. .

Stephen M. Apatow
Director of Research and Development 
Humanitarian Resource Institute Biodefense Reference Library
Foreign Animal and Zoonotic Disease Center
Eastern USA: (203) 668-0282   Western USA: (775) 884-4680
Internet: http://www.humanitarian.net/biodefense/fazdc/
Email: s.m.apatow@humanitarian.net

Colleagues:

In the review of my notes regarding the 2001 UK FMD outbreak (Foot and Mouth Disease Reference Library) and current policy here in the U.S., I would like to invite your input and participation in the following discussion.

Paul Gibbs (College of Veterinary Medicine, University of Florida) wrote an article (J VetMed Education, Vol 30, Summer 2003) entitled "The foot-and-mouth disease epidemic of 2001 in the UK: implications for the USA and the “war on terror.” In his introduction, he highlighted the following:

"Were FMD to occur in the USA, the initial federal and state response would be identical to that used in the UK and continental Europe to control the 2001 epidemic.  A policy of stamping out would be applied.  Were FMD to occur through bioterrorism, it is probable that terrorists would initiate several outbreaks in different parts of the country and possibly caused by several serotypes of the virus. The scale of the stamping out could be extensive."

[Note: We would like to emphasize that Dr. Gibb's (Professor of Virology, College of Veterinary Medicine, University of Florida - Formerly at the Institute for Animal Health Pirbright, England) perspective of the British outbreak does not condone the extensive slaughter and implementation of a non-vaccination policy.  Click here for additional resources associated with the 2001 Outbreak and Foot and Mouth Disease.]

Paul's synopsis places emphasis on stamping out, with no reference to consideration of an emergency vaccination strategy in an initial FMD response plan. Regarding this topic, the USDA/APHIS Emergency Response Plan for Foot and Mouth Disease and Other Foreign Animal Diseases web site, reads 
as follows:

"APHIS' longstanding FMD response plan includes eradicating the disease by depopulating affected and exposed animals. After confirming an outbreak, the Agency would move quickly to trace infected or exposed animals, establish and maintain FMD quarantines, and destroy infected or disease-exposed animals. APHIS is prepared to work with State and local officials to humanely euthanize animals and dispose of carcasses in approved manners. Additionally, indemnity would be paid to affected producers for the fair market value of their animals.

As a further precaution against a widespread FMD outbreak, Agency officials would also order and have on hand an adequate supply of FMD vaccine from the North American Foot-and-Mouth Disease Vaccine Bank (please refer to the APHIS 
Factsheet on the FMD vaccine). While APHIS does not believe widespread vaccination is an appropriate first step against the disease, recent exercises simulating an FMD outbreak in North America have shown that vaccinating animals may enhance other eradication activities and help to prevent a more severe outbreak of the disease. Vaccination may also be useful in helping 
to insulate disease-free areas from areas where FMD is rampant. Should APHIS decide that FMD vaccination is necessary, the Agency is ready to quickly carry out this operation by coordinating vaccination teams consisting of State, Federal, and other veterinary personnel."

In the discussion " Contingency Planning for a Multi-State FMD Outbreak Crucial to Avoiding a UK Level Uncontrolled Epidemic of Foot and Mouth Disease in the United States,' 8.7.2001 , I 
share:

"In the United States, if ground zero of an FMD outbreak were to occur at an auction barn where the movement of animals included transport to multiple states, all movements for a three day window, in which animals are infectious prior to symptoms, plus the time needed for an official confirmation would require tracking, implementation of the appropriate response plans and 
interstate coordination."

As noted on ProMED-mail: Foot & mouth disease - UK (62):

"On March 27 (approximately one month after the index case in the 2001 FMD outbreak) the number of known infected farms diagnosed as of that date in the epidemic was 707 with 342 infected premises that had not yet been detected."

The paper "The Power to Panic: The Animal Health Act 2002," David Campbell and Robert Lee, Cardiff Law School and ESRC Research Centre for Business Relationships, Accountability, Sustainability and Society (B.R.A.S.S.) , presents a number interesting points regarding the UK FMD Response Plan:

• The executive did not initially plan to carry out the contiguous cull in 2001. It did so because its original policy for control of F.M.D. completely collapsed and the ultra vires action that constituted the cull was the executive's panic response to that collapse.
•  In the end, of the over 7 million animals culled, perhaps 90% were uninfected, the result of what has been called "postcode slaughter" or "carnage by computer".
•  M.A.F.F.'s contingency plan envisaged up to ten outbreaks. But so complete a failure was M.A.F.F.'s attempt to identify and isolate an outbreak that there were at least fifty and perhaps up to a hundred sites of infection before M.A.F.F. was even aware of what is now officially regarded as the first outbreak. In the time it took M.A.F.F. to realise what had happened and whilst it was wrongly insisting that the disease was under control, the disease had been spread so widely that in the end almost the entire country was infected or at-risk.
•  The cull was a panic response to a situation of which M.A.F.F. had completely lost control.
•  To the extent that it was a conscious  decision, it was used because it was realised that actual tracing of the disease had become impossible.
•  The extreme haste with which killing within this zone was carried out followed from the adoption of a "24/48 hour slaughter" policy, by which animals on premises infected or suspected of being infected were to be killed within 24 hours and those in the remainder of the zone within 48. This was logistically impossible given the number of animals involved and the targets were not remotely met, but the extreme haste imposed by the attempt to meet them undoubtedly was one of the reasons the cull was so despicably cruel.
•  It is not merely that this debate was very largely based on understandings of E.U. and W.T.O. biosecurity and trade policies maintained by certain special interest groups, notably the national leadership of the National Farmers' Union, accorded questionable privilege in policy-making; it is that it should not have taken place at all. The issue should have been settled earlier in any at all competent contingency planning; but it still remains completely unsettled.
•  If we may quote ourselves, the epidemic: caused an economic loss which D.E.F.R.A. estimates to be £9 billion. This figure is but a remote expression of the concrete losses, which include: the premature deaths of over 10 million animals, killed in ways which were almost always unacceptably, indeed criminally, inhumane and very often so horribly cruel as to be an occasion of lasting national shame; the loss of irreplaceable special breeds; the horror experienced by those with a scrap of humanity involved in the cull; the misery of thousands of small farmers and small businesspersons in areas related to farming and tourism whose incomes were drastically reduced, some of whom were driven into bankruptcy; the (continuing) pollution caused by the disposal; the frustration of the enjoyment of the countryside for a year.

"Now, I feel ashamed of being a veterinarian."

CONTINGENCY PLANNING IN THE UNITED STATES

As outlined by Ekboir, Jarvis, Bervejillo, "Potential Impact of Foot and Mouth Disease Outbreak in California" :

"Successful eradication of the disease would require the commitment of government, livestock industries, farmer's organizations and the general public. Research has suggested that a one week delay could increase the proportion of infected premises from 18% to more than 90%."

Unfortunately, the support and commitment at the producer/grassroots level has not been established despite efforts to mediate these initiatives since August 2001.  In the discussion, "Economic Factors Associated with an Outbreak of Foot and Mouth Disease in the United States: Contingency Planning Discussion," 8.9.2001 , I highlight the following points:

The most important factor in containing the spread of a FMD outbreak is rapid and efficient inter-vention by state and federal animal health services. The efficiency of their actions depends on four factors: (1) preparedness for dealing with an emergency, (2) early diagnosis, (3) timely and adequate access to financial as well as human and physical resources, and (4) support from other civil and military authorities, private veterinarians, processing industries—and, in particular, dairy and live-stock producers (See: NASDA FMD Resource Page for Individual State Resource Web Sites and Emergency Plans).

Note: The clinical signs of FMD are easily confused with other diseases such as vesicular stomatitis,  vesicular exanthema and swine vesicular disease. Since these diseases are present in the U.S., al-though with low prevalence, it is likely that FMD would not be properly identified at the start of the outbreak. One of the major problems in identifying a FMD outbreak is that any farm in the nation with animals showing vesicular lesions is strictly quarantined until the field diagnosis can be verified by the Foreign Animal Disease Diagnostic Laboratory (FADDL) at Plum Island. Because of the economic losses caused by such a quarantine, it is believed that some producers do not report vesicu-lar diseases—assuming that it is vesicular stomatitis, and that the infected animals will heal in two weeks .

The Producers Crucial Role

Modern dairy and pork technologies involve high animal densities. Under these conditions, strict sanitary practices and preventive measures are necessary. Economic considerations, however, dictate that veterinary services are used mainly for reproductive checks and design of preventive plans. Only in extreme cases are veterinarians called to treat clinical symptoms, and it is common to cull animals at the early signs of disease. This practice could favor spread of an exotic disease.

This bias against the use of veterinary services creates problems for the design of animal health policies. The actions taken by producers depend on their judgment about the seriousness of the symptoms. Only if they are aware of the possibility of an exotic disease will they report the symp-toms. In fact, prompt reporting depends crucially on the farmers’ observations and 
actions. This allows early diagnosis and intervention. Early detection was the main factor that determined the difference in magnitude of the 1924 and the 1929 California outbreaks.

It must be stressed that from the individual farmer’s point of view, infected animals need not be eliminated from the herd, because they usually become productive again after the acute period. If other producers do not take measures to control the disease, it makes no sense to the farmer to depopulate a farm and repopulate it with non-exposed animals. Thus, it is only the 
societal decision to eradicate (stamp-out) the disease that justifies depopulation. This point is of crucial importance in considering the government’s role in controlling an outbreak, particularly the need for prompt compensation for depopulation. The solution to this problem is to establish a system that involves all producers in a particular area. The appropriate mechanism varies with local conditions, existing political and legal institutions, capability of government (in particular animal health services), strength of farmers’ organizations, and past experiences with animal health programs. In almost all cases, the coordinating mechanism should be set up by the government with significant participation by the livestock industry. Without strong support of producers and producers’ organizations, it is impossible to maintain proper surveil-lance and to conduct a successful eradication campaign.

Referring back to the discussion " Contingency Planning for a Multi-State FMD Outbreak Crucial to Avoiding a UK Level Uncontrolled Epidemic of Foot and Mouth Disease in the United States, 8.7.2001:

"Alternative policies could be a more economical way of dealing with an outbreak.  As the model’s simulations show, an outbreak could require depopulating California’s entire cattle herd. If it were known in advance that this result was probable, the state might find it more economical to vaccinate the entire herd and quarantine movements with the rest of the US. Stamping 
out would then be applied only to animals that are clearly infected. This approach would result in depopulating many fewer animals and would thus maintain livestock production at a higher level in the years immediately following the outbreak."

The conditions under which alternative policies would be preferable should be evaluated in advance because once an outbreak has occurred, eradication strategies are largely irreversible.

The feasibility of stamping-out depends on the number of animals to be depopulated, as the costs and resources required for rapid depopulation escalate very fast. Vaccination could be used if stamping out becomes unfeasible, but under the present guidelines this would only be known after a substantial number of animals has been slaughtered.  Given the production 
conditions prevailing in California and the U.S., the threshold above which stamping-out is no longer the best policy is not 
known.

Question: In the context of agroterrorism, should an emergency vaccination strategy be included in the initial federal and state response plan in the U.S?