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FOOT AND MOUTH DISEASE LESSONS LEARNED INQUIRYNote of meeting Date: 8 April 2002
Location: 9 Whitehall
Present: Dr Alex Donaldson - Institute for Animal Health (IAH) Pirbright Laboratory
Dr Iain Anderson, Inquiry Chairman
Alun Evans, Secretary to the Inquiry
1. Dr Anderson welcomed Dr Donaldson and introduced the Inquiry. Dr Donaldson had prepared a presentation which he used to illustrate some of his remarks. During discussion the following points were made:
2. Pirbright’s mission related to major livestock diseases (as classified by OIE) that had potential for great economic impact. Its main function was research into 11 out of the 16 OIE List A diseases. There were eight Reference Laboratories at Pirbright including the World Reference Laboratories for FMD and Rinderpest. Through its contacts throughout the world, Pirbright maintained its expertise and with its biosecure facilities, it had provided an emergency diagnostic service for FMD since 1924.
Slide 1 illustrated the main elements of Dr Donaldson’s involvement during the crisis.
AI DONALDSON’S ROLE DURING THE UK FMD EPIDEMIC
Clinical investigation at first confirmed outbreak in Essex Provision of advice and information to SVS, MAFF/DEFRA. Official FMD Science Group, international organisations. Other authorities, the media and general public
3. Dr Donaldson had investigated the first case at the Essex abattoir which had already had been confirmed by the laboratory. He had inspected and aged the lesions on affected animals, and discussed the case with the Chief Veterinary Officer (CVO) on 20 Feb.
- Directing the activities at IAH, Pirbright in support of the SVS:
- epidemiological investigations of early outbreaks
- virological (diagnosis) and serological investigations
- formulation of emergency vaccine <
- recruitment of additional staff
- deriving data for airborne prediction models
- directing & participating in experiments to characterise the UK virus (virulence, excretion and transmission)
- directing quality assurance accreditation management system
- directing the validation of diagnostic tests
- directing the evaluation of real-time PCR tests
4. He had also been invited to join the Chief Scientific Adviser’s (CSA) Science Group, which first met officially on 26 March. He had also previously attended the meeting convened by Sir John Krebs on 21 March.
5. Pirbright had provided advice and information to other groups and to international organisations, as described on the slide. Personally, Dr Donaldson felt that he had had to devote a disproportionate amount of his time to travelling to London to attend meetings of the CSA Science Group time, and to media handling, during the early stages of the crisis.
6. Two of Dr Donaldson’s colleagues, Paul Kitching and Soren Alexandersen, had been involved with the epidemiology of the first outbreaks. Both had visited the pig farm at Heddon-on-the-Wall and the Ponteland farm, and Dr Kitching had also visited the first Devon case. Professor Alexandersen had gone to the pig farm in Essex. Pirbright had not been called out to field investigations after that. The epidemiological work had been written up, submitted for publication and was expected to be published soon.
7. Pirbright’s work was focussed initially on the following tasks:
Virological investigation. Manual serological testing (robotics having not proved satisfactory). Analysis of the risk of airborne spread since pigs had been implicated. Experiments on the precise characteristics of the causal virus. MAFF had insisted that the work done at Pirbright on their behalf duing the emergency should be under an accreditation system and that the diagnostic tests used should be only fully validated. They also required that there should be a full audit trail. In all some 200 extra staff were recruited during the crisis.
8. Asked about the mission of Pirbright, Dr Donaldson said that since it was part of the Biotechnology and Biological Sciences Research Council (BBSRC), the mission of Pirbright was research on exotic viruses - to understand their basic properties and their interaction with host species including their maintenance and transmission. The mission was decided by the Director of the Institute for Animal Health (of which Pirbright was a part) and the Governing Body, which included the CVO.
9. Pirbright’s funding of £29 million per year was about 30-35% from BBSRC, about 30-35% from DEFRA and the rest from other contracts, such as from the Department for International Development, selling reagents and test kits.
10. Dr Anderson commented that, as a semi-independent institute, it was not clear how such a vital resource was tied into the national priorities. Dr Donaldson pointed out that one of the reasons for the establishment of the research councils had been to give scientific activities independence from political issues. The BBSRC reported eventually to the Department of Trade and Industry.
11. No other institute in the UK matched Pirbright’s expertise. Its possession of an FMD reference collection dating back to 1924 gave the laboratory the unique capability to compare samples of virus from the field with those in the reference collection and thereby to determine their origin in many cases. The only other laboratory licensed to work with live FMD virus in the UK was Merial, the vaccine producer, which was located next to the Pirbright site. During the outbreak five other laboratories had been licensed to perform serological tests.
12. MAFF/DEFRA was aware of Pirbright’s capabilities since the Chief Scientist was on the council of the BBSRC. However, Pirbright had not been consulted in the drawing up contingency plans and Dr Donaldson was concerned that their only mention in the interim contingency plan produced recently by DEFRA related to training.
13. Responding to a suggestion that the country would not have coped without Pirbright, Dr Donaldson agreed that laboratory confirmation of the first suspected cases was essential, following which disease control required efficient management and resources to stamp it out. That, in turn, depended on the scale of the outbreak and whether serological surveillance was required to confirm freedom. Many outbreaks had consisted of just one outbreak. The epidemics of 2001, 1967/8 and 1952 were unusual in that respect and may therefore have reflected lack of resources to tackle them. There were examples of countries that had dealt with the disease without reliance on the World Reference Laboratory – such as Greece, Bulgaria, and Italy – who instead relied on their own national FMD Laboratories during emergencies.
14. Pirbright had been contracted by DEFRA during (not before) the epidemic. During “peacetime”, MAFF/DEFRA usually funded service projects on an annual basis, and it had an arrangement for the processing of 300 samples a year.
15. Pirbright did not have a written contingency plan for managing largescale epidemics. Experience had shown how resources should be redeployed and they had tested their ability to ramp up vaccine supplies, as necessary. That said, the scale of the epidemic had been much greater than expected.
16. The volume of media enquiries had increased such that after about two weeks, they were dealt with by another part of IAH to allow Dr Donaldson to concentrate on other priorities. Specific enquiries directed to Dr Donaldson were, however, addressed as soon as possible. During the crisis IAH logged over 2,000 enquiries from the media and public.
17. Resources at Pirbright had been, and still were, an issue, with retention and recruitment difficulties at all levels. Consultants, ex-PhD students and scientists working in the private sector had volunteered to help Pirbright during the epidemic. In 1983 there had been 13 vets but now there were only four.
18. Research for DEFRA was funded through DEFRA’s Science Directorate, but Page Street (formerly Tolworth) funded monitoring and surveillance services. Pirbright was assessed on the quality of its scientific research. The BBSRC assessed the totality of the research via Visiting Group assessments every four years. Pirbright received high ratings because its science was recognised as being of international standard. DEFRA assessed the DEFRA-funded science in separate reviews, the last of which had been in June 1999. The following one, scheduled for February 2001 had been postponed due to the FMD emergency. Whilst the contracts for services were reviewed twice every year, the services themselves were not reviewed regarding quality and efficiency. Dr Donaldson agreed that the services should be reviewed in the future.
19. Turning to the characteristics of the Pan Asia O strain, Dr Donaldson said that the virus had been identified as a serotype O virus on 20 Feb, confirmed as a Pan Asian strain within 24 hours. There had been three considerations:
20. It had been found, in 1997, that the strain of virus which caused a large epidemic in Taiwan was very virulent for pigs but not for cattle or sheep. Therefore, Dr Donaldson had been cautious about making assumptions about the properties of the UK strain both in terms of its virulence and the amounts emitted as aerosols. He had suspected from studies on the airborne excretion of a Pan Asia strain from South Korea that the UK strain would have lower excretion.
- Nucleotide sequencing had previously shown that members of the Pan Asia group of strains had been present in many countries
- Some strains had differed in their virulence for various species but the UK strain had been found to be virulent for cattle, sheep and pigs
- The UK strain had, surprisingly, been found to be emitted as airborne virus in lower amounts than other strains and therefore the distance of spread by this means was likely to be less than for other strains of the virus.
21. Airborne spread was not only influenced by levels of excretion, but also by climatic effects such as humidity and wind speed. Topography was also important. For example, the spread in the Ribble valley could have been affected by the wind direction and humidity. Windborne spread was especially likely to cattle which were very susceptible to infection by inhalation.
22. The evidence for the airborne spread from the farm at Heddon-on-the- Wall had been strong. Pirbright’s collaboration with the Met Office pointed to a period when plumes over Ponteland had clearly been possible. However, other than during the early stages, airborne spread had not been a major mechanism of spread during the epidemic. MAFF/DEFRA had estimated that some 80% of transmission of virus had been by local spread. Dr Donaldson suggested that this could have been due either to breaches of biosecurity or short distance airborne spread by atmospheric prediction models were estimates and not absolutes.
23. Other possibilities such as the following had been considered but were unlikely to have played large roles:
24. That the Heddon-on-the-Wall case had arisen from feeding illegally imported meat to pigs was credible since pigs were relatively susceptible to infection by the oral route.
- Water in streams: unlikely – since virus would be quickly diluted and livestock were relatively resistant to infection by ingestion, probably because virus was inactivated by the low pH of gastrointestinal tract
- Aerosol transmission between pigs kept physically separated – unlikely since experimental results had shown that pigs were difficult to infect by aerosols of virus and direct contact was usually necessary.
25. Asked whether walkers could have spread FMD from footpaths, Dr Donaldson replied that he was not aware of any evidence of such spread. There were reports in the literature for other epidemics of stockmen and vets spreading disease by handling animals. Animals could be easily infected when they were handled around the mouth by people contaminate with the virus but mechanical spread by other means did not readily occur.
26. The disease was unlikely to have been spread by infected deer. No evidence had been found for their involvement. The 400 serological samples (300 of which from a herd in Cumbria) had all tested negative. About 100 virological tests (some of which had been repeated by PCR) had also been negative. All five species of deer had been shown to be capable of transmitting the virus to livestock, but since they were solitary animals, they were unlikely to have had direct contact with infected animals (e.g. on farm).
27. Dr Donaldson had realised that the outbreak would not be easily dealt with once he had heard about the dealer in Devon who had been linked to cases in the north of the country and had been the owner of ten other farms. The seriousness of the outbreak had become evident when the CVO had phoned Dr Donaldson and informed him about the use of a 3 km cull in Cumbria. He had never known such a policy to have been used before on a sustained basis.
28. Dr Donaldson had criticisms of the scientific basis of the mathematical models and the influence they had had on disease control policy. He strongly disagreed with the conclusions of the modellers about their forecasts for the development of the epidemic. The predicted epidemic curves had been based on parameters from the 1967/8 epidemic which had been cattle-driven; they had taken no account of the wide difference between FMD in various species and between farming systems. The influence of spatial factors on the rate of disease spread had not been included in the models. An average infection to confirmation period of 8 days had been used by the modellers but this had been a gross over-simplification since several cycles of infection with incubation periods ranging from 2 to 14 days had been possible. The epidemic had been in decline by the time of the introduction of the contiguous cull policy on 29 March. (In a publication by Keeling and co-authors, it was stated that the epidemic peaked on 26 March with 54 outbreaks per day.)
29. The disease could be controlled and the virus eradicated if control measures were implemented quickly and effectively. The priority should have been to concentrate the resources on the infected premises (IP) rather than diluting the scarce resources to contiguous premises where it had been believed, without any proof, that animals had been incubating the disease. As a result, many negative cases had been slaughtered – on average four to five contiguous farms for every IP. At one stage of the epidemic it had been estimated that fifty per cent of cases on contiguous premises (CPs), dangerous contacts (DCs) and slaughters on suspicion (SoSs), as well as 20% of infected premises (IPs), had tested negative.
30. It was impossible to determine whether the contiguous culling was scientifically tenable since samples had not been routinely taken on CPs, despite his requests for a properly conducted trial to collect the data. DEFRA may have taken samples. However, if the animals had been incubating disease, serological samples would not have been useful since they might have been viraemic and not yet have seroconverted.
31. The contiguous cull policy had been a reasonable policy to pursue at the start of the epidemic, especially in Cumbria, where nearly all of the CPs were, in practice, actually DCs (due to uncontrolled movement). This was not necessarily the case in other areas. Indeed, the contiguous cull itself may even have contributed to the long tail of the epidemic in England.
32. Scotland had not seen a long tail, possibly because they had been better organised to deal with emergencies as a result of the experience of the Lockerbie crisis and had the co-operation of the farmers through greater involvement of the farmers’ union. The 3 km sheep cull there was claimed to have been justified because the resources had not been available to carry out the traditional methods of epidemiological investigation of IPs and patrols in the 3 km areas.
33. Pirbright had contributed to the scientific advice provided to the Minister, Prime Minister and COBR, but Dr Donaldson was not certain where the policy decisions had been taken. He and Paul Kitching had had regular communications with the CVO. He had held frequent discussions with the MAFF epidemiology group (headed by Hugh Morris). The CSA’s Science Group from 26 March (of which he, Paul Kitching and Paul Barnett had been members) discussed and made points that the CSA had taken to COBR, where the CVO had had also been present.
34. The majority of the CSA’s Science Group had known very little about FMD. This was a matter of concern and Dr Donaldson and his colleagues had had to spend much time explaining FMD to them, especially when the Group first met.
35. Discussions about vaccination had continued for months and the issue had been considered very carefully. Ring vaccination around the Essex cases would have been a waste of effort since the disease had soon appeared elsewhere and the stock of vaccine would already have been exhausted. Mass vaccination would not have eradicated the virus without continued stamping out and other measures. Dr Donaldson gave the examples of Argentina and Uruguay in 2001 where large epidemics (over 2000 outbreaks in each country) had been controlled by mass vaccination of the cattle populations. However, Argentina still had the disease after 50 million doses of vaccine had been used and Uruguay was expecting to vaccinate, probably for five years). The only unanimous decision in support of vaccination by the CSA Group had been to vaccinate the cattle which had been about to be released from sheds to spring pasture in Cumbria, but it had met resistance. Overall, the case for vaccination had been marginal and it could have gone for or against.
36. Pirbright had concluded that the SmartCycler portable RT-PCR equipment had potential once the reagents used for tests had been optimised – the first trial had given unsatisfactory results. The results had been comparable to other real-time PCR tests. However, the SmartCycler system for FMD diagnosis had not been validated and its use in the field, untested, could have been unreliable. In addition, before the DNA could be amplified, the nucleic acid had to be extracted from the tissue and the RNA converted into cDNA. These two stages added time. A farm environment would bring added risks of contamination of the sensitive PCR technique. Furthermore, operation would require trained expert. Future use in the field could be in mobile or regional laboratories.
37. Field tests had been an attractive possibility because diagnosis had to be rapid to meet the 24 hour target to slaughter. Pirbright had often been testing samples from dead animals. On average the samples had taken a day to arrive and, in future, the use of helicopters to deliver samples should be considered to reduce the transport time and ensure the fastest possible diagnosis.
38. The management of samples had been poor. Much greater use should be made of electronic information collection and transmission systems. Pirbright had been frustrated by the time spent in trying to decipher the information and inconsistency of forms accompanying samples. Indeed, forms and samples had often not been co-ordinated.
39. Compatible computer systems between Pirbright and DEFRA were essential and these should include computer-based mapping and management systems. Problems had arisen from incompatibility and also from the DEFRA firewall. An email could take 12 to 18 hours to get to DEFRA.
40. Turning to issues associated with other animal diseases and general principles for disease control, Dr Donaldson referred to slides listing diseases which posed a risk (slide 2), and routes of likely entry (slide 3). He suggested that alongside the continuing risk of FMD, Classical Swine Fever (CSF) was the disease that currently posted the greatest risk.
41. International surveillance was important, but currently inadequate. The decision for action on the ground lay with individual countries and the FAO. The EU also had a role to play. The OIE only collected information – it was not operationally involved in surveillance. Globalisation was a continuously increasing risk. Intensified checks were needed at borders, ports and airports.
42. Swill feeding of waste food to pigs had already been banned. This ban should continue.
43. All pigs, sheep, goat and cattle should be subject to movement restrictions for 28 days, rather than 21 days, subsequent to trade (since 28 days was equivalent to two incubation periods). Including poultry in the movement ban restrictions after trade would be sensible.
44. Training and awareness of exotic diseased and their control needed to be improved among, for example, vets, farmers and abattoir staff.
45. Exotic disease outbreaks should continue to be managed through the SVS. On the ground, the Police and Army should be involved in controlling movements and disinfection. MOST LIKELY ROUTES OF ENTRY OF FMD, SVD AND CSF VIRUSES TO THE UK:
Contaminated imported meat (all 3 viruses) carriage of virus by the wind from outtbreaks on the nearby continent (FMD virus)
DISEASES WHICH POSE RISK
Foot-and-mouth disease classical swine fever peste des petits ruminants bluetongue acute encephalomyocarditis swine vesicular disease sheep and goatpox Avian influenza & Newcastle disease rabies etc….
46. Dr Donaldson had not at the time felt that a nation-wide movement ban on 20 February was justified. He had thought the CVO had made a courageous decision to ban movements on 23 February.
47. In future, the CSA and his Science Group should be part of the overall disease control structure with views channelled into one forum.
48. Dr Donaldson had provided most of his input to the CSA and to the CVO. He had been unhappy about the time-consuming questions that arose from the deliberations of the Science Group and the limited time to correct the minutes before the next meeting, often the following morning. He had also briefed Nick Brown for the media on occasions. Paul Kitching had discussed vaccination with the Prime Minister.
49. Dr Donaldson suggested that Australia and Japan were exemplary in their response to disease. Australia had a national biosecure laboratory at Geelong, south of Melbourne, but did not handle FMD virus. However, it had an arrangement with Pirbright for the supply of reagents and antigens, suggesting that they were prepared.
FMD Inquiry Secretariat