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)
Countries
Congo (Dem. Rep.
of the)
Angola
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
1
1
1
1
1
1
1
2
2
2
1
1
2
2
2
2
2
3
2
2
3
3
2
2
3
3
2
2
3
3
2
3
3
3
3
1
1
2
3
3
3
2
2
3
2
3
4
3
2
3
4
3
3
3
4
3
3
3
4
3
3
3
4
3
3
3
4
3
4?
3
4
3
5
5
5
5
5
4
4
4
4
4
4
Angola zone
Tanzania
Islands (Mafia,
Zanzibar, Pemba)
Malawi
Malawi zone
Mozambique
Moz zone (Tete,
Manica)
Moz zone (south)
Seychelles
HF
Swaziland
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
Zambia
2
2
3
3
3
3
3
3
3
3
5
5
5
5
5
5
5
5
5
5
5
5
3
3
3
3
3
Zambia zone
Zambia zone (East)
Zimbabwe
1
2
3
3
3
zonal (highest PCP)
3
Botswana
3z/5
4/5
4/5
3
4/5
5
4/5
5
4/5
5
4/5
5
4/5
3
N
Level 0
Level 1
Level 2
Level 3
Level 4
Level 5
Z
5
4/5
5
4/5
2
7 4
1
5
6
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””
Reference Centres
(UK, Belgium, Italy, South
Africa, India, Russian Fed –
at 3/09)
Reference Laboratories and
Collaborating Centres
Regional/National
Reference Centres
Pool 3
O, A, Asia 1
Pool 1
O, A, Asia 1
Pool 7
O, A
Pool 5
O, A, SAT 1, 2
Pool 4
A, O, SAT 1, 2, 3
Pool 2
O, A, Asia 1
Pool 6
SAT 1, 2, 3
FMD - Free
Endemic
Free. Virus present in game parks
Free with vaccination
Intermediate, sporadic
Countries with multiples zones
Source: Annual OIE/FAO FMD Reference Laboratory Network Report, 2007
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):
41%
2%
- similar seen in other endemic
countries
7%
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, coldchain 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?
vaccination against FMD in 2008 in Africa
Background : low
reported use of FMD
vaccination
…and limited FMDV virus
intelligence to select
vaccines
Mass vaccination
Zonal vaccination
low vaccination ratio
no vaccination
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
PCP concepts -1
Focus of control – changes
with Stage
5
Maintain zero circulation;
withdraw vaccination
4
3
2
1
Event based
control
(and population
level)
Maintain zero circulation and
incursions
Implement
Control strategy to eliminate
circulation
Population level control
Target
population
Changes with
progression
Implement
risk-based control
Sector or herd level control
Identify risk and control
options
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
5
Surveillance
Maintain zero circulation;
withdraw vaccination
4
3
2
1
Identify risk and
control options
Maintain zero
circulation and
incursions
Implement
Control strategy to
eliminate circulation
Implement
risk-based control
Confirm
FMD free
Objectives
change with
progression
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
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
PCP Regional Roadmaps
South Asia
West Eurasia
Western Africa
Eastern Africa
Central Africa
South America
Southern Africa
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 FMDendemic countries to
progressively reduce the
impact and burden of 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
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
assessment of Stage of a country (or zone)
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
1.Husbandry systems.......are described and understood
2. ....a ‘working hypothesis’ of how FMD virus circulates
in the country has been developed
3.Socio-economic impact .........has been estimated
4.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:
8. 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
Stage 1 examples: Value chain analysis in Iran
• Understanding animal movement patterns can be critical for planning
effective FMD control
Qom
Effective control HERE can
prevent spread downstream
Objective Assessment of Progress of PCP for FMD
Baseline serosurveys -
Using NSP-ELISA to identify FMD prevalance
Uncorrected
Corrected for
known risk
factors
• 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
:Susceptible
)1
)2
host
.
:Contact transmission
.
)direct contact (
Indirect (
)contact
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
1.
2.
3.
4.
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)
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!”
Risk management
FMD control
Legislation
Stakeholder
participation
Communication
Knowledge about FMD
transmission
Mass
vaccination
Biosecurity
measures
Animal
movement
restriction
Quarantine
Veterinary
Services
competence
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
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
5
4
3
2
1
Maintain zero
circulation;
withdraw
vaccination
Confirm FMD free
Maintain
zero
circulation
and
incursions
Institutionalisation
Implement
Control
straegy to
eliminate
circulation
Organisation
Implement
risk-based
control
Identify
risk and
control
options
Studies
Incidence
Objective Assessment of Progress of PCP for FMD
Stage 3 of the PCP: 5 outcomes
1.
Ongoing monitoring of circulating strains and risk in
different husbandry systems
2. 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
3. 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:
5.
There is a body of evidence that FMD virus is not circulating
endemically in domestic animals within the country or zone
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
PCP Stage 4 Focus: “To
maintain ‘zero
tolerance’ of FMD
within the country or
zone and eventually
achieve OIE
recognition of FMDfree with
vaccination”
Event based (respond/eliminate) control - in
addition to population level risk management
Objective Assessment of Progress of PCP for FMD
Stage 4 of the PCP: 6 outcomes
1.
2.
3.
4.
5.
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
6. The OIE requirements for recognition of “free with
vaccination” are fulfilled and a dossier is submitted
to OIE for recognition of this status
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
1.
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.
2008
Shiraz
West-Eurasia regional roadmap
2009
Istanbul
2010
Istanbul
2011
2012
2013
2014
2015
2016
2017
2018
2019
Afghanistan
Armenia
Azerbaijan
Georgia
West Eurasia
I.R. Iran
Iraq
Kazakhstan
Kyrgyzstan
Pakistan
Syria
Tajikistan
Turkey
Turkey Thrace
Turkmenistan
Uzbekistan
3
N
Level 0
Level 1
Level 2
Level 3
Level 4
Level 5
Z
2
7 4
1
5
6
2020
Virus pools and outlook and Regional Roadmap
(South Asia - pool 2)
Countries
2010
2011
2012
2013
2014
2015
2016
2017
Afghanistan*
South Asia
Pakistan*
India
Nepal
Bhutan
Bangladesh
Sri Lanka
* Afghanistan and Pakistan are
participating in the West Eurasia
roadmap
N
Level 0
Level 1
Level 2
Level 3
Level 4
Level 5
Z
3
2
7 4
1
5
6
2018
2019
2020
Outlook of Southern Africa Regional Roadmap
(FAO-OIE meeting in Gaborone, March 2011)
Countries
Congo (Dem. Rep.
of the)
Angola
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
1
1
1
1
1
1
1
2
2
2
1
1
2
2
2
2
2
3
2
2
3
3
2
2
3
3
2
2
3
3
2
3
3
3
3
1
1
2
3
3
3
2
2
3
2
3
4
3
2
3
4
3
3
3
4
3
3
3
4
3
3
3
4
3
3
3
4
3
4?
3
4
3
5
5
5
5
5
4
4
4
4
4
4
Angola zone
Tanzania
Islands (Mafia,
Zanzibar, Pemba)
Malawi
Malawi zone
Mozambique
Moz zone (Tete,
Manica)
Moz zone (south)
Seychelles
HF
Swaziland
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
Zambia
2
2
3
3
3
3
3
3
3
3
5
5
5
5
5
5
5
5
5
5
5
5
3
3
3
3
3
Zambia zone
Zambia zone (East)
Zimbabwe
1
2
3
3
3
zonal (highest PCP)
3
Botswana
3z/5
4/5
4/5
3
4/5
5
4/5
5
4/5
5
4/5
5
4/5
3
N
Level 0
Level 1
Level 2
Level 3
Level 4
Level 5
Z
5
4/5
5
4/5
2
7 4
1
5
6
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
Achievement
To ha ve a comprehens i ve pl a n to study epidemiology and
socio-economics of FMD
Al l hus ba ndry s ys tems , the l i ves tock ma rketing network
a nd a s s oci a ted s oci o-economi c dri vers a re wel l
des cri bed for FMD s us ceptibl e s peci es
Des cri be the FMD di s tri bution a nd devel op working
hypothesis of how FMD ci rcul a tes
Es tima te socio-economic impact on di fferent
s takehol ders
Total
number of
issues
asked for
Minimal
number of
issues
required
Additional
number of
issues
requested
7
4
3
12
10
2
9
5
4
3
3
0
ID ci rcul a ting s tra i ns
Devel opment of ena bl i ng envi ronment, s trengtheni ng
VS
Demons tra te tra ns pa rency a nd commitment to FMD
control i n regi on
3
1
2
8
3
5
2
2
0
Outcome 7
Identify i mportant ri s k hotspots for FMD transmisssion
3
1
2
Outcome 8
To a dopt a strategic FMD control plan, ba s ed on ri s ks a nd
s oc.econom. i mpa cts
10
3
7
To enter Stage 1
Outcome 1
Outcome 2
Outcome 3
Outcome 4
Outcome 5
Outcome 6
Objective Assessment of Progress of PCP for FMD
Assessment checklist –and output as spiderweb
chart
Outcome
Criteria
To enter Stage 1
Plan is
comprehensive
To have a comprehensive plan to
study epidemiology and socioeconomicsof FMD
Outcome 1
Questions
Checklist
–Y/N
-Not
applicabl
e
Is there a written plan in place to study the
1.1 epidemiology and socioeconomic impact of
FMD?
Does the plan include a study of the structure of
livestock production throughout the country for
1.2
all FMD susceptible species (cattle, sheep,
goats)?
1.3
Does the plan include activities to estimate FMD
prevalence?
1.4 Does the plan include a timeline for activities?
Does the plan include a budget estimate for each
1.5
activity?
Quality indicators
Does the plan describe the organisational
1.6 structure to carry out the study (defined roles
and responsibilities, nominated persons)
Have any of the activities described in the plan
1.7
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
Have key stakeholders involved in cattle
stakeholders
1.8
production been identified?
Have key stakeholders involved in small
1.9
ruminant production been identified?
All husbandry systems, the
livestock marketing network and
associated socio-economic drivers
are well described for FMD
susceptible species
1.1
Have key stakeholders involved in swine
production been identified?
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
1.1
well understood for cattle?
Country's percentage achievement totally
Minimum requirements for fulfiling Stage 1
Percentage achievement-required
1
Plan to study of
epidemiological and
soc-economics
0
1
1
1
8. Strategic FMD
control plan
1. Value chain
analysis
1
1
0
7. Identification of
"Hotspots"
6. Commitment to
regional approach
2. FMD distribution &
hypothesis
3. Socio-economic
impact
0
0
0
5. Strengthening
Veterinary Services
4. Circulating strains
Procedure of
assessment
STAGE 1
Self assessment
for Stage 1
Year 1
STAGE 2
External
assessment
for Stage 2
in year x
Self assessment
for Stage 1
Year 2
Self assessment
for Stage 2 in
year x
Self assessment
for Stage 1
Year x
Self assessment
for Stage 2 in
year y
Self assessment
for Stage 1
Year y
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
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
Global Progress
As part of Regional Long Term
Roadmaps
Supporting sustainable National
Strategies
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