FAO-EuFMD-OIE Progressive Control Pathway for FMD Presented by Keith Sumption – with acknowledgements to PCP team in FAO, EuFMD and OIE Regional Consultative Seminar on the preliminary work of the GF-TADS FMD Global Working Group on the FAO-OIE Global Strategy for the control of FMD November 2 – 4 2011, OIE Headquarters in Paris, France

The PCP for FMD Background; the rationale Development, application and refinement Stage definitions and Criteria Assessment Acknowledgements This is the work of MANY

Outlook of Southern Africa Regional Roadmap (FAO-OIE meeting in Gaborone, March 2011) 3 5 4 6 7

Summary PCP-FMD : In use since 2008 Joint FAO-EuFMD-OIE Tool 5 stages Outcome oriented , evidence based Strategy development Gap analysis Comparative Work in progress: Tools for assessment linkages to PVS IS: a tool to assist strategy development - in an area of potential policy conflicts

Background – FMDV distribution across 7 virus “”pools”” Regional/National Reference Centres Reference Laboratories and Collaborating Centres Reference Centres (UK, Belgium, Italy, South Africa, India, Russian Fed – at 3/09) Intermediate, sporadic Endemic FMD - Free Free. Virus present in game parks Free with vaccination Countries with multiples zones Source: Annual OIE/FAO FMD Reference Laboratory Network Report, 2007 Pool 1 O, A, Asia 1 Pool 2 Pool 3 Pool 6 SAT 1, 2, 3 Pool 4 A, O, SAT 1, 2, 3 Pool 5 O, A, SAT 1, 2 Pool 7 O, A

Background – serotype distribution Background – serotype distribution. But at animal level – what is the risk of infection?

Background: the scale of infection: - FMD as a “”common childhood illness”” – newly recognised as serology becomes widely applied 2% Turkey Infection in first year of life (2007): similar seen in other endemic countries 2% 7% 41% 54% 28% Age class <1 year Survey at animal markets in Turkey (2008) - for exposure to FMD (NSP +ve) FAO-EUFMD/EC/GDPC

Background: public-private policy issues affecting progress lack of incentives at national level lack of incentives at producer level to invest in prevention lack of opportunity to purchase vaccine (state controlled access, limited or no suppliers, cold-chain issue) lack of technical advice to guide vaccine purchase commonplace high risk situations: open borders/ classical transboundary rangeland issues, and wildlife-domestic interface lack of confidence in the vaccination approach to area wide FMD control FMD is common and damaging disease – but who benefits and who should pay for control?

Background : low reported use of FMD vaccination …and limited FMDV virus intelligence to select vaccines

Background – the behaviour challenge : FMD control –what’s in it for me?

Background – the market chain challenge “if I was vaccinated, I would be less risk when traded”

Critical control points.......or already too late in the infection chain?

Background – the scale of under-reporting Wagging fingers does not change reporting behaviour

Faced with such challenges…the PCP –FMD needed to be : Simple – to communicate, and apply Comprehensive – technically sound, critical factors for success are addressed Credible – progress must be validated with evidence Progressive – easy to enter, each stage a base for progress Risk based – with focus on optimising impact of limited resources, avoid prescriptions Rewarding – potential gains from every Stage Objective – promoting and rewarding active monitoring and the use of evidence Environmentally neutral – and part of the solution to develop integrated approaches involving wildlife

5 4 3 2 1 FMDV Incidence PCP concepts -1 Implement risk-based control 2 1 Identify risk and control options Maintain zero circulation and incursions 4 Control strategy to eliminate circulation 3 Maintain zero circulation; withdraw vaccination 5 PCP concepts -1 Focus of control – changes with Stage Event based control (and population level) Target population Changes with progression Population level control Sector or herd level control FMDV Incidence Objective Assessment of Progress of PCP for FMD

PCP Concept 2 Monitoring (and at higher levels – Surveillance) - is a key principle of the PCP Implement risk-based control 2 1 Identify risk and control options Maintain zero circulation and incursions 4 Control strategy to eliminate circulation 3 Maintain zero circulation; withdraw vaccination 5 Surveillance Objectives change with progression Confirm FMD free Early detection & response to incursions Monitor implementation & impact of the control program Monitor FMD epidemics – and & risk as needed to develop risk-based control program Objective Assessment of Progress of PCP for FMD

Objective Assessment of Progress of PCP for FMD PCP Concept 3 – countries desire recognition of effective efforts and actions - PCP as an enabling tool for regional FMD control W. Eurasia Roadmap to 2020 measured forecast Regional Roadmaps chart Measured progress to 2020 Forecast progress (Expert Opinion) Permits comparison between countries Objective Assessment of Progress of PCP for FMD

The Progressive Control Pathway (PCP) for FMD control developed by FAO/EuFMD in 2008 pathway leading from “”endemic”” towards “free status”” applied in West Eurasia, and for developing Roadmap for subregions of Africa, South Asia ; enables assessment of country progress within a Region between Regions self-assessment at National level Identifies gap and assists project formulation provide progress indicators for donors/investment Since 2011 a Joint FAO/EuFMD/OIE tool

PCP – stepwise along the road Country Stages - facilitate progress monitoring at national and regional level Global scale -across Regional Roadmaps and at every stage generates information for risk assessment

Areas where PCP-FMD has been used- in assessment, and longer term planning

The Progressive Control Pathway for Foot and Mouth Disease (PCP-FMD) : definitions and criteria for progress 5 stages that progressively increase the level of FMD control Developed by FAO and EuFMD Intended to assist FMD- endemic countries to progressively reduce the impact and burden of FMD

Objective Assessment of Progress of PCP for FMD PCP-FMD May be applied at national level ...OR targeted geographically &/or to specific husbandry system(s) Each stage has well-defined outcomes ...which may be achieved through a variety of activities (NON-prescriptive approach) Evidence based and transparent assessment of Stage of a country (or zone) Tools used in PCP Monitoring for impact - Repeated serological surveys Reference laboratory services – vaccine matching Socio-economic studies; identify options and approaches Auditing interventions Evidence based decision support Objective Assessment of Progress of PCP for FMD

Objective Assessment of Progress of PCP for FMD PCP Stage 1 Focus: “To gain an understanding of the epidemiology of FMD in the country and develop a risk-based approach to reduce the impact of FMD ” Comparable with Risk Assessment Objective Assessment of Progress of PCP for FMD

Stage 1 of the PCP: 8 outcomes Husbandry systems.......are described and understood ....a ‘working hypothesis’ of how FMD virus circulates in the country has been developed Socio-economic impact .........has been estimated The most common circulating strains of FMDV identified 5. ........progress towards an enabling environment for control activities 6. ..... transparency and commitment to .....regional FMD control 7. Important risk hotspots for FMD transmission are identified

AND TO PROGRESS TO STAGE 2: A strategic FMD control plan that has the aim of reducing the impact of FMD in at least one zone or husbandry sector is developed

Objective Assessment of Progress of PCP for FMD Stage 1 : Gain understanding of epidemiology and develop risk-based approach to reduce FMD impact Understand Epidemiology Host Environment Agent Composition and distribution of FMD-susceptible species Livestock Wildlife FMD Husbandry systems Movements & marketing Socio-economic impact Strength of veterinary services Holistic approach Prevalence Circulating viral strains Spatial distribution Objective Assessment of Progress of PCP for FMD

Objective Assessment of Progress of PCP for FMD Stage 1 : Gain understanding of epidemiology and develop risk-based approach to reduce FMD impact Develop a risk-based approach: Identify risks: key transmission pathways, based on understanding of epidemiology A strategic FMD control plan that has the aim of reducing the impact of FMD in at least one zone or husbandry sector is developed Required to progress to Stage 2 Objective Assessment of Progress of PCP for FMD

Stage 1 examples: Value chain analysis in Iran Understanding animal movement patterns can be critical for planning effective FMD control Effective control HERE can prevent spread downstream Qom Objective Assessment of Progress of PCP for FMD

Baseline serosurveys - Using NSP-ELISA to identify FMD prevalance Corrected for known risk factors Uncorrected Can be useful to target control Baseline for comparison after interventions introduced Objective Assessment of Progress of PCP for FMD

PCP Stage 1 –developing national ownership of strategy

Objective Assessment of Progress of PCP for FMD PCP Stage 1 – main focus is on FMD risk assessment - to identify options for revised control strategy Assess relevant aspects of Epidemiology Value chain – drivers for animal production Diagnostics Socio-economical impact Strength and capacity of Veterinary Services Participation in Regional FMD meetings - cooperation and transparency in reporting Sheet to emphasize that Stage 1 is primarily to assess the FMD risk as input for strategy development, with illustrations related to Iran Objective Assessment of Progress of PCP for FMD

Objective Assessment of Progress of PCP for FMD PCP Stage 2 Focus: “To implement risk based control measures such that the impact of FMD is reduced in one or more livestock sectors and/or in one or more zones” Comparable with sector level Risk Management Objective Assessment of Progress of PCP for FMD

Stage 2 of the PCP: 5 outcomes Ongoing monitoring of circulating strains and risk in different husbandry systems Risk-based control measures are implemented for the sector or zone targeted, based on the FMD strategic control plan developed in Stage 1 It is clearly established that the impact of FMD is being reduced by the control measures in at least some livestock sectors and/or zones There is further development of an enabling environment for control activities AND TO PROGRESS TO STAGE 3: 5. A revised, more aggressive control strategy that has the aim of eliminating FMD from at least a zone of the country has been developed

PCP Stage 2 - examples of national strategies FMD as a private good: Private sector (stakeholders) can purchase quality vaccines Emphasis on private sector action to protect themselves Public role is to monitor FMD risk in wider population, licensing vaccines, and communication (epidemics, encouragement to buy vaccination in risk situations) Example: Kenya - most FMD vaccination is paid by stakeholders. Transition issues: mix of partial state supply and private purchases leaves many gaps.

PCP Stage 2 : other examples FMD as private and public good: Define sectors that can pay for their vaccination (smallholder dairy?) Define zones where public funded control is for public good: e.g along borders, around wildlife reservoirs Reach stakeholder consensus, implement and monitor impact in each sector/zone Examples: State funded buffer zone vaccination, private sector vaccination elsewhere FMD as a public good State supported FMD control zones to protect the rest of the population (HIGH RISK areas)

Objective Assessment of Progress of PCP for FMD Stage 2 : Implement risk based control measures such that the FMD impact is reduced Development of measurable, objective indicators essential to Demonstrate reduction in FMD impact E.g. Repeated surveys to estimate prevalence, socio-economic studies Prove that reduced impact is related to the control measures E.g. Vaccine quality assurance, inspections to measure compliance with biosecurity and/or movement restrictions, repeated KAP surveys (Knowledge Attitude & Practice) Objective Assessment of Progress of PCP for FMD

PCP Stage 2 have focus is on FMD risk management Or as stated by one CVO : “Surveillance activities in their own right do not reduce FMD impact. That needs decisions, actions and evaluation!” Like to emphasize the need for management, making use of the information collected, analysed and interpreted under the assessment, Stage 1 and converting this into control measures feasible and finetuned to the local situation.

Objective Assessment of Progress of PCP for FMD Stage 2 : Organisational models Central Task Force: defining goal and objectives, developing control strategy and implementation, assessing impact. This sheet and the next may be used for illustrative purposes Objective Assessment of Progress of PCP for FMD

Risk management FMD control FMD Knowledge about FMD transmission Legislation Mass vaccination Biosecurity measures Quarantine Animal movement restriction Stakeholder participation Veterinary Services competence FMD Illustration used to position required control measures (Grey) and supportive requirements/environment (Green) for implementing control measures. During the last mission we have used this to clarify the need to have a central task force that needs to be supported by people in the field to implement control measures but also to have support from stakeholders and Ministries on budgetting, law enforcement, communicaiton etc. Communication Finances Objective Assessment of Progress of PCP for FMD

AND TO PROGRESS TO STAGE 3: A revised, more aggressive control strategy that has the aim of eliminating FMD from at least a zone of the country has been developed Objective Assessment of Progress of PCP for FMD

Objective Assessment of Progress of PCP for FMD PCP Stage 3 Focus: “Progressive reduction in outbreak incidence, followed by elimination of FMD virus circulation in domestic animals in at least one zone of the country” Comparable with population level Risk Management Objective Assessment of Progress of PCP for FMD

Moving up means institutionalisation of FMD control Implement risk-based control 2 1 Identify risk and control options Maintain zero circulation and incursions 4 Control straegy to eliminate circulation 3 Maintain zero circulation; withdraw vaccination 5 Confirm FMD free Institutionalisation Organisation Studies Incidence Objective Assessment of Progress of PCP for FMD

Objective Assessment of Progress of PCP for FMD Stage 3: Progressive reduction in incidence, followed by elimination of FMD virus circulation Again, measurable, objective indicators essential to demonstrate reduction, and eventual elimination, of FMD (E.g. Repeated surveys) Rapid detection and response for all FMD outbreaks Objective Assessment of Progress of PCP for FMD

AND TO PROGRESS TO STAGE 4: Stage 3 of the PCP: 5 outcomes Ongoing monitoring of circulating strains and risk in different husbandry systems The disease control plan developed at the end of Stage 2 is implemented, resulting in rapid detection of, and response to, all FMD outbreaks in at least one zone in the country There is further development of an enabling environment for control activities 4. The incidence of clinical FMD is progressively eliminated in domestic animals in at least a zone in the country AND TO PROGRESS TO STAGE 4: There is a body of evidence that FMD virus is not circulating endemically in domestic animals within the country or zone

Objective Assessment of Progress of PCP for FMD Stage 3 of the PCP NB: Once a country has entered the GF-TADs–supported PCP-Stage 3 and has decided it wants to continue along the pathway to Stage 4 and beyond, implicating the intention to eradicate FMD virus from the domestic animal population, it may ask for formal OIE-endorsement of its national FMD eradication programme Objective Assessment of Progress of PCP for FMD

AND (TO Repeat) – to PROGRESS TO STAGE 4: There is a body of evidence that FMD virus is not circulating endemically in domestic animals within the country or zone Objective Assessment of Progress of PCP for FMD

Objective Assessment of Progress of PCP for FMD PCP Stage 4 Focus: “To maintain ‘zero tolerance’ of FMD within the country or zone and eventually achieve OIE recognition of FMD-free with vaccination” Event based (respond/eliminate) control - in addition to population level risk management Objective Assessment of Progress of PCP for FMD

AND TO PROGRESS TO STAGE 5 Stage 4 of the PCP: 6 outcomes Continued FMD surveillance and risk monitoring The risk of FMD entering the country or zone is mitigated FMD incidence is very low: only occasional incursions from outside (which must eventually cease if successful application for recognition of “free with vaccination” is to be achieved) The environment enables the full implementation of control measures A plan is developed to fulfil the requirements for OIE recognition of “FMD-free with vaccination” status AND TO PROGRESS TO STAGE 5 The OIE requirements for recognition of “free with vaccination” are fulfilled and a dossier is submitted to OIE for recognition of this status

Objective Assessment of Progress of PCP for FMD PCP Stage 5 Focus: “To maintain ‘zero incidence’ of FMD within the country/zone and eventually achieve OIE recognition of FMD-free without vaccination” Event based (respond/eliminate) control - in non-vaccinated populations Objective Assessment of Progress of PCP for FMD

Stage 5 of the PCP: 2 outcomes Zero incidence of FMD outbreaks is maintained in domestic livestock AND TO EXIT STAGE 5 AND COMPLETE THE PATHWAY: 2.The OIE requirements for recognition of “FMD-free without vaccination” are fulfilled and a dossier is submitted to OIE

Assessment of national PCP stage Don’t forget me when you make your paper strategies

Assessment of PCP Stages –West Eurasia FMD Roadmap 2008: self-assessment by countries with peer review (FAO) 2009 (Istanbul): upon submission of evidence of actions required at each stage presentation/review at Regional Meeting 2 month period post-Meeting to supply information , if required 2009: Roadmap progress on track 2010: second Progress Review . Used modified PCP following October 2010 review.

West-Eurasia regional roadmap 1 2 3 5 4 6 7

Virus pools and outlook and Regional Roadmap (South Asia - pool 2) 1 2 3 5 4 6 7 * Afghanistan and Pakistan are participating in the West Eurasia roadmap

Outlook of Southern Africa Regional Roadmap (FAO-OIE meeting in Gaborone, March 2011) 3 5 4 6 7

Objective Assessment of Progress of PCP for FMD Tool 1: Self Assessment Written questionnaire for veterinary services: Follows PCP Guidelines – Outcomes for each Stage Questions based on defined criteria and questions -each Outcome Yes/no answers explained by manual Minimum Requirements differ by outcome Yearly completion - to retain status, demonstrate commitment Enables PCP- Gap Analysis Enables review/revision of forecast progress Yearly completion recommended Objective Assessment of Progress of PCP for FMD

Tool 2: External Assessment (work in progress to refine procedures) External assessment includes FAO (and OIE experts) reviewing national self-assessments Expert review with national authorities - FAO/OIE Workshops Country visits – assessment with national representatives Regional Meetings with opportunities for countries to assess presented progress reports -peer-to-peer scrutiny Comparison of progress on paper – with evidence from monitoring and surveillance reports Year to Year change -both “”paper”” and direct measures (incidence) Objective Assessment of Progress of PCP for FMD

Assessment of PCP Stage 1: checklist for the 8 Outcomes Objective Assessment of Progress of PCP for FMD

Assessment example - PCP Stage 1 Same as one before, now with percentage achievements assessed for Iran in 2011 Objective Assessment of Progress of PCP for FMD

Assessment checklist –and output as spiderweb chart –Y/N -Not applicabl e To enter Stage 1 1.1 Is there a written plan in place to study the epidemiology and socioeconomic impact of FMD? 1 1.2 Does the plan include a study of the structure of livestock production throughout the country for all FMD susceptible species (cattle, sheep, goats)? To have a comprehensive plan to study epidemiology and socio- economics of FMD 1.3 Does the plan include activities to estimate FMD prevalence? 1.4 Does the plan include a timeline for activities? 1.5 Does the plan include a budget estimate for each activity? 1.6 Does the plan describe the organisational structure to carry out the study (defined roles and responsibilities, nominated persons) 1.7 Have any of the activities described in the plan been initiated? Stake holders include farmers/producers PLUS all of the main players (people,organizations,companies) involved in breeding, transport of animals, milk/meat processing, feeding and marketing of animals. There could be scoring for these questions: identified all, most, some, none Outcome 1 1.8 Have key stakeholders involved in cattle production been identified? 1.9 Have key stakeholders involved in small ruminant production been identified? All husbandry systems, the livestock marketing network and associated socio-economic drivers are well described for FMD susceptible species Have key stakeholders involved in swine Information should be available about numbers, origin and destination, drivers or motives for the movement and any seasonal patterns there could be scoring based on how completely movements have been described (eg origin and destination known but not numbers, or for commercial farms only...) Are movements of animals within the country well understood for cattle? well understood for small ruminants? well understood for swine? into the country well understood for cattle? understood for small ruminants? understood for swine? If there is transhumance or nomadic peoples, are their movement patterns understood? Outcome Criteria Questions Plan is comprehensive Quality indicators stakeholders movements

Procedure of assessment STAGE 2 Procedure of assessment Self assessment for Stage 2 in year x Self assessment for Stage 2 in year y External assessment for Stage 2 in year x STAGE 1 Self assessment for Stage 1 Year 1 Self assessment for Stage 1 Year 2 Self assessment for Stage 1 Year x Self assessment for Stage 1 Year y

Objective Assessment of Progress of PCP for FMD Required achievements (in blue) are meant to cover the minimum requirements (red) Red is now red! Objective Assessment of Progress of PCP for FMD

Self assessment: output

Verifiable indicators: results from monitoring Sero-monitoring: Incidence (NSP serology, options) Year-on-year change Performance of vaccination Auditing of vaccination implementation Performance of movement control systems Surveillance –performance of different components Virological – for indicators of incursions and internal movements Again, illustrations from Iran, Percentage inhibition of NSP testing in WAZB and vaccination coverage in September 2011 (so, just one month. We prefer to present this by vaccination campaign, thus 2 or 3 months. However, data are not yet available).

Assessment of PCP Stage 3 Objective Assessment of Progress of PCP for FMD

PCP – Plenty to Chew over, Properly

Summary PCP-FMD In use since 2008 Joint FAO-EuFMD-OIE Tool 5 stages Outcome oriented , evidence based Strategy development Gap analysis Comparative Work in progress: Tools for assessment linkages to PVS

Working together Supporting sustainable National Strategies As part of Regional Long Term Roadmaps Global Progress

Acknowledgements Giancarlo Ferrari, Julio Pinto, Peter De Leeuw Melissa McLaws, Chris Bartels (EuFMD Epi-Team) Nadege Leboucq (FAO & OIE) EUFMD Commission member states CVOs of West Eurasian countries EC (DG-SANCO –Trust Fund; Alf Füssel) FAO (J. Domenech, J. Lubroth, G Ferrari, J Pinto) OIE (G. Bruckner, J Domenech) FAO World Reference Laboratory (WRL) Pirbright (D Paton, Jef Hammond) Supporting centres: EUFMD Secretariat staff (Nadia Rumich) RAHCs in Beirut, Tunis, FAO Ankara and Cairo