A Network of Veterinary Public Health and Zoonotic Diseases in Asia
Electronic conferences
Community-based
Veterinary Public Health (VPH) in Developing Countries
Email
discussion
PRE-Discussion:
20-23 January 2004
Discussion: 1-14 February - 2004
If you are interested to participate please send an e-mail to:
Indicating: subscribe cb-VPH-discussion
Kindly pass on this announcement to other persons who could be
interested to participate in the discussions.
Background
The Millennium Development
goals set out by the United Nations in 1990 include among others, poverty
reduction and improvement of human health. As there are strong links between agriculture/livestock
production, human health and poverty, the field of veterinary public health
(VPH) can make an important contribution to human health through assuring safe
and nutritious food and the prevention of diseases. Furthermore these activities
relate to animal production, environmental health and the delivery of services
at community level.
Animal production,
especially in developing countries, mainly takes place in rural and
increasingly also in peri-urban areas.
For African, Asian and Latin American countries, most of the poor people
still live in rural areas however; increasingly the poor also cluster in urban
areas with a deficient infra-structure.
Rural communities’ settings
in developing countries represent a challenge in public health terms. This is
not only due to their remoteness and inaccessibility in many cases, but also
because of the low level of education and their limited access to information
and healthcare.
Community-based VPH
encompasses several activities, including the identification, prevention and
control of zoonotic and food-borne diseases such as Tuberculosis, Brucellosis,
Anthrax, Leptospirosis, Rabies, etc. Understanding their epidemiology as well
as factors within communities that contribute to their spread is therefore
essential. Since experience suggests
that in most cases, zoonotic and food-borne diseases can be prevented through
changes in behaviour and practices in communities, the inducement for achieving
change has become a major objective. The knowledge and attitudes existing in
the community towards these diseases are the basis for designing and
implementing adequate prevention and control strategies. Public education
programmes need to be culturally-sensitive and socially acceptable, utilizing
the most effective communication channels.
Aims and objectives
The present e-mail discussion emerged on the
initiative of a small group of professionals interested in this field. It is a
follow-up activity to the expert consultation organised by FAO in October 2003
on “Community based VPH delivery systems”.
(Information on the outcome of the expert
consultation can be found on: http://www.fao.org/ag/againfo/programmes/en/vph/events/expert_consult_report.pdf)The present e-mail
discussion envisages to expand on the outcome of the expert consultation. In
addition, it intends to increase the awareness and understanding on the role of
zoonotic and food-borne diseases in rural and peri-urban communities in
developing countries (including their relation to the HIV/AIDS epidemic).
Besides, it will enable the exchange of experiences and ideas between
professionals and other stakeholders from different backgrounds. The overall
goal is to search for effective and sustainable approaches to prevent and
control zoonotic and food-borne diseases, enhance environmental health and
therefore contribute to health and wellbeing of humans and animals especially
in less favoured communities.
Topics for discussion
It has been opted to hold a pre-discussion to
further define the topics that will be addressed during the short but hopefully
intensive discussions. The participants are especially encouraged to provide
inputs and if desired to take the lead in specific issues of their interest.
Some of the areas that are proposed to be addressed are (further areas of
interest can certainly be included!):
- Perceptions: different
perceptions on health and diseases by rural community members and the role
of food, animals and the environment in their transmission
- Risky
behaviours:
what factors contribute to diseases, how to induce behavioural change?
What channels could be used?
- Production
systems and environmental factors: how do they influence the emergence and
persistence of (zoonotic) diseases?
- Relation
between HIV/AIDS and zoonotic diseases in rural communities:
- Epidemiology: surveillance of
existing and emergent zoonotic diseases
- Service
delivery:
what health/veterinary/educational services are required and how can they
be delivered? What are the possibilities for co-operation between the
different sectors involved?
- Upcoming
trends
in service delivery, control methods and information dissemination
- Economic
aspects of disease control of VPH importance
- Geographical
differences
Duration and structure of the email discussion
The discussions will not
follow a pre-conceived structure. The pre-discussion will enable participants
to bring forward subjects of their interest and specific inputs such as
background papers and links that will be made accessible to the other participants.
The participants are welcome not only to contribute to the content of the
discussion but also to guide exchanges on specific topics or make suggestions
on the structure of the e-mail discussion.
During the pre-discussion the different themes,
methods and facilitators will be defined. The objective of this discussion is
to facilitate the exchange of experiences and information between a wide range
of professionals and to explore the issues that relate to effective forms of
VPH delivery at community level.
The pre-discussion will be held from 20-23 of
January 2004
And the e-mail discussion between 1-14 of February
2004
Interested?
Please send an e-mail to;
Indicating: “subscribe to cb-VPH discussion”
If you have any further queries, please feel free
to contact us!
Looking
forward to hear from you
Best
regards
The
Veterinary Public Health team and
The
Pro-Poor Livestock Policy Initiative
Animal
Production and Health Division
Food and Agriculture Organisation
Via delle Terme di Caracalla - Rome
tel. +39.06.57056110 - fax +39.06.57055749
http://www.fao.org/ag/againfo/programmes/en/A6.html
http://www.fao.org/ag/aga/propoor/english/index.html
Some readings/links
§
Zoonoses – VPH
http://whqlibdoc.who.int/trs/WHO_TRS_907.pdf
http://www.fao.org/ag/againfo/programmes/documents/VPHeconf/Home.htm
http://www.paho.org/English/AD/DPC/VP/vp-unit-page.htm
http://www.who.int/health_topics/zoonoses/en/
http://www.fao.org/ag/againfo/resources/en/publications/sector_discuss/PP_Nr2_Final.pdf
§
HIV/AIDS and Agriculture
http://www.fao.org/hivaids/publications/moa.pdf
http://www.fao.org/english/newsroom/news/2003/19743-en.html
http://www.fao.org/english/newsroom/focus/2003/aids.htm
§
Hand Washing
http://www.lshtm.ac.uk/dcvbu/staff/valspage.htm
http://www.lshtm.ac.uk/dcvbu/hygienecentre/
§
Public Health and
Tuberculosis
§
Community-based (animal)
Health Workers
http://www.eldis.org/pastoralism/cape/origins.htm
§
Ethno-medicine - Local
medical knowledge
http://membres.lycos.fr/ethnopharma/links3.htm
http://www.fynu.ucl.ac.be/users/j.lehmann/index.html
_____________________________________________________________________
LIST OF ACRONYMS
AMESH Adaptive
Methodology for Ecosystem Sustainability and Health
BSE Bovine
spongiform encephalopathy
CAHW Community
Animal Health Worker
CD Compact
disc
CDC Centers for Disease Control and Prevention
(USA)
CIT * Countries in Transition
DC * Developing Countries
EU European Union
FAO Food and Agriculture Organization (UN)
GMP Good Manufacturing Procedures
HACCP Hazard Analysis Critical Control Point
IAEA International Atomic Energy Agency
ICT Information and Communication Technology
NGO Non-governmental Organization
PAHO Pan American Health Organization
PAR Participatory Action Research
PC Personal
computer
PCR Polymerase chain reaction
OIE
Office international des epizooties (World Organization for Animal health)
RADISCON Regional Animal Disease Surveillance and
Control Network for North Africa, the Middle East and the Arab Peninsula
TCP Technical cooperation project
VPH Veterinary Public health
WHO World Health Organization (UN)
WVA World Veterinary Association
* The use of the terms
‘Developing Country’ and ‘Countries in transition’ can be ambiguous. Based on
World Bank glossary, a DC is defined as low (64 countries) and middle (93)
income countries in which most people have a lower standard of living with
access to fewer goods and services than do most people in high income
countries. Countries in transition refers to those countries, whose economies
used to be centrally planned by the government but are now changing to
market-based economies.
CONFERENCE BACKGROUND:
In 1999 WHO convened a
conference of invited experts from 18 industrialized, countries in transition,
and developing countries in Teramo, Italy in collaboration with FAO and OIE(1).
The major purpose was to consider the contributions on a global basis of Veterinary
Public Health (VPH) programmes to human health, with a particular emphasis on
the future contributions that VPH could make in developing countries (DC). The consensus definition of VPH at the
Teramo meeting was:
“The
contributions to the physical, mental, and social well being of humans through
an understanding, and application of veterinary science”.
This definition therefore
replaced the original definition of VPH in the 1975 joint FAO/WHO technical
report ‘The veterinary Contribution to Public health Practice’ (2) “ as a component of public health
activities devoted to the application of professional skills, knowledge and
resources to the protection and improvement of human health." It was
believed that this new definition was more consistent with the original WHO
definition of health and also with the values, goals, and targets of the WHO
vision ‘Health for all in the 21st century”.
The scope of VPH is clearly
multidisciplinary, involving not only veterinarians in both government and
non-governmental sectors, but other health professionals and scientists as well
as paraprofessionals who treat, control or prevent diseases of animal origin. A
recurring theme of the meeting was that a team approach to problem solving, research,
control programmes and communication was essential to ensure that veterinary
contributions to the improvement of human health would be both significant and
sustainable.
To publicize the discussions
and recommendations of the Teramo meeting to a wider audience, FAO decided to
sponsor the conference in collaboration with WHO and OIE, and also to focus
primarily on the situation in both countries in transition (CIT) and developing
countries (DC). As a generalization, VPH activities in these two groups of
countries are varied, and limited in scope and delivery. Their priority areas
for the betterment of human and animal health differ markedly from developed
countries. Besides lack of resources, the actual problems faced were different
to those in developing countries.
However there are not only lessons to be learned from developed
countries, but also greater opportunities for cooperation at all levels. Human
and animal health problems are inextricably linked. Health problems are also
not confined to specific regions, nor respect international borders, and may
extend across ethnic, and political divides.
A background paper was
prepared summarizing the deliberations and recommendations of the Teramo
meeting and posted on the conference website (3). The Conference was announced
on ProMED and several other list servers. Potential participants were invited
to sign up and forward contributions to the Moderator who edited them and then
forwarded to all participants. A set of rules for conduct of the conference was
promulgated and participants authorized the sponsors to reference, summarize
and quote all or part of a participant’s contribution for this summary. Contributions were then posted on the
Conference web site. Approximately 700 individuals signed up and contributions
were received from 60. Approximately eighty countries were represented
including many DC and CIT.
CONFERENCE OBJECTIVES AND
DISCUSSION TOPICS:
The major objective was to provide an
open forum for strategy planning in the development or revival of VPH services
to improve both human and animal health. These strategies need to be
technically sound, cost-effective, equitably available, and take advantage of
economies of scale normally associated with the public good delivery of services.
Traditionally VPH activities have included (2,4) but not limited to:
§
Zoonoses diagnosis, surveillance, control, prevention and
eradication.
§
Occupational hazards and diseases associated with live
animals and their products.
§
Biologics development and production
§
Control of Animal populations which may serve as reservoirs
or be noxious.
§
Prevention and control of foodborne illness of animal
origin.
§
Ante-mortem and Post-mortem meat and poultry inspection.
§
Participation in outbreak investigations.
§
Environmental activities including vector, water, wildlife
and use of animal monitors.
§
Biomedical research
§
Emergency actions including natural and man-made disasters.
§
Social aspects including natural and man-made disasters.
§
Social aspects including service animals and human animal
bonding.
A series of
nineteen discussion topics was developed under four general headings as
follows:
A. VPH in the 21st Century.
B. Future Trends that will challenge VPH in the
21st Century.
C. Organization and Management of VPH
programmes.
D. Education,
Training and Extension in VPH.
NOTE: All
contributions are numbered and posted on the Conference Website (3),
http://www-data.fao.org/waicent/FaoInfo/Agricult/AGA/AGAH/VPHeconf/Home.htm
A.VETERINARY PUBLIC HEALTH IN THE 21ST
CENTURY:
1. WHERE DO YOU RECOMMEND
THAT VPH PROGRAMMES AND VETERINARIANS IN DEVELOPING COUNTRIES DIRECT THEIR EFFORTS
TO ATTAIN THE GREATEST EFFECT ?
The basic principle of VPH
programs in DC (Dr.D.Allard et. al. Contribution # 38) should be to deliver
fundamentals of public health programs as close as possible to the individual,
small group, or community. These should include basic hygiene principles,
quarantine and isolation, biosecurity, inexpensive vaccines as well as more
sophisticated priorities such as surveillance systems, diagnostic capability,
treatment options, and depopulation capability. Programmes should evolve in
technical complexity and scope as they are developed over time. This implies
that a coherent and coordinated approach is best. The ideal would be zoonotic
disease control and food safety programmes that educate the individual in
methods and practices that can be carried out at zero to low cost with minimal
equipment and materials. These programs would ultimately require considerable
human resource investments, but little monetary investments especially if the
human resources came from the local community. Training at the top of the
pyramid could be delivered by outside agencies.
In establishing objectives
and priorities that will influence the development and effectiveness of VPH
programmes in DC, consideration should always be given to such factors as the
geographical characteristics of the country, its stage of development, the
current situation with zoonoses (both
impact on health and socio-economic), and also import/export trade in animals,
animal products and human foods of animal origin (Dr A.Panin, Contribution
#36).
The probability of success in
any zoonotic disease control/eradication programme should be a major
consideration (Dr R.Jackson, Contribution #40). Pre-requisites for success include,
effective methods for stopping or reducing agent transmission, high
socio-economic importance and epidemiological features that allow good case
detection, and surveillance for measuring progress and providing information
that can be used to make changes as required. Programmes that are likely to
succeed are also most likely to attract funding for the duration of the
programme. A programme with these features is likely to be attractive to the
public, veterinarians, health workers and policy makers. For most countries
there will probably only be a few diseases that have these necessary
prerequisites, and therefore determining ones to give priority to is usually
fairly easy and does not necessarily require a sophisticated economic analysis.
While donor funding may be helpful at the start, the aim should be to
eventually obtain sustainable ongoing within country funding. There is a very
real and urgent need to develop low cost options for control programmes in DC.
These are more likely to appeal to policy makers also. While there is a
tendency to choose the “latest and greatest” sophisticated tests and methods,
often these may only be viable in countries with well-developed and often
subsidized livestock industries. Pilot exercises to test the feasibility of
large-scale programmes are also an essential prerequisite.
Dr Jackson also proposed that
echinococosis is an ideal candidate for a national control programme in DC.
Praziquantel is highly efficacious and cheap drug for use in the definitive
hosts and experience has shown that public awareness and involvement can be
easily incorporated in control programmes. Surveillance can proceed relatively
cheaply with minimal use of expensive tests. While total eradication may not be
a feasible goal at this stage for some countries, reasonable control in animals
and a significant reduction in new cases in humans (especially children) should
be achievable in most situations. A zoonotic disease such as cystic
echinococcosis with dogs as definitive hosts has added attractions as other VPH
issues of concern such as rabies; mailings and human toxocariasis can be
incorporated into an integrated control programme for additional benefits at
marginal cost.
Dr Jackson also argued that
other high profile zoonotic diseases in DC such as brucellosis
(especially due to B.melitensis) control programmes have
had variable success. There probably has been an over- emphasis on development
of improved vaccines and tests but insufficent emphasis on the basic
epidemiology as an essential means of control. More attention should be given
to monitoring key indicators of disease status and also factors that influence
disease transmission and collecting information on the effectiveness of
specific interventions. Analysis of local surveillance data gives valuable
insights into the epidemiology of the disease within the country.
Finally Dr Jackson suggested
that the time is opportune for DC to gradually move away from heavy reliance on
regulatory and task-oriented disease control programmes towards a more
responsive approach based on risk analysis and management (5,6). Unfortunately these approaches have been
used for many years and are firmly entrenched within the veterinary profession.
As an example he cited the often used and popular surveillance for chemical
residues in DC, yet these are likely to be associated with very low levels of
risk compared to other VPH concerns.
Dr H.Mainzer (Contribution
#22) made the point that if VPH programmes focus only on zoonoses, there is the
risk that this will be the only contribution that veterinarians can make to
promote human health. He makes the point that outbreaks keep occurring and we
keep making the same recommendations. Surveillance and diagnostics do not stop
disease - they only identify it. These public health emergencies are failures
of prevention. Veterinarians need to become involved in all aspects of the
agent/host/environment causation triad so as to identify and develop logical
evaluations, design sound intervention systems and ultimately effective
prevention strategies. At least in the USA veterinarians are involved in
environmental health, vaccine preventable disease programs, disaster
response/assessment, chronic disease and nutrition, occupational health, injury
control, food, drug water, waste issues, pet-facilitated therapy, HIV/AIDS,
teaching managing public health programs and organizations. Veterinarians
should focus on the ‘big’ picture of public health systems and processes that
allow ALL disease/injuries to occur-not just the veterinary ones.
Dr P.Schantz (Contribution
#45) presented a succinct history of VPH in the USA. The Center for Disease
Control has over the last 50 years established itself as the United States’
premier public health agency for epidemiology and prevention. Veterinarians
have been an integral part of the program since its inception and CDC was an
active partner in defining the field of VPH and in developing programs and
policy. A separate VPH Division was created at CDC in 1947 and over the next 28
years made major contributions in the areas of foodborne diseases, and zoonotic
infections such as rabies, psittacosis, trichinosis, cystercercosis, anthrax
and leptospirosis to name only a few. The Division also conducted field
investigations, assisted States in inaugurating new programmes and provided
laboratory support for all aspects of animal diseases transmissible to humans.
The Division also provided support to foreign countries and to WHO for
assistance in panning VPH programmes. In 1975 all discipline-oriented groups at
CDC were abolished and the personnel therein were moved to multidisciplinary
groups dealing with related groups of diseases. While some perceived this as a
setback and threat to VPH, however in practice this administrative change freed
up veterinarians to consider a broader range of career possibilities at CDC.
Now veterinarians are eligible and selected for whatever positions they can
successfully compete on the basis of their qualifications and interests.
Currently there are 70 veterinarians at CDC assigned to 10 different Centers,
Institues or programme offices. Besides being active in zoonoses research and
control, they are working in HIV/AIDS, the national immunization programme,
environmental health, occupational health and international health. Many former
CDC veterinarians are now employed as State Public Health veterinarians and
maintain a functional liaison with CDC through the National Association of
State Public Health Veterinarians. Even when the current responsibilities of
veterinarians at CDC do not involve issues of animal health or veterinary
medicine they often affirm that their educational experiences had been very
appropriate for preparing them to deal with their current tasks. The veterinary
orientation to “herd health” is a metaphor for community health.
CDC has also formed close
links with the US Department of Agriculture and the Food and Drug
Administration. This has proved of great value in the investigation of
foodborne disease, by for example,
traceback of meat incriminated in outbreaks, investigation of other endemic and
emerging zoonotic diseases, and coordination of national surveillance for food
and waterborne disease.
Looking to the future, it is
certain that the challenges of public health in the next 50 years will be
different from those of the past. It is clear that veterinarians are prepared
and willing to work with colleagues from other disciplines to respond to these
challenges and to develop effective programs to continue to improve the
public’s health.
Moderators Comments:
Hopefully these multidisciplinary approaches will in the future expand in
developed countries. However in most DC, the pressing need is for veterinary
expertise to control zoonoses such as rabies, brucellosis and echinococcosis,
recognize that animal disease outbreaks may be sentinels for emerging
environmental health risks (7), as well as improve the safety of food of animal
origin. VPH programs as a whole will be more likely to succeed if tangible
successes are demonstrated in initial component projects and these are
sustainable.
2. SHOULD COUNTRIES OR
REGIONS SET TARGETS FOR THE REDUCTION OF SPECIFIC ZOONOTIC INFECTIONS IN RELATION TO THEIR BURDEN OF DISEASE?
The ‘burden’ of disease as
measured by WHO uses mathematical models and analyses to arrive at outcome
measurements for mortality and disability for a specific disease (8). While this technique has certain
limitations, approximately 90% of the worldwide burden of all causes of death
and disability occur in developing regions of the world. However only 10% of
all health care funds are spent in these regions. Communicable diseases, with
the exception of HIV/AIDS and tuberculosis are expected to decrease by 2020.
Six disease categories (pneumonia and influenza, AIDS, diarrhoeal disease,
tuberculosis, malaria and measles) are responsible for 90% of the estimated
13.3 million deaths in children and young adults due to major infectious and
parasitic diseases (9). Zoonotic agents
contribute in several of these categories. Rabies is the leading cause of
zoonotic deaths and accounts for 40,000-60,000 deaths per year, while other
zoonotic agents such as monkeypox occur at very low levels. e.g. 500 reported
cases since 1992. Clearly surveillance for many zoonoses in DC is subject to
many biases, especially under- reporting of endemic infections.
There appeared to be general
support among conference contributors for the development of specific zoonotic
disease population-based targets for reduction of incidence/prevalence, but
with the caveat that these should be of real public health importance within
that country. For example, it was stated
(Dr D. Allard et al Contribution
#38) that it would probably be best to
word the targets as a percentage reduction from currently reported rates of
various zoonoses in the country, with priority setting of targets influenced by
level of risk (probability x severity) to human health, animal health, and
economic impact. Although risk and to a certain extent prevalence are very
important, ease of implementation and sustainability of the programs over time
must be considered. Programs which rely heavily on external funding and input
in the long-term or indefinitely are less likely to be maintained.
Moderators comments: Where
budgets for health care in DC are very small, it is critical that what funds
available are used where they will do the most good. A recent example from
Tanzania (10) showed that instead of collecting health data from clinics,
door-to-door surveys were carried out to determine deaths and disability and
their symtomatology. A ’burden of disease’ profile was developed, and using
this information health spending was redirected to the actual burden the
communities experienced.
3. WHAT TYPES OF ASSISTANCE
DO DEVELOPING COUNTRIES NEED FROM INTERNATIONAL AGENCIES SUCH AS WHO, FAO AND
OIE, AND ALSO BILATERAL DONORS TO IMPROVE/EXPAND THEIR VPH PROGRAMMES?
A number of contributors
addressed this topic and mentioned the need for:
§
Assistance in the prioritization, support, and implementation of control
and eradication programs for zoonoses of major public health importance.
§
Organization of regional meetings and workshops on zoonotic
diseases.
§
Support for applied research by way of technical cooperation projects
(TCP) to provide training and other expertise.
§
Assistance in the design and implementation of health information
systems.
Dr A.El Idrissi (Contribution
#44) observed that public health authorities in most DC were interested in
zoonotic disease only when the incidence/prevalence was high or during
epidemics. It was also noted that while FAO/OIE/WHO frequently organized groups
of experts to make recommendations on strategies and guidelines to control
zoonotic diseases, there were few joint or common initiatives between these
organizations to develop cohesive VPH programs in developing countries. Joint
interregional scientific programs including both medical and veterinary
professionals from relevant institutions in clusters of countries with similar
epidemiological problems should be developed. Priority should be given to
integrated control programs for rabies, brucellosis, tuberculosis and major
foodborne diseases for example. Another area where international organizations
can play an active role is to ensure education and technology transfer for VPH
programs and support their adaptation to meet local and regional needs in DC.
It was also noted with
concern that WHO currently has no veterinary public health experts in their regional
offices-apart from PAHO in the Americas.
While it has been shown that
some zoonotic diseases are eradicable (e.g. brucellosis, hydatidosis) in
developed countries where there is strong public support and an efficient
administrative infrastructure, This is usually not possible in DC. Dr M.
Lightowers (Contribution #1) makes a strong case for international
organizations such as FAO and WHO as well as bilateral donors to identify and
promote scientific advances, which clearly have the potential to achieve
genuine improvements in zoonotic disease control and prevention. He cited the
example of cystic hydatid disease (Echinoccocus
granulosis) and bovine cystercosis (Taenia
saginata) where highly effective and practical vaccines have been developed
based on the identification of host-protective recombinant antigens (11). The
challenge will be not only to establish ‘good manufacturing practices’( GMP)
production of these vaccines but how they may be best used in developing
countries to reduce the burden of human illness. Ultimately commercialization
of production will be required. The test will be whether these products can
give long-term protection at a reasonable cost.
The actual type of assistance
needed by each DC may be similar in some areas and quite different in other
areas (Dr J.Calder, Contribution # 19).
To take a ‘one size fits all’ approach could be counterproductive. Often
there is a need for both technical and professional support. However the needs
for each country or and region has to be developed at the country and regional
level with local input. There is clearly a temptation for a person who has
worked in a developed country for any length of time to want to take back all
the technology available, but unfortunately in most cases the infrastructure to
maintain it may be lacking. Therefore before assistance is given to a DC an
assessment should be done to see whether the infrastructure is there to support
the type of aid that is to be given.
Other contributors also gave examples of national zoonoses laboratories
built with international assistance but never completed, furnished, or equipped
adequately, nor staffed with trained individuals. .
Networks are an example of
both developed and DC countries joining to focus on a particular VPH problem
.The Informal Working Group on Echinococcosis (P.Schantz, Contribution # 23)
was created in 1985 under the auspices of WHO specifically to promote
scientific exchange and cooperation in research of this parasitic zoonosis.
Currently this group consists of a variety of networks of individuals from many
countries dedicated to areas of research and intervention selected according to
the needs and interests of participants and also the priority areas for
research in those countries most affected by the disease. Current network
subject areas include development, evaluation and standardization of methods
for diagnosis in animal and human hosts, treatment options, evaluation of
vaccines in intermediate hosts, and measurement of economic costs. Although
network activities and research are not directly funded by WHO, the group does
play an important role in defining priorities, coordinating activities and
promoting communication.
Dr S. Sandor (Contribution
#13) described how both WHO and the EU support a comprehensive program to
control and prevent both cystic and alveolar echinococcosis in Romania. Future
plans are to include other southeast European and Balkan countries. Dr M.
Kachani (Contribution#37) indicated that a similar approach was started some
years ago in Morocco and it has hoped to include other Mahgreb countries in the
future. Other areas where international
organizations can assist is in developing, translating and distributing
educational material on VPH issues. For example educational materials developed
in Morocco for Echinococcosis (Hydatidosis) in both Arabic and French can be
used in all North African (Mahgreb) countries where the disease situation is
similar.
All international agencies
have a variety of publications available that may be of use to those in DC
responsible for VPH and zoonoses control. Unfortunately these may be
unavailable, out of print, or in some cases cost prohibitive. Making these
publications available via the Internet or through CD-ROM’S is one solution.
International agencies might also give consideration to making generic computer
simulation models and epidemiological / geographic information systems more
readily available for those working in VPH issues in DC (12,13). This would include within country
demonstrations and courses designed to encourage their use for routine
reporting of disease, analysis of disease patterns, and economic analyses of
costs and benefits.
B.
FUTURE TRENDS THAT WILL CHALLENGE VETERINARY PUBLIC HEALTH
IN THE 21st CENTURY:
IDENTIFIFY
METHODS THAT WOULD IMPROVE THE DELIVERY OF VPH PROGRAMMES IN DEVELOPING
COUNTRIES IN THE FOLLOWING GENERAL AREAS:
4. ACCESSES TO AND RAPID
TRANSFER OF SCIENCE- BASED INFORMATION ESPECIALLY TO THOSE WITH A ‘NEED TO
KNOW’
Dr D.Allard et.al
(Contribution #38) emphasized the need for electronic tools that do not require
high computing power or rapid Internet lines such as: E-mail list-based
discussion groups or conferences, electronic bulletin boards with maintenance
of discussion threads, on-line reading access to VPH discussion documents
(often unpublished) and Power Point presentations suitable for lectures, etc.
Good examples of distance learning sites include the multilingual Supercourse -
“Epidemiology, the Internet, and Global Health” (14) and ”Emerging Infections
of International Public Health Importance” (15).
Dr E.Jette (Contribution #3)
stated the focus should be on electronic access, networking and training by
developing and strengthening access to information for both DC and CIT. This
would strengthen not only the technical veterinary expertise but also their
administrative infrastructure-the former cannot function in a vacuum. A
suggestion was made that the Animal Health Service staff of FAO could maintain
an interactive internet site where VPH related questions could be asked and
answered say with a 48 hour turnaround. There was also an urgent need for
electronic training packages on zoonoses, and food inspection, etc. However
there was concern expressed (Dr.B. Gummow, Contribution # 4) that at present
especially for many African countries, access to the Internet was both
frustrating in terms of delays and also very costly. These problems are
unlikely to be solved in the short term and thus reliance will have to continue
on paper- based continuing education material supplemented by CD’s. It is now
possible to place whole or parts of web sites on a stand alone PC or on CD’s.
How to make important and
up-to-date information more readily available to those in VPH with a ‘need to
know’ was raised by several contributors. For example Dr R. Jackson
(Contribution #40) cited the example of the recently published WHO/OIE Manual
on Echinococcosis in Humans and Animals (16). This is a unique and current
compilation of just about everything known about these diseases. While it is
available for purchase, should it (as well as all OIE publications) not be
available on-line at the OIE web site given the difficulties of those working
in DC to obtain overseas currency?
Dr A.El Idrissi (Contribution
#44) noted that scientific and technical libraries in DC are unable to afford
subscriptions to many journals, which may run as high as $1500(US) per
year. While some VPH related journals
are now available on line free (17) others limit access to subscribers for
current issues, while other journals are unavailable electronically.
Several contributors raised
the issue of how current and accurate was the information on specific zoonotic
disease websites. This problem not just confined to these sites. Often
information is required promptly, and there is little time to review the
original literature. In general University or Government websites tend to be
more reliable than other sites. Hopefully in the future, the scientific peer
review process as used for journals will eventually be used to categorize web
sites. Original publications are usually neither available nor immediately
useful for practical application.
There are a number of list servers now in operation that provide current and valuable VPH and zoonoses information. Some have restricted membership while others are open to all. Probably the most widely recognized is multilingual ProMED mail (18) established to provide an early warning of emerging diseases of humans, animals and plants as well as diseases activities signaling biological warfare and bioterrorist activities. ProMED has a number of specific categories of lists including ProMED-Ahead which focuses on animal hea