what point
in the cycle of international meetings would there be a chance
to inject some of the concerns that you have expressed?
Dr Vallat: The adoption of the current version
of the IHR was made before the big crisis of avian influenza,
which helped to bring about a better dialogue between veterinary
and medical authorities worldwide. Thanks to this crisis, I think
that, if there is a decision to be made in this sense, we could
improve the IHR agreement.
Q1130 Lord Avebury:
Where? At what point?
Dr Vallat: We could introduce some formal obligations
in this agreement for member countries to improve the collaboration
between people working in animal health and public health. We
need a better mechanism for collaboration.
Q1131 Lord Desai:
Just to continue with the IHR. As you know, the IHR has a surveillance
system which has moved away from a fixed list of notifiable diseases
towards a more flexible approach, requiring states to report "public
health emergencies of international concern". Does OIE continue
to rely on a fixed list of notifiable diseases? Or do you have
a flexible approach, such as in the IHR?
Dr Vallat: The list of notifiable diseases is
voted by our member countries and currently we use 100 diseases,
which are established using a decision tree which includes multiple
parameters, including the zoonotic potential threat but also potential
economic damage. We know that with globalisation we have emerging
diseases and every year we have new diseases and that is why our
system is flexible. Our members have an obligation to notify unknown
events in case of doubt. There is a new obligation on that. We
have a list of diseases because there can be a very important
consequence for trade. There is an obligation of surveillance
by countries, because any country can say, "I am free"
if they cannot demonstrate they are making investigations. We
know of at least 400 diseases and a country will not carry out
surveys for 400 diseases, which is why we selected the more important
on our list. In the case of new evidence there is now an obligation
that exists in the OIE for emerging diseases.
Q1132 Lord Desai:
Can I follow that up. We learned that in the IHR the WHO now has
powers to use evidence from the media to be able to tell a government
"you have such and such a problem", even though the
government has not reported. Does the OIE have such powers to
be able to notify?
Dr Vallat: Yes. It is a complex subject. The
OIE cannot make an official statement without the agreement of
the government. The risk of a mistake is important. Sometimes
the media puts news out which is not verified, so the risk of
making a wrong notification is high. We cannot do that, we would
lose our credibility. We never publish information without the
agreement of the government, so the government is sovereign. We
know that some governments are lying and that is why we have a
system called a tracking system. We use some software which is
able to provide us with all information linked with media publications
worldwide. All of the small publications for small villages in
China we can have through the Internet. We have a common platform
with WHO and FAO and the name is GLEWS—Global Early Warning
System—and we exchange our tracking information. When we
have information, we immediately contact the government and say
"This is the information, please could you tell us if this
is true or not". We now solve 95 per cent of the events.
We can have evidence that it is a mistake but when it is true,
probably because of democracy in the world, the government cannot
play with that and we consider that, thanks to tracking, thanks
to communication with governments, we are able to give a very
good picture of the situation worldwide.
Chairman: Thank you. I give the same
option to your colleagues if they want to come in on any of these
questions. Can I now bring in Lady Hooper, please.
Q1133 Baroness Hooper:
Thank you. My name is Gloria Hooper, I am a Conservative Member
of the House of Lords and of this Ad Hoc Committee. In your written
submission, for which many thanks, you wrote: "it is well
established that the control of zoonotic diseases in animals is
both more effective and more cost-effective than managing the
effects of these diseases in humans". This reflects very
much the views of other witnesses we have heard during other sessions,
who have suggested that too much emphasis has been placed on treating
infectious diseases as opposed to prevention efforts, and that
we ought to be picking up new zoonoses from animals rather than
waiting for them to leap the species barrier to humans. I know
that you have already touched on this and stated that there is
a need for more collaboration, but perhaps you would comment in
terms of directing resources. Has there been too much emphasis
on treating the effects of zoonoses and not enough on preventing
or controlling the problem at source?
Dr Vallat: Thank you. We have a panel of 172
members and we know the situation of resources directed to animal
health in many of them. We think that ministers in charge of human
health have more success when they negotiate budgets than ministers
in charge of animal health and they win the competition. I can
give you an example. Worldwide we have more or less 50,000 people
dying from rabies—mainly children, in India, China, Asia
and Africa—and the resources used by governments for the
control of rabies are 95 per cent on post-bite treatments because
dogs are the main source of rabies worldwide. We know too that,
if less than ten per cent of this money was used to vaccinate
dogs, we could eradicate rabies. This is because in the resource
negotiations in parliaments or in front of policy-makers the human
health aspect wins over the animal health aspect. There are other
cases. For example, with avian influenza the money for the prevention
of the pandemic is more important than the money for eradication
of the disease in animals. We know that, if we eradicate this
virus in animals, the risk of a pandemic will be reduced. This
is why we think we need to work politically to put that on the
table in all countries.
Chairman: That is an important point.
Baroness Hooper: Well, I hope that, as
politicians, that we will be able to raise this issue in the various
fora that we work in because on the figures it is incredible.
Thank you.
Q1134 Lord Howarth of Newport:
Good afternoon. I want to go back over ground that we trod on
in your response to my Lord Chairman's questions about what you
might expect the World Bank to do and also partially in your response
to Lady Hooper's question just now. This is about the dilemma
between disease-specific strategies and strategies to strengthen
infrastructure more generally. In your evidence you say: "as
a result of successful disease eradication campaigns, some veterinary
services have been downsized to a point that is unsustainable.
To be capable of early detection of and rapid response to diseases
of animal and/or public health importance, a sustainable veterinary
infrastructure and scientific capability must be maintained".
I have two questions that follow, one just on a point of information.
Which disease eradication campaigns did you have in mind? Where
has this occurred? Secondly, have you experienced the same difficulties
as have been experienced in the field of human health, that an
excessive proportion of available funding goes in programmes to
address particular diseases and an insufficient proportion goes
in programmes to support a broad-based capacity for healthcare
and disease eradication at source?
Dr Vallat: Thank you. That is a very complex
question. I always start by talking about the money invested in
Europe for the eradication of some diseases. For example, in the
case of bovine tuberculosis Europe funded 50 per cent of the cost
of eradication in EU member countries. This started in 1970. Billions
of euros were invested in the eradication of tuberculosis. As
soon as the situation became acceptable in countries, all the
effort that had been made stopped. This gave the possibility for
the disease to be reintroduced. In the UK you now have a big debate
on tuberculosis. Investment will have to be re-made for this problem.
There is the case of foot and mouth disease. In 1970, Europe,
not the UK but the Continent, was heavily infected by FMD and
the policy was to vaccinate all animals for eradication, and that
was successful. After that nothing was invested for prevention.
What is prevention? It is how can we be sure that a free country
will remain free or will be able to limit any re-infection to
a very, very short period. We have to work within the concept
of early detection and this is relevant for any accidental or
intentional introduction of pathogens. Early detection is the
capacity of a country to maintain a network of surveillance mainly
by the training of farmers and a network of veterinarians working
closely with this network of farmers. If something appears in
a farm, or even in a city, the warning will be made the same day,
or very, very soon after, in order to allow a rapid response.
What is a rapid response? It is a specialised team able to go
immediately to where the event is suspected or confirmed to implement
biosecurity measures, which are to block the pathogen when it
appears and to stamp it out if there is no other route to kill
the pathogen, to disinfect, control the movement and be sure the
pathogen, the factor of the new element, disappears. This has
a cost. The government has a responsibility and this has to be
shared by public but also private providers, because it is in
the interests of farmers for it to be prevented. It is clearly
also a public good because it is in the interests of all citizens
to be protected. There is a sharing of the costs between the different
beneficiaries. This is the policy that OIE would like to promote
in all our member countries, to convince governments that prevention
has a cost and it is the responsibility of the government to decide
by negotiation with all beneficiaries who has to pay. In all cases
it is in the public good that government has to participate. This
cost is mainly what we call a cost for a horizontal system, because
90 per cent of any investment in animal health can cover prevention
of all diseases and only ten per cent is an additional cost to
be focused on a specific disease. We always promote these systems
first.
Q1135 Lord Howarth of Newport:
Would you say that historically part of the explanation as to
why there has been under-investment in veterinary infrastructure
has been because it has been seen as the responsibility of agriculture
departments, or ministries, and there has been an insufficient
appreciation among politicians and in governments that there is
an essential intimate link between animal health and human health,
but that perhaps there is now a more widespread recognition of
that?
Dr Vallat: Yes. I think many governments were
not sufficiently focused on the sustainability of investment for
detection and rapid response. A very small cost linked with the
mechanism of surveillance would have avoided a lot of crises with
a very high cost. Surveillance systems are an insurance to be
paid by all beneficiaries and it is a better way to avoid crises
which have very, very high costs.
Q1136 Lord Howarth of Newport:
Do any of your colleagues want to add anything on these issues?
Dr Thiermann: Possibly the other reason could
be that, when countries were affected by bovine tuberculosis,
brucellosis or foot and mouth, as you say, it was clearly an economic
issue for the agricultural sector and it was easy to justify a
rapid reaction to solve the problem. As we all witnessed, the
difficulty is determining how good your insurance should be when
you are not sick. It is a bit more than having to fund crises
and imminent problems rather than putting the money in a preventative
system that will only prove its use once you demonstrate you have
prevented a crisis like the one we are seeing with avian influenza.
Q1137 Chairman:
That is a good analogy.
Dr Dehove: I would like to draw the attention
of this Committee to the fact that, since the written evidence
from this organisation, the OIE has published three economic studies
on that topic. The results of these studies were presented during
an international conference held in Washington in October 2007.
The first study compared the cost of prevention against the cost
of crisis. The second study was on the feasibility of a global
emergency compensation scheme. The third study was on the pre-feasibility
study for the possible use of insurance mechanisms for certain
animal diseases. We are currently carrying out a fourth study
focusing on the cost of prevention to demonstrate that this is
not so expensive and is clearly a saving when compared with the
cost of crisis. In addition to that, we have had a clear signal
from the European Commission that we will work together on a fifth
study on the categorisation of diseases to identify where the
priority should be, what is a global public good, what is maybe
less important, where money from the private sector could be used
and where clearly public money should be focused.
Q1138 Lord Avebury:
You have already touched on this to some extent. We have been
told that OIE is about enforcing the ability of developing countries
to comply with standards. Given the evidence which has been accumulated
by these studies that have just been mentioned, is there a growing
political will, at least in developing countries, to adopt the
standards which simply has to be reinforced by the injection of
money from the developed world to enable them to carry out their
duties in compliance?
Dr Vallat: Yes. One of the main problems we
are facing to implement our mandate is how to convince all governments
to follow the standards that they have democratically adopted.
Many developing countries vote on standards in the full knowledge
that they cannot implement them, but they think it is a good decision
and they will receive support from other countries to implement
these standards. As we said before, we know that, if we would
like to improve the situation of animal health worldwide and reduce
the risk for free countries, such as EU countries, regarding animal
diseases, we need to convince governments and international organisations,
including the World Bank and financial organisations, DG Development
in the EC, to consider compliance of developing countries with
OIE standards in the field of animal health. They have to be considered
as one of the priorities of the development agenda. Because of
zoonoses, we can justify that the directions made for animal health
are also of benefit for human health. This is a very great argument
that we can use. Compliance with OIE standards will have an effect
on human health, of course, but also in this current problem of
food security, the loss of food, the weight of animal diseases
for poor people is more than 20 per cent of the production of
animal proteins, which are very important for children—eggs,
milk and so on. We have more than one billion people worldwide
who are poor and need small animals to survive. The weight on
the production of these animals, the weight of animal diseases,
is very heavy. If we improve the situation, we can win more than
20 per cent of production in this category of people. This is
very important. The link between animal health and the alleviation
of poverty is important. The link with public health is important.
The link with market access is important because, if a country
is complying with standards, they will market access for everybody.
We have more than 100 countries which have no access to the world
market of animal products because they are infected by epizootics.
The control of epizootics is also of economic benefit for free
trade for everybody. This is very important for the economic growth
of the world. Animal health is a great component of animal welfare
because animals which are not healthy are not in a good situation
of welfare, so the impact of improving animal health or animal
welfare is also very important. That is why our member countries
have asked the OIE to provide standards on animal welfare. This
compliance with standards is a political problem because it is
not only a decision of the United States but of all governments
worldwide. We think that communication is really important and
economic surveys also, as described by my colleague, to demonstrate
the benefits of animal health are really important for our communication.
Q1139 Lord Avebury:
Can I just follow that up. You pointed to reasons of self-interest
as to why developing countries should comply with the standards,
but also in your evidence you think this should be reinforced
by the transfer of resources. You have not said very much about
the scale on which this needs to be done. If there is a political
will and if countries are convinced by the arguments you have
just been advancing as to why it would be to their own advantage
to adopt the standards, they may still not have the resources
to do so and you are implying in your written evidence that there
is a question of lack of resources. I am wondering what recommendations
you would make to see where countries have not got the capacity
that the aid donors step in and provide them with the necessary
resources.
Dr Vallat: I can give you an example of the
strategy we are currently developing for that. Our members adopted
standards on the quality of veterinary services, what are the
criteria to be efficient, and using those we made an evaluation
tool, and the name is the Performance of Veterinary Services,
and we use—
Dr Dehove: We have 41 critical competences.
Dr Vallat: --- 41 critical competences. Each
competence has five levels of quality, from one to five. We train,
more or less, 135 experts coming from all over the world. We send
these experts, on request from developing countries, to make independent
evaluations of their compliance with standards on quality. 72
countries have asked us to do that over one and a half years.
Today we have got 54 reports from these experts, who spent two
to three weeks in the country. We have a peer review system and
send the report to the country. If the country accepts the final
version of the evaluation, we have got an agreement with the World
Bank and the World Bank uses that report to design the investment
programme for the country. This is very successful, and we think
the global impact will be important to improve the situation in
developing countries and also to provide appropriate investment
and not investment made without an independent vision of the situation.
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