Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases (2009) / Chapter Skim
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8 Recommendations, Challenges, and Looking to the Future
8 Recommendations, Challenges, and Looking to the Future
Pages 235-268
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From page 235... ...
Limited surveillance and response capacities at the national level represent more than just a national threat; they are, in fact, a serious global threat, especially in countries in which the drivers of zoonotic diseases are most concentrated and where experts predict that zoonotic disease emergence is most likely to occur. The implication of this is clear: that all countries, in partnership with private and public stakeholders, should develop, maintain, and globally coordinate integrated surveillance and response capabilities to prevent, detect, and respond to the emergence of zoonotic diseases in order to limit loss of life and livelihoods.
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From page 236... ...
commitment to provide technical assistance to other countries and to increase its participation in developing international animal health standards for preventing, detecting, and responding to zoonotic diseases. An effective zoonotic disease surveillance and response system needs to be integrated across sectors and disciplines so that it identifies and responds to human and animal disease threats at the earliest time possible, without regard to national boundaries or professional discipline.
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From page 237... ...
to spearhead efforts to achieve a more effective global surveillance and response system, learning from and informing the experiences of other nations. Given finite resources and the complexity of the challenge, an integrated zoonotic disease surveillance and response system can succeed only if the
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For example, surveillance is needed in the following high-risk human populations: • Occupational groups that are at high risk for infection with zoonotic diseases. Such workers include livestock, dairy, and poultry workers; live-animal market workers; veterinarians and animal health technicians; hunters of bushmeat and other wildlife; food preparers (and restaurant workers handling food prepared from bushmeat and exotic animals)
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From page 239... ...
. To detect subclinical or unnoticed infections, ministries of agriculture and natural resources should develop capacity to systematically test laboratory specimens from domesticated animals and wildlife that are at high risk of serving as zoonotic disease reservoirs (e.g., bats, wild aquatic birds, and nonhuman primates)
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While the focus of this committee is primarily scientific, it recognizes that advocacy groups can also provide an important push for integrated surveillance by urging relevant policy changes involving food production, wildlife conservation, poverty alleviation, and global health. Economic: Financing and Incentives for Surveillance and Response Establish Sustainable Funding Strategies Recommendation 2-1: USAID -- in partnership with international fi nance institutions and other bilateral assistance agencies -- should lead an effort to generate sustainable financial resources to adequately sup port the development, implementation, and operation of integrated zoo
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From page 241... ...
government, other countries, and intergovernmental organizations to design and implement strategies that will provide sustainable resources for zoonotic disease surveillance and response. National government access to realigned and new funding should be made conditional on fulfillment of agreed criteria of participation, including the willingness to conduct national assessments of surveillance and response capacity and have such assessments independently reviewed (see Recommendation 2-2)
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From page 242... ...
This has led to the committee's recommendation for further study on a product tax for internationally traded meat and meat products, which represent an important route for the emergence and spread of zoonotic diseases. This levy would be imposed primarily on wealthier exporting countries (see Table 6-4)
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From page 243... ...
and the Terrestrial Animal Health Code, respectively -- to facilitate better governance strategies for zoonotic disease threats. The committee concluded that these positive developments can and should be supplemented by the establishment of an overarching global coordinating body.
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While these initiatives are directed towards human disease, they represent technical models that can be applied to animal disease. Effective use of such technologies facilitates acquisition, integration, management, analysis, and visualization of data sources across hu man and animal health sectors and empowers information sharing across local, national, and international levels.
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To develop the plan the working group should take steps that include 1. conducting an inventory and assessing the quality of the current global capacity for laboratory diagnosis and reporting of zoonotic diseases in human and animal health laboratories; 2.
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. Implementation would include oversight and monitoring of infrastructure development; developing performance standards for network laboratories; reviewing, recommending, and harmonizing diagnostic assays for zoonotic diseases, standardized equipment, and standard operating procedures; overseeing development and validation of new assays when needed; assisting with the provision of reference standards and reagents; ensuring an integrated laboratory network information system (Recommendation 1-2 on information and communication technologies)
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-- should be funded to partner with educational institutions and relevant ministries to develop field-based, integrated, interdisciplinary model curricula and training programs for emerging zoonotic disease surveillance and response. Educational institutions should include U.S.
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• Clinical and pathological diagnosis of emerging zoonotic diseases in humans and animals. • Specimen collection, storage, and transportation for laboratoryconfirmed diagnosis.
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To field a capable workforce that can prevent, detect, and respond effectively to emerging zoonotic infectious diseases, there needs to be political will, priority assigned to surveillance and response, commitment across disciplines, adequate funding, and strong coordination at national and international levels. Establish a Zoonotic Disease Drivers Panel Recommendation 1-5: The U.S.
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It is essential that there is an organizational architecture to ensure that specialized groups such as this do not function in isolation, but are a part of an integrated global system. Economic: Financing and Incentives for Surveillance and Response Create an Audit and Rating Framework for Surveillance and Response Systems Recommendation 2-2: USAID should convene a technical working group to design and implement, by the end of 2012, an independent mechanism to audit and rate national surveillance system capacities for detecting and responding to emerging zoonotic disease outbreaks in humans and animals.
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An independent audit and rating framework can help public and private stakeholders identify problems and develop common strategies in an effort to improve national and global capabilities for integrated human and animal zoonotic disease surveillance and response. To the fullest extent possible, information generated by these reviews should be made publicly available.
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Efforts to control the international spread of zoonotic diseases include trade and travel restrictions that place significant economic hardship on reporting countries. The international community can also minimize the unnecessary cost of sanctions at both levels by using existing regulatory mechanisms, like zoning
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, as well as smallholder farmers and community representatives to determine how best to build trust and communication pathways among these communities in order to achieve the efficient bi-directional flow of both formal and informal informa tion needed to support effective, evidence-based decisionmaking and coordinated actions. The complexity of achieving sustainable, integrated national and global surveillance and response systems for zoonotic diseases requires deliberate and intensified efforts to engage and connect all relevant stakeholders at each governance level -- local, national, and global.
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Articulating the range of possible benefits can improve public acceptance of measures and behaviors designed to reduce the risk of zoonotic disease emergence and spread. Starting at the local level, steps for cooperative action include a better articulation and quantification of potential benefits and costs.
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(d) Empower the OIE Director-General to declare animal health emer gencies of international concern with respect to emerging or re emerging zoonotic diseases that constitute a serious animal or public health risk to other countries and issue recommendations about how countries should address such emergencies.
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(b) Incorporate efforts and initiatives that support actions to prevent, prepare for, protect against, and respond to threats to human and animal health into current and new international negotiations and cooperative processes that address drivers of zoonotic diseases (e.g., exotic pet trade, food safety and security, environmental degradation, and climate change)
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The goal requires unprecedented collaboration on multiple levels: at global, regional, and national levels; among government, industry, academia, and the public; between human and animal health communities, including those working on livestock, poultry, companion animals, and wildlife; and across many disciplines, such as field epidemiology, clinical science, pathology, laboratory science, animal husbandry, social science, communications, economics, and national and international law and governance. These challenges need to be overcome in order to successfully implement a multisectoral and integrated approach to zoonotic disease surveillance
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Uncoordinated Approaches in Designing and Implementing Zoonotic Disease Surveillance and Response The committee frequently referred to multiple players involved in designing, implementing, and evaluating disease surveillance and response systems at local, national, and international levels. The result of these multiple players has been many different, often vertical and single-disease oriented systems that generally have incompatible implementation approaches.
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In response to the fragmented national and international responses to human and animal health emergencies, there is now considerably greater attention with respect to the need to increase and strengthen multisectoral and multilateral collaborations for emerging zoonotic disease surveillance and response. This multidisciplinary approach is being promoted under the banner of "one health," defined as "the collaborative effort of multiple disciplines -- working locally, nationally, and globally -- to attain optimal health for people, animals and the environment" (AVMA, 2008, p.
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Political Will and Elevating Integrated Surveillance and Response to Emerging Zoonotic Diseases as a Priority Among the many challenges for establishing an integrated surveillance and response system is the lack of political will to address emerging zoonotic health threats. Furthermore, health is often assigned as a low priority by political leadership; there is an accompanying lack of commitment to finance the system; ownership of the disease surveillance system is unclear; and there are often conflicting partner priorities.
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From page 261... ...
As these countries are also confronted with HIV/AIDS, malaria, and tuberculosis, for which considerable international assistance has been generated, it is no wonder that national policymakers are unable to allocate scarce resources to newly emerging zoonotic diseases. Any support that has been directed towards zoonotic disease control has come mainly through external and vertical targeted programs.
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The committee reemphasizes that full implementation of IHR 2005 is the bedrock for building a new integrated and sustainable human and animal surveillance and response system for emerging zoonotic diseases. With increasing disease risks related to globalization of trade, in 2007– 2008, the OIE refined an evaluation tool originally developed in collaboration with the Inter-American Institute for Cooperation on Agriculture to produce the Performance of Veterinary Services tool.
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2009, these examples show how delayed information reporting can result in the further spread of disease. Although subsequent catch-up efforts in the latter two examples finally enabled human and animal health experts to effectively connect and collaborate with each other, those connections had to first be forged during the outbreak, enabling the disease to spread and making it more difficult to contain.
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This also requires countries to ensure that responses intended to prevent spread and limit the impact on human and animal health, including the financial and economic consequences of a local or global outbreak, are evidence-based and prompt. The recommendations in this report are broad in their reach and involve technical, financial, and organizational inputs, and they include significant changes in the way global governance of zoonotic disease surveillance and response should be handled.
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RECOMMENDATIONS, CHALLENGES, AND LOOKING TO THE FUTURE • Determining efficacy of and resistance to antibiotics and antivirals; • Evaluating the effectiveness of laws and regulations on compliance with reporting requirements; • Evaluating the effectiveness of integrated zoonotic disease prevention programs; • Identifying and evaluating social and economic incentives to comply with and disincentives to ignore reporting requirements; • Identifying incentives for communicating, cooperating, and building trust across sectors and disciplines; • Evaluating the timeliness and level of response that results from early warning systems and the separation of accurate reports from falsepositive ones; • Developing community-based participatory research in the epidemiology of zoonotic diseases; • Developing social incentives at the local level to promote early disease reporting, avoid outbreak concealment, and engage in effective responses; • Evaluating how communities understand zoonoses epidemiology, prevention, and treatment in order to foster local participation in disease reporting and surveillance activities; and • Tracking media representations of zoonotic diseases and assessing how information is produced, circulated, and responded to by the community and policymakers. To evaluate its progress and impact, it is essential to periodically conduct an in-depth review of how the zoonotic disease surveillance and response system is implemented and functions.
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From page 266... ...
Reaching the goal of a sustainable and better integrated global human and animal surveillance and response system for zoonotic emerging diseases depends on a number of preconditions: sufficient political and social will to accomplish it; allocation of necessary financial and technical resources in a sustainable and continuous way; and ensuring that human and animal health officials have the authority and resources to regulate the drivers associated with zoonotic disease emergence, to report emerging events as they occur, and to determine the proper interventions based on the specific nature of the agent and the circumstances of the emergence itself. This is certainly a tall order, but given that political will and financial resources have been individually marshaled for one emerging zoonotic disease after the other, the committee believes that it is possible to create a reliable and sustainable zoonotic disease surveillance system that is flexible, has assured funding, is efficiently implemented, and is acceptable to all stakeholders.
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Washington, DC: The National Academies Press. OIE (World Organization for Animal Health)
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