Public Health E Conference Web Site
CONFERENCE ON VETERINARY PUBLIC HEALTH
AND CONTROL OF ZOONOSES
IN DEVELOPING COUNTRIES:
SUMMARY OF COMMENTS AND
Prepared by the Conference
Moderator, Dr Ashley Robinson,
College of Veterinary
Medicine, Western University of Health Sciences,
Pomona, California. USA.
List of acronyms:
Background to the conference
Conference Objectives and
Summaries of Contributions
A. Veterinary Public Health
in the 21st Century.
B. New and Future Trends
that will challenge VPH in the 21st Century.
C. Organization and management
of VPH Programmes.
D. Education, Training and
Extension in VPH
E. Conclusions by Moderator.
LIST OF ACRONYMS
AMESH Adaptive Methodology
for Ecosystem Sustainability and Health
BSE Bovine spongiform
CAHW Community Animal
CD Compact disc
Centers for Disease Control and Prevention (USA)
Countries in Transition
Food and Agriculture Organization (UN)
Good Manufacturing Procedures
Hazard Analysis Critical Control Point
International Atomic Energy Agency
Information and Communication Technology
Pan American Health Organization
Participatory Action Research
Polymerase chain reaction
Office international des epizooties (World Organization for Animal
RADISCON Regional Animal
Disease Surveillance and Control Network for North Africa, the Middle East
and the Arab Peninsula
Technical cooperation project
Veterinary Public health
World Health Organization (UN)
World Veterinary Association
* The use of the terms ‘Developing
Country’ and ‘Countries in transition’ can be ambiguous. Based on World
Bank glossary, a DC is defined as low (64 countries) and middle (93) income
countries in which most people have a lower standard of living with access
to fewer goods and services than do most people in high income countries.
Countries in transition refers to those countries, whose economies used
to be centrally planned by the government but are now changing to market-based
In 1999 WHO convened
a conference of invited experts from 18 industrialized, countries in transition,
and developing countries in Teramo, Italy in collaboration with FAO and
OIE(1). The major purpose was to consider the contributions on a global
basis of Veterinary Public Health (VPH) programmes to human health, with
a particular emphasis on the future contributions that VPH could make in
developing countries (DC). The consensus definition of VPH at the
Teramo meeting was:
“The contributions to
the physical, mental, and social well being of humans through an understanding,
and application of veterinary science”.
This definition therefore
replaced the original definition of VPH in the 1975 joint FAO/WHO technical
report ‘The veterinary Contribution to Public health Practice’(2) “
as a component of public health activities devoted to the application of
professional skills, knowledge and resources to the protection and improvement
of human health.” It was believed that this new definition was more
consistent with the original WHO definition of health and also with the
values, goals, and targets of the WHO vision ‘Health for all in the 21st
The scope of VPH is clearly
multidisciplinary, involving not only veterinarians in both government
and non-governmental sectors, but other health professionals and scientists
as well as paraprofessionals who treat, control or prevent diseases of
animal origin. A recurring theme of the meeting was that a team approach
to problem solving, research, control programmes and communication was
essential to ensure that veterinary contributions to the improvement of
human health would be both significant and sustainable.
To publicize the discussions
and recommendations of the Teramo meeting to a wider audience, FAO decided
to sponsor the conference in collaboration with WHO and OIE, and also to
focus primarily on the situation in both countries in transition (CIT)
and developing countries (DC). As a generalization, VPH activities in these
two groups of countries are varied, and limited in scope and delivery.
Their priority areas for the betterment of human and animal health differ
markedly from developed countries. Besides lack of resources, the actual
problems faced were different to those in developing countries. However
there are not only lessons to be learned from developed countries, but
also greater opportunities for cooperation at all levels. Human and animal
health problems are inextricably linked. Health problems are also not confined
to specific regions, nor respect international borders, and may extend
across ethnic, and political divides.
A background paper was prepared
summarizing the deliberations and recommendations of the Teramo meeting
and posted on the conference website (3). The Conference was announced
on ProMED and several other list servers. Potential participants were invited
to sign up and forward contributions to the Moderator who edited them and
then forwarded to all participants. A set of rules for conduct of the conference
was promulgated and participants authorized the sponsors to reference,
summarize and quote all or part of a participant’s contribution for this
summary. Contributions were then posted on the Conference web site.
Approximately 700 individuals signed up and contributions were received
from 60. Approximately eighty countries were represented including many
DC and CIT.
AND DISCUSSION TOPICS:
The major objective was to
provide an open forum for strategy planning in the development or revival
of VPH services to improve both human and animal health. These strategies
need to be technically sound, cost-effective, equitably available, and
take advantage of economies of scale normally associated with the public
good delivery of services. Traditionally VPH activities have included (2,4)
but not limited to:
A series of nineteen discussion
topics was developed under four general headings as follows:
Zoonoses diagnosis, surveillance,
control, prevention and eradication.
Occupational hazards and diseases
associated with live animals and their products.
Biologics development and production
Control of Animal populations
which may serve as reservoirs or be noxious.
Prevention and control of foodborne
illness of animal origin.
Ante-mortem and Post-mortem
meat and poultry inspection.
Participation in outbreak investigations.
Environmental activities including
vector, water, wildlife and use of animal monitors.
Emergency actions including
natural and man-made disasters.
Social aspects including natural
and man-made disasters.
Social aspects including service
animals and human animal bonding.
A. VPH in the 21st
B. Future Trends that
will challenge VPH in the 21st Century.
C. Organization and
Management of VPH programmes.
D. Education, Training and
Extension in VPH.
NOTE: All contributions are
numbered and posted on the Conference Website (3),
A.VETERINARY PUBLIC HEALTH
IN THE 21ST CENTURY:
1. WHERE DO YOU RECOMMEND
THAT VPH PROGRAMMES AND VETERINARIANS IN DEVELOPING COUNTRIES DIRECT THEIR
EFFORTS TO ATTAIN THE GREATEST EFFECT ?
The basic principle of VPH
programs in DC (Dr.D.Allard et. al. Contribution # 38) should be to deliver
fundamentals of public health programs as close as possible to the individual,
small group, or community. These should include basic hygiene principles,
quarantine and isolation, biosecurity, inexpensive vaccines as well as
more sophisticated priorities such as surveillance systems, diagnostic
capability, treatment options, and depopulation capability. Programmes
should evolve in technical complexity and scope as they are developed over
time. This implies that a coherent and coordinated approach is best. The
ideal would be zoonotic disease control and food safety programmes that
educate the individual in methods and practices that can be carried out
at zero to low cost with minimal equipment and materials. These programs
would ultimately require considerable human resource investments, but little
monetary investments especially if the human resources came from the local
community. Training at the top of the pyramid could be delivered by outside
In establishing objectives
and priorities that will influence the development and effectiveness of
VPH programmes in DC, consideration should always be given to such factors
as the geographical characteristics of the country, its stage of development,
the current situation with zoonoses (both impact on health and socio-economic),
and also import/export trade in animals, animal products and human foods
of animal origin (Dr A.Panin, Contribution #36).
The probability of success
in any zoonotic disease control/eradication programme should be a major
consideration (Dr R.Jackson, Contribution #40). Pre-requisites for success
include, effective methods for stopping or reducing agent transmission,
high socio-economic importance and epidemiological features that allow
good case detection, and surveillance for measuring progress and providing
information that can be used to make changes as required. Programmes that
are likely to succeed are also most likely to attract funding for the duration
of the programme. A programme with these features is likely to be attractive
to the public, veterinarians, health workers and policy makers. For most
countries there will probably only be a few diseases that have these necessary
prerequisites, and therefore determining ones to give priority to is usually
fairly easy and does not necessarily require a sophisticated economic analysis.
While donor funding may be helpful at the start, the aim should be to eventually
obtain sustainable ongoing within country funding. There is a very real
and urgent need to develop low cost options for control programmes in DC.
These are more likely to appeal to policy makers also. While there is a
tendency to choose the “latest and greatest” sophisticated tests and methods,
often these may only be viable in countries with well-developed and often
subsidized livestock industries. Pilot exercises to test the feasibility
of large-scale programmes are also an essential prerequisite.
Dr Jackson also proposed
that echinococosis is an ideal candidate for a national control programme
in DC. Praziquantel is highly efficacious and cheap drug for use in the
definitive hosts and experience has shown that public awareness and involvement
can be easily incorporated in control programmes. Surveillance can proceed
relatively cheaply with minimal use of expensive tests. While total eradication
may not be a feasible goal at this stage for some countries, reasonable
control in animals and a significant reduction in new cases in humans (especially
children) should be achievable in most situations. A zoonotic disease such
as cystic echinococcosis with dogs as definitive hosts has added attractions
as other VPH issues of concern such as rabies; mailings and human toxocariasis
can be incorporated into an integrated control programme for additional
benefits at marginal cost.
Dr Jackson also argued that
other high profile zoonotic diseases in DC such as brucellosis
(especially due to B.melitensis)
control programmes have had variable success. There probably has been an
over- emphasis on development of improved vaccines and tests but insufficent
emphasis on the basic epidemiology as an essential means of control. More
attention should be given to monitoring key indicators of disease status
and also factors that influence disease transmission and collecting information
on the effectiveness of specific interventions. Analysis of local surveillance
data gives valuable insights into the epidemiology of the disease within
Finally Dr Jackson suggested
that the time is opportune for DC to gradually move away from heavy reliance
on regulatory and task-oriented disease control programmes towards a more
responsive approach based on risk analysis and management (5,6).
Unfortunately these approaches have been used for many years and are firmly
entrenched within the veterinary profession. As an example he cited the
often used and popular surveillance for chemical residues in DC, yet these
are likely to be associated with very low levels of risk compared to other
Dr H.Mainzer (Contribution
#22) made the point that if VPH programmes focus only on zoonoses, there
is the risk that this will be the only contribution that veterinarians
can make to promote human health. He makes the point that outbreaks keep
occurring and we keep making the same recommendations. Surveillance and
diagnostics do not stop disease - they only identify it. These public health
emergencies are failures of prevention. Veterinarians need to become involved
in all aspects of the agent/host/environment causation triad so as to identify
and develop logical evaluations, design sound intervention systems and
ultimately effective prevention strategies. At least in the USA veterinarians
are involved in environmental health, vaccine preventable disease programs,
disaster response/assessment, chronic disease and nutrition, occupational
health, injury control, food, drug water, waste issues, pet-facilitated
therapy, HIV/AIDS, teaching managing public health programs and organizations.
Veterinarians should focus on the ‘big’ picture of public health systems
and processes that allow ALL disease/injuries to occur-not just the veterinary
Dr P.Schantz (Contribution
#45) presented a succinct history of VPH in the USA. The Center for Disease
Control has over the last 50 years established itself as the United States’
premier public health agency for epidemiology and prevention. Veterinarians
have been an integral part of the program since its inception and CDC was
an active partner in defining the field of VPH and in developing programs
and policy. A separate VPH Division was created at CDC in 1947 and over
the next 28 years made major contributions in the areas of foodborne diseases,
and zoonotic infections such as rabies, psittacosis, trichinosis, cystercercosis,
anthrax and leptospirosis to name only a few. The Division also conducted
field investigations, assisted States in inaugurating new programmes and
provided laboratory support for all aspects of animal diseases transmissible
to humans. The Division also provided support to foreign countries and
to WHO for assistance in panning VPH programmes. In 1975 all discipline-oriented
groups at CDC were abolished and the personnel therein were moved to multidisciplinary
groups dealing with related groups of diseases. While some perceived this
as a setback and threat to VPH, however in practice this administrative
change freed up veterinarians to consider a broader range of career possibilities
at CDC. Now veterinarians are eligible and selected for whatever positions
they can successfully compete on the basis of their qualifications and
interests. Currently there are 70 veterinarians at CDC assigned to 10 different
Centers, Institues or programme offices. Besides being active in zoonoses
research and control, they are working in HIV/AIDS, the national immunization
programme, environmental health, occupational health and international
health. Many former CDC veterinarians are now employed as State Public
Health veterinarians and maintain a functional liaison with CDC through
the National Association of State Public Health Veterinarians. Even when
the current responsibilities of veterinarians at CDC do not involve issues
of animal health or veterinary medicine they often affirm that their educational
experiences had been very appropriate for preparing them to deal with their
current tasks. The veterinary orientation to “herd health” is a metaphor
for community health.
CDC has also formed close
links with the US Department of Agriculture and the Food and Drug Administration.
This has proved of great value in the investigation of foodborne
disease, by for example, traceback of meat incriminated in outbreaks, investigation
of other endemic and emerging zoonotic diseases, and coordination of national
surveillance for food and waterborne disease.
Looking to the future, it
is certain that the challenges of public health in the next 50 years will
be different from those of the past. It is clear that veterinarians are
prepared and willing to work with colleagues from other disciplines to
respond to these challenges and to develop effective programs to continue
to improve the public’s health.
Moderators Comments: Hopefully
these multidisciplinary approaches will in the future expand in developed
countries. However in most DC, the pressing need is for veterinary expertise
to control zoonoses such as rabies, brucellosis and echinococcosis, recognize
that animal disease outbreaks may be sentinels for emerging environmental
health risks(7), as well as improve the safety of food of animal
origin. VPH programs as a whole will be more likely to succeed if tangible
successes are demonstrated in initial component projects and these are
2. SHOULD COUNTRIES OR
REGIONS SET TARGETS FOR THE REDUCTION OF SPECIFIC ZOONOTIC INFECTIONS IN
RELATION TO THEIR BURDEN OF DISEASE ?
The ‘burden’ of disease as
measured by WHO uses mathematical models and analyses to arrive at outcome
measurements for mortality and disability for a specific disease(8).
While this technique has certain limitations, approximately 90% of the
worldwide burden of all causes of death and disability occur in developing
regions of the world. However only 10% of all healt care funds are spent
in these regions. Communicable diseases, with the exception of HIV/AIDS
and tuberculosis are expected to decrease by 2020. Six disease categories
(pneumonia and influenza, AIDS, diarrheal disease, tuberculosis, malaria
and measles) are responsible for 90% of the estimated 13.3 million
deaths in children and young adults due to major infectious and parasitic
diseases (9). Zoonotic agents contribute in several of these categories.
Rabies is the leading cause of zoonotic deaths and accounts for 40,000-60,000
deaths per year, while other zoonotic agents such as monkeypox occur at
very low levels. e.g. 500 reported cases since 1992. Clearly surveillance
for many zoonoses in DC is subject to many biases, especially under- reporting
of endemic infections.
There appeared to be general
support among conference contributors for the development of specific zoonotic
disease population-based targets for reduction of incidence/prevalence,
but with the caveat that these should be of real public health importance
within that country. For example, it was stated ( Dr D. Allard et
al Contribution #38) that it would probably be best to word the targets
as a percentage reduction from currently reported rates of various zoonoses
in the country, with priority setting of targets influenced by level of
risk (probability x severity) to human health, animal health, and economic
impact. Although risk and to a certain extent prevalence are very important,
ease of implementation and sustainability of the programs over time must
be considered. Programs which rely heavily on external funding and input
in the long-term or indefinitely are less likely to be maintained.
Moderators comments: Where
budgets for health care in DC are very small, it is critical that what
funds available are used where they will do the most good. A recent example
from Tanzania (10) showed that instead of collecting health data from clinics,
door to door surveys were carried out to determine deaths and disability
and their symtomatology. A ’burden of disease’ profile was developed, and
using this information health spending was redirected to the actual burden
the communities experienced.
3. WHAT TYPES OF ASSISTANCE
DO DEVELOPING COUNTRIES NEED FROM INTERNATIONAL AGENCIES SUCH AS WHO, FAO
AND OIE, AND ALSO BILATERAL DONORS TO IMPROVE/EXPAND THEIR VPH PROGRAMMES
A number of contributors
addressed this topic and mentioned the need for:
Dr A.El Idrissi (Contribution
#44) observed that public health authorities in most DC were interested
in zoonotic disease only when the incidence/prevalence was high or during
epidemics. It was also noted that while FAO/OIE/WHO frequently organized
groups of experts to make recommendations on strategies and guidelines
to control zoonotic diseases, there were few joint or common initiatives
between these organizations to develop cohesive VPH programs in developing
countries. Joint interregional scientific programs including both medical
and veterinary professionals from relevant institutions in clusters of
countries with similar epidemiological problems should be developed. Priority
should be given to integrated control programs for rabies, brucellosis,
tuberculosis and major foodborne diseases for example. Another area where
international organizations can play an active role is to ensure education
and technology transfer for VPH programs and support their adaptation to
meet local and regional needs in DC.
Assistance in the prioritization,
support, and implementation of control and eradication programs for zoonoses
of major public health importance.
Organization of regional meetings
and workshops on zoonotic diseases.
Support for applied research
by way of technical cooperation projects (TCP) to provide training and
Assistance in the design and
implementation of health information systems.
It was also noted with concern
that WHO currently has no veterinary public health experts in their regional
offices-apart from PAHO in the Americas.
While it has been shown that
some zoonotic diseases are eradicable (e.g. brucellosis, hydatidosis) in
developed countries where there is strong public support and an efficient
administrative infrastructure, This is usually not possible in DC. Dr M.
Lightowers (Contribution #1) makes a strong case for international organizations
such as FAO and WHO as well as bilateral donors to identify and promote
scientific advances, which clearly have the potential to achieve genuine
improvements in zoonotic disease control and prevention. He cited the example
of cystic hydatid disease (Echinoccocus granulosis) and bovine cystercosis
(Taenia saginata) where highly effective and practical vaccines have been
developed based on the identification of host-protective recombinant antigens
(11). The challenge will be not only to establish ‘good manufacturing practices’(
GMP) production of these vaccines but how they may be best used in developing
countries to reduce the burden of human illness. Ultimately commercialization
of production will be required. The test will be whether these products
can give long-term protection at a reasonable cost.
The actual type of assistance
needed by each DC may be similar in some areas and quite different in other
areas (Dr J.Calder, Contribution # 19). To take a ‘one size fits
all’ approach could be counterproductive. Often there is a need for both
technical and professional support. However the needs for each country
or and region has to be developed at the country and regional level with
local input. There is clearly a temptation for a person who has worked
in a developed country for any length of time to want to take back all
the technology available, but unfortunately in most cases the infrastructure
to maintain it may be lacking. Therefore before assistance is given to
a DC an assessment should be done to see whether the infrastructure is
there to support the type of aid that is to be given. Other contributors
also gave examples of national zoonoses laboratories built with international
assistance but never completed, furnished, or equipped adequately, nor
staffed with trained individuals. .
Networks are an example of
both developed and DC countries joining to focus on a particular VPH problem
.The Informal Working Group on Echinococcosis (P.Schantz, Contribution
# 23) was created in 1985 under the auspices of WHO specifically to promote
scientific exchange and cooperation in research of this parasitic zoonosis.
Currently this group consists of a variety of networks of individuals from
many countries dedicated to areas of research and intervention selected
according to the needs and interests of participants and also the priority
areas for research in those countries most affected by the disease. Current
network subject areas include development, evaluation and standardization
of methods for diagnosis in animal and human hosts, treatment options,
evaluation of vaccines in intermediate hosts, and measurement of economic
costs. Although network activities and research are not directly funded
by WHO, the group does play an important role in defining priorities, coordinating
activities and promoting communication.
Dr S. Sandor (Contribution
#13) described how both WHO and the EU support a comprehensive program
to control and prevent both cystic and alveolar echinococcosis in Romania.
Future plans are to include other southeast European and Balkan countries.
Dr M. Kachani (Contribution#37) indicated that a similar approach was started
some years ago in Morocco and it has hoped to include other Mahgreb countries
in the future. Other areas where international organizations can
assist is in developing, translating and distributing educational material
on VPH issues. For example educational materials developed in Morocco for
Echinococcosis (Hydatidosis) in both Arabic and French can be used in all
North African (Mahgreb) countries where the disease situation is similar.
All international agencies
have a variety of publications available that may be of use to those in
DC responsible for VPH and zoonoses control. Unfortunately these may be
unavailable, out of print, or in some cases cost prohibitive. Making these
publications available via the Internet or through CD-ROM’S is one solution.
International agencies might also give consideration to making generic
computer simulation models and epidemiological / geographic information
systems more readily available for those working in VPH issues in DC (
12,13). This would include within country demonstrations and courses
designed to encourage their use for routine reporting of disease, analysis
of disease patterns, and economic analyses of costs and benefits.
B. FUTURE TRENDS THAT
WILL CHALLENGE VETERINARY PUBLIC HEALTH IN THE 21st CENTURY:
IDENTIFIFY METHODS THAT
WOULD IMPROVE THE DELIVERY OF VPH PROGRAMMES IN DEVELOPING COUNTRIES IN
THE FOLLOWING GENERAL AREAS:
4. ACCESS TO AND
RAPID TRANSFER OF SCIENCE- BASED INFORMATION ESPECIALLY TO THOSE WITH A
‘NEED TO KNOW’
Dr D.Allard et.al (Contribution
#38) emphasized the need for electronic tools that do not require high
computing power or rapid Internet lines such as: E-mail list-based discussion
groups or conferences, electronic bulletin boards with maintenance of discussion
threads, on-line reading access to VPH discussion documents (often unpublished)
and Power Point presentations suitable for lectures, etc. Good examples
of distance learning sites include the multilingual Supercourse- “Epidemiology,
the Internet, and Global Health” (14) and ”Emerging Infections of International
Public Health Importance” (15).
Dr E.Jette (Contribution
#3) stated the focus should be on electronic access, networking and training
by developing and strengthening access to information for both DC and CIT.
This would strengthen not only the technical veterinary expertise but also
their administrative infrastructure-the former cannot function in a vacuum.
A suggestion was made that the Animal Health Service staff of FAO could
maintain an interactive internet site where VPH related questions could
be asked and answered say with a 48 hour turnaround. There was also an
urgent need for electronic training packages on zoonoses, and food inspection,
etc. However there was concern expressed (Dr.B. Gummow, Contribution #
4) that at present especially for many African countries, access to the
Internet was both frustrating in terms of delays and also very costly.
These problems are unlikely to be solved in the short term and thus reliance
will have to continue on paper- based continuing education material supplemented
by CD’s. It is now possible to place whole or parts of web sites on a stand
alone PC or on CD’s.
How to make important and
up-to-date information more readily available to those in VPH with a ‘need
to know’ was raised by several contributors. For example Dr R. Jackson
(Contribution #40) cited the example of the recently published WHO/OIE
Manual on Echinococcosis in Humans and Animals (16). This is a unique and
current compilation of just about everything known about these diseases.
While it is available for purchase, should it (as well as all OIE publications)
not be available on-line at the OIE web site given the difficulties of
those working in DC to obtain overseas currency?.
Dr A.El Idrissi (Contribution
#44) noted that scientific and technical libraries in DC are unable to
afford subscriptions to many journals, which may run as high as $1500(US)
per year. While some VPH related journals are now available
on line free (17) others limit access to subscribers for current issues,
while other journals are unavailable electronically.
Several contributors raised
the issue of how current and accurate was the information on specific zoonotic
disease websites. This problem not just confined to these sites. Often
information is required promptly, and there is little time to review the
original literature. In general University or Government websites tend
to be more reliable than other sites. Hopefully in the future, the scientific
peer review process as used for journals will eventually be used to categorize
web sites. Original publications are usually neither available nor immediately
useful for practical application.
There are a number of list
servers now in operation that provide current and valuable VPH and zoonoses
information. Some have restricted membership while others are open to all.
Probably the most widely recognized is multilingual ProMED mail (18)
established to provide an early warning of emerging diseases of humans,
animals and plants as well as diseases activities signaling biological
warfare and bioterrorist activities. ProMED has a number of specific categories
of lists including ProMED-Ahead which focuses on animal health and emerging
animal diseases. ProMED has the distinct advantages of immediacy that print
media lack A number of links to other listservers and websites
reporting current outbreak reports are listed on this conference Website.
In summary, information management
skills must replace memorization and intuition in VPH decision making.
5. COODINATED AND
SUSTAINABLE HUMAN AND VETERINARY SURVEILLANCE PROGRAMMES FOR ZOONOSES AND
ANIMAL RELATED HAZARDS.
Clearly epidemiology must
be used as the primary guide for veterinary public health policies based
on prevention. Surveillance is one of the key issues and is defined as
the ‘ongoing scrutiny of all aspects of occurrence and spread of a disease
that are pertinent to effective control, prevention and eradication’. Unfortunately
in many countries, collection of the animal and human data relating to
zoonoses are carried out quite independently with predictable unsatisfactory
Surveillance systems in many
DC are characterized by the following:
The difficulties in obtaining
accurate and current information and reports on disease situations (both
transboundary and zoonotic) in regions of Africa. was well described
by Dr S. Hailemariam (Contribution #6). Two issue of particular concern
were obtaining information from the grass routes level and also poor communication
between Ministries of Health and Agriculture. Information on zoonotic
diseases needs to be given higher priority at all levels of the administrative
chain and consistent training and standardization of reporting. Another
barrier to be overcome is the perception that reporting may result in livestock
trading bans and affect tourism if zoonotic, which obviously discourages
Attempting to collect too much
information about too many diseases and conditions.
Lack of uniformity and complexity
Local staff has little or no
idea how surveillance data are used, as they are not provided with feedback.
Local staff is also likely to
accept endemic diseases as “status quo” and not report them. Nevertheless
they must report promptly any change from this status.
Data are aggregated and tabulated,
but seldom analyzed or interpreted for the specific information needed
for VPH practice.
The gathering of epidemiological
data can be a frustrating task in DC especially if a real information network
does not exist. It may be better to limit investigations to areas where
teams exist and can operate efficiently, rather than try to expand them
beyond their efficient reach and thus jeopardize the accuracy of observations
(Dr E. Rapoport, Contribution #12).
Dr J. Crowther (Contribution
#8) described a Technical Cooperation project, which the International
Atomic Energy Agency (IAEA) has developed for rinderpest surveillance in
Africa. This project involves all aspects of ICT starting with training
of trainers through specific packages developed for the web and in CD format.
This project has fostered good information collection, encourages teamwork,
identified the exact geographical location where people are and provided
a real time value on data. It is also supported by extensive electronic
hardware as well as telecenters where the focus is on teaching, development,
and information dissemination. This model could obviously be developed/modified
for zoonotic disease surveillance.
Contribution #38 from Dr
D. Allard et al. stressed that an important point in exchanging information
on surveillance of diseases is to ensure that similar criteria are used
to collect and count the data. This is best established by agreement on,
and application of standardized definitions of cases, outbreaks, incursions,
etc. and similar ways for descriptive statistics such as rates, proportions,
ratios etc. This harmonization is best achieved by adherence to standards
developed by international organizations such as OIE and WHO. Capacity
development for coordinated surveillance such as staff recruitment, training,
equipment, networks, coordination is also critical and international/bilateral
donor funding will usually be needed.
The primary objective in
DC surveillance should be to detect significant increases in disease incidence/prevalence
and to detect emerging/re-emerging disease. Information from a few reliable
sources rather than a broad coverage by less reliable contributors will
generally enable surveillance to achieve these objectives. Therefore resources
and training should be concentrated in a few strategically located areas
and these centers could then try and build their networks based on local
Several contributors identified
a lack of trained epidemiologists who are critical for the functioning
of any joint surveillance systems. Service-oriented, ministry-based field
epidemiology training programs are one solution.
Dr Joshi (Contribution #2)
advocated the greater use of computer software programs such as Epi-Info
and Epi Map which are available without charge and are also available in
several languages (12). These programs can be adapted readily for local,
national and regional surveillance.
Examples of zoonotic
diseases cited where coordinated surveillance would be valuable include,
hydatidosis, Japanese B encephalitis and other arboviral infections, leishmaniasis,
brucellosis and tuberculosis. Also attempts should continue to link food
safety and animal health data (Dr Joshi, Contribution #2)
A good example of community-based
surveillance for district rabies in Kenya (19) demonstrated that the traditional
passive surveillance system underestimated rabies prevalence in dogs by
a factor of 72 times. After consultation with local leaders, a resident
rabies worker was recruited to publicize the system. A post-exposure rabies
treatment supply network was organized and this encouraged the continual
participation of the public in reporting rabies suspects cases. Schoolboys
were also recruited to conduct a dog census.
6. RESEARCH TOPICS
(AND POTENTIAL FUNDING SOURCES) WHERE KNOWLEDGE OF THE BIOLOGY AND EPIDEMIOLOGY
OF ZOONOSES (ESPECIALLY EMERGING AND RE-EMERGING) AND OTHER RELATED VPH
PROBLEMS ARE INADEQUATE.
Research into the impacts
of the interactions of human/animal/environment and the better understanding
of the multiple interfaces between these three areas was advocated by several
contributors. The concept of ‘ecosytem health’, its relationship to VPH
and Zoonoses and ongoing needs for research was the subject presented by
Dr Waltner-Toews (contribution #20). This adaptive methodology for ecosystem
sustainability and health (AMESH) involves working with local communities
to define the interacting sets of issues such as livelihoods, environment,
public health, general economic development (20)
The merits of a vertical
approach over a ‘horizontal’ approach to the control of zoonotic diseases
was the subject of considerable discussion using cystic echinococcosis
(CE) as an example. The vertical approach is defined as considering
CE as a specific parasitic infestation with the causative agent (Echinococcus
granulosus), final host (dog) and intermediate hosts (usually sheep but
other grazing animals also). The horizontal approach as defined by Dr A.
Mantovani (Contribution #32) considers CE as complex in which there are
many components besides the agent and hosts including all of the suitable
environmental and social conditions necessary for perpetuation of the life
cycle. Thus a horizontal approach tends to be very long term including
health education, diagnosis, control, improved sanitation, meat inspection,
and long term primary health care. Dr P. Schantz(Contribution #41) stated
that while horizontal approaches to the control of zoonotic diseases
are always beneficial and do reduce transmission , they have
not been effective in permanently reducing infection in animal
and human hosts. He argues that vertical approaches directly targeted at
the parasite using dog population control and treatments, supported by
health education and community involvement have been successful in some
situations. For example CE has been essentially eliminated from New Zealand
and Tasmania, and significantly reduced in Cyprus, Uruguay, and parts of
Chile and Argentina. (16)
Research on this disease
although underfunded, has vastly improved the technology to control this
zoonosis since the above programs were started. There are effective drugs
to treat adult-stage infections in dogs as well as cost-effective treatments
for human cases. Also a vaccine effective for the prevention of larval
stages of infection in animals and humans intermediate hosts has been developed
(Dr. M. Lightowlers, Contribution #1)
Major credit for research
progress has to be given to an Informal Working Group on Echinococcosis
created in 1985 under the auspices of WHO to promote scientific exchange
and cooperation in research and control methods. Although not directly
funded by WHO, at least this concept provides individuals from many countries
with an ongoing focus for discussion and coordination of research. It is
surely a model that could be used in other globally important zoonoses.
Some contributors indicated
that DC should not be unduly influenced by current problems of developed
countries, but rather focus research on practical problems in their own
country or region.
It was suggested (Dr.D. Joshi,
Contribution #2) that Participatory Action Research (PAR) methodology be
applied wherever possible. PAR aims to break out from the relations of
dependency and restore to people their ability to transform their own worlds.
It involves collective research, recovery of history, valuing ‘folk culture’
and diffusion of new knowledge through written, oral and visual forms.
It is but one of several participatory processes used in agricultural research
and extension in DC (21)
7. REALISTIC AND PRACTICAL
FIELD PROGRAMMES TO IMPROVE THE SAFETY OF FOOD AND WATER FROM CONTAMINATION
BY ZOONOTIC PATHOGENS.
While some developed countries
have reasonably accurate data on the impact of foodborne disease, currently
it is rarely possible to derive similar statistics for DC because of the
lack of surveillance systems collecting reliable data. However as DC begin
to participate in international trade in food, they must develop science-based
food safety systems, which will ultimately benefit their own population.
The World veterinary Association
has recently adopted the following policy (Dr H. Scheneider, contribution
#14) “Projects or actions aimed at restructuring of public health services
should consider that veterinarians with expertise in veterinary public
health and hygiene are able to fulfil important services in areas of food
hygiene and safety.”
One suggestion was that both
regional and in-country workshops should be organized with only local participants
and ask them for their essential needs and priorities. Projects should
be developed from these workshops with specific responsibility fixed for
individual stakeholders (Dr. Joshi, contribution #2). Workshops are also
needed for decision-makers in order to put VPH on the veterinary/public
health ‘map’. An example was cited of a successful “farm to fork”
concept currently being used for export meat in Namibia.
A problem identified by one
contributor was that in many DC, responsibility for meat and food inspection
is a function of the Ministry of Health. The training of health inspectors
especially those employed by local or municipal authorities is often minimal
or none in general areas of VPH food safety.
Codes of good manufacturing
practices, HACCP and other similar auditing systems are being introduced
widely in developed countries and also for the export sectors in some DC.
Their primary aim is to reduce the risk of contamination of meat borne
pathogens such as Salmonella and E. coli O157: H7. The development and
implementation of HACCP systems are costly and require skills, training
and organization. Where slaughter, inspection and processing systems in
some developed countries are not well organized and managed, HACCP programs
at the processing level would be difficult to develop. To implement these
systems at the farm level, Dr. Dr J. Butterweck mentioned that even in
developed countries is proving a challenge especially if there are insufficient
incentives. Nevertheless several contributors indicated that in DC, greater
efforts should be made to educate farmers on codes of ” Best Practices”
at the farm and in marketing channels of livestock, poultry and fish.
Dr C.McCrindle (contribution
#17), clearly outlined the difficulties experienced in improving
food safety in rural, peri-urban, and settlement areas of South Africa.
Diarrheal diseases are generally more prevalent in children from rural
and developing areas, but it is difficult to estimate how much can be ascribed
to eating contaminated meat or milk as most cases go to local clinics where
treatment is given by nurses and few records are kept. The cause of death
in rural humans is seldom investigated as post-mortems are not culturally
acceptable, and also there is a high level of HIV/AIDS.
Generally less than 50% of
livestock are slaughtered in abattoirs and this meat sold through the retail
sector or exported. For these markets, HACCP standards may be appropriate,
but in the informal sector where animals (especially small ruminants) are
slaughtered either at home or in local butchers, the carcasses are not
generally inspected and animals may even be consumed after they have died
from other causes. Farmers have few incentives to join the formal sector
for marketing meat as expenses may run as high as 22% of the selling price.
Dr McCrindle advocates that the major focus should be on anthrax vaccination,
not consuming animals that have died from other causes, and cooking meat
very well. The latter is generally adhered to.
Dr D.Waltner- Toews (contribution
#20) believes there are theoretical and practical reasons for focussing
on systems other than HACCP etc. in the informal food sector in DC. He
has developed an adaptive methodology for ecoystem sustainability and health
(AMESH) in which local communities are assisted to define interacting sets
of issues such as environment, public health, and economic development
In DC, foodborne zoonotic
illness from eating meat derived from animals that have died from Anthrax
is recognizable, but increasingly zoonotic agents such as E.coli O157:
H7 or Campylobacter sp. which are not necessarily pathogenic to animals,
are not recognized because the “link” to humans is unclear. Currently the
actual status of these pathogens in most DC is poorly documented.
For example a recent study of Campylobacteriosis in DC (22) showed that
the infection was primarily confined to children less than 2 years of age,
is often accompanied by other enteric pathogens, and was not seasonal.
Exposure, poor hygiene and close proximity to animals appear to be risk
factors in the very young. The burden of Camplyobacteriosis in older HIV
positive individuals is predicted to rise in DC.
Dr I. Klinger addressed the
issue of illegal or non-inspected slaughtering of animals in DC. The reasons
for this are several and include the eating habits of a population- people
are used to eat meat only from their own animals and trust no one else
to slaughter them. Another reason is that for example both Jewish and Islamic
religious laws require that animals be slaughter according to a prescribed
method. If this demand is fulfilled the common rural citizen is satisfied
about the safety of the meat, and lack of any veterinary inspection is
less appreciated. Lastly illegal slaughtered meat is usually cheaper than
inspected meat. The solutions to these problems is not easy but must include
enforcement of veterinary law enforcing the population to purchase inspected
and identified meat only from authorized establishments, together
with public health education regarding common infectious agents,
drug residues, heavy metals and other environmental pollutants.
8. HOW CAN
DECISION-MAKING IN VPH PROGRAMMES BE MADE MORE TRANSPARENT AND CONSISTENT
WITH SOCIETAL VALUES IN THE FACE OF COMPLEXITY, UNCERTAINTY, AND VARYING
There were several suggestions
made that both NGO’s and Universities should be asked to play a greater
role in decision making as often they may well be more knowledgeable as
to what will work at the local level and what will likely fail. Decision
making should always involve community representatives, and they should
be invited to scientific events where the importance of the disease and
its consequences are shown and the need for control justified To aid this
process in rural areas, communication networks are clearly needed.
Dr D. Allard et.al (Contribution
#38) cited the Canadian report “ Science Advice for Government Effectiveness”(23)
which defined several principles which can improve science-based decision
making. ‘Science advice’ is defined as value-added guidance derived from
scientific theories, data, findings, and conclusions provided to inform
policy and regulatory decision making. The following
summarizes these six principles:
1.Identification: Early identification
of situation where science advice will be required.
advice from external and international sources needs to be sought from
a wide range of sources, including ‘traditional knowledge’ of local people.
If necessary independent agencies or advisory panels should be used especially
where there is significant uncertainty, a range of opinions or there are
sensitive areas of public policy where public confidence is important.
3.Sound Science and Science
Advice: Quality, reliability and scientific peer review need to be built
into the science advisory process. Science advisors should contribute sound
scientific information unfiltered by other policy considerations.
4. Uncertainty and Risk:
Science public policy always contains some uncertainty and often a high
degree of risk, which must be assessed, communicated and managed. As such
it is important to adopt a risk management approach.
5. Openness: Democratic
governments are expected to employ decision-making processes that are transparent
and open to stakeholders. This implies a clear articulation of how decisions
are reached, policies are presented in open fora, and the public has access
to the findings and advice of scientists as early as possible.
6.Review: This should include
two elements: a) subsequent review of science- based decisions to determine
whether recent advances in knowledge impact the science and science advice
used to inform the decision, and b) evaluation of the decision making process.
Once the decisions have been
made and adopted, their adherence and accountability should be monitored
as well as their effectiveness.
It may prove challenging
to adopt these principles in toto in VPH decision making in DC, where a
central and hierachial decision making process is common. However veterinarians
should ensure that their advice is offered, listened to, and hopefully
9. THE PERCIEVED
NEED FOR SOUND ECONOMIC JUSTIFICATION FOR ZOONOTIC DISEASE CONTROL AND
Livestock disease control
programs in DC and CIT are often established albeit not very critically
on their economic importance .As a result zoonotic control programs may
not seriously considered especially if they do not apparently impact animal
health and production. Clearly there is a need to better define the economic
impact of zoonoses and other VPH problems using ‘burden of disease’ analyses
as used by WHO and the World Bank. (See Question #2)
Dr G. Sharma (contribution
#24) suggested that there is a very real need for DC to develop economic
justifications for their zoonoses control programs. Where there are limited
financial resources available, flexible computer-based models should be
used to estimate the direct and indirect economic losses and should include
the effect on animal and human populations. These models should also estimate
‘cost benefit ratios’ and ‘Internal rate of Return.’ Models should also
be flexible enough to incorporate varying animal husbandry practices and
other similar parameters. Decision-makers, stakeholders, and the population
at risk must always be made aware of the actual losses caused by zoonotic
diseases especially if their cooperation is to be long term.
Dr J. Zinstaag (contribution
# 28) stated that livestock production is far more than an economic issue;
it requires attention to a much broader range of ecological, ethological,
social, psychological and ethical consideration (24). If VPH veterinarians
are to avoid BSE-like incidents in the future, they will have to play a
significant role in formulating new concepts of livestock production.
10. GIVEN THE INTEGRAL
ROLE THAT COMMUNITY PARTICIPATION HAS IN DETERMINING THE SUCCESS OR FAILURE
OF VPH ACTIVITIES, HOW CAN THESE PROGRAMMES BE EFFECTIVE AT THE LOCAL LEVEL?
Dr J. Boomker (contribution
# 26) used the example of human cysticercoses (T. solium and T. saginata)
as examples of zoonoses where the basic problems are mindsets, cultural
and other factors rather than technical issues. Examples were cited
where despite giving demonstrations on cooking of meat, lectures on the
use of toilets however primitive, and yet going back 6 months later and
finding no changes have occurred. No doubt other examples of failed health
education programs could also be described. Obviously these failures are
indicative that extension methodologies need to be reappraised. Without
a thorough understanding of the knowledge, attitudes and practices of any
community towards say a zoonotic disease, and then an intuitive approach
is likely to fail. Participatory Action Research or similar techniques
as described under question #6 was needed to correct these deficiencies.
Unless the people want change and intend to make it happens, no improvement
Several attempts have been
made to provide both human and animal health services to nomadic people
since often animal health services appear to have a better coverage through
vaccination campaigns. At the same time coordinated surveys of zoonotic
infections can be undertaken in isolated populations. (25,26)
Initiation of pilot projects
using community involvement was recommended and their careful review, evaluation
and revision before implementing on a broader scale (Dr D.Allard et.al,
Several contributors advocated
that children and young people especially should be informed of VPH activities
and trained where appropriate to participate. Awareness of men and women’s
different roles in livestock production and food handling can increase
the effectiveness of VPH programmes at the local level. This issue is discussed
in greater detail in the contribution from Dr B.Miller (contribution #37)
under question 18.
Moderators comment: Communities
should be regularly informed on the progress and achievements of VPH programs
using the local media information sources. If they know they are part of
the action and contributing to it the controls are much more likely to
succeed. While community participation is widely promoted as an important
feature of aid projects in DC, the results have not all been successful.
Projects that encourage interactive participation and self-mobilization
are most likely to result in sustained benefits (27).
11. HOW CAN COLLABORATING
CENTRES, CONSORTIA OF UNIVERSITIES AND RESEARCH INSTITUTIONS BETTER SERVE
THE NEEDS OF VPH IN DEVELOPING COUNTRIES?
Dr Joshi (contribution #2)
recommended that specific VPH problems requiring research be developed
by Universities (both within country and foreign) in conjunction with NGO’s
in DC. Then apply to potential donors for funding. Once a project is funded,
then faculty and students from the University can work together with locals.
He cited the example of his own country (Nepal) where projects involving
Tufts, Washington State, and Colorado State and Guelph Universities from
North America have been undertaken.
Dr J. Zinsstag (contribution
# 28) suggested that developing close North-South research partnerships,
linking researchers from the South with research groups in the North, for
short technical stays in the North without disrupting social and institutional
ties in their own country is optimum. In this way researchers in remote
places with poor infrastructure foster their own work for their own country.
Dr M. Kachani (contribution
#41) identified the following areas where collaborating centers or consortia
of Educational or research institutions could be more effective:
C: ORGANIZATION AND MANAGEMENT
OF VETERINARY PUBLIC HEALTH PROGRAMS:
Conducting appropriate applied
research to answer practical questions to serve the needs of the DC.
Developing project proposals
on control/eradication programs to be submitted to donors and international
By providing experts to solve
particular technical field problems.
By organizing extension programs
in conjunction with local extension services.
Training local NGO members and
community health workers on relevant activities and practices needed by
local populations at risk.
By organizing conferences and
workshops to update the knowledge of scientists involved in VPH programs.
GIVEN THAT VPH IS ESSENTIALLY
A “PUBLIC GOOD” ACTIVITY DEFINED AS “THE CONTRIBUTIONS TO THE PHYSICAL,
MENTAL, AND SOCIAL WELLBEING OF HUMANS THROUGH AN UNDERSTANDING AND APPLICATION
OF VETERINARY SCIENCE”:
12. HOW CAN GOVERNMENTS
THAT ARE ACTIVELY PRIVATIZING THEIR VETERINARY SERVICES BE PERSUADED TO
RETAIN A BASIC SERVICE TO ENSURE THAT COMMUNITIES ARE PROTECTED FROM ZOONOTIC
DISEASE, FOOD AND WATERBORNE INFECTIONS AND OTHER ENVIRONMENTAL PROBLEMS
THAT MAY BE ASSOCIATED WITH ANIMALS OR LIVESTOCK PRODUCTION?
Public goods are those from
which everyone stands to benefit and from which no one can be denied access.
These would include activities such as quarantine, disease surveillance,
and meat and food inspection that are best provided by the State. Private
goods, on the other hand are those for which benefits only accrue to individuals
or groups and are not experienced by the wide community. Clinical services
are an example since the only beneficiary is the owner of the animal receiving
attention. Not all services to society can be clearly categorized as exclusively
public or private goods. For example vaccination of dogs against rabies
not only protects the dog, but also other animals and humans. Therefore
this spillover effect is described as public good with externalities (28).
Functions, which provide
the necessary tools and means for the protection of the health of a country’
people, domestic and wild animal herds should not be privatized. (Dr D.
Allard et.al. -Contribution #38). However there seemed to be general agreement
that veterinary clinical services especially for livestock in DC will continue
to be either privatized or be provided by farmer- owned cooperatives. Saved
financial and manpower resources should be used to strengthen the regulatory
and service delivery infrastructure (i.e. public good activities). These
would include programs for disease control, epidemiological and surveillance
services, quality control and registration of biologics etc. There were
also opinions expressed that extension and research services should be
carried by government institutions preferably in collaboration with Universities
(especially those with Veterinary Schools) and also NGO’s.
The World Veterinary Association
(contributions #21 and 25) has adopted a policy on veterinary involvement
in the restructuring of public health services. This policy recognizes
the very important contribution that veterinarians can make to public health
especially in the whole area of food safety. It also recognizes that the
control of transboundary diseases and food safety are public goods, because
they are multidimensional in scope and in DC, cannot be delegated to the
private sector for profit. Nevertheless private veterinarians and also
veterinary associations can play very important roles in transboundary
disease control programs especially in coordinated disease reporting, information
distribution, continuing professional development.
Basic services such as tuberculosis
and brucellosis testing, meat inspection and quarantine should not be privatized
(Dr. J. Calder, contribution #19)
Dr H. Schneider (contribution
#14) emphasized that as many African countries shift non-core government
functions to private veterinarians, there is the opportunity to employ
these individuals on a part time basis in food/meat inspection or other
VPH activities and thus broaden their income base.
For governments in DC, the
publication “Guiding Principles for Planning, Organization, and Management
of VPH Programmes” (1990) was recommended (4).
13. HOW CAN ACTIVE
COLLABORATION AT NATIONAL, PROVINCIAL, AND LOCAL LEVELS BETWEEN MINISTRIES
OF HEALTH AND AGRICULTURE INCLUDING PHYSICIANS AND VETERINARIANS BECOME
MORE PROACTIVE AND BENEFICIAL?
There was general support
for the proposal that zoonotic disease control committees should be formed
at all levels and be multidisciplinary to include physicians, veterinarians,
epidemiologists, social scientists, and other professionals as required
from both government as well as non-governmental organizations. Community
representation is also very desirable. The importance of Health Systems
Research and intersectoral collaboration in VPH is stressed in a WHO Consultation
By legislating a common law
or regulation for the control of zoonotic diseases, animal owners, animal
product manufacturers, veterinarians, and medical practitioners could be
made more responsible and accountable in DC. Creating task forces and working
groups with representatives from central, provincial and local governments
would also ensure that all those who have a stake in VPH and zoonoses would
hopefully work in a productive and collaborative manner. (Dr G.K. Sharma,
contribution #24) Where difficulties are encountered in setting up VPH
programs either within a Ministry of Health or Agriculture, the suggestion
was made to conduct a ‘pilot experiment ‘with technical cooperation from
an International organization such as WHO or FAO. (Dr G.Togo, contribution
Dr B. Gummow (Contribution
#4) drew attention to the situation in South Africa where the Departments
of Health and Agriculture rarely appear to work together. He also cites
the example of a recent Medical research Council report showing that an
estimated 40% of reproductively active persons are HIV positive. Yet there
does not appear to any clear plan to ensure that VPH policies are incorporated
into HIV control and prevention programs. There is also minimal training
of medical students to recognize common zoonoses such as brucellosis, Q
fever, tick-bite fever, leptospirosis, and psittacosis, all of which can
be misdiagnosed as malaria. To compound the situation, autopsies are rarely
carried out. With almost 50% of the population living in rural areas where
they can be expected to come in contact with animals on a regular basis
and also living under poor socio-economic conditions, as well as being
immunocompromised from HIV infections, many more zoonotic infections are
likely in the future.
Another example of failure
of the two professions to communicate is the not infrequent situation where
persons receive the full schedule of post-exposure rabies prophylaxis despite
the quarantined dogs remaining healthy after 10 days of observation.
These are just two examples of the urgent need for greater cooperation
between the medical and veterinary professions.
Ministries of Health in DC
tend to focus on disease-care delivery, child hood vaccinations and HIV/AIDS
for example. Zoonoses often do not warrant attention unless there is a
major epidemic. To build effective partnerships with individuals in different
ministries and disciplines to address specific diseases (such as plague,
rabies or hydatidosis) is recommended as an excellent start. (Dr.D.Waltner-Toews,
Contribution #31) Later these initiatives can be expanded and built on,
and not allow effort to be restricted to that specific disease, but use
them to leverage broader support for VPH. Effective use of the media by
professionals working in VPH is also strongly recommended.
Dr A. Benkirane (Contribution
# 34) suggested that the most immediate action to be developed in DC (where
the priorities tend to prevent both physicians and veterinarians from concentrating
their efforts on VPH issues) is to create a synergy among all concerned.
A well-identified interface ought to be established in each DC depending
on its overall administration, in order to deal specifically with these
problems. Such an interface should also exist physically, and either be
hosted by the Ministry of Health, Agriculture, or exist as an independent
entity. Other Ministries such as Education may also be involved if school
children were a group targeted for a VPH program Both FAO and WHO as well
as other international organizations involved in VPH should work in close
collaboration to assist DC governments set up relevant VPH units and possibly
network them on a sub-regional or regional basis. The Regional Animal Disease
Surveillance and Control Network for North Africa and the Near East (RADISCON)
was cited as a fairly successful example of an organization for surveillance
in the area. Pilot diseases may be investigated at the launching of national
VPH units using say rabies and hydatidosis as representative models. They
are also more likely to motivate physicians than other topics. To reach
a fully operational VPH unit, funds will have to be raised and these will
only be released if decision-makers respond at the highest levels.
A suggestion was made that
communication and information sharing between human and veterinary medicine
would be encouraged by having a focal zoonotic disease information center
as well as a file server and a web page. (Dr.K. Sato, Contribution # 10).
Dr. D. Allard et. al., (contribution #38) suggested that courses on zoonoses
and foodborne illness be taught jointly by physicians and veterinarians
and attended together by medical and veterinary students. Hopefully this
could strengthen working relationships between the two professional groups.
In DC, it was also suggested that perhaps vaccination campaigns in rural
areas for the human population be carried out at the same time with veterinary
vaccinations to encourage cooperation between the two agencies.
The current controversy
regarding the prudent use of antibiotics by both professions was cited
as another example of where more active collaboration is urgently needed.
While the evidence for antibiotic resistance of microorganisms of animal
origin infecting humans in developed countries is becoming clearer, the
situation in most DC is unknown. The WVA has taken a lead in this area
(Dr. J.Edwards, contribution #21).by advocating that therapeutic antibiotics
should be used under supervision of a veterinarian and also only in those
situations where an infectious agent is likely to be present that will
be susceptible to therapy.
14. IDENTIFY RESOURCES
IN INDUSTRIALIZED COUNTRIES THAT MIGHT BE ABLE TO BETTER ASSIST VPH CAPACITY
AND INSTITUTION BUILDING IN DEVELOPING COUNTRIES.
An innovative example of
bilateral governmental and non-governmental cooperation was described in
contribution #29 from Dr N. Neils-Ole Bjerregaard describing how the Danish
Veterinary Association assisted the veterinary profession in Latvia following
regaining of independence in 1991. Support and contributions were given
for a Latvian Veterinary Journal, an annual veterinary conference, and
also training of Latvian veterinarians in Denmark. The latter included
training in VPH. In virtually all developed countries there are well organized
veterinary associations and they have the resources to cooperate with colleagues
in developing countries by helping to structure the profession and improve
where necessary. This is especially critical in countries where often food
safety is problematical, yet it is a precondition for international trade
in both food and feed.
Several suggestions were
made that companies producing vaccines, pharmaceuticals and diagnostics
for use in zoonotic disease control programs should be approached to determine
whether they would be able to develop the VPH capacity in DC where they
can also market their products. These companies have played a major role
especially in sponsoring extension campaigns. Organization with expertise
in communication and the production of educational materials are also potential
AND EXTENSION IN VETERINARY PUBLIC HEALTH:
GIVEN THAT MANY VETERINARY
SCHOOLS IN DEVELOPING COUNTRIES ARE INADEQUATELY FUNDED, STAFFED AND EQUIPPED
TO TEACH VPH AT BOTH UNDERGRADUATE AND GRADUATE LEVELS AND ALSO PARTICIPATE
IN COMMUNITY EXTENSION PROGRAMS:
15. SUGGEST HOW THIS SITUATION
COULD BE IMPROVED ESPECIALLY TO INCLUDE THE BASIC PRINCIPLES OF FOOD SAFETY,
ZOONOSES CONTROL, AND ENVIRONMENTAL/COMMUNITY HEALTH.
While the curriculum of veterinary
schools is increasingly under pressure to include more material, there
were concerns expressed
that VPH needed to be given a higher priority than it currently receives
especially in DC. Guest lectureships by experienced veterinarians in the
various fields of VPH should be encouraged to assist in broadening the
professional perspective of students. It is becoming more widely accepted
that not all veterinary students need identical education. ‘Tracking’ of
students into health disciplines of particular interest to them helps to
solve the problem of information overload and to tailor their education
to their career aspirations and the expectations of the communities in
which they work.
A number of contributors
indicated that faculty exchange programs between Universities of developed
and DC countries should be started or existing programs expanded.
These types of programs have been undertaken informally over many years
using a variety of sources to fund these such as Fullbright grants to and
from the USA.
A suggestion was made that
curricula for VPH education at the undergraduate level be reviewed and
developed on a regional basis since it is recognized that emphasis may
vary depending on the geographical region. (Dr.G.Nasinyama, Contribution
A difficulty cited by one
Contributor (Dr. B.Gummow, #4) was that veterinary students often fail
to grasp the importance of their role in controlling zoonotic diseases.
While they see clinical animal disease, they do not routinely see human
cases and possibly when there are opportunities, students should be exposed
to say a child with rabies or an adult with tuberculosis. Medical and veterinary
infectious disease faculty should consider giving lectures in each other’s
Dr C. Wilks (Contribution
#22) described an innovative approach being used in the teaching of VPH
in Australia. On the assumption that VPH was “the application of veterinary
science to the protection and promotion of human health and well being”
the decision was made to present an expanded VPH course over the whole
4 year curriculum. Traditionally the VPH course was primarily focussed
on meat inspection, but now it has been expanded to include: quality assurance
of animal-based products to meet consumer expectations, knowledge of the
causes, epidemiology and control of food-borne diseases, zoonotic and emerging
diseases, adverse effects of agricultural and other human activities on
food quality, animal welfare, human health and the environment. The mode
of delivery has shifted to a small number of formal lectures, tutorials
and field visits, which are used to guide the students rather than instruct
them. Specific learning objectives are set for each year and links into
other courses that are already providing core material are identified.
Students are also encouraged to use identified web sites. Under this new
approach, students are required to assemble an electronic portfolio that
draws together, analyses, and discusses the information need to meet the
annual learning objectives. At a set time these portfolios are accessed
and assessed by the responsible faculty member. The portfolios are developed
and enlarged over the four years and on graduation provide a dynamic document
that can continue to be updated and expanded according to the student’s/veterinarian’s
interests and professional needs at the time. In summary VPH should be
seen as students as an integral part of every veterinarian’s responsibility
and education. It is also considered vital that students develop skills
in locating, identifying, assessing and collating information.
Dr B. Miller (Contribution
#37) raised the issue that a critical component of VPH is interacting and
understanding human populations and their relationships with animals. A
frequently overlooked part of this population is women, as livestock producers,
as mothers, and as professionals. i.e. veterinarians. It is well established
that educational messages given to men regarding women’s work is rarely
successful, so VPH personnel need policies, strategies, and training to
help reach both rural and urban women in DC In DC over 40% of the agricultural
work force are female. This means a VPH educational programme that includes
an understanding of the social context and an examination of “gender neutral”
thinking, in which the farmer is assumed to be male, literate and has the
authority to make decisions. VPH is the branch of veterinary medicine most
related to sociology, yet veterinary graduates, both those with and without
explicit VPH training often shy away from thinking about the internal dynamics
within the family and community, fearing to incite controversy. Yet clearly
VPH personnel are agents for change in DC, and must act responsibly in
Awareness of men and women’s
different roles in livestock production and food handling can increase
the effectiveness of VPH educational campaigns. For example, the echinocococis
campaign in Morocco targeted existing women’s groups for training in offal
handling and sanitation. Heifer Project’s technical training in dairy production
in Uganda is designed for whole families, so that women as well as men
can attend. Messages on sanitation and pasteurization can be directly transmitted
to women who can implement them.
Worldwide the percentage
of women entering the veterinary profession has been increasing over the
last decade. Women professionals have a great deal to contribute to VPH
not only as veterinarians, but also as researchers, paravets, and technicians.
They can provide new perspectives and increase outreach to women farmers.
However many women find it difficult to work in institutions designed for
men, so policies regarding dependent care, flexible hours, security and
harassment can help VPH institutions and organizations find and retain
women professionals. In summary, although the challenge of VPH in DC is
great, inclusion, awareness and outreach to women is a ‘low tech’ and affordable
way to increase the effectiveness of programmes.
An example of a VPH course
entitled “Introduction to Community Health” used in Nigeria were described
by Dr B.Olugasa in contribution #30. This was given in the 4th year of
a 6 year programme and should place emphasis on the VPH systems of that
country. Topics included definition of VPH, and discussions on zoonoses,
the role of the abattoir, small clinics, livestock and poultry farms, and
human households for data collection and epidemiological studies, etc.
Moderators Comments: A successful
exercise that has been used for many years in the VPH clinical rotation
at the College of Veterinary Medicine, University of Minnesota, USA is
for all studies to be presented with a ‘real’ problem These are based on
situations where Faculty have been asked to provide advice on a situation
involving human health or exposure from an animal sources. Students are
expected to prepare a written response in the form of a letter, and defend
their advice in an oral presentation to faculty and their peers. These
case-based exercises tend to engender more interest and participation by
students than is customary with formal lectures.
A model of a
VPH/Preventive Medicine curriculum for US Colleges of Veterinary Medicine
based on a 1974 PAHO publication “A Competency Based Curriculum for VPH
and Preventive Medicine” has been recently (1999) been developed (30).
However Veterinary Schools in DC are encouraged to develop the VPH curriculum
for their students that reflects the current and future needs in their
16. HOW CAN VETERINARIANS,
EITHER CURRENTLY EMPLOYED IN VPH PROGRAMS, OR WISHING TO EXPAND THEIR KNOWLEDGE
AND SKILLS EITHER BY FORMAL GRADUATE OR CONTINUING EDUCATION?
Whatever type of course is
developed, it is critical that it is not only well planned, but also designed
with a set of learning objectives that are appropriate for the needs not
only of the individual but also of his/her current or future employer.
Other principles to be followed to maximize the effectiveness of any education/training
with an interest in VPH and Zoonoses have gone to North America, Europe
or Australasia for either Diploma or graduate level education. A list of
educational institutions offering these educational opportunities will
be posted on this FAO VPH web site.
Provision of adequate financial
assistance based on ability, commitment and financial need.
Commitment to continuous learning
by the candidate, educational institution and supporting institution.
Requirement to demonstrate a
focussed need and a plan to address it a basic level before advancing to
a more technical level.
Requirement for a candidate
to be a catalyst for community change and improvement from the perspective
Outcomes assessment should also
be used to measure performance of the individual,
Participants should critique
any courses or programs to ensure their ongoing relevance.
Wherever possible on-line/Internet
based programs should be developed to ensure the widest coverage.
One example is a three-month
course on Animal production and Veterinary Public Health offered by the
Faculty of Veterinary Medicine of the Utrecht University in the Netherlands
as described by Dr K.Balogh (contribution #33). See reference 31.
Participants have come from
DC and also Europe. The emphasis is on providing a broad and intensive
overview of many different aspects of VPH, primarily by way of problem
solving case studies, presentation of group assignments and round table
discussions. In addition to encourage greater harmonization of veterinary
curricula, a number of case studies compiled in a European Module on VPH
has been developed with six other European faculties using EU funding.
These cases follow a specific format and include both a student and teachers
guide. Also a complete two weeks course on VPH has been developed jointly
by three European and three East African faculties primarily in a ‘train
the trainers’ format. Curricula on VPH should ideally have the flexibility
to make use of material/modules already available and introduce new topics
as they arise. The WebCT programme (32) enables the creation of a virtual
classroom. Following the 2000 outbreak of West Nile Virus infection in
the USA, a group of Dutch students were put in touch with Veterinary faculty
at the University of Florida to develop a website for WNV in Northern Europe.
Other contacts have been made with Faculties in South Africa, Brazil, Italy
and Portugal by e-mail and WebCT Even live-chat sessions via WebCT have
been organized. These types of cross border educational experiences can
be developed without large resources and depend on cooperation between
the various institutions.
While there are numerous
excellent publications in the general areas of VPH and zoonoses, many are
inaccessible to veterinarians in DC primarily because of cost. Comments
were made that in the past FAO, WHO and OIE publications were readily available
to Universities in DC gratis, but this appears to have lapsed. A bibliography
of current publications, sources and availability will be appended to the
conference web site
Dr M. Abo-Shehada (contribution
#15) described how a successful one-week course was held in Jordan training
veterinarians and biomedical scientists on using PCR techniques in diagnosis.
This technique is very useful in diagnosing zoonoses in DC at low cots
and using modest laboratory equipment.
The development of a National
Zoonosis Center with associated laboratories, besides acting as a valuable
country resource, could also serve as a learning and skills development
center for veterinarians in VPH programs (Dr. B. Olugasa, contribution
#30). Regular seminars and workshops focussing on epidemiological findings
and control measures in both rural and urban situations could be organized.
17. HOW CAN DISTANCE
LEARNING OR SIMILAR TECHNIQUES BE APPLIED IN DEVELOPING COUNTRIES?
Many contributors commented
that electronic teaching aids are very useful and versatile and knowing
what one requires can match even modest facilities. A wide range of software
and Online resources in VPH is now available. Examples include the epidemiology
“Supercourse”(13) and “Emerging Infections of International Public Health
Importance” (14) described earlier. The US based Association
of Teachers of VPH and Preventive Medicine also list many educational resources
on their web site (30). Where Internet connections are uneven or
absent, scarce materials can be stored on moveable discs such as CD’s and
can be distributed or exchanged.
Dr M. Abo-Shehada in contribution
#15 suggested that production of VPH course materials on CD’s be made available
to educational institutions in DC with the assistance of International
organizations. Some institutions already use such interactive teaching
aids as a complete course. Students or veterinarians are asked to access
the materials for set hours and only see the tutors for evaluation. This
methodology would allow participation of experts worldwide in the production
of accredited courses in VPH and zoonoses. Such courses could be
stored on an Internet site such as FAO or WHO as a public domain to be
downloaded as required. Translation versions would also be required in
the long term.
Other suggestions included
having focal internet sites where VPH related questions could be directed
and also using the internet to hold conferences, continuing education programs
18. GIVEN THAT THE
PRIMARY NEED IN MOST DEVELOPING COUNTRIES IS FOR VILLAGE LEVEL BASIC HUMAN
AND ANIMAL HEALTH CARE, HOW CAN TRAINED LAY PERSONS BE BETTER UTILIZED
TO PROVIDE THESE SERVICES?
In many DC, NGO’s and cooperative
organizations have established good infrastructures and have also won the
confidence of poor and illiterate animal owners in their areas. Involvement
of these organizations in VPH programs is likely to include many extension
and education initiatives to create awareness at the grass roots level.
Ultimately this would facilitate the participation of farmers in these
programs. These organizations have developed a new class of paraprofessional;
the community- based animal health worker (28). These individuals with
appropriate training could play a significant role in VPH extension at
the local level. The emphasis should be on ‘train the trainers’ approach,
taking into accounts the socio-cultural habits and customs of the area.
Dr G.Sharma (contribution
#24) suggested that the services of lay workers could be better utilized
for providing village level basic human and animal care through their education
and training in vaccination, presumptive diagnosis and subsequent reporting
to veterinary or medical officers, data collection, and above all educating
the owners about the importance of VPH, risk involved and steps to avoid
them. Education of animal owners and animal product producers is of critical
importance, for the without a change in their attitude and practices, nothing
substantial can be attained.
Dr D Allard et. al. (contribution
#38) suggested village ‘health workers’ could be taught additional knowledge
and skills for basic diagnosis and control of most prevalent zoonoses in
DC. These workers would already have the biological knowledge to be able
to grasp such information and their access to village populations could
be an asset in the early identification and control of zoonoses, not just
in humans but also in domestic animals.
Dr E.Rapoport (contribution
#43) recommended that farmer community training in DC be better carried
out slowly in order they can assimilate principles and other concepts of
modern management. Often the changes needed are relatively simple and do
not need sophisticated electronic equipment or techniques. They are better
carried out by watching the instructor in model sites such as farms, abattoirs,
dairies, butcheries, homes etc. Generally at least one whole breeding session
(more or less a full year) is necessary before new methods are well assimilated
on livestock farms.
19. GIVE EXAMPLES
OF INNOVATIVE COMMUNITY-BASED VPH PROGRAMS, ESPECIALLY THOSE INVOLVING
Dr B. Olugasa (contribution
#30) described a VPH program developed specifically to identify zoonotic
infections and risks for children (9-16 years of age) working as apprentices
in abattoirs in Nigeria. They may constitute up to 12% of the total workforce.
Abattoir wastewater quality assessment was also included as a measure of
Moderators comment: Dr David
Sherman in his recently published book” Tending Animal in the Global Village-A
guide to International Veterinary Medicine”(28) describes the critical
elements of community based animal health programmes. The importance
of ethnoveterinary medicine, defined as local people’s knowledge pertaining
to animal health and production, derived over long periods of time from
the close association of people and their animals, is emphasized. Human
health knowledge and attitudes regarding zoonoses and other animal- related
risks should be included in these types of programmes.
E. OTHER TOPIC FOR DISCUSSION:
20. IF YOU WISH TO RAISE
OTHER TOPICS OR ISSUES RELATED TO VPH AND ZOONOSES CONTROL IN DEVELOPING
COUNTRIES THAT ARE NOT COVERED IN THE ABOVE TOPICS, PLEASE DO SO UNDER
Contribution # 39 from Drs
A. Mantovani and R. Borrini raised the issue of VPH preparedness for disaster
situations. The major disasters which can and have occurred in DC countries
include: war and civil instability, epidemics and natural disasters such
as droughts, floods and earthquakes .All may result in massive loss of
livestock and other animals with resulting famine .In some instances the
risks of zoonotic disease are exacerbated by the geophysical event such
as rift valley fever following flooding for example. DC are at especial
risk as livestock are critical for both human and economic survival. The
involvement of the veterinary profession including the Italian official
veterinary services in preparations for such events is described in some
For a review and recommendations
see the OIE publication: ”Emergency management of disasters involving livestock
in developing countries”(33)
Dr G.K.Sharma (contribution
#24) recommended that certain VPH problems and also zoonoses present in
developed countries may not be present in DC. The vast majority of DC are
ill equipped to diagnose and prevent the entry of such VPH problems. Developed
countries as a social obligation should not knowingly supply items that
could introduce new VPH problems in the DC. International agencies like
FAO/WHO/OIE could play a very important role in preventing the spread of
VPH problems between countries.
There appeared to be general
agreement that the current needs and future challenges for the delivery
of effective VPH programmes in developing countries (DC) will be very different
from the developed countries. The latter generally have public infrastructures
in place, which will be better able to cope with challenges they face from
emerging or re-emerging zoonotic infections and also bioterrorist threats
from zoonotic agents.
VPH initiatives in DC should
focus at the community levels and also choose programmes prioritized
on the basis of disease burdens, are epidemiologically defensible, risk
based and have a reasonable probability of success and sustainability.
Success is more likely if veterinarians take their place as a member of
the health team rather than try and go it alone.
While international assistance
was available and examples of cooperative projects described by several
contributors, there was obviously many unmet needs for technical help as
well as financial assistance International agencies need to not only make
their numerous publications more readily available but also consider expanding
their staff particularly at the regional level to provide more support.
Electronic access to information for those with a’ need to know’ can and
should be greatly expanded.
A number of deficiencies
in surveillance programmes in DC was noted and coordinated human/animal
health databases for zoonotic infections was supported. Again these would
require extensive training and commitment especially at the local level
if they were to be successful.
While there was a wealth
of knowledge and experience on how to control and prevent zoonotic diseases
in developed countries, it was hazardous to transfer this directly to DC
unless participatory field research had identified local knowledge and
attitudes which might present major barriers for implementation. Food safety
in DC is a good example. New quality control systems being adopted in meat
hygiene in developed countries where virtually all animals are slaughtered
and inspected are of very limited value where the majority of meat is derived
from animals killed at a local butcher or at home. As globalization of
trade in products of animal origin increases, DC should benefit from a
need to meet export standards.
While there was a perceived
need for DC to develop sound risk- based economic justification for zoonoses
control programs, it was also noted by several contributors that attention
should be paid to the issues of ecological, ethological, social, ethical
and psychological considerations.
A number of examples of community
based involvement in VPH programs were presented. These ranged from improving
surveillance, delivery of a combined animal and human health programme
especially to isolated communities, and the involvement of women and young
people in prevention based education. In DC, human and animal health are
interrelated especially as the majority of food is still produced and consumed
A number of suggestions were
made to ensure that ‘public good’ VPH services were not eliminated
as more DC veterinary administrations transfer clinical services to the
private sector. While in some cases NGO’s and farmer cooperatives could
provide some VPH services, ultimately the State must retain responsibility
for disease surveillance, control of transboundary and zoonotic diseases
as well as meat and other food safety.
Several contributors gave
examples of very limited collaboration between Ministries of Health and
Agriculture at all administrative levels. Unfortunately this problem is
not only confined to DC. One solution favored was a well-identified interface
be established in all DC either within an existing Ministry or as an independent
entity. The problems facing DC were too important to be hampered by interprofessional
rivalry or non-communication.
A number of innovative trends
to improve both instruction in teaching VPH in veterinary schools, as well
as make the subject more ‘student friendly’ were reported. These
include reducing the number of formal lectures, and increasing tutorials
and field visits. More use of real life problems for teaching was also
advocated. Specific learning issues were identified for each year
and students were encouraged to use identified websites and also to develop
their own electronic portfolios.
The increase in women veterinary
students presents many opportunities in DC, as women are still the major
caregivers for livestock in many rural areas. Education on basic hygiene
and other preventive measures can often be more effective if given by women
to women directly rather than via men.
Opportunities for graduate
and continuing education in VPH in DC are limited unless funding is available
in North America, Europe and Australasia. However several initiatives were
described involving both inter-University linkages and distance learning
via the Internet. Given the difficulties and also cost of access to the
Internet in DC, a greater use of multilingual CD’s was recommended, but
unfortunately there is only limited material available at present.
If preventive VPH information
especially on zoonoses was to be delivered at the local village level,
greater use of community –based animal and human health workers was advocated.
These individuals could be taught the basic skills needed to advise on
the common zoonoses. This material should be seen as a supplement to local
people’s knowledge relating to animal health and production rather than
as a replacement.
Finally the importance of
dealing with livestock emergencies following natural disasters was advocated
and based on experiences, specific recommendations made.
The assistance of staff in
the Animal Health Service of the Animal Production and Health Division
of FAO, Drs C. Eddi, W. Amanfu and D. Ward is acknowledged. Also Dr Scott
McEwen, University of Guelph, Ontario, Canada, Dr David Hird, University
of California, Davis, California, USA and Dr D.Cordes, New Zealand, for
kindly reviewing the summary document.
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