Improving the Safety of Food International aspects Jørgen Schlundt, Department of Food safety, Zoonoses and Foodborne Diseases, Seattle, April 2008

Food Safety, Zoonoses, Foodborne diseases Mission: To lower the burden of disease from food and animals through the communication of sound science and the provision of effective tools to all levels of society WHO Headquarters, shown here, is located in Geneva, Switzerland. WHO is one of the most decentralized of the UN agencies with Regional Offices in Copenhagen, Washington, Manila, New Dehli, Cairo and Brazzaville, Congo.

What is "Foodborne Disease Burden"? Diseases commonly transmitted through food All causes - pathogens, chemicals, parasites Acute and chronic diseases Long-term complications Morbidity, disability and mortality 1.8 mio deaths/year % foodborne? 7.3 mio deaths/year Morbidity? Disability? Diarrhoea Cancers

Foodborne disease Is a problem in both developing and developed countries Is a strain on health care systems Creates a vicious cycle of diarrhoea and malnutrition Hurts the national economy and development, and international trade.

WHO Surveillance Programme for Control of Foodborne Diseases in Europe Campylobacteriosis trends BgVV; Berlin

FAO/WHO Codex Alimentarius Commission - its mandate - Dual objective: Protecting the health of consumers Facilitating fair practices in food trade Non-mandatory in nature, Codex standards and related texts have since 1995 become international benchmarks for harmonization under the SPS and TBT Agreements of WTO

Codex Meeting Rome

Risk Analysis Risk Communication Risk Assessment Risk Management FAO/WHO Expert Bodies FAO/WHO Codex Alimentarius Commission I would like to use the remainder of my time today to talk about how WHO works with risk managers like Codex in a process called risk analysis. Risk analysis is a process composed of three parts: Risk management, risk assessment, and risk communication. Risk assessment is the scientific evaluation of known or potential adverse health effects resulting from human exposure to foodborne hazards. WHO together with FAO conduct scientific evaluations of known or potential adverse health effects resulting from human exposure to foodborne hazards. Risk communication is an interactive process of exchange of information and opinion on risk among risk assessors, risk managers, and other interested parties. Risk management is the process of weighting policy alternatives in the light of the results of risk assessment and, if required, selecting and implementing appropriate control options, including regulatory measures. An international risk manager for the protection of public health from foodborne illness already exists. The Codex Alimentarius Commission establishes international policy for food safety. Risk Communication  Interactive exchange of information and opinions concerning risks

Codex Alimentarius - its scientific basis - Liaison & Separation Codex – Risk management FAO/WHO Expert Bodies JECFA – food additives, vet. drug residues, contaminants in food JMPR – pesticide residues in food JEMRA – microbiological hazards in food ad hoc Expert Consultations Risk assessment

Outbreak Dose Response Model Salmonella Reasonable dose-response model based on “real world” data

the infection process should be viewed as This means the infection process should be viewed as a probability of infection related to the dose ingested For Salmonella 10-20% probability for infection with a dose of 100 organisms, 50-90% probability for infection at 1,000,000 organisms. For Listeria 10-9 to 10-13 probability with a dose of 100 organisms, and a 10-6 to 10-9 probability with a dose of 1,000,000 organisms

Intervention: Prevalence Strategy for Salmonella in Poultry Prevalence and expected risk has linear relationship 50% reduction in prevalence results in 50% reduction in risk Chicken Prevalence 1% 5% 10% 20% 50% 90% Annual expected human case rate per 100,000 3 12 21 43 104 192

If your problem relates to chicken you can lower it 40 times This means a solution going to the Farm could work: If your problem relates to chicken you can lower it 40 times If you lower the prevalence in chicken (unless you import US chicken)

Scientific analysis – probabilistic modeling Safety cannot be achieved by testing alone Lot: 0.1% defectives 10 samples: Probability of detection ~ 1%

JEMRA Output Codex use Each MRA is published in two formats. A short version of the work is published as an interpretative summary. This document is less technical in nature and is primarily focussed at risk managers (members of the CCFH) or other less technical audiences. It summarises the work including limitations and uncertainties. All the details of the MRA are also published in a comprehensive technical report. This report will include details of all the data used in the assessment, the way in which it was used, the modelling approaches that were used. This publication is aimed at scientists and risk assessors.

What is needed to improve food safety? National systems covering farm-to-fork seamlessly Based on the principle of reducing risk International system building capacity in developing countries Significant proportion of food is imported Prevention at the source is the most efficient food safety measure International system detecting contamination / outbreaks Rapid communication, capacity to verify and make decisions, Procedures to respond and capacity to assist One inter-linked system (covering both intentional and accidental contam)

INFOSAN – The International Food Safety Authorities Network ''Only if we act together can we respond effectively to international food safety problems and ensure safer food for everyone'' Dr Margaret Chan – Director-General

What is INFOSAN? INFOSAN is a global network of food safety authorities that: • disseminates important global food safety information • improves collaboration with a goal of preventing the international spread of contaminated food. INFOSAN is an information network for the world-wide dissemination of important food safety information. The INFOSAN Focal Points are government officials in an agency related to the regulation of food. They are expected to receive INFOSAN information and disseminate it to the appropriate stakeholders in their country.

INFOSAN Emergency Actions Average of 200 per month 1 or 2 per month Surveillance Reports Action Follow Up / Verification 10 – 20 per month Request for Additional Information Initial Assessment Final Assessment Every month the INFOSAN global surveillance identifies an average of 157 notices that are a potential food safety concerns of international significance. On average, there are about 10.5 food notices that require follow up activity by INFOSAN. Since the INFOSAN Emergency network is activated only for food contamination events that are serious and involve international trade, on average there is 1.25 INFOSAN Emergency notices sent out each month. Local issue – NO ACTION Criteria not met NO ACTION

Examples of INFOSAN Emergency ALERTS "Information traveling faster than rumour" September 2006 E.coli 0157:H7 in spinach to all members of INFOSAN Provided contact information for countries receiving primary distribution. For secondary distribution meant all INFOSAN member countries notified. November 2006 Glass found in oatcakes exported to 3 countries All affected countries informed South Africa noted this enabled undertaking action to protect public health September 2007 Shigella in baby corn exported to 3 countries Distribution records identified three countries who received the affected product, INFOSAN members and National IHR Focal Points were notified This slide presents some examples of INFOSAN Emergency Alerts and the impact of the notification of the event In July 2005 Salmonella was discovered in Powdered infant formula that was shipped from France to 13 mostly African countries. All 13 countries received the ALERT message and most countries replied to the request for follow up information and reported that they received official information only from INFOSAN, In November 2006 Glass found in oatcakes that had been exported to 3 countries. INFOSAN Sent an ALERT message to all 3 countries. In response to this message, one of the affected countries South Africa, sent a message to the INFOSAN Secretariat noting that base upon the information provided by INFOSAN they were able to take actions that protect the heath of their citizens In March 2007, the US determined that a major brand of peanut butter was contaminated with Salmonella. The product had been shipped to almost 70 countries and territories. In addition, the product had been sold on the internet, making product tracing very difficult. All INFOSAN members very notified

Economic and Social Development Better than Development Aid Food safety and Poverty Reduction - from a developing country’s viewpoint- Codex Standards (by 174 Member States) Application to export products (by trade sector) Application to Domestic legislation (by health sector) Note: WTO/SPS Agreement requires its Members States to base their sanitary measures on international standards (i.e. Codex Standards on Food Safety) Safety assurance and improved access to Importing country 1 Improvement of Health Efficient Food Safety systems will improve national health as well as export (and tourist sector) potential Poor systems can lead to major food safety incidents setting back the national economies for several years Increased foreign exchange earnings Economic and Social Development & poverty reduction